VACCINATIONS EXPLANATION

WHAT ARE THESE IMMUNISATIONS?!? Immunity bodys ability to fight of

infections without causing any symptoms to the body. So if someone is
immune to an infection it means that their body can fight that particular
infection.
The immunisation programme is a series of injections that we give to children to
protect them against a number of diferent infections that can potentially be fatal. It
is your choice whether you wish to have your child vaccinated, but Id like to stress
the importance of protecting your child against these infections some of which can
be fatal as its better to have the injection and not be infected than to have the
infection after not having the injection.

Explaining the programme:

2 months DTP (diphtheria, tetanus, polio), pertussis, HIB (5 IN 1 INJECTION FAM),
pneumoCOCK

3 months DTP, pertussis, HIB, meningitis C

4 months DTP, pertussis, HIB, meningitis C, pneumoCOCK
12 and 13 months HIB, MMR and pneumoCOCK
35 years booster of DTP, MMR
1213 years GIRLS have HPV vaccine (3 courses @ 1, 2, 6 months)
1318 years school leavers booster

DIPTHERIA sore throat and nerve problems

TETANUS muscle problems and breathing difficulties
POLIO paralysis (nerve and muscle)
PERTUSSIS whooping cough
HIB chest infection and (meningitis (infection in the lining of the brain))
PneumoCOCK meningitis, chest infection
HPV cervical cancer
MMR 3 in 1 injection covers measles, mumps and rubella

BUT YOU ARE INJECTING THE BUG INTO MY CHILD? Live vaccination is not the actual
illness. It is when part of the cell that causes the illness is changed in the lab and then
injected into the body so it allows the body to create its own defences to prevent the
person from getting the illness.
You will have appointments made for these vaccinations and its important to record and

document them in the RED BOOK that you were given so you know where
your child is on the vaccination timeline.
WHAT IF IT IS PAINFUL AS THEY ARE TOO YOUNG? I can understand that it is never a
nice thing to see your child go through something which is painful or distressing
however, it is important to remember that these vaccinations can protect against
these fatal infections. It may also seem that the child is very young but you can
catch these infections at any time thus the earlier we start the better it is for your
child. In addition, the childs natural immunity begins to wear of at about 2 months
so it is a good age for us to start the immunisation programme.

Remember to:

MMR

ICE address the concerns

Explain why they are vital
Benefits outweigh the risks
LAYMANS FAM no medical words
RESPECT THE PATIENT AND MOTHER
EXPLANATION

Do ICE.
WHAT IS IT?!?!?? MMR stands for measles, mumps and rubella. These are 3 separate
infections that are caused by 3 diferent viruses that are highly contagious and can
potentially be fatal. They can cause complications like deafness and blindness. It is
given as ONE INJECTION rather than 3 separate. This is a good thing as it can cause
less distress to the child. The vaccine was produced in 1988 and since then the
number of these infections has dramatically decreased ONLY ONE PERSON HAS
DIED SINCE 1992 OF MEASLES.

WHAT ARE THE INFECTIONS AND SHIT?!

MEASLES cough > fever > rash = can cause Chest infection and blindness
MUMPS orchitis, parotiditis swelling of the neck, face, jaw and testicles =
potential deafness and meningitis (complications)
RUBELLA is a mild infection where you get a rash and sore throat BUT it is very

serious if a

PREGNANT LADY gets it as it can cause serious defects in the child.

Complications like blindness, damage to hear t and brain. Thus it is important
to prevent a pregnant lady from contracting the infection in the first place as
well as stopping it from spreading.
FAM I HEARD THEY CAN GET AUTISM?!? So there was a paper produced by a few Drs
saying that there was a link between the MMR vaccine and autism. BUT this paper was
discredited, the journal withdrew it and the Dr has been struck of. It came out that the
Dr had tried to forge the results to make it seem like there was a link. Since then there
has been a lot of research done in diferent countries and there has been no evidence
to show any sort of link between the two.

ISNT 3 VACCINES IN ONE INJECTION A LOT TO HAVE AT ONCE?!?!? With single

vaccines there is a time gap between when each of the injections is given. In
this time the child may be vulnerable to getting the other infections.
HPV VACCINE EXPLANATION
WHAT IS HPV?!?? It is a very common virus that can be caught through intimate sexual
contact with another person that already has it lol. Because it is so common, most
people get infected with it at some point or other in their lifetime. There are some risk
factors also like smoking, multiple sexual partners, early age of first sexual intercourse.
One of the main complications of HPV is that it can cause changes in the cells of the
womb this is something called cervical cancer.

WHAT IS CERVICAL CANCER?!??! The cervix is the neck of the womb and HPV can
cause the cells to become cancerous. Cervical cancer can be very serious and is the
second most common cancer after breast cancer! About a 1000 women die of it
every year in the UK.

SO HPV IS ?!?!? There are many types of HPV. The vaccine protects against the
two main types (type 16 and 18) that can cause cancer. Because the vaccine
doesnt protect you against all the other types it is very important to attend your
smears regularly as you get older. The vaccination itself you will need 3
injections over 6 months to get the best protection. The injection is given in the
upper arm. HOWEVER, having the vaccination will not protect you against any
STIs and will not stop you from getting pregnant.
WHAT ARE THE SIDE EFFECTS?!? Quite mild tbh stinging and soreness in
the arm. There are more serious side efects but these are extremely rare.
CONSENT you may be given a consent form from the school that you have to
sign.
I SWEAR YOU GET A SORE SWOLLEN ARM MAN !?!? The soreness and swelling

that you get in your arm can last from a few hours to a couple of days.
I MISSED MY VACCINATION, CAN I STILL HAVE IT?!?! If you missed any
vaccinations for whatever reason, speak to your nurse or doctor and
rearrange so that you can try and get all 3 vaccinations. Its never too late to
catch up.
WILL I STILL NEED TO GO FOR SMEAR TESTS?!?!?! All women should go for
smear tests as soon as they are old enough aka 25. The vaccine doesnt cover
all the causes of cervical cancer so it is important to go get checked to make
sure.
MY DAUGHTER THE HOE HAS ALREADY HAD SEX THOUGH If she has had sex
and are in the relevant age group, you should still have the vaccine it is
never too late
COUNSELLING IN PREPREGNANCY
Any kids before?! Do ICE related to their concerns on pregnancy anything
you want to talk through? What do you expect from this consultation?
Have you ever tried to conceive before or is this your first time?! Have you had
any problems conceiving before?! Are you having regular unprotected vaginal
sex, 3 times a week?!? IF THEY ARE DOING IT WRONG ADVISE THEM THE
CORRECT METHOD FAM.

I am now going to talk you through some of the issues around getting pregnant
and some factors which can afect your fertility:

1. 1)

Hazards at home/flat etc anything that is a danger where they live or at

work, if you have any concerns at your work place speak to your boss/health and
safety executive

1. 2)

Diet are you a vegetarian or have any special dietary requirements?! If

yes, they may need to be referred to a dietician
Eat 5 portions of fruit and veg and dairy to build up your supplies of
vitamins. Avoid (due to listeriosis or toxoplasmosis) soft cheeses, uncooked
meat fish (tuna) and eggs, unpasteurised milk
FOLIC ACID (will prescribe anyway) and health start
multivitamin/pregnicare and VITAMIN D. If you drink cafeine reduce
consumption to 2/3 cups a day (in case the examiner asks you folic acid is to
reduce the risk of neural tube defects. The risks of NTD are increased if
diabetes, BMI >30, family history of NTDs, antiepileptic medication, renal
dialysis)

1. 3)

Weight and exercise advise them to lose weight as this can increase risk
of complications (if examiner asks need for Csection, preterm delivery, VTE,
gestational diabetes, breech, macrosomia)

1. 4)

Smoking and alcohol advise them of the dangers. Smoking = IUGR,

miscarriage, premature delivery, placental problems. If anyone else in the house
smokes tell them to not do it around you. Ofer smoking cessation or NRT (can
take patches but take it of at night, DO NOT GIVE BUPROPION). Alcohol can lead
to foetal alcohol syndrome (if examiner asks causes growth and mental
retardation, behavioural problems, and facial anomalies). To avoid this no alc
in first 3 months and after this no more than 1 to 2 units no more than twice a
week.

1. 5)

Medication and drugs advise to reduce consumption of all drugs and

they will have a full medication review at a further date. If they are on VIT A
dose will be reduced. Any illegal substances then advise them to stop and ofer
specialist services. Any illicit drugadvise them to use contraception and tell
them to not get pregnant. If on injected illegal drugs screening for HEP B/C
AND HIV.

1. 6)

Chronic diseases advise them to continue taking contraception, then they will
be referred to their specialist for review and when appropriate they will tell you when to
begin conceiving. Asthma = very low threshold for inhaler usage. Be careful with
steroids. Diabetes both diabetic and obs teams will both be involved. Tight control of
glucose before conception. Every month preconceptually they should be checked and
once they have become pregnant it will be checked once a week at the clinic. Oral
hypoglycaemic should be switched immediately to metformin and insulin. Hypertension
= if on drugs refer to specialist teams. They will be switched to methyldopa, labetalol, or
nifedipine.

BUT IM ALREADY ON ACE INHIBITORS AND IM PREGNANT!!! Continue

taking them as the risk of hypertension is higher than teratogenicity.
STATINS ARE CONTRAINDICATED IN PREGNANCY.

7. 7)

Age >35 years old = higher risk of foetal abnormalities and increased
risk of complications in pregnancy (all mentioned above)

7. 8)

Smears when was your last cervical smear? If they are over 25 and
havent had a smear get it done and if it is due then get it done before they get
pregnant as you cant test the cervix whilst pregnant.
WHAT WILL HAPPEN WHEN IM PREGNANT?!?!?! We will refer you to the local specialist
team in the hospital and we will divide your care according to your needs HOME
CARE, GP, and HOSPITAL. Regular visits (BP and URINE) will ensue after the first
booking visit in the hospital.

DO ICE AGAIN.
DIABETIC PREPREGNANCY COUNSELLING (BEFORE THEY ARE PREGNANT FAM)
Why are you here fam?! Do ICE. Concerns and expectations from the of.
Anything specific that you want me to address?!
Today I will be speaking to you a little bit about diabetes and how it can afect

pregnancy. I will give you some advice as well on issues like diet and exercise,
on what you can expect when you get pregnant, and I will also arrange for you
an appointment for you to be screened to make sure your diabetes is under
good control.
IF A PATIENT COMES IN AND THEY CONFIRM THEY ARE DIABETIC, NICE GUIDANCE STATES
THAT THEY SHOULD BE REFERRED ON TO SPECIALIST SERVICES SO THEIR DIABETES CAN BE
ASSESSED. YOU SHOULD ADVISE THEM TO USE CONTRACEPTION AND NOT TRY TO
CONCEIVE UNTIL THEY HAVE BEEN GIVEN THE ALL CLEAR BY THE DIABETIC TEAM.

[SCREENING QUESTIONS] Do you feel that your diabetes is under good

control?! Have you ever had a hypo (fainted, dizzy) before? If yes, when was
your last one?! If recent strongly advise contraception What medications
are you on for your diabetes?!
As you may well know diabetes is a condition in which the body has trouble
reducing the amount of sugar in the blood. You will be on a range of medication
to help you with this.
Good control = most important things we need to keep on top of to reduce risks of
complications in pregnancy. There are a few conditions which we call high risk in
pregnancy and diabetes is one of these as they increase the risk of complications in
pregnancy. HOWEVER, DONT BE ALARMED as this isnt to say you will develop
them if your control is good the chances are you wont. THIS IS WHAT I WANT TO
TALK YOU THROUGH TODAY.

WHAT IS YOUR AIM DOCTOR?! The aim is to keep your resting blood sugar at a
safe level. This can be done by you checking your blood sugars one hour after
every meal, and also coming in every month before pregnancy OR every one or
two weeks during pregnancy to check that everything is alright.
BUT I HAVE SHIT CONTROL ! If uncontrolled diabetes can cause a few
problems:

1. 1)

Pregnancy increases the demands of the body so even if you have good control
over your diabetes, your control may be compromised slightly. To counter this we will
switch your medications to ones that are more suitable so that your blood control is the
best it can be.

1. 2)

You will be at risk of increased risk of a hypo (blood sugar can go too low).
Diabetes usually afects the eyes, nerves and kidneys so these can be afected more in
pregnancy.

1. 3)

Going into pregnancy with diabetes can increase the risk of you
developing: high BP, clots in the legs, premature labour and the need for a C
section

1. 4)

In the baby it can cause spontaneous abortion, obstructed labour as

baby can be bigger (macrosomia), increased fluid around baby in the womb
(polyhydromnia), foetal distress, injury during delivery, resp distress after birth
To reduce the risk of these happening Imma give you some more advice.
Try and keep on top of your diet (fruit, veg etc etc). Try to lose weight. Important to take
folic

acid, multivit. Exercise, smoking cessation, alc reduction and illicit drug use
cessation.
We will also refer you to the eye Drs during pregnancy just to check diabetes is
not afecting them further. Same with kidney Dr. DO ICE FAM. Chunk and check.
Ofer leaflets etc
Once you become pregnant: diabetic women who become pregnant need to be
seen at least
every two weeks by the diabetic care team BLOOD SUGAR TESTED AN HOUR
AFTER EVERY MEAL. If insulin their blood should be tested before they go to bed.
WHAT OTHER STUFF WILL YOU GIVE ME??! Type 2 we give glucose take it if
you feel dizzy. Type 1 glucagon.
Retinopathy check is done at the first antenatal clinic appointment IF the eyes
havent been checked within the last 12 months. If it is clear at the check ofer
again at 28 weeks if there are signs of retinopathy at the check then ofer it
at 1620 weeks. Same with kidney check (last 12 months bit).
WHAT SCANS WILL I HAVE?!??!
7 to 9 weeks = scan for viability
18 to 20 weeks = antenatal exam + 4 chamber view of the heart
28, 32, 36 weeks = USS to check baby standard shit (macrosomic or not to
decide what type of birth)
38 weeks + = standard weekly checks

IF STEROIDS ARE GIVEN TO HELP BABYS LUNG DEVELOP, YOU WILL NEED MORE
INSULIN.

STRONGLY ADVISE GIVING BIRTH IN HOSPITAL NO HOME BIRTHS!!!

BUT I WANT TO GIVE BIRTH AT HOME?!?! Raaaaaaas allow it fam there are too
many complications that only a specialist can deal with and the transfer will take

too long etc etc

WHAT HAPPENS AFTER THE BABY IS BORN?! CAN I TAKE THE BABY HOME?!? Keep the baby in
hospital for checks. They must be fed every couple of hours. Blood glucose should be
monitored regularly. Once born the baby must also be checked for congenital heart defects.
Send the baby home if MORE THAN 24 HRS, BABY IS FEEDING AND MAINTAINING GOOD
GLUCOSE CONTROL.

For the momma after birth the insulin should be reduced as they are at risk
of a hypo. If they were on glibenclamide prior to pregnancy they can resume.
REMIND WOMAN OF THE IMPORTANCE OF CONTRACEPTION.

DIABETIC COUNSELLING IN PREGNANCY (AFTER THEY HAVE BECOME PREGNANT)

Pretty similar to the above BUT instead of advising you are reassuring that
they have been given the advice. Reiterate their appointment schedule. Check
side efects of medication and how the pregnancy is going so far. DO ICE.

VASECTOMY EXPLANATION
What do you know so far?! Blahblahblah
WHAT IS A VASECTOMY?!? Vasectomy is a permanent form of contraception. It
is a small operation to cut the vas deferens vas deferens is a small tube that
carries the sperm from the testes to the penis. Once cut the sperm cannot get
into the semen.
HOW RELIABLE IS IT??! It is very reliable but not quite 100%. There is a very
small risk that in the future you will become fertile again literally 1 in 2000.
HOW IS IT DONE THEN?!?! Local anaesthetic and sometimes general. Local is
injected into a small area of skin on either side of the scrotum just above the testes.
Then a small cut is made in the skin and the vas deferens is then clearly visible and
it can be cut. You wont feel any pain it will all be numb. SELL THE LOCAL,
GENERAL= MORE COMPLICATIONS. The small cuts are stitched back together with
dissolvable stitches. The actual operation only takes 15 minutes.

WHAT ABOUT AFTER SURGERY?! After surgery you will feel some discomfort
pain this goes away quite quickly. It can be helped by wearing tight fitting
underpants day and night for a week or so. Dont do any heavy work, exercise
or lifting.

WHAT ARE THE RISKS?!? Most people have no problems at all as problems are
very uncommon, however some potential problems are wound infection,
bruising around the operation site, dull ache in the scrotum for a few months.
HOW WILL I KNOW ITS WORKED?!? Some sperm survive in the upstream part of
the vas deferens for up to 8 weeks. About 8 weeks after the operation you will
need to produce 2 semen samples about 36 weeks apart. They will be looked at
under a microscope checking for sperm if there are none you will be given the
all clear. You still need to use additional contraception such as condoms until you
get the all clear.
WHAT ARE THE ADVANTAGES OF A VASECTOMY?!! Its permanent so you
dont have to think about contraception again. It is easier to do and more
efective than female sterilisation (ask about wifes status for
contraceptives).
WHAT IS BAD ABOUT IT?!? It may take a few months before the semen is free
from sperm. As it is permanent some people regret having the procedure.
WILL IT AFFECT MY SEX DRIVE TEEEHEHEHE??!? No. Hormones produced by the
testes (which give you your sex drive) are still absorbed in the bloodstream.
WHAT HAPPENS TO MY SPERM?!? It is still made but cannot get passed the
blockage so it is absorbed by the body.

DONE ON THE NHS REVERSAL IS PRIVATE. DOES NOT HURT DURING OP. YOU CAN RESUME THE

SEX AS SOON AS IT BECOMES COMFORTABLE. DISPELL THE MYTH THAT

VASECTOMY INCREASES CHANCE OF CANCER THERE IS NO LINK.
JAUNDICE EXPLANATION
Do ICE. What do you know about jaundice?! Have you got any worries at the
moment?! What do you expect to gain out of this consultation!?
WHAT IS JAUNDICE?! Jaundice is a very common condition where the skin and whites of
the eyes become yellow. Jaundice is actually caused by an excess of a waste product
called bilirubin that builds up in the blood. It is not a painful condition and it is not a
harmful condition either but if it carries on for longer than 2 weeks then it may indicate
some sort of problem with the babys liver.

So in the blood you have red blood cells which carry oxygen and when these red
cells are broken down they release a waste product called bilirubin. If you have too
many red blood cells that get broken down, you get more bilirubin in the blood.

Bilirubin itself is a yellow substance and so your baby appears yellow if there is too
much in the blood. Normally, your liver works to remove it and reduce the amount
of bilirubin by passing it through the gut so it can pass through in the stool. But in
new born babies the red blood cells are broken down so fast that the liver cant
initially handle it so more bilirubin naturally builds up in the blood.

There are a couple of reasons for this:

1. 1)
1. 2)

Newborn babies have more RBCs than adults

Bilirubin is broken down much slower in babies than adults

SO WHAT CAN HAPPEN?! There are a couple of diferent types and causes of
jaundice based on the time in which they present: so if your baby develops
jaundice from to

First 24hrs = abnormal but we will pick up on this and the baby will need
medical attention.
24hrs to 14 days = this is usually called physiological jaundice which we would
not be concerned about as it is quite common and is harmless usually
resolving in 2 weeks. But we will still monitor the baby throughout just in case.
14 days + = this is usually called prolonged jaundice and we will usually pick up
on this. If the baby is still jaundiced after the first 2 weeks and we have not
picked up on it seek medical attention. You should also seek medical attention
if jaundice develops at a later stage or if their stools are chalky white.

HOW CAN I CHECK!?! It is very easy! Gently press on the tip of the babys nose
or the forehead. If the skin turns white there is no jaundice. If the skin turns
yellow this may indicate jaundice. Drs will do blood tests to check levels of
bilirubin.
HOW WILL YOU TREAT IT?! Treatment usually isnt needed if the baby develops
jaundice in the first week. Your GP will monitor your baby by doing blood tests and the
jaundice usually disappears after 2 weeks. We would advise you to keep breast
feeding regularly. If the jaundice doesnt improve we can treat it. The first way is
through phototherapy which involves shining a

light onto your baby the light changes the molecule from a fat soluble
substance to a water soluble substance which is easily excreted by the liver.
This will remove bilirubin from the blood. The aim of this is to expose as much
light onto the babys skin as possible. We will give them protective eyewear to
prevent eye damage. Some mothers will find it distressing as they just want to
bond particularly in the early few days. Phototherapy is stopped for 30 minutes

every few hours for feeding. The amount of bilirubin in the blood is tested every
46 hrs. In more complex cases the treatment can be something called
exchange transfusion where we replace the full volume of blood twice.
Do ICE, CHUNK N CHECK ETC ETC.

CYSTIC FIBROSIS EXPLANATION

WHAT IS CYSTIC FIBROSIS?! Cystic fibrosis is a condition that mainly afects the lungs and
pancreas

it can afect other things. Normally, cells in the body in these areas produce
a mucus lining. In people with CF the cells that do this do not function
correctly so they produce a thicker than usual mucus.
WHAT CAUSES CF ?!? CF is a genetic disorder. In CF one of your genes does not work
properly. This is called the CFTR gene. This gene is responsible for handling NaCl (salt)
ions in a CF patient this results in sodium not leaving the cell so therefore water
cannot leave as usually water follows the sodium. This means it cannot water down the
mucus making it too thick.

WHAT DO YOU MEAN GENETICS?! CF is what we know as an autosomal recessive

disorder.

WHAT DOES THAT MEAN?!? In order for someone to inherit CF they will need to
inherit TWO CF genes one from the mother and one from the father. Around 1
in 25 people with Caucasian descent in the UK are carriers.
WHAT IS A CARRIER?! A carrier is someone that has one CF gene which isnt enough to
give them CF but it means that they can potentially pass it on to their ofspring. When 2
carriers with CF meet and have INTERCOURSE there is the following chances of having a
child with CF (DRAW OUT THE DIAGRAM YOU PRICK RESULTS = HAVE CF,
CARRIER, HEALTHY).

WHAT ARE THE SYMPTOMS?!? They usually develop within the first year of life.
Lung symptoms = because the mucus is thick they find it difficult to clear the
lungs this traps bacteria in the airways which makes it more susceptible for
infection and inflammation. Persistent cough producing a lot of sputum,
wheezing, SOB, recurrent chest infections. Gut symptoms = pancreas normally
makes digestive chemicals which usually digest food in people with CF the
flow of these secretions is blocked causing food not to be digested or absorbed
properly. This causes malnutrition leading to poor growth, poor weight gain,
large smelly greasy sweaty dutty faeces [LOL], bloated abdo, constipation.
However, 3/10 patients will not sufer any gut symptoms. Birth symptoms =

meconium ileus blockage in babys intestine which may need to be surgically

corrected. Other symptoms = repeat sinus infections, infertility in males,
pancreatitis and osteoporosis.
HOW WILL YOU TEST FOR IT?! Your baby will be tested at birth with a heel prick
test. This is good as if positive we can begin treatment immediately. To confirm
this we would also perform a sweat test with a genetic test also.
WHAT IS A SWEAT TEST?!? A sweat test measures the amount of salt in the sweat. We
expect to see more salt in patients with CF. With the genetic test some cells are
scraped from the inside of the cheek or it can be done with a blood test this is
looking for the gene mentioned earlier.
WHAT IS THE TREATMENT?! Treatment will involve the input from lots of diferent
specialities to ensure the best treatment for your child. This will include child health
Drs, specialist nurses,

physiotherapists, dieticians, counsellors, psychologists as well as your primary

health care team. It will involve regular checks to monitor the condition and to
keep a check on the child. Lung treatment = physiotherapy is important as it
can help to clear the airways physiotherapists will teach the parents how to do
this. Dieticians will be involved giving diet advice and vitamin and enzyme
supplements. Regular antibiotics and antifungals will also be given to prevent
chest infections usually a small dose prophylactically. Inhalers such as
salbutamol are used to open up the airways as much as possible. Dornase alpha
given by nebuliser it thins the mucus making it easier to cough up and clear
it.
WHAT IS THE PROGNOSIS?!! It used to be poor but recent treatment techniques
and the MDT approach means that patients are comfortably living into their 40s
and 50s. A lot of research is being done so as your child grows up hopefully there
will be more developments.

GIVE SOME LEAFLETS, Do ICE, CHUNK N CHECK.

FEBRILE CONVULSION EXPLANATION

Do ICE. Can you explain what happened? [Take a quick history] How old is the
child?! (Shouldnt happen if the child is under months or over 6 years) What
do you know about what has happened?! Has it happened before?! Are you
concerned?

WHAT WAS IT?! After discussing the case with the other senior Drs we have
come to the conclusion that your child sufered from what is known as a febrile
convulsion. Do you know what this is?
WHAT IS A FEBRILE THINGY?! This is where a child has a seizure during a
temperature this is commonly due to an infection. Id just like to reassure you
straight away that your child is fine. I completely understand that it must have
been frightening to watch your child have a seizure. But it is quite a common thing
to happen in children. 1/20 will have a FC before the age of 3. It is not epilepsy
which is where you have repeated fits without a temperature.
WHAT ACTUALLY HAPPENS THOUGH?! So in your brain, cells send messages
between each other via electrical impulses. In FC these electrical impulses are
interrupted because of the high temperature. It is the brains method of resetting
itself and because of that you get the classic symptoms where the child is
shaking. So there is a very small risk in developing epilepsy but this is only minor
2/100 if the child is less than 1 years old when it happens.

WILL IT HAPPEN AGAIN?! Because your child has had this FC there is a risk that
it will occur again. One of the other risk factors is if there is a family history of
this.
WHAT SHALL I DO?! So there are a few things that you can do to manage it. If
your child begins to have an episode:

1. 1)

Lie the child on their side in the recovery position with their face turned
to one side this prevents the child from swallowing their own vomit and keeps
their airway open so they can breathe.
1. 2)
Stay with them note the time of the seizure and how long it lasts for.
1. 3)
Do not put anything in their mouths or shake them.
1. 4)
If the seizure lasts more than 5 minutes call 999.

1. 5)

One important thing to remember is to not put them in a cold bath as this
makes them worse.
CHUNK N CHECK, Do ICE, LEAFLETS.

NOCTURNAL ENURESIS EXPLANATION

Do ICE. Cheeky history. What do you know about what happened?!
So bed wetting is common and can be very frustrating and worrying for

parents. Fortunately this is a condition known as nocturnal enuresis.

WHAT IS NOCTURNAL ENURESIS?! NE basically means wetting the bed during
the night. This usually becomes a concern if the child is wetting the bed more
than 2 times a week. There are 2 types: primary and secondary.
Primary = they have never been dry they have never had a period where
they havent wet their nappy
Secondary = they have had a good period of dry nights they start to become
wet again
It is 2 times more common in boys Although it wont afect the child physically it
can reduce their self esteem and can become quite embarrassing as well as
frustrating for the parents having to continuously change the sheets.
WHAT CAUSES IT?! The majority of the cases there is no specific cause but there
are some things that can make it worse. One of them is stress so if they are
struggling at school or getting bullied. Cafeine, constipation as it can press on
the bladder and irritate it. ADHD a condition that can also cause bed wetting
amongst other things. Some rarer causes include diabetes and infections but
usually with them you would get daytime wetting as well.
WHAT SHALL I DO?! The first thing to do is reassure a child to let them know that
they are not alone and that this will get better with time it is not their fault. The
volume of urine made at night is too much for the bladder to hold and the sensation
of a full bladder isnt strong enough to wake them up. There are things you can get
the child to do to help themselves:

1.
1.
1.
1.
1.
1.
1.

1)
2)
3)
4)
5)
6)
7)

Do not restrict their day time fluid

Do not give them fluid 23 hours before their bedtime
Avoid drinks like cola, tea and cofee as they have cafeine in them
Encourage them to go to the toilet regularly during the day
Make sure they go to the toilet before they go to bed
Positive reinforcement like rewards for going to the toilet regularly etc
Do not punish them for it as it isnt their fault

You can also get a bed wetting alarm this is a small sensor which is attached in the
childs underwear and an alarm that is worn on the pyjamas if the sensor starts to
get wet the alarm goes of. You can get these from your local primary care trust (GP)
and this helps the child over time to recognise the need to pass urine, to wake up and
go to the toilet, and to learn to wake spontaneously. There is a good chance of a cure
with this and is used for 35 months or until the

problem is resolved.

WHAT IF IT DOESNT WORK?! We can also give medicines to try and sort the
problem. The commonest one we use is something called desmopressin this
is a synthetic version of one of the hormones that is made in the body. It
reduces the amount of urine you make at night in the kidneys and works in
about 70% of the cases working straight away. If it does work use it for about
3 months and then try without it. It can be used for trips away from home. It is
taken at bedtime and you may need to increase you doses if your child is not
dry within 2 weeks. If that does not work you may need to use a combination
of the alarm and the medication to see some results.
Do ICE, CHUNK N CHECK, LEAFLETS.

TESTICULAR TORSION EXPLANATION

Do ICE. So what is the story so far?! How much do you know about the
condition? Has someone told you what it is? Would you like me to go through it
with you?!
WHAT IT IS?! Ok to explain what has gone wrong Ill first explain to you what is normal.
There are 2 testes in the scrotum connected to blood vessels that gives them their blood
supply. There is also a tube that carries the sperm called the spermatic cord. The testes
usually can move around in the scrotum but sometimes the spermatic cord becomes
loose and the testes can move around more than usual leading to the testes twisting
which causes the spermatic cord to twist thus blocking of the blood supply. It is similar to
blocking of a hose pipe. This is what causes the extreme pain.

WHAT CAUSES IT?! IS IT NORMAL?! It normally occurs in teenage boys. 1/160 males
a year. There is not a specific cause of this but there are a number of risk factors
which means you can be more susceptible such as large testes, sudden temp
change, undescended and previous testicular pain. The symptoms are scrotum
swelling and redness, abdo pain during sport, nausea, vomiting and fever. So if you
see these symptoms; then it is a MEDICAL EMERGENCY (let them know that there is
a risk of testicular death due to lack of blood supply) and the sooner treatment is
started the better the outcome with a lower chance of long term problems.
WHAT IS THE TREATMENT?! The treatment is minor surgery to detort the testes.
Initially a small cut is made in the scrotum to expose the testes, and then it is
untwisted and stitched to surrounding tissue to hold its position. This must be done
within 6 hours of the symptoms presenting this allows a greater chance of the testes

surviving. [INVESTIGATIONS if they ask the main one to exclude epididymitis is

DOPPLER ULTRASOUND torsion = absent blood flow]

Do ICE really check the concerns and expectations, CHUNK N CHECK,

LEAFLETS.

DOWNS SYNDROME (SCREENING AT ANTENATAL CLINIC) EXPLANATION

Do ICE. Check what they are in for and what they are concerned about. See how
much they know and how far they have come in the booking process.
Do you know or have you heard of Downs Syndrome screening?! Would you
like me to explain a bit more about it?!
YES, WHAT HAPPENS?! Downs Syndrome screening is a test to see if your baby
is at a higher risk of having Downs. It is not compulsory and it is your choice
whether to have it or not. Screening can take place within 1020 weeks however
where possible it is usually completed between by 14 weeks and 2 days. This is
so you can do the Combine test which is the recommended screening strategy.
WHAT SCREENING TESTS ARE AVAILABLE?! There is something called the nuchal
translucency ultrasound scan or known as an NT scan. It is a special ultrasound scan
which is done between 11 weeks and 2 days and 14 weeks and 1 day. It can be done
at the same time as the early dating scan and is carried out in the same way. It
measures the fluid collection under the skin at the back of the babys neck. All babies
have some fluid at the back of the neck but Downs syndrome babies usually have
more. The results are put into a program with other factors including your: age, size of
baby, your weight, ethnicity, smoking status and this will give you a risk result. We
would also do blood tests done to measure various hormones and proteins in your
blood these are produced by the placenta or the developing baby (examples include
PAPPA, beta HCG, AFP). These results are processed by a computer program to give you
a risk factor. A combined screening test includes both of the mentioned methods to give
you a more accurate result.

HOW DO I KNOW WHAT THE RESULTS OF THE TEST MEAN?! It will give you a risk
factor such as 1/1000 risk this means for every 1000 pregnant women there
will be one Downs Syndrome baby and 999 normal ones. This is a relatively low
risk. The higher the second number gets = the lower the risk. If the second

number is 150 and below this is considered a high risk result. If it above 151 it is
considered a low risk result.
WHAT HAPPENS IF IM A LOW RISK RESULT?! This is a reassuring result. This
does not mean your baby will definitely NOT have DS but it is very very
unlikely.
WHAT IF IM A HIGH RISK RESULT?! This does not mean your baby definitely has
DS but further tests are needed to confirm if it is yes or no. You can choose
whether to pursue the further testing or not it is your choice.
WHAT ARE THESE OTHER TESTS?! The two main tests are: amniocentesis and chorionic villus

sampling. During an amniocentesis a sample of your amniotic fluid (the watery

substance around your baby) is taken with a fine needle. This fluid contains cells
from the baby shed skin/urine from the baby etc etc. These cells will contain the
babys genetic information.

Amniocentesis is usually ofered after 15 weeks of pregnancy as this is a safer stage

to do it. There is a small risk of miscarriage due to amniocentesis this is around 1%
(considered low risk). And there is a 1/1000 risk that the test will cause a serious
infection. We do not know why some women miscarry after the test some research
shows that it is because the amniotic sack is damaged or infected after the test.
During chorionic villus sampling a small part of tissue from a part of the placenta
called the chorionic villi is taken. The cells of the chorionic villi contain the exact
same genetic material as the baby. It is done by passing a fine needle through the
abdomen into the uterus to obtain the sample. CVS is usually done between the 11 th
and 14th week of pregnancy and there is a 12% chance of miscarriage.
HOW LONG WILL THE RESULTS TAKE AND HOW WILL I GET THEM?! There are 2
types of tests that can be done on the samples. The first is the rapid test which
gives results in 3 days this test looks for chromosome disorders (DS, Edwards and
Patau). And sometimes Turners Syndrome can also be detected at the same time.
The second test is a full karyotype this looks at the babys full set of chromosomes
and takes 23 weeks. Sometimes only a rapid test is carried out but your Dr or
midwife will inform you of what test is best for you.

WHAT ARE MY OPTIONS IF THE RESULTS OF THE DIAGNOSTIC TESTS ARE

ABNORMAL ?!? Most cases the results are normal. Occasionally, the test does
not give a clear result for the common abnormalities mentioned before. Some
women will be told that they have the chromosome abnormality the test was
looking for. The Dr will give you information on the relevant condition that our
baby has and will refer you to the right specialist. Very occasionally the test
for DS are negative but another chromosome abnormality is discovered. Again
the Dr will give you the right information, refer you to the right specialist as
well as giving you the support routs that are present.

WHAT ARE MY OPTIONS?! When deciding what to do it is important to consider

what is best for you and your family. Making this decision can be very difficult
and it can often help to discuss your feeling with a support organisation such
as Antenatal results and choices, midwife and Dr. You might choose to
continue your pregnancy using the info you have gained to prepare for the
birth and care of the baby. You might continue the pregnancy and consider
adoption or end the pregnancy.

Do ICE, CHUNK N CHECK, LEAFLETS.

DOWNS SYNDROME (POSTDIAGNOSIS) EXPLANATION/BBN

Congratulations on the birth of your child! Empathise. How are you feeling and have
you had loads of skin to skin contact with your child bond?! Have you got any
concerns at the moment? Im here to speak to you about your childs diagnosis. I have
been asked to inform you that your child has DS. Ill give you a minute to take that in.
ONE MINUTE. What do you know about DS?!
I KNOW THIS ASPECT [parent mentions some complete bullshit that is wrong] Well
actually that is not strictly true. So DS is a genetic disorder do you know what this
means? Genetics are the building blocks of life like a cookbook tells you how to make a
dish using a recipe. Genes tell your body how to make cells. Genes make up 46
chromosomes and a baby gets 23 from mum and 23 from dad. In DS a baby has an extra
gene which causes a problem when the body is making cells. It is an extra gene 21 which
is why you may hear it referred to as trisomy 21. Because there is an extra gene there is
extra genetic material which causes the typical features of DS.

DID I CAUSE THIS?! No, anyone can have a baby with DS it is one of the
most common genetic disorders we know about. The only risk factor that has
been identified is the risk of having a DS baby increases as mum gets older.
SO WHAT ARE LIKE YKNO THE FEATURES?! There are some facial and physical features

but there are also some medical problems that can afect people with DS. It is important
to understand that not everybody will be afected to the same degree some will have
milder features and problems than others. Typical facial features = oval shaped face,
eyes that slant upwards and have an extra skin fold, small mouth, tongue that protrudes
first, flat back of the head, small nose with flat low bridge, ears may also be small and
ofset. Other features = single palmar crease, short fingers and a little finger that can
curve inwards, looser joints than normal, bigger than normal space between the 1 st and
2nd toe, muscles lack tone and can be floppy. Everyone with DS will sufer from some
learning difficulty but it can vary from case to case generally they tend to have a lower
than average IQ. They may learn to walk and talk at a later stage but many will learn in
the end. Kids with DS are actually known for their warm and bubbly personalities.
HOW DID YOU DIAGNOSE IT?! [IF THEY SOMEHOW MENTION DIAGNOSIS FAM] This can
be done before or after birth. So when youre pregnant youre ofered screening tests
for DS which shows the likelihood of your baby having DS. If there is an increased risk
then you are ofered more tests. Every woman is given the option but is totally up to
you to decide. Usually done at the end of the first trimester. First youll have a blood
test done which looks at the hormones and

proteins and then a scan which looks at the markers. Nuchal translucency which
looks at the space between the babys spine and the back of the neck. Increased
thickness = increase risk of DS. CVS is also ofered which is a placental sample
done after 10 weeks small needle is passed through the tummy and sent to the
lab. 1/100 risk of miscarriage side efects = infection and bleeding.
Amniocentesis = sample of amniotic fluid. Same risks as above. After birth the
Drs may notice physical features of DS and for a definitive diagnosis they will
organise the baby to have a blood test to look at their genes.
WHAT OTHER TESTS NEED TO BE DONE?! They main need further scans to
check the heart for abnormalities and the babys hearing and sight will be
checked.
WHAT DO YOU MEAN HEART ABNORMALITIES?! Around half of the babies with
DS will have a congenital heart defect (heart problem they are born with). The
most common is atrioventricular septal defect = hole in the muscle that usually
separates the diferent chambers in the heart thus blood flow around the
heart becomes abnormal. It can however be fully corrected at a later date if it
is detected early on.
WHAT OTHER PROBLEMS?! Growth, teeth and bone development = abnormal.
Obesity and thyroid problems, diabetes, premature aging, oesophageal or
duodenal atresia afects when they are babies. Hirschsprungs disease.
HOW LONG WILL THEY LIVE?! Up to 5060 years old and some DS patients will
even be able to live an independent life!

WILL THEY BE MONITORED?! They will receive SALT, physiotherapy, under a

team including paed, GP, cardiologist, ophthalmologist, occupational therapist
and social worker. Regular medical follow ups and dental checks to check
overall development.
Do ICE, CHUNK N CHECK, LEAFLETS.

MENOPAUSE AND HRT EXPLANATION

Do ICE, what have you come in for?! Blahblah do quick PMH, PSH (gauge
whether they have had uterus removed or not). Also find out when their last
period was.
WHAT IS THE MENOPAUSE? It is essentially when your periods stop, and you can no
longer get pregnant. The menopause is a natural and normal event that every
woman goes through.

WHAT CAUSES IT? Your ovaries, which are where eggs are made, and as you get
older around the age of 51 years old, they stop making eggs. Your ovaries then
make less oestrogen which is the main hormone they produce. This then causes
most of the menopausal symptoms that women experience.
WHAT SYMPTOMS CAN I EXPECT TO HAVE? As we mentioned earlier they are
related to the lack of oestrogen and include; hot flushes, sweats, genital area
changes and dry skin.
WHAT ARE THE LONG TERM PROBLEMS/CHANGES WITH MENOPAUSE?! There is a
tendency to lose skin collagen making your skin drier and thinner. Lack of oestrogen
tends to make the vagina thinner and drier. Osteoporosis meaning your bones will break
more easily if you fall. Although not everyone will develop osteoporosis it depends if you
have the following factors:

Menopause before 45

Previous bone fracture

Family history
BMI <19

Have a time where your periods stop for 6 months or up to a year before
your menopause (due to under eating or overexercising)

Steroid usage = 3 months +

Smoker

Alcohol > 4 units/day

Lack of calcium/vit D

Sedentary lifestyle

Medical condition afecting bone

Cardiovasc disease including heart disease and stroke increases after the menopause
this is due

to the loss of the protective oestrogen.

IS THERE ANYTHING I CAN DO FOR THE SYMPTOMS? There is a treatment we use
called hormone replacement therapy, this involves giving you tablets which contain
the hormones that have been reduced due to the menopause, essentially replacing
them in your body.
WHAT ARE THESE MAGICAL TABLETS AND WHEN CAN I GET THEM?? AND DO
THEY HAVE ANY DUTTY SIDE EFFECTS?? If you just take oestrogen by itself, it
can make the lining of the womb thicker and this may be associated with an
increased risk of cancer of the womb, but this risk can be reduced by adding
another hormone called progesterone. The hormones not only come as tablets
but are available as implants or patches. Most women stop HRT after the
symptoms disappear which is usually after 2 to 5 years, the dose will be
reduced gradually rather than suddenly being withdrawn.
HOW DO I TAKE IT? HRT is started 1 year after periods stop. Continuous combined HRT
involves taking oestrogen and progesterone without a break. You may experience
irregular bleeding when you start but this should resolve if it doesnt you should speak
to your Dr. Once you start taking it youll be regularly followed up by your Dr and you
must be breast aware.
IS THERE ANYTHING ELSE I CAN DO TO HELP WITH THE SYMPTOMS?! There are some
lifestyle changes that will help with your symptoms for example: exercising will reduce
the hot flushes help your sleep and has been shown to help mood. You can also do
some things to do to keep cool at night sleeping in looser clothes and keeping the
room temperature down. You should also try to avoid cafeine, spicy foods and alcohol
as these can cause hot flushes. If you do smoke

IF YES TELL THEM TO STOP helps them to reduce hot flushes.

ARE THERE ANY LONG TERM EFFECTS?! If you take HRT long term several years

or more you have reduced risk of osteoporosis, small reduction in risk of

developing colorectal cancer however, increase risk of breast cancer and possible
increase risk of heart disease, risk of venous thromboembolism, small increase
risk of stroke, increase risk of CHD (not in oestrogen only HRT), increase risk of
uterine cancer (due to oestrogen) hence combined = lower risk. Slight increase
risk of ovarian cancer risk decreases after you stop it. If you have a history of
any of the mentioned YOU SHOULD NOT TAKE HRT.
The general rules are if you are troubled with menopausal symptoms the
benefits usually outweigh the risks. You may be happy to take the small risk of
taking HRT for 13 years to reduce the symptoms. You should use the lowest
efective dose. For healthy women without symptoms with menopause and
around 50 or over HRT NOT advised as there is little to be gained and small
risks are not really worth it. If you mainly have genital symptoms = vaginal
oestrogen cream or pessary.
WHAT IS THIS TIBOLONE?! It is an alternative to HRT which has some oestrogen,
progesterone and some male hormone efects so you just have to take this one
tablet. But you need to be under the age of 60. The following are some points
about tibolone is efective in treating sweats and hot flushes reduced risk of
osteroporosis improved libido small increase risk of stroke, endometrial and
breast cancer.
IF PT. DOESNT HAVE A UTERUS = OESTROGEN ONLY HRT (PROGESTERONE
ONLY PROTECTS AGAINST UTERINE CANCER)
Do ICE, CHUNK N CHECK, LEAFLETS.

HOME BIRTH EXPLANATION

Do ICE, find mothers concerns and address them.
Ask how their pregnancy has been so far and if they have had any problems?!
I WANT A HOME BIRTH! Explain to them that home birth is only considered in a low risk
pregnancy. CONTRAINDICATIONS: maternal health problems, premature or postmature

twins, placenta problems, even if decision is made to go for a home birth it will
constantly be evaluated.

HOW CAN I QUALIFY FOR A HOME BIRTH?! There are a number of conditions
and criteria which must be fulfilled in order to go forward with a home birth.
Social conditions:

Should be adequate in size room etc

Enough heating, lighting and hygiene
Telephone in case of emergency
Adequate social support
Someone to help look after any existing children

If hospital transfer is necessary this should not be difficult to do

Obstetric Risk:

more

First baby is best born in hospital environment

Maternal age >20 but under <35
If they have had medical intervention to help them conceive they are
likely to sufer from complications during labour
Should not be breech presentation
Should not have hypertension
Hx of antepartum haemorrhage suggests the placenta is inadequate

In summary home birth is acceptable if the pelvis has been previously tested by
a normal vaginal delivery and there is no reason to expect anything but a normal
uneventful labour.
WHAT ARE THE ADVANTAGES?!

Familiar surroundings which can often help in labour progression

Dont need to interrupt labour with journey to hospital

Will be looked after by small team of midwives who will be familiar

throughout the pregnancy will most likely follow you up (continuity)

May find labour less painful

Wont need to be separated from partner or husband

Do ICE, CHUNK N CHECK, remind of constant monitoring, leaflets.

BREECH PRESENTATION EXPLANATION

Do ICE, find out how their pregnancy has been so far, general chit chat; find
out what they know and any concerns.
[IF THEY DONT KNOW THEIR BABY IS IN BREECH] Our investigations (palpation
and auscultation tell you about position of foetal heart, vaginal examination
and ultrasound) show that your baby is in breech position do you know what
this means?!
NO DOCTOR WHUT DOES DAT MEAN?! So in a normal situation when youre
going to give birth to your baby the head is usually faced down so the baby is
upside down in your tummy. In this case, your babys feet are pointing
downwards so it is if they are standing up. [FEEL FREE TO DRAW IT]
OH SNAP! WHAT DOES THAT MEAN FOR ME N MA BABEH?! Well, breech presentation is
the commonest abnormal presentation with 4/100 births being breech. Have you got a
birth plan? [IF THEY SAY YES I WANT TO HAVE A VAG DELIVERY] well going with your
birth plan and going ahead with the vaginal delivery is something which is possible BUT it
will prove to be quite difficult

this is what we call breech trial. If we find that during a vaginal delivery we are
encountering some problems or difficulties we may need to switch to a C
section.
IS THERE ANYTHING ELSE WE CAN DO?! There is one other option which is called
external cephalic version. It has a 60% success rate so there is a high chance
that it will not work. It is usually ofered to all women who have non complicated
breech presentation pregnancies at term. What happens is in the delivery suite,
scans are performed to confirm the position of the foetal back and a CTG scan to
check for foetal heart distress before and after. The ECV is a series of
movements performed by the Dr to attempt to take the baby from breech to a
sideways position then eventually a normal head first presentation. Tocolytics
may be used (turbutaline) if rhesus negative anti (diggity) D is given. Kleihauer
test is performed (WIKI IT DICKHEAD). If ECV is successful they can go home and
if it is not you will be considered for vaginal breech. There are also some
contraindications against ECV which would mean that you would not be able to
undergo the series of movements these include: multiple pregnancy, vaginal
bleeding, low lying placenta, amniotic fluid abnormalities, uterine malformation,
maternal cardiac disease, pregnancy induced hypertension, major foetal
abnormalities and premature rupture of membranes.
WHAT CAUSED THIS?!? There are a number of risk factors for it. For
example: if the baby is premature, polyhydraminos, oligohydraminos,
uterine or pelvic abnormalities, IUD or prior breech baby.
ARE THERE ANY COMPLICATIONS?! There are a few:

Premature labour

Premature rupture of membranes

Small blood loss from mother and baby
Foetal distress leading to c section
Baby might return to original position

WHAT IF I CHOOSE TO HAVE A VAG DELIVERY AND THE BABY HASNT CHANGED POSITION?!
There are a few factors that have to be considered and a few things that have to happen. You
have to have your baby in hospital where if needs be a Csection can be performed. There
has to be adequate pelvimetry (thick hips fam). Foetus cannot be too large, no previous c
section or cephalopelvic disproportion (big baby, small pelvis lol) and they have to have a
flexed head.

WHAT ARE THE COMPLICATIONS OF THAT (VAG BREECH)?! Well, these include:

Birth trauma as a result of extended arm/head or incomplete dilatation of

the cervix or CPD (cephalopelvic disproportion)

Asphyxia from cord prolapse, cord compression, placental detachment or

arrested head

Damage to internal organs

BROKEN NECK

Do ICE, CHUNK N CHECK, LEAFLETS.

CONTRACEPTIVES EXPLANATION
Do ICE. Explaining how conception occurs. Egg comes out sperm goes in.
Sperm can chill in the cervix for 7 daysish. At this point the eggs come out for a
walk down the fallopian tubes and meet some sperms may get fertilised at this
point.
COCP (Combined Oral Contraceptive Pill)

CONTRAINDICATIONS : ARTERIAL (LONG DIABETES, WILD BP, SMOKING >40/DAY,

AGE>35[>50 DEFO NO]. VENOUS (FH OF CLOTS [PARENTS/SIBLINGS], BMI>30,
IMMOBILE [CAST/WHEELCHAIR]. MIGRAINE WITH AURA (INCREASE STROKE RISK IF
TAKING COCP). DIFFERENT TYPE OF CONTRACEPTION IF BREAST FEEDING
(DECREASES BLOOD VOL).
WHAT IS IT?! Pill containing 2 hormones oestrogen and progesterone these
hormones are made naturally in the body anyway. All we are doing is increasing
certain levels of it.

HOW DOES IT WORK?! The ovaries dont release the egg. The mucus at the
neck of the womb thickens so it doesnt let the sperm through. It also makes
the lining of the womb thinner so that a fertilised egg cant attach. Each of the
methods is efective but by giving you both these hormones we are giving you
3 times the protection.
HOW EFFECTIVE IS IT?! CAN I STILL GET PREGNANT?! If 100 women were to take
this pill 99 would not become pregnant despite regular INTERCOURSE.
WHAT MAKES THIS PILL SO GOOD (ADVANTAGES)?! It doesnt interfere with your
sex life. It also makes your periods a lot more manageable theyll be lighter,
less painful and more regular. It also decreases the risk of certain cancers such
as cancer of the ovaries, the bowels and the womb. Some women also find that
it decreases acne.
ARE THERE ANY DRAWBACKS (DISADVANTAGES)?! There is a slight increase in risk of
developing clots; however we will only put you on this pill if we find that you are not at
increased risk of developing clots anyway. If you smoke this pill could increase your
risk of getting heart disease. There is also a very slight increased risk of breast and
neck of womb cancer (cervix).
OH NO I CAN GET CANCER?! On a few studies that were done, there was found to be a very
small

increased risk of developing breast and cervical cancer. However as we have

already discussed there is a decrease in risk of developing ovarian, colon and
uterine cancer when you group all these cancers together the overall risk of
developing cancer is reduced if you take the pill. After you stop taking the pill the
risk of breast cancer will go down.

DOES IT INTERFERE WITH ANY MEDICATION?! Antibiotics are safe however not
to be taken with TB antibiotics, epilepsy meds or St Johns wart.
HOW DO I TAKE THE PILL?! The pills come in packets of 21 you start the first
pill on the first day of your period and youre protected from pregnancy
immediately. If you start on any other day take another form of contraceptive
(barrier for 7 days). Take the pill at roughly the same time every day you

might find that setting an alarm helps. Between each packet you take a 7 day
break during which you may experience a withdrawal bleed however you will
still be protected from pregnancy during this time.
a pill, take it as soon as you remember even if
this must ensure you use barrier protection for 7
days. If you

miss 2 days worth only take a maximum of 2 pills when you

remember. Use barrier contraceptive and you might want to consider
having a pregnancy test.
WHAT HAPPENS IF I FORGET MY PILL AND I HAVE SEX?! You use emergency
contraception the morning after you will need to see your GP for a
prescription.
ARE THERE ANY SIDE EFFECTS?! You might get a headache which will go away.
Because of the increased hormone levels you might find that your mood changes
and your breasts become tender. You must remember the pill does not protect you
against STIs. If you cannot guarantee that your partner is STI free use a condom.
Slut. The problem that worries most women is that they might experience
excessive bleeding in the first 3 months this will resolve in this time period. If not
other COCP concentrations are available.

WHAT IF I VOMIT OR HAVE LIKE THE SHITS?! If you vomit within 3 hours of taking
the pill it has not been absorbed so you must take another pill. Only severe
diarrhoea will afect pill absorption if you feel this is the case see the GP.
WHAT HAPPENS IF THERE IS NO WITHDRAWAL BLEEDING IN MA 7 DAY BREAK?! It is most
probably not because you are pregnant contain your GP if you have missed a total of 2
withdrawal bleeds or you have a reason to believe you are pregnant. They can arrange
the appropriate tests.

CAN I SKIP WITHDRAWAL BLEEDINGS?! Some will find during stressful/inconvenient

times (exams/holidays) that it would be more appropriate if they were not to have
a withdrawal bleed. They can start the new packet without taking 7 day break. If
you wish to skip more than 1 withdrawal period contact your GP so this may be
arranged with health advice.

SAFETY NET COME BACK IF YOU GET CHEST PAIN, HEADACHE, LEG PAIN OR
YOU COUGH UP BLOOD.

POP
CONTRAINDICATIONS: IF YOU HAVE RECENTLY HAD BREAST CANCER, IF YOU HAVE HEPATITIS,
ANTI EPILEPSY MEDS (REDUCES EFFECTIVENESS THUS SEE DR), PREVIOUS ECTOPIC PREG.

WHAT IS IT?! It is a very efective contraceptive pill which contains the naturally
occurring hormone progesterone. It is commonly given and prescribed to
people when the combined pill is not suitable. It can safely be taken when
breast feeding.
HOW DOES IT WORK?! It thickens the mucus made by your cervix this creates
a plug and stops sperm getting through to an egg in the womb. It also makes the
lining of the womb thinner so that a fertilised egg cannot implant. When taking a
certain type of POP, ovulation is stopped in 90% of women.
HOW EFFECTIVE IS IT?! 99% efective (100 women analogy). [IF THEY ARE BEING
CUNTS AND ARE LIKE AYO THERE IS 1%] Well if 100 women were to have sex without
contraception 80 of them would get pregnant so with this pill you have significantly
decreased your risk.

WHAT ARE THE ADVANTAGES?! No interference with sex, take if youre breast
feeding, risks associated with oestrogen are not involved in this like blood clot
risk increase.

WHAT ARE THE DISADVANTAGES?! Mood swings, reduced libido, increase acne,
weight gain. Most women are concerned with the changes that occur in terms of
the bleeding. Changes in bleeding patterns are common and 2/10 will find there
will be no bleeding. 4/10 will find that they have regular bleeding and another
4/10 with irregular bleeding. If you do have irregular bleeding get it checked
out as it could be infection.
HOW DO I TAKE THE PILL?! Take it at the same time every day within the same 3
hour window. Start taking it straight away but you have to use protection for 7
days. No breaks.

VOMIT AND DIARRHOEA?! Same as COCP.

DOES IT AFFECT ANY OF MY OTHER DRUGS?! Let your Dr know if youre
taking them with antiepilepsy meds, painkillers, anti fungals, St Johns
wort.

IUD INTRAUTERINE DEVICE

CONTRAINDICATIONS: UNTREATED STI, UNEXPLAINED VAG BLEEDING,
UTERINE/CERVIX PROBLEMS.
WHAT IS IT?! It is a small plastic and copper device that is inserted via the
vagina and sits inside your womb. A bit of string will remain in the internal
vagina for the purpose of removal but it will not be visible. It does not contain

the hormone and stays in for 510 years and is fitted by a Dr or a trained nurse
it can even be done at your GP practice.
HOW EFFECTIVE IS IT?! It is 99 percent efective.
HOW DOES IT WORK?! Copper is toxic to sperm and thus stops it from
reaching the egg. It also irritates the lining of the womb preventing
attachment thus you may experience heavier bleeds.
WHAT ARE THE ADVANTAGES?! It can be put in at any time other than
pregnancy and works immediately. It is long acting staying in for 510 years.
It does not interrupt sex. After its removal, fertility returns immediately. One of
its biggest advantages is that it has no interactions with medication.
WHAT ARE THE NEGATIVES?! It does not ofer STI protection thus if you cannot
guarantee your partner is free of BARRIER PROTECTION FAM. Internal
examination is required before and after insertion. Periods may become heavier and
longer but they should resolve within 3 months if not see GP and you may be put
on another contraceptive. You may get breakthrough bleeding between periods but
these will be light and will resolve.
WHAT ARE THE RISKS OF HAVING THIS IN ME?! Infection may experience pain.
Increase in temperature or discharge (see GP). Perforation is very rare check the
thread once a month to ensure there is neither expulsion nor migration. Ectopic
pregnancy risk if you experience abdo pain see a Dr. You should not be aware of
the device being in place so if you experience discomfort or pain this is not normal
and you should seek medical advice.

WHAT HAPPENS WHEN I GET IT REMOVED?! You start using a condom at least a
one week before removal as sperm can chill in vagina for 7 days for jokes. If
youre pregnant you take out the IUD immediately.

IUS INTRAUTERINE SYSTEM

CONTRAINDICATIONS: HX OF BREAST CANCER IN PAST 5 YEARS, FIBROIDS, UNTREATED
INFECTION.

WHAT IS IT?! It is a T shaped plastic device that is inserted via vagina into the womb. It
contains a reservoir of hormone that is progesterone only. Much like the coil there is a
thread which hangs out to assist in removal but this is not visible externally. It stays in
for 5 years. 99% efective.

HOW DOES IT WORK?! The hormone inside is progesterone. It thickens the

mucus made by your cervix this creates a plug and stops sperm getting
through to an egg in the womb. It also makes the lining of the womb thinner so
that a fertilised egg cannot implant.
WHAT ARE THE ADVANTAGES?! Once you put it in you will forget about contraception for

5 years. It does not interfere with sex life. Periods usually become lighter, less painful
and often stop unlike the coil. After 12 months you might find you have a light bleed for
one day a month. 1/5 find they do not have bleeding at all. Fertility returns as soon as it
is removed. Some people do not use it for contraceptive and use it for dealing with
heavy periods that is how efective it is.
WHAT ARE THE NEGATIVES?! There is a slight increased risk in ectopic. The majority of
women have no problem. Irregular bleeding for 6 months that usually resolves. These
bleeds are usually just spottings! It may come out expulsion (1/20). It can perforate
the womb (1/1000). Risk of infection 20 days after insertion pelvic/abdo pain,
discharge and irregular bleeding.

ARE THERE ANY SIDE EFFECTS?! Because the hormone only acts locally unlike the
POP the side efects you get from progesterone (mood swings, decreased libido,
increased acne, breast discomfort) tend to develop only for the first 6 months but
then resolve.
BUT WILL IT MAKE ME GET FAT?! No. The hormone works locally there is no evidence for
this.

EMERGENCY CONTRACEPTIVE
WHAT IS IT?! Either pills or a coil that prevent pregnancy if you believe your
contraceptive has failed.
HOW EFFECTIVE IS IT?! Within the first 24 hours it is 95% efective, 48 hours =
85%, 72 hours = 58%, 120 hours = no very fam peak.
WHAT PILLS ARE AVAILABLE?!

Levenogesterone if they are coming in quite soon safe in breast feeding,

1.5mg pill. Side efects = menstrual irregularities, irregular bleeding in next cycle,
can cause late period, nausea/vomiting. Makes period late but if more than 7 days
late see Dr.

Ulipristal pill (ellaOne) can be taken up to 5 days stops or delays the

release of an egg. 98% efective more than progesterone pill (above) but it does
have contraindications. Cannot take it if: liver disease, severe asthma, epilepsy
meds, TB abx, indigestion tablets. Side efects: headache, nausea, abdo pain,
irregular bleeding.

WHAT ARE THE ALTERNATIVES TO THE PILL?! There is an emergency copper

coil it can be fitted up to 5 days after unprotected sex. Copper
indications/side efects etc.

DEPO
CONTRAINDICATIONS: RECENT BREAST CANCER HX, HEPATITIS, RISK FACTORS FOR
OSTEOPOROSIS, SECONDARY AMENORRHEA FOR 6 MONTHS, ALCOHOLICS.
WHAT IS IT?! This is an injectable form of progesterone and is 99% efective against

pregnancy. The depo provera which is the preferred injection only needs to be
administered every 12 weeks.

HOW DOES IT WORK?! [Look at progesterone mechanism]

WHAT ARE THE ADVANTAGES?! Do not need to remember to keep taking a pill
3 months protection. Can be used in breast feeding helps with heavy
periods and pain.

WHAT ARE THE DISADVANTAGES?! Cannot be removed once given. If you do get
side efects you will have wait 3 months. Fertility can take anywhere from 6
months to 2 years to return. During the first few months youll have irregular
bleeding which is heavier and longer this will settle down and 7/10 women find
that periods have stopped after a year.
WHAT ARE THE SIDE EFFECTS?! Uncommon weight gain, acne, breast
discomfort. Can lead to thinning of bones but your GP will monitor this. Most
women stop the injection because of bleeding problems all of these are
short lived.
HOW IS THIS INJECTION GIVEN?! Given into the muscle of the buttocks not
during pregnancy. Given during the first 5 days of the period and you are
protected immediately. I LOVE U DRAKE. Barrier contraceptive use for the first
7 days if you miss the 5 day window. 12 weeks later you have another
injection.
WHAT HAPPENS IF IM ON HOLIDAY?! You can have your next injection up to 2
weeks early. If you cannot do so use barrier contraceptive or another method
if required.
HORMONAL IMPLANT
WHAT IS IT?! It is an implant referred to as its trade name Nexplanon. Lasts
for 3 years and is 99% efective. If youre an obese woman you should get it
changed before 3 years as in the 3 rd year you are at an increased risk of
pregnancy.
HOW DOES IT WORK?! Same as progesterone prevents ovulation, thickens
cervical mucus, thins uterus.
ARE THERE ANY SIDE EFFECTS?! 12% have heavy bleeding for the first 612 months
but this can be helped with tranexamic acid and the other acid one (mefanamic
acid). Other side efects include: acne, breast tenderness, mood swings and
changes in libido (decrease).
HOW WILL YOU INSERT IT?! So we will be using a slightly thicker than usual needle
to insert it into your arm this might be uncomfortable for you so we will use local
anaesthetic to numb the area first. A very small procedure is required also on local
anaesthetic to remove the implant.

WHAT ARE THE ADVANTAGES?! No delay in return of fertility.

FATTY = IF BMI<30 CONSIDER COCP OTHERWISE COILS (IUD/IUS)

SMOKER = >20/DAY AVOID COCP IF POSS. IF >35Y/O + SMOKING OR
SMOKING >40/DAY = NO COCP. USE POP OR IUD/IUS.
RISK OF ARTERIAL DISEASE = AVOID COCP
AGE = >35Y/O AVOID COCP IF POSS. >50Y/O NO COCP. USE POP OR IUD/IUS.
DUMB SKET = NO PILLS (WILL FORGET) IUD/IUS/DEPO + STI/CONDOM
COUNSELLING.

DIABETIC = AVOID COCP

RAGING PERIODS RAWR = IUS (COPPER COIL MAKES PERIODS WORSE) 2 ND LINE
= TRANEXAMIC ACID, MEFANAMIC ACID OR COCP
ACNE = IF PT. IS ON A PROGESTERONE ONLY TAKE THEM OFF IT COCP/IUD
BREAST FEEDING = AVOID COCP

INFERTILITY EXPLANATION
Do ICE. Ask how often they are having the sex, how long they have been
trying for, doing it correctly, any previous kids?
WHATS GOING ON AM I INFERTILE?! As stressful as it may be you are not alone in
this 1/7 couples have difficulty conceiving despite having regular sex, however
more than half of these that dont conceive go on to have pregnancies within the
next year without treatment.

WILL I NEED TREATMENT?! Before treatment options are considered you will have
to be diagnosed as being medically infertile the current criteria states for a couple

to be infertile they will have to have not conceived within 2 years despite regular
sex (3/week teehehehe).

AM I DOING IT RIGHT?! Talk me through what happens. [ASSESS WHAT THEY

ARE SAYING AND DOING ETC] Ask if they know how pregnancy happens how
the woman gets pregnant. [TALK EM THRU IT]
HOW SHOULD I PLAN TO HAVE SEX?! Although you may want to increase the
amount of sex you are having it is perhaps best to have sex spontaneously
as this increases the chance of conception.
IS IT MY FAULT?! Some of the causes include:

Ovulation problems efect 3/10 couples, its failure to ovulate due to

PCOS, menopause, under/overweight, excessive exercise, thyroid problems

Fallopian/uterine problems 2/10 couples, due to endometriosis, fibroids,

any cysts, PID (any STIs), recent surgery

Male problems 2/10 couples, due to decrease in number of sperm it

can be hormonal, increased exposure to high temp, undescended testes, but for
majority it is due to an unknown cause
HOW WILL WE FIND OUT WHICH IT IS?! GP will take a history of you (including
sexual history) will do a semen analysis, bloods to check ovulation, specialist
referral and blood test for rubella immunity.
ANY PARTICULAR TIME OF THE MONTH WHERE I SHOULD MAKE THE SEX?! Although
the egg is released 12 to 16 days after the first day of the period, it is important not
to confine sex to these times. This can add stress which may afect your chances of
conception. You also need to be aware that sperm can survive up to 7 days inside the
vagina.
WHAT GENERAL ADVICE CAN YOU GIVE ME?! Take folic acid to reduce the chances of spinal
cord

problems in your baby. Have a blood test to make sure they are immune against
rubella and eat a healthy diet, avoid alcohol, quit smoking. Keep your BMI
between 2030.
WHAT TREATMENTS ARE AVAILABLE TO ME?! The 3 categories of treatment
medicine, surgical, assisted conception.

Medical there are certain hormones in the body that control the release
of an egg once a month. Medication is available to either cause more of this
hormone to be released or they contain the hormone themselves.

Surgical if there are problems with your fallopian tubes, problems with
endometriosis or you have PCOS and surgery could be an option to rectify these
problems. This can also be an option for males sufering from infertility to repair

the abnormal structures such as the tubes.

Assisted conception with all the assisted conception techniques fertility

medication is usually given to maximise the chances of conception. If the problem is
with the male reproductive system sperm from either the partner or a donor can
be placed directly into the womens womb. There are a lot of sperm banks available
this is called IUI (IntraUterineInsemination). There is also a technique available
where the fertilisation can occur outside the body sperm can be made to fertilise a
number of eggs in a test tube before one or two are carefully selected to be put into
the womb. Because of this stimulation of the ovaries may be required to produce
more than one egg. This is called IVF. There are other options available that can be
discussed at a later date.
ARE THERE ANY COMPLICATIONS FOR INFERTILITY TREATMENT?! In some forms of
infertility treatment, twins or multiple pregnancies are possible due to ovaries being
stimulated to produce more than 1 egg. Having twins and triplets may be a great thing
however it is important to understand the increase risk of problems during pregnancy
high BP, diabetes. Pregnancy can occur in your fallopian tubes this is called an ectopic
pregnancy. Can cause stress.

WORD AROUND MY ESTATE IS THAT THERE IS AN INCREASE RISK OF DEFECTS?!

Overall, the risk of abnormality is increased by about 30% compared to
conception without help. This may sound like a lot but to put it into perspective
without assisted conception 5/200 babies are born with birth defects
compared to 7/200 in IVF babies.
Do ICE, CHUNK N CHECK, LEAFLETS.

ECZEMA EXPLANATION
Do ICE, what they are concerned about and what they would like to
discuss? What are they expecting from the consultation!
WHAT IS ECZEMA?! Eczema is sometimes called dermatitis which means
inflammation of the skin. Inflammation = when certain bit of your skin
becomes irritated and goes red and swollen. There are many diferent types
one being atopic eczema. Atopic = used to describe people that have certain
allergic tendencies and have an increased risk of having other conditions such

as asthma and hayfever.

WHAT DOES ECZEMA INVOLVE?! Skin is usually dry so areas of the skin become red and
inflamed and these tend to be areas next to skin creases such as the front of elbows,
wrists, back of the knees and around the neck. In babies, there face is commonly
afected. Inflamed skin is itchy and if it is scratched the skin tends to become thicker
sometimes the inflamed areas of the skin become blistered and weapy. Sometimes
inflamed areas of the skin become infected.

IS LITTLE JONNEH GONNA HAVE THIS 4EVA (FOREVER)?! Inflamed areas of the
skin tend to flare up from time to time and then tend to settle down severity and
duration varies from person to person. In mild flare ups = just one or two small
patches and they only occur now and again. However, in more severe cases these
could last for several weeks or more and can cover more areas as you can
imagine this can cause great distress.

WHY ALWAYS ME (JONNEH) ?! Most cases of eczema develop in children under

the age of 5. Unusual to develop eczema after the age of 20. About 1/6 school
children have atopic eczema in some degree.
WILL IT EVER GO AWAY?! In 2/3 cases these school children with eczema will
no longer have any flare ups or they are much less of a problem. However,
there is no way of predicting which children will be afected as adults. About
1/20 adults have eczema.
WHAT HAS CAUSED IT?! The exact cause is not known but what is known is that
the oily layer of the skin tends to be reduced in people with eczema this leads
to more water being lost and an increased tendency towards dry skin. The
immune system can release chemicals under the skin to cause some
inflammation it is not known why this occurs.
IS IT MY FAULT?! Not really your fault but genetics has been shown to play a part
if both parents have eczema then there is an 8/10 chance that the child will
have eczema. If only 1 parent has the condition there is a 6/10 chance.
IS THERE ANY TREATMENT?! There are a number of diferent steps we can take to
manage your

childs symptoms:

Avoid irritants and triggers where possible some flare ups can be
triggered by irritants to the skin it is commonly advised to avoid soaps and
bubble baths as they can dry out the skin. Instead use soap substitutes such as
shower emollients, biological washing powders. Try to avoid scratching as much
as possible keep nails short and antiscratch mittens. If scratch needs to be
relieved rub with fingers as opposed to scratch with nails. Use cotton instead
of irritating materials such as wool. Avoid being too hot/cold as this can irritate

the skin. Dust mites may also trigger flare ups however it is impossible to clear
the house of dust mites therefore we generally advise you not to do anything
about it. About 1/10 children have food allergies which can make the symptoms
worse if you suspect this go see the Dr to get this tested. Pets can sometimes
cause irritation this can be tested to remove the pet for a period of time to
check if the symptoms improve.

Emollients these are lotions, creams, ointments and bath and shower

products that prevent the skin from drying out. It can help prevent itching and reduce
the number of flare ups by keeping the skin moist and supple. The regular use of
emollients is the most important part of treatment it can be applied several times a
day depending on

how dry skin is.

o As a rule greasier ointments work better and longer but they are messier. You
cannot overdose on them. Apply in the same direction as hair growth as it can lead
to hair shafts becoming blocked and infected. Use emollient everyday even if the
skin appears to be in good condition as the may begin to flare up again. Dry the
child by patting with a towel rather than rubbing. If you find that the emollient is
making things worse rather than better see your GP.

Topical steroids work by reducing inflammation in the skin [OH NO

STEROIDS!!] This is a diferent type of steroids which works diferently. These come
in diferent categories depending on their strength and potency. A course of topical
steroids usually requires 1 or more patches of eczema flare up you should use
them until the flare up has gone completely. These should be used with care still
NEVER USE ON THE FACE. [WHAT ABOUT SIDE EFFECTS?!] A few weeks of steroid
use is generally safe but sometimes side efects do develop but they are
uncommon = thinning of the skin, changes in colour, bruising, stretch marks. In
children large doses of strong steroids can afect their group but your GP will
advise you on this.

WHAT IF THESE TREATMENTS DONT WORK?!? Generally these tend to work in

the large proportion of people that are afected with eczema but it does
require time until you can see the efects. If you find that it doesnt work
come see your GP and you can discuss the possible changes of medication as
there are other treatments available.
MY NEIGHBOUR RECOMMENDED SOME OTHER HOME MADE REMEDIES!? You
should be cautious with some of them, especially if the labels are not in English
and you do not know what they contain. Some herbal remedies are mixed with
steroids and some have been linked to liver damage.
Do ICE, CHUNK N CHECK , LEAFLETS.

CEREBRAL PALSY EXPLANATION

Do ICE WHAT DO YOU KNOW SO FAR DO YOU WANT ME TO EXPLAIN
ANY PART OF THE CONDITION TO YOU???
WHAT IS IT DOCTOR???? Well, cerebral is another word for brain, palsy means the
complete or partial loss of the ability to move a part of the body. So cerebral palsy
means that the ability to move a body part is lost due to a problem in a part of the
brain. Cerebral palsy is the term we use to describe a group of conditions that
cause movement problems. The problem lies in damage or fault in development of
a certain part of the brain, depending on the part of the brain with the fault the
results/deficits vary. Depending on the part of the brain, your child may or may not
be able to walk, move, talk, eat, or play in the same way as other children. However
saying this some children are mildly afected and this become clearer as your child
grows older.

WHAT FAM?? MY KID WONT WALK??? There are 4 main types of cerebral palsy,

Spastic; efects 7 in 10, means the efected muscles are more stif than
usual and movements become jerky, some muscles may become shortened,
they could have hemiplegia (leg and arm on one side efected) diplegia (both
legs efected, arms spared) or quadriplegia (all limbs efected)

Athetoid (dyskinetic); 2 in 10, slow writhing movements of hands, arms, feet

or legs, the movements cannot be controlled and are involuntary. Muscles can be
very stif or very floppy. As a result those afected have difficulty staying in one
position; they may not be able to use their hands properly for example to hold
objects properly.

Ataxic; 1 in 10, people have difficulty with balance and fine movement, they
will be unsteady walking and may find writing difficult, muscles are quite floppy.

Mixed; some people may have a combination of 2 or 3 of these, for

example the may be stif and have involuntary movements.
OH.EM.GEE FAM THATS PEAK!!! IS IT SERIOUS THOUGH? CP can range in
severity, from very mild to very extreme. Some will find that they will be fully
mobile active and independent, but may have slightly abnormal leg
movements; others may have difficulty in using one leg or one foot. However at
the other extreme, the efected person may be wheelchair bound and need help
with daily living tasks. The majority of people efected lie somewhere in
between these two extremes, and as a parent you can take solace in the fact
that it is described as a nonprogressive disease. Meaning it wont get worse.

IS IT MY FAULT?? In most cases the exact cause is not known many times it is just an
error in the development of the brain. However some factors are known to increase
the risk of developing
cerebral palsy, such as being born prematurely, babies that are part of a multiple
pregnancy, infections that you may have sufered from such as rubella (german
measles) or chicken pox. Its know that there is an increased risk of cerebral palsy in
children whose mothers smoke, drink excessive alcohol or take street drugs (cocaine
etc). Sometimes the problems can occur after birth, for example a brain infection in
young babies could result in damage causing cerebral palsy.

WHY ALWAYS ME?? HOW COMMON IS IT?? About 1 in 500 babies in the UK are born
with cerebral palsy; this number has not changed in the last 50 years. Although the
health and care of mothers have improved in this time, more babies are being born
prematurely and surviving.

ARE YOU SURE HE HAS CEREBRAL PALSY?? Cerebral palsy is not usually
diagnosed at birth although they may have signs such as abnormal muscle tone.
Most are diagnosed between 6 months and 2 years and the first thing that is
noticed is that the child is not developing at the normal rate. As a rough guide a
child should be able to sit unaided at 6 months, crawl by 8 months, pull to stand
by 12 months and walk by 15 months.
WHAT NOW DOCTOH?? MY KID WONT BE ABLE TO MOVE? OR ARE THERE OTHER
THINGS?? About half the children with cerebral palsy have some degree of
learning difficulty although the severity can vary, the other half have normal
intelligence or above. About half the children will have some degree of speech
problems. A third will have epilepsy; some may have hearing vision and eating
and drinking problems.
WHAT NEXT?? Children with cerebral palsy are in good hands, they will be
under the care of a specialist team of various disciplines, which includes,
doctors, nurses, physio, OTs and STs. You are not on your own in coping with
this and if any help is needed you should feel comfortable contacting the
team for help and support.

Physio This is the mainstay of treatment and the aim is to limit

deformities from occurring and can also help parents and carers by teaching
them the correct positioning of joints and the appropriate exercises for their
child. Physio aims to make your child as independent as possible.

Medication Usually has a limited role, injections can be given to relax

stif muscles.

Surgery If physio and medication are not helping operations can be

done to loosen tightened muscles, in order to allow flexibility

Other treatments speech therapists and nutritionists are available.

Assistive technology is being increasingly used and a range of devices and
gadgets that can help with communication and mobility are available.
IS HE GOING TO DIE???? As we have discussed the severity can vary and this
can be further discussed with the specialist that you will be seeing, the
condition has to be very severe for this to be a major concern for us.
IS HE GOING TO WALK??? It is very difficult to tell at this stage, as children are not
expected to walk at this age anyway, the only way we will be able to tell is with time.
As a general guide almost all children with hemiplegia will walk, diaplegics will and
quadriplegics will walk. However if your child cannot walk we will provide them
with the most appropriate help to give

them mobility and assistance.

Do ICE, CHUNK N CHECK, LEAFLETS.

AUTISM EXPLANATION
Do ICE, find out how much they know about their childs condition and
what are their main concerns regarding it.
WHAT IS AUTISM!? Autism is a group of similar disorders that afect the way a
person communicates and relates to other people therefore the term autistic
spectrum disorder (ASD) is used.
IS MY SON DISABLED?! Symptoms usually become apparent in the first 3 years
of life but a lot of parents begin getting concerned in the first year. The
symptoms of ASD vary between people and they are of varying levels of
intelligence a few have very high IQs but a low IQ is also found in 50% of ASD
suferers. There are 4 diferent groups of symptoms and these can all appear in
children with ASD:

Social these can generally be described as not being able to get along
with people they can have little or no interest in other people. They will find it
difficult to make friends and they will prefer to be alone. This usually afects
patients.

Problems with language and communication they will not be able to

express themselves well, they will not be able to understand facial expressions,

and they might repeat things unnecessarily or make up their own words.
patients.

Poor imagination pretend play is limited and they usually play a game
over and over again exactly the same every day.

Unusual behaviour they can be aggressive if routines are changed and

they might develop obsessions.
ANYTHING ELSE?! Epilepsy occurs in 3/10 but it will only afect those severely afected
by ASD.

WHY ALWAYS ME?! About 1/100 children have a type of ASD with boys being 4x
more likely than girls.
WHAT CAUSES IT IS IT BECAUSE I GAVE EM THE MMR VACCINE?! The cause is
not really known but there is a link showing it may be passed down in families.
Although there has been speculation that the MMR vaccine can somehow cause
autism there is in fact no evidence to prove it and there is a lot of studies that
currently exist that disprove the speculation. The original researcher has now
been struck of.
HOW IS IT DIAGNOSED?! Your child has a series of health checks to make sure they are
developing properly if you have any concerns at this point like your child doesnt look at
you/doesnt point at things you should mention it. If the health professionals are concerned
they may ask a special team to observe your child over a period of time before making a
decision about the diagnosis. Their blood test may be taken. These do not test for ASD but
may look for or rule out other

conditions that are similar.

IS THERE TREATMENT?! Most children with ASD will be under the care of a child
specialist but there are other people that will ofer support such as SALTherapists.
The mainstay of treatment is special education support to help with language,
social and communication skills. Behavioural therapy will aim to reduce bad
behaviour and promote good behaviour. There is no cure but these techniques
should minimise the impact of ASD on your child and there are some medications
available. These will be discussed with you further by your specialist.

IS MY CHILD GONNA BE DUMB ?! The specialist support that is available and

will be given to your child aims to maximise the potential of each child as they
grow into adults the earlier the support is started the better the outcome.
There are a lot of clinical trials currently looking for new treatment.
WHAT HAPPENS WHEN HE GROWS UP?! This depends on the severity of the ASD
on your child. Some with Aspergers can live independently as adults but others
with classical autism need more substantial support and many as adults live at
home with parents or family or in residential homes. Rest assured we will be

with you and your family every step of the way to make sure you both receive
the help and care you both need.
Do ICE, CHUNK N CHECK, LEAFLETS.

ADHD EXPLANATION
Do ICE, what do they know?! What has the child been experiencing?!
WHAT IS IT?! Attention Deficit Hyperactivity Disorder is a fairly common
condition that mainly afects a childs behaviour. There may also be
problems with a childs intellectual, social and psychological development as
a result of the behaviour.
SO WHAT KIND OF THINGS SHALL I EXPECT?! ADHD children are restless,
impulsive and/or inattentive. These features can be seen either at school or at
home they can also happen in more than one activity such as school work or
relationships. They occur at a level greater than expected for their age and
cause significant destruction for the childs daily life. There are 3 main types:

Hyperactiveimpulsive = fidgety, run around a lot and talk excessively,

interrupt conversations

Inattention = trouble concentrating, paying attention, they are easily

distracted and they are forgetful and they lose items

Combined = they have a combination of the two

WHAT CAUSES IT?! The cause is not exactly known but it is thought to be
related to an imbalance of chemicals in the brain. There are various factors that
are thought to increase the risk of a child developing ADHD. These include:

Genetics risks increased if a parent has ADHD

Antenatal mother drinks alcohol, smokes, illicit drugs whilst pregnant
Obstetric problems difficult labour can cause lack of oxygen to the brain

*Poor parenting watching a lot of TV, DVDs DO NOT CAUSE ADHD*

WHY ALWAYS ME?! ADHD afects 5 in 100 school aged children in the UK and is
3x more common in boys.
HOW IS IT DIAGNOSED?! If your childs teacher or Dr suspects ADHD your child will be

referred to a specialist that will confirm the diagnosis by doing an assessment and
starting the treatment.

WHAT ARE THE TREATMENTS?! Treatment depends on how severe the condition
is and the age of the child. There is a multidisciplinary team that will look after
the child and the treatments include drug and non drug options.

NON DRUG: this is usually the first step whereas the parent you are
referred to a training programme where youll learn how to manage and reduce
behavioural problems and to better your understanding of the condition.

DRUG: if the mentioned treatment is not successful, medication is usually

recommended. The drugs used in ADHD have been used for many years with good
efect.

WHAT DRUGS ARE AVAILABLE?! The main drug is methylphenidate also known as
RITALIN. This increases the amount of a certain chemical in the brain that promotes
selfcontrol and attention. We can only prescribe this for your child if they do not
sufer from any heart problems or your family does not either. Your child will be
started on a lower dose e.g. 5mg 3x daily and monitored for side efects. Over
weeks the dose may be increased.

WHAT ARE THE SIDE EFFECTS?! Main ones are:

Insomnia
Loss of appetite
Weight loss

So your child will be monitored regularly to ensure these are kept at a minimum.
Takes 20 mins to start working and lasts 4 hours but it may take a few weeks to
see a full benefit. Not given to under 6 years of age. Benefits outweigh any risks.
[IS ANYONE IN YOUR HOUSEHOLD WITH A HX OF SUBSTANCE ABUSE?].
CAN ENUMBERS AFFECT MY CHILDS ADHD?! The new guidelines published
show that there is no good evidence suggesting a link between diet and ADHD
however if you feel that there is a connection between some foods and your
childs behaviour discuss it with your GP. This is not to say that a strict diet
needs to be put in place for your child but a healthy balance diet is required as
with every child.
WILL HELP BE THERE WHEN HE GROWS UP?! When your child is older we can
discuss other things that can be used to change the way they think and interact
with others.
WHAT IS THE OUTLOOK?! 8/10 children will continue to experience symptoms
into their teenage years. 5/10 will experience symptoms in adulthood. As
adults, ADHD suferers are more likely than average to have unemployment
problems, relationship difficulties and substance misuse. However, as we are
starting treatment and support early we are minimising the impact of ADHD

into adulthood.
Do ICE, CHUNK N CHECK, LEAFLETS.

VAGINAL BIRTH AFTER CSECTION EXPLANATION

Do ICE.
WHY SHOULD I HAVE A VAGINAL BIRTH WHEN A CSECTION WAS SO PUM LAST TIME?!?
Vaginal births have a short recovery time and the stay in hospital is cut short as well.
There is less pain in your belly because youre not going through surgery there is a
decreased chance of your baby developing breathing problems and you should
consider it if youre planning on having more kids. It means that you have more chance
of an uncomplicated normal birth in the future.

WHAT ARE THE DISADVANTAGES?! Because of your surgery last time, we had to
stitch the cut we made in your womb. If you have a vaginal birth now there is a risk
that scar that is there will rupture. If this happens you may need a blood transfusion
and if we cant get the baby out in time it may be deprived of oxygen and this can
cause brain damage. However, these risks are there for any and every vaginal birth
and there are measures in place to prevent this.
ARE THERE ANY BENEFITS TO HAVE ANOTHER CSECTION?! This avoids the risk of
brain damage and reopening of your scar it also lets you know when your baby is
going to be born.

WHY SHOULDNT I HAVE A CSECTION THEN?! It is a longer more difficult operation

it will take longer because there is already scar tissue present. As with any surgery
there are risks of bleeding and getting blood clots in your legs or your lungs. Your
baby might have breathing problems after birth and this is quite common with c
sections but it doesnt last long.

Do ICE, CHUNK N CHECK, LEAFLETS.