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Sleep problems are among the commonest concerns that parents have with their children. About one in four of all children are said to have sleep problems at some stage. Some have difficulty in getting to sleep, others in staying asleep, while others have their sleep interrupted by nightmares or night terrors. All children, like adults, need adequate sleep to replenish energy. Insufficient or interrupted sleep has a deleterious effect on children at any age. Children’s sleep problems also have an impact on the rest of the family and they create an enormous amount of stress for parents, whose own sleep is often interrupted.
There is a great deal of individual variation in sleep patterns and requirements at all ages. What seems sufficient for one child is too little for another. All babies, children and adults go through specific sleep cycles. They move systematically from deep sleep to light sleep to REM (rapid eye movement) sleep. This cycle repeats itself about five times in 8 hours of sleep. Dreaming takes place in REM sleep, which seems to last about 10-20 minutes at a time.
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These injuries are due to violence occurring around the joints. The joint is disrupted and the bones moved from their normal position.
The earlier medical attention is sought, the easier it is to reduce the dislocation. Once the joint has been displaced for some time, rather strong muscular spasm is present, and it may be necessary to anaesthetise the patient to reduce the dislocation.
Simple dislocation of the finger joints can often be replaced by firm pulling of the end of the finger, and holding the wrist with the other hand.
It may be easier to do so immediately after the finger has been dislocated, and many sportsmen are quite adept at fixing their colleagues’ dislocated fingers.
The shoulder joint is a shallow “ball-and-socket” joint and is often subject to dislocation. Only a doctor should attempt its reduction because of damage to nerves and arteries through careless handling.
Some people develop recurrent dislocation of the shoulder, which may “come out” with only a very trivial injury. They become adept at replacing it.
An operation is available to correct recurrent dislocation of the shoulder.
A great deal of force is required to dislocate the knee or the hip, and these injuries are often seen in motor vehicle accidents. They are only to be handled by the expert.
First aid is to immobilise the injured part, relieving pain and treating shock.
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Sometimes, when the gallbladder is not functioning properly, it fails to concentrate the dye and poor films are the result. However, a non-functioning gallbladder on a cholecystogram is indicative of disease. Sometimes the dye is given by injection.
Ultrasound scanning may also be used in detecting gallstones.
Once the diagnosis is made, treatment will be recommended. Of course, this will depend on the symptoms from which the patient is suffering and whether any complications are present.
Large gallstones discovered accidentally, and which are causing no symptoms, are probably best left alone. Multiple small stones are better removed.
This is because they are prone to move and enter the common bile duct, obstructing it. Operation is then a matter of urgency and is more difficult and requires a longer convalesence.
Unfortunately, operation remains the main way of dealing with this problem. It usually only involves a stay of five to seven days in hospital.
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Because most doctors are male, many may not fully appreciate how severe the worry can be to the woman with an excess of body or facial hair. Not every woman with the problem needs to be fully investigated by special tests. A full history and examination usually including a pelvic examination to assess the reproductive organs, should exclude most of the serious disorders. It may be necessary occasionally to carry out hormonal assays by blood tests.
Unfortunately, there is no simple or effective treatment. If there is a definite cause for increased androgen activity it should be treated.
Drugs are sometimes used to counteract the androgen effect. Cortisone in small doses may be effective and the Pill is often used for the same reason. Sometimes, the two are combined. ”
In those who are both obese and hairy, reducing weight may restore the body’s hormonal balance and solve both problems.
In most cases, bleaching the offending hairs so they become less noticeable is acceptable only to a minority. Yet this can be combined with other treatment so that these methods need be used less frequently.
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Tetanus is a disease too terrible to think about. It can affect anybody, and this includes the newborn. In fact, of the million or more cases of tetanus deaths that are reputed to occur world-wide each year, about half are of infants under the age of 12 months. Inadequate hygiene and lack of specific protection are the main reasons.
The disease is produced by an organism called Clostridium tetani. This organism can produce spores which are very resistant and can live for a long period of time. They are a normal inhabitant of the bowel, and for this reason are very common in manure. That’s why persons who enjoy gardening are at special risk. Once it starts to multiply, the germ produces an extremely powerful toxin which may be rapidly fatal. Many cases occur from simple puncture wounds in which germs have been inserted. Often the wound is so small that the person is unaware of it happening. Babies in the Third World are at special risk, for their umbilical cord is a wonderful spot for the germs to dwell and multiply.
The incubation period varies from five days to five weeks. Onset of symptoms may be heralded by crampy pains in the muscles, commonly of the back or abdomen. The patient shows restlessness, irritability and difficulty in swallowing. There may be early convulsions. Gradually, the muscle stiffness and tension increases. The muscles of the jaw often are affected early. They contract, giving the false impression the patient is grinning. As time passes, swallowing becomes more and more difficult, wild tetanic spasms of the muscles occur, with the head and back retracting, and intense pain is felt. Fists and jaws clench.
The course of the disease is terrible and the agony experienced is major and terrifying. Parents should know of these symptoms in detail to understand the urgent need to prevent this awful disease from developing in their own offspring.
Tetanus is a totally preventable disease. In fact, the protection afforded by adequate immunization is remarkable. This is usually started when the baby is two months old. (Refer to the childhood immunization schedule given earlier in this chapter.) The procedure is a very simple one, but the beneficial effects are enormous.
It can totally prevent tetanus, and is probably the most amazing and complete cover against disaster that is currently available in this country. It is wise to continue with regular updating booster shots, ideally throughout life. Therefore following the initial course started at two months, boosters are offered at 18 months, then pre-school and ideally each 5-10 years thenceforth for the rest of a person’s life. If a dirty wound occurs meanwhile, most doctors suggest an immediate booster at that moment also, just to be doubly sure.
There are about twenty cases of tetanus annually in Australia. This is fairly high when it is considered that in Great Britain, a country with a population four times that of Australia, they also have about twenty cases annually.
Treatment
Treatment of tetanus, of course, is basically to prevent it by sensible immunization. After any wound that is potentially dirty—and this may include simple gardening injuries—a check with the doctor is advised to ascertain whether a booster shot is necessary, or other protective given, irrespective of the age of the child.
Tetanus itself requires particularly skilful treatment, ideally in the intensive care ward of a major hospital which has access to full nursing and medical facilities. At the first sign of any of the symptoms after an accident, irrespective of how minor, medical attention by the doctor is strongly advised.
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Baby rapidly grows from the day of birth. Most babies weigh about 3333 g at birth (approximately 7 lb 5 oz). This doubles by the age of six months, and trebles at 12 months. In the second year, the baby will gain about 3.5 kg (about 7% lb), and another 2.5 kg (about 5% lb) in the third year. From this point on, the child will gain about 2.5 kg each year until reaching the period known as puberty. At this time, enormous internal hormonal changes suddenly occur, and there is a wondrous growth spurt as the child sails into adolescence and later into early adulthood.
Baby’s height also increases. This is very rapid in the first six months, after which the rate tends to slow down. Many factors play a part in the individual’s ultimate height. Inherited genetic factors, general health and many environmental considerations all come into play.
But how does the average Australian baby develop month-by-month in the early days? Here is a general guide as to what you may expect during the first six months. Every baby, being an individual, will differ. But the general development usually occurs along these lines. Do not be alarmed if your child does not measure up to this pattern exactly, for differences are often considerable. Conversely, the child may seem to be developing at a much faster rate. But in the long term, it all averages out. The great majority finally fit into the norm which makes up the average Australian child, and finally the average Australian adult.
You might wish to keep a record in the margins of this book of the age the baby achieves each milestone. Also, add any other activities you notice. Later on, especially if other babies follow in your family, you will have a record of the child’s development that can be compared with others to lessen parental worries.
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