An ear infection is perhaps the most uncomfortable, painful minor ailment that we can come down with. More common amongst children and babies, ear infections are very distressing for sufferer and carers alike.

The tube that connects the ears, nose and throat (the Eustachian tube) is very narrow in babies and young children, and it’s also quite horizontal (it starts to slope upwards as we mature) and so ‘pools’ of mucus and fluid can build up. This is most likely to happen when they have a cold, since the cold can cause swelling of the tube, allowing fluid to build up. This can cause temporary hearing loss (through a cause known as ‘glue ear’) and discomfort. If bacteria builds up in the warm, moist conditions of a fluid-filled middle ear, then an ear infection develops and it can become very painful.

It’s often hard to spot when a baby has an ear infection, as they don’t have the vocabulary or other ability to tell us what’s wrong. Babies who are starting to teethe also tend to pull at their ears for that reason, and this can mask times when they might be pulling their ears because of pain caused through infection.

If a child or baby contracts an ear infection, treatment is important. Ear infections can lead to complications like permanent hearing loss (due to scar tissue building up) and even meningitis.

Ear infections are normally called otitis media by doctors. Acute otitis media is when fluid builds up in the middle ear and the result is pain, inflamed eardrums and a fever. The alternative, otitis media effusion, is when the middle ear doesn’t drain properly and fluid gets trapped (this is not necessarily painful but will impede hearing).

These can clear up on their own, or sometimes antibiotics are needed. Occasionally, standard antibiotics don’t work, and a swab of any discharge from the ear needs to be taken to analyse the bacteria that is present so that the appropriate antibiotic can be prescribed.

Since ear infections can impeded hearing (and most commonly this occurs at the time of a child’s life when they are acquiring language, which can be delayed if hearing is impaired), there is now a vaccine available for children under two years, which may prevent the most common causes of ear infections. There is also the pneuomococcal vaccine (PCV) which is designed to reduce the risk of developing certain common viruses, which could otherwise lead to colds (and ear infections). It’s also possible for laser surgery to be used if a child develops recurring infections.

Antibiotics are normally prescribed when an infection is severe or getting worse, and meanwhile (or otherwise) paracetamol can relieve fever and pain, and a warm flannel held against the affected ear can be soothing.

If a child has recurring ear infections that don’t seem to improve with antibiotics, or that last for several weeks (or more than three infections in six months) it might be necessary for them to have grommets inserted. Grommets are tiny tubes that are inserted (under general anaesthetic) in the eardrum to allow pressure to be equalised and for any build up of fluid to be alleviated. This can reduce infection, but many children actually pick up more infections since bathwater can get into the middle ear much more easily and is very hard to get back out.

Grommets usually fall out by themselves after several months or even years as the tubes get bigger with maturity, though sometimes they fall out too soon and have to be replaced. An alternative, a laser treatment that can be done in a GP’s surgery, lasts only a few weeks but does not require a general anaesthetic. However, the noise of the procedure (which is done under local anaesthetic) is distressing and the procedure can produce feelings of pressure and discomfort.

If your baby or child is exposed to other children, then the chances are that they will pick up coughs and colds, and this in turn may mean that they develop ear infections. The alternative is keeping your child isolated from others and wrapping them in cotton wool, which is obviously not renowned for social-skills building. Other things you can do to reduce the likelihood of your child developing an ear infection include breastfeeding (the muscles your baby uses to suckle are different from those used when feeding from a bottle, and less milk gets into the Eustachian tube) and not smoking near your baby.

Speech therapy services through the NHS are overstretched at the best of times, but cuts to their funding have made matters far worse recently.

If your child had speech difficulties (such as a delay in starting speaking, or perhaps a stammer or lisp), chances are you’d want to get them whatever help they needed. After all, speech is vital for communication and poor speech can impact on all sorts of things like social development, reading, emotional development and behaviour (since children with speech problems can often become very frustrated and angry).

Some parents don’t notice that their child has a speech difficulty, either because of inexperience of children in general, or due to lack of attention (in a minority of cases), in which case the problems are only highlighted once the child starts nursery or even school. The earlier that therapy starts the quicker the problems can be resolved, so if therapy doesn’t start until the age of 5 it often takes far longer for the child to ‘catch up’ and in the meantime they have to go through the minefield of starting school without adequate language.

My son started school without language. I had known that there was a problem with his speech from about the age of two, when he just wasn’t making any attempt at forming words or even sounds. He is a very intelligent boy, and his lack of speech was at odds with his general ability. The fact that he started school without language, though, was down to the service he received through the NHS speech therapy department.

His speech therapists (and there were six, over the course of two-and-a-half years) entirely failed to offer a diagnosis and lumped him into group after group of therapy aimed at the most common form of speech disorder, which is speech delay. Had they assessed him and offered him appropriate individual therapy instead of woefully-inadequate blocks of 10 sessions in groups with other children and gaps of 3 months per block, they might have realised that he actually had speech dyspraxia and he could have been talking before he reached school. The fact that they did not offer this basic service was down to budgetary restrictions which force them to get as many children into treatment as possible, to minimise waiting lists and make the figures look good.

My son was not alone in this struggle. I was very lucky in that I was astute enough to realise that the therapy offered was inadequate and not helping, and further that I was able to afford to pay a private therapist. The private therapist (who charges £60 per hour) assessed my son, diagnosed him within half an hour as having speech dyspraxia, set a programme of work for him and had him speaking within a fortnight. It’s taken a year’s worth of work since then to get to the point where my son can offer novel sentences that make sense, and reproduce new words correctly, but had I left it to the NHS I fear that even now he would have the speech of a two year old.

And the problem is getting worse, as Local Authorities and Health Authorities (which jointly fund speech therapy services) both strive to make spending cuts. This is an incredibly short-sighted approach, since children who struggle with language are far more likely to need intervention in later life, from educational psychologists (for behavioural matters) and are statistically far more likely to drop out of school. Research has even shown that there is a high proportion of the prison population who had speech difficulties as children.

What is needed is an investment, not cut-backs, in speech and language services, and for greater training to be given to school and nursery staff to help them to identify those children who may need support.

We knew that my younger brother had become a teenager the day he slouched down the stairs one morning, our dad asked him ‘How did you sleep’… and my brother snapped, ‘What’s it to you??’

We all know that teenagers are moody and stroppy at times.  Their hormones are doing weird things to them, everything is acutely embarrassing, they think they’re the centre of the universe, and they’re going through all sorts of bodily and social changes that don’t even bear thinking about.  Whilst it’s normal for this type of behaviour to kick in in the teenage years (and even earlier, as children achieve puberty at an earlier age these days), how can you tell if it’s more than hormones – how can you tell if maybe there’s something really wrong?

Teenage depression is surprisingly common, with an estimated 2% of teenagers suffering from the condition.  It can be serious, deadly even, but it can be easily treated if recognised.  The trouble is spotting it amongst all the ‘normal’ face-pulling and painting rooms black.

There are lots of social reasons why teenagers might become depressed.  Bullying increases as children hit secondary school; they are much more aware of problems that may exist at home; they may be self-conscious of their size or shape.  It’s all about fitting in as a teenager, and if a teenager feels they are the odd-one-out they can become very despondent.  It can be biological, with neurotransmitters in the brain going haywire when the hormones kick in.  Whatever the cause, though, teenage depression can be differentiated from normal teenage angst by monitoring whether moods improve over time, whether they seem sad or complain of isolation.

Any person with depression, regardless of age, can find it hard to think rationally.  It’s also very hard for a person with depression to recognise that they’re ill or that their thinking is out of line with reality – for example, they may genuinely think that the world would be better off without them in it, and it is very hard for a person in that state to argue themselves out of it.

The sort of things to look out for include a lack of motivation (for school, friends, self-care), withdrawal from family and friends, preferring to spend hours alone.  They may also sleep longer than even most teenagers, may eat less or over-indulge.  They may also start with anti-social or self-destructive behaviour .  Other symptoms include:

-          Poor concentration

-          Feelings of guilt

-          Apathy

-          Finding it hard to make decisions

-          Complaining of pain or fatigue

-          Behaving irresponsibly or rebelliously

-          Becoming ‘nocturnal’ by sleeping in the day and being awake at night

-          Being sad or hopeless

-          Being anxious or expressing feelings of guilt

-          Anxious behaviour

-          Withdrawal (from friends or family).

However, many teenagers can exhibit these signs without actually having depression. 

Depression can run in families, so if there is a family history and your child is exhibiting these symptoms then they may have depression.  But use your instinct – you know your child better than anyone.    If you think your child is depressed then get them to a GP and keep taking them until someone takes it seriously.   You have to fight for your child.  They may be teenagers but they are still your responsibility and they are still young enough to need taking care of.  Even if they don’t want to go to the doctors, use your parental authority to make them go.

Treatment can include talking therapies (usually Cognitive Behaviour Therapy, though this is of limited use for severe depression and other talking therapies are necessary then), usually combined with anti-depressants.  Modern anti-depressants are not addictive and have few side-effects.  If a person with depression has more than two episodes, they may well need anti-depressants in a low dose for a considerable period. 

If your teenager becomes severely depressed then they may start to self-harm, and may even attempt or commit suicide.  Warning signs to look out for include them giving away personal possessions, seeming to tie up ‘loose ends’, giving up on themselves, expressing the view that no-one cares or that everything is hopeless.  They may even be open enough to say that they want to die.  Don’t bury your head in the sand – don’t let it get that bad, take them to the doctor.  You can also call your local Crisis Team (usually based in the mental health unit of your local hospital) for urgent help.

I had a scare in early pregnancy that led me to have an early scan. The nurse who performed the scan said, “One baby, heart beating,” much to my great relief – on both parts.

Multiple births are becoming more and more common, mainly due to the increase in the average age that women are giving birth. After the age of about 30, women’s ovaries go a bit haywire and more than one egg may be released at a time, increasing the likelihood of conceiving twins, triplets or more. There has also been an increase in the number of babies conceived through IVF, which often involves more than one fertilised egg being implanted in the hope that one will develop into a foetus. There has been an increase in the number of terminations as women who have undergone IVF seek to reduce the number of babies unintentionally conceived through the process.

If you discover that you are pregnant with more than one baby, there are some things you need to be aware of.

For a start, you’re likely to be pregnant for about three weeks less than if you were pregnant with just one baby – most twins are delivered (naturally or by Caesarian-section) at 37 weeks.
You’ll also be kept a very close eye on – you’ll have several scans and frequent appointments with your midwife to check that both babies are developing as expected. Sometimes one twin can be in the breach position, or it is possible to develop twin-to-twin transfusion syndrome where one twin takes most of the nutrition and oxygen at the expense of the other.

Pre-eclampsia and high blood pressure are more common in women who are expecting more than one baby. You’ll also gain more weight than you would if you were carrying just one baby – partly due to the extra baby but mainly due to the weight of the extra amniotic fluid.

It is possible to give birth to multiple babies naturally, but much will depend on their positions. If they are both head-down (as they are in around 40% of pregnancies) then you will be able to deliver vaginally. However, if the first twin is head-down but the second is breach then vaginal birth should be possible, but there is an increased risk of complications (including oxygen-deprivation to the second twin); it may be that you have a Caesarian-section, or deliver the first vaginally and the second by Caesarian-section. If they are both in breech, or if the first is in breach, a Caesarian-section will probably be necessary.

If you have a vaginal birth, you’ll have just one set of contractions (you’ll be glad to hear) because your cervix will remain open whilst you push out the second baby.

It is important for any new mum-to-be to get support from other mums, and to develop a network of support before the babies arrive. If you have always worked, you may not have close community contacts, and your family may live some distance away. If so, the early weeks with your new babies could be quite lonely and exceptionally hard to cope with on your own. So build up those friendship networks during pregnancy – there are special clinics and groups that cater for women expecting multiple babies, so seek them out or ask your midwife for advice. Or check out online sources by searching for ‘twins advice’ to find local support groups and general advice.

It’s one of those images that never seems to have changed over the last two or three generations: groups of teens, sitting on swings at the local park at night, passing round a huge bottle of cider. Why cider is anyone’s guess, but the whole elicit buzz some teens get from being out after dark with their mates getting ‘wasted’ is now a time-honoured tradition.

But the dangers of alcohol have never been better known than they are today. Society is getting the message that excessive, irresponsible alcohol consumption is a big no-no, bad for the individual (in terms of their health and, in teenagers, their development) and bad for society (in terms of cost of policing and healthcare for drink-related illness, violence and accidents).

What can we do, as parents, to make sure our child is not the one passing round the cider? Or getting blotto on alcopops? There is undoubtedly a great deal of peer pressure to drink, and it can seem to many teens that they are the only ones not drinking. Part of our role as parents is to educate our children that firstly, alcohol can do harm, and secondly they are not really the only teenager in the world who can and will refuse a drink.

Educate your child as to the risks associated with alcohol, but also bolster their self-esteem by making them realise that it takes a truly strong person to say no to their friends, and that that kind of inner strength is to be admired.

If they want to know exactly what’s wrong with having a drink, you can tell them:

• Alcohol gets you ‘drunk’ by damaging your brain: it slows reaction times, lowers inhibitions (so people will do things that normally the little voice inside them would tell them will make them look blooming stupid), and fogs up their thinking process so they make poor choices;
• It’s extremely addictive;
• You can get addicted to alcohol at any age (becoming ‘alcoholic’). Alcoholics are not just shabby old men on park benches – about half of people who start drinking before the age of 14 end up addicted (compared to about 9% of people who waited until they were 18 to start drinking);
• Driving (or being driven) whilst (the driver is) drunk kills.
• Human brains start developing in the womb and don’t stop until about the age of twenty-one. If you drink whilst you are under that age, you risk damaging your brain’s development and may permanently impair your intellect and general abilities.
• Being drunk makes you more likely to become a victim – of rape, robbery or assault.

Despite what their friends might be telling them, most teenagers do not drink. Fewer than 1 in 10 under-14 year olds have drunk alcohol in the last month; fewer than 3 in 10 teens aged 15 – 17 years have drunk alcohol in the last month. Not everybody is drinking; make sure your child has enough confidence to make sure that they’re not either.

Most people have heard about post-natal depression. Sometimes called the ‘baby blues’ it can range from mild symptoms of sadness, loneliness and fear of the future to black depression, suicidal thoughts, self-harm and even suicide.

There is another similar condition, though, that fewer people are aware of. Post-partum psychosis is triggered by labour and is suffered by approximately 1,000 women each year in the UK. It has a rather more dramatic onset than post-natal depression (which tends to creep up gradually, with the sufferer and her family unaware of just how ill she is for some time) and often ends in the sufferer ending up being sectioned (put in a mental health institution or hospital for some days, weeks or months without having any choice in the matter) usually without their baby.

It is perhaps the involvement of mental health institutions that mean that post-partum psychosis is less well known: there is still a huge stigma surrounding this level of mental health trouble. But one way to tackle that is to talk about it, hence this article.

The sort of symptoms that a woman experiences with post-partum psychosis include mania (constant talking, or constant, frantic activity like cleaning or pacing), inability to sleep, unnaturally high levels of energy, coupled with huge mood swings, massive irritability and hallucinations.

Coupled with the feeling of terror and confusion that anyone suffering these symptoms would feel anyway is a woman’s knowledge that her experience is not matching up with what she expected in those early days and weeks of getting to know her new baby. She will feel a failure, like she’s letting her child down, and though this is through no fault of her own she will, of course, blame herself.

The hallucinations may even centre around the child, with the mother believing her child to be evil. It can sometimes mean that the mother kills her own child.

Anti-psychotic drugs are vital for recovery – since it is a chemical imbalance that causes the illness – but this means that breastfeeding is impossible (though, for most mothers with the condition, breastfeeding presents other problems).

It’s not clear what causes post-partum psychosis but it may be hereditary, and lack of sleep plus hormone changes may be triggers, but there’s often no obvious cause.