Looking after our youngest children

Along with many others who have some knowledge of nursery care and early years education, I must disagree with Elizabeth Truss’s proposals for changing the ratios in child care settings.   If we do manage to achieve the goal of having better-qualified staff, they can only deliver high quality child care if they have both the time and resources to do so – and this cannot happen if the ratios are changed.  In his excellent blog “Inside the Secret Garden,” Julian Grenier quotes from the OECD:  “Research has indicated that staff job satisfaction and retention – and therefore the quality of ECEC– can be improved by: i) high staff-child ratios and low group size; ii) competitive wages and other benefits; iii) reasonable schedule/workload; iv) low staff turnover; v) good physical environment; and vi) a competent and supportive centre manager.”

My main argument relates to the ways in which we can improve the education, training and qualifications of those looking after young children.  There have been far too many changes in this area of vocational training.  When I started teaching would-be nursery nurses (as they were then called) in about 1985 we had the old NNEB (Nursery Nurse Examination Board) system.  Students could be accepted on to the 2-year college course with 4 GCSEs  (to include English and Maths), although exceptions were occasionally made.  Colleges were inundated with applicants for the course, so could be choosy!  Every student we interviewed had to prove an aptitude for working with children – and needed to back this up with relevant work experience references, including references from parents or childminders/nursery teachers.  The NNEB training required students to undertake lengthy blocks of practical training in a variety of placements – as nannies, childminders’ assistants and as trainees in nurseries, infant schools and centres for children with special needs.  They also had to complete many Observations and assignments; all of these were workplace oriented – and they needed to attend and pass a St.John’s Ambulance First Aid qualification.

Since then, we have replaced the old system over the years with GNVQs, BTEC Certificates and Diplomas, CACHE Foundation Awards, Certificates and Diplomas and – most recently – The Children and Young People’s Workforce Level 2 Certificate and Level 3 Diploma.  From my experience as writer of textbooks for this market, the core aims have shifted.  Instead of students being assessed in the workplace by their tutors from college (and schools), they can achieve a Level 2 qualification through a sort of distance learning, with reduced levels of contact with children – some have boasted of getting their Level 2 certificate after 6 months of training!   First Aid disappeared as a mandatory qualification for a while, but I am glad to see it has now been re-introduced.  [I see Paediatric First Aid training as an essential qualification for anyone who is part of the Early Years workforce].

So where do we go from here?  I don’t want to turn back the clock – each system has its faults and its advantages.  We need an educated and motivated workforce – one which understands the developmental needs of children and knows how to provide for them – treating each child as an individual.  This simply can’t be achieved if a practitioner is expected to nurture and promote the development of four babies or six toddlers.  I don’t believe such practitioners necessarily need Maths and English GCSEs, but they do need to develop excellent communication skills and a through knowledge about the health, safety and holistic development of children.  The career structure must encourage practitioners to continue their professional development and reward them with increased pay and benefits.

Last Rights

Much has been written about the hospice movement, which provides expert palliative and supportive care for terminally ill patients and their relatives – but what if the hospice can’t take the dying patient?

This article describes a death which should have been managed in a hospice but which occurred on a busy cancer unit.

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My brother, Bruce, died recently, aged 56.  He was diagnosed with terminal cancer and was ‘given’ three months to live.  In fact he outlasted the doctor’s prognosis by two months.  As he slowly became weaker, his wife cared for him at home, with wonderful support from the district nurses and from the Hospice at Home nurses.  Throughout his illness, my brother remained positive – regarding each fresh disability as a challenge to be overcome or, at least, accepted.  Then he spent two weeks in the hospice and was sent home, complete with hospital bed and assorted aids to living.

During his last week of life, Bruce lost the power of both arms and had to be helped in all daily living activities.  At this point he frequently requested that someone be able to relieve his suffering as he knew death was fast approaching.

His GP called when he was very distressed about the lack of power in his hands and arranged for him to be admitted to the oncology (cancer ward) in hospital.  He said he thought there might be a new tumour growing in the spinal cord at the neck which was causing the paralysis, and arranged for a scan to be performed.  I asked the GP whether the problem was not simply a result of the cancer generally – it was obvious to all of us that he could not sustain life for much longer.  But Bruce was admitted to hospital on a Friday and waited until Monday for the scan.  This showed no new growth of the cancer.  (Bruce already had cancer in the lung, bronchus, brain and liver).

On Wednesday morning a nurse telephoned my brother’s wife to say that he had deteriorated and that we should come immediately.

From 10 am until late in the evening, we – Bruce’s wife, Jean, his two sons, my sister and I  – sat by his bedside in a curtained-off space in the busy 6-bedded ward.  By now Bruce could barely speak although he tried hard to make himself understood.  Visitors to the other patients came and went; it must have been very distressing for them, and we felt great sympathy for them.  Bruce was considered too ill to be moved to the hospice – and in any case there was no bed available.  Fortunately, after asking repeatedly if he could be moved to a single room, the nurses were able to discharge a patient to allow us all some privacy in a small side ward.  Pain was controlled by diamorphine, delivered continuously via a syringe driver, but Bruce became more and more agitated.  The night passed inexorably slowly.  It was extremely painful to watch Bruce struggling to speak to us all in turn.  The nurse who had been caring for him until 9 p.m. returned in the morning and was surprised to see he was still alive.  Two nurses washed and shaved Bruce and made him as comfortable as possible; this allowed us an hour to grab some breakfast and we then returned to our vigil.

By 1.30 p.m. we had been completely alone with Bruce for 27 hours.  The nurses were very busy, but remembered to pop in from time to time to offer us cups of tea and to check on Bruce’s drug administration.  Finally a senior doctor from the hospice arrived and spoke to Jean.  The doctor said that he was aware that Bruce had been talking about euthanasia when in the hospice.   He then asked Jean if Bruce was in any pain.  She said no.  He asked if Bruce was agitated.  Suddenly Jean (and the rest of us) realised that help might be at hand.  She replied that he was very anxious when awake because he couldn’t communicate properly.  The doctor said he would arrange for a sedative drug to be given and that Bruce would be asleep in 10 minutes.  This happened exactly as he said and Bruce died at 2.30.  The final half hour was agonising, with Bruce’s breathing being like a fish gasping for air.  The last breath was the typical Cheyne-Stokes gasping of a person with heart failure or brain death.  That phenomenon, coupled with a terrible spasm which caused his whole body to rear up, was death itself. It was the most awful thing to witness and we all have this visual image to live with.

I trained as a nurse and have witnessed several deaths, but my brother’s death was an unnecessarily bad death.  It was a death without dignity.  It was not the way an expected death should occur in today’s society.  We are all left wondering how it would have been managed in the hospice.  What if we had asked earlier for the magic sedative?  Where were the doctors/experts when we needed them?  Why did the GP request further tests when there was no hope of treatment?  Perhaps most importantly: why could we not have had a hospice nurse – or a nurse trained in terminal care – present with us?  If Bruce had stayed at home, he could have had a Hospice at Home nurse with him.

All these questions remain unanswered.  We do not blame the nurses on the ward.  They had a busy routine caring for people at various stages of cancer therapy.  They simply did not have the appropriate resources to cope with such a protracted death.  I feel strongly that our ‘last rights’ were violated – as well as my brother’s rights to a comfortable, dignified death.

I have detailed this experience in order to highlight the problems which can occur when care of the dying is inappropriate and inadequate. There has been no contact from any of the nurses involved in caring for my brother in the community, although the hospice has provided bereavement group sessions for Jean.

How many others have similar experiences?  And what can be done to ensure that others do not have to endure such an ordeal?

Do we need to care more for first-time mums and their babies?

There was a time – 20+ years ago – when first-time mums were encouraged to stay in hospital for 5 to 7 days.  As a midwife, I couldn’t wait to get off the ward and back home, but looking back I think I gained a lot by being there for 6 days when I had my first child.  I was on a four-bedded ward and we were shown how to bath a baby – in a relaxed manner.  There was also help and support with breastfeeding and salt baths run as often as you liked to help heal those who had perineal stitches.  There were plenty of pillows and foam rings for those who were sore and a general sense of camaraderie on the ward.  The downside was the restricted visiting – I think it was 2 to 6 pm.  How things have changed!  It’s certainly true that childbirth is not an illness, so many more births could take place at home.  I think the main problem for mothers today is that there is not enough support in the first 10 days.  Midwives have a heavy caseload in the community, and just don’t always have the time to help establish breastfeeding, to demonstrate bathing, and to reassure a mother with a fretful, crying baby.  Maybe we should have a proper system of postnatal care – so those who lack family support in those first few weeks can be helped by a doula or some other trained person.

Talking to babies

Talking to babies

I’m always seeing mothers pushing a baby or toddler in a forward facing buggy and chatting on their mobile phone.  I look at the babies and note that they seem generally lacking in stimulation – and this brings to mind the research published by the National Literacy Trust in 2008. The research found that children in front-facing buggies are significantly less likely to talk, laugh and generally interact with their parents than those in buggies that face the pusher.

The majority of buggies on the market are designed so that the child sits facing forwards, cut off from interaction with the pusher.  When confronted with the latest research, most parents have said that they would prefer a buggy where the child faces towards them, enabling general talking and singing – but many are deterred by the elevated price of buggies that face the pusher.

Add to this the problem of constant use of mobile phones and it is easy to see how babies are missing out on valuable communication with their parents.  Parents nowadays have so much to feel guilty about, and I certainly don’t want to create additional pressure.  But it’s so important to talk to babies and toddlers – to promote their language skills and to help them to make sense of their world. Why haven’t the manufacturers of baby and toddler transport systems led the campaign for change?

Make your own Upsy Daisy Cake!

I have just made an Upsy Daisy cake for my two year old granddaughter – and she loved it!  I used a Nigella Lawson recipe for Buttermilk cake.  The cake was enough for 20 people with generous helpings.

I chose that recipe because it is easy to cut without falling apart and holds its shape well.  I doubled up the recipe and made one round cake (in two halves) and 1 square cake in a 23cm tin. It is shown here on an 18″ inch cake board and practically covered it.  Then I enlarged a printout of Upsy Daisy from the In the Night Garden website and traced it onto a baking paper sheet to place over the cakes and cut them out. I used the chocolate buttercream to fix the arms in place and the legs were cut in one piece with the body.

Nigella Lawson’s easy birthday buttermilk cake

This cake is ideal for any birthday cake you want to make in a special mould as it holds its shape brilliantly.

Serves 10

250g plain flour
1/2 tsp baking powder
1/4 tsp bicarbonate of soda
1 tsp salt
200ml buttermilk (or 75g yogurt mixed with 125ml semi-skinned milk) finely grated zest of an unwaxed lemon, plus 1-2 tbsp lemon juice
125g softened butter, plus extra for greasing
200g caster sugar
3 large free-range eggs
icing sugar and ready-to-roll icing to decorate

Preheat the oven to 180C/350F/gas 4. Butter a 23cm ring mould cake tin.
Sift the flour, baking powder, bicarbonate and salt together. Mix the buttermilk (or yogurt mixture) and lemon zest.

Cream the butter and sugar together. Beat in the eggs one at a time, adding a little of the flour with the last one. Gradually add the rest of the flour with the buttermilk, one after the other, until thoroughly mixed.

Pour into the tin and bake for about 30 minutes or until well risen and pale golden brown. Loosen the sides of the cake with a round-bladed knife and turn out onto a wire rack to cool.

My bit: When cold, I put a thin layer of chocolate buttercream frosting over both cakes and used a small amount to sandwich the two round halves together. (I had quite a lot of cake left over which I used to make a trifle. (I made the chocolate frosting but you can buy a large tub fairly cheaply).

I splashed out on ready coloured Regalice – Teddy bear brown, lilac, red, orange and white – but you could make your own!   It was VERY easy to roll really thin and then cut out shapes to put on the cake.  I used chocolate icing for the eyes and mouth and some bendy sticks from an old perfume disperser  to make her “hair.”  I used a cake candle holder to cut out the orange/red daisies on her chest – my least successful bit – have now found out you can buy ready made daisies!

Of course now I have loads of icing left over so may just have to make another for a friend…..      Anyway it was great fun and a great success!

Babies and milk

Parents today are bombarded with promises from advertisers that they have the key to making their children brighter, healthier and in every way better than they are now. And a lot of it is plain nonsense. Take the adverts for formula milk for toddlers. I see them all the time on TV and the claims they make are ridiculous – the manufacturers aren’t allowed to advertise formula milk for babies under 6 months (thank goodness!) as the Government has backed research which shows that breastfeeding is best for babies under 6 months. And now I’ve found out that the toddler milk is not only cheaper than the first formula milks, but also parents are given money-off vouchers as well as free entry to competitions!
I have kept up to date with all the nutritional advice for babies and young children given over the last 10 years and full-fat cow’s milk is the right milk to switch to after the baby is one year old – whether from breast milk or from infant formula. All parents need to do is make sure their babies get a diet rich in iron – which is not difficult to achieve.