A general selection of helpful resources that you and your family may find helpful.

Medicines for Children provide information that cover many of the medicines that are prescribed or recommended for children by health professionals. They answer frequent questions, such as how and when to give the medicine, what to do if you forget to give the medicine, and any possible side-effects. Website: www.medicinesforchildren.org.uk/medicines/

  • A Teenagers Guide to ADHD is for teenagers who have ADHD or for anyone else who knows a teenager who has ADHD. Website: www.adhdfoundation.org.uk/2022/05/30/information-booklets/ 
  • ADDvanced Solutions Community Network encourages, equips and empowers children, young people and their families living with neurodevelopmental conditions, learning difficulties and associated mental health needs. Website: www.addvancedsolutions.co.uk/
  • ADHD Foundation works in partnership with individuals, families, doctors, teachers and other agencies to improving emotional wellbeing, educational attainment, behaviour and life chances through better understanding and self-management of ADHD. Website: www.adhdfoundation.org.uk
  • ADHD North West provides a free support service to empower and improve the wellbeing of individuals and families affected by an Attention Deficit Disorder and associated conditions. Website: www.adhdnorthwest.org.uk
  • ADDISS provide information and resources about ADHD to anyone who needs assistance, such as parents, sufferers, teachers or health professionals. Website: www.addiss.co.uk/
  • ChAPS offers information and support for individuals who may have an Autism Spectrum Condition. Telephone: 0844 850 8607 Website: www.cheshireautism.org.uk
  • Living with ADHD giving advice for teenages, parents and teachers. Website: www.janssenwithme.co.uk/en-gb/living-with-adhd/home
  • National Autistic Society are the UK’s largest provider of specialist autism services. Website: www.autism.org.uk
  • B.I.R.D. works with children and adults with learning difficulties and also people who have brain injuries and additionally with complex needs and mild learning or behavioural difficulties. Telephone: 0800 028 6256 Website: www.birdcharity.org.uk

  • AnxietyUK provide support and help if you’ve been diagnosed with, or suspect you may have an anxiety condition. Website: www.anxietyuk.org.uk
  • Mind, Body & Sole is a non profit organisation which aims to raise awareness trying to help individuals to speak up and stop struggling in silence. www.mindbodysole.uk/mental-health-support
  • Moodjuice is designed to help you think about emotional problems and work towards solving them. Website: www.moodjuice.scot.nhs.uk
  • Positive Penguins offers an educational app developed for children to help them understand why they feel the way they do and help them to challenge their negative thinking. Website: www.positivepenguins.com

The Apps we have listed are currently free* to purchase.

  • Big White Wall – Get round the clock support from therapists to help cope with stress and anxiety
  • Blue Ice – this app helps young people manage their emotions and reduce urges to self-harm
  • Calm Harm – Reduces urges to self-harm and manage emotions in a more positive way
  • Chill Panda – Use breathing techniques to help you relax more, worry less and feel better
  • MeeTwo – A safe and secure forum for teenagers wanting to discuss any issue affecting their lives
  • Sleepio – An online sleep improvement programme, clinically proven to help you fall asleep faster – *free in some areas
  • Thrive – Use games to track your mood and teach yourself methods to control stress and anxiety
  • Molehill Mountain – this app is developed with those with autism and uses adapted Cognitive Behavioural Therapy (CBT) techniques

NHS Patient Webinars - Fussy Eating in Children
Website: https://patientwebinars.co.uk/condition/fussy-eating-in-children/webinars/

Healthy Start (NHS)
www.healthystart.nhs.uk/

  • The Proud Trust offers support for young people who want to find out more about gender and sexuality, offering youth groups and peer support across the Vale Royal and South Cheshire areas. Website: www.theproudtrust.org

A meltdown happens when someone becomes completely overwhelmed by their current situation and temporarily loses behavioural control.

  • Meltdowns are best understood as a panic attack. They are not a battle to be lost or won, but a crisis to manage
  • You are the child’s emotional brakes. How you manage the meltdown makes a difference to outcomes
  • Separate your relationship with the child from the behaviour
  • Emergency rules apply. Your child should not hurt you, others, or damage property. Remember that if things get damaged in a meltdown it may be replaced or fixed, so prioritise safety
  • Traditional discipline is largely ineffective for meltdowns, the child is not in a state to learn anything

Things you can do during a meltdown

  • Be aware of possible triggers and look for signs that anxiety is rising. Prevention is better than cure
  • Try to always keep calm and level. Shouting or getting angry will not help anyone involved. Be careful about your facial expressions and body language. Keep as neutral as possible, be non-confrontational
  • Reduce stimuli that may add to a child’s sense of being overwhelmed e.g. turn down the volume on the TV, ask other people to keep quiet and not intervene
  • Keep communication to a minimum. Instructions should be short and simple
  • It is better to steer a child towards a positive behaviour, rather than give an order to stop a negative one. Encourage a child to stand still rather than tell them to stop running around
  • Give emotional and physical space. Take a step backward from the situation rather than forward into conflict
  • Encourage a child to exit to a safer place such as their bedroom or outside to the garden. Where possible, guide a child rather than use forced removal. Some children prefer to hide away under a table or cover themselves with a blanket
  • Don’t threaten sanctions, punishments or offer rewards during a meltdown. The child is beyond reason and unable to respond appropriately. Such interventions are likely to increase anxiety rather than act as incentive to stop the behaviour
  • Physical intervention should be a last resort and only be used to keep the child or others safe.
  • Be aware of environmental risks for example, objects that may be used as a weapon, proximity to busy roads
  • For children who run away during a meltdown, providing there are no safety concerns, following at a distance is more beneficial than chasing after them

Following a meltdown

  • Children need time to compose themselves. Their safe place is a good way to do this
  • Offer your child a snack or a drink to help them recover
  • Reassure the child that it is all over. They may need to hear that you still like/love them. Let them know that you understand they could not help their behaviour
  • Try to forget what has happened and start afresh
  • Some children will be very upset by what they have done. They may express remorse or be angry at themselves. Provide reassurance
  • Some children can find it helpful to talk about the incidence, this can provide insight into triggers and causes

Useful Strategies

Choose your battles – Have flexibility in your approach. Is this worth a meltdown? This is not the same as letting a child do as they like. Where a boundary is very important (for example the safety of themselves and others) it is important to reinforce that boundary.

Balance tolerance and demand – Accept that some days their anxiety is going to be so high they will struggle to accept even simple demands, so reduce pressure.

Don’t take it personally – Don’t let what happened yesterday drag into today. It has no benefit to your child or yourself.

Support emotional wellbeing – Find ways to help your child communicate in a comfortable way – text, writing a comment and posting it into a special box, drawing. Emotional health is important, but communication regarding emotions is often hard for children with additional needs.

Voice control – Use a calm, even tone of voice

Shutdowns

A shutdown appears less intense to the outside world but can be equally debilitating. Shutdowns are an emotional response to being overwhelmed but may appear more passive. A child may go quiet or switch off.

Shutdowns can be just as frustrating as meltdowns for children. They often cannot figure out how to react. Allow your child time to process their feelings. Try to limit your talking and avoid passing judgement. Be there to listen to your child when needed. It may be useful to offer your child alternative communication strategies such as text, writing a letter, drawing a picture to reflect how they may be feeling.

  • CAMHS Crisis Line If your mental or emotional state quickly gets worse or deteriorates, this can be called a ‘mental health crisis’. In this situation, it is important to get help quickly.

    Please call 0800 145 6485 and our dedicated local staff will support you to access the help you need. The phone line is open 24 hours a day, seven days a week and is open to people of all ages – including children and young people.

    The phone line is now the first port of call for mental health help – it is operated by people in your local area who will know how best to support you. If you call NHS111 you may have to wait longer for help and will be re-directed to this local service so please call 0800 145 6485 in the first instance.

    You should still call 999 or go to A&E if you have an immediate, life-threatening emergency requiring mental or physical health assistance.

  • Cerebra is the national charity dedicated to helping children with brain conditions and their families discover a better life together. Listening to the needs of these families helps us inspire the most helpful research and innovation. Freephone number: 0800 328 1159. Website: https://cerebra.org.uk/get-advice-support/sleep-advice-service/
  • Childline is a free, private and confidential service where you can talk about anything. Website: www.childline.org.uk/ Freephone: 0800 1111
  • Young Minds is the UK’s leading charity fighting for children and young people’s mental health. Parenting isn’t always easy. Although it is often amazing and rewarding to watch your children grow, and to help them learn to be independent, it can also be really hard work. Website: www.youngminds.org.uk
  • MyMind is run by CWP, CAMHS and has been developed for everyone interested in the mental health and wellbeing of children and young people across Cheshire and Wirral. Website: www.mymind.org.uk
  • The Sleep Charity is an impartial organisation that looks at how you can adopt healthier sleep habits and focuses on raising awareness of a good night’s sleep to help and wellbeing. Website: https://thesleepcharity.org.uk/
  • PAPYRUS created this self-harm and suicide support guide for parents following discussions with parents who have experience of supporting a young person struggling with their mental health. It aims to provide information and guidance to help parents cope with a young person who is struggling with thoughts of suicide, to reassure them they are not alone. It is available in both English and Welsh, link below. www.papyrus-uk.org/papyrus-launch-new-guide-for-parents/

  • Kooth offer ‘free, safe and anonymous’ online support for young people. Website: www.kooth.com
  • The Mix is a free, confidential helpline service for young people under 25 who need help but don’t know where to turn. The Mix provides support for anything you may be going through. Telephone: 0808 808 4994 Website: www.themix.org.uk
  • Visyon is a charity that supports the emotional health of children, young people and their families in the Cheshire and Staffordshire Moorlands area. Telephone: 01260 290 000 Website: www.visyon.org.uk
  • South Cheshire CLASP offers free professional, confidential counselling for lone parent families and step families, including counselling for children. Telephone: 01270 250629. Website: www.southcheshireclasp.org.uk

  • Parentline plus is a helpline which offers information, advice, guidance and support on any aspect of parenting and family life. Telephone: 0808 800 2222. Website: www.familylives.org.uk
  • Motherwell Cheshire CIO offer counselling to mum’s who are experiencing their own anxiety and depression difficulties (especially in combination with their child’s own MH difficulties). Telephone: 01606 557666. Website: www.motherwellcheshirecio.com
  • Wishing Well offers a range of different sessions from Parenting Programmes. One to one advice and family drop-in sessions. Telephone: 01270 256919. Website: www.wishingwellproject.com
  • Your child’s school may have staff who support their pupils and their families as well as teaching your child in the classroom. Ask at your child’s school, they may be able to offer some advice and support about challenging behaviours sometimes seen in children.
  • Children’s Centres in your community offer several services. They may run parenting programmes. They may also be able to offer you some advice and support on parenting issues. You will find their contact details on your local authority website.
  • School Nurses
    Cheshire East     0-19 Live Well service. They can discuss your concerns with you.
    Website: https://livewellservices.cheshireeast.gov.uk/Services/1165. Telephone: 0300 123 4058.
    Cheshire West and Chester Starting Well service based at local Children’s Centres. Website: www.startingwell.org.uk/
  • Cheshire East Local offer is part of Live Well Cheshire East - an online resource providing information and advice for children and adults on topics such as education, staying healthy, care and support and community activities, along with a directory of services. They have links to Positive parenting Training. Website: www.cheshireeast.gov.uk/livewell/local-offer-for-children-with-sen-and-disabilities/what-is-the-local-offer/local-offer.aspx
  • Cheshire West and Chester Local offer is a comprehensive site offering advice and support to parents and children. Which may include 1-2-3 Magic. Every day parenting online Course (Free). Triple P. Incredible years programme. By searching the local authority site in which you live you can find the up to date offer for parenting support. Website: www.livewell.cheshirewestandchester.gov.uk/Categories/3948
  • Family Hubs (Cheshire East): https://cheshireeast.gov.uk/livewell/care-and-support-for-children/family-hubs/family-hubs.aspx
  • Parental Education Growth Support (PEGS) is a social enterprise set up to support parents, carers and guardians who are experiencing Child to Parent Abuse (including those with adult offspring). www.pegsupport.co.uk/
  • Summer Club Resources (Witherslack Group). Managing family days out can be a challenge for any parent. Whether its remembering your child's favourite toy or packing a sensory toolkit to help them regulate, check out our friendly days out articles to help you prepare. Summer Holiday Resources

The information below has been taken from Sensory Processing Occupational Therapy Support Service resource list.

What is Sensory Processing?
Broadly speaking it is how we process and understand our environment from what we can sense to understanding how our body moves and relates to the task demands.

The following sensory related information contains widely available links and resources that you can use to support children.

Falkirk Council
An excellent PDF booklet that describes sensory issues and calming and alerting strategies for different occupations. Scroll down to the bottom of the link to access the PDF – ‘Making Sense of Sensory Behaviour’ and other useful downloads. www.falkirk.gov.uk/services/social-care/disabilities/young-people-with-disability.aspx 

Interoception
More info about interoception – what is it, why is it so important and recommendations for further study. https://autismawarenesscentre.com/what-is-alexithymia-and-itsrelationship-tointeroception/#:~:text=Interoception%20is%20a%20sense%20and,what%20emotion%20we% 27re%20feeling

National Autistic Society
There is a wealth of information on the NAS website including –

Middletown Autism
A centre in Northern Ireland that designs and delivers training programs as well as providing a wealth of free information on their website including background and strategies for sensory processing such as PDF’s and video clips. Find the online resources tab and then sensory processing, or follow the link www.middletownautism.com/

A Sensory Life
A website by an occupational therapist with handouts, advice and explanations. Angie Voss OTR has also written a book called ‘Understanding Your Child’s Sensory Signals. A practical daily use handbook for parents and teachers’ https://asensorylife.com/index.html

Healthy Optimal Periods for Everyone (HOPE)
A website developed as part of a multidisciplinary project between the University of Edinburgh's Centre of Reproductive health and the RSE Youth Academy of Scotland. This website offers further information and reading on 'Periods and neurodivergent children: a resource for parents and carers' Royal College of Psychiatry.
www.ed.ac.uk/sites/default/files/atoms/files/periods_and_neurodivergent_children_.pdf

ERIC - The Children's Bowel and Bladder Charity
National charity that provides support and advice on helping to support a child's bowel or bladder when concerns arise. ERIC helpline run parent and carer webinars on specific topics, as well as providing specialist information and advice on any childhood continence issue. To speak to an advisor please call FREEPHONE 0808 801 0343. The Helpline is open Monday - Thursday, 10am to 2pm and is free to call from landline and mobile numbers. https://eric.org.uk/ ERIC - Enuresis Resource and Information Centre

The Sleep Charity
National charity that offers advice on a child's sleep, including bedtime routines, bedroom environment, relaxation ideas, concerns experienced when trying to get to sleep, diet & sleep, nightmares/night terrors, children with SEND, support for teenagers, babies & sleep. https://thesleepcharity.org.uk/information-support/children/

SOS Approach to feeding.
Have complied a comprehensive list of resources, articles podcasts and blogs to help support a child during snack or mealtime. https://sosapproachtofeeding.com/start-here-parents/

Sensory Ladders
A method of writing personalised sensory strategies and supporting people to identify what they need. Free training on https://sensoryladders.org/sensory-spiders/

Autism Level Up
An American company that supports autism advocacy with a wealth free information including thinking about energy levels from maxed out through settled and then down to asleep. Has some translations into 7 other languages. www.autismlevelup.com/

Books
Sensory Processing 101. A quick reference guide with some theory and activities.

Useful for those that do not want to read a lot of detail or who would like to be able to flip through for checklist and activities. Activities more appropriate for home than school. Approx £15, available from a range of online retailers.

The Autism Friendly Guide to Periods. Robyn Steward A guide to menstruation written by an autistic person, full of clear photos and explanations on what periods are, sanitary products, what to expect and how to manage. Approx. £13 available from a range of online retailers.

The Sensory Team Handbook. Nancy Mucklow A guide for older primary school age children and teenagers to help them make sense of their senses and take charge of their sensory processing. Approx. £12 available from a range of online retailers.

Raising a Sensory Smart Child Lindsey Biel and Nancy Peake. Lots of detail on sensory systems and activities, approx. £12 available from a range of online retailers.

Understanding Your Child’s Sensory Signals. A practical daily use handbook for parents and teachers’ Angie Voss. See website information above. Approx. £10, from a range of online retailers.

Following considerable research, a set of guidelines have been developed for you to help your child sleep better. There is much evidence to suggest that these strategies can provide long term solutions to sleep difficulties.

We recommend you follow these tips as the initial treatment for primary insomnia (children who are unable to get to sleep rather than those who wake in the night).

Bedtime Routine- these measures will avoid any excuses for needing to get up again

It is important that the time your child goes to bed and the routine remains consistent. Late nights and sleeping in can disrupt the routine for days. Before going to bed ensure that your child:

  1. Goes to the toilet
  2. Is not hungry – main meals should be eaten 1 – 2 hours before bedtime, however your child may wish to have a snack such as cereal before bedtime
  3. Is not thirsty – ensure your child drinks plenty throughout the day. A warm milky drink prior to bedtime may help your child feel sleepy

Your child’s bedroom should be cool, quiet, and comfortable. Ensure the bedroom is dark enough, especially in the summer months. The hours of darkness help us to produce a natural hormone called melatonin which causes us to feel sleepy.

Bedtime should follow a predictable sequence of events for example:

  1. Thirty minutes to an hour before bedtime, commence a sleep calming activity such as reading, playing a board game, conversations about the day
  2. Warm drink
  3. Snack
  4. Warm bath or shower
  5. Toilet
  6. Brush teeth
  7. Read a story

Children should be put to bed drowsy, but still awake. Do not let them fall asleep in other places as this forms habits that are hard to break.

Have a short story/reading time in bed or “talk time” to ensure your child has time to tell you any worries or things on their minds before they go to sleep. It may be useful to use a worry doll that anxieties can be ‘passed on’ to. Relaxation techniques, such as imagining positive scenes and introducing the use of white noise, such as a desk fan can be useful.

Tell them when it is time to go to sleep, say goodnight and tell them how to go to sleep. For example, lie down, pull the covers up, close your eyes and stay still.

Security objects, such as a favourite teddy or blanket, at bedtime often help children feel safe when their parent is not present.

When checking on your child at night, checks should be brief, and you should not stimulate your child to engage in conversation. The purpose is to reassure your child and reinforce that it is time to sleep.

It may be helpful to keep a sleep diary to track your child’s sleep schedule and activities to be able to target potential problem areas when things are not working.

Tips for dealing with sleeplessness

If your child is awake in bed tossing and turning, it is better for them to get out of bed to do a low stimulation activity for example reading and then return them to bed later. This prevents the bed from becoming associated with sleeplessness. If they are still awake after twenty to thirty minutes, spend another twenty minutes out of bed before returning them to bed again.

If your child is never drowsy at the planned bedtime, you can try a temporary delay of bedtime by using thirty minute increments until your child appears sleepy. This is so that they experience falling asleep more quickly once they get into bed. The bedtime should then be gradually advanced earlier until the desired bedtime is reached.

Points to remember:

  1. Drinks containing caffeine (cola, chocolate, tea, coffee and energy drinks) in the afternoons/evenings can lead to restlessness, shallow sleep and overnight awakenings
  2. Avoid stimulating activities and screen time (TV, game consoles, phones, and computers) one hour before bedtime as these will interfere with the natural production of the sleep hormone melatonin
  3. Avoid spending lots of non-sleep time in bed, for example watching TV, and encourage your child to use the bedroom as a place for relaxation and calmness
  4. Encourage physical exercise and a suitable diet to help improve sleep habits
  5. White noise, such as a desk fan, can help to aid the onset of sleep

For more information, please contact your school nursing team or visit:

The sleep charity

This website provides access to high quality information and advice to deal with most sleep issues. Website: www.thesleepcharity.org.uk

Eric - The Children's Bowel and Bladder Charity

https://eric.org.uk/childrens-bladders/bedwetting/

Teen Sleep Hub

https://teensleephub.org.uk/,

References:

  1. A clinical guide to Paediatric sleep” by Jodi Mindell and Judith Owens
  2. Sleep Hygiene leaflet for parents by School Nursing Service, East Cheshire NHS Trust

What is TB and why do I need to know about it?

Tuberculosis (TB) is an infectious illness caused by bacteria called Mycobacterium tuberculosis. TB can cause serious health problems – particularly if it is not caught early. But the illness is curable, and testing and treatment are free and confidential in the UK, regardless of immigration status.

Every year, around the world 8.6 million people are diagnosed with TB, and 1.3 million die of the disease. This is mainly because they cannot get the drugs that would make them better.

TB cases in the UK are low. Every year around 6,000 people are diagnosed with TB. Most people are successfully cured with a free course of treatment.

How is TB spread?

When someone with TB in their lungs or throat coughs or sneezes, they send droplets into the air that contain the TB bacteria. If you breathe in these bacteria over a long time you may become ill with TB. But most people won’t get ill because:

  • you normally need to spend many hours close to a person with infectious TB to breathe in enough bacteria to be at risk
  • most people’s immune systems are strong enough to kill off TB bacteria.

 TB cannot be spread through touch, sharing cutlery, bedding or clothes.

Am I at risk of TB?

You also have a greater risk of catching TB if you:

  • were born in or have links to countries with high rates of TB, including those in sub-Saharan Africa, the Indian sub-continent and parts of eastern Europe
  • live in an area where there are a lot of people with TB, for example certain areas in London
  • are or have been homeless or live in poorly ventilated or overcrowded housing
  • have a weakened immune system, for example as a result of another illness or condition
  • are HIV positive
  • are dependent on or regularly use drugs or alcohol
  • have been in prison.

If you are worried you might have caught TB, please see your doctor. TB is curable and treatment is free to everyone in the UK.

Do I have TB?

The most common symptoms of TB are:

  • a cough for three weeks or longer
  • weight loss
  • loss of appetite
  • high temperature or fever
  • night sweats
  • extreme tiredness or lack of energy

Because you may have come from a part of the world where there is more TB, it is possible you have come into contact with a person who had TB and could have been infected by the bacteria. If you are exposed to the bacteria that cause TB it is possible for the bacteria to go to sleep in your body and not cause any problems or symptoms of TB. BUT it can wake up later and develop into TB.

If you have any of the symptoms of TB you will have some tests to see if you could have TB.

It is possible to have been infected by the bacteria that cause TB, but for those bacteria to go to sleep in your body and not develop into TB disease. If this happens it is called latent TB. Latent TB is not an illness, you would not feel unwell and you are not infectious to anyone else, but it can develop into TB disease.

Types of TB test

There are a range of tests to show if you have TB, such as a sputum test and x-rays.

  • Chest x-ray: A chest x-ray can show damage in your lungs, but you might need further tests to prove you have TB, such as sputum and culture tests or scans.
  • Testing sputum: A lab will use a microscope to look at any sputum (phlegm) that you cough up. If there are TB bacteria in your sputum, you have tuberculosis of the lungs or throat (pulmonary TB). This test also helps doctors to understand how infectious you may be.
What happens if I have TB?

TB is completely curable, and in the UK treatment is free to everyone, regardless of immigration status.

If tests show you have TB, you should be treated as soon as possible. This means you will feel better sooner and will be less likely to pass TB on.

Maybe a close friend can be your ‘treatment buddy’ and remind you to take your medicine. Your TB nurse will also support you through your treatment.

You will need to have TB treatment for at least six months, to make sure all the TB bacteria are killed. If you have TB of the lungs or throat, after two weeks of treatment you should no longer be infectious.

Gradually you will start to feel better. This may take weeks, but you will stop feeling sick and tired all the time. Even when you feel better, it’s important to take the full course of your treatment, or you could become ill again.

TB testing and treatment is free and confidential.

Latent TB

If you do not have any symptoms of TB, you may have the bacteria in your body asleep. This is called latent TB, and you will be offered tests to see if this has happened to you.

Testing for latent TB

If you are being tested for latent TB, there are two types of test you may be given:

  • TB skin test: A skin test (also called a Mantoux test) is an injection of a tiny amount of tuberculin extract under the skin of your forearm. If you have been exposed to TB bacteria in the past, your skin can become raised and red, which can mean a positive result. It’s not generally painful but could be itchy.
  • IGRA test: Interferon-Gamma Release Assay (IGRA) is a blood test that can diagnose latent TB by looking at the immune system cells in the blood.

It is likely you will also need a chest x-ray and assessment by a doctor or specialist nurse.

What if I have latent TB?

Latent TB can be treated with antibiotics which kill off the sleeping TB bacteria so they cannot wake up and cause active TB.

The treatment normally lasts for 3 months. Your TB nurse will also support you through your treatment.

Latent TB testing and treatment is free and confidential.

What if the tests show I do NOT have TB or latent TB?

If the tests show that you have never been exposed to TB bacteria then you may be offered an injection (BCG) to help protect you from TB in future.

Before getting the BCG vaccination, people are given a skin test (also called a Mantoux test). This an injection of a tiny amount of tuberculin extract under the skin of your forearm. If the test is negative you may be given BCG in the next three months.