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The growing organism must have efficient sleep. The newborn baby whose mechanism is largely vegetative sleeps from 20 to 22 hours out of 24. From this time on the amount of sleep required gradually decreases. At 6 months the average length of sleep is from 16 to 18 hours and at 1 year from 14 to 16. From the second to the six year 12 hours at night and a daily nap or rest meet the needs.
The decrease in sleeping hours should always be made at the expense of the day sleep. At 6 months the baby usually sleeps 2 hours in the forenoon and 2 in the afternoon. The afternoon period should be over by 3 p.m. One of these periods is gradually shortened until the second year but one nap a day is taken, and this should be continued until the sixth year. Even if children of 5 or 6 no longer sleep they should be made to rest in bed alone in the room, without toys and books.
The infant and the child should sleep alone. The bed clothing must vary with the season and the weight should never be too heavy or too light. Sleeping without pillows is best and if the child is trained this way pillows are not liked or needed. Sleeping out of doors when it is not too cold is advisable if it is available; otherwise the windows should be always open. Some children require more sleep than others. Every child must have, however, a certain minimum. The bed hour should be quieting. Rough play and intense excitement at this time are apt to delay the on-coming of sleep. When the child wakes from the nap or night rest it is important to teach habits of rapid dressing, and to prevent dallying and playing until dressing is complete and the morning toilet is finished.
PAIN IN THE HEAD
Pain is nature’s way of telling us that the body has a problem that needs attention. In most instances we know that there is no serious cause for concern, but this does not mean that we have to put up with the associated discomfort and subsequent disruption to our daily routines. The information contained in this article has therefore been designed to prove simple advice on the most effective ways to treat the variety of aches and pains that are commonly encountered.
All of us suffer from the occasional headache and fortunately in the majority of cases they tend to be an irritation rather than a serious problem. The four most common types of headache are described below with some tips for appropriate treatment:
Tension Headaches are usually a direct result of stress, including anxiety and tiredness, and are caused by a tightening of muscles in the shoulders, neck and head. The pain is frequently described as a heavy weight pressing down on the head. It follows that if we are able to identify and avoid stressful situations we may be able to prevent these headaches occurring. If not, anything helping to relax the muscles, for example a soak in a warm bath or a massage, should help relieve the problem.
Migraines are associated with severe pain and are sometimes confused with bad headaches. However they usually affect one side of the head and sometimes an attack is preceded by an “aura” – a period of strange sensations affecting sight, hearing and sometimes the voice. Symptoms include nausea and vomiting and sufferers tend to need to lie down in the dark. Some people are able to identify certain “triggers” responsible for their migraine attacks. Often it will be a certain food, like cheese, chocolate or red wine. It is thought that the actual pain is due to alternate contraction and expansion of blood vessels in the brain, caused by the action of chemicals in the blood. If you are prone to migraines, it is advisable to consult your doctor who may be able to prescribe a medicine to help prevent attacks developing beyond the early stages.
Sinus Headaches are usually easy to recognize but can be extremely painful. They occur when our sinuses are congested, for example, during a bad cold, and are often accompanied by a feeling of pressure on either side of the nose or below the eyes. Using a decongestant spray or vaporiser to unblock the sinuses is helpful in the relief of this type of headache.
Hangovers are famous for their association with the headache. Excessive alcohol can cause low blood sugar levels and dehydration, both of which contribute to the problem. In addition some alcoholic drinks, particularly highly coloured ones like red wine, contain substances called ‘congeners’ which also cause headaches. Naturally the best way to avoid hangovers is to drink only in moderation. If not try and stick to the clearer drinks like vodka and white wine, and drink a pint or two of water before bed.
STRAINS AND SPRAINS
There can be any one of a number of causes for muscle strain or injury. It may be an one-off accident caused by sudden twisting or turning on the sport field. It may be over-use, for example after a long walk if you are not used to taking regular exercise.
Strains and sprains should be treated using the RICE principle:
R – rest the injured area to aid healing and prevent further damage.
I – ice or freeze spray to cool inflammation and reduce swelling (heat treatments should never be used until 2 or 3 days after the injury has been sustained).
C – compress by bandaging. This provides support for the injured area.
E - elevate the damaged limb to lessen swelling and bruising.
Analgesics containing ibuprofen or aspirin are ideal for such problems as they treat the inflammation as well as the pain. These are also appropriate for the more general aches and pains common after over exertion. But as always, prevention is better than cure, so always take the time to warm up properly any sports activity and ensure you are wearing clothing, especially shoes, that won’t restrict movement and lead to damage.
Sportsmen and women, the elderly young children are particularly susceptible to more serious muscular or soft tissue injuries. In general a doctor’s advice should be sought when swelling has not subsided after 72 hours, the injury cannot bear any weight, or there is extensive or persistent bruising.
WATCH YOUR BACK
Back problems vary in severity. For some people a bad back means the odd twinge while for others it can be completely disabling and agonisingly painful.
There are many causes of back pain, including things like pregnancy, kidney infections and obesity. The majority of problems however, result from damage to the mechanical structure of the back which is put under constant stress as we go about our daily activities.
The following points provide simple self-help measures to help protect your back from everyday stresses: - Posture – always keep the back straight when seated or standing; A well-sprung bed will support the spine during sleep. A firm board under the mattress provides additional support; Work surfaces should be adjusted to a height which does not require bending; If overweight, losing a few pounds will ease the strain on the back; When carrying heavy objects, keep them close to the body and the spine straight. Bend the knees not the back when picking things up and putting them down. When carrying heavy shopping, distribute the load evenly between both hands – better still use a rucksack; The elderly should try and take regular, gentle exercise to maintain flexibility and strength of muscles and ligaments.
Pain resulting from back injuries can be treated in a similar way to muscular strains, as outlined above. Anti-inflammatory analgesics are now available in a gel form at your UniChem Pharmacy. These can be applied directly to the area causing discomfort for immediate relief. However if pain should persist beyond three days it is advisable to see your doctor who may recommend further treatment. Always ask your doctor to suggest a reputable osteopath, chiropractor or physiotherapist, if you want to try alternative approaches.
Spasmodic croup without fever. Croup is the word commonly used for various kinds of laryngitis in children. There is usually a hoarse, ringing, barking cough (croupy cough) and some tightness in the breathing.
The commonest and mildest type, spasmodic croup without fever, comes on suddenly during the evening. The child may have been perfectly healthy during the day or have had the mildest kind of cold without cough. Suddenly he wakes up with a violent fit of croupy coughing, is quite hoarse and is having difficulty breathing. He struggles and heaves to get his breath in. It’s quite a scary picture when you see it the first time, but it’s not so serious as it looks. You should call the doctor promptly for any kind of croup.
The emergency treatment of croup, until the doctor can be reached, is moist air. Use a cold mist humidifier if you have one, or other ways to humidify. Carry the child into the bathroom and turn on the hot water in the bathtub or shower – to make steam, not to put the child into. If there is a shower, that will work best of all.
When the child breathes the moist air, the croup usually begins to improve rapidly. Meanwhile, the air in the room where he will go back to be should be moistened. An adult should stay awake as long as there are any symptoms of croup, sleep in the same room with the child for 3 nights, and wake herself 2 or 3 hours after the croup is over to make sure that the child is breathing comfortably.
Spasmodic croup without fever sometimes comes back the next night or two. To avoid this, have the child sleep in a room in which the air has been moistened for 3 nights. This form of croup is apparently caused by the combination of a cold infection, a child with a sensitive larynx, and dry air.
Severe croup with fever (laryngobronchitis). This is a more severe form of croup which is usually accompanied by a real chest cold. The croupy cough and the tight breathing may come on gradually or suddenly at any time of the day or night. Steaming only partly relieves it. If your child has hoarseness with fever or tightness of breathing with fever, he must be put under the close, continuous supervision of a doctor without delay. If you cannot reach your doctor right away, find another doctor. If a doctor cannot reach you, you should take the child to a hospital.
Diphtheria of the larynx is still another cause of croup. There is a gradually increasing hoarseness, cough, difficulty in breathing and moderate fever. There is practically no danger of this form of croup developing if a child has received diphtheria inoculations.
However with any form of croup, a child should be seen promptly by a doctor. The urgency is greatest when hoarseness and tight breathing are persistent.
(B.Spock. Baby and Child Care.)
Children with HIV infection have an increased frequency of minor bacterial infections such as otitis media, sinusitis, impetigo, cellulites, urinary tract infection, and pneumonia. More serious infections reported include meningitis, osteomyelitis, septic arthritis, deep tissue abscesses, and bacteremia. Although the majority of children have hypergammaglobulimia, some present with hypogammaglobulinemia and these children are particularly susceptible to infection. In children, the development of two or more serious bacterial infections within a 2-year period of time is an AIDS-defining condition. The causative organisms are usually common childhood pathogens, particularly Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella species. In children in terminal stages of illnesses and with frequent hospitalizations, Staphylococcus aureus and Gramnegative pathogens, including Pseudomonas spp., take on increased importance.
This increased susceptibility to infection occurs as a result of B cell dysfunction induced by the virus, which leads to a decreased or absent antibody response to specific antigens. This dysfunction affects children to a greater extent than adults, probably because children are infected at a time when the immune response is immature and they do not have preexisting memory cells. The ability to produce antibody to a vaccine antigen can be used as a method to determine the response to other antigens in vivo and as an assessment of B cell function.
Children with HIV infection and recurrent infection may given from intravenous gamma globulin (IVIG) given monthly or bimonthly. A multicenter, doubleblind, placebo-controlled study comparing intravenous gamma globulin with an albumin placebo given to children with HIV infection showed that there was an increased time to development of a serious infection in those children with a CD4+ lymphocyte count greater than 200 mm3.
Tuberculosis continues to be public health problem in the USA. Since 1985, the number of cases have increased over the expected rate, and this is thought to be due to the increased number of cases among patients with HIV. Fourteen children with HIV infection with concomitant infection with tuberculosis have been reported. Of nine children reported from Miami, Florida, eight had pulmonary tuberculosis and four had extrapulmonary disease. Cough, fever, and anorexia were the most common symptoms at presentation. Only one child had a positive skin test reaction to purified protein derivative, and four had no known exposure to tuberculosis. In children with HIV infection, a tuberculin skin test reaction of 5 mm or greater is considered positive. In the severely immunodeficient child, the skin test for tuberculosis may not be reliable, and a control skin test using diphtheria toxoid or Candida antigen should be applied as a control to detect anergy. The diagnosis of pulmonary tuberculosis in the HIV-infected child should be suspected in the presence of perihilar or paratracheal nodes with a chronic lung infiltrate and in those children with pneumonia who are unresponsive to the usual antibiotic therapy. Diagnosis should be confirmed by culture of gastric aspirates in the young infant and child and sputum in older children. Initial therapy should include at least three drugs and these should be continued for at least a 1-year period. Short-course therapy or other abbreviated treatment schedules should not be used for therapy in this population. If multiple drug-resistant tuberculosis organisms are prevalent in the community, the four-drug therapy should be instituted pending results of culture and sensitivity. This epidemic has necessitated a reevaluation of the use of bacillus Calmette-Guerin (BCG) vaccine for those parts of the USA with a high incidence of tuberculosis and/or with a high incidence of drug-resistant strains of Mycobacterium tuberculosis.