Module 04: Keeping Children Well And Healthy

Keeping children safe

When children are young, they need adults to ensure that their usual environment is safe enough that children can explore, play and learn without undue problems.

Checks for safety

Play materials should only be bought from reputable companies and should conform to British safety standards, whenever these apply. Even if your setting is very short of money, it is unacceptable to buy second hand or accept donated equipment that does not meet safety requirements.

You need to check play materials and equipment on a regular basis. If something needs mending, for example, torn dressing-up clothes or a screw that needs tightening, then make the repair promptly. Children can be part of this safety procedure to the extent that they may point out that something needs mending and will be flattered to hear, ‘Well spotted, I’ll see about that this morning’. Check with a senior if any equipment looks as if it needs special attention or is beyond safe repair.

It is good practice to check your setting for obvious hazards and any problems that arise because of the inconsiderate behaviour of neighbours. Some settings have no choice but to check the garden for rubbish or dog excrement before letting children go out to play.

  • If children have learning disabilities, then you need to adjust your expectations since the children’s understanding may be more like that of a younger child.
  • Otherwise, the sign of a good day for a disabled child in your setting will mean some mess and the odd bump or scrape.

Supporting children’s learning

As an early years practitioner, you are responsible for other people’s children. So it is easy, especially in a setting where the team has become anxious, to be too afraid ‘what may happen if …’ and of being blamed for an accident. But you cannot run a good day for children in which they will learn if you mainly think about what can go wrong or abandon valuable activities because of a small level of risk that could be resolved.

Your setting’s policy on health and safety should set a framework. But in the end, it is attentive and supportive adults who keep children safe enough without harassing them or making the children unduly anxious.

  • Young children cannot learn to anticipate and weigh up the very ordinary risks of everyday life unless they have experienced different situations and been guided by supportive adults.
  • Parents, as well as early years practitioners, are often most sensitive to physical risks, but part of childhood is that children need to handle emotional and intellectual risks.
  • They need to experience that mistakes are not all disasters and that some practical problems can be overcome.
  • They also need to learn practical life skills, such as how to handle ordinary tools, simple cooking and how to move around their neighbourhood, including road safety.
  • Early childhood is an excellent time to help children learn since they are keen and still willing, at least sometimes, to pay attention to caring adults.

A safe setting

Your role in keeping children safe covers a range of actions, checks and your skills of observation. Children do not want to be tracked and watched all the time but attentive early years practitioners can keep an eye and ear without the children feeling oppressed.

  • Make sure that children have enough space to move about. Some games may need a bit of organisation or an agreement that they are outdoor activities.
  • Do you have some areas that are out of bounds to children? Remember from your own childhood that such a ban is only likely to make children want to go there. See if you can avoid completely no-go areas and enable visits to rooms that do not have unrestricted access, like the office or kitchen, in a setting.
  • Adults need to be in sight and earshot of children who are playing. There should always be a practitioner in the garden if the children are playing outside. Your setting will need to be flexible about ratios if adults are not to move abruptly just because the children have moved.
  • You do need to have a suitable ratio when you take trips out, and it is worth the effort because children can learn a great deal from trips out and about in your local neighbourhood.
  • Children must be safe and secure in your setting, so that they cannot wander out of your building and so that people with no legitimate business to visit cannot simply wander in through the front gate or door.
  • Attentive adults offer the best protection for children, but secure gates and doors, with a check on visitors, are an important part of safety.
  • Unless your setting is situated in a genuinely high-risk neighbourhood, then closed circuit television (CCTV) is probably unnecessary.

Who is responsible for children?

It must always be clear who is responsible for the children. If you are called away or are taking a break, you must explicitly pass responsibility for your group to another practitioner. You cannot just assume someone will keep an eye on the children. In a family home, the responsible person will continue to be you.

Handing over responsibility

Transition times can be confusing for children and adults. For instance, it needs to be clear when the children pass into your responsibility from their parent or another carer at the beginning of the day and the point at which the responsibility has passed back at the end of the day. You can sort this out between the adults, without it being heavy-handed. You may need a quiet conversation with a parent if the child appears to be playing you off against each other, or if the parent is unreasonably extending the time when you are responsible.

Trips out

Children benefit from simple local trips as well as journeys to venues further afield. Any trip needs enough adults to ensure children are safe and adults are not required to keep a close eye on too many children. But enough adults are also important to enable children to be sure of attention and replies to their questions.

If you do not know the venue of a trip it is wise for somebody to make a visit prior to taking the children. A thorough check of a venue or activity is called a risk assessment.

  • This procedure can be useful to check for any possible issues relevant to this group or individual children and to find ways to resolve any problems.
  • Adults should not use risk assessments to become anxious about everything that could go wrong.
  • Useful information will be whether the venue is accessible for any disabled children or adults.
  • Will it be interesting for younger children? Are there some parts of the visit that will require more adults and practical issues like the location of the toilets?

Skills sharing

No child learns about safe behaviours, like how to hold a hammer safely or how to clean a cut, because they have passed a certain birthday. Children learn because adults have taken the trouble to share their own skills through a process of tell–show–do. You:

  • Tell children about what you do in an activity or routine. You can highlight safety without becoming boring.
  • Show them how to hold the hammer or needle and demonstrate through your actions and a good example of how to be calm when there is an accident or gentle with the baby.
  • Give children plenty of opportunities to do the tasks, to practise and to ask for more help as and when they want.

Using conversations

In an ordinary day as well as organised opportunities, perhaps in circle time, you can use words and actions to highlight the practical safety guidelines.

    • Ask individual children or a small group before they start a gardening or needlework activity to recount what they will do or the best sequence. Give an encouraging ‘well done’ for what they remember and remind the children of anything else that is important.
    • Circle time can be an opportunity to review the day’s or session’s activities. Children can also be invited to remind their peers about ‘what do we do first of all at the woodwork table?’ (put on our special goggles) or ‘who uses the big sharp scissors?’ (only an adult).
    • You can share useful tips and techniques on how to do a practical activity.
    • Be encouraging when a child brings something to your attention or has a good idea. You might say, ‘You’re right, I should watch my fingers with the knife’.
    • Support children’s learning and be friendly about mistakes.

 

Personal safety

Part of children’s growing self-reliance is to be aware of their own personal safety. You can begin to share some basic rules with four-year-olds but you would not cover personal safety in one telling, nor should you depend upon one source of communication, like a single storybook.

Remember that you are not trying to do it all – children learn about personal safety issues over time and they add on ideas and understanding as the months and years pass. Useful learning for children includes the rights over their own body and understanding about their private areas and experiencing respectful touch.

You can share and show children’s rights to personal safety:

  • The right to say ‘No’ – a child’s body belongs to her. She has the right to say ‘No’ to any adult or child who touches her in a way that she does not want.
  • The right to tell – if anybody refuses to take notice when a child says ‘No’, then he can tell on that person.
  • The right not to keep secrets – children need to be encouraged not to keep a secret that does not feel right.
  • The right not to be bound by social rules – reassure children that if adults do not behave properly, then the usual politeness rules do not apply.

It is misleading to place too much emphasis on adults who are unknown to children: the so-called ‘stranger danger’. Most strangers who kill or seriously injure children are behind the wheel of a vehicle. Children are statistically far more at risk of abusive harm from people they know: family and friends and people who have access to children through their work or voluntary activities (see Chapter 19). Furthermore, good safety rules also support children who face bullying.

Communicate with parents about what you do in a low key way so that they understand what you explain and can support their children at home. You can use incidents that arise and explain simply to children, for instance, why you took the group away from the market because somebody was shouting and appeared to be drunk. You can show children practical safety rules like what to do if you get lost on a school outing.

The aim of supportive safety guidelines for children is to help them to make judgements at the time, to empower them. It is important to avoid leaving children with the feeling that they hold the whole responsibility for keeping themselves safe from harm.

  • Adults have the responsibility to behave properly and not impose on children or ask them to do something that makes the child uneasy.
  • Adults who do not behave well, do not deserve courtesy.
  • Children need to feel sure they have permission to shout, run away and tell on adults or other children who threaten them.
  • However, some bullies or abusers may be too strong or it is very hard to tell. Children must not be left feeling that the situation is their fault.

Road safety

You ensure the safety of babies and young children by having them safe in buggies or holding your hand. But you can help children to learn about road safety as part of your normal conversation and local excursions with them.

  • Books, role play and play with dolls can support an understanding but effective support of children has to include regular kerbside practice. Otherwise, children do not make the link between play and real road safety and they do not get the guided practice that is essential for them to learn.
  • Road safety takes time, it is a step by the step learning process that can be started when they are young but continues beyond the age when children will leave you.
  • Use local trips to show children what you do to ensure their safety by saying out loud what you are doing: looking up and down the road, listening for traffic, finding a safe place to cross or waiting for the ‘green
  • Children learn best through regular safe practice with responsible adults. Do not expect even six or seven-year-olds to be reliable. person’ at a lighted crossing.

Coping with injuries

You need to know what to do in response to common accidents that can happen with young children. This section covers only the most basic points for first aid and cannot substitute for a proper first aid course.

Nosebleeds

Children sometimes get nosebleeds because they have crashed into something or someone. But sometimes there is no obvious reason and children just get apparently spontaneous nose bleeds. The treatment is to:

  • Sit the child down leaning forward and pinch the nose firmly between finger and thumb just below the hard part of the nose. An older child will probably be able to do this action himself but you will need to help a younger one. A flannel soaked in cold water and then wrung out can be placed on the bridge of the nose.
  • This treatment will usually work. Explain to the child not to blow their nose for at least a couple of hours.
  • Tell the parents when they pick up the child or come home.
  • If the nosebleed does not stop in ten minutes then the child should be taken to the Accident and Emergency (A&E) department of the local hospital.

Bumps and bruises

Small cuts and grazes can be cleaned with water and cotton wool and protected with a mild antiseptic cream. Use the contents of the first aid box to clean cuts and grazes and to cover them if necessary.

Slight bleeding will be stopped by gentle cleaning. More persistent bleeding may need you to lay a clean cloth over the wound and press firmly. Raise a limb slightly and this will help to stop the bleeding.

Falls

Help the child up and let her sit quietly while she recovers. Children need to be taken to hospital if they are drowsy after the fall, lose consciousness, are limp or very pale, also if they vomit.

If children are very drowsy, they should be put in the recovery position and then get the child to the hospital. If you are uncertain what is wrong or the child seems to have a serious injury, then call an ambulance.

Choking

Children, particularly those aged from 1 to 5, often put objects in their mouth. This is a normal part of how they explore the world. Some small objects, such as marbles, beads and button batteries, are just the right size to get stuck in a child’s airway and cause choking. The best way to avoid this is to make sure that small objects like these are kept out of your child’s reach.
No matter how careful you are, your child may choke on something. In most cases, you or someone else will see your child swallow the object that causes choking. There can be other reasons why your child starts coughing. But if your child suddenly starts coughing, isn’t ill and has a habit of putting small objects in their mouth, there’s a good chance that they’re choking.

Tips on helping a choking child

  • If you can see the object, try to remove it. Don’t poke blindly or repeatedly with your fingers. You could make things worse by pushing the object further in and making it harder to remove.
  • If your child’s coughing loudly, encourage them to carry on coughing to bring up what they’re choking on and don’t leave them.
  • If your child’s coughing isn’t effective (it’s silent or they can’t breathe in properly), shout for help immediately and decide whether they’re still conscious.
  • If your child’s still conscious, but they’re either not coughing or their coughing isn’t effective, use back blows.

Back blows for babies under 1 year

  • Sit down and lay your baby face down along your thighs, supporting their head with your hand.
  • Give up to 5 sharp back blows with the heel of 1 hand in the middle of the back between the shoulder blades.

Back blows for children over 1 year

  • Lay a small child face down on your lap as you would a baby.
  • If this isn’t possible, support your child in a forward-leaning position and give 5 back blows from behind.

If back blows don’t relieve the choking and your baby or child is still conscious, give chest thrusts to infants under 1 year or abdominal thrusts to children over 1 year. This will create an artificial cough, increasing pressure in the chest and helping to dislodge the object.

Chest thrusts for children under 1 year

  • Lay your baby face up along the length of your thighs.
  • Find the breastbone and place 2 fingers in the middle.
  • Give 5 sharp chest thrusts (pushes), compressing the chest by about a third.

Abdominal thrusts for children over 1 year

  • Stand or kneel behind your child. Place your arms under the child’s arms and around their upper abdomen.
  • Clench your fist and place it between the navel and ribs.
  • Grasp this hand with your other hand and pull sharply inwards and upwards.
  • Repeat up to 5 times.
  • Make sure you don’t apply pressure to the lower ribcage, as this may cause damage.

Following chest or abdominal thrusts, reassess your child as follows

  • If the object still isn’t dislodged and your child’s still conscious, continue the sequence of back blows and either chest or abdominal thrusts.
  • Call out or send for help, if you’re still on your own.
  • Don’t leave the child.Call 999 if the blockage doesn’t come out after trying back blows and either chest or abdominal thrusts. Keep trying this cycle until help arrives.

 

Burns and scalds

  • Carry the child to the nearest tap and run cold water over the burned or scalded area immediately. Comfort the child and hold her close but keep the water running for ten minutes. This action reduces the heat in the skin and the risk of scarring.
  • Remove clothing that is not stuck to the skin, otherwise leave it. Take off jewellery or belts since burned skin can swell.
  • Cover the burn or scald with a clean, non-fluffy cloth soaked in cold water.
  • Take a child to the hospital for anything more than a very small burn or scald. Do not put any cream or ointment on the skin and do not prick any blisters.

Going to hospital

After more serious accidents, children may well need to visit the accident and emergency department of the local hospital or may stay overnight for observation. Children and their families need information and support under these circumstances.

The children in the group may all be affected by an accident, not only the child who was actually hurt. Children may feel better to play out their concerns and they often like to play doctors at home or in a role play area in the early years setting. You can provide simple outfits and some pretend medical equipment. Sensitive involvement and observation of their play will help you to judge if one or more children need reassurance. You can offer this support in partnership with their parents.

Health and illness

Talking with parents about illness

Obviously, you will have to contact individual parents if children are sufficiently ill that they need to be picked up before the end of the usual day or session. Any early years setting or individuals such as childminders or nannies should have a contact number (landline or mobile) to get them swiftly in contact with a parent. If you do need to call in the day then explain your reasons, perhaps saying that the child has a high temperature or that she has already vomited twice.

It is practical and courteous to tell parents if you have an outbreak of an infectious illness. You would not usually name the children involved. You would say, or put up a notice explaining that ‘we have two cases of mumps in the pre-school’ or ‘there has been a case of head lice, all parents are advised to check their child’s head tonight’.

Children often feel very ill with some of the common childhood infections. An illness like chicken pox may seem ordinary but it is still unpleasant to have. Adults often feel even more ill with so-called childhood diseases and some illnesses pose a particular threat. Although there have been extensive vaccination programmes, mumps and rubella (German measles) are still around. Rubella can cause very serious damage to a fetus in the early months of pregnancy so pregnant women – parents or practitioners – who have not been vaccinated need to know. Mumps carries a slight risk to men of inflammation of the testicles and subsequent sterility.

Judging when children are ill

Of course, you aim, in partnership with children’s parents, to keep them as healthy as possible, but they will get ill sometimes, it is inevitable. Some children will experience more ill health than their peers. When a child in your care seems to be ill, you have the difficult task of deciding, in consultation with colleagues or seniors:

  • What is the matter?
  • How serious is it? And therefore …
  • Do you need to contact the child’s parent before the end of the day?

Very young children cannot say much to guide you when they are ill or sickening for something. You will also depend a great deal on your knowledge of this child as an individual.

  • Is she behaving in a different way from normal: more lethargic, prone to tears or whining?
  • An underused sense is that of smell. Children who are ill may smell different, not unpleasant, just different from how they do normally.
  • Four and five-year-olds may be more able to tell you what is wrong when they feel ill. Children, however, much like adults, can be subjective in answering ‘How much does it hurt?’
  • Children may also be vague or confused about names for parts of the body, so do ask, ‘Show me where it hurts’ and not just ‘Tell me’.

When you share the care of very young children with parents it is especially important that you communicate at transition times: when you pass over responsibility at the beginning and end of the day. If a baby or child is poorly, you both need to have accurate information on the symptoms and how long they have lasted. Vomiting and diarrhoea can be particularly dangerous for babies and toddlers, who swiftly becomes very ill and dehydrated.

Raised temperature

A child’s temperature should usually be 37°C (98.6°F). It is normal for the temperature to vary a little but a rise in a child’s temperature is a sign of illness. Fever is reached with a temperature of 38°C (100.4°F) and a child is at risk of high-temperature convulsions if it reaches 41°C (106°F).

  • You can check a child’s temperature with a standard mercury thermometer or a digital thermometer. These are placed under the arm of a child younger than five years.
  • Older children can have the thermometer in their mouth since they will understand not to bite on it.
  • It takes 4–5 minutes for the thermometer to register the temperature under the arm and about 2 minutes in the mouth.
  • A plastic strip or a fever scan is less accurate but better than a guess if a child finds it impossible to keep still.
  • A high temperature should be treated by:
  • keeping a child cool
  • giving plenty of liquids to avoid dehydration
  • a paracetamol liquid suitable for the child’s age.
  • aspirin should not be given to children younger than 12 years because of the danger of the complication of Reye’s syndrome if the child has chicken pox.

Stomach ache

Children quite often complain of stomach or tummy ache. Usually, this symptom is not a sign of something serious, but it is important to respond to children and to track their complaints. Listen to the child and suggest she sits quietly for a while. If she soon gets bored and starts playing again then she is probably not ill.

  • If a child looks to be in pain and clutches or rocks holding their stomach, they probably are in pain. Pain can travel and be felt in the stomach when the problem is elsewhere because the nerves in the abdomen are linked to the spinal cord.
  • Young children are not yet sure of the names for all the parts of their body. ‘My tummy hurts’ can be a description applying to almost anything on the front of their body from the throat to the lower trunk. You need to ask ‘show me where it hurts’ to get a better idea.
  • Aches combined with a temperature of more than 38°C could mean an infection. So you would need to tell the child’s parent and suggest that a trip to the doctor might be wise.
  • When children’s bodies are fighting infection their immune system is working hard. A lot of the lymphoid tissue that is part of this system is in the lower abdomen, so children’s stomachs can feel tender or swell.

Some children have frequent stomach aches. In these cases it is worth looking for a pattern using your own informal observation and some simple questions of the child:

  • Are they hungry? Sometimes children have not yet worked out that hunger can make the stomach ache as well as rumble.
  • Have they got indigestion because they eat their food very fast, perhaps not chewing well? Try for a more relaxed mealtime. Consider also if this child gets so hungry that she or he bolts the food. Can you produce a meal earlier (as a nanny) or organise a nutritional snack to keep the child going?
  • Have they got constipation? Apart from making it painful to go to the toilet and pass stools, constipation can give children stomach and lower backache. Have a discreet chat with the child and see what is happening or not happening.
  • The onset of a stomach upset or diarrhoea can give a child pain. You would need to watch out for any other symptoms as well as treating the diarrhoea.
  • Are they lifting heavy objects in play? Children can strain themselves and you may need to explain how to lift and carry something properly and that it is wise to get help.
  • Pain over the loins could mean a kidney problem.

Severe abdominal pain may indicate appendicitis, although this more usually affects children older than five years.

  • In this case, the pain typically starts in the bottom right-hand side of the abdomen and may then spread.
  • It persists over a couple of hours and is often associated with a slightly raised temperature and vomiting.
  • The child’s abdomen feels hard to the touch.
  • You or the parent should contact a doctor urgently if the stomach ache takes on these features.

Illness and emotional distress

Children may use stomach aches or generally feeling ill as a way of gaining attention or to communicate that they are worried:

  • You should find ways to meet this emotional need without criticising the child as attention-seeking or as a hypochondriac.
  • Check that nothing serious is wrong, then pay limited attention to the child’s complaints about feeling ill. Ensure that you and your colleagues pay friendly and positive attention to the child at other times. Look for ways to notice what she has done and alert her to what she has learned recently.
  • Children sometimes say they are ill as a way of communicating that they are troubled or to get out of going somewhere that makes them very unhappy.
  • If there is a pattern that means children avoid going to nursery or school, then you need to open up the conversation with ‘Is something the matter?’, ‘Are you having troubles at playgroup?’ or ‘Did the teachers sort out that problem in the school toilets?’.

Children who complain of feeling ill when there seems to be nothing physically wrong may genuinely feel that they are at risk.

  • One possibility is that the child’s parents are so concerned that they have given the child the impression that germs are everywhere. You may need to give the child a more realistic view of ordinary life.
  • Another possibility is that the child has experienced bereavement and is scared of serious illness and death. This situation is more likely when parents and other adults have scarcely talked with the child about the family loss. The child needs to be able to express her fears and distress.
  • In any of these situations, you will need to talk with parents to share what you have noticed and suggest that they may wish to talk with their child.

Rashes

You may notice signs of rashes or swellings and there may be more obvious events such as vomiting or diarrhoea. Illnesses that produce rashes will look different on individual children depending on their skin colour and many books still only give photos of light-skinned children.

  • If children are light skinned, then spots or an unusual flush will show up as red against the skin.
  • When they run a temperature, children will look unnaturally flushed or, if very ill, children’s colour may drain.
  • The darker a child’s skin colour, the more the spots or a rash will show as raised areas.
  • You may notice a different shading of skin colour around the spots.
  • As soon as children start scratching, the spots will show redder and any blistering will be more obvious.
  • Darker skinned children may also drain of colour, in contrast with how they look when they are healthy.

Some common illnesses have a rash as one of the symptoms but this is not always the first sign. A few common illnesses are now described. Even though some of these are covered by the immunisation programme, not all children are immunised. In addition, some who have been immunised will still get the illness. As you read the following section, you will notice that children usually become infectious before the first symptoms appear. The most caring parents cannot help the fact that their children may have passed on the illness. Once the symptoms appear, children would need to be cared for at home and remain away from early years setting, not only for reasons of infection but also because children will feel ill.

Chickenpox

Children with chickenpox have a mild fever and they feel unwell. Small, itchy, dark red spots appear over a period of 3–4 days. Some children have quantities of spots and some only have a few. The spots then blister and crust over. Children are infectious from two days before the rash appears until the last blister has scabbed. The illness is unpleasant but not usually dangerous unless the child’s immune system is already compromised for some reason. Children need to be treated for any fever and calamine lotion helps relieve the itching. Discourage them from scratching (and recognise that this is very hard!), otherwise the spots may get infected or leave scars.

German measles (rubella)

Children with German measles may not feel ill enough for anyone to realise. There may be a mild fever, cough or sore throat and sometimes swollen glands. The rash is of pink, slightly raised spots. Children are infectious from one week before until four days after the rash has appeared. The greatest risk is to pregnant women in their first trimester.

Measles

Measles is a miserable illness to experience and can bring dangerous complications. The symptoms at the outset are similar to a heavy cold with a cough and a high fever. There may be a rash of small white spots inside the mouth. Then after 3–4 days of the apparent cold, a rash of brownish-pink spots will start, often from behind the ears. The rash spreads across the body sometimes joining to form blotches. Children may have swollen glands and be very sensitive to light. Children are infectious from a few days before the rash appears until five days after it has gone.

You should call the doctor once the illness looks like measles. Children may need antibiotics for secondary infection and you must be ready for complications that can affect a minority of children. All children need to be kept quiet and given home nursing care, including treating any fever. About 1 in 15 children develop a serious ear infection, pneumonia, bronchitis, convulsions or encephalitis.

Mumps

The first sign of mumps is usually swelling in one or both of the salivary glands below the ear or in front of the jaw. Children are in pain and they may have earache or difficulty in swallowing. These symptoms can disturb their sleep. Children are infectious for six days before the swelling until it has gone.

Children need care and comfort if they are unhappy. Soft food and plenty of drinks can ease the problems of swallowing. There is no need to call a doctor unless the child is severely ill or develops a rash.

Allergic conditions

There are a number of conditions that are triggered by allergies and which children may experience in differing levels of severity.

Hay fever

The term hay fever is used to cover a wide range of allergies to a different tree and plant pollens and other common substances such as house dust. The symptoms are like those of a heavy cold: runny nose, sneezing and coughing. Additionally, the eyes become itchy and sore, so that they may be red and swollen. Hay fever seems to run in families and is often linked to asthma or other allergies.

Tests can sometimes establish exactly which substances trigger the allergic reaction, although many people do not know exactly what sets off their allergy. Tree or plant pollens may only be around at certain times of the year whereas an allergy to house dust (literally the dead house mites in the dust) is a continuing problem.

Depending on the severity of a child’s reaction, there are a number of practical steps:

  • A range of medication is now available that deals with the allergy without making a child or adult sleepy. You would need to be guided by parents and their GP since not all preparations are suitable for young children.
  • Children who have an allergy to house dust may need an especially clean environment.

Eczema

Eczema is a miserable condition for a child, even in a mild version. Children can become very irritated by itchy skin and will be in pain if their skin cracks and bleeds. Pain and severe discomfort can keep them awake at night and their parents with them.

Atopic eczema is the most common kind of eczema and is found among babies and young children. Atopic means a family or hereditary tendency to allergic conditions such as asthma, eczema and hay fever. Over the last three decades, there has been a significant increase in atopic eczema and it is estimated that the condition now affects about 10 per cent of children. The reason for the increase seems to be an environmental change in that many homes now have central heating and fitted carpets. This shift has increased children’s exposure to allergens like house dust mites. Some children develop other allergic conditions such as asthma.

The symptoms of eczema can vary:

  • In babies, it can begin with patches of dry and itchy skin on the face.
  • The skin behind the knees and ears, the neck, elbow and wrist skin folds are often affected.
  • In severe case, the rash can cover a baby or child’s whole body.
  • The skin irritation can lead to redness and inflammation, tiny blisters that can weep.
  • With severe itching the skin may scale and, in chronic eczema, the skin may actually thicken (lichenification) as a self-protective mechanism.
  • In severe cases, there may be swelling (oedema).
  • A child with severe eczema is also more vulnerable to infections because the skin has broken.

Most children seem to outgrow the condition, at least to an extent, but about 10 per cent will continue to have to cope with eczema throughout their lives. A child’s parents and their GP will need to decide on treatment and to review its effectiveness on a regular basis.

Eczema is a dry skin condition, so the most important approach is to keep children’s skin soft and moist. You will need to follow the pattern established by the family.

  • Emollients in liquid form are added to a child’s bath and emollient creams can be applied to her skin, smoothed on in downward strokes. Emollients are mild and part of the daily care for a child with eczema.
  • Topical steroid creams reduce inflammation and help to heal damaged skin. They are medicines and should be used according to the instructions and only for short periods of time.
  • Steroid creams have the side effect of thinning the skin over time. So you should wash your hands thoroughly after using such cream on a child.
  • You will do the skin care for a younger child, although children will learn to take over their own skin care as they grow.

You need to avoid any food or toiletries that parents have discovered make the skin condition worse. In a family home, the products should all be suitable anyway. If you work in an early years setting, then you will need to be alert over foods. It is good practice to use non-perfumed toiletries with young children in general, but some children may have extra sensitive skin. Children with eczema are best dressed in cotton clothing and they may need to avoid contact with some materials in the dressing up box or within some sensory activities.

Taking care of yourself

The work of an early years practitioner requires a lot of physical activity, but also emotional energy and commitment. Young children require that you are able to do several things at the same time and readjust swiftly from one child or activity to another. You need to cultivate the skills of being able to change direction, tolerate interruptions and keep track of several children and events at the same time. For example:

  • You change a toddler’s nappy while chatting with an older child who is interested in what you are doing.
  • You need to hold onto what one child has said to you whilst you, ‘Excuse me’, deal with a child who had your attention first, then turn back to the second one.

The importance of a positive outlook

Focus on what you have achieved – a supportive practitioner encourages children and alerts them to what they have learned, seeing mistakes as something positive and not as disasters. You need to offer the same kindness and ‘half full bottle’ approach to yourself. Your colleagues and seniors should support you by pointing out how you have helped and cared for the children, at those times when you are tempted to dwell gloomily on what you have not managed or what has not gone as well as you hoped.

Let annoyances go – young children tend to focus on the present and let the past go and adults can usefully learn from them. Your work will not go smoothly all the time and a bad day will only get worse if you chew over frustrations and dwell on imagined slights. By all means, talk about problems and take what action is possible, then start afresh. In a supportive team, your colleagues and seniors should help with ways to carry on after an argument with a parent or ways to start afresh with a child whom you do not find at all easy.

Keep healthy

You will inevitably come into close contact with many children and adults. You are therefore liable to catch illnesses, especially in your first years of working with young children. Some practitioners find that they get more robust. Good standards of hygiene will help to safeguard you as well as the children.

Watch your back

You need to watch your back, as straining and wrenching the back is a common occupational hazard for people working with children.

  • It is important to get into the habit of bending at the knees, rather than at the waist, to pick up children or shift equipment.
  • Ensure that there are two of you if the equipment is heavy or unwieldy.
  • Facilities for changing babies and toddlers should be at a comfortable height so that you do have to bend over children. It is surprising how quickly you will feel an ache in your back if you have to bend over to a low angle.
  • When you talk and play with young children, they need you at their eye level for good communication. So, get down comfortably – sitting or kneeling rather than bending over them.
  • When babies are very young you may carry them in front of baby carriers. Make sure that the carrier is well placed for you as well as the baby. The carrier should support the baby’s head and hold him snugly close to you, with his bottom about level with your waist.
  • When babies are ready for a back carrier (probably no younger than about 7–8 months), make sure that this type of carrier is also of good quality and sits comfortably on your shoulders and back.