Gestational Diabetes

Introduction 

Gestational diabetes is a type of diabetes that affects women during pregnancy. Diabetes is a condition where there is too much sugar in the blood. Normally, the amount of glucose in the blood is controlled by a hormone called insulin. However, during pregnancy, some women have higher than normal levels of glucose in their blood and their body cannot produce enough insulin to transport it all into the cells. This means that the level of glucose in the blood rises.

How common is gestational diabetes?

Two to five in every 100 women giving birth has diabetes. Most of these women have gestational diabetes, and some have type 1 or type 2 diabetes.

Outlook

Gestational diabetes can be controlled with diet and exercise. However, some women with gestational diabetes will need medication to control blood glucose levels. If gestational diabetes is not detected and controlled, it can increase the risk of birth complications, such as babies being large for their gestational age. In most cases, gestational diabetes develops in the third trimester and usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.

Gestational diabetes often doesn't have any symptoms, but you may:

- feel tired

- have a dry mouth

- be very thirsty

- wee a lot

- get recurring infections, such as thrush

have blurred vision

If you have any of these symptoms, tell your midwife or doctor.

Risk factors

You may be at increased risk of gestational diabetes if:

your body mass index (BMI) is 30 or more

you have previously had a baby who weighed 10lbs or more at birth 

you have a family history of diabetes/ one of your parents or siblings has diabetes

Your baby may be at risk of: 

stillbirth

health problems shortly after birth (such as heart and breathing problems) and needing hospital care

developing obesity or diabetes later in life

Diagnosis

The oral glucose tolerance test (OGTT) can be used to test for GDM. The current National Institute for Health and Care Excellence (NICE) guidance recommends that:Woman who have had GDM in a previous pregnancy should be offered early self-monitoring of blood glucose or a two-hour 75 g OGTT at 16-18 weeks, followed by a repeat OGTT at 28 weeks of pregnancy if the first test is normal.Women with other risk factors should have an OGTT at 24-28 weeks.

Treatment 

Your diabetic treatment is likely to need adjusting during your pregnancy, depending on your needs. If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered.

It's very important to keep any appointments that are made for you, so that your care team can monitor your condition and react to any changes that could affect your own or your baby's wellbeing.

Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check that they are not deteriorating in pregnancy, as eye and kidney problems can get worse. You may also find that as you get better control over your diabetes, you have more low blood sugar attacks. These are harmless for your baby, but you and your partner need to know how to cope with them. 

Controlling gestational diabetes

Gestational diabetes can often be controlled by diet. A dietitian will advise you on how to choose foods that will keep your blood sugar levels stable. You'll also be given a kit to test your blood glucose levels. If your blood sugar levels are unstable, or your baby is shown to be large on an ultrasound scan, you may have to take tablets or give yourself insulin injections.

Labour and birth

If you have diabetes, it's strongly recommended that you give birth with the support of a consultant-led maternity team in a hospital. 

Depending on how your pregnancy is going, you may be offered induction of labour or caesarean section, between 38 weeks and 40 weeks. Another option from 38 weeks is to wait for labour to start naturally but to have regular scans. These scans will check how your baby is doing and check the blood supply from the placenta. 

After the birth

Two to four hours after your baby is born, they will have a heel prick blood test to check whether their blood glucose level is too low. Feed your baby as soon as possible after the birth usually within 30 minutes to help keep your baby's blood glucose at a safe level. If your baby's blood glucose can't be kept at a safe level, they may need extra care. Your baby may be given a drip to increase their blood glucose. 

When your pregnancy is over, you won't need as much insulin to control your blood glucose. You can decrease your insulin to your pre-pregnancy dose or, if you have type 2 diabetes, you can return to the tablets you were taking before you became pregnant. Talk to your doctor about this. If you had gestational diabetes, you can stop all treatment after the birth. You should be offered a test to check your blood glucose levels before you go home and at your six-week postnatal check. You should also be given advice on diet and exercise.

Anti-Bullying

Many children and young people experience school bullying and bullying outside of school but you don't have to put up with it. Almost half of all children and young people say that they've been bullied at some point during their time at school. 

What is bullying?

Bullying can take many forms: from teasing and spreading rumours, to pushing someone around and causing physical harm. It often happens in front of other people. It includes name calling, mocking, kicking, taking belongings, writing or drawing offensive graffiti, messing around with people’s belongings, gossiping, excluding people from groups, and threatening others.

Why are people bullied?

Children and young people are bullied for all sorts of reasons. It can be due to their race, their religion, their appearance, their sexual orientation, because they have a disability or because of their home circumstances. 

Cyberbullying is increasingly common both inside and outside school. Cyberbullying is any form of bullying that involves the use of mobile phones or the internet. 

The effects of bullying

Bullying makes the lives of its victims miserable. It undermines their confidence and destroys their sense of security. Bullying can cause sadness, loneliness, low self-esteem, fear, anxiety, and poor concentration, and lead to self-harm, depression, suicidal thoughts and, in some cases, suicide. Bullying can also affect children and young people's attendance and progress at school.

Getting teenagers to talk openly about what's bothering them can be hard. Follow these tips to help get them talking to you about their worries.

1. Ask, don’t judge

2. Ask, don’t assume or accuse

3. Be clear you want to help

4. Be honest yourself

5. Help them think for themselves

6. Don’t criticise everything

7. If they get angry, try not to react

8. Make them feel safe

Knowing or suspecting that your child is being bullied can be very upsetting, but there are many things you can do to resolve the problem. Bullying is one of the biggest concerns for parents. If you find out or suspect that your child is being bullied, there are things you can do to resolve the problem. 

How to help your child if they are being bullied

If a child tells you they’re being bullied, the first thing to do is listen. The NSPCC advises you to suggest to your child that they keep a diary of bullying incidents. It will help to have concrete facts to show the school. The next step is to talk to the school 

How do you know if your child is being bullied?

Sometimes children don’t talk to their parents or carers because they don’t want to upset them, or they think it will make the problem worse. However, if you suspect that your child is being bullied, there are signs to look out for. These include:

Coming home with damaged or missing clothes, without money they should have, or with scratches and bruises.

Having trouble with homework for no apparent reason.

Using a different route between home and school.

Feeling irritable, easily upset or particularly emotional.

Talking to the school about bullying

To stop the bullying, it's essential for you or your child, or both of you, to talk to the school. Think about who would be the best person to approach first. Discuss this with your child because there may be a particular teacher your child feels more comfortable with. 

It's worth asking about any school schemes to tackle bullying, such as peer mentoring where certain children are trained to listen and help with problems. You could ask to see the school’s anti-bullying policy, which every school has to have by law. This will enable you to see how the school plans to prevent and tackle bullying.

Who can help with bullying?

All the organisations listed below provide support and information to parents.

Family Lives

Bullying UK

Kidscape

NSPCC

Childnet International

Contact a Family

Cyberbullying is the use of technology such as mobile phones and the internet to bully other people. Coping with cyberbullying can be difficult because it can happen at any time of the day.

What is cyberbullying?

Emailing or texting threatening or nasty messages to people.

Posting an embarrassing or humiliating video of someone on a video-hosting site such as YouTube.

Harassing someone by repeatedly sending texts or instant messages in a chat room.

Setting up profiles on social networking sites, such as Facebook, to make fun of someone.

'Happy slapping', which is when people use their mobiles to film and share videos of physical attacks.

Posting or forwarding someone else's personal or private information or images without their permission.

Sending viruses that can damage another person’s computer.

Making abusive comments about another user on a gaming site.

How to respond to cyberbullying

Do

Talk to someone you trust. This could be a teacher, parent, carer or friend. Schools have a responsibility to ensure that students aren’t bullied, and they can take action even if the bullying is happening outside school. 

Report the bullying to the internet service provider if the bullying happened online. Ask a parent or teacher for help.

Report the bullying to your mobile phone provider if you’ve received bullying texts or calls on your mobile. You may even have to change your number if you're repeatedly bullied through your phone.

Block instant messages and emails. Ask a parent or teacher for help. 

Report serious bullying, such as physical or sexual threats, to the police.

Don't

Don’t delete the upsetting emails or messages. Keep the evidence. This will help to identify the bully if the bullying is anonymous. Even people who use a false name or email can be traced.

Don’t reply. This is what the bully wants, and it might make things worse.

How to avoid being cyberbullied

The best way to avoid being cyberbullied is to use the internet and mobile phones carefully.

Don’t give out personal details, such as your phone number or address, in a chat room.

Think carefully before posting photos or videos of you or your friends.

Only give your mobile number to close friends.

Protect passwords, and never give your friends access to your accounts.

Don’t forward nasty emails.

Learn how to block instant messages or use mail filters to block emails.

Congenital Heart Defect (CHD)

Heart defects are one of the most common birth defect. They are the leading cause for birth defect deaths. It's estimated 9 out of 1000 people are born with a congenital heart defect. Many heart defects do not need treatment, but some complex congenital heart defects require medication or surgery.

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To help understand Congenital Heart Defects we think explaining how the heart works first will help.

The Heart:

Your heart is a muscular organ. It has four chambers that are designed to pump blood around your body. When a heart is formed properly there are  two large chambers (ventricles) and two receiving chambers (atria) For those with a Congenital Heart Defect things arent formed like they should be meaning the heart cannot work as it should.

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The Definition of Congenital Heart Defects

Congenital means ‘born with’ or ‘from birth’. Sometimes a Congenital Heart Defect could be left unnoticed until adulthood, but most are detected at birth. Most of these defects can become corrected with surgery.

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What are Congenital Heart Defects?

Congenital Heart Defects occur soon after conceptio & the heart forms abnormally. These defects can range from very severe malformations, eg. complete absence of one or more chambers or valves or simple problems eg. holes between chambers of the heart.

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How are Congenital Heart Defects Detected?

Congenital Heart Defects can sometimes be picked up when you have an ultrasound scan during pregnancy (usually at the 20 week scan), but sometimes they are not found until after your baby has been born. Some conditions may not be discovered until the child is older or even an adult.

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Signs and Symptons

Signs & Symptoms in a Newborn

There may be few or no symptoms for a newborn with a Congenital Heart Defect. The defect may or may not have been picked up on your scans.

These signs and symptoms can sometimes occur in Newborn Babies with A Congenital Heart Defect:

A bluish tint to the skin, lips, and fingernails also known as Cyanosis

Poor circulation

Fast or difficult breathing

Tiredness

Finding feeding hard

Poor blood circulation

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There are 35 known Congential Heart Defects and a whole list of other things that can affect the heart. The most common include:

Aortic Stenosis

Atrial Septal Defect

Atrio-ventricular Septal Defect

Cardiomyopathy

Ebstein’s Anomaly

Eisenmenger Syndrome

Pulmonary Stenosis

Tetralogy of Fallot

Transposition of the Great Arteries

Ticuspid Atresia

Truncus Ateriosus

Ventricular Septal Defect

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Congenital Heart Defects are the number 1 birth defect in UK & are a main cause of loss during pregnancy.

Many people know nothing about heart defects until they have a child born with one.

These defects are not something that can be cured, the heart will have to be monitored through the persons life. 

Many will need multiple open heart surgeries and in some cases they may even need a heart transplant.

Babies born with Congenital Heart Defects will most likely need open heart surgery at just a few hours or days old.

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Treatment of Congential Heart Defects 

Each person who has a Congential Heart Defect is similar to the next but are unique in the fact that they are effected differently. 

There are many surgeries used to help repair the heart, where doctors try to prevent the need for further surgery.

People who have Congential Heart Defects will be monitored throughout their lives for any further problems

 

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Congenital Heart Defect Facts

In the UK there are about 4,600 babies born with congenital heart defects each year

The outlook for babies born with congenital heart defects has improved dramatically over the past 30 years

At least three-quarters of babies with congenital heart defects are predicted to survive to adulthood

The outlook for babies born with congenital heart defects varies widely depending on the complexity of the defect. Survival rates in a number of simple conditions are close to 100%

Around 3100 operations and 725 interventional cardiac catheterisations are performed each year on babies and children with congenital heart defects

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As we have said before Congential Heart Defects aren't curable. This means that in some cases their is nothing more the doctors can do. In others the person may live a full life not knowing there is anything wrong. 

The awareness of Congenital Heart Defects is low & you probably didn't know anything about it until now but we hope the information we have provided has helped a few people learn a little more

Thank you for joining us tonight

Normal PP's will resume shortly

Lauren, Jade & Tessa xx

www.nhs.uk 

www.chd-uk.co.uk

Group B Streptococcus

What is Group B Streptococcus?

Group B Streptococcus (GBS, or group B strep) is a bacteria carried by updating I to 30% of people, but it doesn't usually cause harm or symptoms. In women, it is found in the intestine and vagina. It causes no problem in most pregnancies. In a small number of pregnancies, it infects the baby, usually just before or during labour, leading to serious illness.

Though it's rare, GBS is the most common cause of severe infection in newborns, particularly in the first week after birth.

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Could I be carrying GBS?

If you are carrying GBS you probably won't even know it. This is because there aren't usually any symptoms. You could discover that you have GBS by chance, when having a vaginal swab taken to check for something else. There is a test available for GBS, but it's not routinely carried out in pregnancy due to concerns about its reliability. 

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Pregnancy & GBS

Roughly 1 in 2,000 babies in the UK develops a GBS infection shortly after being born. Sadly, about 1 in 10 of these babies dies. It's a very rare event when a baby does not survive a GBS infection but sadly it does happen. 

It isn't known why some babies develop an infection and others don't. What is clear is that most GBS infections in newborn babies can be prevented. 

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Most pregnant women who carry GBS bacteria have healthy babies. However, there’s a small risk that GBS can pass to the baby during childbirth. 

Rarely, GBS infection in newborn babies can cause serious complications that can be life threatening.

Extremely rarely, GBS infection during pregnancy can also cause miscarriage, early (premature) labour or stillbirth.

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What Happens If I Have GBS?

When you go in to labour, if you are in a high-risk group (listed below) your doctor will give you antibiotics via a drip in your arm. This is to reduce the risk of your baby developing a GBS infection. These are given from the start of your labour, or from when your waters break, right up to your baby's birth. 

If you are given antibiotics, they will need to be taken at least two hours before your baby is born.

As always there are some risks and drawbacks taking antibiotics in labour for you & your child. Your doctor will discuss your case with you.

There are a number of factors that help to predict whether your baby is likely to develop a GBS infection. (If you carry GBS)

These include:

If you go into labour prematurely (before 37 weeks of pregnancy)

If your waters break 18 hours or more before you have your baby

If you have a fever of 38 degrees C or higher during labour

If you have previously had a baby infected with GBS

If you carry GBS in your vagina and/or rectum during your pregnancy

If GBS has been found in your urine during your pregnancy

Having a caesarean is not a method of preventing GBS infection in babies. This is because having a caesarean doesn't eliminate the risk of GBS being passed on to your baby. 

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What Happens After Birth?

If you don't fall into one of the high-risk groups & your had the drip for at least 2 hours before giving birth, your baby is unlikely to develop a GBS infection.

If your baby is at higher risk of developing a GBS infection once they are born, they will be examined by a paediatrician.

Several factors decide whether or not you or your baby are given antibiotics:

If both you and your baby are completely healthy, and you had full treatment with antibiotics during labour, you baby won't need antibiotics.

If you are both healthy, but you didn't have antibiotics during labour, your baby may be started on antibiotics until given the all-clear.

If you or your baby shows signs of a GBS infection, your baby should be started on antibiotics without delay.

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Doctors are still researching the best way to treat newborns at risk of a GBS infection. That's why you may or may not receive antibiotics as your treatment. It may also depend on your hospital's policy and your own circumstances.

You and baby might be treated with penicillin without any side effects. Side effects include a rash, diarrhoea and nausea. These are minor, though penicillin may affect the balance of bacteria in baby's tummy. 

If you are known to be allergic to penicillin you will be given another antibiotic instead, called clindamycin.

These side effects make some doctors wary about using antibiotics particularly for newborns. Some doctors prefer to wait for the first 12 hours after the birth before starting a course of antibiotics, in case there's no need.

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What Are The Signs Of A GBS Infection In My Baby?

GBS infections in babies would usually happen within seven days of birth (early onset), with 90% occurring within 24 hours of your babies birth.

Typical signs of early-onset GBS infection in babies include:

Grunting

Poor feeding

Lethargy (Tiredness)

Irritability

Low Blood Pressure

Abnormally high or low temperature

Abnormally high or low heart rate or breathing rate

GBS infections can also develop when a baby is seven or more days old (late-onset), though it's not common. 

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GBS bacteria can cause bacterial meningitis, though late onset infections tend to be less severe than early onset infections. Most babies respond well to treatment, though meningitis can leave some babies with long term problems. 

GBS infections in babies are rare after they're one month old and are virtually unheard-of once they're over three months old.

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Why isn't there a national screening programme for GBS?

There's conflicting evidence and differing views about whether a national screening programme for GBS would be effective. 

Many experts believe that a screening programme would do more harm than good. If antibiotics are used too widely, bacteria may become resistant to antibiotics in the future. And interventions in pregnancy when it's not necessary may also do more harm than good. 

However, the charity Group B Strep Support continues to campaign for a GBS national screening programme.

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I'm carrying GBS. What happens next?

If you have been affected by GBS in a previous pregnancy, or are carrying it in your current pregnancy, talk to your midwife or obstetrician. You can then discuss a birth plan that includes steps to protect your baby from the infection. 

If you have GBS in your current pregnancy, a hospital birth will be recommended, so you can have antibiotics if you need them. 

Your pregnancy will then be managed so your baby is as protected as possible.

Potty Training

When to start potty training

Most parents start thinking about potty training when their child is around 24 months old, but there's no perfect time. Do it over a period of time when there are no great disruptions or changes to your child's or your family's routine.

Children are able to control their bladder and bowels when they're physically ready and when they want to be dry and clean. Every child is different, so it's best not to compare your child with others. 

It usually takes a little longer to learn to stay dry throughout the night. Although most children are dry by the ages of three and five. 

Signs that your child is ready for potty training:

Physical signs:

Your child is coordinated enough to walk, and even run, steadily.

They urinate a fair amount at one time.

They have regular, well-formed bowel movements at relatively predictable times.

Has "dry" periods of at least two hours or during naps, which shows that thier bladder muscles are developed enough to hold urine.

Behavioral signs:

Can sit down quietly in one position for two to five minutes.

Can pull thier own pants up and down.

Dislikes the feeling of wearing a wet or dirty nappy.

Shows interest in watching you go to the toilet.

Gives a physical or verbal sign when he's having a bowel movement such as grunting, squatting, or telling you

Shows you that they can be independant.

Isn't resistant to learning to use the toilet.

Cognitive signs:

Understands the physical signals that mean he has to go and can tell you before it happens or even hold it until he has time to get to the potty.

Can follow simple instructions, such as "go get the toy."

Ways to help and encourage your child to go on the potty:

A good first step is to buy a potty; put it in the bathroom or somewhere easily accessible and tell your child what it is for. Suggest your child sits on it to see what it's like. Be prepared to demonstrate this yourself!

Make sitting on the potty a part of your child's daily routine, perhaps when dressing in the morning and before the evening bath. Don't expect your child to sit there for long at first your child may only stay there for a very short time - you are simply getting your child used to the potty.

Start encouraging your child to let you know when they are passing urine or having a bowel motion - and give lots of praise when your child tells you what they are doing.  Awareness that a wee or poo has happened is important, and comes before awareness of the need to go.  You may choose to potty train in the summer when your child can run around without nappies. 

If your child has a regular time for opening their bowels; perhaps after breakfast, try to ‘catch it' by sitting your child on the potty at that time. If and when you do ‘catch' something show your pleasure and approval

It helps to remember that you can't force your child to use a potty. If they're not ready, you won't be able to make them use it. In the meantime, the best thing you can do is to encourage the behaviour you want.

ADHD

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

ADHD can occur in people of any intellectual ability but people with ADHD tend to have other learning difficulties too although this isn't always the case.

Causes of ADHD 

The exact cause of ADHD is not fully understood, but a combination of factors is thought to be responsible.

Genetics

ADHD tends to run in families. In most cases, it is thought the genes you inherit from your parents are a significant factor in developing the condition.

Brain Function and Structure

Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition.

Some studies have suggested that people with ADHD could have an imbalance in the level of chemicals in the brain. These chemicals are called neurotransmitters, or that these chemicals may not work properly.

Other Possible Causes

Various other causes have also been suggested as having a role in the development of ADHD, including:

Being born prematurely (before the 37th week of pregnancy)

Having a low birthweight

Brain damage either in the womb or in the first few years of life

Drinking alcohol, smoking or misusing drugs while pregnant

Exposure to high levels of toxic lead at a young age

However, the evidence for many of these factors is inconclusive, and more research is needed to determine if they do actually contribute to ADHD.

Symptoms of ADHD 

The symptoms of ADHD can be categorised into two sets of behavioural problems These categories are inattentiveness & hyperactivity and impulsiveness.

The majority of people with ADHD have problems that fall into both these categories, but not always.

For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD), and it can sometimes go unnoticed because the symptoms may be less obvious.

Symptoms Of ADHD in Children and Teenagers

The symptoms of ADHD in children and teenagers are well outlined, and they are usually noticeable before the age of six & will be displayed at home & at school. Main symptoms include...

Inattentiveness

Short attention span & easily distracted

Making careless mistakes in things such as school work

Appearing forgetful or losing things

Being unable to stick at tasks

Appearing to be unable to listen to or carry out instructions

Constantly changing activity or task

Having difficulty organising tasks

Hyperactivity and Impulsivenes

Being unable to sit still  in calm or quiet surroundings

Constant fidgeting

Being unable to concentrate on tasks

Excessive physical movement

Excessive talking

Being unable to wait their turn

Acting without thinking

Interrupting conversations

Little or no sense of danger

Although not always, some children may also have signs of other problems or conditions alongside ADHD. These include...

Anxiety disorder. This causes your child to worry and be nervous much of the time. It may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness

Oppositional Defiant Disorder (ODD) This is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers

Conduct Disorder. This often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals

depression

Sleep Problems. Finding it difficult to get to sleep at night, and having irregular sleeping patterns

ASD This affects social interaction, communication, interests and behaviour

Epilepsy.  A condition that affects the brain and causes repeated fits or seizures

Tourette’s Syndrome. A condition of the nervous system, characterised by a combination of involuntary noises and movements called tics

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.

ADHD is a developmental disorder. It is believed that it cannot develop in adults without it first appearing during childhood. However, it is known that symptoms of ADHD are often present from childhood into a person's teenage years, and then adulthood. 

An estimated 15% of people diagnosed with ADHD as children will at 25 years old still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.

The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD

Possible Symptoms Of ADHD in Adults

Carelessness and lack of attention to detail

Continually starting new tasks before finishing old ones

Poor organisational skills

Inability to focus or prioritise

Continually losing or misplacing things

Forgetfulness

Restlessness and edginess

Difficulty keeping quiet and speaking out of turn

Blurting out responses and often interrupting others

Mood swings, irritability and a quick temper

Inability to deal with stress

Extreme impatience

Taking risks in activities, with little or no regard for personal safety or the safety of others

One of the most common conditions that can occur alongside ADHD is depression. Other conditions that adults may have alongside ADHD include:

Personality disorders

Bipolar disorders

OCD

Diagnosing ADHD 

If you think you or your child may have ADHD you should speak to your GP.

If it's your child you are worried about, it may help to speak to their teachers before seeing your GP, to find out if they have any concerns about your child's behaviour.

Your GP can't diagnose ADHD but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.

When you visit your GP they may ask you questions similar to these to help. The questions could include...

Explaining your symptoms or those of your child

When these symptoms started

Where the symptoms occur eg. at home or in school

If the symptoms affect your or your child’s day to day life

If there have been any recent significant events in your or your child's life

I there is a family history of ADHD

About any other problems or symptoms of different health conditions you or your child may have.

If your GP thinks your child may have ADHD, they may first suggest a period of "watchful waiting" lasting around 10 weeks. This is to see if you or your child's symptoms improve, stay the same or get worse.

If the behaviour doesn't improve, and both you and your GP thinks it is seriously affecting day-to-day life, you should be referred to a specialist for a formal assessment.

Assessment

There are a number of specialists you or your child may be referred to for a formal assessment, including:

A Psychiatrist

A Paediatrician

A learning disability specialist, social worker or occupational therapist with expertise in ADHD

Who you are referred to will depend on your age and what is available in your local area.

There is no simple test to determine whether you or your child have ADHD, but your specialist can make an accurate diagnosis after a detailed assessment.

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness.

To be diagnosed with ADHD, your child must also have:

Been displaying symptoms continuously for at least six months

Started to show symptoms before the age of 12

Been showing symptoms in at least two different settings eg. at home and at school

Displayed symptoms that make their lives considerably more difficult on a social, academic or occupational level. Symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition

Diagnosis in Adults

Diagnosing ADHD in adults is more difficult because there is some disagreement about whether the list of symptoms used to diagnose children and teenagers applies to adults.

In some cases, an adult may be diagnosed with ADHD if they have five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness, that are listed in the criteria for children with ADHD.

As part of your assessment, the specialist will ask about your present symptoms although, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.

If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school records or talk to your parents, teachers or anyone else who knew you well when you were a child.

For an adult to be diagnosed with ADHD, their symptoms should also have a moderate impact on different areas of their life, such as:

Underachieving at work or in education

Difficultly making or keeping friends

Difficulty in relationships with partners

If your problems are recent and did not occur regularly in the past, you are not considered as having ADHD. This is because it is currently not thought that ADHD can develop for the first time in adults.

Treating ADHD 

There is no cure for ADHD, but treatment can help relieve the symptoms and make the condition much less of a problem day to day.

ADHD can be treated using medication or therapy, but a combination of both is often the best way to treat it.

Treatments include...

Medication

There are four types of medication licensed for the treatment of ADHD. These medications are not a permanent cure for ADHD, but they can help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

If you or your child is prescribed one of these medications, you will probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Therapy

As well as taking medication, different therapies can be used n treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.

These therapies include...

Psychoeducation

Psychoeducation means you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour Therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour. For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent Training and Education Programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour. You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups and can last several weeks. They aim to teach parents and carers about behaviour management while increasing your confidence in your ability to help your child, as well as improving your relationship. 

Social Skills Training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would try and change how your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Living with ADHD 

Caring for a child with attention deficit hyperactivity disorder (ADHD) can be draining.

The behaviours typical of ADHD can make normal everyday activities exhausting and stressful.

Ways to cope...

Although it can be difficult sometimes, it's important to remember a child with ADHD cannot help their behaviour. People with ADHD find it difficult to suppress impulses, which means they do not stop to consider a situation or the consequences before they act.

If you are looking after a child with ADHD, you may find this advice helpful.

Plan the Day

Plan the day so your child knows what to expect. Set routines can make a difference to how a child with ADHD copes with everyday life. 

Set Clear Boundaries

Make sure everyone knows what behaviour is expected, and reinforce positive behaviour with immediate praise or rewards. Be clear, Explaining if the boundaries are crossed there are consequences eg a privilege is ttaken away & and follow these through consistently.

Be Positive

Give specific praise. Instead of saying a general, "Thanks for doing that," you could say, "You washed the dishes really well. Thank you." This will make it clear to your child that you are pleased, and why.

Giving Instructions

If you are asking your child to do something, give brief instructions and be specific. Instead of asking, "Can you tidy your bedroom?" say, "Please put your toys into the box, and put the books back onto the shelf." This makes it clearer what your child needs to do and creates opportunities for praise when they get it right.

Incentive Scheme

Set up your own incentive scheme using a reward chart, so good behaviour can earn a privilege. For example behaving well on a shopping trip will earn your child time on the computer or some sort of game. Involve your child in it and allow them to help decide what the privileges will be.

These charts need regular changes or they become boring. 

Intervene Early

Watch for warning signs. If your child looks like they are becoming frustrated, overstimulated and about to lose self-control, intervene. Distract your child if possible, by taking them away from the situation, which may calm them down.

Social Situations

Keep social situations short and sweet. Invite friends to play, but keep playtimes short so your child does not lose self control. Do not aim to do this when your child is feeling tired or hungry, such as after a day at school.

Exercise

Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep. Make sure they are not doing anything too strenuous or exciting near to bedtime.

Bedtime

Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning. Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.

Night Time

Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse. Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.

Help at School

Children with ADHD often have problems with their behaviour at school, and the condition can have a negative impact on a child's academic progress.

Speak to your child's teachers or their school's special educational needs co-ordinator (SENCO) about any extra support your child may need

Adults with ADHD

If you are an adult living with ADHD, you may find the following advice useful.

Make lists

Keep diaries

Stick up reminders and set aside some time to plan what you need to do if you find it hard to stay organised

Let off steam by exercising regularly

Find ways to help you relax, such as listening to music or learning relaxation techniques

If you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better

Talk to your doctor about your suitability to drive, as you will need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving

Contact or join a local or national support group. These organisations can put you in touch with other people in a similar situation, and they can be a good source of support, information and advice.

Starting School Topic

DEALING WITH TEARS

Going to school for the first time is exciting, but it can also be pretty scarey, for the child and for the grownups!  Teachers agree that helping small children settle happily into school is the most delightful, rewarding part of their job. Have confidence that the teacher will welcome and treasure your child and understand what a big step they are taking when they start school.  Look at these few simple tips, chances are you’ll already be doing a lot of these things and your child will take to school like a duck to water!

Make sure that you have all the equipment and clothing required well ahead of time to avoid a last minute panic. If you panic so will your child!Let your child enjoy the fun of getting a new school bag, pencils and so on. If possible avoid any major changes at home in the weeks around the start of school, so that your child has a secure base. Its not a good week to begin your own new high flying career!If your child has special needs or health issues talk to the school about these before the start of the term. Don’t worry, they will have the right experience to cope.Make sure you know when and where your child should go on the first morning, Act naturally, don’t overdo promises that school will be fun or warn about how different[or difficult] it will be. Just talk pleasantly and sensibly about ‘going to school’ and remember that its a normal part of  childhood- everyone does it!Give your child a simple description of what to expect, for example outline how the day will be organised, ending with ‘and then you come home.’   Remind them that the teacher is there to help them or answer any questions they might have, Remind yourself that teachers understand that starting school is a big step for small children and will be experienced and skilled at helping your child to settle in. Provide healthy but familar food if you send snacks or lunch to school with your child. Find out about any rules the school may have about the food children may bring (for example many schools do not allow peanuts  in any form)

FIRST FEW WEEKS

Be prepared for your child to be very tired for the first few weeks, there is a lot to learn and take in at school. So I advise early bedtimes and normal routine while they are settling in. If your child does cry when you leave them, follow the school rules on what to do. Some schools will allow parents to stay for a little while before they have to leave, other schools will expect parents to leave as soon as school starts, even if their child is upset. My advice is to show your child that you are confident that they will be fine very soon. Children  generally cry because they are upset at separating from their parent, not because they don’t like being at school. So remind your child that you will see them soon and remind yourself that separating is not going to be any easier whether you do it now or in half an hour’s time!Some children don’t settle at school well because they think they are missing out on better things at home. My advice is to keep a low profile on what you have done with younger brothers and sisters at home and save extra special treats for all the family to enjoy.

FREE SCHOOL MEALS

Every child in reception, year 1 and year 2 in state-funded schools will receive a free school lunch from September 2014, Deputy Prime Minister Nick Clegg has announced. The government will fund schools in England to provide every child in reception, year 1 and year 2 with a hot, nutritious meal at lunch time. The aim is to improve academic attainment and save families money – over the course of a year the average family spends £437 on school lunches per child. Universal free school meals for primary school pupils were a key recommendation in a recent review of school food produced independently for the Department for Education. The review found that, in pilots where all children have been given a free school dinner, students were academically months ahead of their peers elsewhere and more likely to eat vegetables at lunchtime instead of less healthy food like crisps. At the same time, the government will extend free school meals to disadvantaged students in further education and sixth form colleges.

What to put in your childs lunchbox?

Theres loads of choices to go for with Wraps, Bagels, Rolls Sandwhiches, Crackers, pita breads

You can have a chicken roll or a ham sandwhich or a cheese bagel or cheese on crackers or a tuna wrap

Please remember not to put peanut butter or nutella in your childs choice as other children may have nut allergies.

You can also put in a yogurt or a piece of fruit like a banana or a packet of raisens.

Some schools dont let you put in crips fpr your child as the seem to be 'unhealthy' for them so as a substitute you could put in some rice crackers orsome bread sticks or some babybells or some cocktail sausages.

For juice it is best to give them sugar free juice or fresh orange or apple juice

Breaktime Snacks

When your little ones first start school some schools let you have breaktime snacks so here are some options if your not sure what to do

You could give them:

 a little pot of dry cereal

Some cucumber and carrot sticks

a cereal bar

a packet of raisins

fruit eg. an orange or a banana or an apple

Some schools have a snack bar for them at school if they wish to buy something, my sons school charges 20p a snack and 20p for a sugar free juice drink.

Starting school means the start of a huge list for School supplies! School supplies vary depending on how old your child is buy Here are some of the items you may require when starting school:

Uniform

school bag

pencil case

pens

pencils

scissors

glue stick

rubber

crayons

pencil sharpener

Ruler

Compass

notebook

folders

Assistance with school uniform is available if you claim any of the following:

Income Support

Income based job seekers allowance

Income related Employment and support allowance

Child tax and your income is less than £16,010

If you are 16-16 years olfd and receive any benefits for yourself 

The clothing allowance is made once per school year, and payment is made directly to the applicant for the sum of £50 for every eligible child in primary or secondary school. For claims received after December, the sum of £25 is paid for every eligible child.

To apply you can dowmload an application pack from your local council's website