Children can be affected by a range of common health issues, such as head lice to sleep problems associated with excessive screen time. How can community pharmacy help and support worried parents?

Parents come to their local pharmacy for expert advice and reassurance on all aspects of children’s health, from how to manage a fever to looking after teeth or coping with asthma and allergies. It’s important for pharmacy staff to keep up to date with the latest parental concerns so they can advise and signpost families.

“Pharmacists are often the first port of call as parents can walk in without an appointment and get advice on treating their child,” says Andrew Gourlay, category manager at Careway pharmacy. “They are generally looking for the quickest, most efficacious treatment to solve their child’s problem. Pharmacy staff can help by asking the right questions.”

Sleep issues

Specialist hospital care for sleep disorders in children in England under 14 has tripled over the past 10 years, according to NHS data, and 10 times more prescriptions for sleep medication melatonin are being prescribed for children and adults. Poor sleep in children has been linked to obesity, diabetes, poor behaviour, impaired performance at school and mental health issues.

“Lack of sleep in children affects their emotional, mental and physical health,” says Vicki Dawson from The Children’s Sleep Charity. “It lowers immunity to infection, so they pick up more coughs and colds, and end up missing days of school. It affects weight and growth and there are strong links with anxiety and depression. Younger children who lack sleep become hyperactive and find it hard to concentrate. This affects school performance.”

A recent study by Ohio State University, Temple University Philadelphia and UCL found children who had a regular bedtime were less likely to be obese at age 11. Children with an as likely to be obese at age 11.

It’s not just irregular bedtimes that are causing sleep problems in our children. Use of smartphones, tablets and laptops before bed is thought to disrupt sleep. “These devices emit blue-tinged light, which suppresses production of melatonin,” says Professor Jim Horne, sleep neuroscientist and author of Sleeplessness: Assessing Sleep Need In Society Today. “This hormone is responsible for setting our body clock. But it’s also the excitement in your brain which screen activity causes, especially social media.”

Many experts recommend parents restrict use of all screens, including television, in the hour before bedtime. “But do this in a planned agreement with your child – just taking away the screen will result in an argument,” observes Professor Horne.

Ms Dawson advises swapping screens for activities that use hand-eye co-ordination, such as puzzles or colouring, before bed. “These can really help to calm and relax children,” she says. “We need to educate children and parents about sleep hygiene and screen usage and why sleep is so important for health.”

Consumption of sugary and caffeinated drinks throughout the day or in the evening can also disturb sleep. “Avoid these drinks during the day as well as evening, as caffeine has a half-life of three to four hours,” says Professor Horne. “Energy drinks should also be avoided.”

Children’s busy lives also contribute to their lack of sleep. “Often both parents work full time and children are at after-school clubs or other activities until late, so evenings tend to be busy rather than relaxing times,” says Ms Dawson.

Professor Horne stresses the importance of good sleep habits for children from an early age to establish good routines for life. “A baby’s body clock takes four to six months to establish,” he says. “It’s important from the early weeks to let them sleep in daylight and ideally not in their cot for day-time naps.

They need to associate their bedroom with night-time and sleep. A regular bedtime and allowing them to self-soothe to get to sleep are also important.”

Sleep tips for children

Pass on the following lifestyle advice to parents, to help their children to sleep well during the night.

• Try a banana and milk as a bedtime snack. Milk contains tryptophan and bananas include melatonin, which aid sleep
• Avoid sugary drinks in the evening
• Turn off all screens an hour before bedtime
• Avoid exercising just before bedtime
• Ensure the bedroom is dark and quiet
• Keep the bedroom temperature at 16°C to 18°C
• Stick to the same bedtime and wake-up time every day.

Market trends

It terms of value sales, paediatric analgesics takes the largest share of the total child health market at £84.2 million – including £26.6 million in multiples and £9.0 million in independent pharmacies – according to data from analysts IRI (52 w/e 15 Apr 17). The total head lice category is valued at £26.1 million.

It’s important to stock what parents are looking for, so we asked pharmacists what sells well in their pharmacies.

“Head lice treatments sell really well for us, especially during the summer and September,” says Lila Thakerar at Shaftesbury Pharmacy in Harrow. “GPs don’t tend to give out prescriptions for treatments now, and it’s hard for parents to get appointments quickly, so they tend to come to us instead. Vitamin supplements for children are very popular, as parents are concerned about their child having a balanced diet. They want vitamins that are chewable, pleasant tasting or liquid because compliance is important.”

Sarah Buchan, clinical pharmacist at Rowlands Pharmacy, says: “Child pain relief continues to drive sales within this category. We have seen an increase in own-brand sales in both GSL and P medicines in the past year. Customers are becoming savvier regarding active ingredients and the money they can save with own-brand, too.”

Stocking a core range of children’s products is key for success, says Ms Buchan. “We are seeing data that suggests shopper habits are changing and people are returning to the high street in search of the best deals.”

Mr Gourlay says pain relief continues to be their biggest sub-category in children’s health, with Calpol and Nurofen making up the majority of sales. “As a trend we have noticed that when cough and cold sales peak, children’s health products do, too,” he says.

Anne-Sophie Martin, healthcare senior brand manager at Church & Dwight for Sterimar, says: “A quarter of parents in the UK with children under two like to use natural alternatives. This means many parents not only want to know that products are effective, but are becoming more aware of the ingredients.”

According to Mintel’s Oral Care report (2016), most parents agree that baby teeth need as much attention as permanent teeth. However, more than half think brushing alone is enough and don’t see the need for flossing. Pharmacy staff can help by educating parents about the benefits of flossing and other forms of interdental care to help maintain their child’s oral health.

The research showed that parents still prefer branded dental care products for their children, with 51 per cent saying they’re more effective than own-label versions.

Pollution and children’s health

According to Asthma UK, two-thirds of people with asthma find poor air quality worsens their condition. Pollution is more of a risk for people with asthma or hayfever because the chemicals in traffic fumes irritate the airways, while the tiny particles found in dust, soot or diesel can cause inflammation in the lungs.

“Children are more vulnerable to the effects of pollution as they have developing airways,” says Amena Warner, head of clinical services at Allergy UK. “They’re also more active, running around outside more than adults, so therefore may be exposed to more pollution. We’re seeing more evidence that children who live in urban areas are more at risk of developing asthma. In built-up areas, pollen can build up because it isn’t able to escape easily when surrounded by tall buildings. This, combined with diesel pollution, makes for an allergenic mix and potentiates the effects on asthma and hayfever.”

Dr Andy Whittamore, Asthma UK’s in-house GP, agrees. “Being exposed long-term to high concentrations of air pollution may cause asthma in children and adults,” he says. “If you’re exposed to high levels of pollution when pregnant, your baby could be more likely to develop it. Particulates can cross through the placenta to the developing baby.”

Dr Whittamore says pharmacy staff can help by ensuring the effects of pollution are minimised for people with asthma. “Taking preventative medication as prescribed, having a written asthma plan and attending asthma reviews will help to reduce risk of symptoms and attacks,” he says.

Ms Warner stresses the importance of educating parents about recognition of and early treatment for hayfever, using nasal saline douching. “You can teach parents how to do this correctly and when to use it,” she says. “Also, recommend non-sedating, long-acting antihistamines so school performance isn’t affected. Nasal steroids are good for controlling inflammation, but many of the OTC ones aren’t suitable for children. Again, you can help by explaining how to use these well.”

Pollution can be more of a problem during summer, partly because of the added issue of pollen. “Thunderstorms are more common, too, and these have a direct effect on asthma,” says Ms Warner.

“A&E admissions for asthma attacks tend to spike after a thunderstorm. This is because the particles of mould spores and pollen become smaller during a storm and penetrate deeper into the lungs, causing more problems.”

Child poverty and health

One in five children in the UK lives in poverty, according to the Royal College of Paediatrics and Child Health’s State Of Child Health report. The UK ranks 15th out of 19 west European countries for infant mortality. Poorer children are experiencing much worse health than their more affluent peers.

Some 40 per cent of children in our most deprived areas are overweight or obese.
“Children living in the most deprived areas are much more likely to be in poor health, be overweight or obese, suffer from asthma, have poorly managed diabetes, experience mental health problems and die early,” says Professor Neena Modi, president of the RCPCH.

One in 10 to 11 children in the UK has asthma and we have one of the highest rates for hospital emergency admission and death for childhood asthma. It is also known that deprivation is strongly linked with emergency admission for asthma.

Improve your child health category

What can you do to highlight what is on offer to help with common childhood conditions?

“Make your category eye catching and easy to negotiate,” says Ms Thakerar. “Parents should be able to browse and find what they need without having to ask a member of staff. They should also be able to pick up packs and leaflets to find out more about products before they buy.”

A growing area that pharmacists could invest in is children’s skin conditions, she suggests. “We have lots of parents who come in and ask about dry skin, eczema and irritation in winter and rashes, heat rash and allergies in the summer months.”

Vitamin D is also an important sector for children’s health, she adds. “We often get asked about it. GPs tend to prescribe an initial six-week supply, but after that parents are advised to buy the supplement from their local pharmacy.”

“If possible, products could be grouped by ailment and put in age-suitable order,” suggests Ms Martin. “Another key grouping would be to put all the natural products together so they are easily identifiable.”

“Vaccination schedules and post-vaccination advice are an increasingly important part of our role,” says Ms Buchan.

“It is important that pharmacy teams can provide safe and accurate advice to parents. We provide private vaccination services, including meningitis B, for children who may have missed out on the NHS immunisation schedule. This is a potential growth area for pharmacies.”

“The range of children’s health products can be overwhelming, so it is important that opportunities to openconversations with parents are identified to put them at ease and develop their understanding of what it available,” advises Mr Gourlay.

“Reassurance that they are choosing the right product for their child’s needs is an important part of any purchase. Having specialist information available builds trust with customers and helps advise them on selecting the best product for their child,” he says.