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##  Quick facts

- A fixation with food rules and overexercise can mask underlying anxiety
- People with orthorexia may become increasingly isolated 
- Help is available in the form of treatments like Cognitive Behavioural Therapy (CBT)

It’s healthy to be healthy, right? Yes, and in these times when stress levels and uncertainty are high, it’s totally natural to try and control what we can, like our diets and exercise.  

But it’s possible to become fixated with what you’re eating and your exercise levels to such an extent that other elements of your life suffer, like your relationships and need for rest and recovery — also essential to your wellbeing.

##  What is orthorexia?

Orthorexia nervosa was first defined in 1997 as ‘having a pathological obsession in pursuit of a healthy diet’.  The word orthorexia is from the Greek orthos (correct) and orexia (appetite or nutrition).  

‘Orthorexia nervosa is a disorder where you become obsessed and fixated with healthy eating,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry. Although it overlaps with eating disorders, it’s not yet recognised as an eating disorder in its own right in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), she explains, though it is increasingly recognised in scientific literature. 

##  How is it different from other eating disorders?

‘There’s a fine line between anorexia and orthorexia,’ Gauffin says. ‘The goals might be different, but the mindset is similar — there is a compulsion around food that simply isn’t healthy.’ 

Anorexia nervosa and bulimia are most often about a preoccupation with weight loss. Those with orthorexia, on the other hand, focus on the quality of food — though it’s likely that weight will play a part too.  

This may develop into ritualised patterns of eating — for example, spending an excessive amount of time thinking about, sourcing and preparing food and a rigid avoidance of foods they believe to be unhealthy or impure. 

Many people with orthorexia also become obsessed with keeping fit. So, exercising compulsively becomes just as important as eating the right foods. In a recent review it was found that there’s often a correlation between orthorexia and exercise addiction. 

‘For most people who eat healthily or exercise regularly, it’s fine to occasionally have some cake or a glass of wine, or skip a workout,’ says Gauffin. ‘But for people with orthorexia, any break in their regime makes them anxious. They’re obsessive about eating certain foods, for example vegan or gluten-free, and avoiding others, like refined sugars.’

##  What are the signs and symptoms of orthorexia to look for?

Orthorexia can be hard to spot — not only in others, but also in yourself — as it’s easy to justify under the umbrella of a healthy lifestyle. Giving up entire food groups without advice from a doctor or other qualified profession can be a particularly insidious sign. 

Here are some more signs of orthorexia: 
- Spending so much time thinking about, choosing and preparing healthy food that it interferes with other areas of life like family, relationships, creativity or work
- Feeling anxious, guilty, ashamed, impure or unclean after eating any food considered unhealthy 
- Judging others who eat foods regarded as unhealthy
- Being excessively dependent on food and exercise choices for a personal sense of peace or happiness
- Being unable to relax around food, even on special occasions
- Steadily eliminating more and more foods whilst repeatedly adding to a rigid list of eating and exercise rules
- Following a healthy eating regime that’s caused more weight loss than is healthy, or resulted in other signs of malnutrition like hair loss, loss of menstruation or skin problems

##  Am I at risk of developing orthorexia?

‘People you would describe as highly functioning, super-ambitious, perfectionist, disciplined, type-A personalities are most at risk,’ says Gauffin. ‘On the outside they appear competent and in control, but there’s nearly always an underlying feeling of not being good enough.’  

Orthorexics believe that they can only be loved if they’re perfect, and they equate this with looking and being healthy, Gauffin explains. ‘This often stems from childhood when they were expected to do well at school and in sport, and later to get the right job. The subliminal message they got was that you have to be successful to be loved. 

‘Life events like bereavement or divorce can also trigger orthorexia, with people using a healthy living focus as a way of coping with emotional pain to the point where it becomes obsession,’ says Gauffin.

##  Is it really that harmful to be obsessed with healthy eating?

‘For one, it can lead to nutritional deficiencies and related health problems,’  says Gauffin. 

But orthorexia can also exacerbate — sometimes even hide — psychological problems. ‘People who develop orthorexia tend to be highly anxious people who use an obsession with food and exercise as a way of blocking out their anxiety. That helps them stay in control of their emotions.’ 

Such mental health struggles can often become vicious cycles, Gauffin asserts. ‘The more time someone spends fixated on obsessively sticking to their rigid food and exercise rules, the more they withdraw into their own world, spending less time socialising and doing other activities. 

‘This can lead to feelings of loneliness and disconnection from family and friends. After a while they find it increasingly hard to step out of their isolation and this makes their anxiety worse.’ 

##  What help is available for orthorexia?

The problem of orthorexia often only emerges by talking about other issues. ‘Most people who seek help usually do so for some other reason such as anxiety, depression, sleep problems, or a relationship break-up,’ says Gauffin. 

What’s more, people with this disorder have often lost sight of just how much they’re missing out on in life, says Gauffin. 

‘So, I might ask them things like – “How alive do you feel? How much freedom do you have?” My aim is to gently help them realise that they don’t have very much freedom. When all your time is spent obsessing over and being controlling about food and exercise, you end up living in a very small box. 

‘Therapy can help someone take small, gradual steps out of that box, and realise what they’re missing out on by hiding in their high-achieving prison. The first step to overcoming orthorexia is to recognise there is a problem.’ 

If you think you may have orthorexia, Cognitive Behavioural Therapy (CBT) can be useful in helping to change the thoughts and behaviours that are leading to your obsession with food and exercise.  

Psychodynamic therapy, on the other hand, can help you explore and work through any emotional issues underlying the condition. 

A Kry GP can help you determine whether you need help with orthorexia or other eating-related issues. 

__This piece has been approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry.__


Kry.co.uk > Your Health > What is orthorexia? A therapist explains

What is orthorexia? A therapist explains

Healthy eating is essential to longevity and wellbeing. But when it becomes an obsession, it can result in a disorder known as orthorexia. Discover more from Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry

Kry.co.uk > Your health > What is orthorexia? A therapist explains

Family

##  Quick takeaways
- During upsets, pausing before you respond is more constructive than reacting immediately
- Managing your own emotional reaction can help you see and hear things more clearly
- Showing you understand another person’s point of view is useful during arguments 

Spending a lot of time with people – even our loved ones – can be tricky at times. As we continue to stay with our immediate households, a build-up of frustration and uncertainty from the past year may bring more heightened emotions than usual.

But it doesn’t have to be this way. Life is pretty tough for many people right now. So, the last thing we want to do is fan the flames of division within our own families and relationships.

Instead, take a deep breath, and pre-empt any potential pitfalls by planning your conflict management toolkit in advance.

##  Learn the art of constructive conflict

Not all disagreements are bad. Having different opinions is what makes us grow and see things from different perspectives. This constructive conflict can sometimes even be a positive thing – but only if you ‘fight clean’. 

##  Tools for ‘clean’ arguments

- __Don’t make it personal.__ No name-calling, character judgements, swearing or insults  
- __Explain how a situation makes you feel.__ For example, ‘Lately I’ve been feeling quite sad when I feel you’re ignoring me’ 
- __Avoid the phrases ‘you always’, ‘you never’.__ These exaggerations are bound to make someone jump to defend themselves and get upset 
- __Pause, then respond.__ If someone upsets you, don’t react immediately as you might give a knee-jerk reaction. For example, you might say, ‘You’re always checking your phone.’ But, what you really mean is you want them to pay you more attention. That opens up a new conversation, rather than just arguing about how your partner is always on the phone
- __Recognise the difference between anger and aggression.__ Anger can be a healthy emotion that alerts you something is wrong. But shouting, screaming and being intimidating is aggression, which is hurtful and abusive 
- __Take responsibility for your emotions.__ You might feel angry and frustrated with someone — but, it’s down to you to choose your emotional state. By managing your emotional reaction, you will see and hear things more clearly

##  Take the time-out option

If you’re feeling overwhelmed by your emotions, avoid getting into a discussion. Of course, this can be difficult, especially if you’re feeling wound-up.  

If you want to avoid the situation escalating, it’s better to say, ‘This is something I want to talk about, but now isn’t the best time. I’d like to take time out.’

Wait until you feel calmer to get back to the discussion. Also, check when would be best to talk with the other person. If you’re feeling inflamed, go to another room or even go for a walk. Let your friend or family member know what you’re doing, so it doesn’t seem like you’re storming off.

##  Tools for diffusing a situation

- __Stop when you sense a situation building up.__ Do everything you can to try to stay calm. For example, go for a walk, count to 10, call a friend or do a short breathing meditation – anything that helps you to stay calm 
- __Find out the other person’s ‘why’.__ Ask someone to explain their opinion in more detail, so you can better understand. This is a useful negotiation tactic. Asking someone to explain how they think and feel takes the emotion out of the situation and allows them to feel they are being heard. Hopefully, in turn they’ll reciprocate by listening to your views too, which can lead to a more peaceful resolution
- __Listen.__ Try to put yourself in someone else’s shoes. Most people stop listening during arguments. That means you’ve got two parties where no one is hearing what the other is saying. Sometimes when you show you understand where someone is coming from, it’s enough to help create a shift. Try saying someone’s point of view back to them with the words, ‘So, as I understand it…’
- __Know that you don’t always have to be right.__ Simply conceding that you can see the other person’s point; that you made a mistake or will do things differently next time, can work wonders. Remember, you don’t always have to be right or have the last word

##  Use respect when dealing with children

It’s normal for children to squabble at times. But if they are really playing up, look at what’s really causing them to behave this way.  

###  Tools for managing arguing children
- __Check yourself first.__ Is their behaviour something they’re picking up from you? Be honest with yourself. Children are sensitive and if they are picking up on tension between you and your partner or sensing that you’re in a bad mood, their behaviour is often a reflection of what’s going on with you
- __Parent by example.__ Children are more likely to be helpful and cooperative if they see the adults around them treating each other with kindness and respect
- __Give children the cooling-off option.__ If your kids are arguing, suggest they do something else for 20-30 minutes and talk about it when they get back. After that, encourage each child to speak and the other to listen 
- __Plan the chore roster in advance.__ Have a family meeting and write down what each member is expected to do on a daily or weekly basis. Make it clear what everyone’s role is and work out a rota. That way, everyone feels part of a team and knows what they have to do

__This article has been approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry__


Kry.co.uk > article page > How to manage arguments at home — a therapist’s toolkit?See a Kry GP in minutes or book up to 7 days ahead. Download the Kry app now. > call out

Kry.co.uk > Your health > How to manage arguments at home — a therapist’s toolkit

14 ways to communicate better with loved ones — a therapist’s toolkit

With many of us spending more time at home, there might be more arguments than usual. This communication toolkit will help you survive with a smile

How to manage arguments at home — a therapist’s toolkit

##  Quick tips
- Reassure your child that dreams are not real — this is vital
- Nightmares are not the same as night terrors, and should be handled differently

The longer the coronavirus crisis continues, the greater the impact on our emotional health. And that includes children. 

A survey by children’s charity World Vision has shown that almost a third of UK parents have noticed negative changes in their children’s behaviour since the start of the pandemic, including tantrums, fighting, crying, even physical symptoms like stomach aches — and nightmares.

The global lockdowns, social distancing and daily restrictions have disrupted our lives and children are just as likely as adults to feel emotions such as anxiety, worry and sadness. 

But unlike adults, children might not have the language to express their feelings. So an increase in nightmares may occur. The good news is, there are many things parents and caregivers can do to help.

##  Why do children have nightmares?

Nightmares are common in children aged 3-6 years and most will grow out of them. 

Like dreams, nightmares occur during the part of the sleep cycle known as rapid eye movement (REM), when the brain is more active. REM sleep first occurs about 90 minutes after falling asleep, with cycles becoming increasingly longer throughout the night.

‘In the same way as dreams, nightmares are often a way to process the events and emotions happening in our daily lives,’ says Martin Forster, Child Psychologist at Kry. 

‘For example, if something has upset them earlier in the day, is traumatising or causing them to worry, it can come out later in a nightmare,’ says Forster. 

##  Nightmares or night terrors — what’s the difference? 

Nightmares are often confused with night terrors, but the two are different. Night terrors are common in children aged 3-8 years old. They occur during deep sleep, when the body is relaxed and we usually don’t dream.

A child who experiences night terrors might scream, shout and thrash around in extreme panic, but they’re unaware of what’s happening because they’re still asleep. 

‘It’s a bit like sleepwalking. The child might appear distressed but in the morning they’ll have no recollection of what happened,’ says Forster. 

‘It’s best not to wake a child when they’re having a night terror, or they will wake up and feel fearful,’ Forster recommends. ‘If they’ve got up while having a night terror, just gently guide them back to their bed.

‘A nightmare is quite different, as the intense emotions will inevitably cause the child to wake up, usually in a state of distress and fear,’ he adds.

##  What’s the best way for you to respond when a child has a nightmare?

‘If your child wakes up having a nightmare, make sure you comfort them and make them feel safe and secure,’ says Forster. 

‘Reassure your child that dreams aren’t real — this is important. But don’t go into the content of the dream. The idea is to calm them down. 

‘If they’re really distressed, you can let them sleep in your bedroom. In fact, if a child is having recurring nightmares, this might be better for a few days or so. Some parents worry that it might establish a pattern that will be hard to break. But, once your child is sleeping normally again, they will usually be fine to sleep in their own bedroom again.’  

##  What’s normal and what is not?

‘It’s normal for children to have the occasional nightmare and usually this is nothing to worry about,’ says Forster. 

‘But if your child starts to experience nightmares regularly, this needs to be looked into. Is something causing them to feel stressed or worried? It’s not always the case, but there may be some issues that need to be addressed, perhaps at school or with their friends. 

‘Also, if a child is frequently waking up in the night feeling terrified, this will disrupt their sleep so they feel tired the next day. Or it could be that, after a while, they start dreading falling asleep. So bedtime becomes an issue,’ he says.

##  What can cause nightmares?

‘It could simply be a one-off after watching a scary film,’ says Forster. ‘Or perhaps a friend has done something to upset them. Perhaps someone close has been ill or they’re worried about something bad happening to a parent or sibling. 

‘Some children are very sensitive and it could be that they’re picking up on worries in the family. 

‘In most cases, nightmares will go. Sometimes there’s no specific reason. Some children just naturally dream more than others, and they are also more likely to experience nightmares. 

##  Should your child see an expert?

‘If your child is still having nightmares a few times a week, after a month ask your doctor for a referral to a child psychologist,’ says Forster.  ‘This can help identify more complex issues at play such as problems within the family that are causing the child anxiety.’

##  Is there anything you can do to minimise nightmares?

‘A good tactic for young children to make them feel safe before they go to bed is to reassure them that they are protected,’ says Forster. 

‘If they have a favourite teddy bear, you could say, “Teddy is always here to protect you. He’s watching over you and nothing bad can happen.”’ 

If a child keeps waking up in the night, you can help to ‘reprogramme’ what happens in their nightmare. The way to do this is to talk about — or draw — what’s happening in the nightmare and ask them to come up with a new ending, Forster recommends. 

‘You could, for example, get them to imagine what would happen if Superman flies in to catch the bad guys. In this way, you’re helping your child to create a new story that has a positive ending. The more you talk about or draw it, the more you reinforce the new ending in their mind, until eventually they start to dream in a different way.’

##  How can you help children process big life changes?

The coronavirus crisis has made us all think about sickness and death more, and even very young children are picking up on this. They may even have lost a relative to Covid.  

‘If your child has a lot of questions about illness and death and is worrying about it, don’t ignore it,’ says Foster. 

‘It’s healthier to address their fears. Unfortunately, sickness and death are part of life and by talking to your child about them, you can help them cope.’ 

‘For example, if someone in the family has died, it’s important to involve the children in the procedures and rituals and not to hide it away,’ he says. ‘Helping your child navigate their way through difficult emotions such as sadness and grief can help them to cope better.’

##  Can you do anything to help prevent child nightmares?

‘Images can be powerful and children respond more intensely to something they’ve seen, rather than what they hear,’ Forster explains. 

‘So, if your child is prone to nightmares, make sure they’re not exposed to distressing images on the news or in a movie. Seeing images of people in hospital as a result of the pandemic, for example, can make them more anxious and fearful about people they love getting ill. Try to protect your children from images and programmes that may distress them.’

__This article has been approved by Martin Forster, Child Psychologist at Kry.__


Kry.co.uk > Your health > Children and nightmares — advice from a child psychologist 

Children and nightmares — advice from a child psychologist 

Nightmares in children are common around the ages of 3-6. If you’re confused about what to do, Martin Forster, Child Psychologist at Kry, has great advice

### Quick facts
- Viral infections can cause temporary lactose intolerance
- Anxiety can cause physical symptoms, including tummy pain and bloating
- Constipation is a common cause of stomach aches in children

‘My tummy hurts,’ is something you may hear quite often as a parent. And it’s very normal – as many as 1 in 4 school-age children experience bouts of abdominal pain. But because there are so many potential triggers for tummy aches, it can be hard to identify the cause. 

‘The most important factor is your child’s general appearance; if they look healthy, that’s very reassuring,’ says Kry Paediatric Consultant Dr Tommy Södergren. 

‘Get them to move around: if they can move without pain, that’s also a very calming sign. Try asking if they want their favourite food, if they say ‘”yes” it’s unlikely there’s anything seriously wrong.’

Here are some common causes of stomach pain in children, and what you can do to help.

### Constipation 

Constipation in children often leads to stomach aches, particularly when toddlers are being potty-trained. 

Clues include:
- Poo that’s large and hard, or looks like little pellets or rabbit droppings
- Not having done at least 3 poos in the past week
- Straining to poo
- Bleeding during or after a poo
- Stomach pain easing after a poo
- Soiled underwear; caused by diarrhoea leaking around the hard, constipated poo

Dr Södergren advises: ‘Encourage them to go to the toilet if they can.’ Offer prunes and high-fibre snacks, or ask a doctor about a suitable laxative. 

To prevent problems, make sure they’re getting plenty of fluids and increase their intake of high-fibre fruit, vegetables and pulses.

Make sure your child can rest their feet on the floor or a step when they’re using the toilet or potty – and make it a fun, relaxed time. If they’re anxious about using the toilet away from home, encourage them to go after eating breakfast, and following an after-school snack.

See a doctor if it persists.

### A build-up of gas 

Cramps, and waves of intense abdominal pain can be caused by a build-up of gas. This is common in infants, but can happen throughout childhood too.

Dr Södergren says he’s seen parents take their child to an emergency department — only to find the pain has disappeared because the movement of the car journey has broken up the large bubbles of gas that caused it. 

Encourage your child to walk, or push them in a buggy along bumpy terrain – this will have the same effect.

Gas can build up because a child’s digestive tract is still maturing and is sensitive to upsets. If it happens a lot, keep a food diary to see if particular foods trigger pain in your child. For example, a build-up of gas and flatulence could indicate lactose or gluten intolerance.

### Emotional upsets 

Although emotional upsets can trigger tummy ache, it doesn’t mean the pain is imaginary. Something can feel ‘gut-wrenching’ or prompt ‘butterflies’ in our stomach because of complex chemical and neural signals going back and forth between our brains and our bellies. ‘The stomach is the window to the soul,’ says Dr Södergren. 

Anxiety, stress and other emotional challenges can cause pain, bloating, constipation, diarrhoea and other physical symptoms. Other clues are poor concentration, sleep problems, irritability and being clingy or fidgety. 

The first step is always to talk to your child, and speak to their teacher or childminder to check whether there are any problems away from home.

### Viral infections 

Viral infections are easier to spot as they’re usually accompanied by diarrhoea and/or vomiting. Pain tends to be generalised over a large area, and the gut often makes gurgling sounds. 

Rest and rehydration are generally all that’s needed, and Dr Södergren says parents shouldn’t worry if children don’t eat for a day or two. ‘These infections can cause temporary lactose intolerance, so it’s a good idea to give up milk for a couple of days,’ he adds.

Encourage children to put the toilet seat down when flushing, to minimise aerosol transmission of the virus. And be vigilant with hand washing. 

### Urinary tract infections (UTIs)

UTIs can cause abdominal pain, and in infancy are equally common in boys and girls. This is because the distance between the urethra (the urinary tract opening) and the rectum (the source of bacteria which cause infections) is still short.

Dr Södergren says if your child complains of stinging when they pee, and pee more frequently, then they probably have a UTI. Children with UTIs may also have a temperature, wet themselves, or try to hold their pee.

Most infections clear within 48 hours but if symptoms persist, see a GP. Teach your child to wipe their bottom away from their genitals to reduce the risk.

### When to see a GP

Dr Södergren stresses that most abdominal pain is not serious, and advises, ‘If the pain is not severe, and there are no other symptoms, call your doctor in a couple of days if it doesn’t get any better — but call straight away if it gets worse.’

You can add your child to the [Kry app](/gp-appointments-online/doctor-app/) under your account, so if you need to see a GP for your child’s tummy problems, you can do so by video the same day.

### Red flag symptoms you should not ignore

There are some symptoms you really shouldn’t ignore — get emergency medical help if your child develops any of the following:
- Extreme pain that doesn’t ease with paracetamol or ibuprofen 
- Your child becomes pale and floppy
- Cold hands and feet
- Drowsiness, difficult to wake
- Testicular pain

### 3 causes of stomach pain in children that need urgent care

__1.  Appendicitis__
This is the medical emergency parents often associate with extreme abdominal pain. It’s caused by inflammation of the appendix, which is a pouch, between 5cm and 10cm long, that hangs from the large intestine.

The first sign is usually intermittent pain in the middle of the abdomen, which quickly moves to the lower right-hand side and becomes constant and very severe. 

‘Walking, coughing or pressing the area will make the pain worse,’ Dr Södergren says. Other symptoms include nausea, fever and a change in bowel movements. It needs urgent medical treatment.

__2.  Testicular torsion__
This occurs when a testicle becomes twisted inside the scrotum, cutting off the blood supply. It is most common in teenage boys, but can occur in younger ones. The pain is intense and generally felt in the groin. It requires emergency surgery.

__3.  Poisoning__
Depending on the toxin ingested, poisoning will present in different ways. 

Potential poisons found around the home include household cleaners, medicines, pesticides, some plants and fungi, alcohol and recreational drugs. Faulty boilers can also release toxic carbon monoxide.

Apart from stomach pain, other warning signs include:
- Vomiting
- Confusion
- Drowsiness
- Fainting fits

If you suspect poisoning, don’t try to treat your child yourself. Get urgent medical advice.

__This article has been medically approved by  Dr Tommy Södergren,
Paediatric Consultant at Kry__


Kry.co.uk > Your health > What’s causing your child’s stomach ache?

What’s causing your child’s stomach ache?

Most stomach aches in children are not serious, but some need medical help. Here’s a guide with expert advice from Paediatric Consultant Dr Tommy Södergren 

A desperate urge to go to the toilet, and a burning sensation when urinating, are just two of the common symptoms of a Urinary Tract Infection (UTI), that millions of people suffer from every year. 

But while uncomfortable and inconvenient, they’re incredibly common and over half of female adults say they’ve had at least one UTI in their lifetime. 

At Kry, we’ve seen an increase in patients calling our doctors with UTIs, so we’ve compiled a guide to answer the most frequently asked questions.

## What is a UTI?

Urinary tract infections (UTIs) are common infections that can affect the bladder, the kidneys and the tubes connected to them. 

Although men and children can get them, they are more common in women. In fact, according to the World Health Organisation (WHO), an estimated 50% of women will report having a UTI at some point in their lives.

## What are the symptoms of a UTI?

The main symptoms of a UTI are: 
- pain while passing urine (typically described as a burning, stinging pain)
- passing urine more frequently 
- an urgency to need to pass urine
- smelly or cloudy urine
- pain in the lower abdomen 

‘Often a UTI will also cause a sense of fatigue in addition to those symptoms, and some people may experience blood in the urine too,’ says Kry GP Dr Rhianna McClymont.

## What causes UTIs?

‘There are many different bacteria which can cause a UTI,’ says Dr McClymont. ‘Bacteria enter the urinary tract via the urethra and then rise to the bladder where they cause an infection’. 

This is why they’re more common in women as the urethra is shorter, which makes it easier for the bacteria to get to the bladder, Dr McClymont explains. 

As a woman, you can’t pass your UTI onto your male partner through sex, although sex may be uncomfortable.

The bacteria may enter the urethra after wiping your bottom or having sex. Other causes of a UTI may include using a contraceptive diaphragm, condoms coated in spermicide or a weakened immune system.

## How is a UTI diagnosed?

For women, a urine test will confirm if you have a UTI and also help rule out other conditions that might be causing your symptoms, like a sexually transmitted infection. Men may be offered a painless swab test to check for other conditions.

## How are they treated?

Most UTIs can be easily treated with antibiotics, although in some severe cases hospital treatment may be needed.

To help alleviate pain while the symptoms clear up, you can take paracetamol and place a hot water bottle on your tummy, back or between your thighs. 

Try to rest and drink plenty of fluids which helps flush out the bacteria. 
Don’t take ibuprofen or aspirin if you have a kidney infection as it may increase problems. Kidney infections are diagnosed with a urine test and a GP will ask about your symptoms and recent medical history. 

## How long does a UTI last?

If treated quickly with antibiotics, mild UTIs normally pass within a few days. 

But sometimes they come back – a condition known as Recurrent Urinary Tract Infections (RUTIs). Although there are few studies into RUTIs, one found that 27% of women aged 17-39 would experience a second UTI within six months of the first, while a further 3% would experience a third in the same period.

## Why do UTIs keep occurring?

Some women are genetically predisposed to having recurring UTIs (for example, if your mother or sister has had them, you’re likely to have them too). The risks vary depending on your age. One recent study found that recurrence can range from 16-36% in premenopausal women to 55% following menopause.

## Does anything increase the risk of a UTI?

Before menopause, the most common risk factors are sexual intercourse which is thought to increase the number of bacteria in the bladder. That’s why experts often advise women to urinate after sex to flush them out. 

The use of spermicides may also cause UTIs in younger women, as they kill off beneficial bacteria in the vagina making it easier for the damaging bacteria to infect. 

After menopause, the number of beneficial bacteria in the vagina naturally decline. The bladder also contracts less strongly than it once did, making it more difficult to empty completely. 

## What helps prevent UTIs?

There are several things you can do to prevent an infection:
- drink plenty of water to stay hydrated
- take showers instead of baths 
- for women, make sure you’re wiping ‘front to back’ when going to the toilet

‘The evidence is conflicting as to whether cranberry juice is actually beneficial, but drinking it isn’t harmful so there’s no problem in trying it to see if it helps your symptoms,’ says Dr McClymont.

Some people may also wish to try D-mannose (a type of sugar you take every day as a tablet or powder), as some research has shown it can help in women who are not pregnant.

## Can UTIs be dangerous?

Most UTIs are in the lower part of the urethra and are not usually a cause for major concern. But occasionally, if left untreated, the bacteria can travel into one or both kidneys, which can become a kidney infection and you may need emergency treatment.

‘Watch out for a very high temperature, feeling unwell, weak and shivery, or pain in your back or sides – which can be a sign of a kidney infection,’ says Dr McClymont. It’s important to seek emergency treatment if suffering from any of these symptoms. 

If treated quickly, antibiotics can clear a kidney infection. But if left untreated it can cause damage to the kidneys or the infection can enter the bloodstream.

## Should you see a doctor?

If your symptoms do not improve within a few days or your symptoms come back after treatment, it’s wise to see your doctor. You should also check with a GP if you have blood in your urine, if you’ve never had a UTI before or if you’re pregnant and have symptoms. 

__This article has been contributed to by Dr Rhianna McClymont,Lead GP at Kry__


Kry.co.uk > article page > UTIs: your questions answered > call out

Kry.co.uk > Your health > UTIs: your questions answered

UTIs: your questions answered

UTIs are incredibly common. They affect an estimated 50% of women at some point in their lives. Our experts have compiled this guide

## Quick facts
- Young children catch 8-10 colds a year before they’re 2 years old
- Vitamin D reduces the risk of respiratory infections
- Sleep really is an effective medicine 

Your child’s immune system is not fully developed until they’re around 8 years old. Until then it can feel as though they catch every cough, cold and infection they encounter.

‘Between 6 and 18 months of age, children are particularly prone to infections because the protective antibodies they inherit from their mother are waning, but they’ve not yet developed their own antibodies,’ says Kry Paediatric Consultant Dr Tommy Södergren.

On average, children catch between 8 and 10 colds a year before they’re 2 years old. This is not a sign of a weak immune system — it simply means they’re coming into contact with a lot of cold viruses for the first time.

Immunity works in 2 ways. First, there’s innate immunity, which we’re born with, providing a general defense. Then there’s adaptive immunity which responds to the threats or antigens we encounter, and creates custom-made defense gadgets, called antibodies. This is also what happens when we’re vaccinated with a weakened version of a virus or bacterium.

Because children encounter so many new infections, their immune systems are on constant alert — which may explain why they’re less likely to become ill with Covid-19. Scientists think they may be identifying and destroying the coronavirus before infection can take hold.

Unfortunately, occasional colds and coughs are inevitable for children. But you can take these 7 steps to support your child’s immune system.

## 1.	Take vitamin D

Many experts believe it’s no accident that colds peak in winter, when our levels of vitamin D are low. Vitamin D supplementation reduces the risk of getting respiratory infections and studies confirm it boosts production of infection-fighting T-cells.

In the UK and Europe, daily vitamin D supplements (usually 10mcg) are recommended for all young children – although the advice on dosages and how long to give them varies slightly. Infant formulas are fortified with vitamin D, but breastfeeding mothers are advised to give their babies a supplement of 8.5mcg to 10mcg a day.

‘In the northern hemisphere it’s been recommended for centuries to give babies vitamin D,’ says Dr Södergren. ‘We’re now starting to recommend giving it to older children too, at least during the winter.’

## 2.	Make sure they get plenty of rest

There’s a saying that a good night’s sleep is the best medicine, and sleep and strong immunity are intertwined. Getting plenty of sleep reduces inflammation and gives our body time to repair damaged cells, which strengthens immunity. And when we’re unwell and our immune system is fighting a threat, our immune response makes us feel sleepy, because the body’s resources are focused on fighting the infection or repairing the injury.

Babies and toddlers need at least 11 hours a night plus a nap during the day. From ages 4 to 9, children need 9.5 to 11.5 hours a night and older children and teens need between 9 and 10 hours a night.

A good bedroom routine is the key to getting children settled. A warm bath, dim lights and quiet time will help them wind down. Ban screen use before bed and keep their bedroom well ventilated and between 16°C and 20°C. Here are some more [tips on helping children sleep](/your-health/tips-to-help-children-get-to-sleep/).

## 3. Choose the right foods

Our immune system needs the right fuel to fight infections, and studies confirm that eating plenty of fruit and vegetables improves immune function. It even makes vaccinations more effective. 

Protein is also important— particularly an amino acid called arginine, which is found in meat, nuts and beans. These foods also provide plenty of zinc, which reduces the risk of respiratory tract infections and diarrhoea in children. Probiotic yogurts and drinks boost levels of friendly bacteria in the gut, and this can help reduce the risk of respiratory infections. Try these [6 tips for healthy cooking for the family](/your-health/6-tips-for-healthy-cooking-at-home/).

## 4. Encourage exercise

Getting the family active could help keep colds away, as exercise helps the immune system seek out and destroy infections, Dr Södergren says. ‘Winter is the high season for common colds because we spend more time indoors, where it’s easier to transmit viral infections. By staying outside more and practising social distancing we could reduce the spread of common colds.’

## 5. Consider pet therapy

Children with pets also have stronger immune systems. Some scientists even believe that owning a pet provides protection from Covid-19, because pet owners will have encountered other coronaviruses carried by animals.

Stroking a pet has been shown to increase levels of an infection-fighting substance in the body called immunoglobulin A. Pet owners are less likely to get repeat bouts of some stomach bugs. And, growing up with a pet may also help the immune system spot the difference between dangerous pathogens and harmless allergens.

## 6. Avoid unnecessary antibiotics

Don’t ask your doctor for antibiotics when your child has a cold. They don’t work against the viruses which cause most colds and coughs, Dr Södergren says. ‘The only thing that will happen is that you will add diarrhoea to their symptoms.’ Antibiotics can also leave us more vulnerable to infections because they disrupt beneficial bacteria in the gut.

Most coughs and colds can be treated at home with rest, fluids and paracetamol or ibuprofen. 

‘In rare cases, children get a bacterial infection — like streptococcal tonsillitis, ear infection or pneumonia — as a cold “complication’’,’ Dr Södergren adds. ‘Even then, in most cases antibiotics are not necessary.’

See a doctor if the cold is not getting better after a week, if it’s getting much worse after 3 days, or if your child has a very high temperature. ‘A sniffle or cough are signs that the immune system is working to clear the body from antigens and mucus and these symptoms can linger for some time after the common cold,’ Dr Södergren asserts. ‘If symptoms persist for more than 6 weeks, see a doctor.’

## 7. Practice great hygiene

Encourage your children to wash their hands with soap and water every time they use the toilet and before eating. To make sure they wash thoroughly, suggest they sing ‘Happy Birthday’ twice.

If someone in the family has a cold, keep their toothbrush away from the rest of the family’s brushes, and replace it as soon as symptoms have passed. Use tissues, rather than handkerchiefs, to avoid spreading germs.

Discourage your child from rubbing their eyes or chewing fingernails, and pop some wipes or hand sanitiser into their school bag to make sure they can always clean their hands.

But don’t worry if they get a bit dirty when they’re playing. Studies show that being exposed to germs and everyday infections strengthens immunity, while going overboard with hygiene may not be helpful for the immune system.

## Children and coronavirus

Rest assured that according to the NHS, while children can get coronavirus, they get it less often and it’s usually less serious. 

### Symptoms of coronavirus in children:
- A high temperature 
- A continuous cough — this means coughing a lot, for more than an hour, or 3 or more coughing episodes in 24 hours
- A loss or change to sense of smell or taste

### Call emergency or a GP immediately if your child:
- Is under 3 months old and has a temperature of 38°C or higher, or if you think they have a fever
- Is 3-6 months old and has a temperature of 39°C or higher, or if you think they have a fever
- Has other signs of illness, like a rash, as well as a high temperature
- Has a high temperature that’s lasted 5 days or more
- Does not want to eat or is not their usual self and you’re worried
- Has a high temperature that does not come down with paracetamol
- Is dehydrated — for example, their nappies are not very wet, they have sunken eyes and no tears when crying

### When to speak to a doctor

This is an unsettling time for everyone, especially parents. If you’re unsure about whether to check a symptom with your GP, err on the side of caution. Kry GPs are here to help. 

__This article has been medically approved by Dr Tommy Södergren, Kry Paediatric Consultant__


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Kry.co.uk > Your health > How to boost children’s immunity this winter: 7 tips

How to boost children’s immunity this winter: 7 tips

It’s understandable to be more concerned than usual about preventing colds and coughs in your children this winter. Here’s some expert help

## Quick facts

- Itching from eczema may be relieved by emollient creams, though severe cases may require prescription medication
- Infants often get nappy rash which usually clears up in a few days
- Urticaria or ‘hives’ is triggered by allergies, so antihistamines may be an option

A child or baby suddenly developing a skin rash can be alarming for parents. The good news is that most rashes are not serious and can easily be treated at home.

That said, it’s helpful to be aware of the serious symptoms which mean that you should seek immediate medical help.

### Red flag symptoms not to ignore

If your child seems unwell or has a fever, you should see your doctor. And if they have a rash that doesn’t fade when you press a glass against it, seek emergency medical treatment via A&E. This could be meningitis. Other signs — which may appear before this tell-tale rash — are:

- a stiff neck
- your child being bothered by light
- your child seeming confused
- uncontrollable shaking
- a high fever you can’t control
- unusually cold hands and feet

Fortunately, most parents will never encounter meningitis. In Europe there are just 0.6 cases reported for every 100,000 people — but it’s important to be alert to the warning signs.

Here we reveal the five most common rashes new parents see our doctors about, and what you can do as well as when to consult a doctor.

## Different types of rashes on babies & children:

### 1. Eczema

[Eczema](/medical-advice/skin-conditions/eczema/) affects 5-15% of children and is characterised by itchy, dry, cracked skin. It can appear anywhere but in children it most commonly affects the hands, insides of the elbows, the backs of the knees, face and scalp. The most common form is atopic eczema, which is also known as atopic dermatitis.

Eczema can be set off by food allergies, chemicals in soaps and detergents, stress, and even cold weather, so it may take a little detective work to identify every trigger. It sometimes coincides with your baby teething or another infection, such as a cold. Eczema often runs in families, where it is closely linked to asthma and allergic nasal conditions causing a runny nose and sneezing (like hayfever). Together, these three conditions, linked by genetics, are termed atopy.

Treatments focus on reducing itching and using special moisturisers called emollients which provide a barrier to protect the area. These are available as lotions, sprays and creams from pharmacies. As a general rule, try to use the richest one which is comfortable. Avoid aqueous cream as this can make eczema worse. Severe cases may need a short course of cortisone cream prescribed by a doctor.

### 2. Impetigo

[Impetigo](/medical-advice/skin-conditions/impetigo/) is a common, and highly contagious, skin infection which starts with red sores or blisters that burst and leave crusty yellow scabs. It usually affects skin that has already been damaged, and is sometimes associated with bad eczema.

If you think your child has impetigo, see your doctor — who may prescribe an antibiotic cream or tablets. The affected area should be kept clean and dry, and covered with loose clothing or gauze bandages.

Wash yours and your child’s hands regularly and wash bedding, towels and flannels at a high temperature to reduce the risk of the infection spreading. It’s also a good idea to wash or wipe down toys and anything else your child touches regularly.

### 3. Chickenpox

[Chickenpox](/medical-advice/infections/chicken-pox/) is another common, and very contagious, childhood infection, which starts with red spots that then fill with fluid. Unlike impetigo, chickenpox is not associated with broken skin and your child will probably have other symptoms. Before the spots appear, your child may also:

- Feel unwell
- Develop a high fever (over 38°C)
- Complain of aches and pains, or
- Lose their appetite.

Chickenpox is intensely itchy and your child will probably feel miserable. Paracetamol will help with discomfort, but do not use ibuprofen as this can trigger skin infections. Encourage your child to drink plenty of fluids to prevent dehydration.

Simple anti-itch measures such as cutting their nails and putting socks over their hands at night can help stop them scratching. A cool bath with added baking soda or finely ground oatmeal will help ease itching, but be careful to pat the skin dry, rather than rubbing it. Dabbing calamine lotion on the blisters will also help.

### 4. Hives (urticaria)

[Hives](/medical-advice/skin-conditions/hives/) is an allergic rash which comes in all shapes and sizes and can appear anywhere on the body. Sometimes urticaria, or ‘hives’ as it’s also known, emerges as large raised patches or red skin and sometimes it appears as a series of small red spots. It’s usually itchy and often stings or burns.

The rash is triggered by the body releasing histamines. These are chemicals the immune system releases as an allergic reaction to substances such as food, plant pollens, insect bites, infections or dust mites. Urticaria can settle down in a matter of minutes, and sometimes it can persist for a few days.

If the itching is severe, ask your pharmacist about antihistamines — there are some which can be given to children over 12 months of age — or ask your doctor, who may prescribe them for infants. Speak to your doctor if the rash doesn’t improve after two days, if your child develops a temperature or if they keep getting hives. Call emergency if the rash spreads quickly, if they have trouble breathing or develop other acute symptoms such as swelling on the face, lips or tongue.

### 5. Nappy rash

Nappy rash affects 1 in 3 babies and toddlers at some time. It develops if they have worn a soiled nappy for too long, the nappy has rubbed against their skin or they haven’t been cleaned thoroughly during nappy changes. Many parents say nappy rash is more common when a child is teething, and it can also be triggered by antibiotics or using alcohol-based baby wipes, soap, detergent or bubble-bath. 

It is characterised by red, irritated and sometimes sore skin. If you use a nappy rash cream, followed by a barrier cream, and change nappies regularly it generally clears in two or three days. Letting your baby lie on a towel without a nappy, and avoiding talcum powder and scented lotions can also help.

But if your child develops a bright red rash with red or white spots, particularly if it spreads into the folds of their skin, they may have a fungal infection, and you should ask your doctor for advice.

To prevent fungal infections spreading, it’s important to wash your hands thoroughly after nappy changes, use separate towels and wash them at a high temperature.

__Reviewed by: Rhianna McClymont, Lead GP, Kry__


Kry.co.uk > Your health > 5 common skin rashes in babies and children — and what to do

5 common skin rashes in babies and children — and what to do

It’s natural to worry when your child develops a rash — but most rashes aren’t serious, and can easily be treated at home

How to spot common rashes in babies and children | Kry UK

2020 hasn’t gone quite as we expected. The pandemic has changed the way we have business meetings, use transport and interact with loved ones. While a lengthy lockdown put many UK childrens’ education on pause, children are now back to school, but with new social distancing measures in place.

Reassuringly, children are less likely to become unwell from COVID-19 than adults. But the virus is still around – along with the usual back-to-school infections like the common cold and stomach bugs – and we want to make sure kids are as safe and happy as possible. 

So, how can you help them feel comfortable both physically and mentally after a rollercoaster first half of the year? Follow these tips for peace of mind... 

## How to help your child settle back in at school

### 1. Have positive conversations about what’s different 

Nobody wants their child to feel surprised or confused because things aren’t quite the same as before. First things first, it’s important to have plenty of conversations about the new normal. But on top of informing them, make sure you gauge how they feel about the changes. Are they experiencing anxiety over separating after a long time spent at home? Do they miss playing with a group of friends? By communicating about these feelings early, you can help motivate and reassure your child as the term goes on.

### 2. Keep practicing excellent hygiene habits at home

The 20-second (or “happy birthday”) handwashing rule is nothing new – we’ve been doing this since we first became aware of coronavirus. But it’s super important not to let good hygiene habits slide. Keep up the good work when it comes to things like washing hands and wiping surfaces frequently. This will help your child transition to new hygiene rules at school. 

### 3. Make healthy food choices to boost immunity 

Preparing your child with good nutrition is a great way to help fight off illnesses – from ear infections to cold sores. And now coronavirus is part of our everyday lives, it’s more important than ever to promote a good diet that supports your child’s immune system.

Key nutrients for healthy immune function include vitamins A, C, D, zinc and selenium, which you can get from something as cheap and simple as an apple. Aim for five portions of nutrient-packed fruits and veg each day, limit sugary foods and boost brain function with plenty of protein. We have an informative [guide to healthy food choices](/your-health/8-ways-to-make-healthier-food-choices-every-day/) – see how many of these you can get in your little one’s lunch box. 

### 4. Keep a good routine 

Has lockdown thrown your child’s daily routine out the window? That’s totally normal. They may be finding the back-to-school adjustment a bit tricky, so it could be a good idea to practice proper routine at weekends too. Try starting the day a little earlier, going back to regular bedtimes (see these [tips on getting children to sleep](/your-health/tips-to-help-children-get-to-sleep/)) and limiting screen time.

### 5. Treat it as a fresh start 

‘Back to school’ this year doesn’t mean back to school as your child knew it before. There will be plenty of changes that make it feel like a new experience. So, make it an exciting one by helping your child with all the right resources. Read up on the new term curriculum and familiarise them with upcoming literature to help them get stuck in – you can use online resources or your local library if it’s open. If you can, upgrade their stationary to get them in a productive mindset, and maybe even get them a cool new haircut for a new term. Most children love to start a term with a few new things. 

As important as it is to help your child settle into an unprecedented return to school, it’s so important for you to be in the best frame of mind, too. Make sure you talk about your own concerns and anxieties to friends, family or a professional if you need. It could also be useful to talk to other parents to be mindful of what their worries are and how they’re handling them – chances are, you’re in the same boat. 


Kry.co.uk > Your health > Back to school 2020: 5 ways to help your child settle in

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Back to school 2020: 5 ways to help your child settle in

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