Decreased activity The baby is less active, and moves arms and legs less. He may just tend to lie around, or want to be cuddled by a parent rather than be involved in activities that are normally of interest.

Breathing difficulty This is an important sign of a potentially serious illness, and may take several forms. The baby may be breathing very quickly, or grunting with each breath. He may be coughing non-stop, and with each breath you may notice the muscles between the ribs being sucked in, or else he may be blue around the mouth. Sometimes it is difficult for parents to assess the baby’s breathing, and you should not hesitate to seek immediate medical advice if you are unsure. Poor circulation The baby may look paler than usual, and this can last for up to several hours. In addition, you may notice that his hands and feet may be cold or even blue.

Poor feeding The baby drinks much less than usual. Breastfed babies suck less strongly and for shorter periods of time. Bottle-fed babies take less than half the normal amount of milk that they normally drink in 24 hours. The baby may not be very interested in feeding in general.

Poor urine output The baby has fewer than four wet nappies in 24 hours.

The more of these signs the baby or young child has, the more chance there is that he has a potentially serious illness. You should see the doctor if any one of these signs is present in your child. If the child shows more than one of these signs, you should seek urgent medical attention.

A doctor should also see the baby as a matter of urgency if any of the following

occur:

• the baby vomits green fluid;

• the baby has a convulsion (fit);

• the baby has a very high temperature (fever). (Note that a high fever is potentially much more serious in a baby of less than 6 months than it is in an older child. Fever in a baby always needs medical attention as it is more likely to indicate a significant and potentially serious infection.);

• the baby stops breathing for more than 15 seconds (apnoeic episode);

• the baby has a lump in the groin area (hernia).

Remember that in babies and young children illness can progress more quickly. If in doubt, seek medical advice.

Sometimes parents may put off seeking advice for a variety of reasons. They may not want to worry the doctor with what may turn out to be a trivial illness, especially at night or if they think that he or she is very busy. They may be anxious that their fears are groundless and that they will appear foolish if the baby turns out to have a minor illness. In addition to diagnosing and treating illness, one of the most important things that a doctor should do is to reassure parents that their child is in fact well. This can alleviate a lot of unnecessary anxiety.

If you are concerned, for whatever reason, you should seek medical advice. Usually this will mean taking the child to your general practitioner. Most doctors repeated difficulty getting a rapid appointment for your baby to be seen by a doctor, or if you are made to feel guilty for ‘wasting the doctor’s time’, then it may be time to find a different doctor.

If you are worried about your baby or young child for any reason, do not hesitate to seek medical advice.

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This test is used to detect the presence of abnormalities of the middle ear, such as whether fluid is present, or whether there is ‘glue ear’. A sophisticated probe attached to an earplug is placed in the child’s ear. This may be slightly uncomfortable but does not hurt. It will help if you sit your child on your knee during the procedure, and continually reassure him. The probe varies the pressure in the ear and results in a graphic printout which represents the functioning of the middle ear. The doctor uses this to determine whether there are abnormalities which need to be treated. Tympanometry is often performed in conjunction with a hearing test.

ULTRASOUND SCANNING

Ultrasound is a technique which uses high frequency sound waves to produce an image on a television screen of internal organs. The sound waves are bounced off individual organs, and converted into pictures. Different organs have characteristic appearances on ultrasounds, so structural abnormalities can be discovered in this way. Many organs can be visualised well using the ultrasound technique but not all can.

The procedure is quite painless. The person to be examined is asked to lie on a bed and an instrument which looks like a microphone is covered in jelly and then rubbed over the abdomen. The procedure does not involve the use of radiation.

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WIFE

Almost half of our population changes residence every five years or so. We are a mobile, relocating society. Every psychotherapist knows that moving, changing where you live, is one of the most disruptive of life experiences. I noticed that the inpatient unit at my hospital typically contained patients who had moved relatively recently. The move itself does not cause their emotional problems, but the stress accompanying moving probably exacerbates any propensity to fail to cope.

Early in the super marital sex program, some couples who seemed to be making excellent progress regressed during the five-year follow-up. One factor often mentioned was relocation. They reported an almost complete upheaval across their life experience and their sexual relationship suffered from either neglect or situational disruption.

At a recent professional meeting on marital and sexual therapy t one of my colleagues questioned the possibility that moving could really cause sexual problems. He felt that such problems were caused by what he called “deeper-seated problems within the marriage.”

This question misses the point that most problems causing marital and sexual difficulties are “transitional problems” common to all of us. To assume that moving is not stressful enough to disrupt sexuality is to fail to realize that any system, particularly a marital system, is affected by change. How the couple copes with the change, and the couple’s ability to preserve emotional intimacy even at times of more mechanical, mundane requirements, is a key predictor of the adaptive strength of the marriage.

Moving alters social support systems and parenting responsibilities; it heightens feelings of vulnerability and causes feelings of “temporariness.” It is not just the stress of moving that makes relaxed, intimate sexuality difficult, but memories or unresolved issues associated with places and people left behind. The couple may move closer to or farther from one set of parents and may feel resentment. “I don’t really think it was a factor,” said one husband, “but when we moved from Boston to Chicago, we were that much closer to her parents, who live in Hawaii. It sounds ludicrous when I say it, but I’ll bet it played some part in why she took this new job.” The lack of communication and trust ?n this statement was playing itself out in the sexuality of this couple. The wife reported, “Since we moved, he has been kind of cold, distant. We have sex, but not quite like before.” If this is what the colleague who questioned the impact of moving meant by “deeper” issues being at work when marital problems result, then certainly these are important to intimacy, but this was and still is a strong and loving couple who was disrupted by the move and for whom the issue of moving brought up issues that would otherwise not have been so intrusive.

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Hydatid cysts are common in countries with large sheep populations and so are found not only in Australia but also in the Middle East, in parts of Europe and in North America.

They were first recognised in Australia in 1850 and in the years between the world wars, Sir Harold Dew, professor of surgery at Sydney University, wrote the definitive textbook on this disease.

What is a tragedy is that, although we have the knowledge to eradicate this problem, it is still as common as it was in the first half of this century.

Echinococcus granulosis is a tapeworm of dogs. It is only 4 to 6 mm in length and consists of a head, or scolex, with three or four segments (proglottides).

Each segment has a complete set of both male and female reproductive organs. When the lowest segment is mature, it drops off and the eggs it contains are liberated and pass out with the faeces. A segment may contain up to 1000 eggs and is usually shed every 14 days.

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It was first described in children in 1978.

It usually has an acute onset with fever, vomiting, diarrhoea, headache, muscular aches, a spreading rash followed by collapse or shock.

Some women use tampons because they have a vaginal discharge rather than only when menstruating. It may be worthwhile considering seeing a doctor to determine the cause of the discharge and what can be done to cure it rather than using tampons for protection and putting up with the discharge.

Any serious illness, such as this, with what appears to be a high mortality can frighten women but, so far, the incidence is low and there may be a greater danger of dying in a road accident than from toxic shock syndrome.

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Dermatitis artefacts. This is a skin disorder which is self-inflicted. Furthermore the patient denies having produced the lesion with his own hands. Chemicals, heat, or other physical and mechanical means may be used to inflict the disorder, and the lesions are therefore of singularly curious patterning, generally not conforming to known disorders and usually in an easily accessible area. A fairly decisive diagnostic indication is the disappearance of the lesion under an occlusive dressing.

Generally speaking two types of patient perpetrate this type of disorder: the hysterical individual, with a rather apathetic appearance, who converts intense anxiety into this symptom; and the malingering individual, who produces the lesion to attain some gain or to explain a lack of success. These patients require definite help, and should certainly not be confronted or accused of self-infliction. Psychiatric referral is very wise.

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Lemon juice (G.I. = 0). A small amount of lemon juice (1 tablespoon) won’t add any carbohydrate but its acidity has a powerful slowing effect on stomach emptying thereby slowing down the rate of starch degestion. Vinegar has the same effect.

Milk (G.I. of 27) • Lactose, the sugar occurring naturally in milk, is a disaccharide which must be digested into its component sugars before absorption. The two sugars that result, glucose and galactose, compete with each other for absorption. This slows down absorption and lowers the G.I. The presence of protein and fat in milk also lowers the G.I. of milk.

Oat bran (G.I. of 55) Unprocessed oat bran is available in the cereal section of supermarkets, usually loosely packed in plastic bags. Its carbohydrate content is lower than that of oats and it is higher in fibre, particularly soluble fibre, which is probably responsible for its low G.I A soft, bland product, it is useful as a partial substitution for flour in baked goods to lower the G.I.

Oranges (G.I. of 44) • Well known as a good source of vitamin C, most of the sugar content of oranges is sucrose. This, and their high acid content, probably accounts for their low G.I. Parboiled rice (G.I. range: 38 to 87) • Parboiling involves steeping rice in hot water and steaming it prior to drying and milling. Nutrients from the bran layer are retained in the grain and the cooked product has less tendency to be sticky- Some studies have found parboiled rice to have a lower G.I. but studies on Australian rice have found only small differences between parboiled and regular rice. The overriding determinant of the G.L of rice is the type of starch present in the grain.

Pasta (G.I. range: 32 to 64) • Pasta is made from hard wheat semolina with a high protein content, which gives a strong dough. Protein-starch interactions and minimal disruption to the starch granules during processing contribute to the low G.I. There is some evidence that thicker pasta has a lower G.I. than thin types.

Peach (G.I. of 42, fresh; 30, canned) • Most of the sugar in peaches is sucrose (4.7 per cent). Other aspects like their acid and fibre content may account for their low G.I.

Peanuts (G.I. of 14) • A low carbohydrate but high fat food, being 50 per cent fat and 25 per cent protein* which is one reason for the low G.I. value.

Pear (G.I. of 38, fresh; 44, canned) Another fruit with a high fructose (6.7 per cent) content, accounting for the low G.I.

Peas (G.I. of 48) • Peas are high in fibre and also higher in protein than most other vegetables. Protein-starch interactions may contribute to their lower G.I. They also average 3.5 per cent sucrose giving them a sweet flavour.

Pineapple juice (G.I. of 46) • Mainly sucrose (7.9 per cent).

Pita bread (G.I. of 57) Unleavened flat bread was found to have a slightly lower G.I. than regular bread in a Canadian study. Sold in supermarkets in packets of flat rounds.

Ploughman’s Loaf™ Wholegrain (GJ. of 47) • A wholemeal bread with additional whole grains. It is widely available in supermarkets. Other varieties under the Ploughman’s label are probably also low G.I.

Plums (GJ. of 39) • The G.I. for plums comes from a European study. Australian plums containing a fairly equal mixture of glucose, fructose and sucrose. The higher the concentration of sugars, the slower the food is emptied from the stomach and hence the slower the absorption. This may account for the low G.I.

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