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Catch them early, The National, 13.10.2009

Childhood afflictions such as head lice and warts may be unpleasant, but they are just part of growing up, writes Jo Wadham

Warts, ulcers, parasites, worms. This reads like a checklist from the Dark Ages, but these are actually some of the symptoms of very common childhood illnesses. While we should all be extra vigilant regarding germs to minimise the spread of the H1N1 flu virus, there are many other horrible bugs lurking in classrooms and playgroups. On spotting some of the more medieval symptoms, many parents will panic and wonder what has happened to their poor offspring. But, if they ask around, they will find that many of these lurgies are surprisingly common and easy to deal with. If you have the stomach to find out more, read on.

The one childhood nasty most parents are likely to have come across is nits, otherwise known as head lice or pediculosis. Nits are actually the name for the eggs that these tiny, wingless parasites lay on the hair shaft. Contrary to common perception, head lice can neither jump, swim nor fly and the cleanliness of hair is irrelevant. They crawl from head to head and for this reason, girls tend to be more prone to them than boys because they spend more time with their heads close together.

Head lice are a nuisance and can cause an itchy head. The insects lay tiny dull-coloured pinhead-sized eggs on the hair shaft. When the eggs hatch after seven to 10 days, they remain glued to the shaft of the hair but appear white. Ten to 14 days later the lice are mature and about two to four millimetres long. The lice live for about three weeks sucking blood from the scalp. Any lice that have crawled off a head into a hat will only live for about six to eight hours.

Years ago in the UK, every child in school would have their head checked regularly by the nit nurse. As Sophie Farskoury, one of the school nurses at the British School Al Khubairat explains, this is no longer recommended by health professionals. Instead, the school nurses aim to teach the children and their parents about prevention and treatment. According to Farskoury, children are equally as likely to catch nits outside of school as they are in school. “It’s a community problem. I even heard of a granny coming from overseas for the holidays and bringing her head lice with her.”

Shampoos and lotions are available which contain chemicals to kill the lice and the eggs, but should be used with caution if your child has sensitive skin. Above all, only use the shampoos if you have seen a live louse. As Farskoury comments, sometimes parents are too quick to act. “We have had parents who have treated a child who had sand or glitter in their hair. The parents are so anxious they automatically go to a chemist.” The shampoos do not always work, there may be a resistance to the chemicals or not all the lice may be affected.

The most effective treatment is to take out every single egg and louse, either by hand or by using a special fine-tooth comb which can be bought from chemists. After washing the child’s hair and leaving in conditioner, section the hair and comb it carefully, wiping the comb in between. The Stafford Report, published by the Public Health Medicine Environmental Group in the UK, recommends that after an outbreak, everyone in the family should be checked for head lice on a weekly basis.

Hand, foot and mouth disease is perhaps the most medieval of all the lurgies with its main symptom being ulcers appearing on and in the body. It is very contagious and very common in children under the age of 10. Most adults are immune to this disease, and if they do catch it, it tends to be very mild. However, this is different to the animal variety and cannot be transmitted to and from animals. The symptoms vary but tend to be raised temperature, loss of appetite, sore throat and small, flat or raised spots in the mouth, throat and on the skin, combined with a general feeling of being unwell. After about 12 to 36 hours, these spots develop into yellowy-red ulcers in the mouth. Another one to two days later and sores develop on the palms of the hands, the soles of the feet and in between fingers and toes. These sores can be itchy and uncomfortable and last for about three to six days.

The disease is viral, so antibiotics will not work against it. “The Coxsackie A virus is the most common cause here,” explains Dr Gerald Brereton-Stiles, consultant paediatrician at the Al Noor Hospital in Abu Dhabi. “We treat the symptoms and let it run its course.” However, in a very small number of cases, the virus can affect the heart muscle and the brain, so a doctor’s diagnosis is always recommended. Carers of young children not yet toilet-trained should be aware that even after the child is better, the virus can live for up to four weeks, so extra care should be taken when washing hands after nappy changes.

Ringworm is not, as its name suggests, an infestation of worms. It is a fungal infection which can leave an itchy ringlike red rash on the skin. On feet it is commonly known as athlete’s foot. According to the UK’s NHS website, around 10 to 20 per cent of people will experience at least one fungal infection in their lifetime. Ringworm on the scalp is very common among prepubescent children. It is thought that the chemical changes to the glands in the scalp during puberty make it less attractive to fungi. As Farskoury explains, ringworm is often misdiagnosed, but in its mildest form, can be treated with over-the-counter medications in 24 hours. In more severe cases, there can be complications including permanent hair-loss and scarring, but this is rare.

Ringworm can be transmitted by household pets as well as cattle, pigs and horses. According to the US government website MedlinePlus, the disease can also be transmitted by skin-to-skin contact, contaminated combs, clothes and shower or pool surfaces. Warts are another grim, yet common, childhood affliction. They are benign rough lumps found on the skin and are caused by a virus. Warts on the sole of the foot are called verrucas and are very common in young children. “These are mildly contagious and the child will need to wear a plaster and some sort of protective rubber sock,” explains Farskoury, who recommends that parents check their child’s feet regularly. Swimming pools are common places for catching verrucas. A child who has a weak immune system is most susceptible and can catch the virus through little cuts or scratches on the sole of his foot.

Without treatment, warts can last up to two years. Huckleberry Finn, in the Adventures of Tom Sawyer by Mark Twain, recommended going to a graveyard with a dead cat to get rid of warts. Happily today, there are numerous over-the-counter topical medications for verrucas. Molluscum contagiosum is the rather grand sounding name for a viral skin disease, which predominantly affects children under the age of 15. As Brereton-Stiles explains, it is called this as the symptoms are several small wart-like bumps, each of which looks a little like an upside-down shell. “It is raised and has a little dent in the middle. It looks like an isolated chickenpox spot but without the red base.” The bumps usually appear in warm areas of the body. However, scratching them can cause them to become infected and to spread. It is also highly contagious through skin-to-skin contact.

More often than not, this benign virus is left to go of its own accord, which can take any time between a few weeks and more than a year. Occasionally it is recommended for a dermatologist to remove the mollusca, either by scraping, curettage, freezing or laser therapy. “If they are in places which are irritating, for example, on the eyelids or groin, they can be treated,” says Brereton-Stiles. Hopefully this will have helped to take the shock out of any little horrors you find on your child, but as with any medical complaint, do see a doctor if you are concerned. As Farskoury points out, some seemingly innocuous childhood illnesses do have the potential to become more serious. Also, tell your school nurse, this way she can help the wider school community and, if necessary, organise an extra clean of the classrooms. Whatever may arise – take heart. You are not alone.

For further information on childhood bugs and infections, visit the Abu Dhabi Health Authority’s website at www.haad.ae; the US Center for Disease Control and Prevention at www.cdc.gov; the UK GP advice website at www.patient.co.uk.

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