Cause

The immediate cause of biting is often the child being angry or frustrated, usually at not getting his own way. The reason some children bite in reaction to these feelings is unknown.

Clinical features

Episodes of biting may occur in the home, at daycare or preschool, or anywhere the child comes into contact with others of his own age. It is usually associated with anger or frustration, though occasionally no immediate precipitating event is noted. In many instances parents are first made aware of the problem by daycare or preschool staff.

Treatment

It should be made very clear to the child that such behaviour will not be tolerated. If it occurs again, the child should immediately be removed from the situation, the adult saying to him in a loud, stern voice: ‘No! You are not to bite other children!’ The child should then be removed to a remote section of the home or childcare facility for ‘time-out’.

After an appropriate period of time-out, during which the child is essentially ignored, he can be returned to the group with a comment that biting is naughty and will not be tolerated. If it occurs again, the same consequences must immediately occur.

Prevention

Sometimes gentle biting occurs during play between the young child and parents, and this may give rise to more serious biting later on. Biting at any age should be discouraged.

When to see your doctor

The doctor may help with reinforcing strategies for parents when biting occurs, and may provide information about referral to a paediatrician or psychologist if the behaviour continues.

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It may be difficult to recall, but try to think of that one girl or boy of the opposite gender who seemed to clash with you. This most likely would have taken place around later elementary school, when the genders are trying to mix in a society that blocks that mixture with a set of double messages. It is strange that boys who “hang around with” or “play too much” with little girls in elementary school are seen as “queers,” as being strange, and that later, too much playing with the boys is labeled the same way, unless of course there is aggressiveness involved. Girls who play too much with boys are tomboys, somehow not appropriately feminine. Too much contact with boys later, and they may be seen as “loose.” Not enough, and they may be seen as “gay.” Listen to children playing at a very young age, and you will hear what they consider to be the ultimate insult: “You’re gay!”

Do you remember that one opposite-sex child with whom every boy/girl, male/female issue in the world seemed to be acted out? One wife reported, “he just would not leave me alone. He’d take my hat, knock my books from my hand, wash my face with snow, just was on me all the time.” One husband reported, “She was a little snitch. She would tell on me anytime, making up things as if I didn’t do enough bad things already.” This aggressive male/female interaction, most likely following some “you always hurt the one you love” pattern, also became a part of how you love later.

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Returning to healthier sleep patterns can be difficult, and this is where the meditation technique can play an important role.

Although we have developed our daily meditation routine, our meditation technique can also be used at night to help us go to sleep. In this case, instead of going into meditation we can let the meditation technique take us gently and easily into sleep.

Exercise also plays an important part in the recovery process, and it would be helpful to seek advice in establishing a regular exercise program.

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-What is the aim of the surgery?

-What is the chance of achieving that aim?

-Would there be a better chance of achieving that aim if I had other forms of treatment as well as, or instead of, the surgery?

-What would it cost financially?

-How would I look afterwards? (You can ask to see photos of patients who have had the proposed operation.)

-What would be removed or damaged?

-How would my body function without these parts?

-Can other parts of my body take over the function of the removed or damaged parts?

-Is there some artificial means of doing this? If so, what exactly would it involve for me?

-What is the risk of dying during or soon after the operation?

-What complications are likely?

-Can they be treated?

-Would they be temporary or permanent?

-How long would I be in hospital?

-How long, if ever, before I would return to normal?

You will get the most accurate answers to these questions from surgeons who have a lot of experience with the particular operation under consideration. These surgeons are also most likely to ‘deliver the goods’, that is, to carry out the proposed operation skilfully and to actually achieve the promised results. Ask your surgeon how many of these particular operations he or she has done, whether or not you suspect lack of experience because you are getting vague or evasive answers to your questions. Ask if there are surgeons in your area who specialise in this type of operation. If there are, ask for a referral to them. Don’t settle for an inexperienced surgeon because you don’t wish to give offence. Your health and comfort are more important than that.

Remember, there are always alternatives. Ask about these if they are not volunteered. What other forms of treatments are possible, including those whose aims are not the same as the proposed surgery? What is the likely benefit and likely cost of each? Don’t forget there is always the possibility of having no anti-cancer treatment at all. This possibility will rarely be mentioned, so you will probably have to ask directly. Try to find out what is likely to happen if you have no actual anti-cancer treatment.

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Should ventricular fibrillation occur, it can be reversed by using a defibrillator machine to give an electric shock directly over the heart.

Mobile intensive care units (MICA) are ambulances with specially-trained officers who can take cardiographs, interpret them and set up intravenous infusions.

They can give drugs, defibrillate the heart and carry out heart massage. As well, they transport the victim to the nearest coronary care centre. In this way, the victim gets expert help as soon as possible and so reduces the risk of sudden death.

If you develop chest pain which you think may be due to a heart attack, seek medical help at once.

If your doctor is unavailable, phone for an ambulance or get someone to take you to the nearest public hospital.

If it isn’t a heart attack, proper examination will show this and no harm has been done.

If there is a doubt, you may be admitted and investigated then discharged.

If it is a heart attack, early treatment will give you the best chance of survival.

But, please, have another look at those risk factors I referred to earlier in this article. How many do you have?

Now, what are you going to do about them?

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Although some women cannot use the Pill without undue side effects, most can take it, especially the newer low-dose ones with minimum side effects and almost 100 per cent success in preventing conception.

Unfortunately, reports about the long-term dangers associated with the use of the Pill increase and the risks in using it now appear to be greater than at first thought.

The risks seem to be an increased incidence of artery and vein problems, which can lead to thrombosis or clots and blocking of the coronary arteries, with the development of a heart attack.

The International Planned Parenthood Federation in 1977 spelled out the dangers: “The risks are concentrated in women over 35 and in those who smoke and who have used the Pill over five years.

“Women under 35 who use the Pill have, overall, an added risk of one in 20,000 of dying; between 35 and 44, the hazard rises to one in 3000 and, over 45, to one in 700.

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The basic daily skin care routine consists of cleansing and conditioning.

All skin types need to be cleansed, for both aesthetic and health reasons. Cleansing removes oily secretions (sebum), sweat, skin debris, dirt, cosmetics, and a certain number of bacteria, and can be carried out most quickly, cheaply and effectively with water and soap. If, however, you have a dry skin, it might be advisable to avoid soap altogether, as it tends to have a drying effect on skin. You will probably find the use of a cleansing cream more suitable.

In addition, dry skin should not be washed as frequently as normal or oily skin. Frequent washing dries the skin by removing normal, oily substances whose purpose it is to keep the skin surface soft and pliable (these oily substances in fact hold a small amount of water within the skin’s layers). This dry skin routine—that is, the avoidance of soap, less frequent washing, and the use of cleansing cream—could also benefit elderly people, those with eczema, or those living in areas of particularly low humidity.

Apart from soap—and indeed, as a less drying alternative to soap—cold cream is one of the best and most popular cleansers. Cold cream is in fact the prototype of all modern cleansing creams. The original cold cream dates back to A.D. 150, when it was thought to be discovered by the great Greek physician, Galen. The original formula consisted of a mixture of olive oil, beeswax, water and rose petals. It was termed ‘cold cream’ because of the cooling effect on the skin when the water evaporated.

Since its discovery, cold cream has undergone numerous formulation changes. Olive oil has been replaced by mineral oils, which do not become rancid, and beeswax has been replaced by more stable synthetic waxes. As a result, we now have a fine, white, glossy cream of firm consistency that spreads easily and cools the skin. The oil and wax provide a cleansing action by liquifying upon contact with the warm skin, and loosening suspended particles of dirt, oily secretions, dead cells, and other material on the skin’s surface. They can then be easily removed with a tissue or cloth or, if left on the skin, act as an emollient and relieve excess dryness.

Cleansing creams, in which a variety of oils, waxes and other ingredients such as alcohol may be included, are only variations of the basic cold cream. They are generally thinner and lighter than cold cream, have less ‘drag’ and feel less oily on the skin. Cleansing lotions and aerosol foams are essentially the same thing in fluid or foam form. Make-up, especially waterproof products such as eye make-up, is best removed with cleansing cream. In most other situations, soap and water are the best combination (except for those with exceptionally dry skin who, as previously mentioned, are better to avoid the use of soap altogether). Some of you may have been mislead by advertisements suggesting that soap alters the skin’s naturally slightly acidic property or ‘pH’, which they suggest dimimshes its protective function. However, within half to one hour, the skin’s pH reverts back to normal. The reason the cosmetic companies are loathe to recommend washing is that they have not yet worked out a way to make a profit out of water.

At this stage we should consider what is meant by ‘a normal skin’. It may be surprising but there is no accepted definition of what may be termed normal skin. Nevertheless we should not ignore the term: it is in our interests to have some idea of what it means Wherever we look the media bombards us with what we should or should not do to attain or retain a ‘normal skin’. The popular assumption that a normal skin is one which is neither oily nor dry is meaningless. Typically, a normal skin is firm, because the supporting connective tissue is dense and solid; it is supple, because its elastic fibres are numerous and in good condition; it is matt, because it secretes minimal sebum; it is fine textured, smooth, without visible pores, and velvety to touch. All this, however, cannot be attained except perhaps in a fortunate and healthy prepubertal child.

*6\44\4*

Smooth steady blood sugar levels can be readily achieved by changing from high to low G.I. foods in the diet. This is particularly important when eating carbohydrate foods by themselves. Low G.I. foods tike whole grain bread, low-fat yoghurt and low G.I. fruits are best for snacks.

If you can stop the big swings in blood glucose levels, then you will not get the symptoms of reactive hypoglycaemia and chances are you will feel a lot better.

Hypoglycaemia due to a serious medical problem is rare. Such conditions require in-depth investigation and treatment of the underlying cause.

An irregular eating pattern is the most common dietary habit mat we see in people who have hypoglycaemia. The following case study illustrates this very well.

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Skinfold thickness is measured by the use of special calipers at certain sites on the body to measure the thickness of subcutaneous body fat. Calipers to measure skinfold thickness can range from a $10 plastic type to a $300 version and have been found to give different outcomes. Skinfold measurements are also extremely dependent on the experience of the measurer. Studies carried out comparing the effectiveness of measurers show that the variability even between experienced measurers can be anything up to 20 per cent.

Skinfolds appear to be reasonably useful measures of body fat in capable hands for adults between 10-40 per cent body fat, but may under-estimate fat in those over 40 per cent fat, Recently, extrapolation of skinfold thickness to percentage of body fat has largely been dropped in favour of just using the sum of skinfolds. This means that skinfolds are not necessarily an indication of percentage body fat, but the sum of skinfolds can give indications of relative changes in body fatness. In 1988 a conference on the standardisation of measurements was conducted in the US and from this a standardisation manual is now available giving 47 different anthopometric dimensions. For detailed reference on how to take these measures, this manual should be consulted. The main sites generally used are:

Biceps: Bicep skinfold is measured as the thickness of a vertical fold raised on the front part of the arm, midway along a vertical line joining the upper shoulder and the elbow joint.

Triceps: Tricep skinfold is measured in the midline at the back of the arm between the lateral projection of the shoulder and the elbow joint. The skinfold is measured with the arm hanging loosely and comfortably at the subject’s side.

Subscapular: This is picked on a diagonal level at approximately 45 degrees to the horizontal in the natural cleavage of the skin parallel to the lower scapular border. To find the site, the measurer can feel for the scapula, running the fingers around the border until the lower angle is identified. Another method is to bend the subject’s arm behind his or her back such that the scapula stands out. Apply the calipers 1cm away from the pinch raised by the finger and thumb.

Suprailiac: The suprailiac skinfold is measured in a line immediately above the iliac crest or upper hip, on the right hand side of the body. A fold of fat is grasped just above the hip in a midline along the body turned side-on. The fold taken should follow the natural cleavage of the skin at about a 45 degree angle.

Abdominal: Abdominal measurement should be done approximately 3cm lateral to the midpoint of the umbilicus (navel) and lcm below this. A horizontal skinfold should be raised with the left hand and its thickness measured to the nearest 0.1cm.

Thigh. Thigh skinfold is located at the midline of the front of the thigh, mid-way between the crease at the hip and the top of the patella, or kneecap. The subject should flex the hip to assist location of the hip, or inguinal crease. The skinfold is selected while the subject is standing but shifting the body weight to the other leg. Calipers should be about l cm lower than the finger pinch of the skinfold.

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There may be few, if any, symptoms at all in the early stages, until suddenly the kidneys fail. Tell-tale symptoms that all is not well include weakness, early tiredness, vomiting, headaches and restlessness, muscle cramps and probably twitching movements, drowsiness, mental disorientation and confusion. There may be swelling in the lower limbs (called oedema) and elevated blood pressure.

Tests carried out by the doctor will show that blood and protein are present in the urine, often in large amounts, which indicate the kidney system is severely impaired. Various tests that check the kidneys also indicate that they are diseased.

Treatment

Once the condition has been diagnosed, the patient may be admitted to hospital where full facilities for treatment are available. The course is a variable one, and close medical supervision for a long time may be necessary.

Parents must be alert for symptoms that indicate kidney infections and disease, for the sooner a diagnosis is made and treatment started the better.

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