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Parents will often have different concerns about a child’s sleeping patterns at different ages. In infancy these will usually be about the unpredictable nature of sleep. Many babies take a very long time to settle into any sort of predictable rhythm of sleeping, feeding and playing. This makes life very difficult for the rest of the family, of course, as it is impossible to schedule other activities, such as paying attention to other children, shopping, cleaning and most importantly, the parents’ (usually the mother’s) own relaxation or sleep. There is always the possibility that the baby will wake up, demanding a feed or attention.

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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It is important for everyone to know how to do artificial respiration.

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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Chronic glaucoma comes on slowly and insidiously. It is a common cause of blindness and has often progressed to a stage where the vision is markedly impaired before it is noticed by the sufferer.

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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About 100 hairs are shed each day from the average scalp. The normal pattern of cyclical growth of hair may be disturbed by general health factors, either physical or mental. Most women notice their hair becomes thinner and loses its lustre after childbirth and may take a year or two to recover.

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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Foreign bodies seem to have an amazing attraction for children, and it is incredible the number and range of items that are swallowed. The incidence is highest in infants in the 1-3 year age group. Coins, screws, nails, washers, bits from toys, plastic gadgets such as doll’s eyes, wheels from toy cars, and pins, safety pins and otherwise, have all gone down the red lane. Sheer good luck, and the body’s ability to deal with these onslaughts, make the risks happily fairly small.

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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‘I think I should breast feed Joanna,’ Karen said, as she looked happily at her tiny baby, now a few days old. ‘I mean, properly, not for just a week or two like some of my friends, but for as long as I am capable. Is that a good idea?’

‘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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Women’s menstrual cycles are almost as individual as they are — there’s a large variation in what is ‘normal’. The cycle can take from 24 to 35 days (counting the day you start bleeding as the first day); bleeding can last for between two and seven days; and the amount of blood lost can range from 10ml to 80ml (the average being around 35ml). If blood loss is heavy it can lead to anaemia (iron deficiency).

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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Chest pain is common during childhood. Although chest pain in adults can be serious, it is rarely a symptom of serious disease in children.

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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In order to establish meaningful contact with other humans, you have to learn how to talk-openly. Learn how to communicate in ways that let others hear you better. A key, says Dr. Ornish, is to practice expressing feelings rather than thoughts. Feelings connect; thoughts-particularly judgmental ones-isolate us, he says. Here are some of Dr. Ornish’s communication tips.

•     Express a thought-”I think you’re wrong,” for instance-and your listener may feel attacked and argumentative. Express a feeling, though-”I feel sad about what you said,” for instance-and the listener is more likely to hear you, Dr. Ornish says.

•     Express feelings and you make indisputably true statements. No one can argue about how you feel. How you feel is how you feel.

•     Express feelings and you exhibit a bit of vulnerability that people generally recognize and respond to in kind, raising the level of the communication.

•     Feelings-that is, emotions-are more effective than thoughts in influencing people.

It is just as important to express negative feelings as positive ones, Dr. Ornish says. Just learn to express them as feelings, not as judgments or attacks. Add the words I feel to your vocabulary. One caution, though: Dr. Ornish says that if you add the word that after an I feel, you probably are not truly expressing a feeling but, rather, a thought.

One way to encourage more expressions of feelings rather than thoughts is to rid your language of the phrases “You should,” “I think,” “You ought,” “You never,” and “You always.” Instead, add the phrase, “I want.”

We communicate more intimately when we acknowledge what we hear other people saying to us, making it clear that we really listened and really heard what they said and making sure that we understand their meaning, Dr. Ornish notes. Try it and you’ll see that people warm to you as they feel more understood. And you will warm to them, too, because you will be focusing on their feelings and expressions, rather than paying more attention to what you’re going to say next.

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Many-if not most-people believe that they should have ‘a thorough check-up’ now and again. There is a widely held misconception that a doctor (usually a general practitioner) can do a kind of 10,000 miles service of everything that really matters and do it in a few minutes. This is totally untrue. Even a very lengthy clinical examination by a highly expert physician might well miss even quite obvious disease which cannot be picked up by his or her bedside diagnostic skills. The problem with such examinations, even if they are very well done, is that if given an ‘all clear’ patients imagine themselves to be well and may as a result actually take less care of themselves because their current lifestyle, they argue, appears to be doing them no harm.

Young children and the elderly need more regular professional examinations because they get ill more often and can go downhill very quickly once something starts. Physical examinations in middle age are more worth while than in younger people because of the higher rates of heart disease and cancer.

Obviously it makes sense to limit physical examinations to those periods of life at which they are most likely to produce results. A thorough physical examination at birth and periodically throughout early childhood makes good sense because so much is going on developmentally that it is reasonable to try to pick up abnormalities so that they can be dealt with quickly. It is probably sensible to have a physical examination every five years after this up to the age of 40 and then every other year up to 65.

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Protein is the second most plentiful substance in our bodies next to water. Protein builds new tissue and repairs damaged cells. Protein also is needed in our bodies for the formation of hormones and enzymes which play a variety of roles in the body such as metabolism, growth, and sexual development. It is also used by the body to regulate the body’s fluid level and help control the acid alkaline level.

Protein consists of around 22 amino acids which are the building blocks of protein. Protein is classified into two types: complete and incomplete proteins. Complete proteins supply all of the 8 essential amino acids: lysine, tryptophan, phenylalanine, methionine, threonine, leucine, isoluecine and valine. Eggs are the best source of amino acids (complete proteins), followed by dairy products and meats.

Vegetarians can obtain their protein from seeds, nuts and lentils but it is best to vary the diet and obtain your dietary protein from a range of different foods. Remember eggs, dairy products, and red meats are high in cholesterol. The use of egg whites, skim milk, lean meats and fish is best.

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Fats, or lipids, furnish us with twice as much energy for our bodies than that of protein or carbohydrate. Fat is needed in our daily diet for the correct usage of fat soluble vitamins A, D, E, K.

Fat insulates our bodies giving us protection from sudden changes in temperature and at the same time protects the vital organs of the body against damage.

The average Australian consumes around 40 per cent of their total calorie intake in the form of fat. Fat is important in the diet because it gives the diet staying qualities as fat is absorbed in the body at a much slower rate than that of carbohydrate or protein. This is very important because it makes the meal satisfying, so, by having a little fat in our diets the feeling of hunger will be delayed.

There are two types of substances that give fat different flavours and textures. They are known as fatty acids, either saturated (which come mainly from animal sources) or unsaturated, including polyunsaturated fatty acids (which come from the vegetable kingdom) and are found in foods such as nuts, vegetables, and seeds’. There are three essential fatty acids. They are linolenic, arachidonic, and linoleic. All are very important and because they cannot be manufactured in our bodies they must become an integral part of our daily diet.

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There are three types of carbohydrates that are important to us:

Polysaccharides: These are the most complex of the carbohydrates and they are made up from many carbohydrate units. The most common polysaccharide in our diet would be in the form of starch which is found in grains such as rice, wheat, corn. Other foods such as potatoes are another good source of complex carbohydrate.

The other carbohydrates are monosaccharides and disaccharides.

Disaccharides: These are double sugar: sucrose, lactose, and maltose: sucrose, or table sugar is the most widely consumed disaccharide. The average consumption of sugar in Australia is around 60kg per person per year. In these quantities sugar is a health problem, leading to heart disease and other health problems.

Monosaccharides: There are three types of monosaccharides: glucose, fructose, and galactose. Glucose is the most important monosaccharide. All other carbohydrates are either obtained from it or changed into it. The body stores glucose by changing it into glycogen which is stored in the muscles and liver. This can be easily changed back to glucose when the body requires it for quick energy.

The main function of carbohydrates is to supply the body with energy and for the formation of cellular constituents.

A lack of carbohydrate in the diet (as with some of the liquid quick weight-loss diets) can lead to the production of ketones in the body. This increase in ketones decreases the alkalinity and increases the acidity of the blood resulting in a condition known as Ketosis and metabolic acidosis. It is important to balance the diet as metabolic acidosis can be very serious.

Your carbohydrate intake should be around 60 per cent of your food intake in the form of complex carbohydrates. Eating too many monosaccharides such as table sugar is not the way to get your sugar requirement. Although it will give quick energy (because of the increased blood sugar level) these levels soon drop and leave you feeling run down and craving for more sugar. Eat fruit instead.

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First, what is this thing we call nutrition? All of us have seen a never-ending number of fad diets: some to control weight, others supposedly to stop us growing old. Where will it end? We seem to be getting further and further away from the basics. In this chapter, we will look at the six basic nutrients that make our food and what part they play in our bodies. Nutrition is not just what we eat but what we absorb from our foods.

The Six Basic Nutrients

1 Water

2 Carbohydrates

3 Fats

4 Proteins

5 Vitamins

6 Minerals

Water

The first nutrient that we have on the list is probably the most under-rated and yet the most important.

Did you know that your body is made up of around 70% water? This water is needed to form blood and body fluids without which our bodies would not be able to dissolve and carry the essential nutrients to all parts of the body. Water is needed in the body to help maintain the body temperature and it is also needed to carry away the body’s waste products.

The human body will die if deprived of water for only a few days. Yes, our water supply is very important to us and the average Australian should consume around 8 to 10 glasses of water each day in the form of foods containing water or liquids.

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