25 Nov 2015

I is for Immunisation

It was early spring. At a gathering of friends my son began to cough. His face turned red. He calmly got up and walked away doubled over. Concerned adults looked on. One jumped up and asked “is he choking?” This was the aftermath of whooping cough - the 100-day cough.

On a grey rainy day, listening to the radio, a segment on whooping cough was announced. There’s a spike in whooping cough (NSW Health recorded 3134 cases in 2014 and 8621 cases so far in 2015). Guest, Peter Collignon, ANU Medical school, spoke about timely molecular tests, which detect the DNA of bacteria that cause whooping cough.  The infectious nature of this respiratory disease produces toxins which damage airway linings. Infants have very little protection and are at higher risk. The vaccine has 75% + immunity, waning over time.

Prof Peter McIntyre, Children’s Hospital at Westmead speaks in an informative short film. Parents explain the tragic death of their infant who had whooping cough, asking “why don’t people know, why don’t adults know they need a booster?”

For my family, the beginning of spring had seen us with whooping cough, times four.  The first person to get sick in the family had become the guinea pig.  I consulted Healthdirect Australia which explains early identification and a specific antibiotic that lessens symptoms.

It took three appointments with GPs before we were on the right track to diagnosing whooping cough. By this time my second whooping cough victim was also moving from coughs to night time coughs, gasps and some vomiting. Whooping cough can be difficult to identify unless it is picked up in the first few weeks.

Health authorities advocate best protection is through immunisation. Immunisation may have problems but leads to herd protection.  The Australian government report, Immunisations myths and realities, responds to arguments against vaccination. Whooping cough is still here but immunised people are much less likely to have severe complications.

"babies in a cloud of cotton wool"
Pregnant women are encouraged to get free vaccinations passing on some level of immunity. Also fathers, grandparents and anyone around newborns are encouraged to have boosters. Someone said “It is a bit like wrapping babies in a cloud of “cotton wool”.

Campaigns such as Save the date to vaccinate, Apps to download or printed immunisation schedules are helpful reminders.

Emotionally draining for families

Doctors inform and we benefit from their clinical experience and knowledge of evidence based medicine. This is invaluable. When people get sick under these circumstances there are a lot of intangibles which can be emotionally draining. Where did it come from and who else is affected? For parents who are lacking sleep, asking the right questions can be difficult. I found it helpful to call Healthdirect or NSW Health, Communicable Diseases. The National Centre for Immunisation Research and Surveillance, NCIRS provides consumer resources.

I heard varied medical advice amongst families about diagnosis, nasal or throat swabs, test result waiting times, staying home or not whilst waiting, who should take the antibiotic, be given a booster or stay home if symptom free.

In my neighbourhood, none of the three chemists stocked the antibiotics for children in liquid form. Parents with sick children, trailed about trying to commence the antibiotic as soon as possible.

Adolescents take part in school immunisation programs. Some avoid their injections. Department of Health shares tips for parents about how to make this easier, reducing fear and apprehension. Teens who don’t want to line up in a large hall may find medical practices with experienced nurses and doctors reassuring.

AWCH Child Health Library has a number of useful resources to help prepare yourself and your child for a vaccination:

An end to whooping cough?

In September I wrote, “Its night-time and I hear my children coughing, sometimes in unison, gasping for air and gagging. The oldest didn’t get early diagnosis or antibiotics and the coughing started a month ago.” An end to whooping cough is not in sight but will awareness change its impact?

Jillian Rattray
AWCH librarian
November 2015

22 Oct 2015

H is for Healthcare preparation

“…positive healthcare experiences for children shape their long term good health and wellbeing.” (1)

Why prepare for healthcare?
“It took me lots of work to get over my fear of dentists!” Rachel exclaimed. As a child, dental surgeries were “no go zones” with metamorphosis taking place. She became a scratching, biting “wild child”. Now a mother of three, family dentist visits are routine.

Does this remind you of a childhood experience? Healthcare professionals (HCPs), know something small to an adult may be traumatic for a child.

AWCH helps parents
AWCH was amidst an emerging “groovy” movement of international organisations in the 1960’s -70’s supporting emotional care of children in hospital. Others were Action for Sick Children, EACH and Children in Hospital Ireland, yeah baby!

Terrified children aren’t peeled from parents/carers during healthcare today. This is not something to blink at, for a long time parents have been involved in their child’s hospital care (Please don’t leave me film, 1979). AWCH put this best practice in motion in Australia, now seen as the norm, so much so that most people can’t recall it any other way.

AWCH educated parents in the 1970’s about healthcare preparation with AWCH Barwon branch launching a poster (1979), Is your child to be hospitalised? How would you explain to him?

AWCH Child Health Library has great reads for children on healthcare familiarisation including picture books.

Australian parent resources have evolved in the last few years:
  • Child life therapists are healthcare professionals helping children and young people cope with medical procedures and hospital.  Keeping kids needs in the picture, by Renee Campbell (Child Life Therapist) is for parents supporting their children through medical imaging.
  • The Australian Commission on Safety and Quality in Healthcare, NPS Medicine Wise and AWCH partnered to create awareness for parents on medical imaging and kids. There’s now an App for parents and professionals.

Hospital familiarisation and healthy kids
AWCH WA runs Hospital Familiarisation Program (HFP). “Designed to prepare young healthy children for possible hospitalisation or visits to the doctor or dentist. The aim is to minimise anxiety, fear and misconceptions children may have about medical intervention.”

Sydney Children’s Hospital, Randwick, Health education unit offers “Hospital Explorer Box: a play and learn resource kit for stage 1 students” (contact Schools Project Officer, Health Education Unit). Other community hospital incursions are available.

Thanks to the children who coloured in cut-outs
from Althea adding their colourful interpretation.

Preparing in an emergency?
One quarter of children in NSW visit an emergency department in a year. In an emergency parents may not pack a hospital bag especially not with their child’s help (children learn this way). Also stressed parents may not bring a toy, book, soft toy or comfort blanket. Going out usually involves taking a drink and snacks but in an emergency and chance of medical procedure, don’t give food or drink.  Parents can ask health professionals about medical procedures and become advocates for their child, taking a moment to ask questions if unsure. Parents are there to comfort kids.

If you liked this blog, you might also like The three little “P’s” - Playgroup and Peppa Pig which touches on one parent’s traumatic experience of hospital without preparation. We’d love to hear from you if you have related comments/experiences.

Jillian Rattray
AWCH librarian
October 2015

18 Aug 2015

G is for Grief and Grandma

“MG”, a dear friend of mine died recently. She had been fighting illness for over eight years and before thinking that is long enough, the health professionals who got to know her, regarded her as a miracle person. There were times of bounce back and return to health.

Even in the ill stages my friend was not known for sitting back, she took herself to and from treatment at different times for many years, was dynamic, stylish, generous and energetic. She had a spirit of compassion, acceptance of others and was also gifted with the ability to care. Her language of love included cooking fresh food from scratch, recipes came from the top of her head along with the dishes that just kept coming. MG always had a beautiful home and used her green thumbs to create a lush garden. Dance was a lifelong passion and included teaching seniors. Over recent years she cherished time with her grandchildren and cared for one grandson from nine months old for several days a week. With a sparkle in her eyes and a song in her voice, MG loved a lot and left many better off with her presence.

It was not easy for MG to be cared for in the last few months, having spent most of her life giving to others. Yet even at the end, in her fragile state, she reached out to her grandson and they began a little dance by the hospital bed.  Hearing about this caught my breath away.

“Yet even at the end, in her fragile state, she reached out to her grandson and they began a little dance by the hospital bed”

For much of his three years, this little boy had known Grandma was sick and also that she went to hospital. Recently, he watched nurses asking Grandma questions such as “what’s your name, birthdate and is this your medication?” Visiting Grandma in hospital meant he was an expert observer of Grandma’s care. It was a poignant moment for his mother, when she was about to take some medicine and her three-year old asked, “where’s your bracelet, what’s your name and birthdate?” With these words, I’m taken to a childish place.
This little boy’s parents had communicated about Grandma’s sickness and then her death. There are many children who are not given this opportunity, through circumstances and by parent or carer choice.

Children approaching a medical or surgical procedure are cared for by adults who are trained and experienced in pediatrics, they are “child-friendly”. However, children visiting sick adults in hospital are in an adult world with strange circumstances, sights and sounds.  I wonder what children who face this experience think? Parents and carers are there to guide, comfort and help make sense of what is happening.

My friend MG and her grandson, had a unique way of observing life and death. Amidst the grief felt by families, children observe many things. I've learned that a child’s approach to death may catch adults by surprise and for at least a moment, take our breath away.

Jillian Rattray
AWCH librarian
August 2015

Photograph: thank you to the children who created dancing grandmother, grandson and the special happy tree.

8 May 2015

F is for Feelings - from fear to resiliency

It can be hard for a teenager when her peers move from the excitement of “can I sign your cast” to “it’s really going to hurt when they take it off”?

Fresh out of a visit to hospital with my daughter yesterday, I’m reminded of the importance of feelings. It seems all too obvious, that a trip to hospital will result in feelings of anxiety and fear.

Photo from: http://www.clipartpanda.com

Yet my thirteen year old had shown stoicism from the outset of breaking her arm. She picked herself up and trudged across the sporting field asking for her water bottle. Meanwhile I hastened to keep up, asking her to slow down. Over the weeks she coped with waits at two hospital emergency departments, an adult’s hospital and a children’s hospital, then repeated waiting at orthopaedic and x-ray clinic queues. She had it down pat and knew where to go and what to do, seeing herself as one of the many other children waiting for treatment.

There were certainly challenges along the way, worst being no food or drink and for me watching the pain under gas as her arm was manipulated and put back into shape. Once again I had to hasten to keep up as she jumped up after the procedure to head off to make an appointment at the orthopaedic clinic. The only sign of something being wrong was the cast from wrist and over bent elbow.

Later that night the pain and challenge of sleeping with a heavy bent elbow came. This was followed by challenges of dressing, washing, undertaking school work with her weak arm and carrying a heavy  bag which included books and a laptop. Transport on the bus with kids pushing and pulling also led to pain and concern. Despite all this she managed to walk, run and dance her way through the weeks.

Photo from:
So where in all this resiliency do fearful feelings occur? It can be hard for a teenager when her peers move from the excitement of “can I sign your cast” to “it’s really going to hurt when they take it off” and so the stories begin.

I wasn’t prepared for my daughter’s sleepless night that preceded the day when the cast came off or for the impact of some of the “kid-fabricated” stories.  As we waited one last time in the waiting room she was distracted by the funny things around her, a parent talking to their young child about what was on TV, “look there’s a penguin with a rainbow coloured beak”, no it’s a puffin she thought! Just when things weren’t looking good she was called up. One boy had cheered earlier when his name was called, adults chuckled, a moment of relief.

Photo from:
What made the difference to my daughter’s trepidation were the explanations health professionals gave. Speaking to her and demonstrating the procedure of having the cast taken off made all the difference. Phrases like “what you can expect”, “what you might expect” were really helpful. She even smiled as the cast came off. She was glad her arm was not green.

Being “armed” with information makes all the difference. The first test of this was as she reluctantly passed by the swings on our way to the car. It was great to know that she understood and can resist the temptation to hop on a swing, bike or other moving object.

How can books and resources help?

As parents, we won’t always know what our children are feeling. The AWCH library holds books to help adolescents and children understand what they are feeling. There are books written to help children identify and manage how they are feeling so they can develop self-esteem and coping skills.

 A book to help adolescents is the Stress reduction workbook for teens: mindfulness skills to help you deal with stress. Teenagers can use this easy to read workbook with activities to develop an understanding of what stress is and how to live in the present moment, “mindfulness”. They will gain a sense of control over stressful situations and develop resilience. 
There are books too for school children such as Relax, which teaches relaxation techniques or Be the boss of your stress : self-care for kids and Be the boss of your pain: self-care for kids.  

Nowadays there are plenty of online resources to help children and families prepare for hospital experiences, an example for young children is the child-friendly free app Okee in medical imaging. This fun app will help young children learn all about medical imaging and feel relaxed and supported.
Help! My Child’s in Hospital has practical advice for parents on preparing their child for hospital. Visit the website to find out about other families experiences.

Everybody stay calm: how to support your young child through medical tests and procedures will also help families prepare. These books will help parents with practical skills to support their children through stressful times, so they gain confidence and better health.

So I invite you to borrow a book and be well prepared for that next encounter with the doctor, dentist or hospital.

Jillian Rattray
AWCH librarian
April 2015