For some cultures and in some families co-sleeping is the norm, and there is no real evidence that it does any long-term harm. For parents who want to put a stop to this habit, the strategy is fairly straightforward, although both parents will need to be certain they want to commit themselves to the process.

The first step is to prepare the child by letting him know that the rules are to be changed, and that now if the child wakes during the night, he must stay in his own bed. During the night, if the child enters the parents’ bed, he is immediately returned to his own bed. There must be no cuddles or conversation — just a matter of fact return to bed. This may need to be repeated a number of times, over a few nights, before the child gets the message.

The next morning the parents should tell the child how good/grown up he is for having stayed in his room all night. The reinforcement of expected and appropriate behaviour is an important part of the strategy.

These strategies will almost always work. If they do not, it is often because parents don’t persist or support each other adequately. Sometimes the help of an interested family doctor, pediatrician or psychologist is a good idea, such a person can act as a sort of ‘coach’ for the parents, especially for the more difficult or stubborn youngsters.

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Prolapsing piles can lead to a mucoid discharge and soiling of the underclothes.

Sometimes a clot may form in an external pile and this thrombosis produces a hard tender lump which slowly subsides over about five days. It may leave a projecting skin tag which can lead to irritation.

It is amazing how many people will put up with the discomfort of haemorrhoids before seeking treatment. This may be because of embarrassment or because of the unjustified belief that treatment, especially operation, is associated with a lot of pain.

Creams and suppositories to insert into the rectum can produce relief in the early stages. Most contain local anaesthetics and drugs to reduce the congestion. Many tablets, obtained directly from the chemist without prescription, are claimed to reduce or even “cure” piles. These seem to work only because of a mild laxative effect.

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How well she masters this stage and the symptoms which might arise, often depend on her knowledge of, and attitudes to, her own body.

Both sexes go through the changes of puberty as men and women enter their reproductive lives.

But, for a woman, this reproductive phase of her life has a definite end. This is the menopause. For a man, there is no such dramatic change and he may continue reproductive ability into old age.

The female reproductive system is under the control of the pituitary gland, which lies at the base of the brain. This produces hormones or chemicals which act on the ovaries.

Each month, due to these hormones, an ovum or egg ripens in the ovary and oestrogen is formed. This hormone causes the endometrium, or lining of the womb, to build up.

When the egg is released, a further hormone is produced by the ovary and makes the regenerated endometrium soft and spongy, ready to receive the fertilised ovum, if conception has occurred.

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The disease affects the small bowel. Frequent and loose bowel actions, general debility, a failure to thrive and a pot belly in children are the usual symptoms. Many become irritable and peevish for no obvious reasons.

The cause is an allergy to the gliadin fraction of gluten. Gluten is the protein part of wheat and certain other grains. In this disease the cells of the jejunum, the first part of the small bowel, are sensitive to gluten and simply cease to function normally. Diagnosis is often overlooked for many years. The fact that the infant does not thrive as well as other members of the family may be accepted without proper medical investigation. A diagnosis is firmly established when a biopsy of the jujenum is performed and the diseased cells examined under the microscope. In 1977 a simple test was invented which consists of a simple injection of the skin. This is much quicker, but it has not yet become generally available.

Treatment

Once an accurate diagnosis has been made, treatment is usually dramatic in its beneficial effects. The patient is placed on a gluten-free diet. Symptoms vanish like magic, often within a few days. A feeling of well-being commences almost immediately. But it may take many months, even up to a year, for the full benefits to become evident. As symptoms have often been present for a long time, reversal and a total cure may be time-consuming. Between 80 and 90 per cent of patients improve dramatically on this simple routine.

Today, Coeliac Societies exist in many countries, and membership is an excellent idea. Recipes for making gluten-free products are made available, and helpful advice offered. Also, lists of commercially available items are regularly mailed to members, allowing them wider selection in foods if they wish to purchase them. In Australia, the address is: The Coeliac Society, P.O. Box 73, Cronulla, N.S.W. 2230.

Parents soon become proficient at making gluten-free bread and other food items. Often this may be conveniently made on a weekly basis, and deep frozen until needed. Once the routine has been commenced, it is usually no great domestic burden, and most parents are only too happy to have discovered a way of helping their child, and seeing the symptoms disappear. The stress and anxiety of caring for a perpetually ill and undernourished child far outweighs any extra work in preparing a gluten-free diet.

Symptoms suggesting coeliac disease should never be dismissed or neglected. Referral to a paediatric physician is usually necessary, so that adequate investigation and treatment can be carried out.

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This is not a criticism. It is a statement of fact. Parents may benefit from it—for just as tensions and stresses breed psychosomatic symptoms, so reactions of calmness, happiness, joy and brightness may similarly yield these results in one’s offspring.

That is why many children do not necessarily require drug therapy for every symptom. Certainly organic disease must be looked for first, and that is why so much of this book is devoted to recognition and treatment of actual, organic illness. It must never be overlooked. A parent should never screech at little Harry and tell him he is a bad-tempered brat, when in fact he may have a true organic illness that needs the doctor, or medication at least’

But parents should also keep the emotional factors well in mind. If little Harry’s symptoms are recurring ones that follow a similar pattern each time they happen, do they reflect a recurring stress situation in the family? Do these symptoms follow on from an emotional problem in which the child has been involved? From infancy through to old age, but more frequently in the younger age levels, reactions of this nature will occur and they will keep on recurring.

Ideally, efforts should be made to discover causes. If causes are found, then answers are usually possible. Helping children cope is one of the major responsibilities of parents; and other, older members of the family circle can help too. In fact, everybody can be involved, and the closer this co-operation, the more successful and happy everybody will be. Not only little Harry, but every member of the home.

This is where those who follow the Christian ethic often have it over those who do not. The Christian principle of ‘Do to the other person what you would like him to do to you’ may work wonders for all. If you have any doubts, simply read Christ’s Sermon on the Mount (Matthew 5). Filling the mind with thoughts of happiness and confidence, and without anxiety and tension, is beneficial. You do not have to be a religionist to derive benefit from this. It works on a short-term as well as long-term basis. It is excellent psychology, and a very successful method.

Endeavouring to secure co-operation, happiness, freedom from anxiety and tension, understanding of each other, playing down life’s hardships, forgiving grievances (most of which are minor anyway), being honest and sharing, can only yield benefits.

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Vaccines against mumps are available and many doctors recommend immunisation for all babies aged between 12 and 15 months. The vaccine has a life of five years, following which boosters are required. Pregnant women should not receive these vaccines since they contain live viruses which can affect the foetus. Normally, once a person has had mumps, they develop an immunity to the disease. However, there are some cases where people have been re-infected.

Treatment of mumps includes isolation to prevent the spread of infection. Rest is recommended until the swollen glands subside, and mild painkillers may be used. Medical treatment may be required if there are complications such as painful or swollen testicles, severe earaches or headaches or a stiff neck. Natural practitioners prescribe a range of treatments. These include herbal medicines such as infusions of yarrow, elderflower and marigold, supplements to boost the immune system, homeopathic medicines or tissue salts and cold compresses to reduce swelling.

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Signs and Symptoms

Epilepsy must be diagnosed by a doctor. However, signs of possible epilepsy can be seen in the typical behavior that occurs in different types of seizures.

In a generalized convulsive seizure, the child suddenly loses consciousness and may cry out as the seizure starts. The body stiffens, and the child may fall. Muscle spasms cause jerking or wild thrashing movements. The child may lose control of the bladder and bowels. When spasms end, the child may fall into a deep sleep and will usually be confused and sleepy upon awakening. Sometimes there is a warning sensation (aura) before this type of seizure begins, including sleepiness, headache, yawning, or tingling in the arms and legs.

Generalized non-convulsive or absence seizures are so different from major convulsive seizures that they are often not recognized as epilepsy – or may not even be noticed. The child may simply stare into space. There may be rapid blinking or fluttering of the eyes. The child remains conscious yet may be totally unaware that the seizure is occurring. If it is not recognized as a seizure, it may be mistaken for a learning disability, not paying attention, or simple daydreaming.

In complex partial seizures the child remains conscious, but may sit motionless or may make repeated or unusual movements.

In simple partial seizures the child is conscious and may simply feel tingling in the hands and feet. The child may also perceive bad odors, see flashing lights, or speak unintelligibly.

Home Care

Call your doctor any time a child has convulsions.

Of course, you must immediately care for the child during the convulsions. The most important home care is to prevent your child from injury during the thrashing phase of convulsions. Do not put your fingers in the child’s mouth.

If epilepsy is diagnosed, the doctor will give instructions for caring for the child at home. Until the seizures are controlled, discourage the child from climbing high ladders or tall trees. Do not allow the child to swim alone. Otherwise, your child can and should live a normal life with only minor changes in activities.

Precaution

• If you find your child unconscious, do not assume that your child has been made unconscious by a fall. Do consider the possibility that epilepsy has led to a fall and unconsciousness.

Medical Treatment

Your doctor will perform physical and neurological (nervous system) examinations. The doctor may order a variety of laboratory or diagnostic tests. A number of prescription medications that control seizures are available. The doctor may order blood tests to determine the amount and type of drug to be used. In difficult cases, your doctor may recommend consultation with a neurologist (a specialist in diseases of the nervous system).

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1. You’re climbing off the couch. “You have to walk before you run,” Lentz says. He means it literally. Start by taking a 10-minute walk, three days a week. Sure, there’s very minimal aerobic effect yet, but you’re introducing your body and brain to a new world. Pick a consistent time for your walk. “If you usually come home and watch television before dinner, walk first and then watch television,” Lentz says. Start stretching right away. For now, do it at the end of your walk, stretching just your hamstrings and calves, some of the muscles you use while walking.

2. You’re mowing away from the couch. Take your walk up to 15 minutes. Add 5 minutes a week until you hit 20 or 30 minutes, says Lentz. Take your stretching up to five days a week. Add a stretch a week to your routine.

3. You’re starting to forget about the couch. Boost your walking pace to “brisk.” You’re on your way to getting your heart rate up to an aerobic-benefiting level. Throw in some strength training, Lentz says. Nothing fancy. Get used to the idea of moving weight around. Do it at home twice a week on the days you don’t walk. There’s a lot you can do without weights-pushups and crunches are just a couple examples. But buy a pair of weight-adjustable dumbbells to expand your options, Lentz suggests.

4. You’ve covered the couch with plastic. Jack up the aerobic pace by doing intervals. “If you’ve been walking briskly for 20 minutes, you may not be able to just start jogging 20 minutes all at once,” says Mark Taranta of the Physical Therapy Practice. “So walk for 3 minutes and jog for 3 minutes, walk, jog, walk, jog.” Move your strength show to a more organized venue. That means joining a gym, or investing in enough home equipment to work all your major body parts. Taranta suggests keeping your start-up routine simple-one set per major body part, 12 to 15 repetitions, two days a week.

5. You gave the couch to Goodwill. You’re at or near exercise commitment. Start cross-training by shifting your aerobic work from jogging to something else, like a little bike work or swimming to keep things interesting. Keep the interval-training idea alive with whatever activity you choose, working your way up to a steady, challenging (but not exhausting) aerobic pace. Include more body parts (that is, biceps, triceps, calves) in your strength routine, adding a little weight to each exercise as it becomes easy, Taranta says.

Welcome to fitness.

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Perhaps the most widely used and accepted screening programme is for phenylketonuria. If an affected baby is not detected and treated very soon after birth, irreversible mental retardation results. The test is simple. A pinprick in the child’s heel very soon after birth allows a drop of blood to be analyzed. Several studies have shown that this simple, effective screening test is cost-effective even though the condition itself is very rare. Screening for other metabolic diseases has not been found to be cost-effective.

Screening for high blood pressure is cheap but because so many people do not take their medicines properly the benefits that accrue are not nearly as great as they could be and the cost-benefit analysis looks rather poor. Selective screening of high-risk populations almost certainly is worth while, but even this is not as simple as it might appear in the light of the Canadian study mentioned earlier which found that newly diagnosed hypertensives who did not bring their blood pressure under control had an 80 per cent increase in work absenteeism due to illness-attributed largely to an awareness of their condition. Here the cost of the screening was low but the accompanying costs of the drugs (a large proportion of which are not taken by blood-pressure patients) and the work days lost were high. This illustrates just how difficult it is to put a value on preventive measures.

A wide range of estimates has been published concerning the benefits of screening for cervical cancer. Evidence on the efficacy of this screening is complicated by the fact that death rates have been falling in unscreened as well as in screened populations and by uncertainty about the natural course of the disease. Those women who are most likely to be examined regularly (middle- and upper-income women) normally have a lower rate of cervical cancer than do lower-income women. Recent Canadian studies show that cervical cancer screening is cost-effective. The frequency at which it should take place, however, is still open to debate.

The evidence for the cost-effectiveness of screening for breast cancer is better than that for cervical cancer. A New York study found that the screening did not affect the survival rate of women aged 40-44 but it did lead to a significant reduction in mortality in women aged 50-59. It also seemed to be beneficial to women aged 60-64. The cost-benefit ratio of mammography appears to be very favourable. The US National Cancer Institute estimated that 20 per cent of breast cancers were discovered at the localized stage as a result of mammography. At a cost of 40 dollars per mammogram the minimum cost per life prolonged is 240,000 dollars (24,000 dollars per year of life saved) for women aged 55-64.

Quite recently then, and prompted by the vast and escalating cost of modern sickness intervention (as compared with health care), governments the world over have started to question the sense and economic viability of continuing down the ‘more-is-better’ path. The primary prevention of chronic disease looks like being the most cost-effective area in which to start off, if only because the after-the-fact treatments of many chronic diseases range from the expensive and basically unsuccessful to the almost endlessly expensive maintenance of a generally lower quality of life for many of the sufferers. Lifespans are getting longer, and a person with an untreated chronic disease today will probably be around with his or her condition for many years. This need not be the case, however, because the control of high blood pressure, for example, can postpone or prevent about a third of all strokes at a hundredth of the cost of living with a stroke.

But it is not just in chronic diseases that prevention definitely pays. An educational programme for surgical patients in a Massachusetts hospital explained the risk, the pain, and the post-operative effects the patients could expect. Doing these simple things reduced the need for painkilling drugs by 50 per cent and hospital stays by 2.7 days. In another study the education of asthmatics, who used an emergency room produced a cost saving of $6 for every dollar spend educating the patient to care for him or herself. Even more dramatic results have been obtained with hemophiliacs. Education on care, prevention of injury and simple treatment reduced hospital stays from 432 to 42 days!

Quite clearly prevention can pay but does not necessarily do so. Every new programme has to be looked at very carefully before it is implemented on any large scale, if only to make sure that it does not fall into the trap that so much western medicine has historically-that of doing something simply because it could be done and then worrying about the cost of it all afterwards.

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