[PS1PF]
Natasha ?
WMN: F8L_529
Dialogue: F8L
[F8LPSUNK]
Yes
[PS1PF]
Sarah , I 've seen Sarah
[F8LPSUNK]
Yeah
[PS1PF]
Susie [ANONYMIZATION]
[F8LPSUNK]
Yeah
[PS1PF]
yes , Aysha ? Natasha [ANONYMIZATION]
[F8LPSUNK]
Yes
[PS1PF]
Claire , over there , Brea oh yeah , does anybody know if Brea is still in hospital ?
[F8LPSUNK]
She 's , she came out last week , but I still think she 's feeling a bit
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Jane
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Melanie here ? Kate here ? Susie 's here , Sarah [ANONYMIZATION]
[F8LPSUNK]
Have n't seen her yet , she might be here
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Janice
[F8LPSUNK]
Yes
[PS1PF]
Holly I 've seen , Kerry 's not here yet is she ? Right , shall we make a start because the time 's pressing on . I 've got some erm announcements for this morning , Vicky , erm first of all I 'd like to introduce you to Anthony [ANONYMIZATION] who comes from Longman 's Dictionaries why did , why did you do that Melanie ?
[F8LPSUNK]
Er cos I think you just told us that man you know
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
last count did n't we , ask me
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Yes
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
Good morning
[PS1PF]
Hello
[F8LPSUNK]
I 'm from the Evening News you 're , you 're recording
[PS1PF]
Oh good grief
[F8LPSUNK]
sorry I 've been all round the
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
yeah carry on
[F8LPSUNK]
Right
[PS1PF]
take a picture of the recordist
[F8LPSUNK]
never mind
[PS1PF]
Erm Anthony is taping , he 's in the college today , he 's taping erm , the , the sounds that we make , the vocabulary that we use , not for the content of our classes that 's right is n't it ?
[F8LPSUNK]
Mm
[PS1PF]
But for the way we actually use and pronounce our English language .
[F8LPSUNK]
Oh no
[PS1PF]
And
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Anthony and his , Anthony and his colleagues are going around , is it just England or are you going to Scotland and Wales as well ?
[F8LPSUNK]
The whole of Great Britain , so Northern , Northern Ireland as well .
[PS1PF]
The whole of British Isles , right , erm in various sort of settings , different places , you 're going to a school are n't you tomorrow
[F8LPSUNK]
Mm
[PS1PF]
is that right ? Various other places too , so they get a good idea of the English language as it 's spoken in the nineteen nineties . This is for pros posterity
[F8LPSUNK]
Smile
[PS1PF]
posterity , is that right ? For the future for erm , for record , we 've not been able in the past to know how people spoke only from books , dictionaries and try to describe how people said things , erm , but this is a living record and I 'm getting more and more embarrassed as the minutes go by and those of you who are doing drama this afternoon , anybody doing drama ? Erm he 's going to be recording Frances ' session
[F8LPSUNK]
Oh right
[PS1PF]
as well , alright ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Okay ? So that 's that , but he 's not going to interfere with us talking , let's carry on , at about ten o'clock Graham [ANONYMIZATION] is coming who is , I 'm , as you know I 'm doing erm , er a teaching course , I 'm not a teacher you see , I 'm a , I 'm a nurse , he 's coming to assess me on er , this is a teaching practice for me , alright , so he will come in and I think he 'll sit over there and we 'll just get on . Right last , last week we did erm cold injury in the new born did n't we ? We 'll just recap briefly on what we did . Thank you , fine now this is
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Is that clear ?
[F8LPSUNK]
Yeah
[PS1PF]
Right did we actually do the susceptible babies ?
[F8LPSUNK]
Yeah
[PS1PF]
Alright Jane ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Is that alright ?
[F8LPSUNK]
I do n't know it 's engaged , er Jill 's trying to phone the school as well and that 's engaged , so I do n't know
[PS1PF]
The bab the babies who are susceptible to getting this cold injury are , what did we do last week ? What did we cover ?
[F8LPSUNK]
Erm cold
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
what type of babies did they cover ?
[F8LPSUNK]
Low birth weight
[PS1PF]
Pre-term , premature and small
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
babies , there that , are you alright Kate ? There are other reasons why babies might be susceptible , and there are a list of things that you may well know about from babies you 're looking after . Where after they 've been born , they might have had delayed breathing , not breathed immediately , so that type of baby might be at risk . If the actual delivery or the birth of the baby had been difficult , traumatic for example a forceps delivery or a very long labour , where the baby and the mum got very tired and exhausted If there 's any , if there 's any congenital amalgamation we can discuss it
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
we just have a recap , okay , if there 's any congenital amalgamation particularly in the central nervous system , things like spina bifida , hydrocephalus , problems like that and any underlying infection or feeding difficulties and the feeding difficulties could be cause or effect , we 've got a baby that 's erm , who 's temperature is dropping , it 's getting more sleepy and erm it 's difficult to feed and if a baby 's not feeding properly it wo n't be able to warm itself up . If you 're , if you 're outside and you get really cold what do you do ?
[F8LPSUNK]
Warm yourself
[F8LPSUNK]
More clothing
[PS1PF]
Yeah , what else might you do ? You 'd go inside and have what a hot ?
[F8LPSUNK]
Drink
[PS1PF]
Yeah or a hot meal and that would really warm you up would n't it ? So you can see that the last , this is a vicious circle . Kerry would you like to sort of sit over there or something ?
[F8LPSUNK]
I can see it 's okay .
[PS1PF]
It 's alright Kerry it 's just that Graham [ANONYMIZATION] has come to do , to observe my teaching and he 'll be wanting to sit there , is that alright ?
[F8LPSUNK]
Yeah
[F8LPSUNK]
Kerry get a chair
[F8LPSUNK]
Oh , erm could you leave that up Cathy for a minute ?
[PS1PF]
We need to think that why new babies are so prone to cold injury and a lot of the reasons , can I take that down , are very obvious if you think about them cold injury is the same as hypothermia . What other group of people get hypothermia ?
[F8LPSUNK]
Old people
[PS1PF]
Old people that 's right , why do old people get hypothermia ?
[F8LPSUNK]
Because they do n't move about very much .
[F8LPSUNK]
Cathy did we write this last week or not ?
[PS1PF]
Erm
[F8LPSUNK]
This one
[PS1PF]
I do n't think we did
[F8LPSUNK]
Right
[PS1PF]
I just want to go through it with you and recap . Old people because they do n't move around , what else do n't they do ? They perhaps do n't eat much . What might be where they 're living ? It might be quite
[F8LPSUNK]
Cold
[F8LPSUNK]
Cold and damp
[PS1PF]
Right their environment 's cold babies actually have a very large surface area in relation to their weight . If you look at a baby they 're totally out of proportion and they have huge heads do n't they ? Compared to the rest of their body and they do n't have much hair , if any , to keep them warm . They have very large bodies and little limbs , so the heat lost from their heads and their bodies could be quite great . That makes sense to you ?
[F8LPSUNK]
Yeah .
[F8LPSUNK]
What does it say at the end in relation to what ?
[PS1PF]
Weight , W T
[F8LPSUNK]
Yeah , that 's what I thought
[PS1PF]
abbreviation , weight
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
When babies are born , erm what are they ? Er are they dry or
[F8LPSUNK]
Wet
[F8LPSUNK]
Wet
[PS1PF]
If you come out of a swimming pool and stand at the side what happens to you ?
[F8LPSUNK]
You get cold
[PS1PF]
Mm and shiver . Right the body surface at birth is wet and therefore cools quite rapidly so they 've got big surface area and they 're born wet and they have to be dried off . When they 're , when they 're inside their mums , do they have to control their temperature ?
[F8LPSUNK]
No
[F8LPSUNK]
because the mother does that for them
[PS1PF]
That 's right , well it 's in a , they 're in a , in a very warm environment are n't they ? And it 's con the temperature is constant , it 's like being in an incubator . Body temperature is ninety eight point four is n't it ? And it stays like that throughout , so the baby does not use its mechanism to control the temperature , it 's kept at that constant degree of warmth and it 's only when the baby comes out that it has to start looking after itself . So what I 've written is babies prior to birth do not control their temperature , they have the ability to control their temperature because that 's a little space in the brain , but they do n't need to use it . They 're kept warm When you saw those little babies last week that were born very , very premature , apart from being very small , if you looked at those arms and legs and their bodies what was the noticeably different about them than a full term baby ?
[F8LPSUNK]
Colour of their skin .
[PS1PF]
Colour , yeah , something else
[F8LPSUNK]
The way they breath , breathing
[PS1PF]
What was that Sarah ?
[F8LPSUNK]
breathing
[PS1PF]
Breathing , no something to do about their physical appearance
[F8LPSUNK]
They 're really curled up more than like a normal baby are n't they , they 're all sort of , you know , foetal position .
[PS1PF]
No it 's to do with
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
they do n't have that much fat on them . A new born baby can be really quite chubby and these little premature babies have very , very little fat under their skin and fat insulates us does n't it ? It keeps us warm , so pre-term and small
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
babies have very little fat to insulate them , therefore they 're gon na get cold are n't they ? And these are all reasons why these babies might get cold . If you come out of our , out of a swimming pool and you 're wet and you stand on the side and you 're beginning to get cold , what 's your body reaction , what do you do ?
[F8LPSUNK]
Shiver
[F8LPSUNK]
Shiver and you get goose bumps
[PS1PF]
Shiver , right . Have you ever seen a baby shiver ?
[F8LPSUNK]
No they ca n't shiver
[F8LPSUNK]
They do n't shiver
[F8LPSUNK]
And they [UNCLEAR]
[PS1PF]
Babies , babies actually ca n't shiver . They 're unable to do it and shivering is a body reaction to being cold to make you warm up because it 's rapid movement and babies ca n't do that , this is n't very clear , hang on that better ?
[F8LPSUNK]
Yeah
[PS1PF]
That 's better , top goes , but right so babies can not shiver which is a temperature raising or maintaining mechanism . We 've said that when it 's a baby inside its mum , does n't have to control its own temperature , and in actual fact it 's several days after birth , after the baby 's born that it can effectively produce its own heat and its metabolism functions efficiently . Metabolism is the process by which you take in food , use it and convert it into energy and heat , er several days , so there were several days after the baby 's born when it 's really very much at risk of getting cold injury . it 's an enormous adaptation that the baby has to make from being cocooned inside its mum to actually living outside , it has a whole host of new things to do , it 's got ta breath , it 's got ta eat it 's erm , it 's excretory system has got to work , bowels and bladder , it 's got to control its own temperature . When a baby 's born , er you wrap it up and you put it in its cot and it 's very inactive is n't it ? They 're not very active are they ?
[F8LPSUNK]
No
[PS1PF]
And in the first day of life they tend to sleep an awful lot , right , so newborns tend to be sleepy and inactive and the things that , that wake babies up and warm them are feeding , crying , limb movement . So within , your very new born sleeping all the time it , its body temperature can begin to drop without you knowing . the older the baby gets the less common it is to find the cold injury . Can I take that down ?
[F8LPSUNK]
No
[PS1PF]
Move up ? We 're going to go on to the effects of chilling and what damage does that do ?
[F8LPSUNK]
Chilling ?
[PS1PF]
We did , chilling , yeah getting cold , last year we did , in your first aid course you did hypothermia did n't you ? What 's the normal body temperature , can anybody remember ?
[F8LPSUNK]
Thirty seven degrees
[PS1PF]
Or
[F8LPSUNK]
Ninety eight
[F8LPSUNK]
Ninety eight
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
Thirty six
[PS1PF]
What , what is it in fahrenheit ?
[F8LPSUNK]
Ninety eight
[PS1PF]
Thirty seven or ninety eight point four
[F8LPSUNK]
Oh
[PS1PF]
round about okay ? If the body temperature falls to , sorry we 're not clear again are we ? Falls to thirty two degrees centigrade or ninety degrees fahrenheit the following can occur and that 's a big drop , that 's a drop of five degrees in this country we 're very used to rapid temperature changes in our environment in the spring you can have frost in the morning and it can get really quite hot by the afternoon , sometimes up to about seventy ca n't it ? And then the temperature drops down rapidly again . Right , what do you think might happen if a baby 's getting chilled , what signs do you think might you notice ?
[F8LPSUNK]
Blue
[F8LPSUNK]
Cold to the touch .
[PS1PF]
Yeah cold to touch
[F8LPSUNK]
Blue
[F8LPSUNK]
Blue
[PS1PF]
Yeah
[F8LPSUNK]
Crying
[F8LPSUNK]
Pale skin
[PS1PF]
Pale skin , right , what about its behaviour ?
[F8LPSUNK]
Crying
[PS1PF]
They may not cry actually
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
something else that could be quite actually misleading might sleep , be very sleepy , difficult to wake , so if you 've got the baby and you think your baby 's due for a feed and it did n't take very much at the last feed , you ca n't wake it up you should n't think oh well I 'll have to wait for another four hours , beginning to get worried so if the baby 's difficult to wake if it 's difficult to feed not sucking very well if the baby 's cold to touch and then there 's something which is very , very misleading , these babies can have bright red cheeks and bright red hands and feet and if you look at them you think oh they must be warm because they 're red
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
do n't be fooled by the healthy appearance . Always touch a baby , its hands and its feet and the feet are a better guide to my hands , because babies ' hands can often be cold . If you 've got cold feet at night can you go to sleep ?
[F8LPSUNK]
Depends how tired I am .
[F8LPSUNK]
[PS1PF]
Who , who if they 've cold feet lies awake , till they warm up ?
[F8LPSUNK]
Got socks
[PS1PF]
So that 's very , very important because it can be very misleading and you could be fooled into thinking that there 's nothing wrong with the baby , then there 'll also be swelling of the hands , feet and the eyelids might swell up , the medical word for that is oedema which you may well see in books , which means swelling occasionally the overlying skin is
[F8LPSUNK]
Cathy
[PS1PF]
hard and these babies can look really serene and peaceful so serene and peaceful that next time you go they 're not there any more , well their body 's there . Okay got that down ? Serene it means peaceful and calm , erm Treatment , you should , if you think back to your hypothermia , what are the very simple practical things you can do if you find a baby that you think , suspect 's got cold injury ?
[F8LPSUNK]
Give it hot , oh not hot
[F8LPSUNK]
[F8LPSUNK]
a warm drink or
[F8LPSUNK]
You have to warm it up
[F8LPSUNK]
cuddle it and
[PS1PF]
You may or may not be able to do that because it may have lost consciousness , alright , but we 'll put down warm drink if possible .
[F8LPSUNK]
Raise the temperature of the room .
[PS1PF]
If it 's unconscious you ca n't do that , you 'd choke it
[F8LPSUNK]
Raise the temperature of the room
[F8LPSUNK]
Mouth to mouth do n't you ?
[F8LPSUNK]
and cuddle the baby
[PS1PF]
You would give it mouth to mouth if it was dead , if its heart had stopped beating . If you find a baby er you 'd pick it up , it 's sort of very erm sleepy you ca n't rouse it and it 's got bright red cheeks and feet and you realize that it 's cold , what are you going to do immediately ?
[F8LPSUNK]
Cuddle it
[PS1PF]
Cuddle it right , it 's wrapped up in about six layers of erm whatever , are you just going to pick it up and cuddle it or are you going to do anything with all those layers ?
[F8LPSUNK]
Take
[F8LPSUNK]
Take into the room temperature and take the covers off .
[PS1PF]
You 've got a number of things here , you would take off the outer layer and you would bring it close to your body , if you , if you just pick it up with lots of layers around it you 're insulating it are n't you , to keep it cold , so you cuddle it close to your body right , and you remove outer layers of cloths Melanie said something about room temperature , right you raise the room temperature , okay ? What else would it be a good idea to do if you had something to do it with , about the temperature ? You 'd want to know
[F8LPSUNK]
Take its temperature
[PS1PF]
Yes take the ta baby 's temperature that , this way you know whether the temperature 's falling or going up , do n't you ? And you can report that because this baby 's going to need to go to hospital right so those are the three things you do , you raise the room temperature , erm you cuddle the baby close to your own body which should be warm , removing any excess layers , you can then wrap a blanket around yourself and the baby , if you can , give it a warm drink but you , you may , may not be able to do that , you take the baby 's temperature and you seek medical advice right Is that quite clear ? That 's very similar to the straightforward hypothermia that you 'd might find in an old person or somebody who 's in a , in a snowy field all night , have you all got that ?
[F8LPSUNK]
Yeah
[PS1PF]
But of course , better than treatment we have prevention do n't we ? What can we do to prevent this situation from arising ? Quite a lot of things , right Melanie
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
what , what temperature would you like ?
[F8LPSUNK]
About
[PS1PF]
Shall we say seventy degrees fahrenheit
[F8LPSUNK]
What 's that in normal
[PS1PF]
What 's that in
[F8LPSUNK]
We 're asking you
[F8LPSUNK]
Twenty five , no
[PS1PF]
Is twenty five a bit hot ?
[F8LPSUNK]
Yeah
[F8LPSUNK]
No cosy
[F8LPSUNK]
[F8LPSUNK]
Is n't it eighteen or twenty ?
[PS1PF]
Yes I think you 're right actually , shall we put , shall we put twenty ?
[F8LPSUNK]
Go on then .
[PS1PF]
Er it 's important to keep that constant twenty four hours a day there 's a danger area when new born babies are actually put into their own rooms , particularly in the winter , if they 're in the room with their , with their parents and the room temperature falls very low , the parent 's likely to notice and get cold themselves which means they 'll pay attention to the baby , if the baby is far end of the house , up the north end where the wind 's blowing , right , er what else can we do to keep the baby warm ?
[F8LPSUNK]
Blankets and clothing .
[PS1PF]
Right , what , what about blankets and clothing ?
[F8LPSUNK]
Well not too much
[PS1PF]
Right
[F8LPSUNK]
not one big thing
[F8LPSUNK]
Yeah lots of small things
[F8LPSUNK]
Not one big thing , lots of little layers
[PS1PF]
Several layers , lots of , fairly thin layers , why is that warmer than one thick layer ?
[F8LPSUNK]
Because it insulates the
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
it traps air between each layer .
[PS1PF]
It traps the air between the layer , the layer and air , air is a good insulator , alright . So several layers ' warmer than one thick one . What else about the fabrics that you use ? Celia , what about the fabrics that you might use for a baby ? Which are the natural fibres ?
[F8LPSUNK]
Cotton
[PS1PF]
There 's another one to keep very warm
[F8LPSUNK]
silk
[PS1PF]
Silk in actual fact mixtures of synthetic and natural fibres are very , very good because they give the warmth of the natural fibres plus the erm enduring properties of the manmade fibres which wash and last well , okay , but natural fibres are much , much warmer . What else might you do ? What should you do ? What other things is the baby exposed to , it might make it cold ?
[F8LPSUNK]
Draughts
[PS1PF]
Draughts , very good make sure the baby 's not in a draught can you think of anything else ?
[F8LPSUNK]
Damp
[F8LPSUNK]
Keep a baby in like a warm baby-gro
[PS1PF]
Babies should have their nappies changed regularly because when they become wet they give off heat do n't they ?
[F8LPSUNK]
Oh yeah
[PS1PF]
Right , the
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
the same way as when they dribble and they 're , maybe a little bit sick , their clothing gets damp , it acts as a conductor of warmth so it will cool them and it will make them sore as well , so keep the baby dry as possible . Now these are all things that you should be doing with the baby all the time anyway are n't they ?
[F8LPSUNK]
Yeah
[PS1PF]
The good care there 's one other thing that we talked briefly about in the signs and symptoms and what happened that you could check for you look at a baby , what else do you do ?
[F8LPSUNK]
Touch
[PS1PF]
Right , what would you touch ?
[F8LPSUNK]
The feet
[F8LPSUNK]
The feet
[PS1PF]
Right so you touch its extremities and if you feel that its little feet are lovely and warm you know that it 's alright , okay ? You touch the extremities , the hands and feet you can keep the head covered as well particularly when you take the baby out . Other things you can do , when you put a baby into its bed you can make sure the bed 's warm ca n't you ? You could have warmed it up with a hot water bottle or a heat pad do n't leave it there with the baby in it , but you can certainly warm the bed first , you can warm the baby 's clothes , keep them in the airing cupboard , or lots of houses around here have Agas do n't they ? You can warm them up on the Aga , okay ? Obviously cold injury is far more common when would you expect cold injury to be common ?
[F8LPSUNK]
In a temperature of maybe erm
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
er right , what about seasonal ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Right , winter babies are more susceptible and small
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
okay ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Do you want to pass a chair up Sarah and Tasha ? Sarah you 'll need to get all this information from somebody else .
[F8LPSUNK]
Right .
[PS1PF]
Are there any questions about that ? Does it worry anybody ? We 're going to go on to what used to be called club foot which is a fairly gross word word Right
[F8LPSUNK]
How do you pronounce that , talipes ?
[PS1PF]
Talipes
[F8LPSUNK]
Talipes
[PS1PF]
the er main word for that is club foot , what does that mean , does anybody like to tell me ?
[F8LPSUNK]
We saw it at the hospital
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
did you ? Right
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
What did , Melanie , can you tell us what you did then ?
[F8LPSUNK]
It 's when the foot 's twisted round , it wo n't stay square .
[PS1PF]
It can be , it can be two types of , what can it be do you know ? It can either be fixed or it can be mobile , we 'll go on to that , I 've actually drawn you four pictures , not very good pictures
[F8LPSUNK]
Aargh
[PS1PF]
There you are you think of that as your foot , this one is where the foot , erm goes inwards , can you see ? That one , that 's the big toe , is where the foot actually is twisted outwards this one is where the foot is curved under , and that I 've put in red because it 's the most common sort , very common , that is where the foot is forced up and that one is where it looks as though it 's standing on its toes . Those are the more or less the five variations on a theme .
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
What problems do you think club foot talipes might cause ?
[F8LPSUNK]
Shoes
[F8LPSUNK]
Delays walking does n't it ?
[F8LPSUNK]
Ca n't walk
[F8LPSUNK]
Difficulty walking
[F8LPSUNK]
Delays growth and walking does n't it ?
[PS1PF]
If you have , sorry ?
[F8LPSUNK]
Delays growth and development and walking
[PS1PF]
Certainly delays walking , that earlier development . If you had this type you would n't actually be able to walk properly at all would you ?
[F8LPSUNK]
Would n't be able to walk
[F8LPSUNK]
Oh no
[PS1PF]
Want to draw them all do you ?
[F8LPSUNK]
Oh yeah
[F8LPSUNK]
No
[F8LPSUNK]
Yeah
[F8LPSUNK]
Can you quickly stick it up please
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
is a foot deformity , present at birth right , present at birth , it does n't happen afterwards , it happens , it 's caused before the baby 's born and it 's more common in boys can be one or both foot , feet . How do you think it might be caused ?
[F8LPSUNK]
If the mother 's had mumps or something
[F8LPSUNK]
Bad feet posi positioning in , in the stomach .
[PS1PF]
Foetal position , yes , what sort of foetal position ?
[F8LPSUNK]
Wow
[F8LPSUNK]
Breach
[F8LPSUNK]
If it 's been , if the baby 's sort of squashed
[F8LPSUNK]
The feet have been bent up , the feet have been squashed and bent up .
[PS1PF]
So it 's caused by foetal position and there 's something that can make it worse , you know the mother erm inside erm the womb there 's a bag of fluid that the baby floats in
[F8LPSUNK]
Yeah
[PS1PF]
right , if there is n't very much of that fluid , there 's very little fluid , there 'll be more pressure on the baby wo n't there ? Because the fluid acts as a kind of cushion . So I 've written too little liquor for them , a wonderful word which is actually the proper word , called onigohydromonous
[F8LPSUNK]
That 's wonderful
[PS1PF]
Amniotic fluid , you all know what that is do n't you ?
[F8LPSUNK]
Yeah
[PS1PF]
If I write this on the board , I 'll break it down for you because it 's a word you may well see , sorry about that
[F8LPSUNK]
Cathy
[PS1PF]
Yeah
[F8LPSUNK]
what does that say too little ?
[PS1PF]
Liquor
[F8LPSUNK]
Pardon ?
[PS1PF]
you know that word
[F8LPSUNK]
It 's liquor
[PS1PF]
liquor , liquor , yeah , that 's erm the fluid that the baby floats in , amniotic fluid , liquor
[F8LPSUNK]
I 've never heard of that
[PS1PF]
Have you not heard it ?
[F8LPSUNK]
No
[PS1PF]
Pe , if you have n't heard , you 've all heard of amniotic fluid , put that then .
[F8LPSUNK]
What 's the other one ?
[F8LPSUNK]
How do you spell that onigohydromo
[PS1PF]
I was going to write it on the board for you
[F8LPSUNK]
What 's the other one ?
[PS1PF]
it 's all one word , but I 'll write it
[F8LPSUNK]
What one ?
[F8LPSUNK]
Onigo
[PS1PF]
That is water is n't it ? Hydro is water
[F8LPSUNK]
Yeah
[PS1PF]
amnio amniotic fluid , and onigo means not much
[F8LPSUNK]
Oh
[PS1PF]
and that 's the medical word for it , draw , write it in a line
[F8LPSUNK]
not much amniotic fluid
[PS1PF]
Sorry I 've left a bit out
[F8LPSUNK]
That 's what it means
[PS1PF]
Can you see that ? It 's quite a common event in , and it can be two types , it can be either fixed or flexible , if it 's fixed it means the foot is in a position that you ca n't move out of if it 's flexible it means that the baby has its foot like that but you can actually rotate it
[F8LPSUNK]
Aargh
[F8LPSUNK]
But it will go back to the same position as that ?
[PS1PF]
Yes , would they go back to the same position , quite right Sarah
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
when do babies start to walk ?
[F8LPSUNK]
It could be er
[PS1PF]
Between what ages ?
[F8LPSUNK]
Nine to a year
[PS1PF]
Nine months , yeah , to what ?
[F8LPSUNK]
Eighteen months or eighteen
[F8LPSUNK]
Behave
[PS1PF]
Right , if babies actually do n't walk normally until they 're between nine months or eighteen months to two years . When you walk you wait there for the first time do n't you ?
[F8LPSUNK]
Yeah
[PS1PF]
Until that time a baby wo n't hurt its feet in a walking position , they 'll be fairly mobile wo n't they if you think about it , and how does a baby hold its feet when it 's crawling ? When a baby 's crawling how does it hold its feet ?
[F8LPSUNK]
Like that .
[PS1PF]
Right , they go out behind do n't they ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
yeah
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Have any of you been on , on placements where mums have been really quite worried about their baby 's feet and asked questions ?
[F8LPSUNK]
No
[F8LPSUNK]
No
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
lots of mums will ask about their baby 's feet , do you think there 's anything wrong with this , and they 'll sort of be holding their feet sort of wiggling them around , doing this , that and the other
[F8LPSUNK]
That 's disgusting in n it ?
[PS1PF]
and they 'll get very worried , and it 's quite a difficult area because you have to be on the look out for something that 's not right , but you do n't want people to get er very worried because those feet are going to be very mobile and doing non walking thing until the child walks , they 're also very fat and podgy are n't they little babies ' feet ? And they have very short toes
[F8LPSUNK]
Stodgy
[PS1PF]
What I would say , if there 's any doubt , if a mother has any doubt about her baby 's feet she should see the doctor and he will refer if he thinks necessary so most babies ' feet can look quite odd at times and they will hold them in strange positions .
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
What 's pigeon toed ?
[PS1PF]
Pigeon toed is where you actually walk with your toes like that , is n't it ?
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
Move over a bit I ca n't see
[PS1PF]
What would you do for pigeon toes Kelly ?
[F8LPSUNK]
Do what ?
[F8LPSUNK]
For pigeon toes
[PS1PF]
What 's the best treatment for pigeon toed ?
[F8LPSUNK]
I had that and my mum sent me to ballet classes
[PS1PF]
That 's the answer , ballet classes
[F8LPSUNK]
Really , yeah that 's what my mum did .
[PS1PF]
because er train trains them the girls and the boys to turn their toes out , which is what we require in our society I believe . Right keep notes , er we 're not talking about pigeon toes , we 're talking about club foot , which is a real problem , if we do n't treat this the baby when it grows up it 's gon na have difficulties in walking . What do you think the treatment might be ?
[F8LPSUNK]
They
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
That 's right , that 's one treatment
[F8LPSUNK]
Have physiotherapy done
[PS1PF]
If the foot Melanie could you give us of the Jenny [ANONYMIZATION] in the plaster room ?
[F8LPSUNK]
Yeah
[PS1PF]
How old was the child ?
[F8LPSUNK]
Some of them were like babies the little babies
[F8LPSUNK]
Yeah some of them
[F8LPSUNK]
and some of them are quite like about seven or
[PS1PF]
Really that big ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
alright , fair enough , if , if the , if the deformity is mobile that means you can move it , you can actually do a lot of manipulation and physiotherapy and that can work very well .
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
What would happen is that the physiotherapist would actually train the mother to do it , she would show her what exercises need to be done and they have to be done almost constantly , several times a day and whenever there 's a spare moment , so therefore it 's not feasible for it to be done in a hospital is it ? And then the mum would bring the child back up regularly for assessment , to make sure that it was satisfactory . If it 's fixed that means that you ca n't move it or it 's very problematic , it 's not going right , they do strapping , splints and plaster of paris as some of you have seen . How do the children react to having these plasters put on their feet ?
[F8LPSUNK]
Some of them
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
They do n't like it
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
coming off was the worse
[F8LPSUNK]
They thought it was gon na cut through their leg .
[PS1PF]
If , for instance , if extremely problematic strapping , splints or plaster of paris treatments are used and treatment should be started as soon as possible after birth , so the sooner you notice these things the better You 've all had your hospital experience , has anybody not actually seen a child with erm club foot ? You all seen one ?
[F8LPSUNK]
I have n't .
[F8LPSUNK]
I do n't think so .
[PS1PF]
Does anybody know whether they had one when they were a child ?
[F8LPSUNK]
I , I had , my foot was in that way .
[F8LPSUNK]
I had one that
[PS1PF]
What treatment did you have ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
it sort of sorted itself out did it ?
[F8LPSUNK]
No I had a few things done , but
[PS1PF]
You probably had the physiotherapy and the
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
your mum
[F8LPSUNK]
I do n't , I 'd have to ask her
[PS1PF]
Well you would n't remember would you ? Can you take one of these each and just read it through .
[F8LPSUNK]
What does it say after
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
What does it say after what ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
As soon after birth as possible .
[F8LPSUNK]
Cathy
[PS1PF]
Right have you , have you read that ?
[F8LPSUNK]
No not yet .
[PS1PF]
Just read it through Are there any question ? Right so that 's looked for at birth , what 's the other thing they check for at birth ? Well they check a number of things , but Sarah do you know what they 're looking for ?
[F8LPSUNK]
Erm , where the ball is n't in the socket properly or it does n't
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
clicky hips
[PS1PF]
Right , clicky hips , right does anybody know what the proper name for it is ?
[F8LPSUNK]
Genital dislocation
[F8LPSUNK]
Genital dislocation of the hip
[F8LPSUNK]
Hip dislocation
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
that means you 're born with it right ? You all know what dislocation is of the hips and this is another condition which should be spotted at birth , soon after . I 've drawn some pictures just to show you what happens .
[F8LPSUNK]
Are we gon na get a leaflet on this or not ?
[F8LPSUNK]
Cathy do we need to draw these ?
[PS1PF]
Well if we genital dislocation of the hips
[F8LPSUNK]
Cathy , Cathy do we have to draw these pictures ?
[PS1PF]
Erm I think I 've got a picture for you , no you need n't , but you need
[F8LPSUNK]
Right , thank you
[PS1PF]
you need to look carefully , alright ? Liked to pull that down that 's a normal hip joint , this is your bony pelvis with the socket joint , right , socket , this is your leg bone the femur , with the head of the femur at the top and it looks like that and they fit into one another and it forms a very good swinging joint you can do all sorts of things with your hip joint , ca n't you ? You can swing your leg round , move it outwards it 's a simple ball and socket joint and it 's used in engineering quite a bit is n't it ? Is it ? Oh , so the head of the femur locks into this socket , this groove , this hollow and it 's held , what 's it held with ?
[F8LPSUNK]
Cartilage
[F8LPSUNK]
Tissue
[PS1PF]
Yeah , what sort of tissue ?
[F8LPSUNK]
Well erm
[F8LPSUNK]
Cartilage
[PS1PF]
Muscles and what else ?
[F8LPSUNK]
Cartilage
[PS1PF]
Not really , no it 's held by muscles and ligaments , hello Graham , I have told them that you 're coming , this is Graham [ANONYMIZATION]
[F8LPSUNK]
Morning
[PS1PF]
right , he 's coming to learn about dislocated hips , so this is a normal hip joint and you can see that the socket is well into the grooves , is n't it ?
[F8LPSUNK]
Yeah
[PS1PF]
Right , this red thing here is just the lining of the socket joint , right is that clear ?
[F8LPSUNK]
Yeah
[PS1PF]
Happy about that ? The one underneath shows us what happens if the hip is dislocated or loose
[F8LPSUNK]
Urgh
[PS1PF]
right , got your socket joint the same , but you can see the head of the femur is not inside it is it ?
[F8LPSUNK]
How does that happen ?
[PS1PF]
That 's a very good question , there 's a number of reasons for it happening , erm it might be that the groove , the , the socket bit is very shallow , like a shallow tea cup and the hip , the leg bone does n't stay in it properly , does that make sense to you ?
[F8LPSUNK]
Yeah
[PS1PF]
Big one , it might be that the muscles and ligaments are weak
[F8LPSUNK]
Cathy surely if it 's like you know said that would be too big to go in there anyway
[PS1PF]
No not
[F8LPSUNK]
you said that was too shallow , so it did n't fit in , how can it be mended ?
[PS1PF]
Erm well what I , what happens , I think that 's good , it 's act it 's not , it 's not inside because it 's encapsulated , it 's not inside because it 's held in there by the socket joint if I draw , draw you a picture , it 's not because the socket joint is so tight it ca n't fall out , is that what you 're saying to me ?
[F8LPSUNK]
No , no , you said that it was , you said that because it was not always in there maybe because the socket 's too shallow
[F8LPSUNK]
So how can it be fixed if that 's too small to put it in
[F8LPSUNK]
so how can you put it back in if that 's too shallow ?
[PS1PF]
Because it would , it would slide back in and it 's actually held in by muscles and ligaments , right
[F8LPSUNK]
So it does n't matter that it 's too shallow
[PS1PF]
It makes it easier for it to fall out , when a woman is pregnant , in the last few months of pregnancy she produces lots of hormones which relax the muscles in her body do n't they ?
[F8LPSUNK]
Mm , mm
[PS1PF]
Do you remember doing this ? Muscle relaxants during pregnancy , these get into the baby as well and it relax the baby 's muscles and they would relax these ligaments and muscles around the hip joint which means that the hips can be not as they should be , alright ? So the causes are , the socket might be too shallow or the ligaments or muscles might be too loose
[F8LPSUNK]
Is there writing on the sheet as well ?
[PS1PF]
Yes
[F8LPSUNK]
Should , no do we have to write it ?
[PS1PF]
I would write it down if I were you , yes , right and things like a breach delivery , what 's a breach delivery ?
[F8LPSUNK]
Feet first
[F8LPSUNK]
Bum upwards
[PS1PF]
If you think about a baby coming out bottom first , it ca n't do very much for its hips can it ? Really gives them a good old yank and a push
[F8LPSUNK]
Ooh
[PS1PF]
and then somebody comes and grabs it by the legs and pulls it .
[F8LPSUNK]
Ah
[PS1PF]
There are various types of breach delivery you can come out one foot first , two feet first or you can come out with your legs actually up against your face , in which case there 's terrible traction on the hips , alright , and all that will cause dislocation so you , you can see the difference ca n't you ? That socket inside of the hip joint held together nicely with er
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
muscles and ligaments and this one not in at all properly . All it is , is where the head of the femur is not correctly positioned in the hip socket and the proper name for the hip socket , you 'll see in your books is acetabulum This is definitely a condition which is familiar as a fam a family tendency and if you think about it if you have a , a , a big hip socket your children are likely to have big hip sockets it 's a family
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
family tendency , it affects more girls than boys , many more girls than boys , having said that Lord Byron had erm congenital dislocated hips .
[F8LPSUNK]
Who 's he ?
[F8LPSUNK]
Is he ?
[PS1PF]
It 's about one in fifteen hundred
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
birth and as we 've said before it is often found in abnormal presentation like a breach , bottom first . To spot this what procedure is carried out ?
[F8LPSUNK]
Examination and physio
[F8LPSUNK]
Yeah
[PS1PF]
Do you know what they do ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
They rotate the hips , all babies are routinely examined at delivery and they 'll find quite a number I would , of babies with slightly clicky hips , the reason for that is because of the hormones that have , er are in the baby 's body to relax all the muscles , those will go away after a few days , so when they 're re-checked at twelve days a number of the clicks they heard originally will no longer be there . And what they do , I 'm going to try and show you on this doll in a minute , the hips are abducted which means they 're brought right up against the chest and then they 're pulled round and they 're rotated in the socket and you feel and listen for a click
[F8LPSUNK]
What does it say in green Cathy ?
[PS1PF]
Feel and listen
[F8LPSUNK]
No the above one
[PS1PF]
Observe talk about that in a minute . There are other signs that might lead you to believe that there 's things not as they might be , the legs may not be equal length particularly if only one is dislocated and that 's fairly obvious is n't it because the , the , the ball joint 's not in the socket and there 's a bigger gap so the leg hangs down longer and you 've all changed a baby have n't you and you see that they 've got little creases in the insides of their legs and across their buttocks , and those creases may not be a mirror matching they are normally , so those are clues . Can I turn that off ? I 've brought a doll to show you if you 'd like to see what they do when they rotate babies ' hips , would you all like to see that ?
[F8LPSUNK]
Yes
[PS1PF]
One doll out of the cupboard . Do you want to come up round ? I 'll explain it to you , if you 've got to stand in a circle because you ca n't see from over there you wo n't actually ever do this yourself , but you may well see it being done , in fact you probably will . People who do this are actually given a training , this does n't hurt the baby , they do n't mind , their bones are very soft you 'll look at your baby , all of you can look at babies that you 're caring for and you hold them and you see well is that leg longer than the other ? I think this one is definitely longer than the other , right , so hold its legs down . You look for the creases , if you look at this doll is lov beautifully creased and you can see that the creases almost match each other , you turn the baby over and there 's lots of little creases and they match , can you all see that ?
[F8LPSUNK]
Ca n't see .
[PS1PF]
Right you then get your baby , you 'll see the midwives doing this , you stabilize the baby pelvis , because otherwise it will just sort of go all over the place wo n't it , and this doll is , is fairly fixed , it 's not a very soft thing like a baby and you , with your hand you put your finger which is about the same length as the baby 's finger is n't it ? If you think about it , you slide it into where the joint would be along the line of the femur bone , you bend the knee up , and you pull it right up and you rotate it
[F8LPSUNK]
Ouch
[PS1PF]
and you bring it down , and if there 's anything wrong you 'll feel it slowly so that it may click , you do one side and then the other , right the old fashioned treatment for erm dislocated hip was double nappies , er do you know what that ?
[F8LPSUNK]
Give it more support
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
you 're actually splaying the legs out are n't you ? Right and if you splay the legs out like that
[F8LPSUNK]
Ouch
[PS1PF]
you 're actually
[F8LPSUNK]
Doing yoga there
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
you 're actually pushing the head of the femur back into the joint
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
and the modern treatment is they put babies in splints , they lay them on like frames from splints and they 're strapped into them and they stay in them from anything up to a year , and babies do n't mind , but if you , if you think about it , if you do a double nappy
[F8LPSUNK]
Very absorbent
[PS1PF]
you 're actually putting a great thick wedge between the baby 's legs
[F8LPSUNK]
Cor
[PS1PF]
and you 're
[F8LPSUNK]
got a bloody
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
in n it ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
and you 're actually partly doing that are n't you ?
[F8LPSUNK]
My sister had it when she had
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Oh did she ? What happened to your sister ?
[F8LPSUNK]
Oh she 's alright , she just had double nappies on for a very long time
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
and they were n't disposable were they ?
[F8LPSUNK]
No , no they were terries
[PS1PF]
Right , so the terries , terries are the best things any questions about that ? You 'll probably see that being done and you may well see some babies in a splint . So the treatment is double nappy if it 's not a very er serious one or if they notice a click just after delivery they would immediately put the baby in double nappies . If it 's diagnosed as erm leaving treatment there 's a variety of splints that frames that you lie the baby on , strap them in and they remain in that position with their legs
[F8LPSUNK]
Alright do n't do it again Cathy
[PS1PF]
like that
[F8LPSUNK]
[PS1PF]
okay , that 's how they are . They 're not uncomfortable , they get used to it .
[F8LPSUNK]
Used to it , god .
[PS1PF]
You all see six month old babies putting their feet in their mouths have n't you ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
they do n't , it does n't bother them at all right , they 're used under
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
supervision and they 're used until the head of the femur right , the head of the femur is fixed back into the socket joint and the muscles and ligaments have tightened up so that they hold the bone in place and treatment can go on until they 're about a year the consequences of not treating this condition are quite severe , the child will grow up with a very odd gait .
[F8LPSUNK]
Gait ?
[PS1PF]
If you , if you are standing like this and you pick up one foot you will slightly raise your pelvis on the opposite side wo n't you ? Do you want to try that ?
[F8LPSUNK]
No , not particularly .
[PS1PF]
Stand up
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
pick up , pick up your , your right foot what happens to your pelvis , does it go up a bit ?
[F8LPSUNK]
Yeah .
[PS1PF]
Right , somebody with congenital dislocation of the hip , the hip will sag down it will cause them great difficulty and they have a waddling gait , and they 'll walk like this and if you look at African women a lot of them have congenital dislocation of the hip when they waddle
[F8LPSUNK]
Cathy
[PS1PF]
because it 's not treated
[F8LPSUNK]
what does erm , that blue writing , the third line down ? Last word
[PS1PF]
Right
[F8LPSUNK]
keep going
[PS1PF]
this is used until the femoral head , head of femur , femoral head and the acetabulum which is that
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
socket joint have grown , because they will grow , they both get bigger and the muscles and ligaments hold them firmly together , right , so that the hip no longer slides out of its joint . it 's essential that that 's treated .
[F8LPSUNK]
Can we have another look at it please .
[PS1PF]
You have a
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
sorry I 've got a little handout for you with bits of information and there 's also a picture of a breach presentation and this baby has got its feet right up into its high socket . Can I take this down ?
[F8LPSUNK]
Yeah
[PS1PF]
Are there any questions about that ? Is it quite clear what happens , why and how it 's treated ?
[F8LPSUNK]
Yeah
[F8LPSUNK]
Sorry I missed the whole , what did she say ?
[F8LPSUNK]
Cathy when I was in hospital in er a physiotherapy bit , where they , where they brought children in , erm there was this little girl and like she was riding round on a little bike , you know , so she 's quite , quite old and she had er , in , in brace , but her legs were like out at the side and her feet were pointing down and they 're pointing up , I 'm just a bit confused .
[PS1PF]
Well this is a fixed doll is n't it ?
[F8LPSUNK]
Yeah , well they would go down would n't they ?
[PS1PF]
And she might well hold her because , but when you say quite old , what do you mean ?
[F8LPSUNK]
Well she is
[PS1PF]
Was she seven or was she
[F8LPSUNK]
Oh no about three something like that , she was n't a baby what I meant
[PS1PF]
She , she 's about three right , fine , okay , she 's got past toddler stage , if , you see , if , if she was three and her feet were in splint , did she wal she did n't wait there did she ?
[F8LPSUNK]
No it was in er , in was in like a plaster of paris thing
[PS1PF]
Right , so she could n't actually walk
[F8LPSUNK]
No , she was riding a little bike
[PS1PF]
She could pedal ?
[F8LPSUNK]
No she was had her feet on the ground
[PS1PF]
Oh right
[F8LPSUNK]
they were straight
[F8LPSUNK]
Her feet
[F8LPSUNK]
Her legs , she could n't bend the legs
[F8LPSUNK]
Her legs were out to the side like that
[PS1PF]
Yes
[F8LPSUNK]
and when she walked they were sort of
[PS1PF]
right , so she was like a frog ? Like , like that ?
[F8LPSUNK]
Oh no , you 're talking about
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
I ca n't describe it , she had , her legs were out to the side , but they were pointing down like that
[PS1PF]
Yes that 's right , right well that 's a baby , that 's a baby that will be like that , but she 's older , so her legs would be , she would be in that position would n't she ? Because she 's an older child .
[F8LPSUNK]
But is it because they left it too late or something then ?
[PS1PF]
Erm , it sounds a bit grim if she 's three and she 's in a hip plaster , yes or a splint
[F8LPSUNK]
Yeah it was a plaster , it was a plaster
[PS1PF]
Yeah , yeah , but every case is different , you do n't , I mean she might of been in some car accident or something like that you see , might n't she ?
[F8LPSUNK]
Mm , she might of been , I do n't think she was , but
[PS1PF]
There are , you know , there are , yeah , occasionally they , they are n't diagnosed , very unfortunate . Look at this position my rubber , when about six days after baby 's born they take erm blood erm do n't they from the heel , do you remember that ? What 's it called ?
[F8LPSUNK]
The birth blood test
[PS1PF]
Named after a person by the name of Guffbry it is initially used to diagnosed what ? Can you remember ? Do you know ?
[F8LPSUNK]
Brain damage or something
[F8LPSUNK]
Spina bifida is n't it ?
[PS1PF]
Somebody mentioned this to me the other day
[F8LPSUNK]
P K U
[F8LPSUNK]
Penal
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
P K U , have you all heard of P K U ?
[F8LPSUNK]
Yes
[F8LPSUNK]
What is it ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
we 're going to find out .
[F8LPSUNK]
I 've said it about four times
[F8LPSUNK]
What is it ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
The proper word is , come from a very long word , a real mouthful , phenylketonuria , known as P K U for short P U , and Mr Guffbry developed this test specifically to diagnose this condition , but in nineteen ninety two there are other conditions which they diagnose at the same time with the same blood test , do you know what they are ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
no that 's obvious , because this is after the baby 's born
[F8LPSUNK]
Oh right
[PS1PF]
Something that you may not notice at birth
[F8LPSUNK]
Is it brain damage ?
[PS1PF]
this will cause brain damage
[F8LPSUNK]
Oh that 's right
[PS1PF]
another dis another disorder
[F8LPSUNK]
Diabetes ?
[PS1PF]
An awful word which is used in the English language cretinism have you heard of this awful word cretinism ?
[F8LPSUNK]
No , it 's horrible
[PS1PF]
Cretinism is used as a term of abuse is n't it ?
[F8LPSUNK]
Yeah
[PS1PF]
Right , in actual fact cretinism is a medical condition where there 's lack of thyroid and this is found , this is tested for at birth as well so we do n't have any cretins in our society because they 're all treated , the other thing they check for , do you know what it is ? Cystic fibrosis , you 've all heard of that have n't you ?
[F8LPSUNK]
Yes
[PS1PF]
A very nasty disorder , which causes
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
so after these tests , and we did this last year , check the P K U , cretinism and cystic fibrosis , we 're going to look at P K U today , right , erm what it is , rub that off ?
[F8LPSUNK]
Can I just , can I just erm
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
that please , write it rather .
[F8LPSUNK]
Is that done at birth then that blood test , is the blood test done at birth ?
[PS1PF]
It 's done at six days
[F8LPSUNK]
Excuse me Cathy , excuse me .
[PS1PF]
The proper name for cretinism is hypothyroidism , which means hypo is not enough as in hypothermia , thyroid means thyroid , -ism , it 's the three things they check for , can I pull that down ?
[F8LPSUNK]
Yeah .
[PS1PF]
Does , does anybody know what P K U is caused by ?
[F8LPSUNK]
Do n't know .
[PS1PF]
Has anybody got any idea ?
[F8LPSUNK]
No
[PS1PF]
It 's actually caused by an inability in the digestive system to break down an essential food that we eat , so there 's one type of food that the body can not use and this body , this , this component , this food substance turns to a , a poison and causes severe damage to the individual who 's affected . Do you remember doing your , your di nutrition assignments last year ?
[F8LPSUNK]
Yes
[PS1PF]
And protein is made up of a number of what , can you remember ?
[F8LPSUNK]
Amino acids
[PS1PF]
Yes lovely , amino acids , right , it 's one particular amino acid there are eight essential amino , amino acids and it 's one of these and it 's called venial alanine you do n't have to remember that , it 's very difficult to , to remember . The body can not use it
[F8LPSUNK]
What was it ?
[PS1PF]
but it 's essential to the body to have it
[F8LPSUNK]
The result is a what a rise in it or
[PS1PF]
Right , this results in a rise
[F8LPSUNK]
A rise
[PS1PF]
of the substance venial alanine it , the level rises up in the blood , it 's a bit like overfilling a jug , if you have a quarter pint jug and you have a pint of milk , when you get to the top you do n't stop pouring , it spills out the edge and in the body it actually goes into the body tissues , nowhere else to go and it causes a devastating result , it causes abnormal mental development , it causes gross retardation . It causes abnormal physical development , now you 've all seen a Downs Syndrome person have n't you ?
[F8LPSUNK]
Mm , mm
[PS1PF]
And you know they have a very distinctive characteristic do n't they , they have round faces and they 're short and they have slightly slanting eyes , etcetera etcetera , well these children have very marked physical erm appearance they 're fair haired and blue eyed the reason for that is that this substance venial alanine is responsible for the production of pigment , so if that 's interfered with they 're going to be fair haired and blue eyed , they get eczema a lot , they have small heads and they have very widely spaced teeth , sorry down a bit , is that what you want ?
[F8LPSUNK]
No I thought you was you were reading them off as you
[PS1PF]
No I 'm not I 'm just telling you
[F8LPSUNK]
Oh right
[PS1PF]
so they , they , their physical appearance is very marked , they 're fair haired , blue eyed erm they get ecz they have small heads and very widely spaced , spaced teeth , a bit like a cartoon and they have , they have general ill health , they 're not very well people
[F8LPSUNK]
Oh excuse me .
[PS1PF]
Now when they 're born there wo n't be any problems at all and that 's to do with the way they feed before they 're born , how 's a baby fed before it 's born ?
[F8LPSUNK]
From the placenta
[PS1PF]
It gets all its nutrition , all its oxygen etcetera etcetera through the placenta from its mother 's circulation and the mother has no problem whatsoever in her body functions , right , otherwise she would be a mongrel , so the food is going straight into the baby , it 's like being drip fed , there 's no problem . When the baby is born what is the baby fed on ?
[F8LPSUNK]
Milk
[PS1PF]
Milk , after the baby is born the first time the baby actually has to digest its own food it has to process the food that it takes in , what 's in milk ? What nutritional substance
[F8LPSUNK]
Calcium
[F8LPSUNK]
Calcium
[PS1PF]
Calcium , protein
[F8LPSUNK]
Iron
[PS1PF]
fat , right
[F8LPSUNK]
Fat ?
[PS1PF]
A lot of fat in milk so there 's protein in milk and in protein you will find this amino acid that the baby ca n't metabolize , ca n't use . So it 's only after several days that this will build up in the blood , does that make sense to you , do you realize now why tests is not done until six days ?
[F8LPSUNK]
Yeah
[PS1PF]
If you do it at birth you wo n't find anything wrong
[F8LPSUNK]
cos it has n't had a chance to
[PS1PF]
you do it after six days when the baby 's been taking milk , you may well find something wrong . If the baby 's fed on water or for some reason does not take food normally , you may not find the problem , but a few days after milk feed this substance will begin to rise and it can be protected so the diagnosis is made by a test , does anybody know how the Guffbry test is done ?
[F8LPSUNK]
The heel
[PS1PF]
Stab the heel and they drip the blood out onto a piece of blotting paper and it dries and they send it to the laboratory and they punch it out and they examine it and they test it . Right , so diagnosis , Guffbry blood test at six days when milk feeding is established . The incidence is one in ten thousand so it 's pretty rare but untreated these children will grow up very seriously , mentally retarded , very , very poor quality of life and enormous stress on their families , when they could of been nearly normal , right so the cause is one of these essential amino acids which is powdered protein , so what 's the treatment ?
[F8LPSUNK]
Give them some
[PS1PF]
Eh ?
[F8LPSUNK]
Give it to them the amino acid
[PS1PF]
Give it to them , give them what ?
[F8LPSUNK]
Whatever it is that they 're deficient in .
[PS1PF]
If this , if this erm essential amino acid is found in all protein what foods do we have that have got protein in ?
[F8LPSUNK]
Fish
[PS1PF]
Fish
[F8LPSUNK]
Vegetables
[F8LPSUNK]
Dairy products
[F8LPSUNK]
Dairy products
[PS1PF]
Eggs , dairy produce , meat , pulses , right . If everything you give them that 's got protein in and it 's going to make their condition worse , what , what have you got to do ?
[F8LPSUNK]
[F8LPSUNK]
Do n't give
[F8LPSUNK]
Do n't give them anything with protein in
[PS1PF]
Right , no protein
[F8LPSUNK]
How they gon na grow ?
[F8LPSUNK]
What do they do then ?
[PS1PF]
How they gon na grow ?
[F8LPSUNK]
Yeah
[F8LPSUNK]
With great difficulty
[PS1PF]
We 've got a problem have n't we ? Eh ? The aim of the treatment is to keep the blood levels of this substance venial alanine as low as we possible can . And the treatment is very simple , it 's by diet and if these children are given appropriate diet they will grow up entirely normal as intellectually able as anybody else . So the diet is to restrict the protein . There is a problem because this , this amino acid is essential and it 's necessary for life , so you 've actually got to have some of it , but if they have too much it will cause severe damage . So the diet is quite simple . When these babies are diagnosed there 's a mad panic everywhere I can tell you , phone calls everywhere , people rushing round . Treatment has to be started as soon as possible , between two two e too much itl doolb eht peek ot si all ? id
[F8LPSUNK]
Mm
[F8LPSUNK]
Does n't their immune system cope with it or
[PS1PF]
Sorry Sarah ?
[F8LPSUNK]
Does n't their immune system cope with it or not ?
[PS1PF]
Their immune system would be quite normal , right , if they 're not given the protein , they 're actually going to run into problems are n't they , but we have to overcome that by other , other ways . There 's nothing wrong with their immune system , they 're perfectly normal they just ca n't metabolize this one particular type of protein , so they have no milk , no fish , no meat , no cheese
[F8LPSUNK]
Oh
[PS1PF]
very boring is n't it ?
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
They 're allowed to have unlimited amounts of cornflour
[F8LPSUNK]
Urgh
[PS1PF]
vegetables jelly and they have specially prepared flour , pasta , biscuits , bread and this is all erm provided on prescription . What would happen is the prescription would be written and they 'd either get it from the chemist who would constantly have a stock coming in or the hospital .
[F8LPSUNK]
Jelly , urgh .
[PS1PF]
Very costly business all this , but it 's infinitely preferable than having a severely mentally retarded child .
[F8LPSUNK]
Do they survive for a long time ?
[PS1PF]
Yes , they will grow up , we will go onto this , they grow up totally normally , and when they stop growing , when do we stop growing ?
[F8LPSUNK]
Twenty
[PS1PF]
Sixteen to eighteen years , they can actually have a normal diet and they can begin to eat all these wonderful things , okay ? So this has to be continued until maturity is reached , sixteen or seventeen years . It seems to be that only during the period of very rapid growth . So they go on like this till they get to late adolescence and then they can have a reasonably normal diet , having said that , they need constant monitoring and they would also be very used to a diet with not very much of milk , egg , fish and cheese etcetera . They would n't be able to have pulses either , just put that in there .
[F8LPSUNK]
Are , they healthy enough then ?
[PS1PF]
Are they happy ?
[F8LPSUNK]
Healthy
[PS1PF]
Healthy , oh yes , perfectly healthy . It would be very carefully calculated and they 'd be given the right amount of the proteins that they could use to grow , because in the first years of life there 's very rapid growth and development is n't there ? Body repair , and then they 're given minute mediastinal amounts of the essential amino acid which would otherwise poison them , they 're given really tiny amounts of it to keep them healthy . Are there any questions about that ?
[F8LPSUNK]
Cathy , Cathy if they got some disease like , I du n no something like I du n no cancer or something like that , would they be more ill than normal ?
[F8LPSUNK]
Susceptible yeah
[PS1PF]
Not necessarily , no . Just as ill as anybody else . In the past , in the past these children would be so severely mentally handicapped that they could n't lead a normal life , but if , if your able to control this disease and bring them up intellectually normal so that they 're like everybody else , they 're going to have the same life expectation and hopes and aspirations as the best , that 's the best of us , and what do women do when they get to the
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
they have children do n't they ? Do you think that these women can actually have children ?
[F8LPSUNK]
Yeah , but they might pass onto what they had to the child .
[PS1PF]
That 's a good question and that 's quite interesting , yes , they can actually if a girl has this and she becomes pregnant she has to go back on to her low protein diet while she 's pregnant in case her baby is affected right .
[F8LPSUNK]
What does that say ? In female
[PS1PF]
Normal life , I 'll read out to you , normal life is possible if diet during childhood is adhered to , in the female , if the female suffers , when she becomes pregnant the protein intake has to be monitored so as not to affect her developing baby . Now in the past , any child with P K U would of grown up mentally handicapped and would not of reproduced itself , would n't have children . Today although there 's still a problem area it 's not a straightforward pregnancy today , the boys are able to father children and the girls are able to have children which means you 're actually going to increase the incidence of P K U into the community is n't it ? Alright ? Does that make sense to you ?
[F8LPSUNK]
Is it not erm , does the baby get all what that it should get from the mother ?
[F8LPSUNK]
Is it hereditary Cathy ?
[PS1PF]
Yes it is , and underneath here I 've actually written down , you alright ? P , P K U is definitely an , an inherited genetic disorder , do you understand these charts ? Have you seen these charts before ?
[F8LPSUNK]
No
[F8LPSUNK]
No
[PS1PF]
Right , not very complicated , mum , dad , right mum and dad have got a normal gene and a P K U gene , right , normal gene and P K U gene which means that they are carriers , they carry the disease but they do n't actually have it
[F8LPSUNK]
That makes sense
[PS1PF]
do you understand that ? Right , who 's got brown eyes here ?
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
Yes
[PS1PF]
Who 's got brown eyes but has got a mum or dad with blue eyes ?
[F8LPSUNK]
Got one blue one and one green one .
[PS1PF]
Right , okay , what we 're saying here is that the mum and the dad are normal people , they do n't have any problems , but they have got each of them have got abnormal gene and they 're going to have a family , the first baby that they have gets two normal genes , one from each parent , you only get one gene from each parent , fuses so that makes two genes so the baby has two genes , right , the first baby gets two normal genes , right and that baby is normal , which is very clear right , so here we have written this baby is not P K U affected and is normal and does n't actually carry the gene any more , does that make sense to you ? Right , second baby has a P K U gene from his mum and a normal gene from his dad and he is not affected , but he is a P K U carrier , right , third baby gets a normal gene from his mum and a P K U gene from his dad and he 's the same , or she 's the same P K U carrier , but not affected , unfortunately the last baby gets a P K U gene from , from mum and a P K U gene from dad and this baby has got P K U and that is a simple , simple sort of exercise of how genetic disorders sometimes appear and sometimes do n't
[F8LPSUNK]
Can I just write that yeah , you 're not just gon na take that down ?
[PS1PF]
Does that make sense to you ?
[F8LPSUNK]
Yeah
[PS1PF]
Or is that just
[F8LPSUNK]
Ask her to start again
[PS1PF]
So having four children , one of them will have P K U , but all the others wo n't , they will be normal .
[F8LPSUNK]
Yeah , but you ca n't say that because I know someone with six children and they 've
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
You 're right Eileen it , you could have really bad luck and have all four children with P K U or you could have really good luck and none of them have P K U , or you could have half and half , that 's just an example , with each successive pregnancy you stand a one in four chance , those are all the possibilities , but like throwing the dice it comes up at random .
[F8LPSUNK]
Is that it then Cathy ?
[PS1PF]
What do you mean is that it ?
[F8LPSUNK]
[UNCLEAR]
[F8LPSUNK]
We have a break now
[PS1PF]
Oh fine , yes , then you go to is it
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
is n't it , ten past , on Friday
[F8LPSUNK]
Ten past ?
[PS1PF]
I was going to do , I was going to do rhesus blood disease with you , but we 'll do that on Friday .
[F8LPSUNK]
[UNCLEAR]
[PS1PF]
Shall I turn that off ?