NORMAL SLEEP PATTERNS: NEWBORN
The newborn sleeps for 18 hours a day or more, usually in spells of 2 to 4 hours at a time, and awakes only if he is hungry, cold, or otherwise uncomfortable. For the first few weeks of life, it is very difficult to ‘read’ the baby’s behaviour and sleep patterns. He is making a huge transition to the outside world and will be affected by such factors as his level of maturity (whether the baby is premature), any drugs given to the mother during labour, the delivery itself, and so on. Mothers often find it difficult to interpret signals from a newborn baby, and it takes some time, varying from days to many weeks, to settle into any sort of pattern or rhythm. This period of being unsettled can last considerably longer if the baby was very premature or has medical problems during the newborn period. A newborn baby tends to sleep very soundly and is not easily awakened by loud noises or body movements in the way that an older child is.
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FRACTURES – DESCRIPTION
A fracture is a broken bone; it may be complete or incomplete, as in a greenstick fracture in a child. It is recognised by pain, swelling and loss of function but sometimes this last sign is not present. Just because somebody can still move his fingers does not mean that the wrist has NOT been broken.
Fractures may be complicated by causing damage to arteries and nerves, or compound, that is involving lacerations or exposing the bone. With large fractures there is always marked loss of blood internally (so you can’t see it) and the risk of shock is present.
The essence of first aid treatment is to immobilise the fractured bone. Don’t try to straighten a crooked limb — splint it as it is.
Splints are easily improvised. Strap one leg to another or one arm to the side of the body, or put one arm in a sling. A piece of wood, a stick, even a ruler, bandaged against the broken limb will do to immobilise the ends of the broken bone.
All suspected fractures must be seen by a doctor. FINGERS
These may be splinted with bandages, or by strapping to the adjoining fingers. BONES OF THE ARM
May be immobilised in a sling, or strapped to the side.
CLAVICLE (COLLARBONE)
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GALLSTONES – TREATMENT
At times, it is necessary to open and explore the common bile duct, as when there is a history of jaundice or if there are indications at operation that a small stone may lie within the duct.
When the duct is explored, it usually extends the stay in hospital to 10 to 14 days.
In the past, quacks often gained a reputation for themselves by claiming to cure gallstones. Their potions usually consisted of one part of oil and another of alkali. These reacted in the bowel to form a soap which collected as one or more pellets.
When these were passed in the motion, the quack claimed he had rid the person of their stones.
While researchers have long sought to dissolve stones, rather than operate, it is only recently that this has become possible.
Chenodeoxycholic acid (CDC) is a naturally occurring bile acid which can be given by mouth in large quantities and can both prevent and dissolve the cholesterol stones.
It only works for these rather than the pigment or mixed stones and, even then, is only effective in about 20 per cent of cases, although up to half the stones may be reduced in size.
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EXCESSIVE BODY HAIR – GENERAL INFORMATION
Shaving is probably the most used method and can be done by a blade or an electric shaver. While most women seem happy to shave their legs and under their arms, they have a reluctance to shave their faces, perhaps because it seems unfeminine.
Many still believe shaving tends to increase hair growth and to make it coarser. Tests have shown that hairs cut across by shaving have a stubbly appearance and feel, but do not become thicker or harder.
Chemical means of removing hairs are available and effective. They may irritate sensitive skins and have little benefit over shaving, except that the regrowth does not feel as rough as after shaving.
Plucking the hairs is the most popular means of reducing the number in the eyebrows and is effective elsewhere. It is painful and may lead to irritation of the follicles.
Electrolysis or burning out the hair follicle by an electric current is a popular method of treatment. If the hair follicle is destroyed, there should be no regrowth and permanent cure results, but this is not easy to achieve.
Repeated treatments are usually necessary and some hairs in their “resting” stage may not be destroyed. This method may lead to inflammation and even to scarring or an increase in pigmentation.
So there is no one satisfactory method of clearing those unwanted and unsightly hairs.
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BABY AND CHILDHOOD INFECTIOUS DISEASES: POLIOMYELITIS
The prevention of poliomyelitis, commonly known as polio, is the conquest of the current quarter of a century. Once a disastrous and diabolical disease with a high mortality rate, and an even higher harbinger of partially paralysed bodies, it is now seldom seen in the acute stage. Until the mid-1950s it regularly left a trail of wreckage and havoc on the Australian population, and in fact in all Western countries, to say nothing of the appalling disasters it wrought in the developing lands.
But in the mid-1950s, all that changed. The sudden development of a suitable and highly effective vaccine by Dr Salk, and mass immunization campaigns, brought the disease to a sudden halt. Since then, Salk injections have been largely replaced by Sabin oral vaccine, and this is currently recommended for all babies from the age of two months. The death rate from polio plummeted, and the figure has been zero for several years now.
But it will remain this way only as long as parents are vigilant and continue to have their infants immunized along the recommended lines. Polio is still as rampant as ever in the Third World, which is not very far from Australia’s shores. If our national immunization rates fall, then polio could rapidly make a come back in Australia. It is perfectly feasible that it could even return to the pre-vaccination days and again become a major killer and paralyser. It is unlikely that, if the present trend for vaccination against polio continues, many doctors (or anybody for that matter) will witness a case of polio during their lifetime. However, it is worth knowing the symptoms, if only to alert parents to the horrid consequences if they happen to become careless in not arranging for a child to receive the proper course of immunization.
Early symptoms are often vague. They may simulate an oncoming bout of the flu, and the patient may seem to recover temporarily. But a recurrence of fever, backache, neck stiffness, nausea and vomiting may supervene. This may ’smoulder’ for several days, perhaps up to a week.
Then suddenly the major symptom occurs: paralysis. It may accompany the fever. It is often very variable, ranging from minor weakness of a single muscle group, to severe debilitating loss of function of any section of the body. The most important is the respiratory system; if this is affected, death may be imminent unless immediate emergency facilities are available. These entail the use of an artificial respirator, and its use for an ongoing period of time may be essential to maintain life.
Treatment
Symptoms such as those mentioned above, occurring in an unvaccinated child, require the urgent attention of the doctor. Prompt treatment may be essential to preserve life, especially if the breathing mechanism is affected. Treatment must be carried out in hospitals where the attention of experts is available and full facilities aimed at preserving life are available. This is no game for amateurs or do-it-yourself methods at home.
Younger generations of parents have only heard about polio. With the passage of time and the paucity of cases heard about, stories of the disastrous consequences of yesteryear often fall on deaf ears. And as the likelihood of contracting polio seems minimal there is a general tendency for young people to be complacent. ‘It can’t happen to me or to my child. It’s history … old hat… something in granny’s day.’ All too often apathy can set in. Do not be lulled into a false sense of security and neglect to have your babies immunized against this potential killer. It is simply not worth the risk.
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THE FIRST MONTH
Activity
Baby actively thrusts arms and legs about willy nilly in a playful attitude. Movements of the arms, hands and legs are largely reflex actions. For example, when you rub your finger gently over the baby’s palm you will notice how the baby will automatically, reflexively grasp it with curled fingers. If the baby’s head is unsupported, it will flop backwards and forwards loosely. If left lying on the abdomen, the baby will try to lift the head or turn it to one side so that breathing is not obstructed. Supported in a sitting position, the baby may try to hold the head in line with the body for brief periods of time. Fingers are quite often kept clenched. If an effort is made to keep them open, the baby will automatically tend to close them. The baby may hold an object for a short time but generally drops it after a few seconds. There is a tendency to stare at things, but no effort made to reach out and grab them. The two eyes tend to be co-ordinated in their movements.
Talk
The baby tends to cry a good deal, this being a method of gaining attention as well as filling the lungs with oxygen. The baby also makes little noises in the throat. If spoken to, he or she tends to respond.
Mind
The 1-month-old baby prefers to sleep most of the time, being attentive for only about ten per cent of the time. There is little facial expression, and the baby tends to give a vague stare during waking hours. He or she seems to prefer patterns to look at, rather than be attracted by colour or brightness or size of objects; familiar objects, such as parents, tend to give a little excitement. However, at this age the baby cannot concentrate on any single object for long, tending only to pick it up automatically if it comes into the range of vision but readily letting it. slip out of view without making an effort to retain it—when a person walks past, for example. The baby tends to look up and down at objects, or from one side towards the centre of the line of vision. If objects reappear within a few seconds the baby may remember them.
The baby becomes alert to the value of crying for attention, likes receiving attention, and will tend to stop crying if held and cuddled, or if seeing familiar faces, such as mother’s. Reflexes tend to become more efficient and effective.
Relationships
The baby dislikes pain and will let you know about it by crying. He also responds to comforting, and ceasing crying quickly indicates the desire to be comforted when in distress. Occasionally the baby will react to a smiling face, and may return the smile; a familiar voice may also bring a response. The baby will tend to look at mother’s face, looking intently into her eyes, and if obviously distressed may quieten down. The response to changing a wet nappy is often remarkable.
Baby tends to adjust to the person holding him or her, to mould to the body for a more comfortable union; the little one may pluck at the person, curling fingers reflexively around parts of their body such as their fingers. During feeding the baby may suckle noisily, grasping at the breast and nipple actively.
There may be obvious recognition of parents’ voices, but for the most part there is a vagueness about the baby’s stares. He or she may lie impassively for many hours, and when awake tend to stare into space without obviously concentrating on anything. The baby tends to sleep, wake up, cry, make little noises and eat, in a very disorganized manner.
At this age, the baby likes to have two feeds at night and five or six during the day. There are two to four bowel actions each day.
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ENDOCRINE DISORDERS AND THE LYMPHATIC SYSTEM: GLANDS WITH INTERNAL SECRETIONS
Apart from the genital glands and the pancreas which have been described elsewhere, the following glands belong to the endocrine system:
i. Pituitary
ii. Pineal
iii. Thyroid
iv. Parathyroid
v. Thymus
vi. Suprarenal
i. Pituitary: which lies in the sella turcica, is recognisable by iris changes in the brain sector, locally as follows—right iris 60-2′, left iris 58-60′—in the muscle zone.
There are no muscles in the brain, so the skeletal zone representing the base of the skull reaches as far as the blood zone. Thus, for example, in a case of fracture of the base of the skull the signs of damage are observed in the blood zone, here lying closer in towards the iris-wreath than would be the case with skeletal injuries of other parts. The bones of the cranial vault are represented in the skin zone.
The recognition of a disturbance of the pituitary is of greatest importance, since the pituitary is the regulator of all the remaining organs of internal secretion.
The disease-signs are shown as follows:
Lightening—as sign of over-activity, very often with a similar lightening in the areas for the corresponding sexual organs.
Pituitary tumours show clearly as dark tumour-signs extending width wise, as is characteristic of tumours of other organs.
In the iris, the pituitary area lies opposite the suprarenal area, indicating the close connection between these two organs. When one of these glands is shown in the iris, indicating abnormal disturbance, then one considers the possibilities of cure. If both organs are registered then the slightest condition must be attended to.
ii. Epiphysis (pineal): according to many other authors, the gland has its place in the iris according to the indication made on the topographical chart. I can give no iris sign for
disturbance of this gland.
iii. Thyroid gland: shows in the right iris at approx. 14′-17′ and left iris 43′-46′ in the sixth minor zone. In the case of hyperfunction, a lightening of the area appears. A thyroid hypofunction is recognised by a darkening of the area.
Clinically, there is more or less a definite picture of myxoedema with hypofunction, which in its lighter forms is more widely distributed than is generally diagnosed. In thyroid disturbance the heart can register in sympathy, and the heart area must be thoroughly scrutinised. In most cases one finds lacunae, eventually in association with white lines. Therefore, appropriate cardiac medicinal support should not be omitted. A close connection also exists between the thyroid and the abdomen (Premenstrual syndrome).
iv. Parathyroid glands: as is well known, the parathyroid glands lie behind, or near to the thyroid glands, and so we also find the iris signs in the thyroid gland areas, rather nearer to the iris-wreath. The signs are very difficult to recognise. With these organs one rather relies upon the clinical symptoms of tetany: von Recklinghausens disease, and also the significance of the contraction-rings in the iris.
v. Thymus gland: the thymus gland shows its sign in the following areas—right iris 43′ approx., left iris 17′ approx.—in the fourth and fifth minor zones. In the same place, though rather more peripherally (fifth minor zone) lies the mammary gland position. One may easily
distinguish these two signs since the mammary gland itself only develops fully when the thymus has atrophied.
vi. Suprarenal glands: these glands, whose functions have only in recent times been fully investigated, have their areas next to the kidney areas directly adjacent to the iris-wreath—right iris 30′-32′ approx., left iris 28′-30′ approx. If the suprarenal areas are lighter, then the indication is one of over-activity. We find these signs in rheumatic conditions together with an overlay in the entire muscle zone of whitish to yellowish clouds.
A dark weakness-sign (lacuna) in the suprarenal area indicates a suprarenal insufficiency. If these conditions have already occurred, one also finds besides the suprarenal sign, a lacuna in the heart area and a large dilatation of the iris-wreath.
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MEDICAL TESTS FOR CHILDREN: ECG AND EEG
Electrocardiogram (ECG)
An electrocardiogram, or ECG, is a recording of the electrical impulses of the heart. These impulses are what makes the heart beat in a regular rhythm. To make such a record, an ECG machine is attached to the patient with electrodes, metal plates that are placed on the arms, legs, and chest. These electrodes pick up the electrical impulses that move through the body. The impulses cause a needle in the machine to move on a piece of paper, as the paper moves through the machine. Where the needle touches the paper, it makes a line. The physician studies the pattern on the paper to see if the heart rhythm is normal.
The ECG does not hurt the patient, but it is important for the patient to stay very still while the recording is done.- All muscle movements, not just movements of the heart muscle, are caused by electrical impulses. Therefore, any movement can affect the ECG recording and give an inaccurate picture of the heartbeat.
An ECG is done to check for irregular heart rhythms (arrhythmias), an enlarged heart, heart valve disorders, heart malformations, and many other heart disorders. The test can be done in a doctor’s surgery or an out-patient laboratory.
Electroencephalogram (EEG)
An electroencephalogram, or EEG, is a recording of electrical activity in the brain. It is a painless procedure similar to an ECG. The metal plates known as electrodes are attached to the patient’s head and to an EEG machine. The electrodes pick up the brain’s electrical impulses. These impulses activate a needle, which traces the pattern of the impulses on a piece of paper moving through the machine. The physician compares the pattern on the recording to patterns of normal brain activity, and determines if there is an abnormality. Recordings from opposite sides of the brain can also be compared to see if the patterns match.
An EEG is done to test for epilepsy, brain tumours, encephalitis (inflammation of the brain), and other brain disorders.
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BOWLEGS AND KNOCK-KNEES IN CHILDREN
Bowlegs and knock-knees are two conditions in which the legs are not as straight as they are in most persons. In bowlegs, the legs bend outward so that the knees are farther apart than usual. In knock-knees, the legs bend inward so that the knees are closer together.
Theoretically, when a child stands straight, the ankle bones should touch or almost touch each other, and the knee bones should touch or almost touch each other. With an infant lying on the stomach or back, the legs can be pulled straight with the toes and knees pointed straight ahead to determine whether the bones of the knees and ankles come together. If ankles touch but the knees do not, the child can be said to be bowlegged. If the knees touch but the ankles do not, the child is knock-kneed.
By these standards, however, all infants, children, and adults are bowlegged or knock-kneed to some degree, so you should not become alarmed. Most infants appear bowlegged until they walk. Then when they start to walk, they walk “cowboy” style. This condition usually corrects itself by age two. Most preschoolers stand knock-kneed, especially if they are plump. This condition also corrects itself.
True bowlegs and knock-knees either are due to rickets (vitamin D deficiency) or are inherited. Once common 50 and more years ago, rickets is now rare. An unusual form of bowlegs, often occurring only on one side, is Blount’s disease, in which the top of the tibia (shin bone) becomes deformed.
Signs and symptoms
Have the child stand with the legs straight and the toes pointed forward. Then observe if there is any distance between the knees or ankles. Remember that any distance between the ankles or the knees varies from person to person and that these differences are usually normal. If you think that there might be a problem, ask your doctor.
Home care
In most cases, no home care is needed. To prevent rickets, all children should receive about 400 international units of vitamin D daily. This amount is found in many commercial infant formulas and in most commercial milk. Some vitamin D is present in breast milk, but the amount varies. If your child is being breast-fed, ask your doctor whether the child is receiving enough vitamin D.
Precautions
• If you think your infant or child is bow-legged or knock-kneed, watch to see if, after several months, the condition worsens. If it does, consult your doctor.
• Do not use orthopedic shoes without your doctor’s prescription.
• Do not give your child vitamin D supplements unless your doctor has prescribed them. Overdoses of vitamin D can be harmful.
Medical treatment
In most instances, your doctor will examine your child and then prescribe no treatment—except to wait and watch. X rays of the knees may be required as well as blood tests for rickets. Use of orthopedic shoes or night splints is rarely necessary. For Blount’s disease, braces or corrective operations on bones may be required.
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LIVING LONG: ALL IN THE FAMILY
Though many hospitals are equipped with Orwellian, high-tech equipment that can read your genetic legacy from a single drop of blood, the easiest way to know what’s in your genes is to look at your family tree, says Dr. John J. Mulvihill of the University of Pittsburgh. “You can definitely see your prominent risk factors in your family history,” Dr. Mulvihill says. “And we’re learning more all the time. Ten years ago, we didn’t think there was any family linkage to prostate cancer. Then people started talking about it and uncovered a strong family connection. The problem is that most men don’t know their family history.”
Worse, even when they do know, most don’t give it a second thought. Of the 58 people interviewed for one study, nearly half of those having family members who suffered from heart disease or cancer did not believe that their family history had any bearing on their own risk. And men were much less likely than women to think that having a family member afflicted with cancer was relevant to their own risk for the disease. Despite their disbelief, studies show clear connections. In Japan, for instance, researchers comparing 363 people with colorectal cancer with an equal number of people who were cancer-free found that those having one first-degree relative (a parent, sibling, or child) with colorectal cancer had almost twice the risk of developing the disease as those with no family history of colon cancer. In a similar Canadian study, researchers found that 15 percent of 640 men with newly diagnosed cases of prostate cancer had at least one blood relative who also had the disease, while only 5 percent of 639 men who did not have prostate cancer had any family ties to the disease.
And almost nowhere is family history a stronger link than it is for heart disease. As mentioned earlier, just inheriting one tiny bit of faulty DNA from both Mom and Dad can double your risk for developing heart disease In the final analysis, we’re all likely to be at genetic risk for something, concludes Reed E. Pyeritz, M.D., Ph.D., professor of human genetics, medicine, and pediatrics at Allegheny University of the Health Sciences in Pittsburgh. “I’m fairly convinced that, to some degree, all disease is genetic. So far, the major common diseases to which we’ve identified genetic links include Alzheimer’s disease; arteriosclerosis and all that comes with it, like heart disease, hypertension, and stroke; diabetes; and, of course, most forms of cancer. There’s surely more to come.”
That’s all the bad news. The better news is that studies show these genetic risk factors can be largely offset by making appropriate lifestyle changes or by seeking early medical help in some cases.
*21/36/5*
