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Preschoolers experience the same sleep problems as toddlers. Bad habits and behaviours learned during the toddler period have often become entrenched by this time. During school age most children will have outgrown the problems seen at younger ages, but this is the peak age for nightmares, school terrors and sleepwalking. Some children also have trouble getting off to sleep, or wake very early in the morning. This is often related to stresses in their day to day life, and many children ruminate endlessly about the day’s events or worry about what the next day will bring.

In general, the problems referred to above are those that persist for prolonged periods of time when the child is well and there are no specific family disruptions. It is very important for parents to understand that all children will exhibit altered sleep patterns when they are sick or there are changes to family routine. Even trivial illnesses, such as colds, that do not seem to affect young children much during the day, may affect them at night. They may need more cuddling and become more dependent on parents, and may wake during the night even if they have already established regular sleep patterns.

Similarly, it is quite normal for children to regress at times of stress or family disruption. Children who have to spend time in hospital or have been separated from the parents for some other reason will behave like a younger child for a period of time. One of the commonest reasons children regress, including reverting to more immature sleep patterns, is the arrival of a younger sibling.

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Pinch the patient’s nose between finger and thumb, take a deep breath and apply your lips firmly on the lips of the patient.

If this procedure or blood or vomit around the mouth makes you sick, place a clean handkerchief over the mouth and breathe through that.

If the mouth is injured or if it is difficult to breathe through the mouth, “mouth-to-nose” resuscitation will produce equally good results.

Breathe into the mouth and watch to see if the chest is rising. This will show that your breath is getting into the patient’s lungs. Then sit up and watch the chest collapse. This will show that the air is coming out. Take another deep breath and repeat the exercise.

For a child, breathe at the rate of about 20 per minute, and for adults about 10-15 per minute. As a rule a few quick breaths for a start, then settle into a routine.

If artificial respiration has to be maintained for some time, you may become tired. If there is someone with you, taking turns will make it easier. Keep it up until the patient starts breathing on his own.

If your patient starts breathing, even shallowly, time your breathing to coincide with his.

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Mention gout and people are apt to snigger, yet this common disease is no laughing matter.

My introduction to gout was in the comics of my youth, where the Indian Army colonel with the flushed face had his foot wrapped in a turban and his mood was always irascible.

This comic attitude, unfortunately, still persists, so that the sufferer gets little sympathy. But he himself is also likely to regard it too lightly.

Gout, or podagra, is an ancient disease, being well known even before the time of Hippocrates, the “father of medicine” who lived nearly 500 years before Christ. The list of famous men who have had this disorder reads like an historical Who’s Who.

Gout is mainly a male disease — 20 times as many men get it for every woman sufferer. The first attack usually comes in the forties but it is not unusual in men in their twenties — and it can even occur in children.

The trouble is an inborn error in metabolism — the tendency to gout is inherited.

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The operation which women most fear is removal of the breast.

This is only done for cancer and the fear of that disease is added to the feeling of disfigurement and loss of femininity.

Hysterectomy, or removal of the womb, on the other hand is usually done for non-cancerous conditions. Yet this operation is often misunderstood by women and as a result leads to many problems which are mainly preventable.

The uterus or womb is an organ, shaped like a pear and about the size of a golf ball. It lies low in the pelvis and can’t be felt through the abdomen unless it is enlarged. The neck of the womb, or cervix, projects into the top of the vagina.

From either side of the uterus come the Fallopian tubes and the outer open ends of these lie over the ovaries. The womb is held in place by ligaments.

The inside of the womb is hollow and lined by tissue called the endometrium.

During a woman’s reproductive life, this tissue is acted on by the hormones, oestrogen and proger-sterone, which are produced by the ovaries.

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There are all kinds of worms. Some you find when digging in the garden. They’re usually long, juicy-looking, slimey things but they are useful (so my gardening friends remind me) for aerating the ground and helping plants grow. Then there are cut-worms which always seemed to chop off my new seedlings at ground level (that’s why I gave up gardening). My older brother, an inveterate and fanatical fisherman in his spare time, often searches the beach for worms when holidaying. He says they make good bait.

But I’m getting carried away… I wish to talk about human worms, or rather worms that inhabit the human system. They are commonly called threadworms, or Enterobius vermicularis if you like scientific names you can hardly get your tongue around. They are called threadworms because they look just like that. A bit of white cotton cut up into little lengths. Only they are very active and can turn and twist and crawl around in a most active way.

Worm infestations are common in children. Often the worms, in large numbers, come from the anal canal and crawl around the external part of the back passage. In fact, if examined at night with a torch, many of these creepy crawling things may be seen in a child with a heavy infestation. Personally, they give me the creeps.

In turn, this produces irritation and itching of the back passage. Often the child scratches, and the area may become sore or even infected if the skin is broken and germs start multiplying. Worms are commonly blamed for irritation, nail biting, nervousness and restlessness, especially during the night. Often vague gastric and nerve symptoms are related to infestations, rightfully or wrongfully. And the worms in their merry-making may become lost; cases have been reported in girls where the worms have reached the vagina and set up irritations there. They are also blamed for some cases of ongoing bed-wetting in children. But often there are few or no symptoms.

Commonly all of the children in a family may be infected. The eggs are highly infectious, and transmitted by scratching fingers from the anal region, they may reach toys, school books, writing implements and other objects that are of common interest. Once the eggs have reached the fingers, it is only a matter of time before they reach the mouth, then the bowel. Here they readily and rapidly hatch out, to set up further infestation. Inattention to adequate hygiene is a major factor in their spread. Inadequate hand washing after handling another person’s property, or before handling food or putting the hands to the mouth, is an important factor.

Treatment

Often it is simple to make the diagnosis, and often parents themselves will see the worms in their children. A simple examination of the stools will often reveal their presence; sometimes the doctor will have an examination carried out to discover either the worms or their eggs. These may be collected from fresh stools, or from around the anal margin. A simple test to detect their presence is done by sticking a piece of cellophane adhesive against the patient’s skin, removing it and replacing it on a glass slide which is then examined under the microscope. The doctor or pathologist may do this.

General hygiene is important. All members of the household should be treated at the same time—or the whole class if the disorder is widespread and has come to the general attention of the teachers.

The hand-washing routine after attending the toilet every time, and before handling or eating food, is essential. Soap and hot water should be used. The fingernails should be scrubbed often with a nail brush and soap. Nails should be kept short at all times, and regularly retrimmed. Regular washing of underclothing and bedclothes is important in getting rid of eggs.

Medication is usually very effective. However, although a single dose is often adequate to kill the organism in the bowel, reinfection is common. Ideally, the whole family is treated at the same time, and proper medical supervision is suggested. Pyrantel embonate (commercially known as Combantrin) and viprynium embonate (Vanquin) have been widely and successfully used for several years. Mebendazole (Vermox) in one single dose is also extremely effective.

Roundworms

Infestation by roundworms (Ascaris lumbricordes) is rare in this country. It is common in tropical countries, and may cause abdominal distention, colic, diarrhoea and emaciation. It is diagnosed when the worm or its eggs are located in stools. The egg may be passed in the faeces into the soil, where larvae develop, and are retransmitted to humans via soil-contaminated fingers or feet. Medical treatment is satisfactory.

Tapeworms

Tapeworms (caused by Taenia saginata from beef or Taenia solium from pork) come through eating inadequately cooked infected meat. General abdominal symptoms, diarrhoea and fever may occur. The parasite sucks blood from the bowel lining. Diagnosis is made when parts of the body are detected in faeces. Medical treatment effects a cure.

Giardiasis

A parasitic bowel infestation, giardiasis has been around for many years, but only for a short time, to any appreciable extent, in Australia. It produces loose bowel actions that do not stop within a few days, as do most bowel upsets. Motions are loose, watery, frothy, offensive. Most doctors consider a diarrhoea that has been persisting for a week or more to be most likely caused by this parasite. It is treated with metronidazole, and proper medical supervision is advisable. Treatment is invariably effective, but recurrences may occur. Most cases have been imported into Australia from European and Eastern lands, and it is now firmly entrenched in this country, especially in the eastern states.

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‘Over the years millions and millions of babies have been successfully bottle fed and have come to no harm. If this kind of feeding is necessary, the mother should accept the fact and not have “hang-ups” over it, for the baby will certainly thrive and develop into a happy and healthy child and adult.

‘When bottle feeding the ideal is to hold the baby as close to your body as possible, for close body contact, once more, increases the mother-baby bond which we believe is important to normal development.

‘Is cow’s milk given straight?’ Karen asked.

‘No, cow’s milk must be modified to make it suitable for the baby. Many excellent commercial brands are available which have been modified to simulate mother’s milk as much as possible. Often the proper amount of vitamins and minerals have been added to provide the necessary requirements.

‘Once more, demand feeding may be practised. But, it has been found that overweight is more common in bottle-fed babies. Whereas a baby will automatically gauge how much breast milk he or she takes, a vigilant parent may think it essential that the baby drain the last dregs from a measured amount of fluid in a bottle. Often the baby is best barometer of food needs.’

‘We often hear horrible stories about breast feeding. Some claim it will ruin your figure; your breasts will look terrible afterwards; that you develop fat on the hips and thighs and around the tummy, and so on. What do you say about this?’

‘The breasts certainly increase in size before the birth and during lactation,’ I said. ‘This is inevitable. After it is all over, the breasts tend to return to their previous size. Sometimes, there is a change in the fat distribution of the mother’s body, possibly because of the various hormonal changes that took place during the whole experience. Many women find breast dimensions similar to the time before they were pregnant. Others find them smaller as the fat deposits have lessened.

‘Many women put on from three to six kilograms (6-14 lb) in weight, from the time before pregnancy to the time the baby is a few months old. What’s more, this weight is often hard to dislodge. It tends to accumulate around the hips, thighs and buttocks and abdominal wall. It is often a consequence of the woman’s eating more during these months, perhaps in the hope of producing enough good-quality milk for the baby. But, commonsense eating habits and a sensible diet after it is all over will help her regain her normal pre-pregnancy shape again.’

‘Normally my breasts are quite small,’ Karen said. ‘They are large right now, but will this affect my milk-producing ability?’

‘No, breast size is no indication of how good your supply of milk will be. Often women with small breasts prove to be the most prolific milk producers, whereas many large-busted women are the opposite. Large breasts simply mean they contain more fat, and this has nothing to do with the milk glands and milk production. Aren’t you lucky?’

“What about taking medicines during breast feeding? Is this safe?’

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