4 ways to get your child to sleep

If your child has trouble sleeping, it’s an issue which can affect the whole family. Sleep is so important to our wellbeing, and we really feel it when we’re not getting enough.

Sam Parr, Health and Family Support Worker at Carlton Children’s Centre, gave us her advice for a good night’s sleep. So if bed time is a daily battle, or your child isn’t sleeping well, these tips should help:

1. Avoid sugar and caffeine

Caffeine can make it hard to get to sleep, so avoid things like chocolate, coffee and tea.

Sugar filled foods are not helpful either, so biscuits, sweets and cakes should be limited in the run up to bedtime.

If your child wets the bed, it could be because fizzy drinks and cordials can aggravate the bladder. Switch to a small drink of water for a dry night.

2. Switch off

Avoid stimulating activities before bedtime such as watching television or playing computer games.

As well as stopping your child from winding down, light from screens is also known to affect children’s sleep.

Try a relaxing activity instead, such as reading a book or a having a warm bath.

3. Be clear about bed time

Be clear and explain to your child what’s happening. Telling them, “it’s night time, go to sleep” or, “it’s morning, time to wake up” can help them understand what’s going on.

Put your child in their cot or bed when they are still awake and leave them to fall asleep. Staying with them can be a distraction.

4. Stick to your routine

Giving your child a routine is really important for a good night’s sleep. It helps their brain and body clock to know when it’s time to go to sleep, and when it’s time to wake up.

Tips for a good routine:

• Put your child to bed at the same time each day.
• Get them up at the same time each morning, even on weekends.

Clothes and pyjamas are part of a good routine, too. Always change your child’s clothes at night time and make sure that you change them into day clothes in the morning, even if you have nothing planned and a pyjama day would be easier.

Still having problems?

If you need support with your child’s sleep, contact your local Sure Start Centre. You can find more information and contact details on the Sure Start page of our website.

You can also get advice from The Children's Sleep Charity.

Carers rights: Ann's story

"People need to listen to carers. You might hear me, but that doesn't mean you’re listening."

We're sharing Ann's story, to highlight some of the challenges carers face.

Ann, 75, helps to care for her grandson, who was diagnosed with schizoaffective disorder aged 18. He has been an inpatient at Highbury Hospital four times in the last six years.

"Being a carer has taken over my life quite a lot. I've not had the relaxing retirement I planned!"

When he isn't in hospital, Ann's grandson has a flat of his own. "His mum works full-time, as a special needs teaching assistant, so I support him at home if he needs me."

"It can be tiring – there are hospital appointments, reviews. A lot of life is governed by visiting."

"But we have a very good relationship. We enjoy walking together. We go to the cinema and he visits church with me when he can. We volunteer at the Trust together as well; the Involvement Centre has been a tremendous support to us both."

"I want proper care in the community for service users and their carers. I'd also like to see an increase in funding for mental health services, rather than a reduction."

"Carers have to have a voice – and be listened to; we know a lot about who we are caring for."

You can find information about support for carers on our website.

Be pressure ulcer aware - check your skin

Many people are affected by pressure ulcers which can have a devastating effect on people’s lives and their families.

It's estimated that just under half a million people in the UK will develop at least one pressure ulcer in any given year and research suggests 80-95% of all pressure ulcers are preventable. (NHS England)

As part of Worldwide Stop the Pressure Day, we caught up with Geri Reevell, Specialist Nurse Tissue Viability, to find out how to spot the signs and what we all can do to help prevent developing pressure ulcers.

You can also watch our ‘Commitment to Care’ film which talks about the Trust’s ambition to eliminate avoidable pressure ulcers and the commitment by staff to continue to build on the work already done both locally and nationally.

What is a pressure ulcer?
A pressure ulcer or ‘bed sore’ is an area of the skin and underlying tissue which is damaged. This is due to lying or sitting in one position for too long without moving or by prolonged rubbing of the skin.

Are you at risk? 
You may be at risk of developing a pressure ulcer if you suffer from:

• problems with movement
• poor circulation
• moist skin caused by incontinence, sweating or a weeping wound
• previous skin damage
• a poor diet or fluid intake 
• lack of sensitivity to pain or discomfort from conditions such as diabetes, stroke and disorders that affect nerve supply and muscle movement.

What to look for?
Pressure ulcers are most likely to develop over bony areas. The areas most at risk are the heels, bottom, base of the spine, elbows, shoulders and the back of the head.

Red or dark patches of skin which do not disappear within 1-2 hours; discomfort or pain; blistering and any numbness, soreness, swelling or hardening of the skin are all signs that a pressure ulcer may be developing.

How do you know if it's a pressure ulcer?

Redness is the first response to pressure

Press your finger over the reddened area for 5 seconds, then lift up your finger

When you take your finger off the area it should go paler or blanch. If it blanches, it is not the beginning of a pressure ulcer (or stage 1 pressure ulcer). If it stays red, it is.



What can you do to avoid pressure ulcers?

There are simple things you can do while in hospital, community care or in your own home to prevent developing a pressure ulcer:

Look for signs of damage – if you are able, check your skin regularly or ask a relative or carer. Do not continue to put pressure on reddened areas, particularly on areas at risk.

Keep moving – one of the best ways to prevent a pressure ulcer is to relieve the pressure by regularly changing your position.  This can be as simple as standing and walking on the spot for a few minutes every hour. If you are sitting, try and lift your bottom off the seat every hour.  If you are in bed, try and change your position without digging your heels into the bed as this can cause damage.  Try not to slide down the bed as this can damage your skin.

Protect your skin – wash your skin using warm water or pH neutral soap cleansers. Do not rub or massage your skin as this can cause damage.  Do not use heavily perfumed soap or talcum powder.   If you have continence problems, please inform your healthcare team.

Eat a well-balanced diet – aim to eat a balanced diet, which is rich in energy, protein (meat, fish, nuts etc), vitamins and minerals and drink at least 6-8 cups of fluid a day.  Your healthcare team may refer you to the dietician for advice if necessary.

If you suspect that you or someone you care for may have a pressure ulcer, speak to your community nursing team or other health professional.

The Trust’s Tissue Viability Teams operate across Nottinghamshire and provide specialist assessment, expert advice, education and training to health professionals in hospitals and community settings for all ages.

Referrals can be made by community nurses, GPs, practices nurses, inpatient wards/ departments or nursing or residential care homes.  Visit Nottinghamshire Healthcare for more information.

Top tips for living well with COPD

Most of us will know someone affected by COPD. According to NHS England, there are around 900,000 people in the UK with the condition and a further two million are living undiagnosed.

Living with COPD is no easy feat. Many struggle with difficult symptoms such as shortness of breath, wheezing, coughing, phlegm, fatigue and frequent chest infections. And these symptoms are often worse in winter; people with COPD will have regular flare-ups during the colder months which can often lead to a stay in hospital.

The damage to the lungs caused by COPD cannot be reversed. Instead, treatment aims to slow down the progression of the disease and alleviate the symptoms. In addition to medications, there are lots of things someone with COPD can do to help make living with the condition easier.

Vanessa Holmes is a Highly Specialist Respiratory Physiotherapist, helping people with COPD maintain a good quality of life. Here are Vanessa’s top five tips for living well with COPD.

1. Stop smoking
If you smoke, the best way to prevent COPD from getting worse is to stop smoking, to avoid further damage to your lungs. Research has shown that you are up to four times more likely to give up smoking successfully if you use NHS support. Talk to your GP or visit NHS Smokefree.

2. Get vaccinated
Make sure you get vaccinated against flu and pneumonia to avoid getting infections in the winter. The pneumonia vaccination is given just once but you should have a flu vaccination every year.

3. Keep taking your medicine
Take your medicine as instructed by your doctor even if you start to feel better; taking medication continuously can help to prevent flare-ups. You should also visit your GP at least twice a year for a check-up. Talk about your medicines at each visit and, if you’re not sure how to use your inhaler, ask.
 
4. Plan ahead
It’s important you know what to do if your breathing suddenly worsens. Make sure you have telephone numbers handy and information all in one place so you can act fast if you become unwell. If you need an ambulance, make sure you tell the emergency staff that you have COPD.

5. Exercise
Exercising or keeping active helps to improve breathing and lessen symptoms. If you have COPD, you may be eligible for a pulmonary rehab programme which can help you to become more active and manage your condition. Ask your GP, nurse or consultant about being referred.

Need more information? Come along to our COPD awareness stand on 18 November at Mansfield Community Hospital to find out more about COPD and the support that is available in Nottinghamshire.

The British Lung Foundation also has lots of information online about living with COPD.

World COPD Day: Peter's Story

Peter Burrows was 65 when he was diagnosed with COPD, a lung disease where the airways become narrow, making it hard to breathe. There’s no cure. Instead, treatment aims to slow down the disease and ease symptoms.

As part of World COPD Day on 18 November, Peter is sharing his story to encourage others with the condition to access local support and begin living well with COPD.

“Unless you’ve got COPD it’s hard to understand what it’s like to live with" explains Peter. "When I was first diagnosed, it hit me. I didn’t know what to think.”

Shortly after his diagnosis, Peter’s GP referred him to a pulmonary rehab clinic, run by the Trust, and Peter says since then he hasn’t looked back.

“Talking to others with COPD [at the clinic] helped me to adjust and come to terms with my condition. I decided I wasn’t going to let it beat me.

“Pulmonary rehab is all about helping you to take control of your condition. And it works - I’m living proof! We were shown how to control our breathing, how to manage a flare-up. We were given information about medication, taught how to recognise our symptoms, and how to use our inhalers. I learnt why I should exercise and how. Understanding your condition can make such a big difference to your life.”

In addition to volunteering with the Trust’s Respiratory Service, Peter is also treasurer for his local Breathe Easy group, supported by the British Lung Foundation.

“It’s somewhere sociable to go. You’re amongst people with a similar condition. You can talk to each other. And it’s surprising what you pick up and learn.

“I’m not saying it’s easy; there’s no magic pill. You’ve got to do it yourself. But, you get out what you put in. Be positive. I still go caravanning. I enjoy photography. I play with my grandchildren. I just take it a bit slower now. The nurses in Mansfield and Ashfield, I think, are some of the best in the country; they’re supportive in every way.

“I want people to know they can live with COPD. I’m doing it, they can too!”

Specialist nurses are holding a COPD Awareness Stand on Wednesday 18 November at Mansfield Community Hospital. Drop in from 9am - 1pm. Hear from people with COPD; understand what COPD is and its impact; learn ways to live with COPD; and discover local support for people with COPD.

The Trust’s Respiratory / COPD teams operate across Nottinghamshire, helping patients to manage their condition, through exercise and education. Referrals can be made via GP, nurse or consultant. For more information visit Nottinghamshire Healthcare.

Thinking differently about dementia

Robin Williams’ widow revealed last week that the actor was developing a type of dementia before he died. Much of the media coverage has focussed on the despair which often surrounds the disease. Tom Dening, Professor of Dementia Research, spoke to us about thinking differently about dementia.

Developing dementia is dreaded more than any other medical condition, at least by people of middle age and upwards. People often say that they would rather be dead than live like that. Last week the media featured the story of Robin Williams, who was developing dementia with Lewy bodies and took his own life the week before he was due to be admitted for further medical investigations. Given that one in three of us is likely to develop dementia before we die, this is sobering stuff.

In fact, most people with dementia die of natural causes, most of them well into old age. We do know that there is an increased risk of suicide or self-harm around the time of diagnosis. Although the commonest early symptom of dementia is memory loss, there are other changes, including in mood and perceptions, and before the person receives a diagnosis these can be worrying or even frightening as the person and their family may not understand what is happening.

The commonest cause of dementia is Alzheimer’s disease and it tends to present with memory problems and difficulty with language, for example finding the right words for things. Other forms of dementia affect the brain differently and may cause other problems. Dementia with Lewy bodies (often known as DLB) is an example. DLB is a bit like having a mixture of Alzheimer’s disease and Parkinson’s disease, so as well as memory problems there are also difficulties with movement, gait and balance. As well as this, DLB has other distinct features of its own. It has a tendency to fluctuate so that at times a person can be quite confused and then shortly afterwards lucid. People often experience visual hallucinations, for example seeing other people in the room, but they also have other problems perceiving where objects are in space. If you combine all of these features, they can be quite bewildering – especially if you don’t have a diagnosis. In which case, you are just likely to think that you are going stir crazy.

However, dementia is not alone among medical conditions in having no cure, so simply to counsel despair is not good enough. What can we do to help?

First of all, we need to reduce stigma around dementia and encourage everyone to talk about it. Second, we need to encourage people to seek help if they are worried. People who are hiding their symptoms are at far more risk than those who seek help. Then we need to make a proper diagnosis, doing whatever tests and investigations are needed to make this as clear as possible. We then have to give people a good explanation as to why they are having the experiences that they do (e.g. you have difficulty in finding words not because you are stupid but because this part of your brain is not working properly). They need time to absorb the information and to ask questions, as do their families.

Beyond this, we need to discuss how dementia is more like a disability than an illness – like, say, arthritis, it doesn’t get worse from day to day but only very slowly. Most of the time, a person with dementia feels well and feels like their normal self. They can enjoy things, and look forward to pleasurable events, even if they may need reminding. They can be transfixed by emotional or artistic experiences. They can still contribute to their role as a parent or grandparent and as a source of family history. We need to hang on to all of this and celebrate it.

Difficult though it often is, we need to walk alongside people on the road of dementia, holding hands when needed and learning from their experiences as well as offering our support. By this approach we can prevent many people from feeling lonely, isolated and desperate with their condition.

If you’ve been affected by the issues in this blog and would like to speak to someone, call Samaritans on 116 123 (UK).

What is an occupational therapist?

This week is Occupational Therapy Week. We caught up with Sue Richardson, Paediatric Occupational Therapy Pathway Lead and Professional Lead, to find out more.

What is an occupational therapist?

Occupational therapy is about supporting individuals whose health, disability or impairment stops them from doing the activities that they need to do and that matter to them.

We help people to develop skills and maintain, regain or improve their independence by using different techniques, changing their environment and using specialist equipment.

Occupational therapists work with children and adults and can look at all aspects of daily life, from the home to the school or workplace.


What do you do?

As a Children’s Occupational Therapist I work mostly with children and young adults in the sixth form at a special school for children with severe and complex physical and learning disabilities.

As well as my clinical work, I am also Professional Lead and Pathway Lead.

This means that I am responsible for making sure the occupational therapy voice is heard when important decisions are being made and influence changes to improve the service that we provide. I also have to make sure that our service meets the needs of the children that we see.

I am responsible for a team of occupational therapists, and the delivery of our service across three special schools, working with health, education and social care colleagues in both children’s and adult services.

How do you help people?

As an occupational therapist, it is my job to:

• carry out assessments with the children and young adults on all aspects of daily living
• create a treatment plan
• provide individual, group or classroom based support
• give advice and recommendations

An example of the type of support I give is the use of hand splints. This improves wrist posture and use of the young person’s hands to help them grasp and hold everyday objects. This helps with cutlery, pencils, computers or self- propelling their wheelchair. I will monitor the young person, and advise school staff and parents on using the hand splints.

Another part of my role is assessing young people for specialist equipment and establishing its use in school.

What is a typical day like?

A typical day at the special schools starts by liaising with my health and education colleagues. I answer emails and any queries that are waiting for me, as well as managing referrals and supporting staff.

Once the children and young adults have arrived in school, I start my work with them. I might be leading a practical session around personal hygiene or having a meeting to help a young person move in to adult services.

At the end of the day, I’m often involved in training school staff to use specialist equipment or giving advice and support to parents and carers.


What’s the best part of your job?

One of the most rewarding aspects of my job is to know that I have made a difference, however small, to the quality of life of a child or young adult and their family. It might be by providing equipment so that they can use the toilet more easily; or providing practical solutions to help improve a young person’s involvement in their own personal care. The aim is to improve a child or young adult’s independence as much as possible.

Pregnancy and bipolar disorder

Bipolar disorder has been the focus of BBC One’s EastEnders recently, as Stacey Branning tries to manage her condition during pregnancy.  Dr Neelam Sisodia is a Lead Consultant with the Trust’s Perinatal Psychiatric Service, which works to prevent and treat serious mental illness during and after pregnancy.

We caught up with Neelam to find out more about bipolar disorder during pregnancy.

What is bipolar disorder?
Bipolar disorder is a serious mental illness which affects mood. Someone with a bipolar illness will have periods of depression, periods of elation (known as mania) or a mixture of the two. In severe cases, it can also be accompanied by psychotic symptoms, such as hallucinations and/or delusions.

Women are often diagnosed with bipolar disorder in their 20’s or 30’s. A woman who has not previously suffered from it, but has a family history of mood disorder, may develop a bipolar illness for the first time during pregnancy.

Usually bipolar disorder is treated with either a mood stabilising medication or a combination of antidepressant and antipsychotic medication. Some people may also use psychological treatments, such as talking therapy, or find lifestyle changes can help. All women are informed about the risks of conceiving whilst taking medication and are encouraged to discuss plans to become pregnant with their psychiatrist beforehand if possible, so that adjustments can be made to their treatment plan.

How is bipolar disorder managed during pregnancy? 

This can be very complex and challenging. Women who have bipolar disorder are more likely to become unwell during pregnancy or after childbirth, than at any other time in their lives. Some are also at risk of developing a psychosis postpartum (the period immediately after childbirth.)   

Treatment during pregnancy will vary, just as the needs of each woman will vary. An individual treatment plan is developed between the woman, her perinatal consultant psychiatrist and her Community Psychiatric Nurse (CPN). She’ll also be supported by a specialist midwife.

What about medication?
The decision about taking or not taking medication is always difficult. The balance of risk and benefit will vary between medications and will be different for each woman. Some of the mood stabilising medications used to treat bipolar disorder can cause serious foetal abnormalities however a relapse can have a significant impact on the mother’s wellbeing, which could, in turn, also have adverse effects on the unborn baby.

If you become pregnant whilst taking medication for bipolar disorder, it’s very important that you do not stop taking it until you have discussed it with your prescribing doctor. You will then be referred to a perinatal consultant psychiatrist. Suddenly discontinuing medication greatly increases the risk of relapse which is extremely risky for you and your baby.

What are postpartum psychosis and postnatal depression? 
Around the time of childbirth, high and low mood episodes can occur in women with mood disorders, including bipolar disorder. Psychotic symptoms such as hallucinations, delusions and persecutory ideas may also occur and can be very frightening. When symptoms are this severe, it is called postpartum psychosis. Postpartum psychosis is a relatively rare, but serious, illness affecting 1 or 2 women in every 1,000 women who give birth. A woman could develop postpartum psychosis without having had or developing bipolar disorder.

Postnatal depression is a depressive illness like any other, but is called postnatal depression when it occurs after a woman gives birth. It is more common and often more easily treated than postpartum psychosis. For most women, antidepressant medication, along with support from family, a GP and health visitor is enough to help them recover. In severe cases, a woman with postnatal depression may also be referred to her local Perinatal Mental Health Service.

What happens after the baby is born? 
This is a particularly risky time; hormone imbalances, disturbances to sleep and changes to medication can all trigger illness.  The treatment plan agreed during pregnancy will include plans for after birth. A mother who has just given birth will also be monitored closely by her CPN, midwife and health visitor so that if she becomes unwell, she can get treatment quickly.  If she needs admission to hospital, this may be to a Mother and Baby Unit, staffed by mental health nurses and nursery nurses.

What about breastfeeding? 
A mother can breastfeed her baby whilst taking some medications. Your perinatal psychiatrist or CPN will be able to discuss this with you. If a woman has expressed a wish to breastfeed she can usually be supported to continue with breastfeeding, even if she becomes unwell. Medications not suitable in breastfeeding are only used if there really is no other option.

How can a woman minimise the risk of becoming ill during and just after pregnancy?
We offer pre-conception counselling for women with bipolar disorder who are considering having a baby. This helps to manage medication and minimise risk before a woman becomes pregnant. Once pregnant, referral to the specialist Perinatal Psychiatric Service as soon as possible is essential as mental illness can complicate pregnancy and put a woman at higher risk of relapse.

If you have a history of serious mood disorder or other mental illness, be open with your GP and midwife, so they can access the most appropriate services for you. Working with mental health professionals allows for your treatment to be planned and implemented, helping to minimise the risk to you, your child and the rest of your family.

Where can I get more information? 
Open House is a peer support group in Nottingham for those affected by maternal mental health problems. You can also find further information on the NHS Choices and Bipolar UK websites.
Action Postpartum Psychosis (APP) campaign nationally for the development of services for women with serious mental illness related to childbirth.

Above all, don’t be frightened. If you’re concerned about your illness and how it may affect your ability to get pregnant and cope with motherhood, talk to you psychiatrist, CPN or GP. There will be someone locally who can help you access the care most appropriate for you.