1. RECOGNITION ●Breathing difficulties ●A ‘barking’ cough ●A whistling noise particularly when breathing in ●A hoarse voice ●Possible blueness around the extremities (Cyanosis). CROUP TREATMENT ●Keep calm – panic will distress the child and make the attack worse. ●Sit the child up to help their breathing and reassure them. ●Seek medical advice. ●If the attack is severe, does not ease, the child has blue tinged lips or a temperature, call 999/112 for emergency help. Croup is a condition usually suffered by young children, where the voice box and windpipe are swollen. The attacks, which often occur during the night, can appear very alarming, but nearly always clear without causing the child and lasting harm.

2. RECOGNITION ●Your child will be crying. They are able to breathe in but they will not breathe out TREATMENT ●They will generally come out of this themselves through spontaneous breathing ●Blow in their face to force a reaction which will get them to breathe ●If they become unconscious, then you must follow your Basic Life Support procedures as mentioned before. BREATH HOLDING Generally speaking breath-holding attacks are brought on as a result of pain or sheer frustration. It can be alarming but you must stay calm.

3. Sickle Cell Sickle cell is a hereditary problem with the red blood cells. If both parents have the “sickle cell trait” the child may develop what is known as “sickle cell disease”, or “sickle cell anaemia”. Sickle cell is most common among people of African and Caribbean origin, but it is also found among people originating from the Middle East, India and Pakistan. The main functions of the red blood cells is to carry oxygen around the body. With sickle cell disease, some of the red blood cells are distorted into a sickle shape, instead of their usual doughnut shape. The distorted shape of the cells can lead to blockages in the narrow blood vessels. A blockage can lead to damage to internal organs or even the brain and is known as “sickle cell crisis”. To prevent a crisis, protect a child from the common triggers that can induce it, such as: Getting cold and wet Over-exertion that causes extreme fatigue Sudden temperature changes (particularly from hot to cold). Prolonged infections Stress or emotional upset Dehydration (its important that the child drinks regularly) Poor eating habits

4. Sickle Cell Possible signs and symptoms ●Pain or stiffness in the arms, legs, back, stomach, chest, neck or joints ●Swelling of the hands or feet ●Drowsiness, jaundice or sudden infection ●Face drooping, arm weakness on one side, speech problems or unconsciousness (signs of a blockage in the brain) Treatment of sickle cell crisis ●Follow the care plan. Call the child’s parents without delay and give agreed medication to ease the pain. ●Agree in advance with the parents the measures that can be taken to ease pain. Get signed consent if medication is required ●If in doubt, or if you can’t get hold of the parents, seek medical advice ●If the child has difficulty breathing, shows signs of having a lack of oxygen or a blockage in the brain call 999/112 for emergency medical care