Safeguarding the needs of children and young people in Jersey
Our School Nurses are specialist practitioners and function as both health promoters and health educators; working in partnership with many agencies, professionals and families to promote and protect the physical and emotional wellbeing of children and young people, in their developing years.
We work tirelessly to safeguard the needs of children and young people in Jersey, providing a fully confidential health service including, child immunisation programmes, advice on healthy eating, sexual health and substance misuse, as well as providing specific support for families with complex needs in the school setting.
- I am worried my daughter has caught nits from school. It is going around her class and she keeps scratching her head. What can I do if she has nits and how do I treat it?
- My four year old holds on to her poo! It is obvious she needs to go and will stand there holding it in. We have to almost force her to go but I don't want it to become an issue and I’m not sure how to proceed with this?
- What causes night terrors, and can they be prevented?
- What are the main reasons why children are starting school not toilet trained?
- What effect can this have on the child?
- What help is available for parents who are struggling to potty train their child? What tips have you for parents who do not know where to start potty training their child?
- We have received a letter saying that our five year old son is 'very overweight' after he was measured and weighed during the child development programme at school. I am very upset at the wording saying he is 'very overweight' and do not think that is the case as he eats healthy, plays sport and looks just like a normal five year old.
Head lice are an extremely common problem and they are not easy to avoid particularly in primary school children where they are the most prevalent. Transmission requires direct head to head contact as lice cannot jump, fly or swim but they can crawl from one head to another. The only reliable way to determine if they are present is to find a live head louse by carefully combing through wet or dry hair using a lice comb.
Treatment choices include the ‘wet combing’ method, chemical insecticides or physical insecticides. The ‘wet combing’ method uses 4 combing sessions with a lice comb during the first 2 weeks and should continue thereafter until no lice are found for at three consecutive sessions.
Chemical insecticide (Malathion 0.5%) and physical insecticides such as dimeticone 4% lotion each have pros and cons which your local pharmacist will discuss with you. If you choose one of these methods, it is important to closely follow the manufacturer’s directions.
Unfortunately, no treatment offers 100% cure rate. Treatment is based upon your own individual choice, as well as your child’s age and any pre-existing asthma or skin conditions. Whatever method you use, please persevere and check your child (and other family members) regularly.
You’ve highlighted a common problem for children in this age group and one that can cause parents quite a lot of anxiety. ‘Holding on’ is usually the result of a child passing a hard poo that hurts, so they try to avoid this happening again by holding on the next time they feel the urge to ‘go’.
If this cycle is repeated, it can result in the child becoming constipated. Constipation is best avoided as it can, over a period of time, effect the feeling of the urge to poo, which is lost if the bowel becomes overloaded and stretched. The whole process can be confusing as well as painful for the child and distressing for the parents.
The good news is the simple advice below can really help address the problem:
- Have a calm, supportive and understanding approach
- Establish a regular and consistent routine of sitting on the toilet, trying to allow plenty of time so your child doesn’t feel rushed
- Encourage plenty of fresh fruit, vegetables and whole grains in your child’s diet (to increase the fibre) and water based drinks, as this will help make the stools soft and easier to pass
- Encourage regular exercise as this will also help avoid constipation
- Establish some form of reward system such as stickers or star charts to reinforce the messages you are giving – this can be used for ‘bite-sized’ achievements such as “drinking an extra glass of water each day this week”
If the simple measures haven’t worked, then consult your doctor who can complete an assessment and general examination to rule out any underlying causes and advise on the use of laxatives which may be prescribed to help.
Helpful information can be found at www.eric.org.uk
Night terrors are said to occur in 3 to 6 percent of young children and technically speaking, they are caused by partial awakenings from non-dream sleep. It is would be recommended to rule out any medical causes first with your GP.
Often your child cannot be comforted, may cry, shout or flail around but won’t have any memory of what happened the next day and this is unlike when nightmares are experienced. As a result, night terrors can be distressing for parents to witness.
There's no definitive way to prevent night terrors because no one knows exactly what causes them. What is known is that night terrors, on their own, do not mean a child has a psychological problem or is even upset about something necessarily.
However, night terrors can sometimes result from stress, illness, an erratic or insufficient sleep schedule or any type of sleep deprivation, for example. Solving any other sleep problems your child has (such as getting up in the middle of the night) and making sure she has a regular bedtime with a calming routine such as a bath, a song, a book and lots of cuddles and gets enough hours of sleep; can help .Children who go to bed overtired are more likely to experience sleep disturbances. To avoid fatigue, extend your toddler's nap time, let her sleep a little later in the morning, or put her to bed earlier at night. Certain medications or caffeine also can contribute to night terrors.
The best way of handling night terrors is to wait it out patiently and ensure your child stays safe, as they will usually settler within a few minutes with no ill effects.
Further strategies are best discussed with your Health Visitor in line with the Institute of Health visiting guidelines.
There a many reasons why a child could be starting school and not yet fully toilet trained and by this I mean they could be dry by day but not at night; they may have urinary (wetting) accidents during the day; or they may suffer from constipation which can lead to both wetting and soiling accidents.
The reasons are varied; children are all different but most children will usually become continent in the day between the ages of two and three years. Around the age of two years, a child will start to show signs (cues) that they are possibly ready and interested to start toilet training. There will be physical signs, behavioural signs and cognitive signs of readiness; the two year developmental assessment is an ideal time to discuss this with your Health Visitor. Signs include the regular and relatively predictable passing of a soft, formed poo during the day and not at night; dry periods of at least one to two hours; a dry nappy on waking; the ability to pull up and down pants with only a little assistance; an interest shown in the bathroom; shows a wish to please and enjoys praise; demonstrates a desire for independence; shows signs of discomfort at a wet nappy; can understand and follow simple instructions and requests, such as “do you need a wee?”; has a word for wee and poo; shows an awareness that they are having a wee or poo, which may be that they stop what they are doing for a minute, or tell the parent; telling the carer that they need to have a wee or poo before they do it. It may be that the parent or carer misses these cues, or is not aware of the message they signal and may simply miss the window of opportunity which can make it a little more, tricky to toilet train.
Life is often very busy and many of us don’t have the benefit of the experience of our extended family around us to prompt and support with parenting. This is not always the case by any means and children lead busy lives too; they may well have been successfully toilet trained but often become engrossed in far more interesting activities, leaving the trip to the toilet until it’s too late. They may have had an unpleasant experience using the toilet, possibly feeling unsafe on a large toilet seat with their legs left dangling, or falling into the pan; someone may have walked in on them in a public toilet, making them uncomfortable to use toilets other than the one in their own home; the toilet may not feel like a safe or comfortable place to carry out your most private business. Some children may be toilet trained at the appropriate age but will regress and this could be as a result of a trauma, loss, or an unpleasant experience; or something as normal as the birth of a sibling.
There are of course other reasons why a child may not be toilet trained which may be as a result of anatomical, medical, physical, or developmental problems. This does not mean that we don’t support children affected by such problems; every child has the right to be helped to achieve whatever they are capable of, but it may mean that we need to give the child longer, or require the expertise of Paediatricians, Continence Specialist, General Practitioners and of course the parents. Of course, we must not forget the importance of a healthy diet and adequate intake of suitable drinks, preferably water.
The impact on the child depends on a number of factors; those being the age of the child; the reaction and support of the parent or carer; and the severity of the problem. As a child gets older, they become more self conscious, their world changes as they become more independent, they may want to go on overnight trips, or to sleepovers which may be something they cannot do if they have a problem with bed wetting. They cannot easily confide in a friend for fear of being teased or bullied. The support and patience of their parents is essential, but we recognise that waking up to a wet bed every morning, or being called from work to change your child who has had an accident at school, can be very demanding. The child’s confidence may be affected and this can affect their socialising and interaction with their peers, which in turn can impact on their emotional wellbeing. They may be distracted or worried about it, or tired from waking up through the night with a wet bed which may impact on their learning. We, as School Nurses, understand the impact on the whole family and work with the parents and the child to provide them with the strategies to overcome this problem. It is very rewarding when we have positive feedback from parents as we know how important it is to the parent and the child.
If a parent is struggling to toilet train their child they can contact either their Health Visitor, who is available to them up to the time the child goes into Reception class, by phoning Family Nursing and Home Care on 443600. Once the child is in Reception, contact the School Health Nurse Team at Family Nursing and Home Care on 443622 or email email@example.com
It is firstly important to say that parents or guardians are always informed that their child will be seen by the School Health Nursing Team as part of the Healthy Child Programme, offered to all children in Jersey. Parents have the option to decline if they do not wish their child to be included in the programme, or elements of it. All aspects of the process are dealt with in a sensitive and confidential nature, including the results of the Child Weight Measurement Programme, which are not shared with the child or school staff. We are very conscious of the language we use in front of the child, avoiding words such as heavy or big.
The main purpose of the Child Weight Measurements Programme is to monitor trends of obesity across school aged children in Jersey. This helps allocate and plan Public Health resources and ensure they are going to the right priorities. This also provides the ideal opportunity to identify children who may be underweight, overweight, or very overweight, so that advice can be given to support the child and family to make some lifestyle and dietary changes to improve their health. No one likes to receive negative or bad news, but some parents do find this information useful. It would be unethical to identify a health risk and withhold information from parents that is relevant to their child’s health. As Specialist Community Public Health Nurses our focus is to prevent ill health and promote healthy lifestyles and choices.
We appreciate that this is only a snapshot of the child’s health and wellbeing and that whilst some results may indicate that a child is overweight, or very overweight, we understand that they may be very active and have a well-balanced diet, or it may be dictated by genetics. For some children however, this is an indicator of more serious health problems in the future if it is not addressed. Research shows that if a child is overweight in Reception they are likely to be overweight, or very overweight in Year 6. Early identification of any problem increases the likelihood of a better outcome. It is not only physical health that is affected by being overweight, but confidence and emotional wellbeing can also be seriously affected.
Finally, the wording of the results e.g. ‘very overweight’ are internationally recognised clinical definitions, rather than opinion, and so it is important not to change wording or provide information that is incorrect or misleading.
The aim of the service is to support and advise children , young people and families with the most current evidence base available and to inform any strategies or choices that they make. If you have any concerns then please contact School Nurses at Le Bas Centre on 443600