By the time children are 1-2 years of age, their sleep patterns tend to be geared to household routines. Most will be awake for lengthy periods during the day, and have a nap in the afternoon, though some may still need two naps a day. Sometimes they will be very tired and not relaxed enough to go to sleep. Some will have fears and phobias which affect sleep patterns, and many will not have learnt adequately how to get themselves off to sleep because of inconsistent parental handling of sleep problems, which are exceedingly common at this age. Parents who always stay with their child until he is asleep will inadvertently teach him to always require a parental presence to fall asleep — he may end up not being able to fall asleep on his own.

Preschoolers

Children of this age sleep on average between 10 and 12 hours a night, and some will only nap occasionally, depending on family routine, attendance at daycare or kindergarten, and their individual temperament characteristics.

Most school age children will sleep between 8 and 12 hours, with great individual variation, and by the time they reach adolescence their sleep requirement will have reduced further to between 7 and 10 hours per night. Sleep patterns are often erratic in later childhood, especially in adolescence, when staying up late is often the norm, and actual times of sleep fluctuate wildly between schooldays and weekends or holidays. Children of this age begin to establish their own sleep patterns based on their particular temperament and lifestyle, and become increasingly independent of family routines or preferences.

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IF MINOR: Clean the wound with clean, running water, follow up by cleaning with an antiseptic solution, then apply an antiseptic dressing — mercurochrome or acriflavine are useful.

Use a clean dressing to cover the wound — a band aid or a bandage — and change it frequently. Dirty dressings rub dirt into the wound and infection results.

IF MAJOR: The wound may require stitching, otherwise the same treatment as above, then see the doctor. Before you do, check your tetanus immunisation, take your record with you. Remember that scalp wounds always bleed a great deal, but direct pressure will always stop it.

Children often break the humerus, or arm bone, near the elbow. This is a very serious break and can cause damage to blood vessels. Immediate medical attention is essential. Splint it by immobilising it in a sling.

When bones in the leg are broken there is often considerable internal bleeding, especially with the thigh bone or femur. Two or three pints of blood may be lost into the thigh of an adult and may only cause a small visible swelling.

Shock due to pain and this loss of blood is quite common. Splint the lower limbs. Do this with a piece of wood (even a broom handle), a flat board or by strapping the two legs together.

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During the teens, a sore throat may be due to tonsillitis or it may be due to glandular fever or infectious mononucleosis.

In the early stages, it may be difficult to tell the difference between them but later the typical greyish-white membrane over the tonsils in glandular fever plus the enlargement of the lymph glands and spleen point to the diagnosis.

This can usually be confirmed by a blood test although this test may be negative in the first few days.

Infectious mononucleosis is believed to be a viral disease common in late childhood and adolescence but uncommon in smaller children and unusual in the older age groups.

It does occur in the 20s, is uncommon in the 30s and rarely seen after 40.

It is usually spread by breathing over people, and particularly by kissing.

Some recent research has shown that it may also be spread sexually.

It normally presents itself with a sore throat, fever and general malaise.

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In the technique of frozen section, the piece of tissue removed is frozen by carbon dioxide snow (what we know as “dry ice”).

The tissue is then sliced thinly with a special knife and examined under the microscope. The diagnosis can be given to the surgeon within 10 minutes.

If it is benign, the surgeon can close the wound and the operation is finished. If it proves to be cancer, the most commonly accepted procedure is to go ahead and remove the breast and the lymph glands from the armpit.

This technique of establishing the diagnosis quickly allows the surgeon to proceed with a definitive operation rather than having to wait a day or two, then expect the woman to face up to a second more extensive procedure.

A one-stage operation is also believed to pose less risk of spreading the tumor during the operation.

Fibroadenomas do not become cancer and have no complications. They are only removed because no surgeon can be 100 per cent sure that the lump is benign.

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Chemicals manufactured by the liver and stored in the gall bladder find their way into the bowel via the duodenum. These are called bile salts, and they help fats to be digested.

Every so often, even though they have been studying the bowel system for many years, research doctors are discovering new chemicals that are used in the digestive processes, ones they didn’t realize existed before. Just how many different kinds there are we will perhaps never know. But they are all important and do a very valuable job.

The liver, the huge organ in the upper right side of the abdominal cavity, also produces many other chemicals which are vital in the normal functioning of the body. Besides, the liver tears apart unwanted products; it renders them harmless and prepares them for elimination from the system.

The spleen is another massive abdominal organ. This sits in the opposite upper side of the cavity. It has important duties associated with the blood system.

The kidneys, the filtering system, lie in the back part of the abdominal cavity. They are hooked up to the blood system and also do the job of getting rid of unwanted debris from the body.

Certain glands called endocrines are housed in this vast cavity. A very important one is the pancreas. It produces a number of vital hormones. Insulin, which regulates the way in which body sugars are cared for, is manufactured there. If this system is not working properly, a condition called diabetes may occur.

Down below is the pelvis, and the abdominal cavity is continuous with that region. The pelvis houses the bladder and, in women, the reproductive organs—the uterus (womb), the tubes and the ovaries. In males, it houses the prostate gland, which sits just under the bladder (the part which stores urine until it may be voided).

The entire cavity is lined with a thin, slippery, shiny tissue called the peritoneum. This keeps the inner region and all of its contents germ free. It is a wondrous system.

But alas, many things may go wrong within its boundaries. Let’s take a peek at some of the hapless things that can go wrong with our insides.

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Gradually more control of muscular movements is gained. When lying on the back the baby is able to keep the head in the mid position, and is able to rotate the head in many directions, while sitting or while lying down. If a baby so desires, he is able to keep his head erect and still for short periods. He is able to lift his head to a right angle when lying on his tummy.

He frequently lies on his tummy with the arms outstretched, and will often flex the muscles of the lower limbs, partially raising his body. He tends to rock when lying on his abdomen, with the limbs stretched straight out, and the back arched, or he may roll from one side to the other. If pulled to a standing position, he will stand erect for short periods.

He gradually finds he can sit with support for upwards of a quarter of an hour. I lis head may remain steady, and the back quite erect.

He is able to use his hands to do more activities, and uses his fingers and toes. He grasps for objects with his palms, and often takes them between the fingers, either using the thumb and index or the index and second finger.

His aim when grasping is still often inaccurate. But he tends to grab and will follow objects as they pass to his hand. Often he misses an object when trying to grasp it.

Talk

Baby talk gains rhythm and pitch. It is gradually becoming more modulated, and he may continue with his baby babblings for 10 to 15 minutes, or even longer, at a time. His words, even though in baby talk, gradually take on some of the impressions of vowels of more mature speech.

The quality of his voice becomes more normal, and his cry stronger and more definite. He smiles when spoken to, and he often squeals and cooes. He starts to chortle, giggle, grin and goo, and may keep this up for half an hour. He becomes a great imitator.

Mind

Visual ability becomes more adult-like. He is able to discern colour, and his eyes adjust so that he focuses on objects irrespective of their position.

He becomes even more interested in objects and details and activity around him, and may concentrate for an hour. He becomes increasingly responsive.

His head and gaze will tend to follow objects, especially moving ones, in a more co-ordinated fashion. He will immediately react to a noise, such as a rattle or ringing noise.

He tends to co-ordinate his activities, and will make efforts of his muscle groups (arms, legs, body) to reach things he wants. He grabs for objects, including moving objects, with increasing skill and accuracy, although still often wide off the mark. He often carries objects in his mouth; persists in swiping at things whether he hits or misses them.

He starts to appreciate the third dimension, and is aware of height, depth and size. He will stare at a place from which something drops.

He can remember things over a span of 5-10 seconds. Recognition improves and he will often react to a face he knows. He can differentiate between faces and objects. He tends to dislike strangers, preferring the safety of those he is familiar with.

He can tell the difference between his hands and fingers. He smiles at himself in the mirror. His reaction to faces and those he knows or does not know will vary. He becomes aware of his own little act in life, realizing it is something a bit special and different from the general nature of the outside world.

He becomes aware of situations. He can pick and choose between toys. He often transfers a toy from one hand to the other.

Relationships

His personal relationships, both with himself and with others, gradually develop. He learns to laugh, protest, show anticipation, become excited, breathe heavily, as circumstances vary. He learns to soothe himself and often finds music calming. He clasps his fingers when at play. He shows interest in familiar faces, and will smile at his reflection in a mirror and readily reacts to the familiar features of his mother’s face.

He makes a variety of noises; ‘talks’ to himself as if vocalizing and socializing. He generally enjoys being handled and tends to enjoy being helped to sit or stand. He often indicates discontentment when he has to sit down again.

He is interested in his toys, often having a favourite plaything that he prefers. He enjoys playing, games and generally socializing.

His interest in his social surroundings often reduces his interest in eating. When he hears food being prepared, he anticipates its arrival. Will screw up his mouth when he sees food coming, or he is offered a bottle.

Sounds become quite readily distinguishable.

The time interval between feedings and bowel actions tends to become longer.

He obviously enjoys his bath, and will garrolously splash, kick and lift his head.

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Ciguatera poisoning is caused by eating fish which have consumed toxic algae which colonise damaged coral reefs. Herbivorous fish graze on the algae, which is incorporated into their tissues, although it causes no damage to them. Carnivores eat the herbivores and the toxin is concentrated in their tissue. Eating large carnivorous species of tropical fish, such as Spanish mackerel, barracuda, snapper and trevally, can expose humans to ciguatera poisoning.

Within 12 hours of ingestion the sufferer may experience general weakness, aching limbs, tingling in hands, feet and lips, itching in the palms of the hands and soles of the feet, reversal of hot and cold sensations, chest tightness, headache, toothache and convulsions. In severe cases, death can result. If the poisoning is recognised within six hours, vomiting should be induced. In any case medical attention should be sought urgently. In order to prevent exposure to ciguatera poisoning, fish should be eaten with caution.

A number of plankton-eating fish and bivalves (such as clams, mussels, abalone and shellfish) can accumulate high concentrations of toxins by feeding on toxic red-tide microalgae without harming themselves. Birds, fish, crabs, other animals and humans consuming such animals are affected by these toxins. Paralytic shellfish poisoning is caused by neurotoxins which can cause nausea, loss of balance, defective vision and, in severe cases, convulsions and death due to muscle paralysis. Diarrhoetic shellfish poisoning causes abdominal pain, diarrhoea, nausea and vomiting. Symptoms develop within a few minutes to a few hours of eating contaminated fish or bivalves. Amnesic shellfish poisoning causes vomiting, diarrhoea, abdominal cramps and permanent memory loss due to the loss of brain cells. Fortunately none of these forms of poisoning is common. However, increasing pollution of our coastal waters by nutrients from sewage outfalls may lead to increased outbreaks of shellfish poisoning. In countries where reported outbreaks have taken place, it is part of fisheries management practice to regularly monitor microalgae and make random checks of shellfish tissue.

A number of marine animals have venomous stings. These include jellyfish (see Bites and Stings).

The blue-ringed octopus is well-known for its venomous bite. Found in the southern coastal waters of Australia, the blue-ringed octopus is rarely seen because it has a span of only 12 cm, moves very fast and has excellent

camouflage. It also has a habit of hiding in discarded cans and bottles, dead gastropod shells or clumps of mussels.

Another animal with a poisonous bite is the cone shell, an oblong smooth dark brown shell with white markings, approximately 10-15 cm long. The following remarks apply to both animals. The initial bite is rarely felt. There may be slight bruising, but otherwise the wound is hard to see. Symptoms are numbness, nausea, visual disturbances, speech impairment, numbness of tongue and breathing difficulties. Paralysis may develop rapidly with respiratory failure, in severe cases within one hour. Medical aid should be sought urgently. Before paralysis sets in, the bite should be washed and a firm bandage placed all the way up the affected limb. The patient should be rested on her or his side. Following paralysis, EAR (mouth-to-mouth resuscitation) should be applied, and in advanced cases cardio-pulmonary resuscitation may be needed.

Some fish, such as stonefish and bullrout have stinging spines which may inject poison when disturbed by humans. It is therefore advisable to wear protective footwear when walking on rocks on the shore or wading in deep water or on mud flats. Symptoms include immediate intense pain at the site of the puncture, followed by the spread of pain along the limb and swelling. The stinging spine may be present in the wound and the area sometimes turns grey or blue. Sweating, shock and irrational behaviour can also be signs. Medical aid should be sought urgently. The affected part should be placed in very warm fluids and foreign bodies should be removed if they come away easily. Mouth-to-mouth resuscitation may be necessary if breathing stops.

Stingrays also have stinging spines halfway along their tails which can inflict painful wounds. Since these animals often lie submerged in the sand, care should be exercised when wading. The injection of a stingray’s barb will cause immediate intense burning pain, bleeding and possible difficulty in breathing. The barb should be gently extracted if visible and the wound bathed with hot water. Medical aid should be sought.

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If the escape of blood has been deep in the tissues-as with torn ligaments or broken bones-it may take days to reach the skin’s surface as a visible bruise. Escaped blood often travels to other parts of the body. For example, a bruise of the forehead may travel to form black eyes.

Most bruises are caused by physical injuries. Most normally active children always seem to have one or more bruises. Children with fair complexions bruise more easily than children with darker complexions. Areas most likely to bruise are the shins, knees, arms, and thighs. Bruises may take days or weeks to disappear, depending upon their size.

A different type of bruises, called spontaneous bruises, may be a cause for concern. Spontaneous bruises suddenly appear on their own even though no injury or blow to the skin has occurred. Spontaneous bruises may be caused by abnormally fragile capillaries (sometimes due to scurvy, or a lack of vitamin C); capillaries injured by infections or by allergic reactions; or a lack of proper clotting of the blood.

Remember, however, that bruises often are caused by injuries that were simply not noticed. But if bruises appear in areas not likely to be injured, or if a great many bruises appear, it is less likely that they were caused by unnoticed injuries; these may be spontaneous bruises.

There is another type of bruise known as a petechia. Petechiae are pinhead to one-eighth inch in size. They are dark red or maroon in color and often appear by the hundreds. Forceful vomiting or coughing can sometimes cause many petechiae to appear on the body from the neck up.

Petechiae may also appear in one smaller area when caused by a blow to the skin.

Signs and symptoms

Bruises are easily recognized when an area of the skin is discolored (black, blue, purple, red, green, or yellow). Bruises can be distinguished from other skin marks or rashes by a simple test. A bruise of any size does not blanch (turn white or lighter color) when pressed; all other red or purple marks or skin rashes will blanch when pressed.

Home care

Cold applications soon after an injury has occurred help decrease bleeding and lessen bruising. Warm applications 24 or more hours after the injury can help the body reabsorb the blood in the bruise.

Precautions

• Spontaneous bruising should always be examined by a doctor. Spontaneous bruising may be a sign of illness.

• Petechiae scattered over the body can indicate an urgent situation. If there is also fever or prostration (extreme exhaustion or collapse), a true emergency exists. Don’t waste any time: See your doctor at once.

Medical treatment

For bruises caused by injuries, a doctor’s treatment is the same as home care. For spontaneous bruises, including petechiae that are scattered over the body, your doctor will give a complete physical examination. The examination may include a blood count; platelet count; blood coagulation studies; nose, throat, and blood cultures; spinal tap; and bone marrow studies. The patient may be hospitalized to be given intravenous fluids and antibiotics.

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One in 10 people who drink will become an alcoholic. While moderate drinking yields health benefits, problem drinking wrecks lives. If you have trouble with alcohol, you should not drink at all, states the National Council on Alcoholism and Drug Dependence. Check yourself for the following signs that you may or could develop a problem with alcohol.

•     Heredity. If your mother or father had a drinking problem, your risk is fourfold.

•     Drinking mom than two. The national government and other experts draw the line at two drinks a day for men. Drink more than that and you put yourself at higher risk for developing a problem.

•     High tolerance. If you drink excessively without really feeling any ill effects, you also may have a drinking problem.

•     Secret drinking. If you’re sneaking drinks, won’t talk about your drinking, feel loss of control, or have blackouts, you need help with your drinking.

The cancer connection

Though heavy drinkers have higher risks for cancers in areas like the mouth, esophagus, and liver, people who drink less – six or fewer drinks a week-show no increased risk. And those who drink moderately may actually lessen their risk for lung, prostate, and other cancers, say scientists.

Researchers in Chicago found that one particularly potent wine compound, resveratrol, not only fought cancer at several stages but also actually seemed to reverse it. In a similar study, researchers from the University of California, Davis, found that when they fed dehydrated wine solids to mice who had been genetically altered to develop cancer, those who ate the wine feed took approximately 40 percent longer to develop tumors than the mice who didn’t eat the wine solids. “The antioxidant properties of the phenolic compounds like catechin and quercetin may play a major role in this cancer prevention,” says researcher Susan E. Ebeler, Ph.D., of the University of California, Davis. “But we need more research to know for sure.”

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