Toddler health questions – answered

Our family GP tackles your questions about threadworms, slapped cheeks and more

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Is your child constipated?

Q. My toddler has enlarged tonsils. Does this mean he needs them out?

A. It’s unlikely. The tonsils tend to become enlarged during infections, such as colds and sore throats, which children encounter regularly. As long as your child is well, has no breathing troubles and doesn’t snore continually, then it’s unlikely his tonsils need to be removed, but ask your GP for reassurance. Tonsillectomies are usually carried out because of severe episodes of tonsillitis over at least a year.

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Q. What should I give my toddler to eat and drink when he has a tummy bug?

A. The most important thing when your tot has a bug is to keep his fluid levels topped up. Children under 1 and those with certain medical conditions are more at risk of dehydration, and you may need to ask your GP about special rehydration solutions. Continue normal feeds (breastfeeding or milk feeds), encourage water or squash but avoid fruit juice or fizzy drinks until the diarrhoea has stopped. After rehydrating, gradually increase his normal diet, keeping it plain at first.

Q. My child’s nursery has threadworms going round. How do I know whether she has them?

A. The main symptoms will be an itchy bottom (or vagina in girls) and disturbed sleep as adult worms come out at night to lay their eggs, but she may have no symptoms.

Occasionally you can see the worms in your child’s poo – they look like pieces of white thread. Try and look between her buttocks at night for the adult worms. If she does have them, treat the whole family with medicine from the chemist, wash hands and under nails after going to the toilet and before eating, and ensure everyone washes their bottoms in the morning to get rid of any eggs.

Threadworms are small worms that live in the gut and are very common in small children. They thrive because their eggs make little bottoms itchy, and the scratching then gets eggs under fingernails and back to the gut as toddlers put their hands near their mouths.

Q. My 3 year old has mesenteric adenitis. My doctor said not to worry but it sounds serious…

A. Mesenteric adenitis is a condition in which lymph glands (part of your child’s immune system that swell up when he has an infection) in the tummy become inflamed and swollen, causing pain. The infection is often in another part of the body such as a sore throat or cold, but the tummy glands can swell as well.

Mesenteric adenitis is fairly common in children, but it can cause severe pain and even mimic appendicitis, so while it will resolve without treatment, if your child’s pain increases see your GP again.

Q. A friend said my toddler might have slapped cheek disease. What is it?

A. Slapped cheek disease (also called fifth disease) is a viral infection, and presents itself as a mild illness with fever and cold-like symptoms along with a rash that causes bright red cheeks, followed by a lacy rash on the body. The illness can be so mild that it’s not even noticed and doctors don’t always prescribe treatment (if they do, it’s just painkillers). The virus that causes slapped cheek can affect a developing baby, so go and see your GP if you’re expecting and are concerned.

Q. My 3-year-old son’s feet turn inwards. Should I be worried?

A. It sounds like your son has a condition called intoeing, which you probably know as pigeon toes. This is where the feet turn gently inwards, both when he’s stood still or when he walks. It’s a very common condition, usually occurring between the ages of 3 and 5. Children with intoeing often trip slightly more, but, in most cases, there is nothing you need to do about it as it usually gets better on its own. If you’re worried or it’s getting worse, see your GP.

Q. My toddler has conjunctivitis. How long does she need to stay off nursery?

A. If she’s feeling and acting well in herself and there hasn’t been an outbreak at her nursery then she doesn’t need to stay off at all under current Health Protection Agency advice. If, however, there has been an outbreak at her nursery, then they may well want her to have time off as conjunctivitis is infectious and the nursery might want to try and halt the spread. Have a word with your GP about how to care for her eyes while she still has the infection.

Q. My 2 year old cries when he poos and there is sometimes some blood in it too, what should I do?

A. It sounds as though he’s constipated, which is fairly common in young children. Sometimes this can cause a small split in the skin just inside his bottom, known as an anal fissure. When he passes a hard stool, this small tear can bleed a bit and hurt.

If he’s otherwise OK, with no tummy pain or other health problems, and assuming his poo is hard with only a small amount of blood, then this is the most likely cause, but it’s worth taking him to your GP to ensure there’s no other cause, such as an infection.

Treatment involves softening his poo with a gentle laxative, as well as ensuring he drinks plenty of fluids and eats fibre-rich food like fruit and wholewheat cereals. Don’t be tempted to stop laxatives or dietary changes the minute his poo softens, as he should have time to get into a routine of pooing regularly.

Q. My 2 year old keeps getting tonsillitis, why won’t they take her tonsils out?

A. Young children often get recurrent infections as their immune system develops and they encounter new bugs. A lot of tots I see have enlarged tonsils all the time as a reaction to the bugs they’re dealing with daily. Typically, tonsillitis causes a sore throat, fever and difficulty swallowing. It can also cause a cough and neck pain as the neck glands can react to the infection. Generally, I’d prescribe painkillers such as paracetamol or ibuprofen, and recommend an anti-inflammatory or anaesthetic throat spray. Sometimes antibiotics may be needed, and if your daughter is unwell, or has a fever, she should be assessed by your GP. Removal of the tonsils (tonsillectomy) is less common than it was as it’s been found that a lot of children grow out of having tonsillitis as their immune systems develop. A tonsillectomy is an operation, and obviously there are risks involved, so it’s only done in extreme circumstances.

Q. My 3 year old is very unclear when she says anything. I’m wondering if she’s got a speech problem?

A. It really depends what you mean by ‘unclear’, so it’s worth taking her to your GP to explain what’s happening.

Hearing problems can often affect speech development, so the first thing the doctor will do is look in your little one’s ears and then possibly send her to a specialist for a hearing test. As she grows, speech will become increasingly important for social interaction, so if her hearing’s normal but you’re still not sure what she’s trying to say at times, your GP or health visitor may refer her to a speech and language therapist to help.

In the meantime, you can keep things clear for her by minimising background noise in the house, such as TVs and radios, so that she can concentrate on you speaking to her. Look her in the eye when you’re talking, and be clear yourself. Be patient, and ask if she can repeat what she’s said, too.

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Q. My fully potty-trained 3 year old has suddenly started having accidents. Should I worry?

A. You need to take her to your GP, who will check her urine for infection and make sure she isn’t constipated. The other possible cause could be that she is upset about something. If your GP feels none of these apply, she may suggest just keeping an eye on your little one and reviewing the problem if it doesn’t settle.

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