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There's been an increase in both physical and emotional abuse since the onset of the pandemic.

In a report by Women’s Aid UK, 61% of women living with their abuser said the abuse had escalated during lockdown. And the Respect Men’s Advice Line report that calls and emails from men experiencing domestic abuse have more than doubled. 

The danger doesn’t only come from the threat of physical violence – there may be emotional domestic abuse, too. Although this poses just as much of a threat as physical abuse, it can be harder to spot. 

## What is emotional abuse?

‘Physical abuse is easier to recognise, but emotional abuse is more subtle and insidious, yet equally traumatic,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Livi.

‘Just as with physical violence, emotional domestic abuse is all about power and control, but rather than using physical force, the abuser uses mental and emotional tactics to insult, criticise, shame, threaten, ridicule, undermine, scare, “gaslight” and punish the victim.’   

‘Physical abuse leaves signs like new bruises or injuries,’ says Dr Rhianna McClymont, Lead GP at Livi. ‘Emotional abuse can be harder to spot, but clues can be that a partner constantly puts you down or criticises you, or makes you feel nervous, intimidated or unsure of yourself.’ 

Control is one of the common signs of an emotionally abusive relationship — control of money, the clothes you wear, the friends you see or things you do. ‘If your partner is tracking your movements and constantly checking up on you, or checks your messages, those are other warning signs,’ says Dr McClymont.

## What are the signs of emotional abuse by a partner? 

Some signs of emotional abuse could be if a partner...

- Continually criticises or belittles you – so you feel as though no matter what you do, it’s never good enough
- Humiliates and shames you in public
- Makes cruel jokes at your expense then tells you you’re over-sensitive if you get upset
- Blames you during all arguments
- Denies or downplays that the abuse is happening
- Isolates you from family and friends – so the more isolated you feel, the more you lose perspective and become more dependent on your partner
- “Gaslights” you – this could involve saying things they later deny, or insisting you said or did something that’s not true
- Controls your money, or does not give you enough to buy food or other essentials
- Threatens you or insinuates they may hurt you physically, leave you or make you suffer in some way
- Destroys things that belong to you or invades your personal space
- Uses emotional blackmail – getting you to do what they want by playing on your fear, guilt or compassion

## What is sexual coercion?

Sexual coercion is unwanted sexual activity that happens when you’re pressurised, tricked or forced, in a non-physical way. Coercion can make you think you ‘owe’ sex to someone. It’s a form of emotional abuse that can affect women and men. In a healthy relationship, you never have sex unless you want to. 

__Signs of sexual coercion may include being:__
- Threatened if you don’t have sex 
- Bullied and worn down by someone to have sex
- Lied to or promised things if you have sex
- Kept awake until you agree to have sex

## What are the effects of emotional abuse?

‘Emotional abuse is extremely harmful,’ says Gauffin. ‘The abuser inevitably starts off by being loving, caring and sweet. But once they know you trust and care about them, their behaviour changes.’ 

The abuser may become like Jekyll and Hyde – loving and attentive one minute, turning nasty, vicious and controlling the next. 

‘This unpredictability leaves you on tenterhooks,’ she explains. ‘You can’t relax, as their mood can change at any time. You constantly feel as if you’re walking on eggshells.’ 

To the outside world, the emotoinal abuser may appear charming and reasonable. ‘You may feel as if you’re going mad and start to doubt your judgement,’ says Gauffin. ‘You may not even realise what’s happening and blame yourself when they blow hot and cold. But this is all part of the manipulation to make you feel as if you’re the one in the wrong.’

‘The emotional toll can make you feel moody, irritable and constantly on edge,’ Gauffin continues. ‘You may find it difficult to think straight and become more withdrawn and isolated from friends and family, which makes you even more vulnerable.’ 

Symptoms of emotional abuse may also start to show in your behaviour. You may become more self-destructive, for example drinking or smoking more to help you cope. Or you may lose your appetite and find your sleep is affected. 

‘Emotional abuse can also lead to mental health problems like [anxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/) and [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/),’ says Gauffin. ‘In some cases, you may develop symptoms of [post-traumatic stress disorder (PTSD)](https://www.livi.co.uk/medical-advice/mental-health/post-traumatic-stress-disorder/) such as flashbacks, intrusive thoughts and nightmares.’    

## What you can do if you’re a victim of emotional abuse

‘The first thing is to recognise that things aren’t right,’ says Gauffin. 

‘It can be much easier for many people to leave a physically abusive relationship, because it’s so obviously wrong. The signs of an emotionally abusive relationship are more complex, and it can take a while for someone to realise what’s going on.’

But the longer the situation continues, the greater the risks to your mental and physical health. And, in some cases, emotional domestic abuse can escalate into physical abuse.

‘Don’t let the pandemic put you off, even if you’re isolating,’ says Gauffin. ‘The longer you stay, the worse it can get.’

## What if a friend is showing signs of emotional abuse?

‘Signs and symptoms of emotional abuse can be difficult to spot, but look out for a friend or relative who seems to have changed recently — becoming more insecure, apologetic or anxious,’ says Dr McClymont. 

‘Another warning sign is if their partner makes hurtful comments or jokes at their expense in front of you, or constantly checks in on them to find out where they are or what they are doing.’

To help a friend experiencing emotional abuse, Dr McClymont recommends:

- Keep an eye on loved ones and talk to them if you see or hear something that worries you 
- If someone confides in you about abuse at home, it’s important to believe them, listen to their story, and help them to get the right support
- It’s important not to pass judgement. Nor to bombard them with advice and start telling them what they should or shouldn’t do
- Don’t criticise or shame someone for not leaving an abusive relationship earlier. When it comes to emotional abuse it’s sometimes difficult for someone to first recognise that they’re a victim, and then to leave the relationship
- Whatever decision your friend makes, be there for them. They may not feel strong enough to leave right now, but with your encouragement and support this is something they can work towards in the future. The worst thing you can do is turn away, as this will make your friend feel more isolated. 

## The Signal for Help hand gesture

Since domenstic violence against women and girls increased in the pandemic, the Signal for Help hand gesture has been created by the Canadian Women's Foundation. This can be used either in person or over video call to quietly let others know you're unsafe and need help. 

To perform the signal, hold one hand up with your thumb tucked into your palm then fold your other 4 fingers over your thumb to cover it.

![Violence at home Signal for Help hand gesture](//images.contentful.com/h8qzhh7m9m8u/5BwSQsNTOR3X5vgZyjXIEm/e7f6077520d55351581c1a685835471d/3001x2918_-_In_article.jpg)

If you see the signal, try to safely check in with the person to find out what they want you to do. If they're in danger, call 999.

## How a GP can help

‘If you’re in an emoptionally abusive relationship and don’t know where to turn, talk to a doctor,’ says Dr McClymont. 

‘They can help you access organisations like emergency support groups and shelters. They can also refer you to a psychologist or psychotherapist, if you feel you need emotional or mental health support before taking steps to make the break.’ 

## Emergency help for emotional abuse

There are many services that provide support. Women and children’s charity Refuge provides emergency shelters for women who are fleeing domestic abuse and a range of support and information on how to recognise and recover from abuse.

It runs a 24-hour free domestic abuse helpline on 0808 2000 247. Women’s Aid also offers support, information and live chat for victims. For men, the charity Respect provides advice and help on 0808 801 0327.

__This article has been approved by Dr Rhianna McClymont, Lead GP at Livi, and Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Livi.__


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Stress and [anxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/) can seem like adult problems, but children are vulnerable too. Up to 20% of children and adolescents experience mental health problems,  and half of all mental disorders start before age 14.  The most common disorders in children are generalised anxiety disorder and depression. They’ve been on the rise for decades, and the pandemic has only added to the rise.

‘There are a lot of reasons why children might be stressed, but generally speaking, we live in a society that doesn’t provide a lot of space for children to be encouraged and validated,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Livi.

By creating safe, restful spaces and routines, you can give your child the best chance of growing into a resilient adult. 

## What causes anxiety in children?

High levels of stress, whether at home, school or elsewhere, can affect children and their nervous systems.

The home environment is especially significant for a child’s wellbeing. ‘The more conscious we can be of children’s need for calm and peace, the better,’ says Gauffin. In particular, the way parents talk to their children can have a big impact. Research shows that using controlling, fear-inducing language, like ‘don’t climb too high’ or ‘do it this way’ can contribute to anxiety in children.  

Screens can also be stressful for children. While social media can have its positives, spending too much time on social media channels is linked to mental health problems, particularly in combination with poor sleep. 

Other risk factors for generalised anxiety disorder are a family history of the condition, physical or emotional stress, a history of trauma, and experiencing another anxiety disorder or chronic health condition. 

## Signs and symptoms of anxiety in children

The symptoms of stress and anxiety in children and young people are the same as in adults. Here are some of the symptoms to look out for in your child:

### Physical symptoms: 
- Nausea
- Pain in different parts of the body, particularly headaches and tummy aches
- Dizziness
- Recurring infections

### Psychological symptoms: 
- Difficulty falling asleep or getting back to sleep after waking at night
- Nightmares
- Appearing lethargic or apathetic (sluggish)
- Restlessness or hyperactivity

## 7 tips for supporting anxious children and minimising stress in their lives

### 1.	Make time to talk things through
If you’re worried about your child’s anxiety levels, start a conversation. ‘Ask what’s going on and how they’re feeling,’ says Gauffin. ‘A small child won’t be able to tell you why they feel the way they do, but you can help them figure it out.’ 

Making time for these chats is crucial. ‘You might need to cancel activities and take some time to really show you are there for your child,’ adds Gauffin. 

You can also help your child identify their triggers. ‘Ask how they feel in certain situations and around certain people to pinpoint the situations triggering their anxiety,’ Gauffin advises. ‘It could be a specific subject in school that makes them feel insecure or perhaps a specific person or group – maybe bullying is a culprit. The key thing is making time for a proper chat, not just 5 minutes before bedtime.’

### 2.	Validate your child’s feelings
‘Show your child that you take their experiences seriously. Validate their feelings – try not to minimise the situation, or they’ll be less likely to confide in you again,’ says Gauffin. 

### 3.	Be there in the moment
In situations where your child is overwhelmed or panicking, try to stay calm. ‘Hold them, breathe calmly, and see if you can help them to breathe more calmly too,’ advises Gauffin. ‘Reassure your child that you’re there for them and not going anywhere.’

### 4.	Plan ahead
Gauffin recommends planning ahead to help streamline your morning routine. ‘Get everything ready the evening before,’ she says. ‘Put out their clothes, and serve whatever breakfast you know they will eat.’

A smooth bedtime routine can also help the parasympathetic nervous system kick in and promote calmness. ‘Listening to relaxation tracks and sleep music is a great way to help your child unwind,’ says Gauffin. 

Avoiding screens, if possible, is also key. ‘Depending on the age of your child, you might choose to stay with them until they fall asleep,’ adds Gauffin. ‘Many children need that – they can’t let go on their own. It might take an extra half an hour, but that’s half an hour well spent.’

If your child is having trouble sleeping, read our guides to [helping your child get to sleep](https://www.livi.co.uk/your-health/tips-to-help-children-get-to-sleep/) and [what to do if they have nightmares](https://www.livi.co.uk/your-health/children-and-nightmares-advice-from-a-child-psychologist/).

### 5.	Prioritise downtime
Do what you can to create a calm home environment. Consider the number of extra-curricular activities your children are doing – although it’s well-intended, young children don’t necessarily need a packed schedule to thrive. 

Try making time to do things like going for a walk after school. ‘Too much activity in the evenings can contribute to high stress levels in children,’ says Gauffin. ‘Stress hormone levels should go back down after a spike, but we know that continuously high levels tend to stay high – that’s what makes us burn out.’

### 6.	Keep an eye on your own stress levels
‘The more aware you can be of your own ways of dealing with everyday challenges and fears, and how you express stress, the better,’ says Gauffin. ‘If you’re frequently grumpy and snap at your children, ask yourself what you can do about the stress levels in the family.’

### 7.	Lead by example
‘We need to show children that resting is allowed and that there’s time and space for it,’ says Gauffin, explaining that time to unwind together each day is important – and ideally not just in front of a screen. ‘It can be good to model this by saying, “I’m feeling stressed, so I’m going to have a rest.”’

## When should you seek professional help?

If the problem persists for more than a few weeks, and you’re having trouble helping your child, seeking help is an option. A professional can help your child learn coping mechanisms like acceptance, problem-solving and CBT strategies to change negative thought patterns.  

‘Don’t put it off,’ says Gauffin. ‘If you’re stressed yourself and can’t get through to your child, ask for help so that someone else can help them.’ Mental health issues that are not addressed in childhood are more likely to continue into adulthood, so helping your child get timely help can be an important, positive turning point.  

__This article has been medically approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Livi.__


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How to help a child with anxiety – a therapist’s tips

What are the signs of stress and anxiety in children, and what can you as a parent do to help? Get expert advice here from our Licensed Psychologist and Psychotherapist

How to help a child with anxiety – a therapist’s tips | Livi UK

Sex can be one of life’s great pleasures but occasionally, it can be painful and cause worry for both partners. While painful sex is more common in women, with an estimated 3 out of 4 affected at some point in their lives, around 5% of men are also thought to experience it. 

‘Pain during or after sex is known as dyspareunia and there’s a variety of reasons why both men and women may experience it, including infections, illness, a physical or a psychological problem,’ says Dr Rhianna McClymont, Livi Lead GP. 

‘Don’t be embarrassed to discuss it with a doctor. Medical professionals are used to dealing with things like this and your symptoms might be your body’s way of telling you it needs attention,’ she says.

Here, Dr McClymont shares some of the main reasons why you might experience painful sex.

## 1. An infection down there
There are two types of non-STI infections that may cause painful sex:

### Thrush
This is an infection caused by the fungus candida albicans. Both men and women can suffer from it but thrush is more common in women, with around 75% experiencing it at some point in their lives.

‘Symptoms of thrush in women include itching and soreness, particularly around the entrance to the vagina, [vaginal discharge](https://www.livi.co.uk/your-health/is-my-vaginal-discharge-healthy-a-doctors-guide/) which is often thick and creamy in appearance, and sometimes discomfort during sex,’ says Dr McClymont. ‘In men, it can present as irritation and redness in the skin of the penis.’

Thrush can be treated with over-the-counter antifungal pessaries or cream but if symptoms persist after treatment, you should see a GP. 

You may be able to prevent further attacks of thrush by avoiding soap and shower gels on the genital area, wearing cotton underwear and avoiding tight jeans. It’s also wise to avoid sex while you have thrush to prevent passing it to a partner (although it’s not classed as an STI).

### Cystitis
Up to 60% of women will experience a [urinary tract infection (UTI)](https://www.livi.co.uk/your-health/utis-your-questions-answered/) like cystitis at some point. In men, it’s less common and so men should seek medical help if they believe they are suffering from one of the symptoms, says Dr McClymont. 

Symptoms in both sexes include a burning sensation when trying to urinate, feeling like you need to go to the toilet more often, cloudy or smelly urine and sometimes painful sex. Most mild cases in women will clear up on their own or with over-the-counter products from a pharmacy. But if you suffer from recurring bouts, or you have a temperature over 38C and pain in your lower back or side, see a GP as it may be a sign of a kidney infection. 

### An STI
Sexually transmitted infections like chlamydia or gonorrhoea can cause symptoms of painful sex, bleeding after sex (chlamydia), vaginal or penile discharge, pain when passing urine or for women, bleeding between periods (gonorrhoea). ‘But sometimes there are no symptoms at all. If you suspect you have an STI, it is important to see a GP or attend a sexual health clinic for tests and treatment.’

## 2. The effects of menopause
Painful sex is one of the most commonly reported problems in post-menopausal women. ‘During menopause, falling oestrogen levels lead to reduced vaginal secretions, which can cause dryness in the vagina, making sex uncomfortable or even painful,’ says Dr McClymont. You may also experience these symptoms in the years leading up to menopause, [known as perimenopause](https://www.livi.co.uk/your-health/7-signs-of-perimenopause-a-doctors-guide/). 

‘Lubricants can help improve this dryness and can be bought from a pharmacy. But if symptoms persist, despite lubricants, you may wish to discuss other treatments with your GP such as topical hormone replacement therapy (HRT).’

## 3. Not being aroused enough
One of the key causes of painful sex may simply be down to lack of arousal. When a woman is aroused she produces more vaginal secretions, and this lubrication makes penetrative sex easier.

‘If you’re not aroused, you may not have produced enough natural lubrication to make sex comfortable. You can buy vaginal lubricants from a pharmacy to help with this, but it’s also important to explore and discuss any sexual problems or lack of arousal with your partner to see if there are things that you can do together to improve this. If there are other stressors in your life or problems that are affecting your libido, it’s important to address these or talk to a GP or counsellor.’

Read more about the [causes of a low libido](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/) and what you can do to help.

## 4. Irritated or inflamed skin
‘Skin may become inflamed due to allergies or irritants like latex condoms, soaps or certain spermicides,’ says Dr McClymont. ‘If you have a skin condition such as [eczema](https://www.livi.co.uk/medical-advice/skin-conditions/eczema/) or dermatitis, and it’s present around the opening to the vagina or over the penis, it may cause dry, cracked and fissured genital skin that can lead to painful sex.’

Silicone-based lubricants can help in the short term, but it's important to get the underlying skin condition treated by a GP.

## 5. An underlying medical cause
Here are some of the medical conditions that can cause painful sex and why it’s important to get symptoms checked by a doctor. 

### Vaginismus
This is the automatic tightening and contracting of the muscles of the vagina at the point of intercourse, making sex either impossible or painful. It’s thought to be one of the most common female psychosexual conditions, although figures vary as to how many women suffer from it.

‘Vaginismus is an uncontrolled reaction and often happens due to fear of penetration,’ says Dr McClymont. ‘Treatment usually focuses on psychological help, relaxation techniques and exercises to help you become accustomed to penetration.’ 

### Pelvic inflammatory disease (PID)
Although it’s not known exactly how many women suffer from PID, it usually affects women under 24. ‘Pelvic inflammatory disease is inflammation in the pelvis, normally caused by an infection,’ says Dr McClymont. ‘It may cause pain during sex, [pelvic or abdominal pain](https://www.livi.co.uk/your-health/what-causes-lower-abdominal-pain-in-women/), a temperature, vaginal discharge or vaginal bleeding. Pelvic inflammatory disease needs assessment and treatment by a GP, usually with antibiotics.’ 

### Endometriosis
Around 1 in 10 women — an estimated 176 million worldwide — suffer with [endometriosis](https://www.livi.co.uk/medical-advice/womens-health/endometriosis/). ‘It’s a condition where cells resembling those in the uterus grow in other places in the body, for example around the ovaries, and can cause painful sex in some women,’ says Dr McClymont. ‘It may also cause painful periods and abdominal pain’.

While there’s no known cure, there are different methods of treatment to manage the symptoms, including surgery, hormone treatment and pain relief.

### Fibroids
‘These are benign growths in the womb which may cause no symptoms,’ says Dr McClymont. ‘But in some women they can cause painful sex, particularly if the fibroids are large and located close to the cervix.

Fibroids may also cause [heavy menstrual periods](https://www.livi.co.uk/your-health/what-causes-heavy-or-irregular-periods-a-doctors-guide/), [lower back pain](https://www.livi.co.uk/your-health/what-can-help-my-lower-back-pain-a-doctors-tips/) and frequent urination.’ Treatment usually involves medicine from a GP but if your symptoms are particularly severe, surgery may be an option.

### Phimosis
‘This is a condition where the foreskin is tight so cannot retract around the tip of the penis,’ says Dr McClymont. Although rare, occurring in about 1% of boys, phimosis can cause pain during sex if it continues into adulthood and is left untreated. ‘Discomfort may be improved by using condoms or lubricant, but if it continues to cause problems it’s best to speak to a GP.’

Inflammation of the prostate gland – ‘This is known as prostatitis and can cause pain around the penis, testicles, anus and lower back,’ says Dr McClymont. It can occur at any age and up to 10%-15% of the population may suffer with it at some point. ‘It also often causes pain when passing urine, or [urinary frequency or urgency](https://www.livi.co.uk/your-health/urinary-frequency-constant-need-to-pee/). Treatment with antibiotics is needed for acute prostatitis.’ 


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Painful sex pain after sex

If you’re feeling pain when you have sex, don’t be embarrassed to talk to a doctor. Here are the most common reasons for painful sex and what to do.

What causes painful sex and pain after sex? | Livi UK

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What causes painful sex? — A doctor’s guide

Familiar with the discomfort of constipation? You’re not alone – nearly everyone has experienced it at one time or another. It’s estimated that 1 in 7 adults and 1 in 3 children  suffer from constipation at any one time, women are twice as likely to have constipation as men,  and older adults are 5 times more likely than younger adults  to have it. 

Your poo and how often you go to the loo can indicate a lot about your overall health and wellbeing. After your digestive system has absorbed all the usable nutrients from food, you poo to get rid of the remaining bodily waste that’s no longer required. 

‘It’s important to keep an eye on your bowel habits so that problems with the digestive system can be picked up,’ says Dr Rhianna McClymont, Lead GP at Livi. 

## What is constipation? 

[Constipation](https://www.livi.co.uk/medical-advice/digestive-problems/constipation/) generally means that you have uncomfortable or infrequent bowel movements. You’re likely to be constipated if you:

- have fewer than 3 bowel movements a week 
- pass hard, pellet-like poos
- need to strain on the toilet 

Constipation is usually temporary and resolves within a few days or weeks, but for others, it can be long term and continue for several weeks or longer. This is known as chronic constipation. 

## What causes constipation?

There are many possible causes, and often it might be difficult to identify the exact cause. Here are some of the most common causes of constipation to look out for: 

### 1.	Eating a high-fibre diet 

Research suggests that high-fibre diets are essential for a healthy bowel.  Not only does fibre help to reduce the risk of bowel cancer and heart disease, but it can also prevent and ease constipation. 

‘Fibre works by bulking out our stools – it increases their size and makes them softer. Larger, softer stools move more quickly through your digestive system and are easier to pass, helping to keep you regular,’ says Dr McClymont. 

You can find plenty of fibre in fruit, vegetables, whole grains, nuts, seeds and oats. If you feel that you might not be eating enough of it, you’ll want to gradually increase your intake, as suddenly eating a lot more fibre can cause digestive problems like [bloating](https://www.livi.co.uk/your-health/a-doctors-tips-to-help-bloating/), gas or diarrhoea.

### 2.	 Not moving enough

Staying physically active helps to keep your gut moving. ‘Regular exercise gets your heart pumping and sends more blood to your intestines. This helps to stimulate a series of wave-like contractions (peristalsis) within the bowel, which helps to move food through the digestive system,’ explains Dr McClymont.

Research backs this too – one study found that aerobic exercise like walking was an effective treatment for patients with constipation.  

### 3.	Switching up your routine or holding in your poo 

We’ve all been there – a simple change of routine can be enough to throw off your regular poo habits. ‘Sporadic access to a bathroom, a sudden change in diet or increased time spent sitting can all cause you to become constipated,’ says Dr McClymont. 

‘Similarly, ignoring the urge to poo can also cause constipation because the longer the stool stays in the bowel, the more water gets reabsorbed, making it harder and more difficult to pass.’ So, when you feel the need to go, go.

### 4.	Emotional factors

You might become constipated when you’re anxious or stressed. This is because your brain and gut are closely linked – just as an unhappy digestive system can send signals to the brain, a troubled brain can send signals to the gut. The impact of [stress](https://www.livi.co.uk/medical-advice/mental-health/anxiety/), anger, anxiety and [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) can all affect your bowel movements.

High levels of stress can also affect digestive disorders, including [irritable bowel syndrome (IBS)](https://www.livi.co.uk/medical-advice/digestive-problems/irritable-bowel-syndrome-ibs/). ‘One of the symptoms of IBS is constipation,’ says Dr McClymont. ‘If this is a symptom for you, you might find that it gets worse as you feel more stressed.’

### 5.	Some medicines 

Constipation is a common side effect of some medicines, including painkillers containing codeine and opioids. ‘Opioid medications can hinder the movement of the gut, resulting in constipation,’ says Dr McClymont. 

Other medications that can cause constipation include iron supplements, non-steroidal anti-inflammatory drugs such as ibuprofen, blood pressure medications, antidepressants and antihistamines.

### 6.	Pregnancy and postpartum 

Constipation is very common during pregnancy. One study found that women are 2-3 times more likely to experience constipation during pregnancy and straight after childbirth than when they’re not pregnant.  

‘During pregnancy, progesterone levels increase,’ explains Dr McClymont. ‘This hormone causes your muscles to relax, including those within the digestive system. This causes slower-moving stools through the intestines, leading to constipation. Postpartum constipation is also very common in the first few days after delivery, and for some women, it may continue for several months.’

### 7.	Neurological conditions 

Constipation is more common in people with conditions that affect the nervous system, such as multiple sclerosis and Parkinson’s disease. ‘When nerves are damaged, it impacts the ability of the intestines to move food along towards the rectum and push stools out,’ explains Dr McClymont.

## How can I prevent and ease constipation? 

The good news is that in most cases, making some small lifestyle changes can lower your risk of developing it in the first place. Here are Dr McClymont’s suggestions:

- Aim to eat 30g fibre a day by eating more fruit, vegetables and whole grains
- Add some sorbitol, a naturally occurring sugar found in apricots, apples, plums, prunes and raisins, to your diet
- Drink plenty of fluids (about 8-10 cups per day) to prevent dehydration
- Aim to go to the bathroom at the same time each morning, and prioritise enough time to empty your bowel
- Try to do at least 150 minutes of physical activity like walking, running, cycling or swimming each week 
- Change your toilet position and try using a small footstool under your feet. This is a simple way to pass bowel movements more easily 
- Practice relaxation techniques, such as deep breathing exercises or meditation, if you feel that emotional factors might be triggering your constipation 

## When should I speak to a doctor about constipation?

‘If your constipation isn’t improving with lifestyle changes or you’ve been constipated for a long time, it’s best to discuss it with a doctor,’ advises Dr McClymont.

‘If you notice any symptoms such as blood in your poo, feeling unusually tired or bloated, a persistent change in your poo habits or losing weight unintentionally, it’s worth making an [appointment](https://www.livi.co.uk/gp-appointments-online/) for a check-up.’

__This article has been medically reviewed by Dr Rhianna McClymont, Lead GP at Livi.__


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Why am I constipated? 7 possible causes 

Expert advice from a Livi Lead GP on how to help constipation, plus what constipation might be caused by

Why am I constipated? 7 possible causes | Livi UK

Struggling with [breakouts and acne](https://www.livi.co.uk/medical-advice/skin-conditions/acne/)? You’re not alone. ‘Acne is incredibly common, with many people affected during adulthood,’ says Dr Samuel Menon. One significant study found that around 50% of women and 40% of men have some kind of facial acne. 

For many people, acne affects more than just their appearance – it can also have a real psychological impact. As of June 2021, the National Institute for Health and Care Excellence now recommends mental health support for those who are severely affected by their acne.  

‘Studies or trials in skin disease often include depression assessments for a reason,’ says Dr Menon. ‘People with a skin condition like acne often suffer in silence. It’s important to remember that you’re not the only one.’

## What causes acne? 

‘Acne is one of those conditions with several possible causes, which we continue to learn more about,’ says Dr Menon. ‘But what we do know is that acne happens when our skin’s sebaceous glands make too much of an oil called sebum. At the same time, the lining of our pores gets thicker, trapping dead skin cells the body wants to shed. A mixture of oil and dead skin cells builds up in our pores, causing blackheads and whiteheads.’

Oily skin is an ideal condition for acne-causing bacteria to multiply, leading to inflammation that can show up as red, swollen or pus-filled spots. 

‘The possible causes and aggravators are often a complex interplay of genetic and environmental factors,’ says Dr Menon. The following are some of the common, established causes: 

### Hormonal changes 
‘Our sex hormones – the androgens – are key to our development in adolescence and play an important role throughout our lives, but they can also cause and exacerbate acne,’ Dr Menon explains. ‘They influence both the production and type of sebum we make and the levels of inflammation.’

### Insulin
‘This is another hormonal culprit,’ says Dr Menon. ‘Insulin is an essential powerhouse of a hormone that helps to control our blood sugar levels and metabolism. But if you’re eating a lot of processed or sugary foods, your body will need to keep releasing insulin as a response. There is some evidence that suggests too much insulin can make acne worse.’

### Stress
‘When we’re stressed, we release more cortisol, a steroid hormone. This increases levels of sebum production, one of the key causes of acne,’ says Dr Menon. ‘This is not to say that stress alone will cause acne – it may just make it worse for people who are prone to it.’

### Lifestyle
‘Lifestyle habits – from eating processed foods to being sedentary to smoking – all play a role in our skin health,’ says Dr Menon. 

## Does acne change with age and hormonal fluctuations? 

Most people suffer less with acne as they age, and their symptoms tend to improve. But people still have acne in their 30s and sometimes in their 40s.

Many women under 30 report experiencing acne flares just before, during and just after their period.  But for lots of women, the trigger seems to be a complex mix of hormones, stress and other factors.  

‘Menstrual cycles do play a role in acne, and the combined oral contraceptive pill can be a useful tool in helping to control flares,’ says Dr Menon. ‘We would often recommend these in place of oral antibiotics and alongside topical treatments for those who are able to take them.

‘If, alongside acne, you’ve noticed some weight gain, your periods have become irregular or less frequent, or you’ve had hair growth where you wouldn’t normally expect it, speak to a doctor. We would want to rule out polycystic ovary syndrome, a common, treatable condition that can cause or aggravate acne.’ 

## What is ‘maskne’?

The term ‘maskne’ arose during the pandemic as we started wearing face masks, and some of us noticed an increase in acne on the parts of the face covered by our masks. 

It’s not unusual for those who need to wear surgical or cloth masks to notice breakouts, and this was the case before the pandemic, too. Most commonly, this is a result of either irritant contact dermatitis, allergic contact dermatitis or some form of [atopic eczema](https://www.livi.co.uk/medical-advice/skin-conditions/eczema/), though there are different reasons why mask-wearing can trigger acne.  

‘If skin is covered for long periods, whether that’s by a heavy cream or ointment or something physical, like a mask, acne is more likely in those who are prone,’ Dr Menon explains. ‘That said, masks are often loose-fitting enough not to cause a problem.’

## How do I avoid ‘maskne’?

Using a gentle, soap-free cleanser and applying nothing but a light moisturiser at least half an hour before putting on your mask can help. 

Wearing minimal or no make-up when you need to wear PPE is also a good idea. Choosing a mask with a soft, natural, breathable fabric like cotton on the inside can help too.

## What really works when it comes to treating adult acne?

### Resist the urge to squeeze
‘Try not to panic, and don’t pick or squeeze or scrub. Chances are, you’ll aggravate your skin, making your spots larger, more painful and more likely to scar,’ Dr Menon advises. ‘Applying a little Duac, a commonly prescribed acne medication, as spots start to appear is a good idea.’

### Choose gentle products with active ingredients
Acne treatments don’t need to be expensive, complicated or fancy, according to Dr Menon. The most important thing is to be gentle with your skin barrier. ‘Use products that are simple and relatively inexpensive, without “buzz” ingredients or promises,’ he recommends. Try brands like Cetaphil, Cerave or Aveeno. 

Products with ingredients like salicylic acid and benzoyl peroxide are useful but often irritating. ‘They’re also not particularly sophisticated in the way they work,’ says Dr Menon.

### Try retinoids

‘Retinoids are clever and centralised in treating acne,’ says Dr Menon. They can help skin shed normally, lower inflammation and, if taken by mouth when recommended by a dermatologist, reduce how much oil your skin makes. 

‘They’re prescription-only, but a weaker retinol is available in some over-the-counter products,’ adds Dr Menon. ‘The initial few weeks of using a topical retinoid can come with dryness, flakiness, redness and even more spots, but this period is short-lived and usually passes within a few weeks. You’ll usually notice improvements after 12 weeks – but they’re sustained with continued use, so try to be patient.’

### Take note of your diet
‘There’s some evidence that high glycaemic foods and dairy have an impact on acne severity, with the evidence for the former stronger,’ says Dr Menon. ‘Do what’s right for you – if you notice that drinking, for example, a lot of milk makes things worse, reduce your intake, but lots of people won’t notice much.’

A healthy, active lifestyle is more important. ‘Avoiding unhealthy foods and staving off obesity will help,’ says Dr Menon.

## How can I prevent and deal with acne scarring?

‘To prevent scarring, you must first prevent acne – which is easier said than done,’ Dr Menon notes. ‘But once you’ve developed scarring, there are several options to improve the skin’s appearance. This also tends to happen naturally over time without any treatments, too.’

- __Microdermabrasion__

Microdermabrasion can be helpful for some, if done regularly. However, it’s an expensive method and the results aren’t always great

- __Skin-needling__

Dr Menon suggests trying skin-needling with a derma roller – done by a trained practitioner. ‘A few sessions a couple of months apart will often bring improvements,’ he says. 

- __Laser skin treatments__

‘There are also laser treatments that help with active acne alongside improving acne scarring,’ says Dr Menon. ‘There are several different types, but they’re mostly only available privately, so consult a doctor or dermatologist first.’

## How do I prepare for an acne consultation with a doctor?

‘Try to be honest about how you’re feeling,’ Dr Menon reassures. ‘You might want to bring photos, but don’t feel like you need to prove anything. If you have acne and it’s bothering you, a doctor can help.’ 

A doctor will likely prescribe a topical retinoid, oral antibiotics or the oral contraceptive pill. ‘If you’ve been trying treatments with your doctor but haven’t seen progress in 6 months or more, ask about a referral to dermatology,’ he says. ‘If your skin is starting to scar, or your acne is impacting your self-esteem and how you feel about yourself, it’s important to seek help.’

__This article has been medically approved by Dr Samuel Menon, Lead GP at Livi__


livi.co.uk >      article page >       CTA

Speak to a GP about adult acne 

Livi.co.uk > Your health > Managing adult acne – a doctor’s advice on what really works

Managing adult acne – a doctor’s advice on what really works

Dr Samuel Menon, Lead GP at Livi, shares his expert advice on which treatments help with adult acne and what to do if it’s affecting your mental health

How to manage adult acne | Livi UK

When the sun’s shining, there’s no better place to be than the great outdoors. But hot summer days carry a risk of heat exhaustion, which, if left untreated, can turn into heatstroke.

Heatstroke is a serious and life-threatening condition that happens when your core body temperature is too high.  With climate change hiking up global temperatures,  heatstroke-related deaths are expected to more than double by the 2050s. 

Heatstroke can affect anyone, but the risk is highest for the elderly, young children and babies; those who suffer from long-term health conditions like diabetes or heart, lung or kidney disease; and people taking certain medications. 

## What causes heatstroke?

Heatstroke happens when your body is exposed to so much heat that it can no longer regulate its temperature. ‘Heatstroke is a severe heat-related illness that can occur when strenuous physical exertion or exposure to hot weather – or a combination of both – causes our body temperature to rise to 40°C or above,’ says Dr Menon.

Our bodies are sophisticated machines. Our vital organs cooperate to keep everything working in balance through a practice called homeostasis, carefully controlling temperature, blood sugar levels and the concentration of different ions in your blood. In hot weather, your body has a few ways to maintain a steady temperature:

- Your skin sweats to shed heat
- Your body tells you you’re thirsty and you need to drink water
- Your kidneys start making less pee to conserve water

If you stay in the heat for too long, your body has to work harder to maintain its core temperature. This can result in heat exhaustion, which may escalate to heatstroke. 

## What are the signs of heat exhaustion?

On its own, heat exhaustion is not usually serious, but it comes with the risk of heatstroke. The key symptoms of heat exhaustion are:

- A temperature of 38°C or above
- Dizziness and confusion
- A headache
- Intense thirst
- Feeling sick and a loss of appetite 
- Excessively sweating 
- Tiredness 
- A rapid pulse 
- Cramps in the arms, legs and stomach
- Passing less urine, which is also very dark 

If you think you have any symptoms of heat exhaustion, it’s important to take action to cool your body down quickly and avoid heatstroke. Move to a shady area or cool room as soon as possible, then lie down and raise your feet slightly. Make sure to drink plenty of water or a sports drink. Cool your skin by spraying it with tepid water or switching on a fan, and if you can, try placing ice packs on your groin, armpits or neck.

## What are the signs of heatstroke?

Heatstroke is a medical emergency. It must be treated quickly before it causes serious damage to your brain, heart, kidneys and other vital organs. Here are the symptoms to look out for:

- A high temperature of over 40°C
- Nausea
- Headache
- Fast, strong pulse
- Flushed, hot skin 
- Feeling confused
- Loss of consciousness 

If you’re still feeling unwell 30 minutes after cooling down, call emergency services. ‘Heatstroke requires hospital admission for assessment and treatment. You may also have to stay in hospital for observation,’ says Dr Menon. ‘Recovery time is dependent on the individual and how unwell they were when taken to hospital.’

## Can children get heatstroke?

‘Children are more vulnerable to heat-related illness than adults,’ explains Dr Menon. ‘In comparison with adults, they produce more metabolic heat and absorb more heat. They also sweat less and are less well adapted to losing it.’

The symptoms of both heat exhaustion and heatstroke are usually the same in children as in adults. ‘Often children are less able than adults to communicate their distress,’ says Dr Menon. ‘If your child has a high temperature and doesn’t seem themselves after being out in the sun, it’s vital you consult a doctor or take them to A&E. Your child may feel sick or vomit, complain of a headache or appear sleepy or floppy. They’ll likely be sweating and breathing more quickly than normal too,’ he says.

To keep children safe in higher temperatures, encourage them to play in shaded areas, and always keep babies under six months old out of direct sunlight. Make sure they are wearing light, breathable clothes. Small children may not ask for water, so make sure they’re drinking plenty of fluids throughout the day.

## How can I avoid heat exhaustion and heatstroke?

Of course, it’s always better to prevent heat exhaustion and heatstroke in the first place. Follow these simple steps to stay safe this summer.

### __1.	Stay hydrated__
Drink plenty of cold drinks, and if you’re exercising outside, make sure you’re taking in more fluid than you’re losing. Drink before you feel thirsty – as you get older, your body gets less responsive at recognising dehydration.  The colour of your pee can also tell you if you’re drinking enough. A pale straw colour usually means you’re well hydrated. 

### __2.	Stay clear of the midday sun__
It’s best to stay in the shade between 11am to 3pm when the sun’s rays are most intense. Make sure you use a sunscreen of SPF 30+ that protects against both UVA and UVB rays on all exposed parts of the body.

### __3.	Dress for the weather__
Light-coloured clothes reflect heat, and loose clothing made from natural fibres like cotton or linen allows sweat to evaporate and cool you down. Wearing a wide-brimmed hat is a simple way to protect your ears, face and the back of your neck from the sun. Keep your eyes safe by choosing sunglasses with high-UV protection.

### __4.	Be mindful of alcohol__
Drinking alcohol in the heat can have an impact on your core body temperature. Alcohol is a diuretic, which encourages your kidneys to lose extra fluid and causes you to pee more, making it even more likely you’ll get dehydrated.

While heat-related illnesses can be serious, the good news is that they’re usually simple to prevent. Next time you’re out in the sun, watch out for the tell-tale signs of heat exhaustion and heatstroke. 

__This article has been medically approved by Dr Samuel Menon, Lead GP at Livi.__


livi.co.uk >    article page >     CTA

See a GP about heatstroke

Livi.co.uk > Your health > What are the warning signs of heatstroke?

What are the warning signs of heatstroke?

From spotting the symptoms of heatstroke to knowing quick cool-down techniques, discover how to avoid heatstroke with advice from Dr Samuel Menon, Lead GP at Livi

What are the warning signs of heatstroke? | Livi UK

There are some common conditions that could have a number of causes, for example depression, tiredness or unexplained weight gain. But when they also come with other symptoms like constipation or sensitivity to cold, they may signal a thyroid problem. 

It’s estimated that 200 million people worldwide have some form of thyroid problem. The two most common thyroid disorders are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) with women 10 times more likely to be affected than men.

## What is the thyroid gland?

The thyroid gland has a small, butterfly shape and is located in the front of the neck, just below the larynx. It produces two hormones, thyroxine (T4) and triiodothyronine (T3). Two areas of the brain, the hypothalamus and the pituitary gland, control the hormone balance in the blood and the amount of thyroid hormones to be produced and secreted.

Thyroid hormones regulate energy, metabolism, body temperature, body weight, muscle strength, appetite, breathing, growth, the reproductive system and also heart, brain and kidney function. When your thyroid is functioning well and producing the right amount of hormones, everything runs smoothly. 

Lifestyle factors are important if you want to keep your thyroid healthy. Eating a nutritious, balanced diet, getting enough sleep, exercising regularly, managing stress levels and a healthy immune system all go a long way to keeping your thyroid in balance. 

## What can go wrong with the thyroid?

There are different types of thyroid disorders, including:

- __Goitre__ – enlarged thyroid, most commonly caused by low levels of the mineral iodine
- __Graves’ disease__ – an autoimmune disease that causes hyperthyroidism
- __Hashimoto’s disease__ – an autoimmune disease that cause hypothyroidism
- __Thyroid nodules__ – 90% of these are usually benign
- __Thyroid cancer__ – although this is a rare type of cancer

The two most common disorders are hypothyroidism and hyperthyroidism – so let’s look at some of their common symptoms.

Because these symptoms could be down to many other reasons, we’ve also listed some other potential common causes that your doctor may ask you about — along with other thyroid symptoms to look out for too, also below.

## Symptoms of hypothyroidism (underactive thyroid gland)

This is where the thyroid gland does not produce enough thyroxine (T4) and triiodothyronine (T3). As hormone levels fall, the thyroid-stimulating hormone (TSH) rises. The result is that you can feel tired, cold and depressed. It’s more common for women to get thyroid problems like this, especially around menopause, but hypothyroidism occurs at all ages. Common symptoms include:

### - Tiredness 
When thyroid hormones drop, your body processes slow down. Your metabolism and heart rate become slower, blood circulation becomes more sluggish and energy levels go down. This can leave you feeling exhausted.    

__Other causes of tiredness__
Stress,[ lack of sleep](https://www.livi.co.uk/your-health/5-sleep-problems-to-discuss-with-a-doctor/), post-viral fatigue, overworking, psychological factors, food intolerances and nutritional deficiencies, including [iron deficiency](https://www.livi.co.uk/your-health/a-doctors-guide-to-iron-deficiency-symptoms-causes/) [anaemia](https://www.livi.co.uk/your-health/a-doctors-guide-to-iron-deficiency-symptoms-causes/), can all lead to tiredness. If you’re concerned, always talk to your doctor, who can test for other problems such as low iron levels. 

### - Weight gain 
When the thyroid is not producing enough hormones, it can lead to a low basal metabolic rate (BMR). When your metabolism is slowed down, this means you’re not burning energy (calories) as efficiently, so weight goes on more easily. Weight gain and bloating can also occur due to fluid retention. 

__Other reasons for weight gain__
Underactive thyroid weight gain is nearly always accompanied by other symptoms. But if weight gain is your only symptom, it could be that you’re overeating, not exercising enough or you’re producing too much of the hormone cortisol due to stress and this is causing you to accumulate fat, particularly around the abdomen. It’s still worth talking to a doctor about this.   

### - Depression 
Thyroid hormones play an important role in maintaining healthy brain function. When they are low, [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) may result. For example, thyroid hormones help to regulate the [hypothalamic-pituitary-thyroid axis](https://www.hindawi.com/journals/jtr/2012/590648/), involved in the regulation of emotions, moods and behaviours. Depression induced by an underactive thyroid can be reversed with hypothyroid treatment.

__Other causes of depression__
Lack of sleep, poor diet, lack of natural light, stress, feeling powerless, upsetting life events (like a bereavement, losing your job, or a relationship break-up), physical, sexual or emotional abuse, low self-esteem, traumatic events or an unstable home situation. If you’re feeling depressed and this is beginning to affect your daily life, you should always seek help. Always talk to a GP, who may refer you for counselling or psychotherapy or prescribe medication where appropriate. Read more on [help for depression](https://www.livi.co.uk/your-health/help-for-depression-7-daily-tools-to-improve-your-mood/).

### - Constipation
An underactive thyroid slows down digestion. This can mean the transit of wastes through the gastrointestinal system takes longer, making you more prone to constipation.

Other common hypothyroidism symptoms to report to your doctor include:

- Sensitivity to cold
- General lethargy
- Lack of energy
- Muscle and joint aches
- Fluid retention
- Dry skin
- Hair that is thinning or brittle; hair loss
- Menstrual irregularities in women, such as heavier, more frequent periods
- Difficulty concentrating  
- Swelling of the face
- Low heart rate and low blood pressure

### Testing for hypothyroidism

Your doctor can take a blood test and measure different values to see what is causing the problem. If the thyroid gland is also enlarged, further investigations may be done such as ultrasound, fine needle puncture and cell samples.

### Treatment for hypothyroidism
Daily hormone replacement tablets can be given on prescription by a doctor. The dosage varies depending on the individual and needs to be monitored regularly. Hypothyroidism can be a transient condition, which means you may not need to be on medication long term.

## Symptoms of hyperthyroidism (overactive thyroid gland)

This is where the thyroid gland produces too many thyroid hormones. This causes the whole system to speed up; feeling like the body is on ‘high’. Common signs of an overactive thyroid include:

### - Weight loss (despite eating normally)
Too many thyroid hormones cause the metabolism to speed up, causing weight loss. But sudden weight loss may happen for a number of reasons, for example, after a traumatic event. It may be caused by some of the side effects of alcohol or drug misuse, heart, kidney, lung or liver disease, gut problems, dental issues, dysphagia (problems swallowing), diabetes or dementia.

### - Frequent trips to the loo
Thyroid hormones act on the gastrointestinal tract so an excess can cause more frequent bowel movements, including diarrhoea. Kidney function may also be affected, causing more frequent urination.

__Other common causes__
If you’re urinating a lot and feeling thirsty, ask your doctor to test for diabetes. If you’re a man and constantly feel the urge to pee (especially if you’re finding it hard to empty your bladder) tell a GP, as you may need your prostate gland checked. [Urinary tract infections (UTIs)](https://www.livi.co.uk/your-health/utis-your-questions-answered/) may also be a cause. If you have any change in bowel habits, always talk to a doctor.

### - Anxiety  
Thyroid hormones help to regulate the sympathetic nervous system (SNS). When the SNS is overstimulated this triggers the body’s ‘fight or flight’ response, leading to increased heart rate, anxiety, irritability, mood swings, panic attacks, and affects your ability to deal with stress.

Stress, traumatic life events, lack of sleep and poor diet can also lead to a[nxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/). Always talk to your doctor, who may be able to provide a course of therapy or medication.

Other common symptoms of hyperthyroidism (overactive thyroid) include:

- Nervousness
- Tiredness
- Weakness
- Palpitations and increased heart rate
- Increased sweating
- Insomnia
- Dry skin and hair (which may be thinning)
- Mood swings
- Sensitivity to heat
- Menstrual irregularities in women (for example, shorter, scantier and irregular periods)
- Swelling in the neck from an enlarged thyroid gland (goitre)
- Eye symptoms
- Tremor

### Testing for hyperthyroidism

Your doctor can take a blood test and measure different values to see what is causing the problem. If the thyroid gland is also enlarged, further investigations may be done such as ultrasound, fine needle puncture and cell samples.

### Treatment for hyperthyroidism
Daily hormone replacement tablets can be given on prescription by a doctor. The dosage varies depending on the individual and needs to be monitored regularly. Hypothyroidism can be a transient condition, which means you may not need to be on medication long term.

### Should I get help for thyroid symptoms?
If you suspect that your symptoms might be thyroid-related, talk to a GP who can perform the tests mentioned above. Your symptoms might have different causes, but a blood test can help determine whether there is a thyroid problem and what treatment is required. Even if thyroid problems are ruled out, a Livi doctor may be able to help by, for example, prescribing a course of therapy or medication to help with symptoms of anxiety or depression.


livi.co.uk > Your health > Thyroid symptoms to check with a doctor

Thyroid symptoms to check with a doctor

200 million people worldwide have some form of thyroid problem – usually hypothyroidism and hyperthyroidism. Here’s a guide to symptoms of each

Thyroid symptoms to check with your doctor | Livi

IMG 20200730 224911 865[33] (1)

Attention-Deficit Hyperactivity Disorder (ADHD) is thought to affect between 3 and 5% of school-age children in the UK. Boys are more likely to be diagnosed with ADHD than girls, and people are usually diagnosed between the ages of 6 and 12. But it can affect adults just as much, although the symptoms aren’t always as clear.

If you struggle with feeling restless, fidgetty, and can’t stay focused when you need to, it’s not necessarily your fault – it could be adult ADHD. Getting medical advice can help you understand more about the condition, and what your symptoms might mean.

## Five adult ADHD symptoms to be aware of

The signs of ADHD can vary from one person to another, but the classic symptoms include: 

#### 1. A short attention span
ADHD inattention is the ‘attention-deficit’ part of the condition. It means someone is easily distracted and finds it hard to concentrate. This may be worse in certain situations – most people with adult ADHD find it naturally hard to stay focused on tasks they find difficult or boring, preferring exciting or fast-moving activities.

#### 2.	Hyperactivity
Hyperactivity in adults is often shown through being very fidgety and unable to sit still, especially where it causes problems in school or work situations. Hyperactive people may find it difficult to wait their turn, often interrupting in conversations, and can be very impulsive, even to the point where it can get them into dangerous situations.

#### 3.	Mood swings
Adults with ADHD often have trouble with mood swings and irritability – it’s easy to get frustrated when you’re finding it difficult to focus. 

#### 4. Difficulty organising your life
ADHD inattention makes it difficult to organise your day and keep on top of things, whether you’re at home or at work. You might also seem quite forgetful, losing keys and missing appointments! 

#### 5.	Extreme impulsiveness
People with ADHD sometimes seem to have a lack of awareness of the dangers of certain situations – adult ADHD is often a cause of dangerous driving, and with taking serious financial or physical risks. 

ADHD is closely linked with some mental health conditions, particularly depression, bipolar disorder, and obsessive-compulsive disorder. This is probably because adults with ADHD can have different patterns of thought that make them more likely to also have one of these conditions. It might also be partly because life with ADHD – particularly before a diagnosis – can cause strain. The condition can affect lots of aspects of a person’s life, including how much they feel they’ve achieved their potential.

## What’s different about ADHD in women?

Girls and boys, women and men, often have differing patterns of ADHD – the reasons for this are not completely clear and are likely to be complex, with unconscious coping mechanisms matching people’s expectations of normal behaviour for each person. Broadly, a man with ADHD may show more of the hyperactive signs, where women with ADHD may struggle more with attention deficit.

The signs of ADHD in women may be less obvious to an onlooker, which can mean women find it harder to get a diagnosis. This might partly explain why there are so many more men than women with a proper diagnosis, though genetic factors also affect a person’s likelihood of developing ADHD. Some things which make it harder to get a diagnosis might include the coping strategies they’ve developed, and their own and other people’s ideas.

## I think I have adult ADHD – should I see a doctor?

Adults with ADHD have often learned coping mechanisms and strategies, so the signs of ADHD can be even more varied, and sometimes quite subtle, in adults. But although ADHD is thought of as a condition affecting young people at school, people who are diagnosed later in life can find that having the diagnosis helps them better understand and manage behaviours and feelings they’ve found troublesome in the past.
A GP will need to know what adult ADHD signs and symptoms you’re worried about, so it can be useful to keep a diary or make a list of symptoms to talk to the doctor about.  

Being aware of the symptoms can help you work out how long you might have had them, which can help a doctor understand the effect the symptoms are having on your life. 

Some ADHD symptoms could also point to some other conditions to do with behaviour and mental health, so consulting a GP is really important. Make sure you’re properly assessed as different conditions might need different treatments or management plans.

ADHD can have a huge effect on a person’s home, school, and work life, so if you’ve got any concerns you should see a GP as soon as you can. Having the right diagnosis can help you get treatment and support which can make all the difference if you and your family are living with ADHD. 


livi.co.uk > Your health > A guide to ADHD in adults

A guide to ADHD in adults

As awareness of ADHD is improving, more and more people are noticing signs of ADHD as an adult. Here’s how to spot ADHD in adults, and what can be done to manage it.

Adult ADHD Signs & Symptoms | Livi

Reviewer > Dr Rhianna

There are many different types of relationships, and what works for some people may not be right for others. But what exactly constitutes a ‘good’ relationship? And what tools do therapists suggest when it comes to finding, building and maintaining a strong relationship?

‘The initial attraction and falling in love — that’s the easy bit,’ says Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Livi. ‘It’s what happens when the passion and sparkle become less intense that matters.  

‘A strong relationship is where there’s also a deep friendship. So, there should also be respect, trust, empathy, kindness and a willingness to try and understand each other. That’s what builds a deeper connection that lasts beyond the physical.’ 

Here are some practical tools Gauffin suggests to help you build a better relationship.

## 1. Prioritise being kind to each other

Kindness is the number 1 predictor of a good relationship, a study  showed. In the research, being kind to each other — for example, taking turns when looking after children or a pet, and supporting each other through stress — was even more important than sexual attraction, compatibility, wisdom, intelligence and shared values.

When researchers analysed 2,500 long-term (more than 20 years) couples, they found those who reported higher levels of agreeableness (being kind and considerate generally) and lower levels of emotional instability (worrying a lot) were also happier with their relationships.  

## 2. Practice the 5:1 relationship ratio

The 5:1 ratio simply means that in a healthy relationship, for every negative interaction there should be at least 5 positive interactions and it’s a psychological tool used by many therapists.  Examples of negative interactions include being critical, dismissive or defensive or forgetting a special occasion. Examples of positive interactions include showing appreciation, interest, affection and empathy.

## 3. Use these tips to communicate more clearly

‘If you’re not able to communicate effectively with your partner, it can lead to misunderstandings, resentment and conflict,’ says Gauffin.
Here are 5 steps  to help improve communication between couples.

- __Don’t ignore or sweep things under the carpet.__ If there’s something bothering you, talk to your partner about it. By addressing smaller issues along the way, you can prevent damaging resentments from building up.

- __Avoid being accusatory.__ Instead of telling them exactly where they’re going wrong or getting personal, explain how their behaviour makes you feel. For example, rather than saying ‘you’re so selfish, you never tidy up,’ tell them how you feel. For example, ‘When you don’t help with the tidying up, it makes me feel upset and stressed.’

- __Pick the right place and time.__ There’s no point launching into a discussion about something when your partner is about to go into a business meeting. Instead, if you want to bring something up, do so when there’s time, for example, after your evening meal or when you’re out walking together.

- __Make time.__ Whether it’s trying new activities, or just relaxing and having fun together, schedule times when you put everything else aside and focus on each other.

- __Know your boundaries.__ Ideally, this is something you should set early on in the relationship. Having boundaries is about letting others know how you wish to be treated. For example, you may have a boundary about being spoken to with respect. Therefore, it’s important to clearly and calmly state that, rather than expect people to automatically know your limits. 

## 4. Learn to argue more effectively

‘If you’re in a relationship, it’s normal to argue,’ says Gauffin. ‘Arguments enable people to learn from each other and show there’s enough space and trust for you both to stand up for your own needs. It’s how you manage the conflict that counts.’ Here are some guidelines:

- __Try to remain calm.__ Even if you feel emotional. This isn’t always easy and you may have to remind yourself to count to 10, or take a few deep breaths
- __Don’t get personal.__ Keep on topic. If you’re angry because of something they’ve done or said, don’t start to insult your partner or bring up issues from the past
- __Really listen to what they’re saying.__ Even if it’s hard, try to ‘hear’ where they’re coming from. Part of the reason people persist in arguing is that they want to get their point across and make the other person understand how they feel. If you make it clear that you’re listening and empathising with their point of view — even if you don’t agree — it can really help to defuse a situation
- __Use humour to lighten the tension.__ Sometimes, it helps if you can see the funny side

## 5. Be aware of your own history and triggers

If there’s something your partner does or says that always drives you mad, this may be a trigger for something that’s happened in the past that you haven’t dealt with, says Gauffin.

Or, if you’ve always had a tendency to fly into a rage, or get very jealous, in every relationship, these are issues you need to resolve within yourself. If not, you’ll only keep repeating the same patterns of behaviour to the detriment of this relationship and others. 

‘If you are prone to jealousy, for example, you may need to work on building up your self-esteem,’ says Gauffin. ‘This is where talking to a therapist can be useful in helping you to identify issues from your past that may be causing you to react in a certain way. Likewise, if your partner has any issues, it’s not your place to try and fix them.’ A Livi doctor can help you identify any issues that may be triggering your behaviour.

__This article has been approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Livi.__


livi.co.uk > 5 ways to build a stronger relationship — a therapist’s toolkit> button

livi.co.uk > Your health > 15 ways to build a stronger relationship — a therapist’s toolkit

13 ways to build a stronger relationship — a therapist’s toolkit

Boundaries, communication… we all know the foundations for a healthy relationship, but how can we put it all into practice? This guide delivers some of the essential advice therapists suggest to their couple clients, to help build a stronger relationship

livi.co.uk > Your health > 5 ways to build a stronger relationship — a therapist’s toolkit

5 ways to build a stronger relationship — a therapist’s toolkit

##  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 Livi. 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 Livi 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 Livi.__


Livi.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 Livi

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

##  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 Livi. 

‘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 Livi.__


Livi.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 Livi, has great advice

##  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 Livi__


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

Livi.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 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 Livi 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 [Livi app](https://www.livi.co.uk/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 Livi__


Livi.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 Livi, 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 Livi 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 Livi__


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

Livi.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 Livi 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](https://www.livi.co.uk/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](https://www.livi.co.uk/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. Livi GPs are here to help. 

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


Livi.co.uk > article page >How to boost children’s immunity this winter: 7 tips > call out

Livi.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

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

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

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)

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

Affects one in three 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, Livi__


Livi.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 | Livi 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](https://www.livi.co.uk/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](https://www.livi.co.uk/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. 


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

Back to school v01

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

__Here are some practical tips…__

## 1. Use colour

One of the key principles of healthy eating is to ‘eat a rainbow of fruit and vegetables’. The more colour you can get into your family’s diet from varied, brightly-coloured fruit and vegetables, the healthier their diet will be.
 
The pigments in foods that give them their colour come from natural compounds called phytochemicals. Many of these are antioxidants (natural chemicals) thought to protect against harmful substances called free radicals. The richest sources of these are fresh fruit and vegetables, which are associated with lower levels of diseases such as heart disease and cancer. 
 
For example, red, purple and blue foods such as currants, berries and grapes are rich in phytochemicals called anthocyanins. Studies show that these have antioxidative and antimicrobial activities that might help improve visual and neurological health, and might help protect against various diseases. 
 
Here’s a simple guide to other coloured vegetables and fruit that are rich in protective phytochemicals – use a wide variety:
 
__Red__ - Tomatoes, red berries, watermelon, cherries, red peppers and pomegranates
__Yellow__ - Butternut squash, honeydew melons, lemons, papayas, peaches, persimmons, swedes, yellow peppers
__Orange__ - Carrots, butternut squash, pumpkins and sweet potatoes
__Beige/white__ - Bananas, celeriac, garlic, Jerusalem artichokes, mushrooms, onions, turnips, white peaches
__Purple/blue__ - Aubergines, blackberries, blackcurrants, purple grapes, red cabbage, purple/green vegetables such as purple kale, broccoli and artichokes
__Green__ - Broccoli, cabbage, Brussels sprouts, kale and pak choi.
 
## 2. Use your senses
Touching and smelling food during its preparation and cooking activates the hormonal, nervous and enzymatic processes that help us digest it and absorb nutrients. 

This can start from choosing fruits and vegetables by smelling for ripeness. It can continue when you appreciate the texture and delicious scents as you chop and squeeze pungent foods such as parsley, garlic and lemon. Cooking healthily is a delicious journey, long before you start eating. 

Try to get children involved in this process. Encouraging them to enjoy food preparation with you will help engender an ease around fresh food in them as they get older. Also, studies show children who are involved in cooking make better diet choices.

## 3. Hide the healthy 
Try not to declare ‘We’re going to start eating healthy food.’ This can make the family think they’re getting boring or bland food. Instead, slowly start to include healthy food into meals that look as appetising and delicious as the foods they’re used to. The following tiny hacks can make a big difference:

- When making Bolognese sauce, try substituting half the mince with tinned brown lentils (rinse them off to remove salty residue)
- To use less salt, which is associated with increased risk of high blood pressure, try substituting it with lemon or lime. It sounds odd but it works. Or, use fresh herbs instead (see below). Lower your salt use gradually and your family’s taste buds will adapt
- Try substituting half the mayonnaise in coleslaw for yogurt or cutting potatoes into chip-like shapes and roasting them so they look like chips. If it looks like the food they’re used to,  children are more likely to eat it

## 4. Emphasise wholegrains

One of the simplest changes that will make your cooking healthier is to use more wholegrains. Studies show that 2-3 daily servings of wholegrains might help prevent illnesses such as type 2 diabetes, cardiovascular disease, and colorectal, pancreatic, and gastric cancers.
 
Wholegrains contain more fibre, which is essential for digestion. They’re also unprocessed and retain many nutrients that their processed hybrids don’t. Many such foods also have a lower glycaemic index (GI), which means they take longer to be digested. That also means they can keep your blood sugar stable for longer so you avoid excessive cravings between meals. 
 
Here are some ways to add more wholegrains to your cooking:
 
- __Short grain brown rice instead of white__ - It has the same texture but is higher in fibre and nutrients
- __Opt for wholemeal sourdough bread__ - This is high in fibre and contains healthy bacteria that might help with gut health. It’s much more filling than regular bread, too
- __Swap porridge oats for whole (sometimes called ‘jumbo’) oats__ - They’re less processed, cook in a similar way and contain more essential heart-healthy beta-glucan fibres 
- __Use high-protein wholegrains__ - This will help increase the protein content of your meals (which can help with satiety as well as bone and muscle growth) as well as adding fibre and nutrients. Wholegrains that are high in protein include quinoa, buckwheat, wild rice, millet and couscous
 
## 5. Have a few healthy bases – and use them often

You can’t reinvent the wheel at every meal. And, if you try to create a brand new meal from scratch each time you cook at home, you might start to feel that healthy cooking is a chore. But it needn’t be. 
 
By knowing a few healthy essentials that work for you and using them often, you can save time looking for recipes and buying new ingredients. There’s nothing wrong with a little repetitive eating, if it helps you to make healthier choices. 
 
Here are some suggestions for go-to tricks that can help make healthy food tastier without much thought:
 
- __The healthy salad dressing__ - Take 2 tbsp olive oil, a drizzle of balsamic vinegar, a tsp honey and a pinch of mustard. Mix together to brighten up a leafy salad
- __The vegetable brighteners__ - Add lemon, fresh herbs and a little avocado, sesame or olive oil to give steamed vegetables more appeal. Foods like broccoli, asparagus and mangetout can be lightly sautéed in a little warm oil for about 2 minutes, then drizzled with lemon or lime and a pinch of black pepper
- __The satisfying stew__ - Use the following as your go-to stew recipe – then all you have to do is change the base. Sauté chopped onions or garlic in a little warm oil, add fresh spices or herbs and stir until translucent. Then stir in the stew base – this could be chicken, lean lamb or beef pieces, or it might be tinned beans or chopped tofu if you’re vegan – until brown. Add a litre of stock, some tomato purée, season and bring to the boil. Then lower the heat and simmer and reduce until the base is cooked through. You can add fresh vegetables near the end of cooking time for added nutrition 
- __The child-friendly dip__ - Studies show children are more likely to eat vegetables if they are served with a dip. Try this healthy garlic mayonnaise alternative: mix a little garlic powder, onion powder, a pinch of salt, soy sauce, paprika, and chopped spring onions into a cup of plain Greek yogurt and serve with raw vegetable crudités

## 6. Use fresh herbs

There’s no better way to flavour your food than using fresh herbs and avoid leaning on salt for taste.
 
But knowing which ones to use can be confusing. Herbs also have a short shelf life, which makes many people reluctant to use them often.
 
To minimise waste, figure out your family’s 3-4 favourite fresh herbs, especially those that pair well with lots of different foods. Then, keep these on hand for use in your staple meals. It’s easier to experiment with something you know the family like the taste of, than to constantly test out new flavours on them.
 
Here are some versatile suggestions: 
 
- __Basil__ - For Italian-based dishes, and tomato-based salads – tomato, mozzarella, avocado and fresh basil drizzled with olive oil and apple cider vinegar is a wonderful quick lunch
- __Coriander__ - For Asian- and Oriental-inspired foods, especially stir-fries and curries
- __Flat-leaf parsley__ - For everything, but especially for Middle Eastern-inspired dishes and fresh fish 
- __Chives__ - For fresh fish, dips and salads
 
For use in cooked foods, buy and chop fresh herbs then put into ice cube trays. Cover with water and freeze. Once they’re frozen, you can pop your herb ‘ice’ into plastic bags for use when you’re ready.
 
We hope these hacks have inspired you to experiment more with cooking healthy at home. Now, over to you.
 
__Reviewed by: Rhianna McClymont, Lead GP, Livi__

 


Livi.co.uk > Your health > 6 tips for healthy cooking at home

Header GettyImages-1062249974 cook healthy

There’s no inborn art to healthy cooking – it’s something that can be learned. The good news is a few simple principles can help you put together healthy, filling and nutritious food for the family, with minimum fuss.

6 tips for healthy cooking at home

## Quick Facts 
 
- Reassure children and never show your own frustration and stress
- Getting children active outdoors will help reset their sleep/wake cycle, making bedtimes easier
- Setting boundaries around screen time will help encourage healthy sleep

For a lot of children, the past few months have brought many changes. Their normal routine might be out of sync and their home environment might have changed. They might have had to take time off school, with their parents working from home.
 
That’s a lot of change to deal with. One of the consequences of this could be changes to their sleep habits, with a later sleep schedule and more fluidity in their wake-up times.
 
Some of the ways that sleep issues can manifest include:

- Problems falling asleep
- Waking in the night and unable to go back to sleep
- Vivid dreams or nightmares
- Increased bedwetting (small children)
- Separation anxiety

These tips can help reduce bedtime issues and help your child get enough sleep, whatever their age.
 
## TODDLERS 

__1. __Stick to a routine____
A bedtime routine is one of the most helpful ways for toddlers and small children to fall asleep easily. It provides cues that it’s time for bed and is calming and reassuring.
 
Licensed Livi child psychologist Martin Forster recommends keeping to a routine even at weekends and during holidays. You can make it quite playful, talking through what you’re going to do and in what order.
 
You can help promote a good night’s sleep with quiet and relaxing activities such as a warm bath and reading them a story.

__2. __Wear them out____
Regular exercise and fresh air will make your toddler feel tired. Very young children and toddlers benefit from outdoor play in many ways but it also helps to tire them out, which promotes better sleep at night.


__3. __Fade away your presence____
If a child won’t sleep in their own bed or without a parent present, Forster says one of the best ways to help them become more independent is to ‘fade away’ your presence. Start sleeping next to the child and gradually move further out of the room each night. 


__4. __Create a suitable sleep climate____
A cool, dark, comfortable room helps a good night’s sleep. Try to keep your child’s room around 17-18C and use blackout curtains or blinds. 

 
## PRIMARY YEARS 


__1. __Stick to a routine____
If schedules have changed due to coronavirus, sleep times might have become later. Try to keep to a schedule that will regulate their sleep patterns. Although their routine will be a little different to when they were toddlers, consistency is key. A bath or shower and a book at bedtime are still cues that it’s time for sleep. A routine also acts as extra comfort and reassurance.
 
__2. __Get them outdoors____
Time outside in the sunshine is important for young children. It helps their immune system and regulates their circadian rhythms (their natural sleep-wake cycle), which improves their sleep.
 
‘There’s a connection between exercise and movement throughout the day and sleep,’ says Forster. ‘Kids who exercise will sleep well.’ He advises not to do lots of exercise within 2 hours of going to bed as it can stimulate children.
 
__3. __Reassurance and support____
Children pick up on family worries, even when you’re trying to hide things from them. This can affect their sleep and cause problems such as bedwetting.
 
‘Help them cope with their worries by talking about them and easing the burden,’ says Forster. Reassuring a child is one of the first ways to alleviate their anxiety, he says. ‘The most important thing to communicate to a child is: “We have a plan.”’
 
If their sleep is disrupted by bedwetting, Forster says try not to show your frustration. ‘It’s important to carry those emotions within yourself and be comforting and not to make a big fuss about it,’ he says. ‘Try to deal with your own stress or you can get into a vicious circle where a child is stressed about wetting the bed, which can make it worse.’
 
It helps to make sure your child doesn’t have too much to drink before bed. Make going to the toilet part of the bedtime routine.
 
Gentle breathing exercises can also reduce anxiety before bedtime. The [Headspace app for children](https://www.headspace.com/meditation/kids) has easy breathing exercises and meditation techniques.

__4. __Limit screen time____
Increased screen time impacts sleep quality. 
Schoolwork and educational apps mean children need to use tablets and computers but you still need to set boundaries around screen time. Try to keep a schedule for screen use, offer alternatives and come up with other ways to learn and have fun. Model healthy screen use by putting aside your own screen at certain times.
 
Forster says breaking up screen time with getting outdoors and exercising is vitally important.

__5. __Drawing and talking about dreams____
Stress or worry might show up in vivid dreams or nightmares. A child’s life experiences and what happens during their day is ‘material for their dreams,’ says Forster.
 
‘Talk to them about their dream, then discuss how a good ending to that dream might look. What would happen to change the ending of the dream?’ Forster says that making up stories and drawing pictures about a troubling dream is helpful as it ‘re-programmes the brain’.


## TEENS

__1. __Morning exercise____
For teens, it’s useful to get outdoors. Encourage them to do a workout such as a run in the fresh air, first thing. This triggers the body to produce more melatonin in the early evening, which helps prepare their bodies for sleep.
 
__2. __Reassurance to ease anxiety____
Anxiety is one of the most common mental health problems in children and adults. Teenagers might be concerned about global issues. They’re also prone to stress from school demands, problems with friendships, self-esteem issues, and changes to their body.
 
As the teenage years are a challenging time, ensuring they have enough sleep is one way to support them. You can help to ease their anxiety with regular chats and fun activities, encouraging them to grow in independence and confidence.
 
A set routine for meals, schoolwork and bedtime is still useful to help them get good quality sleep. Offering to chat before they go to bed can help them get things off their chest.

 
__3. __Encourage them to stop using devices before bed____
Teenagers are adjusting to remote learning and social gatherings via video calls. Setting limits around screen use and making sure teens take screen breaks is really important.
 
Try to encourage them to avoid screen time 1-2 hours before bed. The blue light given off by electronic devices suppresses the production of melatonin – the hormone that helps us prepare for sleep. Blue light also reduces Rapid Eye Movement (REM) sleep, essential to the processing of emotions and learning. So, too much screen time may mean your teen wakes up feeling sleepier, not refreshed.

__4. __Associate the bedroom with sleep____
For teens who wake in the night, Forster recommends they do not lie in bed struggling to sleep. He suggests they get up and do something else in another room until they feel tired again. That way, they only associate the bedroom with sleep.





livi.co.uk > Your health > Tips to help children get to sleep

Tips to help children get to sleep

If your child’s routine has been disturbed in the past few months, it might have affected their sleep patterns. Get bedtime back on track with these expert tips


While the spread of Covid-19 might have you feeling stressed or uneasy, your children may be experiencing even deeper levels of fear and confusion. Some might show it.  Others will keep it to themselves.
 
Younger children especially are less able to express or understand their fears and might be feeling concerned about this ‘new illness’ everyone is talking about.
 
## Gauge their level of fear – don’t assume it

However, before talking about it with your child, licensed Kry/Livi psychologist, Martin Forster PhD, says, ‘It’s important to assess whether your child is actually worried about coronavirus or not, so you don’t impose worries that aren’t there.’
 
He advises asking questions about what your child has heard and whether they have talked about it with anyone else. 
 
Whether it’s from reports on the news or from friends, children pick up snippets of stories and don’t always understand how to process new information. Their lack of understanding can heighten anxiety because – both for children and adults – stress originates from uncertainty. 
 
Making sure your children feel informed is one of the first ways you can help lessen their anxiety. If they already have some knowledge of the virus, gauge their level of understanding and find out what specifically, they’re confused about. 
 
## Keep it simple
 
According to the UK Mental Health Foundation, some of the ways to help children stay mentally well include ensuring they feel understood, valued and safe.
 
Reassuring your child that they are unlikely to become seriously ill with coronavirus is important. Forster advises answering questions honestly, simply and as concisely as possible but putting certain facts into context. 
 
If they hear about people dying, explain that it’s very uncommon. If they worry about their grandparents, explain that the lockdown rules are to protect them and keep them safe.
 
## Watch how you’re talking about the virus with other adults
 
As parents, we need to be careful about how we act and what we talk about with other adults that children might overhear, says Forster.
 
‘You need to avoid displaying hopelessness or loss of control as children fear seeing their parents losing it. They need to see hope,’ he says. ‘Letting them know that you’re there and will look after them will also help’.
 
## Make it practical
 
Empower kids by giving them practical tips on how they can look after themselves. Talk to them about the importance of hygiene and keeping their hands clean.  
There are lots of videos online about how to wash hands properly and the advice is that you should take as long to wash your hands as it takes to sing Happy Birthday twice.
 
Letting them see you take precautions and follow the health guidelines can help to reassure them that you’re being proactive when it comes to keeping everybody safe and well.  And the singing is a bit of fun, too.
 
## How to explain social distancing
 
Children, by nature, are generally lively, active and less aware of personal physical boundaries so social distancing can be a challenge, especially for very young children.
 
Don’t make social distancing seem scary or strange. The term won’t mean anything to young children so use phrases they can relate to. Talk about how they can help everybody stay well by not getting too close to people.
 
Older children are more likely to see stories online and with so much more of our life becoming virtual, it’s going to be hard to avoid reading rumours on the Internet. 
 
Encourage older children to be savvy about what they view online. Just as we as adults need to be mindful of how much content we consume and the sources of our information, we need to educate our children to be the same.
 
Come up with a list of reputable sites and platforms together so they feel involved. Two links that we recommend are below;

[Get information about coronavirus on NHS.UK](https://www.nhs.uk/conditions/coronavirus-covid-19/ "NHS coronavirus information link")

[Get advice about staying at home](https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/ "self isolation advice from the NHS")

Have an open conversation about why certain things we see, especially on social media, might be inaccurate.
 
## Keeping children mentally well during isolation
 
Whilst opportunities to get outside are limited, get young children engaged in creative play and using their imaginations.
 
Forster suggests that some of the main worries for children during this time will be about schools being closed and not seeing friends or delays getting their grades.
 
Explaining how ‘society is making a massive effort to compensate,’ will give them hope and a sense that they’re not alone in this situation.
 
Establishing routines so that older children can continue with online education and keep up with their studies helps maintain a sense of normality.
 
Forster also believes this is a time for families to create new opportunities and do activities you might not usually do as a family, even just going for a walk together.
  
Use the time to come together and bond as a family. This will also help your children feel soothed and safe.


| DO SAY     | DON’T SAY  |
| ---------- | ---------- |
| ‘We can all stay healthy by not getting too close to people’    | ‘Don’t go near others, they could be sick’             |
| ‘Lockdown rules keep us safe’ | ‘These lockdown rules are ridiculous’    |
| ‘I'm here and will take care of you'       | ‘I feel so hopeless’        |
  
## What should I do next?
- Speak honestly and openly with your children and answer any questions they might have – but be concise and simple, no gorey details.
- Offer practical and useful ways they can help protect themselves and others.
- Come together as a family to work on a project that can help the wider community.


livi.co.uk > Your health > How to calm your children’s anxiety about coronavirus – an update for parents

How to calm your children’s anxiety about coronavirus – an update for parents

If your children are frightened by their new life under Covid-19, this expert guide will help

How to manage your children’s anxiety about Covid | Livi UK

If you’ve found yourself with your hand in the biscuit jar more often lately, you're not alone. Supermarkets are reporting a big rise in the sale of baked goods, carb-heavy foods and ‘sweet treats’. More people are buying in bulk too – and evidence shows that buying in bulk often leads to eating more. 

Of course it’s natural to turn to these kinds of foods occasionally at times like this. But limiting your intake of sugary or carb-heavy snacks will ultimately make you feel better, help boost your energy levels and improve your focus as well as your waistline! 

## How ‘mindless eating’ can take over
Did you know that you actually make over 200 decisions about food every day? But most of these decisions happen unconsciously, so we don’t even notice them. That’s why when your life and work patterns change, so do the unconscious triggers to eating. Being at home more with your children may mean you have a snack when they have one. The start of a new video call might trigger a desire for a cup of tea and some chocolate. Or it could just be that you’re passing the biscuit tin more often! 

This type of snacking is not about having no ‘willpower’, being greedy, or even about being more hungry – it’s about the changing circumstances and a whole bunch of new unconscious triggers. So one of the most important things is simply to be aware that it’s happening. 

## 7 simple ways to beat snack attacks
__1. Watch out for new snack ‘routines’__
Look at your new daily routine and watch where you’re snacking when you wouldn’t usually. Be aware and ask yourself ‘Am I really hungry’ or are you just eating without thinking?

__2. Keep snacks out of sight and harder to get to__
It may seem simple, but if you see snacks more, you’re likely to eat them more. If you’re now working in an open-plan kitchen rather than at the office, that could be a real problem! So hide the snacks away. And maybe even put them in a place where you have to make a clear and concerted effort to get to them – like a high cupboard.

__3. Leave a reminder of what you’ve eaten__
A plate covered in crumbs, a wrapper, even an apple core. Behavioural scientists say that seeing what you’ve eaten recently is a useful visual cue that tells your mind that you’re not hungry. 

__4. Keep some water to hand__
If spending more time at home is making you eat more, having a glass of water to hand and drinking it regularly will stop you feeling hungry. Drinking water regularly may be a habit you’ve fallen out of, especially if you’ve broken your normal daytime routine. 

__5. Buy less (or smaller) snack packs__
Because you’re at home constantly, it might be tempting to  increase the size of the products you buy, buy more of them at once or simply get more unhealthy treats. Try not to, as having more around often leads to eating everything faster, rather than it lasting longer! 

__6. Don’t multitask when you eat__
Stop what you’re doing. Focus on your food. And eat slowly. If you rush down your meals while doing something else, you’ll feel less satisfied and less aware of what you’ve eaten. Studies into ‘attentive eating’ show eating mindfully can have long-term positive effects on weight loss.

__7. Load up on healthy snacks__
Although it might seem the most obvious solution, this doesn’t necessarily overcome the problem of mindless eating. But of course, eating fruit, sugar-free snacks, nuts and seeds etc. is always better for you, so make sure you’ve got plenty of healthy snacks around – that you actually like!

__If you do one thing...__

Pay attention to what you’re eating and when. This will help you avoid mindless snacking triggered by the many changes happening at the moment. 

livi.co.uk > Your health > Keep snacking under control

Keep snacking under control

Spending so much time at home can make it easy to slip into bad habits. But whether you’re comfort eating, or snacking from stress or just sheer boredom, there are simple ways to stop. And what’s more, you don’t need any willpower at all.

livi.co.uk > Your health > Keep snacking under control > Metainfo

Keep snacking under control 

livi.co.uk > Family health > Articles 

Livi UK

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