Jen and Amy chat to the wonderful Terri and Caroline from the charity Harry's HAT (Hydrocephalus Awareness Trust). 

We talk about the pitfalls and common things to look out for as a health visitor, as well as some lesser known warning signs that should be ringing alarm bells for us all. 

Do you know what the most accurate tape measure is we should be using? The most important factor in getting accuracy for head circumference measurement? Why you shouldn't be measuring head circumference for hydrocephalus monitoring in a baby clinic? We certainly learnt a lot in the process of this episode and we hope you will too!

Thank-you to Caroline for sharing her very personal story of her son Harry's journey navigating this complex condition and her own experience of health visitor support... and thank-you to her HV Becks - it sounds like you are doing a FANTASTIC job! 

This episode may be usefully listened to alongside our additional episode on head circumference measurement more broadly, which includes other conditions as well as when and how to measure. 

Please do contact us at iamahealthvisitor@gmail.com with any comments or suggestions. 

Resources and Further Reading: 
Harry's HAT:
https://harrys-hat.org

Shine: 
http://shinecharity.org.uk

Hydrocephalus with Harry's HAT Charity

Small seizures with big consequences. Infantile spasms or 'west syndrome' is a devastating diagnosis for any family and can so easily be missed. Listen to Jen and Amy discuss the health visitors role in supporting the family with identification of this tricky and subtle disorder as well as being alongside them through diagnosis, treatment and supporting the development of the child as they grow. 

For comments and suggestions please do email us at iamahealthvisitor@gmail.com

Resources and Further Reading: 

UK Infantile Spasms Trust: 
https://ukinfantilespasmstrust.org/about-infantile-spasms/
https://ukinfantilespasmstrust.org/ukistwp/wp-content/uploads/2018/11/UKIST-Information-Guide.pdf

Epilepsy Action: 
https://www.epilepsy.org.uk/info/syndromes/west-syndrome-infantile-spasms

Infantile Spasms Trust YouTube channel for example videos: https://www.youtube.com/channel/UCIZdN9LjQrYF7EwT16cuhmw

Pavone et al 2020 academic review article:
https://link.springer.com/article/10.1007/s10072-020-04600-5

Sheilds 2006 "little seizures, big consequences". Clinical summary article: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464162/

Infantile Spasms

Following our last episode talking about combi-feeding with Lucy Ruddle, we discuss top-ups; how they're used, how they should be used, and alternative strategies that can be used to limit or reduce their use.

The NICE faltering growth guideline is the starting point, while it does detail everything that needs to be done, it remains open to interpretation over the level of breastfeeding assessment needed, and quickly moves on to talk of setting goals/review dates without specifying which actions can help establish and continue breastfeeding.

To try and fill this gap, Jenny uses her IBCLC knowledge to talk through strategies used in practice which can be adopted by HV’s/HCP’s and how there are many more ways to do top ups than just using a bottle.

To help avoid all babies of any age or size being told to have 40mls top-ups (the figure that most often seems to be plucked from the air without an evidence base), we explain how to calculate a top up using weight and weight loss.

The NICE Faltering growth guideline https://www.nice.org.uk/guidance/qs197

Finger feeding: https://breastfeeding.support/what-is-finger-feeding/

Breast compressions: https://breastfeeding.support/what-is-breast-compression/

Paced bottle feeding: https://breastfeeding.support/tips-to-bottle-feed-a-breastfed-baby/

Book recommendation: Making more milk by Lisa Marasco & Diana West https://www.amazon.co.uk/Making-More-Milk-Breastfeeding-Increasing-ebook/dp/B07SQS22LC/ref=sr_1_1?dchild=1&keywords=making+more+milk&qid=1625065400&sr=8-1

Top-Ups - When, What, How and How Much to give!

Jen and Amy chat to the wonderful Lucy Ruddle IBCLC about her new book 'Mixed Up: Combination Feeding By Choice or Necessity', which is an absolute must read for any health visitor wanting to give evidence based information to families about combining formula and breastmilk. 

Combination feeding is massively under-rated and misunderstood; despite being central to almost every UK parents feeding journey.
In this episode we cover the toxicity of the 'formula versus breastmilk' debate and how to honestly and sensitively negotiate conversations with families who have introduced formula, the WHO code and how to safely and confidently practice within it as well as different types of combined feeding and their value. 

If you have something to add to our discussion or would like to give us some feedback we would love to hear from you at iamahealthvisitor@gmail.com

Resources and Further Reading: 
Lucy Ruddle IBCLC
https://www.facebook.com/LucyruddleIBCLC/

The WHO code:
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/

Combination Feeding With Lucy Ruddle IBCLC

Following our previous episode with Harry’s Hat, Amy and Jen review the guidance on measuring head circumference.

We discuss when (and how frequently) as well as how to measure.
Many of us may be doing it incorrectly - using lasso/plastic tapes (which can stretch and lead to inaccurate measurements), instead of paper.

We also discuss the potential consequences of not detecting problems with head circumference with reference to a recent court case and consider what lessons we can learn from this case. 

Further Reading and Resources:

Court Case
https://www.bailii.org/ew/cases/EWHC/QB/2020/3102.html

NICE Guidance on abnormal head shape or size:
https://www.nice.org.uk/guidance/ng127/chapter/Recommendations-for-children-aged-under-16#head-shape-or-size-abnormalities

https://www.nice.org.uk/guidance/qs198/chapter/Quality-statement-2-Head-size-and-shape-in-children

NHS Choices page on Plagiocephaly and Brachycephaly:
https://www.nhs.uk/conditions/plagiocephaly-brachycephaly/

Great Ormond Street pages on positional plagiocephaly:
https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/positional-plagiocephaly/

Craniostenosis CDC pages: 
https://www.cdc.gov/ncbddd/birthdefects/craniosynostosis.html#:~:text=Lambdoid%20synostosis%20%E2%80%93%20The%20lambdoid%20suture,the%20rarest%20types%20of%20craniosynostosis

Image of Cranial Suture Lines:
https://www.stanfordchildrens.org/en/topic/default?id=anatomy-of-the-newborn-skull-90-P01840

BMJ article evidencing that plastic lasso Measuring tapes stretch: 
https://adc.bmj.com/content/90/8/820

Head Circumference

Our 'bread and butter' (no pun intended!) but as with everything our perspective and advice changes over time so time for an update! 

What are the current important messages we should be conveying to parents as they begin to introduce solids to their babies. Why should we not be calling it 'weaning' and what about giving milk alongside solids? What signs of readiness should we look for? What is responsive feeding in terms of solid foods and what key messages about this should we be passing on to parents? What is the current guidance on introducing allergens, including where there is a known allergy in the family?

We put the emphasis on discussing the important messages about food - feeding responsively to the child's cues, building healthy habits for life, satiety and hunger signals, the social aspects of a mealtime and enjoyment of food; rather than on arbitrary rules or lists of requirements.

We would love to hear from you with any thoughts or suggestions, email us at iamahealthvisitor@gmail.com

**Resources and Further Reading: **

Our previous podcast - Does early weaning REALLY make babies sleep better?:
https://soundcloud.com/iamahealthvisitor/does-early-weaning-really-help-babies-sleep-better

Dewey 2001 - Nutrition, growth, and complementary feeding of the breastfed infant:
https://pubmed.ncbi.nlm.nih.gov/11236735/

First Steps Nutrition 'Eating well recipe book
Simple, cost-effective ideas for the whole family':
https://www.firststepsnutrition.org/eating-well-infants-new-mums

Introducing allergens to baby - Allergy UK:
https://www.allergyuk.org/assets/000/002/342/Weaning_–_Introducing_your_baby_to_solids_original.pdf?1547805087

St John's Ambulance: 
https://www.youtube.com/watch?v=oswDpwzbAV8

Introducing solids to the breastfed baby:
https://kellymom.com/nutrition/starting-solids/solids-how/

Rewards and Punishments for food - Why not?: 
https://www.health.qld.gov.au/news-events/news/ask-an-expert-reward-punish-children-with-food

HENRY - Health Exercise and Nutrition for the Really Young:
https://www.henry.org.uk

NHS Choices info on food storage and preparation:
https://www.nhs.uk/start4life/weaning/safe-weaning/preparing-food-safely/#anchor-tabs

Feed Eat Speak: 
https://www.feedeatspeak.co.uk

Introducing Solid Foods

Have you ever considered a career in academia? Or perhaps a blended career with a mixture of clinical and research across your week? If so then listen in as Amy chats about the process of finding and applying for a PhD. You might be more well qualified than you realise! Health visitors make excellent candidates because of our passion for evidence based healthcare and our ability to read and think critically about the literature; applying it to real life.

For comments, suggestions or questions get in touch at iamahealthvisitor@gmail.com

Further reading and Resources: 

National Institute of Healthcare Research Fellowship Programmes:
https://www.nihr.ac.uk/explore-nihr/academy-programmes/fellowship-programme.htm

Find a PhD: 
https://www.findaphd.com

Considering a PhD?

Merry Christmas! 

Get your IamaHV Bingo card at the ready (downloadable from our twitter and instagram feeds @IamaHV), mince pies and cup of tea lined up and get ready to laugh. A lot. 

Have your tissues at the ready for the last section, which got unexpectedly emotional! 

Thank-you everyone for all your amazing funny stories. You are all hilarious! Thank-you to our volunteer voices who have recorded the specially selected few. 

Thank-you to every single one of you who is continuing to just. keep. going. through everything and still managing to have a smile on your face from time to time. You are awesome. 

Merry Christmas with so much love, 

Jen and Amy x
iamahealthvisitor@gmail.com

Merry Christmas 2021: "We see and hear it all!"

Amy and Jen discuss a government guidance document published in the past year which reviews the Hepatitis B selective immunisation pathway for pregnant people and newborns. 

We look at this guidance from the perspective of health visitors in practice - what do you need to know? What should be happening, what actually IS happening and what do you need to do when this crops up on your caseload?

As ever we love to hear from you with any comments or thoughts by email on iamahealthvisitor@gmail.com.

Resources and Further Reading: 

I am a HV episode on the Hexavalent vaccine: 
https://soundcloud.com/iamahealthvisitor/changes-to-the-immunisation-schedule-august-2017-episode-2

Guidance Document - Hepatitis B antenatal screening and selective neonatal immunisation pathway.
https://www.gov.uk/government/publications/hepatitis-b-antenatal-screening-and-selective-neonatal-immunisation-pathway

Hepatitis B Selective Vaccination Policy

We discuss postnatal anxiety, specifically the measurement of anxiety after birth. In practice we are often using generic anxiety measures which are simply just not appropriate for use in this specific period of a parent's life. 

Listen in to learn more about the scale, how it can be used and how you might be able to incorporate it in your clinical practice. 

As ever, we love to hear from you. Get in touch with comments or suggestions at iamahealthvisitor@gmail.com

If you would like to use the PSAS in your practice or you would like to be involved with her stakeholder engagement research then Vicky would love to hear from you! Email her at vfallon@liverpool.ac.uk.

Resources and Further Reading: 

Dr Vicky Fallon - other relevant publications mentioned in the episode:
1. A feasibility trial of a single session Acceptance and Commitment Therapy intervention to reduce fear of childbirth in first time mums. 
https://www.tandfonline.com/doi/full/10.1080/08870446.2021.2024190

2. Challenges and opportunities for child health services in responses to the COVID-19 pandemic
https://www.tandfonline.com/doi/full/10.1080/02646838.2021.1890422

THE POSTPARTUM SPECIFIC ANXIETY SCALE - Research Background:
Parent Infant Foundation Briefing Paper:
https://www.researchgate.net/profile/Sergio-Silverio-2/publication/351736241_The_Postpartum_Specific_Anxiety_Scale_PSAS_Briefing_Paper/links/60a6c586299bf1031fbe1378/The-Postpartum-Specific-Anxiety-Scale-PSAS-Briefing-Paper.pdf 

Validation study: 
https://link.springer.com/article/10.1007/s00737-016-0658-9

Short form validation:
Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF)
https://pubmed.ncbi.nlm.nih.gov/33900462/

Childbearing specific validation - predicts infant feeding outcomes: 
https://link.springer.com/article/10.1007/s00737-017-0775-0

Measurement of Postnatal Anxiety with Dr Vicky Fallon

Jen and Amy gently guide you through the main headlines of the huge, massive, overwhelming and generally awe inspiring 'CHILD Cohort Study' all about the human microbiome. 

We will discuss how all the things you might expect, and some very unexpected factors, can all impact the infant microbiome and the important long term impacts this can have on that child's health. 

If you would like to look more into the myriad of research which has been produced from the CHILD dataset, just do a quick google scholar search and you will find heaps to keep you going. For a more curated starting point, check out our further reading down below! 

We love to hear from you, contact us on iamahealthvisitor@gmail.com

Thanks for listening!

Further reading: 

YouTube Summary of the CHILD study:
https://youtu.be/eL9dAGiCNLU

Study website with the key discoveries highlighted:
https://childstudy.ca/portfolio/key-discoveries/

The infant microbiome - headlines from the CHILD study

Jen and Amy go through the world of contraceptive advice. Although not directly our work, it's definitely connected and very relevant to health visitors. Often a bit of a neglected topic, it can be something we feel uncomfortable or poorly prepared to discuss with families. 

We hope our discussion solves some of those problems as we go through the contraceptive options for families, talk about contraception and lactation and the more emotional side of the conversation about physical intimacy after the birth of a baby. 

References and further reading:
 
Faculty for Sexual and Reproductive Health Guideline:
https://www.fsrh.org/documents/contraception-after-pregnancy-guideline-january-2017/ 

NHS Contraception Guide:
https://www.nhs.uk/conditions/contraception/

Lactation and Breastfeeding:
https://www.breastfeedingnetwork.org.uk/contraception/

iCaSH Sexual Health Service & the C-Card Scheme: 
https://www.icash.nhs.uk/contraception-sexual-health/c-card-scheme

Emotional Factors and broader conversation prompts:
https://www.nct.org.uk/life-parent/sex-after-baby/sex-after-baby-10-questions-ask-yourself

Contraception

Amy and Jenny chat to the lovely Alice from the Baby and Infant Sleep Information Source (BASIS) about sleep pods and nests. 

We cover the evidence base - what can we and can't we say about these products. Are they safe or not? In what circumstances? How do we actually know one way or the other? 

We talk about what manufacturing standards these products are held to, as well as some of more the hidden risks and implications the use of these items have. We also consider the disproportionate impact on families who live with a low income, who may be tempted to recreate homemade versions and leading to a cluster of co-occurring SIDS risks. 

Alice tells us about her research from a recent survey with parents about their use of sleep pods and we discuss how to have appropriate conversations with families to help minimise risk while sticking to the evidence base and avoiding scaremongering or judgement. 

We have quite a few other episodes on sleep now - so do check back through our back catalogue if this is a topic that interests you!

Thanks so much for listening everyone - we would love to hear from you with any comments or suggestions to iamahealthvisitor@gmail.com

Resources and Further Reading: 
The BASIS website - check out their resources if you haven't ever used them, they're brilliant:
https://www.basisonline.org.uk

Professor Helen Ball webinar on "What is Normal Infant Sleep: The View From Anthropology":
https://www.youtube.com/watch?v=g5fOogsUpIk

Lullaby Trust Resources on Baby Products:
https://www.lullabytrust.org.uk/safer-sleep-advice/sleeping-products/

and:
https://www.lullabytrust.org.uk/wp-content/uploads/The-Lullaby-Trust-Product-Guide-Web.pdf

Specific to sleep positioners:
https://www.lullabytrust.org.uk/are-sleep-positioners-safe-for-babies/

BASIS on Sleep Pods and Nests

This week Jen talks to Maria Renshaw who runs a local sling library in Colchester about her experience of slings and all things baby-wearing from a very practical perspective. 

She goes through different types of baby wearing from soft wrap slings to buckle carriers with some tips on the differences, fitting, safety tips including the TICKs acronym, common worries about hips and knees, how to find your local services for sharing with parents.

Thanks so much Maria for sharing your experience and knowledge with us! 

As ever we love to hear from you, contact us with your comments or feedback on iamahealthvisitor@gmail.com

Amy and Jen

References and Resources:

Maria's website:
https://www.beautiful-bonds.co.uk/meet-the-team

The TICKS rules for safe baby wearing:
http://babyslingsafety.co.uk

Sling Pages (to find a local sling library): 
http://www.slingpages.co.uk

'Why Babywearing Matters' by Rosie Knowles
https://www.amazon.co.uk/Why-Babywearing-Matters-Pinter-Martin/dp/1780665350

Babywearing training and resources: 
https://www.carryingmatters.co.uk/training/

Slings and Babywearing with Maria Renshaw

Amy and Jen chat to the inspiring Alison Spiro who has a PhD in anthropology as well as practicing as a health visitor. Listing all her achievements is a podcast summary in itself, but across her career she has worked as a breastfeeding counsellor herself, established an incredibly successful peer support service, taken both a hospital and community trust to BabyFriendly accreditation, worked on the world breastfeeding trends initiative report in 2015, contributes to the APPG on infant feeding on behalf of BestBeginnings, volunteers with the Breastfeeding Alliance, has been the iHV expert advisor on breastfeeding. Most recently, she is the author of 'Breastfeeding for Public Health: A resource for community healthcare professionals'.

We discuss with Alison some of the most important issues in breastfeeding support - from culture and anthropology to emotions, wellbeing, mental health and therapeutic communication skills. We talk about the importance of debriefing your own infant feeding experiences and bringing an unbiased listening ear to your interactions with families. Hopefully this will be an interesting and relevant discussion for your health visiting practice. 

We would love to her your thoughts and comments at iamahealthvisitor@gmail.com


Reading & Resources:
Alison's new book - 'Breastfeeding for Public Health: A resource for community healthcare professionals': 
https://www.amazon.co.uk/Breastfeeding-Public-Health-Healthcare-Professionals/dp/0367689561/ref=sr_1_2?crid=3M4VF06U18GP7&keywords=breastfeeding+for+public+health&qid=1652711900&sprefix=breastfeeding+for+p%2Caps%2C71&sr=8-2 

World Breastfeeding Trends Report:
https://www.worldbreastfeedingtrends.org/resources/publications

Becoming Breastfeeding Friendly with Yale University:
https://ysph.yale.edu/bfci/

Kathryn Stagg IBCLC: 
https://kathrynstaggibclc.com

Eve Canavan lived experience story:
https://www.app-network.org/news-events/news/personal-experiences/story-eves/

Breastfeeding for Public Health Professionals - with Alison Spiro

Amy and Jen take a dive into a recent research paper suggesting there may be a newly identified biomarker for infants at high risk of SIDS. We look at the recent paper in detail, review the statistics and the methodology and consider what we are able to say and what we are not, as well as possible harms that might come from misinterpretation of the results. 

We also discuss the article in the context of the current theoretical approaches to SIDS research and general safe sleep advice which importantly still needs to be followed. 

We love to hear from you. Contact us with suggestions or ideas for future episodes at iamahealthvisitor@gmail.com.

Thanks for listening, Amy and Jen

References and Resources for further reading: 

Harrington, Hafid & Waters 2022 - the full text article:
https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00222-5/fulltext

Media coverage: 
1. https://www.biospace.com/article/researchers-answer-how-and-why-infants-die-from-sids/?utm_content=207502735&utm_medium=social&utm_source=facebook&hss_channel=fbp-10530620221

2. https://www.theverge.com/2022/5/13/23071364/sids-research-hype-science-studies 

for context - there is so much about SIDS deaths we still do not understand:
https://www.nejm.org/doi/full/10.1056/NEJMp2119221

Critical analysis of the media hype:
https://www.theatlantic.com/health/archive/2022/05/sudden-infant-death-syndrome-cause-study/629886/

Lullaby trust statement about this article: 
https://www.lullabytrust.org.uk/our-response-to-new-australian-sids-biomarker-study/

Is there a new SIDs Biomarker?

Jen and Amy delve into the murky world of infant poo in the first six months! What to expect, what is a worry and what isn't. How is poo different between formula and breast or chestfed babies? Or mixed fed babies? What does that green poo mean? What about giving a bit of fruit juice or water for constipation? We answer all your questions and as usual it turns out to be more complicated than we imagined! 

Thanks to a listener for this request! 

Do get in touch with any questions, comments or suggestions for future episodes on iamahealthvisitor@gmail.com

Thanks for listening!
Amy and Jen 

Resources 

The baby poo gallery:
https://www.facebook.com/babypoogallery/

Philippa Pearson-Glaze IBCLC on green poo:
https://breastfeeding.support/why-is-my-babys-poop-green/

Drugs in Breastmilk Advice:
https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

Child Liver Disease on pale stools: 
https://www.childliverdisease.org/wp-content/uploads/2018/01/Yellow-Alert-Stool-Chart-Bookmark.pdf

Frequency of stool slowing - Carol Smythe IBCLC:
https://www.carolsmyth.co.uk/breastfeeding-resources/posts/2016/december/should-my-breastfed-baby-poo-every-day-or-is-breast-milk-all-used-up/

First Steps Nutrition: 
https://www.firststepsnutrition.org

Our previous episode on the Aptamil formula changes:
https://soundcloud.com/iamahealthvisitor/those-aptamil-formulation-changes

GP Infant Feeding Network on constipation:
https://gpifn.org.uk/constipation/

Infant poo under 6months - what's normal and what's not

This episode links really well with our previous episodes about combination feeding and giving top ups (linked in resources section below). In this episode Jen shares all her IBCLC wisdom with us on expressing breastmilk. How much do you know about flanges?! 

We talk about:
- when to express
- the emotional and physical load of pumping
- how to pump
- 'hands on' expressing 
- does the flange fit
- how much milk to expect

Resources and Further Reading: 

Our previous episode on Combination Feeding with Lucy Ruddle (IBCLC
and author of 'Mixed Up'):
https://soundcloud.com/iamahealthvisitor/combination-feeding-with-lucy-ruddle-ibclc?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing 

Our previous episode on Top Ups: 
https://soundcloud.com/iamahealthvisitor/top-ups-when-what-how-and-how-much-to-give?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing 

Breastfeeding twins and triplets charity (Kathryn Stagg IBCLC):
https://breastfeedingtwinsandtriplets.co.uk

Hand Expressing Video:
https://globalhealthmedia.org/videos/how-to-express-breastmilk/

Hands Free Pumping Bra Hack:
https://www.youtube.com/watch?v=8stY-2fxt4M

Flange Sizing: 
(see our instagram account 'IamaHV' for a visual)

Hands On Expressing: 
http://www.nancymohrbacher.com/articles/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html 
 
Some social media pages to follow and recommend for free resources:
Olivia - Hospital Lactation Consultant
https://www.instagram.com/olivia_lactation_consultant/?hl=en

Stacey Zimmel at Feed Eat Speak: 
https://www.instagram.com/feedeatspeak/

Kathryn Stagg IBCLC
https://www.instagram.com/kathrynstaggibclc/

All about Expressing Breastmilk

SO, who are we and what on earth is this podcast all about? 

In this episode we introduce each other, our backgrounds and interests and explain why we thought this podcast was needed. 

We would love for this podcast to be interactive, so please do get in touch! 

PLEASE SEND REQUESTS / SUGGESTIONS TO: iamahealthvisitor@gmail.com

Introduction to the Podcast - I Am A Health Visitor - Episode 1

Gastro-Oesophageal Reflux - It's something we all come across very regularly! What do health visitors need to know? How does assessment and advice differ for breastfed and bottle-fed babies? What are the red flags to rule out? What does the NICE guidance recommend as treatment? 

For more information check out the NICE Guidelines:
https://www.nice.org.uk/guidance/ng1/resources/gastrooesophageal-reflux-disease-in-children-and-young-people-diagnosis-and-management-pdf-51035086789

iHV Good Practice Guide:
https://ihv.org.uk/for-health-visitors/resources/good-practice-points/

We would love to hear from you! Comments or suggestions to iamahealthvisitor@gmail.com or tweet us @IamaHV 

Thanks for listening!

Reflux - Episode 4

This month the Institute of Health Visiting have updated their 'Good Practice Points' and 'Top Tips for Parents' on Umbilical Granulomas, continuing to recommend treatment with common table salt for umbilical granuloma. 

Health Visitors are well placed to identify these granulomas and advice parents on how to treat these, preventing unnecessary and potentially harmful treatment with silver nitrate. 

Jenny and Amy discuss what Health Visitors need to know to advise parents confidently on this, including the practicalities of how to apply the salt and common parent concerns with this. 

We would love to hear your thoughts or suggestions for future episodes. Email us at iamahealthvisitor@gmail.com

Thanks for listening!

iHV Top Tips for Parents: https://ihv.org.uk/wp-content/uploads/2017/11/iHV_PT_Understanding_Umbilical_Granuloma_26_9_2017_b-1.pdf

iHV Good Practice Points: file:///Users/richard/Downloads/iHV_GPP_Treatment_of_Umbilical-Granuloma_19_9_2017_b-1.pdf

Umbilical Granuloma: Treatment with Common Table Salt - Episode 6

Ho ho ho! Merry Christmas everyone! 

The festive season is here and with it comes everyone's favourite christmas present... bronchiolitis! 

Jenny and Amy discuss how to assess the babies on your caseload who have caught the dreaded RSV, when to signpost them to the GP and how to know when it's urgent enough to be sending them to A&E. 

We also discuss the progression of the illness and some encouraging words you can share with parents on your caseload who are exhausted with bronchiolitis at the moment. 

Have you ever heard of the bronchiolitis vaccine? Amy and Jenny tell you who is eligible and what the vaccine is all about.

Have a wonderful Christmas and a very happy new year from both of us. Eat plenty of mince pies and enjoy an extremely well deserved break. 

Feel proud of yourself for everything you have done to support children and families in 2017, you are all heroes. 

Further Reading: 
NHS Choices:
https://www.nhs.uk/conditions/bronchiolitis/

Bronchiolitis Vaccine - The Green Book: 
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/458469/Green_Book_Chapter_27a_v2_0W.PDF

Example of Work of Breathing in an infant: 
https://www.youtube.com/watch?v=bYso_Oz-35k
*PLEASE NOTE: we chose this clip because it is quite a good, natural example of what you are looking for on a child's chest, however the terminology is American. If you are a SCPHN in the UK then we usually refer to 'subcostal recession' and 'tracheal tug'.

Jingle Bells from: https://freesound.org/people/juskiddink/sounds/110158/

Bronchiolitis - Episode 7

Welcome back! Hope 2018 is looking exciting for all of you! 

This week Jen and Amy discuss Laryngomalacia and other conditions of the airway from a health visiting perspective. Find out what to look (and listen) out for in practice, what action to take and have the confidence to seek a further opinion when you need it! 

As ever, we welcome comments or suggestions to iamahealthvisitor@gmail.com

Thanks for listening! 

Further Information and Resources 
First YouTube Clip: 
https://www.youtube.com/watch?v=6f5H8OhIeVo&t=29s

Second YouTube Clip: 
https://www.youtube.com/watch?v=19zQv9ooFsI

Great Ormond Street Resource Sheets: http://www.gosh.nhs.uk/medical-information/tracheobronchomalacia

Laryngomalacia and Other Throaty Things - Episode 8

The lovely Alina joins us from ERIC - the children's wee and poo charity to talk all things bladder and bowel. In this episode we focus on toilet training, constipation and nighttime dryness. Alina gives us loads of really fabulous information based on her extensive experience as well as the latest research. For me to be honest, chatting with Alina was a bit like being on an episode of QI - everything you think you know is wrong!

Although lots of health visitors are now likely spending less time talking to parents about toilet training and our nursery nurse colleagues may be taking on more of this role, recording this chat reminded me just how complex and important these issues can be for families and I certainly learnt loads from Alina. 

We talk about lots of myth busting around common questions - when should parents start thinking about toilet training and how do you know the child is 'ready'? What is the first line treatment for constipation according to the NICE guidelines? Is dietary change the best solution?  You might be surprised by some of the answers, I certainly was!

We would love to hear from you with any suggestions or comments to iamahealthvisitor@gmail.com


Resources and further reading:

ERIC website and helpline: 
https://www.eric.org.uk/poo-and-wee

ERICs guide for children with additional needs: 
https://www.eric.org.uk/Handlers/Download.ashx?IDMF=9b1c4466-ef97-436f-ad8a-9d53ffddb6a9

ERIC resources and guides: 
https://www.eric.org.uk/guides-to-childrens-bowel-and-bladder-problems

Intake and Output chart to help parents know if their child is 'ready': 
https://www.eric.org.uk/pdf-intake-output-chart

ERICs 'Children who will only poo in a nappy and other toilet avoiders':
https://www.eric.org.uk/pdf-children-who-will-only-poo-in-a-nappy

ERICs guide to children's bowel problems: 
https://www.eric.org.uk/Handlers/Download.ashx?IDMF=d34eca57-7f98-48ec-a538-0ea08abe8c4c

NICE guidelines for childhood constipation: 
https://www.nice.org.uk/guidance/cg99

ERIC Potty Training and Constipation

Jen and Amy are back in the first of a series of five brand new episodes! 

In this first episode we are looking at a proposed new 8-stage model of domestic abuse published earlier this year by Dr Jane Monckton-Smith of Gloucester University. Dr Monckton-Smith has produced an excellent summary video explaining the 8 stages if you would like to see her talking through the model - link is below. 

We talk about the utility of this model in practice, compare it with other tools we are currently seeing, including the DASH, and also discuss the portrayal of intimate partner violence in UK media and how this may impact on perpetrator and victims as well as us professionals.

As ever we would love to hear from you, email us at iamahealthvisitor@gmail.com

Thank-you and we hope you enjoy this new series! 
Amy and Jen


References and further reading: 

BBC News article summarising 8-stage model:
https://www.bbc.co.uk/news/uk-49481998


Original article (Monckton-Smith 2019)
Intimate Partner Femicide: Using Foucauldian Analysis to Track an Eight Stage Progression to Homicide
https://journals.sagepub.com/doi/pdf/10.1177/1077801219863876


Video explaining the model by Probation Service and Dr Jane Monckton Smith 
http://eprints.glos.ac.uk/7010/1/7010%20Monckton-Smith%20National%20Probation%20Service%20film.mp4


DASH risk assessment checklist: 
https://www.dashriskchecklist.co.uk/


Almond, McManus, Brian & Merrington 2017
Demonstrates that individual questions on DASH not independently predictive of reoffending. 
https://www.emerald.com/insight/content/doi/10.1108/JACPR-01-2016-0211/full/html


Turner, Medina & Brown 2019
DASH little better than random at predicting high risk cases 
https://academic.oup.com/bjc/article/59/5/1013/5518314


Challenging the dominant discourse around domestic abuse in the media: Luke and Ryan Hart
https://www.cocoawareness.co.uk/

“he just snapped” media representations
https://www.tandfonline.com/doi/abs/10.1080/1461670X.2017.1350117

Smoke and Mirrors: U.K. Newspaper Representations of Intimate Partner Domestic Violence
https://journals.sagepub.com/doi/full/10.1177/1077801216634468

New paper proposing 8-stage model of Domestic Homicide

Amy and Jen discuss the efficacy (and what that percentage ACTUALLY means, in terms of the stats), safety and mechanisms of the three vaccines currently approved for use in the UK at the time of recording - The Oxford-AstraZenaca, Moderna-NIAID and the BioNtech-Pfizer. 

We also talk about some worries that either you might be having about these vaccines or that you might come across from families in your practice over the next few weeks and months. 

As ever, fear is born of a lack of understanding. Some of this science is new, but despite that there is much we do know and much that we can say with confidence. 

If you have a worry we have not covered - we want to hear from you. Please don't be shy - if you have thought it there will certainly be plenty of others worrying the same things. Questioning and thinking about these things demonstrates that we are scientifically minded and keen to interrogate the data. So speak up and we can work it out together as a community. Email us at iamahealthvisitor@gmail.com.

Thankyou for all your incredible work, both inside and outside of a pandemic. Health visitors are superheroes. 

Amy and Jen xxx

*Please note* There is now additional information to this episode also available which answers listener questions on fertility and conception, allergy and anaphylaxis and having the vaccine after having already had COVID-19. This is available in your podcast feed so please do check it out if it might be helpful for you.
 
Resources and Further Reading: 

COVID19 chapter in the Green Book: 
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948757/Greenbook_chapter_14a_v4.pdf

Clear explanation on different types of vaccines and how they work:
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html

The Oxford-AstraZenaca Trial Data: 
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1

The Pfeizer-BioNTech Trial Data: 
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2034577?articleTools=true

The Moderna-NIAID Trial Data: 
https://www.nejm.org/doi/full/10.1056/NEJMoa2035389

Drugs in Breastmilk Service (Breastfeeding Network) Info on the COVID vaccines: 
https://www.breastfeedingnetwork.org.uk/coronavirus/

WHO guidance on pregnancy and COVID: 
https://www.who.int/news/item/01-09-2020-new-research-helps-to-increase-understanding-of-the-impact-of-covid-19-for-pregnant-women-and-their-babies

November 2020 BMJ study of COVID in pregnancy:
https://www.bmj.com/content/370/bmj.m3320

Panorama BBC episode ‘the race for a vaccine’. 
https://www.bbc.co.uk/iplayer/episode/m000qdzd/panorama-the-race-for-a-vaccine

E-Learning for Healthcare: 
https://www.e-lfh.org.uk/programmes/covid-19-vaccination/

Oxford Vaccine Group FAQs: 
https://www.research.ox.ac.uk/Article/2020-12-30-oxford-vaccine-regulatory-faq

WHO description of how vaccines work: 
https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work?utm_source=facebook&utm_medium=landingpageviews&utm_campaign=vaccinebls&fbclid=IwAR1H5aAE-KZTfzLrEqzkxKQAH4BDd-UsFo_BcH4dP3C67CifXkQJwBy3LB0

Interesting discussion on vaccine hesitancy: 
https://www.ox.ac.uk/news/science-blog/covid-19-vaccine-hesitancy-uk

COVID-19 Vaccines - The Facts

We chat to Rachael about her wonderful book "Handle with Care: Confessions of an NHS Health Visitor". It was so easy and wonderful to talk about her journey to writing the book, as well as all the daily challenges of health visiting in the current climate, chronic underfunding, poor understanding and valuing of the health visiting role and increased pressure on health visitors.

We hope you feel heard and understood listening to this - you are doing such a wonderful job.

"Handle With Care: Confessions of an NHS Health Visitor" with author Rachael Hearson

Jen and Amy do a 'small but mighty' overview of Infantile Sebhorric Dermatitis, otherwise known as Cradle Cap! Something we all see in clinic and at 6-8week checks, but do we actually know what the evidence base is for the advice we give? 

What actually causes the sebaceous glands to excrete excessive oils causing the scaley rash which can be so distressing to parents? What (if anything) can we or should we do about it? What advice or reassurance can we give to parents on this? 

As ever, we love to hear from you with any comments on this episode or requests for other episodes on iamahealthvisitor@gmail.com

References and Further Reading: 
Cochrane Review:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011380.pub2/full

iHV parents information sheet:
https://ihv.org.uk/wp-content/uploads/2015/10/22-PT_Cradle-Cap_V4.pdf

NHS Choices page
https://www.nhs.uk/conditions/cradle-cap/
- however be aware this page still advises olive oil so is outdated advice.

Cradle Cap

Amy and Jen take a deep, deep dive into the muddy murky world of "Cry It Out" or "Extinction" sleep techniques. Put on your wellies and join us!

We talk about the research groups and individual studies which have looked at these techniques with our usual critical eye. Attempting to keep our personal feelings out of the objective assessment of the research; nevertheless we still concluded that there is a substantial body of evidence which suggests CIO sleep techniques should not be recommended by health visitors. In the episode we take a closer look at the studies suggesting it is harmless and discuss why these are flawed and why we have come to a different conclusion. 

We will also talk about possible alternatives for health visitors who are reaching for some sort of intervention to support parents who feel they are at their 'wits end' in terms of sleep and those suffering with mental illness which may be exacerbated by a lack of sleep.

Hopefully, we leave you with some possible avenues to explore with families as well as getting into the sleep debate in a meaningful way. 

As always, we love to hear from you so drop us an email on iamahealthvisitor@gmail.com to chat with us. 

Thanks 
Amy and Jen

Resources and Further Reading: 

Honakar et al 2018
https://scholarworks.iupui.edu/bitstream/handle/1805/18975/Honaker_2018_real.pdf?sequence=1&isAllowed=n
Accessed 30.11.2020

The news furore recently caused by Bilgin & Wolke 2020
https://www.theguardian.com/lifeandstyle/2020/mar/11/leaving-babies-to-cry-does-no-harm-study-finds?CMP=Share_iOSApp_Other
Accessed 30.11.2020

Bilgin & Wolke 2020
https://sovendeboern.dk/wp-content/uploads/2020/06/Bilgin-og-Wolke-2020.pdf
Accessed 30.11.2020Accessed 30.11.2020

Lindsey Hookway 2020 statement - an IBCLC critique and response to the Bilgin & Wolke study.
https://feedsleepbond.com/response-to-bilgin-and-wolke-cry-it-out-study/
Accessed 30.11.2020

Tronnick Still Face Phenomenon Video example:
https://www.youtube.com/watch?v=apzXGEbZht0&list=PLpCQJ8MCxYM7yJXB2vcib0ai-4PZ4TlBL&index=12
Accessed 30.11.2020

Middlemiss et al 2012 - Cortisol and Asynchrony
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.671.2134&rep=rep1&type=pdf
Accessed 30.11.2020

Hiscock et al 2007 - Cluster Randomised Trial of CIO intervention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083609/

Price et al 2012 - five year follow up
https://www.researchgate.net/profile/Anna_Price5/publication/230830539_Five-Year_Follow-up_of_Harms_and_Benefits_of_Behavioral_Infant_Sleep_Intervention_Randomized_Trial/links/54d9d57c0cf24647581f8c21/Five-Year-Follow-up-of-Harms-and-Benefits-of-Behavioral-Infant-Sleep-Intervention-Randomized-Trial.pdf

Middlemiss and colleagues - commentaries on Hiscock et al 2007 follow up Price at al 2012
https://pediatrics.aappublications.org/content/130/4/643/tab-e-letters#unethical-and-unscientific-conclusions-ignore-how-infants-are-harmed

Rudzik, Smith & Ball 2018 - Parent's reported infant sleep against actigraphy data:
https://pubmed.ncbi.nlm.nih.gov/30097331/

Douglas & Hill 2013
Review CIO (0-6m) found no improved sleep outcomes.
https://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf

Ball et al 2020 - "Sleep, Baby and you"
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237240
A proposed possible alternative to CIO - new, awaiting full validation. Proposes balance between meeting parents sleep needs and infant needs. 

Durham Infant Sleep Lab: 
https://www.dur.ac.uk/disc/projects/current/slb/

Middlemiss et al 2017
Second proposed alternative - increased total sleep time but no crying. Teaching responsive soothing and cues based methods.
https://static1.squarespace.com/static/5666b428dc5cb462d9f1e05a/t/5905be69725e256add1604d2/1493548654959/Early+Human+development+2017.pdf

Why not to "Cry It Out" : The research on extinction sleep techniques

Jenny and Amy chat to the lovely Stella Parkin from the Lullaby Trust. In a really broad and interesting interview Stella shares with us lots of information and guidance for health visitors on having informed, non judgemental and helpful conversations with parents and caregivers about SIDs and safe sleep and how to support a family in reducing the risk to their baby on any given sleep occasion. 

We also chat about the upcoming Safe Sleep Week starting next week on the 15th March and the theme of that week this year which is dads and coparents. 

Finally, we end with a brief overview of the wonderful CONI scheme - what it involves, how it operates and the rationale behind it. 

Feel free to email us with questions or comments at iamahealthvisitor@gmail.com, we love to hear from you

Resources and Further Reading: 

Lullaby Trust Webpages: 
https://www.lullabytrust.org.uk

Training joint with Basis: 
https://www.lullabytrust.org.uk/professionals/sids-training/

CONI scheme: 
https://www.lullabytrust.org.uk/professionals/care-of-next-infant/

Baby Check App by the Lullaby Trust: 
https://www.lullabytrust.org.uk/safer-sleep-advice/baby-check-app/

Lullaby Trust - SIDs and the CONI scheme

Welcome!
 
We are Health Visitors in the UK and this podcast is for other Health Visitors, parents or anyone who works with families from antenatal to 5yrs. In each episode we chat about professional issues, common practice questions and cutting edge research to keep your knowledge current. We've done the reading and we'll discuss it together over a cup of tea, giving you the concise headlines you need to know to feel confident and prepared.
 
PLEASE SEND REQUESTS / TOPIC SUGGESTIONS TO: iamahealthvisitor@gmail.com

Facebook: https://www.facebook.com/I-am-a-Health-Visitor-1732845000342774/
 
Twitter: @iamaHV

Thanks for listening!
Jenny & Amy

I am a Health Visitor

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