One thing to be aware of is the levels of mercury in fish and ensure that children avoid fish with high levels of mercury.
This fish puree recipe from Little Foodies provides plenty of healthy fats for growing bodies with the avocado and salmon.
This is a simply recipe that involves cooking the fish with some lemon and olive oil in the oven wrapped in baking paper.
For a quick meal I simply spray fish fillets with olive oil and cook in the fry pan for a couple of minutes on each side.
Sushi is another healthy family favourite, try cooked tuna sushi or raw salmon and avocado.
Enter your name & email to download our guide to making baby's first fruit & veggie purees. It is also important to recognise that if a child is clearly ill, but you can find no abnormality of airway, breathing, circulation or conscious level, referral for a second opinion is still appropriate although it may be less urgent. Check HR, pulse volume and capillary refill (press on the skin over the sternum for 5 seconds – in a healthy child the blanched area will re-perfuse in less than 2 seconds). BP drops late in most conditions and, in itself, is of limited value as other signs should be present.
Features of meningitis such as neck stiffness or irritability (a child may be upset by being handled). If good response continue up to 10 puffs of nebulised ?2 agonist as needed (up to 4 hourly).
Around 3% of children between the age of 6 months and 5 years will have at least one convulsion triggered by fever rather than any underlying neurological pathology. Viral infection (eg upper respiratory tract infection, nonspecific viral illness, roseola, chickenpox etc), otitis media and tonsillitis are the underlying cause of 8590% of presentations.
If the parent or carer telephones, advise them to keep the child lying on his or her side in order to prevent inhalation of vomit. Could the fit be the result of some other condition requiring urgent treatment such as hypoglycaemia (check BM), drug overdose, encephalitis or head injury?
In general, a child in supportive circumstances who has a single febrile convulsion can be managed at home. These occur in around 3% of children between 6m and 5 years and are triggered by a fever  rather than any underling neurological illness such as epilepsy. 95% of cases are caused by common infections such as  viral URTIs and illness, chicken pox, otitis media, and tonsillitis. Witnessing a child have a seizure can be frightening for a parent, reassurance and education will help alleviate some of the parents concerns.
Children who present with a febrile seizure and a family history of epilepsy or underlying neurological conditions such as cerebal palsy should be further investigated as the cause of the seizure may not be the fever, as these children are more likely to have recurrent seizures or epilepsy.
The vast majority of children recover completely even if they have more than one febrile seizure. The use of antipyretic agents should be considered in children with fever who appear distressed or unwell. Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.
An other wise well child over 18m may who has made a full recovery after a first febrile seizure  may be managed at home if parents are happy and there are no worrying features. While the child is restrained there will be an opportunity to check the cornea for abrasions or foreign bodies; treatment for this may be given immediately. Specifically ask about social smile, are they moving their eyes to follow things and startling to loud noises? It’s a systematic check but you can do the component parts in any order, as with all paediatric examinations auscultate the heart while they’re settled, before undressing if necessary. Ortolanis test for hip that is already dislocated the hips and knees are flexed with examiners middle finger over the greater trochanter and thumb along the medial femur.

Coagulation may be prolonged secondary to vitamin K deficiency, particularly in breastfed babies not given vitamin K at birth.
Langerhans’ cell histiocytosis commonly presents in the third month of life with persistent intertrigo. Candidal infection — sharply marginated redness around the perianal skin, which may involve the perineum.
The nappy should remain off for as long as possible each day and allow the baby’s bottom to air dry as much as possible.
A water repellent emollient or barrier preparation should be used with each nappy change; a pharmacist can advise about suitable nappy rash creams. If disposable nappies are used, choose those that are made with materials that lock wetness inside the nappy and away from the skin.
Patient information: Change nappies frequently and whenever possible leave the affected area exposed to the air. Bright red, sharply demarcated rash that is commonly misdiagnosed and treated as a fungal infection. Perianal pain and itching are common and blood-streaked stools occur in up to a third of cases.
Caused by a disorder in the production of sebum from glands in the skin of the scalp eyebrows, ears, and nasolabial folds. Thick crusts on a baby’s scalp can be removed by soaking them with baby oil for 20-30 minutes every day. Attacks tend to occur in the early everling when, without any clear reason, the child begins to cry inconsolably, bends the knees and pulls the legs up towards the abdomen, seems to be in pain, and may pass wind. A babies only way of communicating and usually an expression of unmet need – hunger thirst discomfort or need for more physical contact. If feeding weight gain and overall health OK parents can be reassured wil settle at 3-4 months.
Excessive air swallowing may be due to blocked teat or excesive milk secretion in first few minutes. Sedatives can be used as a short-term measure, but they don’t solve the problem in the long run and often they can have the side-effects of making the child drowsy the following day or have the paradoxical effect of making them hyperactive. Follow a regular routine leading up to bedtime and put the child to bed at a consistent time.
Alternatively you can choose to sit quietly at the bedside of the child until they start to fall asleep. Decide on a length of time to leave the child crying for before you attend to them and the length of time depends on how tolerant the parent is and how genuinely upset the child becomes. After the allotted time has passed then go to the toddler room, lift, cuddle and comfort until the loud upset crying turns to sobs and eventually sniffles. In this method the child knows that the comfort is always there and they are not left to cry for hours in fear alone, but they soon learn that it is not readily available and you won’t rush to their every whimper and demand and that it isn’t worth all the effort.
In infants up to 5 months old, constipation is usually related to the composition of the milk. Fish that contains high levels of mercury include shark, orange roughy, swordfish and ling. You can puree a serve for young babies, add additional milk to get a smooth, creamy consistency. Heat a tin of chopped tomatoes in a saucepan, add some peeled green prawns and stir until the prawns are cooked through. I serve with a squeeze of lemon, a little mayonnaise and some homemade baked potato and sweet potato fries.
Intermittent wheezing attacks are usually due to viral infection and the response to asthma medication is inconsistent.
Normal PEF values in children correlate best with height; with increasing age, larger differences occur between the sexes.

Refer urgently a child with signs of obstruction epiglottitis is one instance where the GP should accompany the child to Casualty.
Treatment of croup is steam inhalation, sitting the child in a bathroom full of steam or boiling a kettle in the bedroom. Convulsions usually occur at the beginning of the febrile illness and are more likely if the temperature rise is rapid. Other possible causes include urinary tract infection, gastroenteritis, lower respiratory tract infection, meningitis, and immunisation.
It is particularly important to check for the possibility of acute bacterial meningitis, UTI or septicaemia. They typically occur at the outset of the fever, particularly when rising rapidly or spiking.
Antipyretic agents should not routinely be used with the sole aim of reducing body temperature in children with fever who are otherwise well. Foundation stage profile (teacher) physical, emotional, social creative development language and literacy.
It is more common in premature infants and is associated with dermatitis around the mouth and erosive lesions of the nails and palmar creases.
If there is no improvement after 7 days return to your doctor; if there is an improvement, continue using this cream for up to 14 days.
It has been shown that in children who wake in the middle of the night where comfort is not readily available, generally decide it is easier to settle themselves back to sleep without making much of a fuss.
Fish that contain low levels of mercury include salmon, bream, rainbow trout, ocean trout, flathead, kingfish and whiting as well as tinned tuna and shellfish. The cheese sauce gives a delicious flavour and I always feel I am earning lots of “good mummy points” for feeding my children fish and spinach! I also find pasta freezes and reheats well so I store leftovers in individual serves in Littlelock glass containers and freeze them for a quick meal another day. This is also a great meal for babies that like to feed themselves, flake the fish for them and ensure there are no bones and then leave them to it. Measure ONE ‘fingertip unit’ by squeezing the cream in a line from the tip of an adult’s index finger to the first crease in the finger. Keep repeating this process each time the child reappears and make sure both parents do the same to show a united front. If they lie quietly then you stay, but once they start to climb out of bed or question then leave decisively.
The child may be quite taken aback that the parents has dared to leave and likely will immediately start to cry again in protest.
Authorities advise “small fish for small children” because smaller fish have less mercury than larger fish. Then I simply take out of the freezer and put straight into the oven for a quick and healthy mid week dinner. Instead ease them down by giving them bath, talking to them quietly and gently, tucking them in bed, giving them a cuddle, reading a bed time story.
This time leave the child to cry 2mins longer than the last time and repeat the same procedure and continue adding on 2mins and increasing the time you take attend to the child.
Follow the same routine each night and after a couple of days to weeks , they should soon notice a different.

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