World Stop the Pressure Day: Protecting vulnerable children from pressure ulcers

Next up in our World Stop the Pressure Day spotlight is Kimberley Bignall. Kimberley is a Paediatric Tissue Viability Nurse, helping to improves the care for vulnerable children across the county, reducing their risk of pressure ulcers and other skin damage. Here she tells us more. 

Developmental Language Disorder (DLD) and the crucial role of speech and language therapy

Up to two children in every classroom of 30 will have developmental language disorder yet it is probably one of the most common childhood conditions that is never heard of. 

Tracey Corbett, highly specialist speech and language therapist from the Trust, explains more about DLD and the crucial role speech and language therapy plays in diagnosing and managing the condition.

The life of a Community Dietitian

Dietitian’s Week is 3 – 7 June, we’re taking this opportunity to celebrate our community dietitians, and to highlight some of the great and varied work that many people are not aware is supported by them.  

With GPs potentially seeing a considerable amount of people with conditions relating to diet and lifestyle, dietitians play a key role in making nutritional information accessible and practical as well as supporting a range of conditions.

There are nine Community Dietitians, as well as the support team, that work across two bases, Mansfield and Stapleford.  Cindy Woolley, gives us a flavour of life as a community dietitian in the Trust.

Happy Baby Corner: returning to work

Going back to work after having a baby can be traumatic for mums. As part of our Happy Baby Corner Series, we’re sharing our tips for returning to work after having a baby.

Happy Baby Corner: breastfeeding support groups

Our Baby and Breastfeeding Encouragement and Support groups (known as BABES groups) offer a welcoming atmosphere for all mums who breastfeed.

Happy Baby Corner: introducing solid foods

As part of our Happy Baby Corner series, we’re sharing some top tips for successful weaning.

Introducing solid foods is an important step in your baby’s development. It can be an exciting milestone but for many mums it also brings with it some anxieties and worries - am I giving him the correct foods? Will she choke? What if he won’t eat? Is she eating too much? Should I still give him milk?

Happy Baby Corner: concerns of a breastfeeding mum

Starting to breastfeed can be a difficult time. You’re tired and emotional and then your new baby decides it’s time to feed, feed…and feed again!

As part of our new Happy Baby Corner series, Alison Jee, Infant Feeding Lead for the Trust, shares some of the most common concerns of a new breastfeeding mum and some tips for overcoming them.

“Health visitors are a lifeboat in the stormy days of having a new baby.”

As a doctor, Lucy knew all about the role of health visitors. However, it wasn’t until she became a mum herself that she realised just how important their work really was.

At seven-weeks-old Lucy’s daughter, Rosie, was diagnosed with an inguinal hernia which occurs when fatty tissue or part of the bowel pokes through into the groin. Shortly afterwards, Rosie underwent an operation to have her hernia repaired.

It was a difficult time for Lucy, who found support not only from her family, but from her local health visitor too.

“Nicola had been helping me with breastfeeding Rosie because she had lost a lot of weight following her birth” recalls Lucy. “When I showed her the hernia, she was reassuring and kind, which was just what I needed."

All you need to know about potty training

Most families will experience the ups and downs of potty training at one time or another. Nicola Lilley, a health visitor with the Trust, gave us her top tips for toilet training.

Wait until they are ready

Don’t feel pressured to start toilet training if you do not feel your child is ready. Toilet training is more likely to be successful if you let your child set the pace. If your child isn’t ready, success will take longer and the likelihood of accidents is greater.

When are children ready to toilet train?

There is no right age to start toilet training. Most children are around two-years-old but many are nearer three-years-old before they start showing signs of being ready.

"I never expected to get the care that we did. Nicola was fantastic!"

When Gina, mum to two-year-old Cleo, contacted her local health visitor for help with potty training, she wasn’t sure what to expect. However, after a few visits from Nicola, a health visitor with the Trust, Gina soon realised she’d get more than she expected.

“My GP suggested I contact my health visitor” explains Gina, “because Cleo was struggling to poo on the potty. I didn’t know what to expect from Nicola, but I didn’t think we’d get anything like the one-to-one care that we did. She was fantastic."

Supporting young carers

Last week we heard from Mike, who shared his experience of being a young carer. We spoke to Alyson Leeks, Family Intervention Coordinator, to find out more about young carers, and what the Trust is doing to help.

Who do young carers care for? 

A young carer is anyone under the age of 18 who provides physical or emotional support for a family member or loved one.

Young carers may be involved in caring for a parent, grandparent, sibling or other family member with a range of physical, mental health difficulties or intellectual disabilities. Many do not identify themselves as carers.

Young people caring for loved ones with mental health difficulties or substance misuse issues can be “hidden” carers. They carry out a caring role unnoticed by others, and this can have an enormous impact on their own development, education and opportunities.

7 emotions of a young carer

The experience of being a carer can run from helping someone with mild physical limitations to do a few activities or tasks, all the way to providing round-the-clock care for a person with a high level of need, whether that be physical, mental or both.

Whatever the need, the challenge is always compounded when the carer is young.

Mike’s experience of being a young adult carer began when he was 22, after a close family member developed a severe mental health condition.

Here he talks through some of the most common emotions of being a young carer.

Confusion

This originates in one of two ways, depending on how the caring role begins.

For those who have been carers from a very young age, the situation may initially seem normal because it’s all they’ve ever known. But as they get older and discover that their friends don’t carry out the same caring role, they may find it confusing. Why doesn't their mum/dad need them to help out like mine does? For many very young carers, real childhood is something they never experience.

In cases where the family member suddenly falls ill and the young carer is much older, the situation is a lot more jarring and disorientating. With caring, you learn on-the-job, and the upheaval and reversal of roles can be difficult to adjust to.

Loss

When a loved one develops a serious mental health condition, it can often feel like a death has occurred. There is not enough time and too much risk for you to leave the person you care for on their own, so your social life evaporates.

If you live with other family members who help to care, this is alleviated somewhat, but for those who live on their own it can be an excruciatingly solitary experience. The sense of loss can be profound.

For a very young carer, the loss may not be felt until many years later, when they realise that in many ways, they weren’t able to have a ‘normal’ childhood. While they may have gained skills such as independence, compassion and self-reliance, in doing so they missed out on being a child.

Anger

While I loved the person I cared for, I often felt bitter and angry about the situation I was in. How could they do this to me, to my life? It wasn't their fault, how could it be? But caring is so full of strong and contradictory emotions, that it’s no wonder I was sometimes angry and frustrated.

There was also a sense of guilt and self-recrimination that maybe my family had somehow been the cause of this illness, that we could have done something to stop it. That's not rational, but anger rarely is.

Fear

Fear that the person you care for will never get better. Fear that they’ll hurt themselves. Fear that you and your family will never get your lives back. Fear that you will be trapped in this demanding situation forever. These are all thoughts I had, which became more prevalent as the years went past.

Fear can go both ways. Parents who are cared for by their young children may often be afraid to seek help from local authorities as they fear their child will be taken away.

Exhaustion

One of the worst aspects of being a long-term carer is exhaustion. When caring for someone with a mental health problem, you sleep very lightly, and the slightest noise can have you wide awake in seconds. Are they wandering around again? Are they trying to get outside? What will I find if I go downstairs at 3 o'clock in the morning?

And during the day, if they keep pestering you over and over, telling you their fixations and delusions, it can seem endless when you try to explain everything is going to be alright.

When young carers are trying to combine the efforts of school, exams, university and  part-time jobs, all with the focus of trying to better themselves and improve their prospects, it can often feel like there’s not enough time to do everything.

Loneliness 

The person you love seems little more than a ghost most days. You often don't get time to go to school, college or university. You don't really see your friends any more. You ask yourself "why me?" But there’s no real answer. It’s just one of those things, with no-one to blame.

The sense of having no route of escape, no way out of the situation, makes the world seem like a grey and lonely place.

That is why it is absolutely vital that carers' groups and social support for carers, especially young ones, are given the chance to exist. Seeing that you are not alone and that a happy, productive life is possible is essential for the wellbeing of carers. This is especially true for young carers, who may be going through a difficult enough time in adolescence as it is, when loneliness is often commonplace already.

Hope

And yet, despite all this, something keeps most carers going; love for the person they care for, determination and grit, or the presence of a support network which can facilitate and reinforce these qualities and emotions. Life can continue, and continue well, provided that the young carer is given what they need to make the most of a very challenging situation.

I was lucky that I had the Rosewood Involvement Centre, which rescued me from my feelings of gloom and isolation and reminded me that I am never alone as long as I am with people who have known the struggle of caring, and can offer support in good times and bad.

It’s worth remembering that people can recover. My loved one has made a full recovery since September 2014, and there has been no relapse since. I'm cautious, but it feels as though life may have gone back to normal forever.

Still, I take it one day at a time, and am mindful that so many others may never recover. Some young people may be carers for decades to come, or even their entire lives.

It is vital that we never forget what carers do for our society, especially young carers, who need extra support to help them achieve their full potential in life.

For information about caring, or if you’re a carer looking for advice or support, visit Carers Trust.

How to keep your kids on the nice list

Christmas with kids is supposed to be one of the best parts of being a parent. But a change of routine, arguing over presents and over-indulgence can all make your child’s behaviour a Christmas nightmare.

Kate Simpson - Early Years Specialist Practitioner, and Fran Breed - Health and Family Support Worker, from Sure Start, gave us their top tips on managing your child’s behaviour at Christmas.

Stick to your routine

It’s difficult with so much going on, but try to stick to your routine as much as possible. This will help you keep a sense of normality and show that your normal rules still apply.

If children are staying with grandparents or with their other parent, have discussions beforehand on how you manage behaviour so that it’s consistent for your child.

Encourage sharing

With all those new toys, there are bound to be disagreements!

It’s natural for young children to think of themselves, so they find the concept of sharing very difficult. Don’t expect young children to want to share their brand new toy – we wouldn’t want to share our Christmas gifts!

Be realistic with your expectations, and give children time to enjoy their gifts before expecting them to share.

You can encourage sharing by setting a time limit using visuals. For example, say ‘when the big hand on the clock gets to the top’, use an egg timer if you have one or set the alarm on your phone. Give lots of praise for sharing and lead by example.

Use praise and positive language

If you only give your child attention for negative behaviour, it’s easy to see why they might want to act up. Try to stay positive, and make sure you notice the good things.

Your time is the best gift

It might sound cheesy, but your presence really is the best present. Children still need quality one to one time, otherwise negative behaviour will present itself.

Choose your battles

Behaviour will be different due to tiredness, being over excited and too much sugar. Keep this in mind and try to have realistic expectations over the Christmas period.

Stay calm and smile!

Don’t put pressure on yourself for everything to be perfect - the things which go wrong can end up being the best family stories!

Try to stay calm and enjoy yourself, and you’ll find everyone ends up in a better mood.


If you’re still struggling with your child’s behaviour after Christmas, you can get advice from your local Sure Start centre. 

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.

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.

“Why do I need a Befriender? I’ve got friends, I’ve got family. How can they help me?”

For Alexandra, 31, from Eastwood, the first few months of motherhood didn’t go quite as she’d hoped. However, after finding support from a local befriending service, Alexandra is now sharing her story, encouraging other families who are struggling to access the help that's available.

At six-months-old, Alexandra’s son, Cal, was admitted to hospital as the result of a severe milk allergy; a condition that can cause diarrhoea and vomiting, skin rashes and difficulty breathing. In rare cases, it can also result in anaphylactic shock, a potentially life-threatening allergic reaction. At around the same time as his hospitalisation, Cal also developed a hernia which, after a long wait, eventually led to surgery.

All this took its toll on new mum Alexandra, who was eventually prescribed anti-depressants by her GP. He also suggested she try the Perinatal Befriending Programme, run by Nottinghamshire Children and Families Partnership, part of Nottinghamshire Healthcare.

“I went to my doctor and said ‘I think there’s something wrong with me’” Alexandra explains. “Feeding Cal was like force-feeding. I feared he’d go back into hospital. I was anxious that he wasn’t getting enough milk. Doctors told me ‘try not to let him cry too much, because his hernia may pop out.’ It was exhausting. Mentally, I couldn’t cope.

“I lost the confidence to go out, it was just too stressful. I felt I had no one to talk to. I was really isolated.

“When my doctor first suggested it, I thought: ‘Why do I need a befriender? I’ve got friends, I’ve got family. How is that going to deal with what I’m going through?’ But, I gave it some thought and decided to give it a try."

Soon after, Alexandra was paired with Emily and, from then on, things slowly started improving for Alexandra and Cal.

“After her first few visits, I began to look forward to Emily visiting. She had experienced many of the same issues I had; it was so reassuring to talk to someone who knew how I felt! 

"It was baby steps at first; a walk round the block, then to the local park and, eventually, into town. She went with me to groups so that I wasn’t sitting on my own. She introduced me to other parents. If Cal got upset, she’d remind me ‘it’s ok if he cries.’ She’d recognise if I was struggling and say ‘let’s go.’ She wasn’t too pushy. Some health professionals tend to dictate, but Emily would just suggest ideas. She always let me choose.

“Slowly, my confidence built up. The anxiety, the nerves, all calmed down. And, as soon as I calmed down, so did Cal. Having Emily around helped me to relax.

“Now, things are improving each day. And Cal is eating me out of house and home! Weaning has been a challenge but I’m slowly introducing him to new foods. I’ve started a new job and I’m looking forward to enjoying him this Christmas, without worrying about feeding and hernias! I’ve got a bit more of a spring in my step. I’m slowly coming off my anti-depressants and by next year, I want to be off them completely.”

For more information about Perinatal Support Services, contact your GP, Health Visitor or local Children's Centre Coordinator.