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Here are some reasons why parents and children often find themselves involved in a struggle about sleep:
1. Resisting going to bed and waking during the night are so common in the toddler and preschool age groups that they should be considered perfectly normal developmental behaviours.
2. One of the developmental tasks of the toddler is to engage in a power struggle with his parents. This includes struggles around bedtime and sleep habits. Toddlers seem to be constantly engaged in testing the limits, in pressing parents’ buttons.
3. All parents are more vulnerable in the middle of the night, so the best laid plans inevitably come unstuck. What seems a perfectly reasonable strategy when discussed during the day doesn’t seem nearly so practical in the middle of the night. Many parents take the easy option. Rather than fight with their tough, indefatigable toddler, they find it is easier to give in and let him get into their bed. One can always start the plan the next night.
4. There is very often disagreement between the parents about the best way to handle the problem, and a lot of blaming as well. Any management strategy for sleep problems has no chance of success until both parents agree that there is a problem, that now is the time to do something about it, and that the strategy they agree on initially needs to be implemented with equal commitment by both of them. Many professionals insist on seeing both parents when working out a management plan for sleep problems and other behaviour problems.
is a reflection of their competence as parents — ‘If I were a good parent, then my child would not have sleep problems’. One of the essential first tasks is to understand that this is simply not so. In any struggle with a toddler, the toddler will always win unless the parents have a consistent strategy. Winning strategies are surprisingly easy to learn — many parents initially think them too simple to have any chance to be effective — but they are more difficult to implement. This is discussed also in the section on management of behaviour problems.
Some of the techniques described below may seem drastic or even cruel. Parents should be reassured that they have been used successfully all over the world with countless youngsters with no untoward effects. Some parents who initially seek help decide not to persist with these suggestions once they know the details, either because they feel they are too harsh, or because they do not want to put in the time and effort and especially the persistence that are essential for the strategy to work, or because they decide that the sleep problems are not such a great problem after all. The strategies suggested here may not be needed for a child who has occasional sleep problems. In these instances the parents may be happy to tolerate some inconvenience. They are particularly relevant for problems that are severe and longstanding, and where parents really do want to put a stop to them.
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Gout is a recurrent disease but it may be months or years between each bout.
The diagnosis is usually straightforward in the middle-aged male but may be missed in a woman or in a young man, particularly if some other joint is involved. Usually the level of uric acid in the blood will be high. X-rays may not show any changes in the early stages.
Aspiration of the joint by inserting a needle and withdrawing fluid for examination may reveal the true diagnosis. The crystals of urate can be seen and identified.
If untreated, gout attacks may become more frequent. But the concern is for the long-term complications — urate crystals laid down as tophi may disrupt the joints and lead to deformity; kidney damage may occur and lead eventually to failure.
High blood pressure and hardening of the arteries are both associated with the kidney changes.
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Whether the ovaries should be removed at the same time is still a debatable issue.
Some surgeons leave them, believing that normal organs should not be removed. Others remove them, believing that their function ceases following hysterectomy, and leaving them may allow disease, such as cancer or cysts to develop, thus requiring a further operation.
Many surgeons remove one ovary, thus halving the risk of developing cancer and leave the other to go on producing oestrogen so as to make the artificial menopause smoother. In women past the menopause, there is no hesitation about removing both ovaries.
With modern surgical techniques and anaesthesia, this operation is now safe.
Unfortunately nearly 50 per cent of those who have the uterus removed suffer from the post operative side-effects. These are mostly depression or interference in sexual function. Most of these side-effects are preventable.
Sometimes the operation is carried out for symptoms which are due more to nervous factors than to pathology or disease in the uterus. Of course, the operation doesn’t cure these symptoms, but only adds a few more.
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A hernia means that something is being pushed through a hole. During the last few months of pregnancy, the male baby’s testes which sit close by the kidney begin to descend. They pass via a hole or canal in the front wall of the abdomen, down in the pubic or inguinal region (as it is called) and slip into the scrotum, the sac on each side of the penis, where they remain for the rest of the individual’s life. During this journey, they drag with them a thin sheet of tissue which is continuous with the lining of the abdominal cavity. Normally the canal through which they pass closes up before birth, and the lining, called the tunica vaginalis, seals off around the testes and the rest also simply seals off.
Inguinal hernias
Occasionally, things do not go as planned. The tiny canal may not close off. Also, the lining may not seal off. This means that both are open. The result is that the contents of the abdominal cavity may be forced through the canal into the scrotal sac. In minor cases, this will appear as a bulge in the groin. It is usually worse with standing, coughing or straining (for example, when a bowel action is occurring). Often the material flows back and forth through the hole, vanishing if the boy lies down. But sometimes in bigger hernias, the material may penetrate right down to the scrotal sac, and it may stay there.
The main fear is that it may gradually swell and be trapped by the neck of the canal which suddenly becomes tight. If it is a piece of bowel, a sudden surgical emergency called a bowel obstruction may occur. Food is no longer able to pass along the bowel. The blood supply may be cut off. Unless there is an operation immediately, the bowel may turn gangrenous and the boy become acutely and dangerously ill.
Incarceration is the term given to a hernia that will not easily slip back into the body. Obstruction occurs when the passage of food is blocked. Both are serious and need prompt medical attention.
If there is a visible inguinal hernia on the left side, there is a 50 per cent chance there will also be one on the right side, even though it may have not yet put in appearance. On the other hand, for some strange reason, if there is a hernia on the right side, there is only a 10 per cent chance that a hernial sac will be present on the left side too! Don’t ask why—nobody knows. It’s just one of those strange quirks of life.
Hernias can also occur in females, and are related to development of the ovaries and their descent. They are most likely to be present on both sides if present.
Treatment of inguinal hernias
There is only one form of treatment for hernias, and that is by surgery. This is usually carried out at a time when the child is in good health. The hernia is reduced (as the doctors say)—that means the contents are pushed back into the abdominal cavity where they belong. The canal is stitched up securely, and usually recurrences do not take place. It is a successful operation and may prevent serious consequences.
If complications have already occurred, and the bowel has become incarcerated and strangulation (obstruction) taken place, it may be a matter of urgency to operate before serious irreversible damage occurs with the bowel.
Sometimes incarceration can be corrected manually by pushing the bowel back towards the abdominal cavity. With strangulation, the abdomen becomes distended, and there is vomiting and the signs of bowel obstruction. Surgery may quickly relieve the symptoms and the condition.
Incarceration is fairly common in children under the age of one year. Strangulation tends to follow incarceration. Any lump noted in the groin should be reported to the doctor promptly. Do not leave it there, hoping it will vanish. Most cases will not, and a serious emergency may occur when most inopportune.
Scrotal swellings (hydrocele)
A swelling in the scrotum is fairly common in babies, particularly the newborn. Fortunately, most disappear on their own accord by the age of six months. Some persist, or may recur during childhood.
The cause is similar to hernias. Instead of sealing off at birth, the tunica vaginalis which surrounds the testes still communicates with the abdominal cavity. The connection may only be minimal, but it allows fluid to accumulate in the scrotum, and the swelling may be large. If a torch is shone into the swelling, it appears as a large fluid-filled bag. Sizes may vary tremendously.
Treatment of hydrocele
Treatment must be carried out by the doctor and the sooner this is done the better. If left, pressure may damage the testes. Simple removal of fluid by a needle will give temporary relief. But in any case that does persist, surgical intervention will bring about a rapid and complete cure. It is not a major operation.
Umbilical (navel) hernia
Another fairly common site for hernias is the navel, referred to then as an umbilical hernia. This means that the umbilical ring has not closed up at birth. Before birth, the baby received nutritional needs and oxygen via the umbilical vessels attached to the placenta. This large organ (which became the afterbirth at the time of confinement) was firmly secured to the side wall of the mother’s womb. It had access to the mother’s blood supply, and here exchanges of food, oxygen and other vital needs took place.
Soon after birth, when the umbilical vessels became redundant and oxygen was received via the baby’s own lungs and food via the baby’s own mouth, the umbilical ring usually closed down. Occasionally this did not happen. So, with a persisting hole present (covered only by an outer layer of skin and some fat), with any straining of the abdomen the contents tend to be forced into the weak area. Therefore, a swelling may occur at the navel.
This is most evident if the child is straining (having a bowel action, or trying to pass urine, or crying or yelling). In fact, the hernia can sometimes become large. Some fearful parents are terrified lest the whole thing explode with an almighty bang. I assure you this never happens. On other occasions, the covering can look awfully thin, and even turn a bit blue.
However, none of the hazardous events occur as might take place with inguinal hernias. No incarceration of the bowel contents, no strangulation, no bowel obstruction. These are seldom if ever reported.
Treatment of umbilical hernias
The treatment consists of not treating it. The majority are cared for by the body itself. The umbilical ring invariably closes down of its own accord, with no interference.
The old ideas of taping the sides together is worthless. Do not shove a marble or a two cent coin into the hole and tape it there either. This idea belongs to the Dark Ages. It has no place in modern medical care, so do not try it.
If the condition seems to be getting worse (which is unusual but occasionally happens), see the doctor. Some instances need a surgical repair. But be directed by the doctor in these matters, and follow the doctor’s advice. The child may be referred to a paediatric surgeon for further investigation.
Other hernias may occasionally occur in other regions, but they are relatively uncommon and unimportant. However, any abnormal swelling in any part of the body (abdomen or elsewhere) should be examined by the doctor. This is a general rule for all parts of the body.
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Little by little, babies grow up and commence looking around for more solid food to fill their needs. So, at breakfast time gradually phase in soft fruits, such as a banana either mashed with some water or milk or, later on, peeled so that the infant can eat it without your help. (Independence soon sets in!) Also, you may offer some softened cereal or porridge, some of yours to begin with. Try sieving it for the first few days.
Purchasing special baby foods is usually unnecessary, and many are relatively expensive. On the other hand, you may offer the baby these if you wish to, and many different varieties are available. I must admit that my four children all loved their tinned foods, and even now (aged over 21 years) still dig out a tin from the pantry occasionally. As I’ve often said, habits started in babyhood often persist. Food is no exception.
Babies usually love sucking a crust, or piece of toast, or a rusk. Be careful to supervise this and do not leave the baby alone, for a chunk may inadvertently slip down the windpipe and cause trouble.
The baby will soon start using a cup—you can show him the first few times, and he will rapidly follow the idea and soon become expert. Offer water or unsweetened orange juice.
At lunch-time, offer some meat moistened with warm water. Later on, offer a piece of meat to suck. Or perhaps a largish chicken bone with meat hanging to it. Give soft fruit or pieces of vegetable such as tomato. Eggs are very useful and highly nutritious—you may spoon feed the baby with soft-boiled egg, or you may prepare a small sandwich from chopped-up or mashed-up hard-boiled egg.
Evening meals may consist of cooked meat and vegetables. Add minimum or no salt or sugar to the food. If you are cooking the baby’s food with the family meal, take it out first before adding salt or sugar to the rest of the family’s food. It is best to offer vegetables separately, rather than mixed up in a messy hotchpotch. Unsweetened stewed fruit, plain dessert, custards or yoghurt are suitable. The baby will like something to chew on, so offer foods similar to those recommended for lunch-time. Adequate fluids are necessary, so always offer water.
Gradually, as babies thrive and grow longer and heavier, they will want to increase the range and amount of food eaten. They will usually let you know when they are hungry and when they have met their needs. Little by little, their food intake and variety will become very similar to that of the rest of the family. Making a baby part of the family circle is important, and the sooner the child eats the same type of food the better. It is easier for the cook and it means that the baby is gradually taking his or her place in the social setting of the family.
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Morning sickness is characterised by nausea and vomiting during pregnancy. It usually occurs during the early months. About 60% of pregnant women suffer from morning sickness at some stage of their pregnancies, and some actually vomit. Morning sickness is most common between weeks 5 and 8 of pregnancy, but can persist to week 16.
Morning sickness gained its name because the most common symptom is a feeling of nausea upon arising. There are no established causes of the illness, although many believe that hunger makes a significant contribution. Metabolic changes resulting from pregnancy have also been suggested as causal factors. In unusual cases pernicious vomiting can develop in pregnancy and should not be confused with the relatively mild symptoms of morning sickness. Although this affects only one woman in 200, it can cause dehydration and weight loss and treatment for it must be sought.
The treatment of morning sickness involves a number of approaches. A cup of tea and a slice of toast eaten in bed before arising is sufficient to allay the symptoms in many women. Peppermint or raspberry tea are also recommended. Raspberry tablets can be substituted if preferred. Most effective of all is ginger, either fresh or in tablet form, but it should not be taken in the last few months of pregnancy as it may cause colic in the unborn child.
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Colic is any cramp-like, recurring abdominal pain. Colic has a variety of causes and may occur at any age. Most often, however, people use the term to refer to colic that occurs in infants.
Infantile colic, or “three-month” colic, is a specific problem that bothers 10 to 20 percent of babies. Colic is far more common in bottle-fed babies than in breast-fed babies. Colic starts during the first few weeks of life and lasts one to six months (an average of three months).
Signs and symptoms
The signs of colic are seen in the typical behavior of colicky infants. A baby with colic cries for hours a day, particularly in the late afternoon and evening. The child pulls the legs up, clenches the fists, screams, and turns red. The child may feed briefly but soon stops feeding and returns to crying. Rocking and cuddling also stop the cries only briefly. In other respects, the infant is normal; the baby gains weight well, has normal bowel movements, and doesn’t spit up any more than most infants do.
A variation of this classical form of colic is the infant past two weeks of age who wakes frequently (every two hours or so), cries fretfully, takes one to two ounces of formula or a few minutes at the mother’s breast, falls into a fitful sleep, and wakens later to repeat this pattern.
Home care
First check for obvious causes of crying and discomfort other than colic. Look for diarrhea or constipation; loose nappy pins; severe nappy rash; a trapped arm or leg; whether the baby is too hot or too cold; or signs of illness – fever, nasal discharge, cough, reddened eyes, vomiting, hernia (a lump in the groin), or sores on the body. See whether your baby responds promptly to talking and cuddling and remains comfortable. A baby in pain can be distracted, but only temporarily. If breast-feeding, check that the mother’s nipples are not bleeding. Swallowed blood causes cramps. If a breast-feeding mother drinks too much cow’s milk, this can also cause cramps in the infant.
Offer your baby a feeding. If your baby drinks generously and falls asleep comfortably for several hours, the child was hungry, not colicky. Keep the baby partially upright in an infant carrier between feedings to be sure the baby is not regurgitating food in the oesophagus.
If colic still seems likely, applying gentle heat to the abdomen temporarily relieves the pain. First place a cloth nappy over the infant’s abdomen. Then place a heating pad (turned to “low”) on top of the nappy. Giving the child a pacifier may help. Also try inserting a glycerin suppository or lubricated thermometer to induce a bowel movement.
Precautions
• Make sure the formula is properly prepared.
• When bottle-feeding your baby, be sure that the nipple is kept full; this keeps your baby from swallowing too much air.
• Make sure the bottle’s nipple hole is large enough so that the baby can finish feeding in a reasonable time.
• Carefully burp the baby in different positions after each feeding.
Medical treatment
Your doctor will check for signs of illness, such as sores in the mouth or urinary tract problems. A urinalysis may be ordered. Your doctor also may recommend a change in formula to investigate the possibility that the child is allergic to the formula. A breast-feeding mother may need to eliminate all milk products from her diet to see if this is what is affecting her child. The doctor may also temporarily stop any solids already started to determine if the child may be allergic to certain foods.
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Correct, deep, belly breathing, says Dr. Hendricks, has been shown to:
• Melt tension. It counters the shallow tight breaths produced by the instinctive fight-or-flight response that we find ourselves kicked into frequently.
• Clarify and focus the mind.
• Increase energy and endurance.
• Clear unpleasant emotions. Two or three big breaths at the onset of an injurious emotion such as fear, anxiety, or depression are often enough to move it out of the body.
• Help manage pain. (This is why it is taught in natural childbirth classes.) Do not hold your breath when in pain or anticipating pain. Instead, breathe – calmly, deeply.
• Improve athletic performance.
• Significantly lower blood pressure.
Deep breathing and breathing in general help in treating many modern-day maladies. “Breathing exercises are a major emphasis of the yoga classes I teach in Hawaii,” says Arthur Brownstein, M.D., medical director of the Princeville Medical Clinic and clinical instructor of medicine at the University of Hawaii John A. Burns School of Medicine in Honolulu. Breathing exercises are also a major component of the stress-management program taught to heart patients during the highly touted programs conducted by the Preventive Medicine Research Institute in Sausalito, California.
Breathing exercises
The following are the basics of Breathing 101, as taught by Dr. Hendricks as well as Barbara Lang, who teaches Yogic breathing in an intensive medically supervised program for people with heart problems and other degenerative diseases.
Get past tense. Tense your abdomen. Relax your abdomen. Tense your abdomen. Relax your abdomen. Do this maybe a dozen times, until you are well aware of how a relaxed abdomen feels.
Give yourself a hand. Put your hand on your abdomen. Breathe slowly, comfortably, deeply enough to make your hand rise with each inhalation and fall with each exhalation.
Go for ribs. Keep breathing slowly, comfortably and into your belly. If you are truly breathing correctly, you will feel your rib cage expand to the side with each inhalation.
Move your spine. “Babies can lie in a crib all day without getting a backache because they move their spines with each breath,” says Dr. Hendricks. “We tend to hold ourselves more stiffly as we age.” With each in-breath, let your spine move away from the chair back (if you’re sitting) or away from the floor (if you’re lying on your back). On each out-breath, let it flatten against the chair or floor.
That’s your basic, healthy breathing. To remember to do it, associate the term breathe with normal everyday activities such as standing, sitting, or turning, says Larry J.
Feldman, Ph.D., director of the Pain and Stress Rehabilitation Center in New Castle, Delaware. Then, he says, taking healthy, deep breaths at intervals throughout your day will be as natural as, well, breathing.
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Screening procedures that are definitely not worth doing routinely are barium enemas; barium meals; looking for cells in the sputum (spit); stress testing; lung-function tests; and biopsies of the lining of the uterus. All of these are, of course, useful diagnostic procedures in specific individuals.
Screening can be carried out in the community in general or it can be focused on specific sub-groups who are thought to be ‘at risk’. As we have seen, when screening for cervical cancer, money is best spent on screening women from lower down the socio-economic scale because it is much more common in this group.
Families are population sub-groups ripe for screening. The predisposition for many diseases (as well as truly hereditary disease, of course) runs in families. Common examples are breast cancer, diabetes, asthma and high blood pressure. Doctors have always considered screening families in the context of infectious diseases in the past but few do this kind î intra-family screening for chronic conditions.
Screening, especially the sort that involves paying a fixed sum for a batch of tests and examinations, is currently enjoying something of a revival. One of the attractions of screening programmes is that the; can often be inexpensive and can be implemented by relatively low grade personnel rather than doctors. But as the price has come down, fewer questions tend to be asked and screening is now-with the coming interactive computer systems-set become even more popular, after decade of apathy and serious questioning of its worth. Another reason for an increased interest in screening recently is that, with the setting-up of new health maintenance and prevention-orientated medical organizations, screening equipment and personnel can be used with the curative staff on hand. A major criticism of screening centers in the past has been that they left the patient high and dry with his or her findings from the screening. These new ways numbers of false positives that occur of working enable responsible follow- with certain screening procedures, up to be a part of the whole picture. This is essential in the light of the Much more research needs to be done before we can be absolutely sure just how valuable many screening procedures are. What looks like commonsense preventive medicine is often not so on deeper analysis. The danger with the coming of cheaper and easier screening methods is that society might ask fewer questions, not more.
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Sinusitis is inflammation of the sinuses or passages which are found in the bones surrounding the nose and eyes.
Sinusitis is a debilitating problem that can cause pain, mild fever, headaches, stuffy nose and depression. Allergies are a common cause (see ‘Allergies’). Dairy products can be a problem and should be avoided. There are some herbs that can help relieve the problem. Horseradish is one. Horseradish forms mustard oil in the body and it gives off mustard gas. This can help clear out the sinuses. Garlic is another herb that can help. It has anti-bacterial activity and will help dry up the infected sinuses.
Elder flower (Sambucus nigra) is a herb that I have found very helpful when used for the treatment of sinus problems, especially when used in conjunction with Echinacea, garlic, and horseradish.
Vitamin A supplementation is also beneficial as it strengthens the mucous membranes in the nose and throat. The antiinflammatory properties of the essential fatty acids found in cod liver oil give relief from the inflammation and pain.
SUPPLEMENTS
elder flower 1250 mg twice daily
eyebright 1000 mg twice daily
horseradish 300 mg twice daily
garlic 2000 mg fresh herb twice daily
liquorice 200 mg twice daily
Echinacea 375 mg twice daily
cod liver oil 5 ml daily
vitamin C 2000 mg daily
iron phosphate 15 mg 3 times daily
potassium chloride 32 mg 3 times daily
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