Arnold House School

Head Lice and Nits 
Threadworm
Conjunctivitis
Impetigo
Chicken Pox

Head Lice and Nits
Head lice are common. They can usually be cleared with treatment.
What are head lice and nits?
• Head lice are tiny grey/brown insects. They are about the size of a sesame seed (the seeds on burger buns). Head lice cling to hairs, but stay close to the scalp which they feed off. Head lice lay eggs which hatch after 7-10 days. It takes about 10 days for a newly hatched louse to grow to an adult and start to lay eggs.
• Nits are the empty white egg shells which are left when the lice hatch. Nits look like dandruff, but stick strongly to hair. Unlike dandruff, you cannot easily brush out nits.
Who gets head lice?
Head lice are common in children, but can affect anyone of any age. They are not a sign of dirty hair or poor hygiene. Close 'hair to hair' contact is usually needed to pass lice on. Head lice cannot jump or fly, but walk from one head to another. They soon die when away from hair, and do not live in clothes, bedding, etc. Most head lice infections are caught from family or close friends who are not aware that they have head lice.
What are the problems with head lice?
Many people with head lice do not have any symptoms. An itchy scalp occurs in some cases. This is due to an allergy to the lice, not due to them biting. It often takes about three months for an itch to develop after you are infested with lice. Therefore, you may not notice that you have head lice for a while, and you may have passed them on to others for some time. Head lice and nits do not wash off with normal shampoo. Head lice do not cause any other medical problems. In many cases the head is not 'crawling with lice'. Commonly, there are less than 12 lice present..
How can you tell if you have head lice?
Head lice are difficult to find just by looking in the hair. If you suspect that your child (or you yourself) have head lice, it is best to do 'detection combing'. Some people advise that you do this to children's hair regularly, about once a week.

Detection combing:
• Wash the hair in the normal way with ordinary shampoo.
• Rinse out the shampoo and put on lots of ordinary conditioner.
• Comb the hair with a normal comb to get rid of tangles.
• When the hair is untangled switch to a detection comb. This is a special fine-toothed comb. (The teeth of normal combs are too far apart.) Some pharmacies stock detection combs. You can also get them by mail order from:
Community Hygiene Concern Tel: 020 7686 4321 Web: www.nits.net
• Slot the teeth of the comb into the hair at the roots so it is touching the scalp.
• Draw the detection comb through to the tips of the hair.
• Make sure that all parts of the hair are combed by working around the head.
• Check the comb for lice after each stroke. A magnifying glass may help.
• If you see any lice, clean the comb by wiping it on a tissue or rinse it before the next stroke.
• After the whole head has been combed, rinse out the conditioner.
• It takes about 15-60 minutes to do detection combing properly, depending on how thick and long the hair is.
What are the treatment options for head lice?
Treatment is needed only if you see one or more live lice. Nits (empty eggshells) do not always mean that you are infested with lice. Nits can stick to hair even when lice are gone (for example, after treatment that kills the lice).
Currently, there are three main ways of clearing head lice:
• Using an insecticide lotion.
• Using dimeticone lotion, a lotion that works in a different way to insecticides.
• Wet combing treatment (often called 'bug-busting').
The method you use to treat the lice is often a personal preference. Each method has a good chance of success, but no method is 100% certain of clearing lice. Each method is now discussed further.
Insecticide lotion
Treatment with insecticide lotions has been used for many years. Insecticides are chemicals that kill insects. Research studies show that lice can be cleared in about 8 in 10 cases by using an insecticide lotion. You can buy an insecticide lotion from pharmacies. There are various brands. The active ingredient is usually malathion or phenothrin. You can also get these on prescription. Carbaryl is another insecticide lotion that is only available on prescription. (Shampoo, mousse and creme rinse preparations of these insecticides are not recommended as they do not work as well as lotions.) Insecticide lotions come in water or alcohol bases. In general, water based lotions are usually recommended as they are safer. Also, some people with asthma, eczema, or broken skin cannot use alcohol based lotions. Note: if you do use an alcohol based lotion, remember it is flammable. Therefore, do not use it near naked lights, cigarettes, fires, or flames including hair dryers. Be careful to keep children who have alcohol lotion in their hair away from fires. Follow the instructions on the packet. This may include the following:
• Apply the lotion to dry hair.
• Part the hair near the top and pour a few drops onto the scalp. Rub well into the hair. Part the hair again a little further down and repeat. Repeat this until the scalp and roots of the hair are saturated. Apply down to where a pony tail band would be. Leave on for 12 hours (overnight) and then wash off. Each person needs about 50ml of lotion, and up to 150ml if the hair is long and thick.
• Do not use a hairdryer to dry hair after applying lotion.
• Re-apply the same lotion after seven days. Although lice are usually killed by one application, not all eggs may be. The second application makes sure that any lice that hatch from eggs which survived the first application will be killed before they are old enough to lay further eggs. This advice - to use two applications seven days apart - may be different to what some manufacturers state on the lotion packet. However, it is current advice from UK experts on head lice to give the best chance that the treatment will work.
• Inspect the hair by detection combing 2-3 days after the second application. If you find any live head lice, despite treatment, then see a doctor or nurse for advice.
One problem with insecticide lotions is that some lice are now resistant to some insecticides. This is one reason why the treatment is not successful in every case. Some areas of the country have policies which advise on which insecticide to use based on the known 'resistance pattern' of the lice in the area. In addition, there is a possible small risk that repeated use of insecticides may be harmful. Therefore, some parents are not happy to use repeated applications of insecticides on their children. However, one course of two applications, seven days apart, is thought to be very unlikely to cause any harm.
Dimeticone lotion
Dimeticone has recently been found to clear head lice. It is a silicone based product and is not classed as an insecticide chemical. Dimeticone has a good safety record and is widely used in cosmetics and toiletries. Dimeticone is applied in a similar way to insecticide lotions as described earlier. As with insecticide lotions, you need to apply the same lotion twice - seven days apart. Each application is left on for at least eight hours (overnight) and then washed off. Dimeticone is thought to kill lice by a physical process rather than by any chemical effect. It may block the way the lice pass out water, which kills them. However, it is not thought to kill unhatched eggs, which is why two applications are needed, seven days apart. (The second application makes sure that any lice that hatch from eggs which survived the first application will be killed before they are old enough to lay further eggs.) A recent research study showed that lice can be cleared in about 7 in 10 cases by using dimeticone lotion. The downside to dimeticone is that it is a relatively new treatment with only this one main research study to back up the claim that it works well. Hopefully, more studies will be done to confirm that it is an effective treatment.
Wet combing treatment (using 'Bug Busting' or similar kits)
Wet combing is a way of removing head lice without having to use a lotion to kill them. Briefly, the method is similar to wet combing (detection combing) described earlier. But, you need to do this several times, four days apart. You will need to do this on every member of the household who has head lice. It takes up to an hour to do a wet combing session properly. You need the correct toothed 'detection comb' as described earlier. (The teeth of normal combs are too far apart.) Only one kit is needed for a family and it is washable and reusable.
• Wash the hair in the normal way with ordinary shampoo.
• Rinse out the shampoo and put on lots of ordinary conditioner.
• Comb the hair with a normal comb to get rid of tangles.
• When the hair is untangled switch to the detection comb.
• Slot the teeth of the detection comb into the hair at the roots so it is touching the scalp.
• Draw the detection comb through to the tips of the hair.
• Make sure that all parts of the hair are combed by working around the head.
• Check the comb for lice after each stroke. A magnifying glass may help.
• If you see any lice, clean the comb by wiping it on a tissue, or rinse it before the next stroke.
• After you have combed the whole head, rinse out the conditioner.
You need to do the above routine at least four times, every four days. The number of sessions required depends on the last time you see lice.
• The first combing session should remove all hatched head lice, but does not remove eggs. Therefore lice that hatch from eggs after the first session may still be present.
• Subsequent sessions clear newly hatched lice. Keep doing the combing sessions every four days until you have had three sessions where no lice are detected.
• Once you have had three sessions where you do not see any lice, it usually means that you are then free of lice.
Research studies show that lice can be cleared in about 6 in 10 cases by using the above wet combing method. Even higher rates of success are reported by some - and success may depend on how well and thorough the method is used. The downside to this treatment is that it is time consuming. 
Fuller details of wet combing (bug busting) treatment can be obtained from:
Community Hygiene Concern, Manor Gardens Centre, 6-9 Manor Gardens, London, N7 6LA
Tel: 020 7686 4321
Web: www.nits.net
What about other treatments?
There are various other treatments that are said to work by some people. For example, tea tree oil, quassia, other essential oils, herbal remedies, electric combs. However, there is a lack of research studies to confirm that they work well in most cases. Therefore, until more research is done, these other methods cannot be recommended.
Do family and friends need treatment?
Only if they have head lice. All people in the same home, and other close 'head to head' contacts of the previous 4-6 weeks should be contacted. Tell them to look for lice and treat if necessary. (It used to be advised to treat all close contacts even if they had no symptoms. This has changed to just treating people who have head lice.) All people with head lice in the same home should be treated at the same time. This stops lice being passed around again.
What about school?
Children with head lice should carry on going to school. Contrary to popular belief, head lice do not spread quickly through schools. Alarming 'head lice letters' from schools are usually unhelpful. You need close head-to-head contact to pass lice on to others. Young children who are 'best friends' and play closely together may pass lice on. If your child has head lice, a common-sense approach is to tell the parents of their close friends to look out for lice in their children.
Can head lice be prevented?
There is no good way of preventing head lice. Lice repellent sprays do not work very well. If you do detection combing of children's hair every week or so, you will detect head lice soon after they have affected the hair. You can then start treatment quickly and reduce the risk of passing them on to others.
Some other points about head lice
• Use an anti-lice lotion only when you are sure that you or your child have head lice. Do not use them to prevent head lice, or 'just in case'. Frequent use may cause a build up of small amounts of the active ingredient in the body. The risk of harm from this is very small, but it is best to use anti-lice lotions only when lice are present.
• A common reason for head lice to recur in one person is because close contacts (family and close friends) are not checked for head lice, and not treated if they have head lice. The treated person is then likely to get head lice back again from untreated family or friends.
• After treatment and the lice have gone, it may take 2-3 weeks for the itch to go fully.
• Nits may remain after lice have gone. They are empty egg shells and stick strongly to hair. They will eventually fall out. If you prefer, a fine toothed 'nit comb' can remove them.
A final reminder - alcohol based lotions are flammable. Some children have been badly burnt as their hair caught fire whilst being treated. Keep children away from fires, cigarettes, flames, etc, whilst any alcohol based lotion is in their hair.
References
• Clinical Knowledge Summaries Head Lice (2007)
• MeReC Management of head louse infection. MeReC Bulletin 10(5), 17-20. (1999)
• IF Burgess et al. Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial BMJ 2005;330:1423

Threadworms
Threadworms are common but are not usually serious. They can infect the gut and lay eggs around your anus which causes itch. Medication kills the worms, but not their eggs which can survive for two weeks. Hygiene measures for two weeks after taking medication prevents you from swallowing eggs to cause re-infection. All household members should be treated.
What are threadworms?
Threadworms are small, white, thread-like worms between 2 and 13 mm long. They infect human guts (intestines). They are common in children, but anyone of any age can be affected.
The life cycle of threadworms
Threadworms live about 5-6 weeks in the gut, and then die. However, before they die the female worms lay tiny eggs around the anus (back passage). This tends to occur at night when you are warm and still in bed. The eggs are too small to see without a microscope, but cause itch around the anus. You then scratch around the anus to relieve the itch. You often do this without realising when you are asleep. When you scratch, eggs get onto fingers and under nails. You may then swallow some eggs if you put a finger into your mouth.
Also, threadworm eggs can survive for up to two weeks outside the body. They fall off the skin around the anus and can fall onto bedding, clothes, etc. They can then get 'wafted' in the air as you change clothes, bedding etc, and become part of the dust in a home. Some eggs may settle on food or toothbrushes. So, children may swallow some eggs at first by playing with other children who have eggs on their fingers, or from food, drink, toothbrushes, or dust that has been contaminated with threadworm eggs. Any eggs that you swallow then hatch and grow into adult worms in the gut. So a 'cycle' of threadworm infection can go on and on.
Are threadworms harmful?
Not usually. Often, the worst thing about them is the itch and discomfort around the anus. This sometimes wakes children from sleep. Scratching may make the anus sore. Large numbers of threadworms may possibly cause mild abdominal (tummy) pains and make a child irritable. In girls, threadworms can wander forwards and lay their eggs in the vagina or urethra (the tube that passes urine). A doctor may check for threadworms in young girls with a vaginal discharge, bedwetting, or problems with passing urine. Rarely, threadworms can cause other problems.
How can I tell if my child has threadworms?
Threadworms look like thin, white, cotton threads. Sometimes you can see them in faeces (stools or motions) in the toilet. If you cannot see threadworms in the faeces, but suspect your child has threadworms (if they have an itchy bottom), try looking at the child's anus. You can do this with a torch in the late evening after the child has gone to sleep. Part the child's buttocks and look at the opening of the anus. If the child has threadworms you can often see one or two coming out of the anus. Do not be alarmed! Ask a pharmacist for advice on treatment in the next day or so. Your doctor may ask you to do a 'sticky tape test' to confirm the presence of threadworms. To do this you press some clear see-through tape onto the skin around the anus first thing in the morning, before wiping or bathing. You then place the tape on a glass slide or put it in a specimen container. The tape is then sent to the 'lab' to be looked at under a microscope to see if any threadworm eggs are stuck to the tape.
What is the treatment for threadworms?
The common treatment is to take a medicine to kill the worms in your gut AND hygiene measures to clear eggs which may be around your anus or in your home.
Medication
You can buy the following medicines from pharmacies. You can also get them on prescription. (The medicines below are not recommended if you are pregnant or breastfeeding. Hygiene measures alone may be sufficient.)
• Mebendazole is the usual treatment for people aged over two years. All household members, including adults and those without symptoms, should take a dose at the same time. This is because it is common to have worms in the gut with little or no symptoms. Just one dose kills the worms. A second dose two weeks after the first is sometimes needed if the infection has not cleared (which may occur if you swallow some eggs after taking the medication).
• Piperazine is an alternative medicine, and can be used in children under two years (but over three months). You need to take two doses, 14 days apart.
Hygiene measures
Medicine will kill the worms in the gut, but not the eggs that have been laid around the anus. These can survive for up to two weeks outside the body on underwear, bedding, in the dust, etc (as described above). So, hygiene measures aim to clear any eggs from the body and the home, and to prevent any eggs from being swallowed. This will then break the cycle of 're-infection'. Every member of the household should do the following for two weeks after the first dose of medicine.
• Wear underpants or knickers at night. This is so that if you scratch in your sleep, you will not touch the skin near the anus.
• Keep fingernails short. Wash hands and scrub nails each morning. Wash hands before meals or snacks, before preparing food, and after going to the toilet or changing nappies.
• Every morning have a bath, or wash around the anus, to get rid of any eggs laid overnight. You must do this straight away after getting up from bed.
• Change and wash underwear, nightwear (and bed linen if possible) each day. Avoid shaking clothes and linen as any eggs on them may be wafted into the air and become part of the dust.
• Keep toothbrushes in a closed cupboard. Rinse well before use.
Also, on the day when you take the medicine, it is best to have a 'blitz' around the home which aims to clear any eggs which may be part of the dust. This should include:
• Vacuum and dust all household carpets, particularly those where children play.
• Damp-dust smooth surfaces with a cloth rinsed in hot water. Again, particularly in places where children play, and in bedrooms and the bathroom. Throw out the cloth after use.
After an initial thorough cleaning blitz, some people suggest that you vacuum and damp-dust every day for 14 days.
However, it may not be your home which is a main source of threadworm eggs. Your children may come into contact with eggs in schools or nurseries, particularly in the toilets if they are not cleaned properly. If your child has recurring threadworms, it may be worth checking that toilet facilities at schools, nurseries, etc, are regularly cleaned in a way that will remove any threadworm eggs which may be present.
If you are pregnant you should not take medicines which kill worms. The worms die after about 6 weeks. Provided that you do not swallow any new eggs, then no new worms will grow to replace them. So, if you continue the hygiene measures described above for 6 weeks, then this should break the cycle of 're-infection', and clear your gut of threadworms.
Can a child with threadworms go to school?
Yes. There is no need to keep a child with threadworms off school, nursery, etc. The hygiene measures described above will mean that children will not have any eggs on their fingers when they go out from the home each day and so cannot infect others. However, it may be sensible to alert the school to the fact that a child has threadworms to ensure that all parents are informed to look out for symptoms in their child.
© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated
Comprehensive patient resources are available at www.patient.co.uk

Infective Conjunctivitis
With infective conjunctivitis one or both eyes become red or pink, they may be sticky or watery and may have surface irritation. Most cases soon clear. Antibiotic drops or ointments are common treatments but are not always needed.
What is conjunctivitis?
Conjunctivitis means inflammation of the conjunctiva. The conjunctiva is the thin 'skin' that covers the white part of the eyes and the inside of the eyelids.
What causes conjunctivitis?
• Infection is the most common cause.
• Allergy is another common cause. For example, many people with hay fever (allergic to pollen) have red and inflamed conjunctiva.
• Irritant conjunctivitis sometimes occurs. For example, your conjunctiva may become inflamed after getting some shampoo in your eyes. The chlorine in swimming baths is a common cause of mild irritant conjunctivitis.
Common infective conjunctivitis
Most cases of infective conjunctivitis are caused by common bacteria and viruses - often the same ones that cause coughs and colds. Conjunctivitis commonly develops when you have a cold or cough. Sometimes it occurs alone. In the vast majority of cases, infective conjunctivitis is not serious and clears within a few days without leaving any permanent damage to the eye.
What are the symptoms of common infective conjunctivitis?
• One eye may be infected, but it usually spreads to both eyes. The 'whites' of the eyes look inflamed, and red or pink.
• The eyes may feel gritty and water more than usual.
• Some mild soreness may develop, but it is not usually very painful.
• The eyelids may become swollen, and are often stuck together with gluey material ('discharge') after a sleep.
What is the treatment for common infective conjunctivitis?
• Not treating is an option for mild infections. The tears contain chemicals that fight off bacteria. Many infections clear on their own within 2-5 days without treatment. If symptoms get worse then see a doctor to check your eye and to see if you need treatment.
• Bathing the eyes with cool clean water may be soothing.
• Antibiotic eye drops or ointment are often prescribed. Antibiotics do not kill viruses. However, it can be difficult to tell the difference between viral and bacterial conjunctivitis. An antibiotic will clear bacteria, and prevent secondary bacterial infection of a viral conjunctivitis. (Tell your doctor if you are pregnant as some eye drops may not be suitable.)
Other general advice
• Do not wear contact lenses until symptoms have completely gone, and for 24 hours after the last dose of any eye drops or ointment.
• Infective conjunctivitis is contagious. The likelihood of passing it on is not high unless you are in close contact with others. However, until the infection has gone, to help to prevent passing it on:
o Wash your hands regularly, particularly after touching your eyes.
o Do not share towels, pillows or utensils.
o Infectivity to others decreases after two or more applications of antibiotic drops and many doctors would advise not sending children to school until this has been done.
© EMIS and PIP 2006   Updated: October 2006   PRODIGY Validated
Comprehensive patient resources are available at www.patient.co.uk

Impetigo
Impetigo is a common contagious infection of the skin. Antibiotic cream usually clears the infection quickly. Antibiotic tablets or liquid medicines are sometimes needed.
What is impetigo and what does it look like?
Impetigo is a skin infection. It is usually caused by a bacterium (germ) called Staphylococcus aureus. Another type of bacterium called Streptococcus pyogenes is sometimes the cause.
• Primary impetigo is when the infection affects healthy skin. However, any tiny cut to the skin makes infection more likely as bacteria more easily get under the skin to cause infection.
• Secondary impetigo is when the infection affects skin that is already 'broken' by another skin condition. For example, skin with eczema sometimes develops a secondary impetigo.
The rash typically appears 4-10 days after you have been infected with the bacteria. Small blisters develop at first. You may not see the blisters as they often soon burst to leave scabby patches on the skin. Sometimes only one or two patches develop. They look like moist, golden crusts stuck onto the skin. An area of redness (inflammation) may develop under each patch. The face is the most common area affected but impetigo can occur on any part of the skin. Patches of impetigo vary in size, but are usually quite small - a centimetre or so to begin with. Smaller 'satellite' patches may develop around an existing patch and spread outwards.
Who gets impetigo?
Impetigo commonly occurs in children but it can affect anyone at any age. It occurs more commonly in hot humid weather. It is contagious.
What is the treatment for impetigo?
There is a good chance that impetigo will clear without treatment after 2-3 weeks. However, treatment is usually advised as it is contagious and severe infection sometimes develops.
An antibiotic cream used for 7-10 days is the usual treatment if there are only a few small patches of impetigo on the skin. The crusts should be cleaned off with warm soapy water before applying the cream. This allows the antibiotic to penetrate into the skin. Antibiotic liquid medicine or tablets may be prescribed if the rash is more widespread.
As impetigo is contagious (can be passed on by touching):
• Try not to touch patches of impetigo, and do not allow other children to touch them.
• Wash your hands after touching a patch of impetigo, and after applying antibiotic cream.
• Don't share towels, flannels, bathwater, etc, until the infection has gone.
• Children should be kept off school or nursery until there is no more blistering or crusting, or until 48 hours after antibiotic treatment has been started.
© EMIS and PIP 2006   Updated: April 2006   PRODIGY Validated
Comprehensive patient resources are available at www.patient.co.uk

Chickenpox in Children
Chickenpox causes a rash and can make a child feel generally unwell. Treatment aims to ease symptoms until the illness goes. Full recovery is usual in children.
What is chickenpox?
Chickenpox is an infection caused by the varicella-zoster virus. Most children have chickenpox at some stage. The immune system makes antibodies during the infection. These fight the virus and then provide lifelong immunity. Therefore, it is rare to have more than one bout of chickenpox.
What are the symptoms of chickenpox?
• Fever (temperature), aches and headache often start a day or so before a rash appears.
• Rash. Spots appear in crops. They develop into small blisters and are itchy. They can be anywhere on the body, and sometimes in the mouth. Several crops may develop over several days. Some children may be covered in spots, others have only a few or even none.
• Dry cough and sore throat are common.
Some children feel quite unwell for a few days. Others appear only mildly ill. Most are much better within a week. The blisters dry up and scab. They gradually fade, but may take up to two weeks to go completely.
What is the treatment for chickenpox?
Treatment aims to ease symptoms whilst the immune system fights the virus.
• Give plenty to drink to avoid dehydration.
• Give paracetamol or ibuprofen to ease fever, headaches, and aches and pains.
• Crotamiton lotion or cream put on the spots may ease itching.
• Antihistamine tablets or liquid medicine may help with sleep if itch is a problem. Give a dose at bedtime. You can buy these at pharmacies or get them on prescription.
• Keep fingernails cut short to stop deep scratching.
Are there any complications?
• The spots do not usually scar unless they are badly scratched.
• Some spots become infected with bacteria in about 1 in 10 cases. If this occurs, the surrounding skin becomes red and sore. Antibiotics may then be needed.
• An ear infection develops in about 1 in 20 cases.
• Pneumonia and inflammation of the brain (encephalitis) are rare complications. See a doctor if your child develops any worrying symptoms such as:
o breathing problems
o drowsiness
o convulsions
o pains or headaches which become worse despite paracetamol or ibuprofen
o becoming generally more and more unwell.
Is chickenpox infectious?
Yes, it is very infectious. The virus travels in the air and then settles on clothes, bedding, etc. A child with chickenpox is likely to pass it on to most classmates and household members who have not already had it. It takes 11-20 days to develop symptoms after catching the virus (the 'incubation period'). A person with chickenpox is infectious from 2-4 days before the rash first appears until all the spots have crusted over (commonly about 5-6 days after onset of the illness).
Protecting others
When a child is infectious keep him or her off school and also away from people who may get a severe illness if they get chickenpox. These are:
• Pregnant women who have not had chickenpox in the past. Chickenpox can be severe and cause complications during pregnancy.
• People with a poor immune system. For example, people with leukaemia, with HIV/AIDS, on high dose steroid medication, or are taking chemotherapy.
Healthy adults who have not had chickenpox may also want to avoid catching it as the illness tends to be worse in adults.
Should I let my child catch chickenpox?
Some parents encourage their children to mix with others who have chickenpox in order to catch it.
Some arguments for this:
• Chickenpox is usually a milder illness in a child than in an adult.
• The risk of serious complications is higher in adults with chickenpox. In particular, chickenpox during pregnancy can cause serious complications to both mother and baby.
• Most people get chickenpox at some stage. As the risks are less if you have it as a child, it may be better to get it over with.
Some arguments against this:
• "I could not willingly let my child develop an illness."
• Although rare, some children do have serious complications..
Different parents have different views on this issue.
© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated
Comprehensive patient resources are available at www.patient.co.uk