Health news blog

The principles outlined above also hold true for children who wake during the night, unwanted habits of the child. The suggestions outlined here should not be considered for babies of less than 6 months, who are not yet into an established sleep pattern, and should be used with caution in those younger than 12 months. Beyond this age group, they are almost always effective in assisting the child to develop better sleep habits.

Waking during the night is not abnormal. What is abnormal is a child who wakes and then demands, indeed has come to expect, attention from his parents in the middle of the night. The problem usually begins because the parents will go to the child soon after he wakes up, rather than let him cry.

There are two ways that parents can deal with children who wake during the night and have learned to expect a feed or cuddle. They can either wean the child from this habit ‘cold turkey’ or else do it by ‘extinction’ over a period of time. Which of these is used depends on the preference of the parents — both are likely to be effective. Parents need to be sure they want to implement the treatment regime, then pick a starting date. Often a relationship with a health professional can be reassuring and supportive during this time.

*161\90\8*

What if?’. How many times during the course of the disorder have we all said this in one form or another: ‘what if I have an attack?’,'what if something happens?’,'what if I make a fool of myself?’ How many times has the anxiety stopped us from doing what we have wanted to do? How many times have we spent days, weeks or months worrying about ‘what if? What if this is perpetuating the disorder? It is.

Thinking about it

We give our thoughts the power and our thoughts destroy our lives. Everyone is always telling us ‘it is mind over matter’, or ‘you are always thinking about it’ and ‘you should just stop thinking about it’. This is exactly what we have to do. We have to stop thinking about it. We have to get to the point where it is mind over matter—we don’t really mind because it doesn’t really matter. In other words, we don’t mind if we do have an attack because it doesn’t really matter.

It is difficult for most people who haven’t experienced a panic attack and/or anxiety to understand why we can’t stop thinking about it and why we can’t ‘pull ourselves together’. If it were that simple we wouldn’t have the disorder. It is no use trying to ‘think positive’, because it is extremely hard to be positive when we are living with unremitting symptoms of anxiety and ongoing attacks.

Even though we are told repeatedly that nothing is going to happen to us, it is difficult to believe when we are constantly betrayed by the attacks and anxiety. We think the next attack is going to be ‘the one’ in which our fears will be realised. We can’t just ‘not think about it’ when we live and breathe it every day. This is the problem—we live and breathe it—because we constantly think it!

*75\94\8*

Refer to the definition of sleep problem: When a child’s sleep habits cause recurring or continuing problems for him or for his family, then there is a sleep problem.

The best way to identify a possible problem is to listen to the parents— yourselves. Listen to how you describe the experience of parenting. How quickly, or how often, does the subject of sleep come up? How much energy do you spend thinking, worrying, or complaining about sleep? Are your feelings about your child being colored by your frustration and exhaustion? If there were just one thing you could change about your child or your life, would it be sleep?

EXERCISE 1-1: Types Of Problems

The following checklist will help clarify the type or types of problem your child is having. Mark each sentence that generally describes your child. Use a check mark for those that fit at some times. Circle that check mark if it is a current issue.

1. She wakes during the night and can’t find her pacifier.

2. The only way I can get him back to sleep is to feed him.

3. He sleeps in late and won’t take a nap.

4. She hops out of bed defiantly.

5. He wants several drinks of water and goodnight kisses.

6. She comes to our bed during the night.

7. I can’t wake him in the morning.

8. He won’t be alone in his room because of the “monsters and snakes.”

9. She comes to our room scared and crying.

10. He needs to have all the lights on at bedtime but will look at books forever if I let him.

11. She screams and thrashes around.

12. My husband can’t put her to bed—she only wants Mom.

13. We are ready for bed, but he is not!

14. He calls out during the night wanting juice.

15. She wakes up several times with no particular pattern.    

16. He seems to wake about every few hours.

17. He is reluctant to go to sleep at bedtime because he’s afraid of bad dreams.

18. Note any uncircled check marks; these indicate changes—possibly improvements. Fit your answers into the following key to see possible types of problems your child shows. There may be some overlap because the same symptom can be an indicator of several types of problems.

Frequent waken 1, 6, 9, 14, 15, 16    Nightmares and sleep terrors: 8, 9, 11, 17

Night feeder: 2, 14    Difficulty getting to sleep: 4, 5, 8, 10, 12, 13, 17

Unusual sleep cycle: 3, 7, 10, 13, 15    

*4\67\8*

Inability to pass urine can be due to weakness of the bladder muscle or blockage of the passage running from the bladder to the outside. Weakness of the bladder muscle can arise from damage to or pressure on the nerves of the bladder—the trouble spot could be in the spinal cord or the pelvis. Such nerve damage usually causes loss of feeling in the bladder as well, so that you can’t tell when it is full. You may also become unable to empty your bladder properly as a result of certain drugs such as the chemotherapy drug vinblastine, some anti-depressants and some drugs which are used to control diarrhoea or urinary incontinence (inability to hold the urine).

Cancer of the cervix or prostate can block the urinary passage. So can non-cancerous enlargement of the prostate gland. If you »re unable to pass any urine at all naturally, it can be released either by passing a soft plastic tube (catheter) up through the urinary passage from the outside or by inserting a small tube through the skin of the lower part of your abdomen. Either of these can be comfortably done with the help of some local anaesthetic. The catheter may only be needed temporarily while the cause of the problem is tackled. If the cause cannot be corrected, or you decide that the cost of doing so would be greater than the benefit, you might have to keep a catheter permanently in place. This carries a risk of infection, but could still be the best alternative for you.

There are medications which can stimulate the bladder muscle to work better, for example, bethanechol chloride. With or without their help, you may be able to train yourself to empty a partially paralysed bladder naturally, so ask about this if the idea appeals to you.

*198/40/1*

There are drugs available which reduce the production of uric acid and others which help the kidney to excrete it. This 24-hour urine test will help the doctor decide which is the most appropriate.

These drugs include allopurinol (to reduce production) and probenecid and sulfinpyrozone (to improve excretion).

Colchicine is still used both to treat acute attacks and for prevention. It can be used with the other newer drugs.

In these days of screening medical tests, we find a number of men with high levels of uric acid who have not yet had an attack of gout.

Some doctors advocate treating them to prevent its onset, but most are reluctant to treat biochemical levels alone, waiting until gout shows itself with an acute arthritis rather than embarking on lifetime treatment.

Sufferers should take heart that proper treatment is available, as gout can be potentially serious as well as painful.

*387/71/1*

Of course, following hysterectomy, there is no risk of cancer of the womb, because there is no womb. The possibility that oestrogen may cause cancer of the breast is not supported by the evidence and the risk of clots is so small as not to count when compared to the advantages.

Many women experience depression following removal of the womb, others lose all interest in sex. These side-effects can be prevented if proper care in explaining to women what the operation entails is given before the operation.

This must be given in language the woman can understand. It may need to be repeated, especially if the woman is worried, as she may not take it all in the first time.

Then following the operation repeated counselling may be necessary.

The number of hysterectomies is increasing. This is not because doctors are increasing their incomes, but because of the changing expectations of women.

In the past many tolerated discomfort from heavy periods or pain from many of the pelvic disorders. Now a new generation is not prepared to tolerate these symptoms and demands relief, and, often, operation is the only effective treatment.

Women, being better educated and more insistent on their rights, properly demand operation rather than tolerate severe discomfort.

An added bonus for many women is removal of the risk of pregnancy.

Far from a hysterectomy being a defeminising operation, it can, and should be, a liberating factor in her life, taking away the tyranny of pain, discomfort and ill-health.

*134/71/1*

Before you read any further, it’s important to appreciate the type of event where the G.I. factor will help. It is one in which the athlete is undertaking a very strenuous form of exercise for longer than 90 minutes. Exercise physiologists define this by saying that the athlete is exercising at more than 65 per cent of their maximum capacity for a prolonged period. Examples of such events include a running or swimming marathon, a triathlon, non-stop tennis competition or football game (depending on the player’s position). Some forms of recreation such as cross-country skiing and mountain climbing may also benefit from the G.I. approach. In some occupations that require prolonged strenuous activity for hours and hours (such as bush fire-fighting), low G.I. foods may be beneficial.

Low G.I. foods are best before an event—approximately two hours before the big race. The meal will have left the stomach by then but continues to be digested in the small intestine for hours afterwards. The slow rate of carbohydrate digestion in low G.I. foods helps ensure that a steady stream of glucose is released into the bloodstream during the event. The extra glucose is available when needed towards the end of the exercise when muscle carbohydrate stores are running low. In this way, low G.I. foods increase endurance and prolong the time before exhaustion hits.

It’s also important to select low G.I. foods that do not cause gastrointestinal discomfort such as stomach cramps and flatulence. Some low G.I. foods such as legumes are high in fibre or indigestible sugars. However, not all low G.I. foods are fibrous and high residue The high amylose rices (Basmati and Doongara) and any form of white pasta are good examples of low G.I. foods that don’t contain much fibre. Instant noodles have a low G.L, too. Athletes who are too nervous to eat a solid meal, may prefer a liquid supplement such as Sustagen™ sport, which has a low G.I. (43).

Helen O’Connor, a dietitian who works with many of Australia’s Olympic athletes, teaches them how to manipulate the G.I. factor of their diet. Her pocket guide The G.L factor and Sports Nutrition provides menu plans and case studies and more hints for eating and competing. Her book The Taste of Fitness is packed with low G.L recipes for sports people.

The food industry is keenly interested in the G.I. factor, too, and it won’t be long before there are specially formulated low G.I. foods on the supermarket shelves specifically aimed at the serious sports person. The sports drinks that are enjoying much popularity at present have a high G.L, between 70 and 80. So they may not be an advantage before the event, but they are an invaluable aid during the event when blood sugar needs to be topped up, as well as after the event when glycogen stores need to be replenished.

The following table shows the serving sizes of low G.I. foods containing 50 grams or 75 grams of carbohydrate.

You will not win if your pre-event meal is jiggling around in your stomach (this will affect the jogger more than the cyclist). So test the timing and amount of low G.I. food during your training sessions. Then you’ll be ready for the big day. Don’t try it out for the first time on the day of the competition!

*114\42\4*

Male and female fat distribution and fat cell reactivity differs. Male-type centrally stored fat cells (around the abdomen) are known to be different in size and function to gluteal tissue, being more responsive to lipolytic and less responsive to lipogenic stimuli. Males generally use more energy for a set amount of exercise because of the larger proportion of lean body mass, or muscle, for a given body mass. Gluteal fat stores in females are widely regarded as having a biological function as an energy reserve for reproduction and milk production during lactation, and these are relatively resistant to fat loss even with high energy output or low energy intake.

Women experience greater hormonal swings throughout life (menarche, menstrual cycle, pregnancy and menopause) and these can impact significantly on body fat levels. The hormone levels in men by contrast, change only gradually with time as testosterone levels gradually decline with age. Women who don’t gain excessive weight during pregnancy, and who remain active both during pregnancy and after parturition, don’t seem to be at risk for extra fat gain—at least for the first 1-2 pregnancies. Women who are overfat or obese and who gain excessive weight during pregnancy are more likely to have problems after delivery. Breast-feeding mothers (over 6 months of breast-feeding) have been shown to stay leaner for longer than non-breast feeding mothers. In general also, the more babies a woman has, the greater her chances of becoming overfat or obese. It’s not known, however, whether this is due to physiological factors or the reduced ability to exercise and increased opportunity for over-eating, or whether it’s simply an association with other socioeconomic factors. Large families and obesity are more common in lower socioeconomic groups and the social status may be the determining factor for both.

Body composition differences between the genders also favour males in terms of energy expenditure. Men, in general, have a higher lean body mass to total mass ratio, with 12-24 per cent of body composition in the form of adipose tissue. Females on the other hand carry 15-30 per cent of their body mass in the form of fat. Higher lean body mass, even given constant weight, ensures a higher resting metabolic rate and hence men tend to have a greater energy use at rest. During exercise it has been shown that a man utilises up to 40 per cent more energy walking a set distance than a similar sized female.

Finally, there are psychological and sociological differences between the sexes which, although potentially changeable, can have a profound impact on body fat levels. The idealised female shape, for example, is now one of thinness. This has changed throughout history, there being good evidence (in art and literature) that a more ample female form has been preferred in the past. When fatness indicated wealth, a well-fed female body was desired. In the 20th century in Western countries, where energy-rich food is generally plentiful, fatness is easy and leanness is more associated with wealth, status and influence. Anorexia nervosa is the pathological extreme of this obsession with a thin figure.

Dietitian Jenny O’Dea from Sydney University has shown that females generally idealise a much thinner body size for themselves than is preferred by most males. The social pressures to conform to an ideal shape is greater in females (even if it is largely females who apply that pressure). A pot belly in a male doesn’t attract the same social pressures as a similar degree of fatness in a female, even though the male’s fatness is more dangerous to health.

Sex differences in body fatness have very real implications for fat loss planning. It is totally unrealistic to expect similar results from a male and female placed on the same type of fat loss program, although this is often expected by partners who may undertake the same kind of program. To the extreme frustration (and often guilt and depression) of the female partner, it is usually the male who is able to lose fat more easily and faster, and to keep this off longer, than the female. More support is often needed for females to ensure adequate eating patterns to encourage satisfaction with a body shape which is less than ideal and to prevent discouragement with slow fat losses.

*178\186\4*

The energy content of foods, or the energy requirements of physical activities, can be measured in a number of ways. Basically there are three categories of measures that are used:

1. Direct calorimetry. Direct calorimetry can also be used to measure energy expenditure in the form of heat loss from the human body. This requires placing a person in a small chamber in which all the heat released is measured. Unfortunately, such chambers are very expensive and are only present in well-established research laboratories. Direct calorimetry can also be used to measure the energy content of food through ‘bomb calorimetry’, as previously discussed.

2. Indirect calorimetry. This calculates energy use directly from measurements of the amount of oxygen (O2) consumed, carbon dioxide (CO2) and nitrogen produced (the latter to eliminate protein metabolism in the equation). This can also be done in a chamber (metabolic or respiratory chamber) over periods of 24 hours or more, or it can be done with a hood system over a period of minutes or hours.

From indirect calorimetry equations, the amount of each type of energy substrate being used can also be calculated. This is expressed as the respiratory exchange ratio (RER), or respiratory quotient (RQ).

The RER, which is based on the ratio of oxygen (02) consumed to carbon dioxide (CO2) produced, can provide information about whether the predominant energy source being used is carbohydrate or fat. The theory behind this is that more oxygen is required to bum fat relative to the amount of carbon dioxide produced. In fact, the ratio of 02 to C02 is around 0.7 when fat is the total fuel being oxidised. On the other hand, when carbohydrate is used as a fuel, equal amounts of 02 and C02 are involved. Where carbohydrate is the sole fuel therefore the ratio of 02 to C02 is 1.0.

At rest, the terms respiratory exchange ratio (RER) and respiratory quotient (RQ) can be used interchangeably, although strictly speaking there is a difference. RER refers to the exchange ratio of gases expired, whereas RQ is a measure of the ratio of fuel use at the tissue level. RER, which is more relevant for our purposes here, is derived from the chemical calculations.

*39\186\4*

Every baby, infant and child will experience various disorders of the abdomen and gastro-intestinal system. This is inevitable. The ones we have already discussed are among the more common. However, there is a huge list of others. The average child will not be involved in these, but without doubt a certain number of little ones are destined to contract one of them. Diagnosis is often difficult, and even doctors expert in the field of baby care may be hoodwinked and find the exact diagnosis takes time and many tests.

Only a few of the important but less common abdominal disorders are described on the following pages. It is not an exhaustive list of complaints, nor does it give more than brief general information. But it may offer some extra detail if a parent hears of the complaint or wishes to have some added knowledge.

As I have emphasized earlier, this book is intended to be used only as a general guide. It is not a do-it-yourself compendium, and is not intended to be used that way. Whilst many simple ailments may be treated at home by parents, others require proper medical diagnosis and supervision in treatment. Never begrudge money or time spent in having the best possible attention for your child. It may pay handsome dividends and may be life-saving.

*60\87\2*