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Because this behaviour is always transitory and self-limited, and there are never any consequences, no intervention is necessary. Parents should be reassured that it is harmless, despite the vigour with wich the activity the activity is pursued, and the best course of action is to ignore it. There is no effective intervention that will reduce the frequency or duration of the head-banging, or will result in making it disappear any more quickly than it otherwise would have.

Some parents, concerned about the consequences of head-banging, try to stop it by smacking the child, or otherwise punishing him. This will often have the opposite result to the desired effect. By drawing further attention to the activity, there is a very good chance that it will continue longer than it otherwise would have, because the behaviour is being reinforced by the parents paying attention to it.

Prevention

There is nothing effective that can be done to prevent head-banging, because it is not known why some children exhibit this behaviour. It is important to simply ignore the behaviour so as to ensure that paying attention to it does not prolong it.

When to see your doctor

You may want to see your doctor for reassurance that the child is not hurting himself, especially if there is evidence of bruising or swelling. There is generally no need to seek medical advice.

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Vaccines are extremely safe and effective compounds which have been thoroughly tested. They are in use worldwide. As with all medicines, some people do have unwanted reactions. These are virtually never serious, and pass quickly. We stress again that the benefits of immunisation far outweigh any risks.

Some children have mild reactions to immunisation, such as local redness and swelling at the site of injection, or mild fever and irritability. To reduce fever and reactions, paracetamol should be given according to recommended doses prior to the immunisation and afterwards if necessary.

PERTUSSIS (WHOOPING COUGH) VACCINE

A lot of controversy surrounds this vaccine, which is usually given in combination with diphtheria and tetanus vaccines. Pertussis is a serious and sometimes fatal infection of the respiratory system. Although it mostly passes without complications, young children have been known to become extremely ill and even die from whooping cough. Babies do not acquire natural immunity from their mothers after birth, and are most vulnerable. Antibiotics do not provide effective treatment for the disease. The pertussis vaccine is extremely effective in preventing the disease and reducing its severity. The major controversy surrounding immunisation is related to concern that it may cause neurological damage.

Recent figures show a slightly higher incidence of short-lived, unpleasant side effects such as fever, crying and swelling and redness at the injection site but more serious reactions are extremely rare.

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The elastic tissue degenerates and the skin becomes thin and more prone to injury. Solar keratoses are reddened patches covered by white scale and are common on the face and backs of the hand.

These small lesions are unsightly and may go on to develop into skin cancers. Cancer of the skin has reached epidemic proportions in Australia and will eventually develop in a third of us.

For this reason, we should all learn to cover up when the sun shines and to avoid the middle of the day when the sun is at its zenith and the rays are most potent.

Some chemicals applied to the skin can sensitise the skin to UV light and lead to a rash. Some drugs taken internally can do the same.

During the long summer, millions of us swim each weekend. We seem to have an abnormal fear of sharks but give little thought to the risk of drowning. Unfortunately, drownings are like road accidents — most victims have been drinking alcohol.

Be careful about swimming in rivers, pools or at the beach after drinking.

And if you are going near water, learn how to carry out artificial respiration, by the mouth-to-mouth method.

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Sometimes, they were used in younger women who still wanted to have more children and may be still used for that purpose.

For those with severe symptoms, operation is usually indicated. This repair operation is usually called the Manchester or Forthergill Repair, after Dr Fothergill, a gynaecologist of Manchester in the UK, who devised it.

In this procedure, the cervix is amputated and the ligaments at the side of the womb are brought in front of the remainder of the cervix and stitched together to lift up and support the uterus.

As well, the lax tissue from the front and back walls of the vagina is cut out, like taking a tuck in a piece of material. The underlying tissues are pulled together with stitches. In elderly women who are no longer leading active sex lives, the opening of the vagina may be considerably tightened so as to lessen the chance of recurrence. This would make intercourse impossible.

In sexually active women, vaginal repair tightens the opening to what it was before childbirth.

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Early in life (the first few months), the mother may notice that her baby is very thirsty, drinking a lot of fluid (and often wanting more), and passing fairly large quantities of urine. Instead of a normal weight gain, the baby may actually lose weight, despite a fairly good appetite. The child seems continually tired, and fatigues easily. Crampy pains in the limbs or body are common. In some cases, the baby may dramatically slip into unconsciousness (< ailed a diabetic coma).

In older children in whom the disorder has not been treated, there may be a reduced rate of growth and poor development. There may be psychological problems. As such children grow older, more and more symptoms will gradually appear, and damage to the blood vessels and various organs takes place.

Treatment

Usually, an alert parent will soon detect abnormal symptoms and will seek medical advice. There are many tests, some simple screening tests which will soon give an indication of the problem. The urine is tested for sugar (or ‘glucose’, as the doctors say), and frequently there is plenty present. Blood tests are more accurate and will indicate if there are elevated levels. A test called the glucose tolerance test usually confirms the disorder. Various other investigations may be suggested.

Treatment is usually very satisfactory and will be worked out on an individual basis for each patient. For childhood diabetes, the use of insulin is usually necessary and may be necessary for the rest of the patient’s life. Parents are taught how to administer this, and soon become experts. Later on, the young patient will also learn how.

Special instructions will be given on food intake. There will be certain restrictions, and these will probably vary according to the nature and extent of activity of the child. Insulin needs may vary with exercise, and certainly if an infection takes place more insulin may be needed.

Most children with diabetes will be under the regular attention of a specialist or may attend the diabetic clinic of a major hospital which has the full facilities for treating the patient on a long-term basis.

In Australia diabetes is fairly common. There are believed to be between 75 000 and 100000 known diabetics; add to this the number of undiagnosed cases, and the figure is high. Many diabetics do not come to notice until their thirties or forties, or even later. This is called maturity onset diabetes. It is the most common kind. Patients are harbouring the disorder, but it is silent and for many years may cause no symptoms. Later in life, it may be diagnosed by chance when a patient visits the doctor for some unrelated condition and a urine test is carried out by the physician.

Diabetic coma

Occasionally the diabetic patient may slip into a diabetic coma. This may commence with marked thirst and passing a lot of urine frequently. Nausea, vomiting, abdominal pains and dehydration may occur. Breathing may be long, deep and laboured, and there may be headaches, irritability and drowsiness. This may increase until the patient becomes unconscious. The skin is dry, lips very red, blood pressure low, and pulse rapid. It may be preceded by an infection.

Any form of unconsciousness needs prompt medical attention and this is no exception. The sooner the patient is taken to the emergency care ward of a large hospital the better. There proper investigation and treatment may be carried out, and there are full facilities for performing the necessary therapy.

Hypoglycaemia (‘hypo’)

Sometimes the diabetic may receive too much insulin, or may fail to eat the prescribed amount of food, or may exercise too vigorously, so that too much sugar is removed from the blood. This is called hypoglycaemia, meaning insufficient sugar (glucose) in the blood. Most diabetics (and their parents) are aware of this possibility and are usually cautioned well beforehand.

Symptoms include weakness, hunger, irritability, a faint feeling, perspiring, rapid pulse, mood changes, vomiting, feeling nervous, walking in an unsteady manner, feeling shaky and trembly; and finally the diabetic may be semiconscious. If left untreated this may lead to serious brain damage, and even death.

However, treatment is simple and very effective. Giving glucose quickly reverses the situation and symptoms may vanish. Sugar in almost any form is suitable, but never try to give anything by mouth to an unconscious patient. Patients learn to recognize the early symptoms and will usually carry glucose with them and self-medicate promptly if they feel symptoms developing. The sooner .m unconscious diabetic receives medical help the better, so taking .m unconscious person immediately to a large hospital may be the best action.

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Three main symptoms occur: a sore throat, swollen glands in the neck (and later elsewhere), and a fever. Often this is preceded by the patient feeling generally off-colour. The tongue and often the tonsils become coated with a creamy discharge. Breath is unpleasant, nose congested, and tiny lymph glands under the jaw and in front of the neck swell and become tender.

As the illness develops, the liver and spleen (two large organs in the upper part of the abdomen) swell, and tenderness in this region is common.

Lack of appetite, feeling unwell in a vague sort of way, lack of energy, aches all over the body, nausea, sweating and general abdominal discomfort are typical symptoms. Occasionally there is a red rash, especially on those who have been given penicillin. Sometimes a mild jaundice may occur (the whites of the eyes and the skin turn yellow). Depression, headaches, fatigue and inability to concentrate are common symptoms that often persist for many weeks, and often months. A simple blood test usually gives the doctor the diagnosis.

Treatment

This illness is a self-limiting one and invariably cures itself. It simply takes time. Bed, fluids and adequate nutrition are necessary. Small, attractively prepared meals, emphasizing foods the patient normally likes, are the best idea. Gargling the throat with warm salty water gives relief from the sore throat. Analgesics and antipyretics aimed at reducing elevated temperatures and relieving aches and pains are given. There is no single drug that will magically bring about a cure. Vitamins aimed at increasing the body’s general health and vitality are often prescribed. Proper medical supervision is recommended with any of the symptoms that suggest this disorder.

Infectivity is low but appears to be spread via the saliva; therefore, kissing and sharing drinking utensils should be avoided until the patient is cured.

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To avoid spreading the infection, care should be taken to avoid sharing clothing, towels and bedlinen. Keeping the skin dry will prevent further growth of the fungus.

Tea tree oil applied directly to the area is often beneficial. Antifungal ointments and powders are also available from chemists without prescription. Garlic, either eaten fresh or in the form of capsules, may also help the infection clear up.

Dietary habits which may help to reduce the incidence of ringworm and other fungal infections include the elimination of refined starches and sugars and alcohol from the diet, as fungi thrive on these foods. Diabetics are particularly prone to ringworm when their sugar levels are high.

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In newborns, the openings into the tear ducts are often too small. These openings may be further blocked by the silver nitrate or other drops placed in the eyes at birth to prevent eye infections. Blockage of these openings may cause tears to flow out of the outer corner of the baby’s eye, even when the infant is not crying. Occasionally, instead of normal eye fluid, green or yellow pus will collect in the eye. This discharge will further block the tiny tear ducts.

If the nasolacrimal duct becomes blocked at the end inside the nose, tearing and possible infection will occur. Blockage at the nose end of the duct can be present at birth, or it may be caused by congestion from a cold or an allergy. When the nose end of the duct is blocked, the nasolacrimal sac between the eye and the side of the nose may swell with fluid and be visible as a distinct lump the size of a green pea.

Signs and symptoms

In infants, simple tearing of one or both eyes is so common as to be considered normal; it is harmless. However, if there is pus in the eye, redness and rawness at the outer coiners of the eyelids, or swelling of the tear sac (with or without redness), treatment may be needed.

Home care

Simple tearing needs no treatment. The tears can be wiped away and the eyelids cleaned by wiping with a cotton ball dipped in sterile water. Call the doctor if the eye is red, pus is present, or the tear duct is swollen. Redness of the skin at the outer corner of the eye, redness of the eye itself, or the presence of pus may be treated with antibiotic eye drops prescribed by the doctor, often over the telephone. If the tear sac at the side of the nose is swollen, your doctor may teach you how to gently massage the tear sac. (Do not attempt to massage the tear sac without a doctor’s instructions.)

Precautions

• With home treatment, the eyes should improve within 24 hours. If there is no improvement, notify your doctor.

• If improvement is prompt, continue treatment until the eye is clear for at least two days.

• Repeated problems of eye tearing are common in infants; save the eye drops for possible future use, but check the expiration date on the label before reusing.

Medical treatment

Your doctor’s treatment is the same as home treatment. Your doctor can demonstrate the proper method of massaging the tear sac, if needed. If the condition continues past the age of eight months to one year, your doctor may refer your child to an ophthalmologist (an eye specialist) who may surgically enlarge the nasolacrimal duct under general anesthesia.

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