1. Decide on a reasonable bedtime for the child. There are no rigid rules for this. It depends on a number of factors, including the number and length of his daytime naps, the amount of sleep the child seems to need at night, the time of awakening in the morning and so on.

2. Establish a set routine that begins 30 minutes before the actual bedtime. Tell the child that it will be bedtime in 30 minutes. Each routine will vary according to child preferences, family routines and so on, but it must be adhered to. A typical routine may involve the child changing into pyjamas, brushing teeth, playing a game with a parent, reading a bedtime story, then saying goodnight to various toys and pets and kissing family members. All of these activities should be quiet so as not to overstimulate the child. Strenuous physical activities are not a good idea.

3. At bedtime, take the child into his bed, tuck him in, say goodnight (Til see you in the morning’), turn off the light (apart from a night light, if the child has one), and leave the room. Some children may like to take a cuddly toy to bed — this is fine.

4. If the child calls out, ignore it. Do not reason in any way. Resist the temptation to call out ‘Go to sleep’. You should not say anything, no matter how desperate the calls and pleas become (and they will become increasingly desperate — young children have an amazing and endless repertoire of wishes and requests designed to tug at the heartstrings of even the most hardened parent).

5. If the child cries, ignore it. The crying may sound as if the child is verydistressed, and persist for a very long time, but the parents must ignore it. To allow the child to cry for a long time and then go in will simply teach him that if he cries for long enough then eventually the crying will be rewarded by the appearance of a parent.

6. If the child comes out of his room take him straight back, without saying a word. Talking to the child or explaining what or why is taken by the child as a form of reinforcement, and will guarantee that the behaviour will continue. It may be necessary to take the child back literally dozens of times initially. Again it is important not to weaken in this resolve — if parents give up in the middle of such an intervention, the child learns that as long as he keeps coming out of the room, sooner or later the parents will weaken and allow him to stay out.

Sometimes a gate can be placed across the bedroom door to prevent the child from leaving the room. This is less frightening for parents and child than locking the door.

7. The next morning, if the child has gone to bed with a minimum of fuss, he should be praised for being ‘such a good/big/grownup boy’. Sometimes a material reward may be given, though there is a danger that the child may come to expect a treat every time.

Sometimes extinction or controlled crying is used for the child who resists going to bed, but this is generally not as successful in this situation as it is for the child who wakes during the night.

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Diet has always been a controversial factor in studying gout. Purines are the chemicals which readily break down to form uric acid, so food high in purine should be avoided. These include anchovies, liver, tongue, kidneys and sweetbreads.

Alcohol also has been controversial. It is now established that beer tends to precipitate an acute attack, as does red wine — but whisky appears to be free of blame.

An injury to the joint or the stress of an operation or acute infection may bring on an attack. Penicillin, aspirin, some diuretics (used for blood pressure or heart trouble and which remove fluid from the body) may all raise the uric acid levels.

In psoriasis, or some blood disorders like leukaemia where there is a rapid breakdown of cells, an excess of uric acid may result.

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What is required to prevent the upsets in a woman’s emotional and sexual function following hysterectomy is better pre-operative preparation.

Every woman is entitled to a full explanation of what is wrong with her and what the doctor intends to do about it.

Following hysterectomy, the ovaries may not continue functioning beyond six months or so and so many women experience the symptoms associated with the menopause, including depression, hot flushes, headaches, tiredness, a dry vagina and often pain on intercourse.

There is no doubt that giving oestrogen to a menopausal woman will relieve most of these symptoms.

The big difficulty has been that prolonged treatment with oestrogen carries a considerable risk of causing cancer of the body of the womb. This risk is increased some five to seven times in those taking oestrogen beyond six months.

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A fissure is a tear, often very small and hardly detectable. Its size has no direct bearing on the intensity of pain produced. Parents often look in disbelief when they see how tiny it is. It is usually located right at the anal orifice; and as the hole distends, it is also stretched, hence the pain. In fact, the child will often yell its head off. Sometimes there is bright red blood in the motions. Generally it happens in the under 2 age group.

Treatment

Treatment is fairly simple and straightforward. Most cases are not self-diagnosed but usually the doctor will discover it first.

Relieving constipation is the first essential step. (Read the section on constipation, earlier in this chapter, for the general principles). Plenty of fluids is the best starting point.

Applying an ointment containing a local anaesthetic is the next step. The doctor will prescribe this, probably one containing xylocaine which is popular and effective. This ointment should be applied half an hour before you expect the infant to have the next bowel action—often it is after a normal feed.

Long term, following the general principles to avoid constipation will help check recurrences after the fissure has healed. Using very soft toilet tissue or napkins, and applying lanoline after bowel actions, keeps the area soft.

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But the variety and nature of the food eaten during school days is extremely important. Sad to say, many parents give little thought to this vital aspect of living, and growing, and developing.

The food children eat at school is vitally important to their health. In fact, bad habits that commence in childhood often persist throughout life. Problems in adulthood almost always start during the younger years. In this respect, food and eating habits probably top the list.

High cholesterol levels and heart disease account for the majority of deaths of Australians. In fact, it now stands around 50000 a year—about 1000 a week. Frequently, many of these sudden unplanned disasters can be traced back to faulty eating routines that started during school days. Overweight, the problem confronting about five million (or more) Australians, generally has its origins in school days, or even earlier. It is now well established that overweight children invariably develop into overweight, obese adults. The number of diseases that strikes this group is legendary.

So, as a parent it is largely up to you to guide your child’s eating routines from the first day of commencing school. Leaving the youngster’s food requirements to chance, and to the chance that the school tuck-shop will fulfil the youngster’s dietetic needs, is tantamount to disaster.

The majority of school tuck-shops are run as commercial undertakings; therefore, most tend to sell the products that are most saleable and asked for in greatest frequency. Almost invariably these are the cheaper, high-starch products. They include sweets in all forms, pastries, cakes, biscuits, bread products and similar high-calorie foods. Aerated beverages come high on the list also.

The food value of these products is very low. Certainly they provide calories, which are often equated with energy. But excessive amounts are merely laid down as rolls of fat. The vitamin levels are small. The protein content is usually very small also. These two items are essential for body growth and the normal wear-and-tear repair of the system. These are the products that should be emphasized in any juvenile diet, together with coarse grain products called complex carbohydrates.

It is far better to prepare your child’s food each day before school. This is superior planning, and will be of greater value to the child than relying on the products sold at tuck-shops. Unless your school has a health-orientated canteen, tuck-shops are best let alone.

It is pleasing to note that some schools, usually those run by parent organizations, are at long last realizing the value of good-quality food in the tuck-shop. Some have completely thrown out all sweet lines and products that are dietetically useless. These have been replaced by high-protein, high-vitamin and complex carbohydrate (grains, etc.) lines of definite value to the growing child. Such action is to be condoned. It is hoped other schools will follow this trend. But, unfortunately, the over-whelming majority are still slumming along with the sort of food they’ve been selling since mum was in pigtails.

Quite apart from the high-calorie, high-cholesterol level of most of the average tuck-shop fare, the high-sugar levels are proving a disaster as far as teeth are concerned. Not long ago a survey was conducted to check schoolchildren’s teeth. It was equated with the nature of food sold at tuck-shops. There was a distinct relationship: children regularly consuming large quantities of high-sugar products suffered far more adversely with dental caries (tooth decay) than children who ate a sensible, lower-sugar diet.

As researchers pointed out, the saving in cost in dental bills far exceeded any increased cost incurred by the better-quality (and marginally more expensive) foods. In short, pay a bit more for good-quality food and you more than recoup this in fewer dental accounts.

Generally speaking, the foods that should be soft-pedalled include products that contain three basic ingredients: Sugar, refined flour and potato.

This may not seem serious, hut it actually involves many commonly used foods. ‘Sugar’ means sugar in all its forms; this includes sweets, lollies, chocolates, fizzy drinks (usually laden with sugar), cordials and icy-blocks; syrupy, stewed (and tinned) fruits, icings in cakes, pastry, etc. Sugar is contained in many desserts. Honey is merely another form of sugar.

Refined flour is widely used in our modern society. Its uses include bread, cakes, scones, pastry, biscuits, many sweet dishes, pancakes, doughnuts, porridge and many cereals.

Potato comes in many forms. The most popular with children are potato chips, crisps and ‘straws’. But mashed, boiled or baked potato are just as high in calories and low in protein. They are best used in moderate helpings only.

Many mothers will probably claim they could not possibly do without these items. Nobody is recommending “complete cessation in their use. However, moderation in their use is strongly recommended. This is even more important if your child shows a tendency to be overweight. These products will only aggravate the condition, and may produce long-term problems. There are many simple substitutes, or more healthy variations to the items already listed.

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Avoid alcohol, rich, aromatic food and excessive tobacco and do not attempt to read until your body has adapted to the motion. Do not try to focus your eyes on objects moving around you.

To prevent and treat motion sickness, administer strong ginger tea before travelling and carry a supply for the journey. This simple anti-nausea medicine is highly effective and can safely be given to young children.

Some motion sickness has emotional causes such as fear of flying. In this case, counselling may help.

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Many fruitless years were spent trying to develop a vaccine against the cold germ. Then it was discovered that there is not just one cold germ. Colds are actually caused by many different viruses, and all respiratory viruses can cause common colds. An attack by any of the more than 185 viruses makes a person immune to only that virus and none of the others. Often this immunity lasts only for a short time.

Many cold viruses can cause complications such as croup, laryngitis, bronchitis, viral pneumonia, and encephalitis. All cold viruses can make a child more susceptible to additional bacterial infections – ear infections, sinus infections, lymph infections, or bacterial pneumonia. No child’s cold should be taken lightly.

Signs and symptoms

The symptoms of a cold are nasal congestion, sneezing, clear nasal discharge, scratchy sore throat, and fever up to 39.4°C. In general, the younger the child, the higher the fever. Symptoms may also include reddened, watery eyes; dry cough; mild swelling and tenderness of the lymph nodes in the neck; and mild pain in the ears.

It is often difficult to tell a cold from other illnesses that have similar symptoms. Usually it is assumed to be a cold if the familiar cold symptoms occur but symptoms of other illnesses do not. Another clue is that a cold lasts only three to ten days.

Home care

Increase room humidity with a vaporizer or humidifier. Have your child drink a lot of liquids. Isolate the child from others, particularly from infants and the elderly. Bed rest is not required, but the child should avoid strenuous physical activities while fever is present. Give aspirin or paracetamol for fever or pain. Use nose drops or oral decongestants and a nasal aspirator to relieve nasal stuffiness and discharge. Use cough medicines for easing a severe cough. Remember, however, that overuse of any of these medications can cause more harm than good. Chest rubs and vitamin Ñ treatments have not proven to be helpful. Your child should eat only what he or she is able to eat.

Precautions

• The following symptoms do not usually occur with a common cold and may be signs of another illness: fever lasting more than two to three days; pus-like discharge from the eyes, nose, or ears; large, red, tender neck glands; breathing difficulties; chest pain; severe headache; stiff neck; vomiting; shaking chills; prostration (collapse). If any of these symptoms occur, call your doctor.

• Some viruses that cause common colds stay in the body for one to two weeks, so the child remains contagious for the entire time of the cold.

• Infants should not be exposed to anyone with a cold, even a mild cold. Infants are not protected against the common cold by the mother’s antibodies; young infants can become seriously ill from these viruses.

Medical treatment

Your doctor will perform a physical examination to check for signs of other illnesses and for signs of complications. The doctor sometimes will order a blood count and throat culture. Otherwise, the doctor’s treatment is the same as home care.

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Much of the “breathwork” taught by experts today is drawn from ancient Oriental spiritual teachings. Many of the health claims for ancient Taoist, Hindu, and Yogic breathing exercises have been substantiated in the laboratory. One such exercise, alternate nostril breathing, is a proven tension-tamer and mental energizer, Dr. Hendricks says. Here’s how he teaches it.

Close off one nostril with the index finger of your dominant hand and breathe out and then in through the open nostril, slowly, gently, fully. Then close off the other nostril, still using your dominant index finger, and breathe out and then in through the open nostril. Keep your belly muscles relaxed and breathe comfortably, slowly in and out of your abdomen. Put your attention on the sensations of the breath leaving your nose and the breath returning. Alternate like this for two minutes, and then switch to the index finger of your non-dominant hand and continue for two minutes. Switch back to your dominant hand for one more minute, and then rest for a minute with your hands in your lap. Just don’t try it while you have a runny nose.

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