Babies who continue to wake through the night cause similar problems. Parents get very tired and become exasperated at having their sleep interrupted regularly, sometimes several times a night. This is always a source of considerable tension in the whole family. Nothing seems worse than having to get up in the morning to face the day tired and grumpy.

Many children seem never to get into a predictable routine. Those who have a difficult temperament seem to go right through infancy and the toddler periods without sleeping through the night. Parents will report that ‘Johnny didn’t sleep through the night until he was 4 years of age’. While this may be true and it may also be true that some children do have an intrinsic predisposition to be irregular sleepers, the problem is often contributed to by the parents’ inadvertent reinforcement of the very sleep patterns that they complain of. There is no doubt that all children, no matter what their temperament, can be taught to sleep through the night.

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The easiest and most effective is mouth-to-mouth resuscitation — or the “Kiss-of-Life.” This is simple to learn — and simple to forget. So you will need to refresh your knowledge from time to time.

Cardiac massage is harder to learn. You may do harm if you try this when a person’s heart has not stopped. But if it has, then that person will die unless CPR, a combination of external massage and mouth-to-mouth resuscitation is begun at once.

The brain cells are very sensitive to lack of oxygen. If breathing stops, then oxygen is not taken in and various organs of the body will suffer from the lack of oxygen. The heart itself may also stop.

If the brain cells are deprived of oxygen for longer than 3-4 minutes, irreversible damage may occur. However, this should not be considered a reason for not trying artificial respiration or heart massage. It is possible that breathing may stop but the heart may continue beating for some time, pushing around an ever diminishing amount of oxygen in the blood, but still supplying the brain with enough oxygen so that permanent damage has not occurred.

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It becomes increasingly common after 40 and most eye specialists recommend that all those over 50 should have the pressure in their eyes checked each two years, even if the vision seems satisfactory. Three per cent of people over 50 can suffer from glaucoma.

Tonometry, or the measurement of the pressure inside the eye, can be done by an eye doctor, by an optometrist, or sometimes by your general practitioner if he has learned the technique.

Sometimes, service clubs organise a drive in their suburb where all those over 40 can present themselves for a check on the pressure of their eyes. The condition is so uncommon under this age that there is little point in the routine screening of younger people.

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Alopecia areata is a condition where the hair is lost in patches. It may spread to involve the whole scalp or even the eyebrows or all the body hair. The cause is uncertain and there are several theories. Some believe it is one of the auto-immune diseases where the body, as it were, develops an allergy to its own tissues and produces antibodies which tend to destroy those tissues.

Cortisone, by mouth or locally applied as a cream, or injected into the skin of the scalp seems to help.

Women whose male relatives suffer from male pattern baldness may also suffer a more diffuse hair loss. This is more usual after the menopause and is due to the action of androgens or male hormones on the predisposed hair follicles. This may respond to the use of oestrogens.

Diffuse hair loss may also be due to metabolic illnesses such as myxoedema or thyroid insufficiency.

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Most foreign bodies simply pass through the full length of the bowel, and in the majority of cases are passed at the far end with little discomfort within four to five days. In fact, a parent may be totally unaware of what has occurred. Occasionally symptoms may develop, but overall this is uncommon. Usually, the doctor’s assistance is needed if there is pain, a fever or vomiting resulting from the incident.

Sometimes a foreign body may be held up at certain critical points in the bowel. A sharp object, such as a pin or a needle, may penetrate the bowel lining and fail to move or it may actually perforate the wall.

Treatment

Most cases do not require any treatment. However, if the foreign body is known and especially if it is a sharp, potentially dangerous one, treatment may become necessary. If symptoms (as noted) occur, it will require medical attention.

The doctor may ask for a bowel X-ray if the foreign body has not been passed within a few days. However, only about 2-4 per cent of cases require active surgical intervention. These days, with the use of a long, flexible device called the endoscope, it is possible to locate foreign bodies and remove them fairly simply under an anaesthetic.

There is probably one major exception to the suggestion of waiting for the child to pass the object. That is in the case of the miniature mercury batteries that are now widely used in hearing aids, cameras and calculators; it is becoming more common for these to be in homes, often in ready access to infants. Their shiny silver metal coat is attractive to some children, who suck them, and several cases of their being swallowed have been reported. The incidence will inevitably increase over the next few years.

The acid of the child’s stomach may rapidly destroy the thin metal lining of the battery, so releasing very toxic quantities of mercury which may be lethal to small children. If this occurs, immediate treatment either from the doctor or at the emergency ward of the nearest big hospital is essential. The battery must be removed as urgently as possible before it disintegrates and allows the toxic substances to be absorbed by the body. Never forget this danger.

Do not give cathartics for foreign bodies. Do not give cottonwool sandwiches or follow other antiquated old wives’ tales. These all belong to a bygone era. Castor oil is definitely out, and so is cascara and similar products. They could stimulate the bowel violently and with sharp objects increase the risk of perforation. Do not get hysterical—death is not imminent. Ring the doctor for advice or take the child immediately to the nearest large hospital.

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‘It’s an excellent idea,’ I replied, and I meant it. ‘I am always pleased to hear young mothers opt for this sensible, safe and perfectly natural form of baby care. Breast milk is meant for human babies. Cow’s milk, as I’ve said for years, is great, but it is meant for baby cows.’

‘What are the chief advantages of breastfeeding?’ Karen asked. ‘I know there are lots, but I would like to hear the reasons doctors give.’

‘There are many,’ I answered. ‘The obvious ones are that the milk is just the right consistency for your baby. It is manufactured strictly for her. It contains all the nutritional needs she will have for the first several months. It comes ready made, free from germs, and there is no messy fiddling around with bottles and teats and the need to cleanse, wash and sterilize these. It contains the correct amount of most of the vital vitamins, proteins and other foods the baby needs. It is also manufactured in a form that is acceptable lo her, and does not need modification or diluting or anything else. The temperature is just right. And as one proud father once said with a sigh, “it comes in very attractive containers, too”.’

‘Isn’t breast milk supposed to contain protective chemicals?’ Karen cut in. ‘I’ve heard that breast-fed babies are less likely to develop certain illnesses.’

That’s true. It contains special products called antibodies, and these can guard against certain potentially serious infections. It is well known that gastric infections, sometimes life imperilling, seem much less common in breast-fed babies.

‘This is sometimes because germs are present in milk. Keeping milk is sometimes difficult, especially if there is inadequate refrigeration during hot summer weather. Germs causing gastric: upsets breed rapidly in milk products in the heat. These were once a serious cause of death for babies, though happily not so commonly seen today. But it is still a plus for breast feeding, because no special storage or refrigeration is needed.

‘What’s more, it is claimed by many doctors that “cot deaths” are less likely in breast-fed babies. Nobody knows what causes this terrible condition. The baby simply dies in his sleep, even though he appeared quite well when put to bed. It occurs during the first six months of life. It is not common, but still, many babies die.’

‘Don’t you agree that a mother can get closer to her baby if she is actively breast feeding her?’

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To familiarise yourself with what is ‘normal’ for you, it’s a good idea to keep a menstrual dairy. Some women are extremely regular, others less so, but once you get a feel for your usual pattern, you can be more alert to ‘abnormal’ variations.

Heavy periods (also called menorrhagia) may be caused by things like fibroids, pelvic inflammation, hormonal disturbances, tumours, and IUDs, but there may also be no apparent cause (this is known as ‘dysfunctional uterine bleeding’). If your periods become much heavier than what’s normal for you, you should seek advice from a health practitioner as it may indicate an underlying problem.

Shortages of iron, zinc, Vitamin B6 and Vitamin A have been suggested as causes of excessive bleeding, so supplements may help (but beware of taking large amounts of Vitamin A without supervision). Food intolerance may be a factor for some women, and if you’re being treated for candidiasis, your periods may get heavier for a while before settling down again. Make sure you eat plenty of iron-rich foods such as green leafy vegetables and lean meat to counteract the possibility of anaemia. Among the herbs, bayberry, raspberry leaves, golden seal, sage or shepherd’s purse may be useful, and supplements of dolomite (calcium and magnesium) taken for a few days before and during the period have been reported as effective.

Period pain (dysmenorrhoea) varies greatly among women. There are two types: primary dysmenorrhoea is related to the uterus actually contracting under the influence of prostaglandins (hormones); secondary dysmenorrhoea tends to extend outside the time when you are actually bleeding and can be caused by problems such as cysts, fibroids, polyps, infections or tumours.

You should investigate the cause if you feel you are experiencing secondary dysmenorrhoea, but there are many self-help treatments that can help relieve the pain. A hot water bottle against the abdomen can be soothing, as can a warm bath or shower. Exercise, especially swimming or yoga may help. Try massaging the uterus directly — pressing into your abdomen just above the pubic hairs; or experiment with acupressure — direct pressure on the Achilles tendon behind your ankle. Eat plenty of fresh fruit and vegetables, vegetable juices, fish and liver. Useful supplements may include magnesium, calcium and potassium; and the herbs crampbark, cimicifuga, chamomile, golden seal and raspberry leaf.

Amenorrhoea — absence of periods — is most commonly the result of pregnancy or breast-feeding. But if this is not the case, you should consult a health practitioner to try and track down the reason. Amenorrhoea can be caused by hormonal imbalances, extreme loss of weight (for example, as a result of a disorder such as anorexia nervosa — see separate entry), or by some drugs used to treat high blood pressure or cancer.

Cessation of menstruation is known as menopause.

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A very common form of chest pain in children is the so-called stitch in the side—a stabbing pain in the lower chest, more often on the left side than the right. This pain occurs with exercise and will stop after a minute or two of rest. This type of pain may be caused by gas pains in the large intestine, contraction of the spleen, or spasm of the diaphragm. Regardless of the cause, it is harmless.

Pain in the area of the sternum (breastbone) is common when a child has bronchitis or a head cold combined with a cough. A frequent, hard cough often makes the diaphragm sore, causing a pain just below the ribs. Pain on one side of the chest may be caused by pleurodynia (inflammation of the lining of the chest cavity) or by shingles.

Injuries (including muscle strains, bruises, and fractured ribs) cause pain that is worsened by deep breathing and movements of the chest. All of these types of chest pain are relatively minor and usually can be cared for at home.

There are a few causes of chest pain in children that are more serious, but these are also uncommon. Pleurisy that develops as a complication of pneumonia may cause chest pain; the pain is accompanied by other signs of pleurisy (fever, difficult breathing, cough).

Another more serious cause of chest pain is spontaneous pneumothorax, which is a bursting of a small bubble on the surface of the lung. When the bubble bursts, air escapes into the chest cavity, causing gradual collapse of the lung. This condition comes on suddenly, often with sharp pain, and causes increasing shortness of breath. A hernia of the diaphragm causes chest pain that is usually worse when lying down and less or absent when sitting and standing. Heart pain in children, even those with serious heart conditions, is so rare that it is practically unknown.

Signs and symptoms

Chest pain may occur alone or along with other symptoms. The exact location of the pain and the circumstances that bring on the pain or make it worse are clues to the type and cause of chest pain. Other symptoms (cough, fever, rash at the site of the pain, and shortness of breath) are also clues to the cause.

Home care

Most cases of minor chest pain can be treated at home with aspirin or paracetamol, mild heat, and reassurance. If chest pain is caused by a hard cough, cough medicines may help.

Pleurisy, spontaneous pneumothorax, and hernia of the diaphragm should be treated by a doctor.

Precautions

• If chest pain is accompanied by shortness of breath, high fever, a cough producing blood flecks, or prostration (collapse), get medical help immediately.

• If there is persistent pain beneath either armpit that is made worse by breathing, see your doctor.

• Do not give cough medicines if the child is having difficulty breathing.

Medical treatment

Your doctor may recommend X rays and blood tests. Pneumothorax is treated by hospitalization, close observation, and possibly a puncture of the chest wall to remove trapped air.

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