Parents should expect the child to be distressed at these times — this is perfectly normal. In most instances, if properly handled, the distress will quickly dissipate and will become less frequent and less intense as the child becomes more familiar with the new surroundings, and more comfortable with his new care-givers, and as he becomes more confident with experience that the parent will indeed return.

The situation is often made worse by the parents’ own ambivalence about the separation. The mother and/or father may have all sorts of mixed feelings about leaving their child — ambivalence about a child growing up too quickly, anxiety about the child’s safety and so on — that are transmitted to the child. While such feelings are only too normal and often understandable, they may develop into an overprotective attitude towards the child which serves to hinder his development. This may also manifest itself in other ways, such as a reluctance to set consistent limits, and so on. Ultimately this may lead to a child who is reluctant to participate fully in the various experiences of life, who is overdependent on adults, and who reacts to any anxiety or stress by turning these feelings inwards so they are expressed as somatic symptoms such as abdominal pain, sleep problems and nightmares, and headaches.

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Working with our avoidance behaviour, and the whole process of recovery, means we need to learn to care of ourselves. We need to learn when it is appropriate to pull back and take a break, as long as the break doesn’t go on for weeks. After the break, begin again.

Begin again. These two words can mean so much in the working-through process. If we feel that we are not making progress, if we feel that some of our attempts didn’t quite work out the way we would have liked, let them go and begin again.

Our ultra-sensitivity also increases the sense of guilt we feel towards our families because we can’t do everything we would like to do. We need to be aware of the extra stress caused by this. We can spend a week worrying and feeling guilty over one small incident which we think of as a failure. Guilt only increases our anxiety. It keep us locked into the cycle. We need to let it go, so we can move forward to recovery and to the time when we will be able to do everything we haven’t been able to do.

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After the cause of such a disturbance is addressed, some children slip back naturally into smooth sleep patterns. Others learn new habits or are thrown such disequilibrium that the wakefulness continues. This may be the beginning of sleep difficulties. Recognizing the changes as they occur can help you I watch to see if a desirable pattern is developing.

You can decide how long to allow a child to re-establish a desirable pattern on his own. Several factors should be taken into consideration:

?    His history of being able to settle himself: after his last illness, did he return

quickly to his old patterns or did you need to “draw the line?”

?    His temperament: is he a “natural night owl” who will take any opportunity

to stay awake?

? His needs: how well is he coping during the day with reduced sleep?

? Your needs: how are you coping? How long can you wait it out? When a reasonable amount of time has passed and you have decided that a new habit has formed or has the potential to develop, you can change your response or intervene with the method that works for you.

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A fit happens when part or all of the brain becomes abnormally irritable. If it is only part of the brain, there may just be jerky movements of part of the body — say one arm or leg— without loss of consciousness. A generalised fit involves jerking movements of the whole body and loss of consciousness for a few minutes. There may be some warning immediately before the fit in the form of strange feelings — anxiety, flashing lights, unusual smells, noises in the head or some other unusual feeling. When people come to from a fit they usually feel rather strange and tired for some hours and just want to sleep. Some part of their body may be paralysed when they first come to but this usually goes back to normal over the next few hours.

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Where a patient has specific symptoms for which a doctor cannot find enough evidence to make a diagnosis, he should carry out specific tests, usually one or two at a time, to find out what is going on. Ordering a whole battery of tests may save time but often means many are ordered unnecessarily and this may be expensive.

The Australian Medical Association has recently reaffirmed its policy that multiphasic health screening of healthy persons should not attract a subsidy from the Government or the health funds but the cost of it should be totally borne by the individual.

This opinion is not shared by all doctors and some are wholeheartedly in favor of screening of healthy people and believe early disease may thus be detected before symptoms make themselves known.

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Those that occur in the second trimester or between three to six months, usually are due to dilatation or opening of the cervix or neck of the womb.

This may happen as the result of a previous injury to the muscles of the cervix, during childbirth, or from stretching of these muscles during a curette or induced abortion.

If trouble is recognised early, or as a preventive measure with a subsequent pregnancy, a firm suture or stitch can be put in the cervix early in the pregnancy, and this may enable the pregnancy to continue to full term.

Why should a woman miscarry?

Unfortunately, in most instances, we doctors just do not know the reason, although some doctors tell their patients it’s nature’s way of ensuring that most babies born are normal — thereby assuming that a pregnancy that miscarried is abnormal.

This probably is just speculation.

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A hypo is a potentially dangerous situation and must be treated straight away by eating some carbohydrate food. In this case you should pick a carbohydrate with a high G.I. factor because you need to increase your blood sugar quickly. Jelly beans (with a G.I. factor of 80) are a good choice. If you are not due for your next meal or snack you should also have some low G.I. carbohdyrate, like an apple, to keep your blood sugar from falling again until you next eat.

Hypos in the night were a particularly worrying problem for Jane. Her evening insulin doses had been adjusted in an effort to stop her blood sugar going too low at night, but she believed experimenting with her supper carbohydrate could also help. After trying all sorts of different foods and many 3 am blood tests, she struck the answer that the G.I. factor predicted would work—milk! Jane found that a large glass of milk before going to bed, rather than her usual plain biscuits was easy to have, and maintained her blood sugar at a good level through the night.

Sometimes, despite your best efforts with diet, tablets will still be needed to obtain good blood sugar control. This is eventually the case for most people with type 2 diabetes.

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Physical activity at this stage of life is vital. Excessive TV viewing in adolescents has been linked with inactivity which may foreshadow the development of obesity in an adult. Prevention strategies at this critical period are obviously preferable and easier than trying to cure overfatness later in life. More recognition needs to be given to this fact in public health approaches to the problem.

One prominent study carried out in the US has shown that strategies which decrease TV viewing and other inactive pastimes may be more effective as a fat loss technique in children than attempting to increase their involvement in physical activity and sports.

Myth-information. Any fat loss program that proclaims ‘no exercise, no effort’ needs to be looked at suspiciously. While it is possible to lose fat through diet alone, long term maintenance of fat loss requires at least a moderate level of physical activity.

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• Unlike carbohydrate and protein, fat is not finely balancec in the body.

• Fat (from the diet and adipose tissue) is the energy buffer for the body—it makes up the difference between what the body obtains from non-fat calories and what it needs.

• Alcohol is the highest priority fuel for burning, but unlike protein and carbohydrate, it does not reduce hunger.

• Energy balance and fat balance are essentially equivalent.

1. Reducing dietary fat in favour of carbohydrate and protein is likely to be the most effective long term dietary fat loss technique.

2. Alcohol denial may not be necessary on a fat loss program but restriction of dietary fat is advisable if mamtairiing alcohol intake.

3. Because alcohol in the body is only partially balanced, control of hunger may be more of a problem with alcohol consumption in terms of fat gain than the alcohol itself.

4. Carbohydrate intake in the presence of a low-fat diet can be surprisingly high, thus allowing for greater satiation and less hunger.

5. The use of a low-fat ad libitum eating plan, in contrast to reduced total calories may result in a less immediate weight loss, but a slower and more permanent reduction in body fat.

6. A low-fat eating plan is likely to be a much more liveable option for most people than trying to get them to eat less total food.

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In years past, this was common with tuberculosis, and fluid or pus would frequently collect between the lungs and the lung cage.

This was called effusion and empyema. This is seldom seen today, particularly as tuberculosis is far less common.

Treatment

Medical attention as early as practical is recommended with symptoms of this nature. Antibiotics are usually extremely quick and effective in killing the germs. A large range of organisms may be responsible, but many are amenable to treatment, and often a rapid cure is readily forthcoming.

Plenty of fluids, bed rest for a few days, linctuses for coughs, analgesics and antipyretics for pain relief, and to reduce elevated temperatures, may be given as necessary. Paracetamol elixir for children under the age of six years is effective in the latter case, or paracetamol or aspirin tablets for those in the 6-12 age group. Dosage varies with age—check the label, which usually lists the dose for each age. Check the details given earlier for the common cold, for the advice is similar.

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