Body image - tips for parents

There are many ways that parents can foster positive body image and strong self-esteem in their children. If you are at all concerned about your child’s body image, self-esteem or eating behaviours, consult with your doctor for information and referral.

Your body image is how you think and feel about your body, and what you imagine it looks like. This may have nothing to do with your actual appearance. Poor body image can have a range of negative effects, including disordered eating, depression, anxiety and low self-esteem.

Relationships and career choices can be seriously affected by low self-esteem. Feeling embarrassed about physical appearance can cause some people to stop exercising, because they don’t want other people to see their bodies. A sedentary lifestyle leads to a host of health problems including increased risk of obesity and heart disease.

Be a good role model
The most influential role model in your child’s life is you. Parents can encourage their children to feel good about themselves by showing them how it’s done. For example:

Get them into the exercise habit
Studies show that a person who appreciates what their body can do, rather than what it looks like, feels good about their body and tends to have higher self-esteem. Suggestions include:

• Make your family an active one. Exercise yourself and encourage your child from an early age to exercise right along with you. For example, take little ones for strolls in the pram. Once they’re old enough, encourage them to walk part of the way.
• Emphasise fitness, health and enjoyment as the motivations for exercise rather than weight loss or weight management.
• Try to find a team sport they enjoy. Team sports encourage camaraderie, teamwork, competition and mastery of physical skills. A child who feels passionate about their sport is more likely to continue playing into adulthood.
• Regular exercise helps to maintain a healthy body weight. A known trigger of poor body image is being overweight.
• Be cautious of sports that have a strong emphasis on thinness - for example, gymnastics and ballet. Vulnerable children may feel pressured to lose weight.

Help them feel confident about themselves
A strong sense of identity and self-worth are crucial to your child’s self-esteem. Suggestions include:

• Encourage problem solving, expression of opinions and individuality.
• Teach your child various coping strategies to help them deal with life’s challenges.
• Allow them to say ‘no’. Encourage them to be assertive if they feel they have been mistreated.
• Listen to their concerns about body shape and appearance. Puberty, in particular, can be a worrying time. Reassure your child that their physical changes are normal and that everyone develops at different times and rates.
• Don’t tease them about their weight, body shape or looks. Even seemingly friendly nicknames can be hurtful if they focus on some aspect of the child’s appearance.
• Place value on their achievements, such as talents, skills and school grades.
• Make your child feel they have an important role in the family; for example, give them age-appropriate household tasks. Tell them what a valuable contribution they make to the running of the house.

Talk to your school
Your child’s school can be a positive environment that fosters healthy body image and self-esteem. Talk to your principal about any concerns you may have. Issues may include:

• Teasing about physical appearance is a known risk factor for poor body image. Make sure your school has an effective anti-bullying policy. If your child is being teased, contact the principal immediately.
• Peer pressure can contribute to poor body image if the peer group is concerned with physical appearance and thinness. Talk to the school about their body image programs.
• If you think your child is hanging out with a ‘thin is in’ crowd, try to arrange opportunities for them to mix with other children. Once again, team sports could be a valuable avenue, since the emphasis is on how the person plays, not what they look like.
• Self-conscious students may shy away from school sports because of the uniforms. If necessary, consult with your school on possible changes to make the sports uniforms less revealing or figure-hugging.

Eczema                     

Published by Bupa's health information team, October 2005

This factsheet is for people, or parents of children, who have atopic eczema.

Eczema, also known as dermatitis, describes a group of skin conditions where the skin is irritated or inflamed. There are many different types of eczema - the most common is atopic eczema (also called endogenous eczema). About 1 in 6 children get atopic eczema in the UK, but most grow out of it by their teens. However for some people, it can continue into adulthood.

What is eczema?                                                                              

There are various types of eczema, with slightly different causes and symptoms. This factsheet will focus on atopic eczema but the other types are described below.

Allergic contact eczema

Also called exogenous eczema, allergic contact eczema develops when substances or chemicals irritate the skin and cause an allergic reaction. The rash usually starts at the site of contact with the substance, but may then spread to other areas.

Irritant contact eczema

Irritant contact eczema is similar to allergic contact eczema and is caused by frequent contact with everyday substances such as detergents in toiletries or cleaning products.

Seborrhoeic eczema

Seborrhoeic eczema is common in babies under one, although adults can get it too. The rash is greasy and it usually starts on the scalp (this is sometimes called cradle cap in babies) and can then spread to other areas. It usually clears up in babies by the time they are one but can go on for a number of years in adults.

Varicose eczema

Varicose eczema (also known as gravitational or stasis eczema) is found in older people. It occurs on the lower legs and is associated with varicose veins and poor circulation.

Discoid eczema

Discoid eczema affects the arms and legs. It occurs in round scaly patches and is incredibly itchy. Discoid eczema is most common in middle-aged men.

Eczema symptoms

The symptoms of eczema vary depending on the type. Atopic eczema symptoms include:

• red skin
• dry skin
• itchy skin
• small water blisters on the skin, particularly on the hands and feet - or the skin can become wet and weepy if it gets infected
• scaly areas of skin in places that are scratched frequently - this is known as lichenification

Atopic eczema usually affects the backs of the knees and the front of the elbows as well as the chest, face and neck.

Causes

You cannot catch eczema. It does not spread from one person to another.

The exact cause of atopic eczema isn't fully understood at present. People do have a genetic, or inherited, tendency to develop the condition however. Atopy means a family tendency to a variety of allergic conditions, including asthma, hay fever and eczema.

Sometimes, the symptoms "flare up" for no obvious reason. But you may notice certain triggers that set off your, or your child's, eczema including:

• chemicals, detergents, soap or shampoo
• inhaled irritants such as pollen or house dust mites
• infections with bacteria or viruses
• certain foods in people that have food allergies, although this is quite rare
• dry skin
• being "run down", if you are ill with a cold, for example
• changes in hormone levels - eczema can be worse in women before their monthly period
• stress

Diagnosis

Your GP will ask you about your symptoms and examine your, or your child's, skin. Your doctor may also rub a sterile cotton bud on the skin to check for infections.

Most people with atopic eczema are treated by their GP but you may be referred to a specialist.

Treatment

Atopic eczema cannot be cured. Treatments aim to control the symptoms.

Home treatment

There are a number of over-the-counter remedies available from pharmacies to treat eczema including those below. Ask your doctor or pharmacist for advice on which treatment to use.

• Emollients are moisturisers which soothe, smooth and add water to (hydrate) the skin. They are the most common treatment and should be used every day even if you do not have eczema symptoms. Examples include aqueous cream and E45 cream. You can apply emollients directly to your skin as lotions, creams or ointments. A good time to apply them is just after a bath, while your skin is still slightly moist. Oils or washes are also available, which you can use in the shower or add to a bath.
• Mild steroid creams, such as hydrocortisone (eg Dermacort or Lanacort) can calm flare-ups of eczema by suppressing your body's inflammatory response. You should ask the pharmacist's advice or see your GP before using any steroid cream. The stronger steroids are only available on prescription (see below). You should continue to use emollients at the same time as steroid creams.

Prescription drug treatments

If emollients and mild steroids don't treat your condition, there are a range of other treatment options that your doctor can prescribe.

• Stronger steroid creams, such as betamethasone (eg Betnovate) are available on prescription. You should apply them sparingly and use the mildest cream that works as steroids may have side-effects. If you use a strong steroid for too long or on a delicate area of skin such as the face and armpits, it can thin the skin. This can make the skin more fragile leading to blemishes, wrinkles or visible small blood vessels. You should see your doctor for regular check-ups to prevent this happening and follow their advice or that of a pharmacist or nurse.
• Oral steroids, such as prednisolone, are available as tablets to treat severe eczema. They are only used for short periods of time (typically a course of up to a week).
• Immunosuppressant tablets, such as azathioprine or ciclosporin, are prescribed for severe eczema. They can have severe side-effects so you should not take them for long periods - ask your doctor for more information.
• Topical immunosuppressants are creams or lotions that you apply to your skin to reduce inflammation. They may be prescribed to you if other treatments have not worked or you cannot use them due to side-effects. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). These are new treatments that do not contain steroids so they may have less side-effects but the long-term safety has not been evaluated.
• Antibiotics, such as flucloxacillin or erythromycin, will be prescribed if your, or your child's skin is infected.
• Antihistamine tablets can help people with eczema to sleep, but they are unlikely to ease itching.

Hospital treatment

• If your, or your child's, eczema is severe you may need hospital treatment. This will remove you from the environment that may be triggering your symptoms and the hospital staff will ensure that you are taking your treatments correctly.
• If your, or your child's, skin is infected with a herpes simplex infection, antiviral treatment will be given to you in hospital.
• For some people with eczema, ultra violet light treatment is helpful. This is usually given in hospital by a specialist.

Complementary treatments

Some people find that complementary treatments such as herbal creams and homeopathy are helpful, although there is no firm scientific evidence for this.

Chinese herbal medicines may also help, but the active ingredients are poorly understood. Also, information about the quality and safety of the preparations is hard to obtain and side-effects such as liver damage have been reported.

If you use additional creams on your skin, you should use reputable brands and tell your doctor about these as well as other treatments you are taking.

Eczema management

Drug treatments are only part of the treatment for eczema. Eczema also needs to be managed by dealing with the things that make it worse.

Identifying and avoiding the things that trigger your, or your child's, eczema are an essential part of your overall treatment plan. Keeping a diary to record anything that triggers eczema can help you to discover a pattern.

If your, or your child's, eczema is triggered by certain foods you should ask your doctor for advice on how to deal with this. Excluding foods may not have any effect and can lead to a deficiency of essential nutrients, calcium or protein. It should only be considered for children under the supervision of a doctor or dietitian.

With good management and appropriate treatment, most people are able to control their atopic eczema

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD stands for Attention Deficit Hyperactivity Disorder. It is normally used to describe children who have three main kinds of problems:

What is ADHD?

We know that young children have lots of energy and like to be active. Young children also tend to have a short attention span - they soon get tired of an activity and want to move on to something new. So how can you tell whether your child has ADHD or is simply restless or bored? To a certain extent it may be a matter of degree - children with ADHD are not just very active but have a wide range of problem behaviours which can make them very difficult to care for and control.

Because they are overactive and impulsive, children with ADHD often find it difficult to fit in at school. They may also have problems getting on with other children. These difficulties can continue as they grow up, particularly if children and families do not get the help they need.

Some children have significant problems in concentration and attention, but are not necessarily overactive or impulsive. These children are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD. ADD can easily be missed because the child is quiet and dreamy rather than disruptive. ADHD is not related to intelligence. Children with all levels of ability can have ADHD.

Do children grow out of ADHD?

Some children do appear to grow out of ADHD although others have problems that continue into adolescence and beyond. Approximately two out of five children with ADHD continue to have difficulties at age 18. The main symptoms of ADHD, such as attention difficulties, may improve as children got older, but behavioural problems such as disobedience or aggression may become worse if children do not receive help. In particular, research has found that boys who are hyperactive and aggressive tend to become unpopular with other children. It is therefore very important for children to receive help as early as possible, to prevent them from developing other behaviour problems.

Does medication help?

Research studies have demonstrated clearly that stimulant medication can produce short-term benefits for many children with ADHD. Many parents have commented on the dramatic improvements which can occur. As children calm down they are able to mix better with others, and they can respond more effectively to teachers and parents. Children may become less aggressive as well as less hyperactive, and their performance at school may improve significantly.

One of the main concerns about using stimulant medication is that these drugs may be used too readily to deal with behaviour problems which are not due to ADHD at all. It is therefore important to understand what the drugs can achieve and what their limitations are. They should only be prescribed to children who are carefully assessed and who have received a professional diagnosis. Medication does not cure ADHD - but it can provide a ‘window of opportunity’ in which we can help children learn to manage their own behaviour.

How can you help? 

As a parent

If you are a parent of a child with ADHD you have a very important role to play in helping your child to gain control over their behaviour. But first of all you need to be reassured that ADHD is not your fault – you are not a ‘bad parent’. You can learn some specific ways of talking, playing and working with your child which have been shown to improve children’s attention and behaviour. (Of course these techniques can also be very helpful for other carers and friends, not just parents).

There are now a number of programmes run by professionals to help parents. Most of these programmes focus on ‘behaviour management’. This involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

As a teacher

If you are a teacher there are many ways in which you can organise your classroom, lessons and behaviour in order to help children with ADHD.  For example, arrange the classroom to minimise distractions, for example seating pupils with ADHD away from windows, avoiding the use of tables with groups of pupils.  Include a variety of activities during each lesson, alternating physical and sitting-down activities. Set short, achievable targets and give immediate rewards when the child completes the task.

Children and young people

If you are in distress, you are not alone. 1 in 5 young people experience a mental health problem in the course of a year. You may find it helpful to talk to a friend, your boyfriend or girlfriend or a relative about your problems if you do not want to speak to a parent. Or you may prefer to talk to someone else you trust like a teacher or faith leader.

You can seek help on your own by ringing a confidential helpline or by seeing a professional, but if you are under 16 a parent / carer’s consent is usually needed before you can get any medical care. You have a right to privacy if you do not want to tell anyone about your conversations with professionals. 

Good mental health 

The emotional wellbeing of children is just as important as their physical health. Good mental health allows children and young people to develop the resilience to cope with whatever life throws at them and grow into well-rounded, healthy adults. 

Things that can help keep children and young people mentally well include:

§ being in good physical health, eating a balanced diet and getting regular exercise

§ having time and the freedom to play, indoorsand outdoors

§ being part of a family that gets along well most of the time

§ going to a school that looks after the wellbeing of all its pupils

§ taking part in local activities for young people

Other factors are also important, including:

§ feeling loved, trusted, understood, valued and safe

§ being interested in life and having opportunities to enjoy themselves

§ being hopeful and optimistic

§ being able to learn and having opportunities to succeed

§ accepting who they are and recognising what they are good at

§ having a sense of belonging in their family, school and community

§ feeling they have some control over their own life

§ having the strength to cope when something is wrong (resilience) and the ability to solve problems

Most children grow up mentally healthy, but evidence suggests that more children and young people have problems with their mental health today than 30 years ago. That’s probably because of changes to the experience of growing up and to the way we live now.  

Dealing with change

The things that happen to children won’t usually lead to problems with their mental health on their own, but traumatic events can trigger problems for children and young people whose mental health is not already robust. Changes often act as triggers: moving home or school or the arrival of a new brother or sister, for example. Some children who start school feel excited about making new friends and doing new activities, but there may also be some who feel anxious about entering a new environment.

Teenagers often experience emotional turmoil as their minds and bodiesdevelop. An important part of growing up is working out and accepting who you are. Some young people find it hard to cope and may experiment with alcohol, drugs or other substances that can alter how they feel.

Risk factors

There are certain ‘risk factors’ that make some children and young people more likely to experience problems than other children, but they don’t necessarily mean difficulties are bound to come up or are even probable.

Some of these factors include:

§ having a long-term physical illness

§ having a parent who has had mental health problems, problems with alcohol or has been in trouble with the law

§ experiencing the death of someone close to them

§ having parents who separate or divorce

§ having been severely bullied or physically or sexually abused

§ living in poverty or being homeless

§ experiencing discrimination, perhaps because of their race, sexuality or religion

§ acting as a carer for a relative, taking on adult responsibilities

§ having long-standing educational difficulties

How parents can help

If parents have a warm, open relationship with their children, their children will usually feel able to tell them if they are troubled. One of the most important ways to help is to listen to them and take their feelings seriously. They may want a hug, they may want you to help them change something themselvesor they may want practical help.

Children and young people’s negative feelings usually pass. However, it’s a good idea to get help if your child is distressed for a long time, their negative feelings are stopping them from getting on with their lives, their distress is disrupting family life or they are repeatedly behaving in ways you would not expect at their age.

Types of mental health problem 

Some of the mental health problems that can affect children and young people are listed below.

Depression affects more children and young people today than in the last few decades, but it is still more common in adults. Teenagers are more likely to experience depression than young children who rarely face depression.

Self-harm is a very common problem among young people. It describes the different ways that people deliberately harm their bodies, to help them deal with intense emotional pain.

Children and young people with a generalised anxiety disorder become extremely worried. Very young children or children starting or moving school may have separation anxiety.

Post-traumatic stress disorder can follow physical or sexual abuse, witnessing something extremely frightening, being the victim of violence or severe bullying or living through a disaster.

Children who are consistently overactive (‘hyperactive'), behave impulsively and have difficulty paying attention may have Attention Deficit Hyperactivity Disorder (ADHD). Many more boys than girls are affected, but the cause of ADHD isn’t fully understood.

Eating disorders usually start in the teenage years andare more common in girls than boys. The number of young people who develop an eating disorder is small, but eating disorders such as anorexia nervosa and bulimia nervosa can have serious consequences for their physical health.

Professional help

If your child is having problems at school, a teacher, school nurse, school counsellor or educational psychologist may get in touch with you. Otherwise, go to your GP or speak to a health visitor. These professionals are able to refer a child to further help. Different professionals often work together in Child and Adolescent Mental Health Services (CAMHS).

Most support for children and young people who are troubled is provided free by the NHS, your child’s school or your local council’s social services department. In some parts of the country, there are long waiting lists for children and young people to see mental health specialists or to have a talking therapy on the NHS. Some people choose to pay for their children to have treatment.

Talking it through

Assessing and treating children and young people with mental health problems isn’t the same as for other health problems. There is more emphasis on talking and on understanding the problem to work out the best way to tackle it. For young children, this may be done through playing.

Most of the time, the action that professionals recommend is not complex. and it often involves the rest of the family. Your child may be referred to a specialist who is trained to help them explore their feelings and behaviour. This kind of treatment is called a talking therapy, psychological therapy or counselling.

Medication

More research has concentrated on the effect on adults of drugs for mental health problems than on children. Children and young people need to be assessed by a specialist before they are prescribed any drugs. There is a lot of evidence that talking therapies can be effective for children and young people, but drugs may be also be important in some cases.

Confidentiality

The professionals supporting your child will keep information about them and your family confidential. Young people can seek help on their own, either by ringing a helpline or by approaching a professional directly, but your consent is usually needed for them to get medical care if they are under 16. Young people have a right to privacy if they do not want to talk to you about their conversations with professionals, but you should still respond sensitively if they seem to be upset.