Paediatric Pearls

This service, for parents who are anxious about their relationship with their baby and/or child under 3, resides within North East London NHS Foundation Trust and serves Redbridge, Waltham Forest, Barking and Dagenham and Havering communities.

The PPIMHS teams are made up of psychiatrists, community mental health practitioners and psychotherapists/psychologists and they accept referrals from Health Visitors, GPs, midwives, Children’s Centres workers or other health professionals.  Click here for their referral form.  They may signpost elsewhere after the initial consultation if appropriate or they will offer the parent/carer and infant/child 9-12 sessions to work on the parent-infant relationship.

Groups particularly at risk of having problems with bonding include families with ex-premature babies who have spent a significant amount of time on the Special Care Baby Unit, those where the baby has feeding issues or is difficult to soothe, those where breastfeeding failed to establish and those where there was a traumatic birth or difficult conception and/or pregnancy.  Many of the parents on their case load have a personal history of disturbed attachments and are keen not to let history repeat itself.  A recent audit showed that 41% of their mothers had some sort of mental health diagnosis which means that 59% did not.  Click here for an information leaflet about their service that you might like to give to your patients.

Mums with postnatal depression or post-partum psychosis should be referred directly to a perinatal psychiatrist rather than PPIMHS.  Parents struggling with a crying baby or fussy toddler but with no bonding issues should be referred to their health visitor.  The PPIMHS team is a tier 3 (specialised) service concentrating primarily on the parent-infant relationship.

Symptoms in the baby that might suggest a bonding problem:

extreme clingy behaviours, fussy, difficult to soothe, abnormal self-soothing behaviours (eg. head-banging, hair-pulling, scratching), excessive sleep problems, extreme feeding problems, lack of verbal and non-verbal communication, stiff or floppy posture, extreme fearfulness or watchfulness, lack of interest in the world, no comfort sought from parents, avoids eye contact with parents, smiles very little.

Symptoms in the parent:

high anxiety and panic about the baby, excessive A and E or GP presentations, feeling frightened of harming the baby, lack of separation between parent and baby, baby never put down, excessive sterilising of bottles and toys, detached feelings about the baby, no pride in their development, anger about baby as if baby intends to upset the parent, feelings of failure as a parent, inability to cope.

There is some evidence around this issue and around maternal stress during pregnancy and the effect of high maternal cortisol levels on the foetus’ developing brain.  I have asked the Waltham Forest PPIMHS psychologists to write a bit about that and correct anything I have written about their service!

This is the first time in ages I’ve managed to get the finalised version on line in time for the end of the month!  NICE on autism this month, a bit on the use of corticosteroids in croup with help from the Cochrane Library, update on secondary prevention of meningococcal disease and a pointer to our local educational psychologist service which is hoping to make stronger links with the borough’s GPs (see also below).  Our feeding series continues with an article on colic from one of the junior paediatricians with lots of useful links and updates.

Our local educational psychologists are running drop in sessions on the 3rd Wednesday of every month at their base in Leyton, E10.  The current flyer which includes contact details is here and sessions will be on-going in 2012 even if not listed here.  They tell me that they would be happy to run EP drop in sessions or parent workshops/training/support groups  at local GP surgeries and jointly with GPs or other medical colleagues  – GPs are welcome to contact them to discuss.  Their Urdu speaking colleague runs sessions in a local Mosque as well.

It is not unusual for us to see children in clinic with non-specific ailments who have been bereaved and are still trying to come to terms with their loss, sometimes years later.   I am sure it is not uncommon in General Practice either.  Whenever a child dies at my hospital I worry about how the siblings are going to feel.  Children experience death differently according to their age and stage.  There is some good advice on “Explaining death to children” and some other useful links at www.bbc.co.uk/health/emotional_health/bereavement/bereavement_childtalk.shtml.  www.childbereavement.org.uk/For/ForBereavedFamilies/SuggestedReadingandResources lists some very helpful reading material for all ages of bereaved people.

This month I have been across to the Margaret Centre at Whipps where our Psychological Support Service (PSS) is, to try and get a clearer idea of what sort of support there is in Waltham Forest for bereaved children and their families.

The Zig Zag Children’s Service accepts referrals from health professionals of children aged 3-11 in Waltham Forest with pre- and post-bereavement difficulties.  This would include children with a life-limiting illness themselves or those with a family member with a life-limiting illness as well as those who have been bereaved.    There is also a service for bereaved young people (11-17yr olds) and adults.  Contact the PSS on 0208 539 5592 or by post at The Margaret Centre, Whipps Cross Hospital, Whipps Cross Road, E11 1NR for further information.

They do not offer crisis counselling but there is no stipulated amount of time a family or individual has to wait before being offered an appointment.  In the ED we refer the family of a child who has died under our care to this service straight away, a letter is then sent to them suggesting that they ask their GP for a referral if they wish to make use of the child bereavement service.  You can download their referral forms here:

Referral form for adults and children

Extra, additional referral form for a child (3-11yrs)

Additional referral form for young person aged 12-17 years

You may be reading this from outside our region.  Nationally I can recommend the Child Bereavement Trust which is a UK charity supporting families when a child dies or is bereaved.  It also trains health professionals to deal with the effect that a bereavement has on a family and indeed on us, the health professionals.  http://www.bereavement.org.uk/home/html_index.asp?p=222 seems to have information on other bereavement services in London.  Do leave a comment below if you want to recommend any other services you are aware of.

Some of the Zig Zag staff have added comments below which I think all of us who come across bereaved families will find helpful.