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GENERAL HEALTH

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GENERAL HEALTH

Some toddlers are happy enough to go to bed but then refuse to sleep. Again, reasons, all of which, of course, are designed to involve the parents. They may be hungry, thirsty, need to go to the toilet (having just been), are afraid of the dark, or the dog, or something else, or just want to say one last thing to mummy or daddy, or are just not tired, and so on. All parents will be able to add to this list. The one thing that all of these excuses have in common is that they all are intended to involve the parents in giving a response. Indeed, as we shall discuss shortly, it is precisely because the parents respond that these behaviours continue. They are dependent on a response from the parents — once this is not forthcoming, they very quickly stop.

Other toddlers wake during the night, and either call out to their parents or else come out of bed to be with the parents wherever they are, including the parents’ bed. Again the continuation of this behaviour depends on the parents reinforcing it.

Some children have got so used to having a parent present when they go off to sleep that it may be impossible for them to go to sleep alone. The usual scenario is for the child to go to sleep in the parent’s arms, or at the breast, or with the parent lying alongside the child until he falls asleep. While in some families this is the norm, and without saying necessarily that it is wrong or leads to any long-term harm, it does mean that the parents should be resigned to having to be involved with the child falling asleep for a long, long time.

During the toddler period other sleep problems begin to emerge, such as nightmares, night terrors, sleepwalking and sleeptalking, as well as fears and phobias that may affect a child’s sleep patterns.

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If breathing has stopped, place the patient on his back. Check to see whether his heart is beating. The pulse can be felt at the wrist or at the neck, or you can place your hand over his heart and feel his heart beat, or you can listen with your ear placed on his chest.

If the heart has stopped, the pupils of the eyes dilate and they do not respond to light. If the heart has stopped, you must begin external cardiac massage.

If the heart is still beating, but the breathing has stopped, the patient will show signs of cyanosis. This is the blue discoloration of the skin, more noticeable on the lips and other mucous membranes in a dark-skinned person. It is due to a build-up of carbon dioxide in the blood.

Check the mouth and remove any foreign body, such as seaweed, blood or vomit. In an adult you may have to remove false teeth. Do this quickly.

If possible place a small pillow or a folded towel or a coat under the shoulder blades. Kneel beside the head of the patient. Lift the lower jaw forward and keep this up all the time, otherwise the tongue will fall back and obstruct breathing.

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Later it may involve the outer area and so lead to “tunnel vision”, where it appears the vision is reduced to seeing straight ahead as if one were looking through a tunnel.

The visual loss may not involve the central area and so the person may still appear to have good vision with or without correcting glasses. Being unaware of the progressive loss, the sufferer may see no need to have his eyesight checked.

As in acute glaucoma, haloes may be seen on looking at bright lights. This phenomenon can occur in any condition which gives rise to oedema of the cornea. Once diagnosed, chronic glaucoma can usually be brought under control.

Pilocarpine has been the mainstay of treatment. It is instilled into the affected eye several times a day, constricts the pupil and so prevents the bunching up of the colored iris into the corner of the eye where the duct to drain away the fluid from the chamber behind the cornea is.

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Confinements are normal and mother and baby do well in 70 per cent of cases with no complications so for the majority it really doesn’t matter where the mother has the baby.

But what of the others?

Good obstetric care has meant a great drop in the maternal mortality. In NSW, in 1936, the maternal mortality was 6.3 per thousand live births and in 1977 0.13 per thousand live births. Babies have also benefited from this care.

Criticism of obstetric intervention is now com-monNand doctors are believed to resort too quickly to induction of births and caesarian section.

The Medical Journal of Australia, in talking about recent research in this area, says “… even if labor does not progress in a normal manner and manipulative interference is required, the outlook for the baby is not prejudiced.

“With the advent of ante-natal care, availability of blood transfusion and increased use of caesarian section, women began to expect a live baby from each pregnancy. As is shown from this research, modern obstetrics is ensuring the baby is not only alive, but well. We must avoid turning back the clock half a century because someone thinks that darkness is beneficial or the home environment is best for mother and baby.”

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A large number of disorders have been blamed on the teething process. Diarrhoea, convulsions, coughs and cold and general respiratory illnesses and skin rashes have all been attributed to the teething mechanism. Many parents know that teething time can be the time of an unhappy, distressed baby. Inside the baby’s mouth will often be gums that are red, inflamed and swollen; for sure, this must cause discomfort and pain and make the infant crochety and irritable. The baby may cry, go off food, and in turn predispose to a lot of other symptoms.

During teething time, I believe that a baby’s general body resistance tends to fall temporarily. Therefore the child is more susceptible than usual to respiratory and bowel viruses that are always ready to pounce. Resistance factors in the blood are less, and the child is more susceptible to skin irritations and allergies. So rashes may appear.

All of these should be treated along the appropriate lines. Most respond well to simple measures. If they do not, visit the doctor. Have the baby thoroughly examined to make certain that more sinister disorders are not present. Go along with any further treatment the doctor advises.

A word must be said here about teeth staining. Many older children today have teeth that are irregularly stained an unattractive yellowish colour. In many cases, this was caused by the antibiotic tetracycline being given early in life to treat various infections. Tetracycline has the propensity for collecting in the teeth and causing the discoloration. Today, doctors do not prescribe it for babies and children, but occasionally mothers may have it prescribed, and if they are breast-feeding it may reach their babies via their milk. Ideally, mothers and babies today are not given the tetracycline family of antibiotics.

Some infants and children show evidence of early tooth decay, now referred to as caries. Normally, the teeth have a strong outer coating that resists penetration by germs; however, the free use of sugars appears to contribute to the destruction of this natural barrier. So, the less sugar the diet contains, the better for the infant. Not only in respect of teeth, but for general health as well.

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‘Then why is it some mothers have difficulty?’ Karen asked.

‘Some are simply not interested or may have a mental block. The more you talk in positive terms before the baby is born, the more successful you will be. Mental preparation is an excellent idea, and these mothers seem to be the ones chalking up the best success records.

‘A peaceful atmosphere is important. Peace and calm, and freedom from tensions and anxieties, will let the milk flow be even, regular and plentiful in most cases. Ideally, the baby should go to the breast soon after birth, and thereafter “on demand”, as they say.

This will in most instances soon establish a plentiful milk supply. If there are early difficulties (and this is not uncommon), the aid of a sympathetic person experienced in baby care will often help considerably.’

‘Is it best to feed the baby while lying down or while sitting up,’ Karen asked. ‘I’ve tried both. Which is the ideal?’

‘The ideal is what suits you both best. Sometimes, with the milk running downhill, baby receives too much too quickly; so she coughs and splutters and has difficulty, and this may frighten her in the early stages. Try lying down, with baby on top, so she has to suck “uphill”. This makes it a bit more difficult and reduces the rate of flow, but makes the experience more satisfactory for both.

‘Some babies are vigorous suckers; others are slower, take their time and may even go to sleep. Don’t forget that the baby is a personality in her own right and will tend to do things the way she likes it best.’

‘It’s interesting to see that she certainly knows where the food supply is,’ Karen said.

‘They have an inbuilt intuition,’ I commented. ‘All babies can sense food, and when anywhere near it will automatically seek the correct connection. Another automatic reflex starts as soon as she gets the nipple in her mouth. She commences sucking. It is an inbuilt and automatic reflex.’

‘It seems to me that some mothers simply give up the idea of breast feeding after a week or two, claiming it is impossible. Is this really true?’ Karen asked.

‘Sometimes it takes time for the milk pattern to become established. Also, in the days following birth, some women become morose and depressed and wonder what everything is all about. They tend to give up in despair and become discouraged easily. Some suffer from cracked nipples, which may be very painful, so do not persist. After a few weeks of feeding, most mothers sense a feeling of the milk coming into the breasts at feeding time. Even thinking about feeding their babies or hearing them cry can initiate this interesting automatic reflex.’

‘When I go home, how often do I feed Joanna?’ was Karen’s next query.

‘Most doctors today suggest that you feed “on demand”. It doesn’t take the baby long to fall into a regular feeding pattern. At first she may want ten or twelve feeds a day, but this quickly reduces until most babies are content with four or five a day in each 24 hours.

‘In the first few days, a very rich, creamy kind of milk called colostrum is produced. This is believed to contain special antibodies aimed at giving the baby protection during the first few days of life. This persists for several days after birth, and then normal lactation takes place.

‘The baby is often hungry at each feed. Commence with one side for five to ten minutes, then switch to the opposite side. Let her suckle for as long as she desires, possibly up to 20 minutes. Next feed, commence with the opposite breast.’

‘One of my girl friends said that her milk supply seemed to diminish quickly after she left hospital and returned home,’ Karen said. ‘Is this common?’

‘It is not uncommon, for the new mother is back in the world of normal activity, with its inherent stresses and strains, and these may play a part in the milk supply,’ I answered. ‘But if she persists with breast feeding, the milk supply will soon return to normal. Ideally, she will benefit if she can gain some rest during the early days.

‘More fluids are essential for her also. Usually she should be able to supply all of the baby’s needs, although many mothers like to give their babies extra fluids, especially if the weather is hot. Boiled water or diluted fruit juice (orange) with vitamin C are suitable. Fluoride, should be given in the appropriate doses to babies fed entirely on breast milk, before they are drinking water. This assists in preventing later dental caries, tooth decay; for both breast milk and cow’s milk, the dentists say, have insufficient amounts of this.’

‘But why do some women refuse to breast feed if the advantages are so obvious?’ Karen asked.

‘Sometimes it is impossible,’ I answered. ‘If the baby is weak, ill or premature, or if there is some structural deformity such as a cleft palate or lip, it may be difficult to breast feed. Then ideally breast milk is used but given via a bottle. On the other hand, some mothers are simply unable to produce adequate amounts of milk, so formula or artificial feeding may be recommended. In today’s affluent society, many women simply opt for bottle feeding, although in recent times, wherever possible, more and more are happily returning to nature’s way.’

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In the case of migraine, prevention is certainly easier than cure. They are known to be brought on by stress and can be the result of food allergy in many people. The kinds of food which trigger a migraine differ from person to person, but common culprits include coffee, chocolate, alcohol, monosodium glutamate (MSG), oranges and hard cheeses. You should avoid these foods as well as high salt, fried or greasy foods. In many people, the avoidance of certain foods will prevent up to 90% of migraine attacks. Make sure you keep a record of foods eaten just prior to the onset of a migraine. Some women suffer migraines in conjunction with their menstrual period and others fall victim when taking oral contraceptives. If, as a woman, you suffer tingly sensations in your limbs during a migraine, it is wise to avoid taking the contraceptive pill altogether.

The herb feverfew, when taken daily, is known to protect against migraines. A study in Britain in 1985 proved that those taking feverfew capsules of 50mg strength suffered considerably less migraines than the control group. Only one particular species of feverfew is effective and potency can vary greatly. A qualified naturopath should be able to provide you with a suitable dosage.

Air ionisers are increasingly popular among migraine sufferers. It is believed that migraine is associated with the release of a substance called serotonin from the platelets in the blood and negative ions are said to reduce the platelets’ capacity to carry the substance. Migraines can thus be averted or the symptoms made much less severe by the installation of an ioniser.

Once a migraine is underway, the best methods for relieving the pain include acupuncture and acupressure techniques. If you suffer from migraines it may be advantageous to locate an acupuncturist near your home or place of work in case of an attack. Moxibustion, the use of heated needles in acupuncture, is thought to be particularly successful in the control of migraine pain. Acupressure points for migraine are located at the base of the web between the finger and thumb (apply pressure in the direction of the finger bone) and at the top of the neck beneath the skull. If you are not well acquainted with acupressure techniques it may be wise to seek professional help and advice for future attacks.

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One attack of chicken pox makes a person immune for life, unless the attack is extremely mild. There is no vaccine available to prevent chicken pox.

Signs and symptoms

Chicken pox may start with the symptoms of a mild cold, but often a rash is the first sign. The rash worsens for three to four days and then heals in three to four days. The child is contagious from 24 hours before the rash appears until all blisters of the rash have dried. Fever can be low or as high as 40.6°C; fever is the worst on the third or fourth day after the rash appears.

The key symptom of chicken pox is the rash. Each new spot resembles an insect bite. Within hours the spot develops a small clear blister in the center, which may be hard to see without good light. Most blisters break and are replaced by a brown scab. The rash usually begins on the trunk and moves outward to the limbs and face. However, the rash may appear anywhere on the skin, including the scalp and the mucous membranes of the mouth, genitals, anus, and eyelids. It becomes quite itchy. The spots never appear in bunches or groups. New pox continue to appear hourly for three to four days.

Home care

Bed rest is not required, but your child should be isolated from other people. Cut the child’s fingernails to lessen scratching. To reduce the itching, bathe your child in lukewarm water with cornstarch added, or apply calamine lotion to the skin. Give paracetamol, not aspirin, for fever or pain.

Precautions

• Do not give aspirin to a child with chicken pox. Aspirin use during chicken pox may be a factor causing Reye’s syndrome, which is a life-threatening illness.

• Encephalitis (inflammation of the brain) is a rare complication of chicken pox. If high fever, prostration (collapse), headache, vomiting, and convulsions occur, see your doctor immediately. • Chicken pox can be dangerous to newborns. If a young infant is exposed to chicken pox or develops chicken pox, call your doctor.

• Chicken pox is also dangerous to persons taking steroids or other immunosuppressant drugs and to children with immune mechanism deficiencies, which hinder the child’s ability to fight infectious diseases. If such a child develops chicken pox or is exposed to it, call your doctor.

• Even if a child has already been exposed to someone with chicken pox, prevent any further exposure. The longer the exposure is, the more severe the attack of chicken pox will be.

• If the pox become infected, (showing an increasing redness, soreness, and formation of pus), call your doctor.

• The lymph glands of the neck, armpits, groin, and back of the skull ordinarily swell with chicken pox; however, if they become red and tender, they may be infected. Report this to your doctor.

• Do not apply calamine with phenol.

• When your child is bathed, pat the skin dry without breaking the blisters or disturbing the scabs to avoid scarring.

• If spontaneous bruises (bruises not caused by injuries) appear, or if ruptured blood vessels appear under the skin, see your doctor.

Medical treatment

If pox has become infected, your doctor will usually culture the infected pox and will treat your child with oral antibiotics for five to ten days. (Antibiotics do not influence the course of the chicken pox, however; they work only against the secondary infection.) If a child at high risk is exposed to chicken pox, your doctor will probably give a zoster immune globulin or a gamma globulin shot. If there are signs of encephalitis, your child will probably be hospitalized for tests and treatment. Spontaneous bleeding under the skin may be treated with oral medications, or your doctor may order hospitalization.

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