If you notice that your baby has a little lump which protrudes from his umbilicus when he cries or coughs, it is likely that he has an umbilical hernia. This is very common and is caused by the ring which normally surrounds the umbilical cord failing to close completely after birth. An umbilical hernia generally does not cause problems, and usually does not persist beyond 5 years of age. In rare cases, a small loop of bowel can be trapped in the opening and may require surgical removal. Umbilical hernias which do not disappear or are larger than 2-3 cm can be repaired surgically — this is usually for cosmetic rather than medical reasons. Do not tape the hernia — it does not help and may damage the baby’s tender skin.

WIND (FLATULENCE, EXCESSIVE GAS)

Passing bowel gas is a normal and necessary function in humans. Bowel gas is released by gas-producing foods and by the swallowing of air. Children swallow large amounts of air when sucking on empty bottles, and when crying. Carbonated drinks cause excess wind, as do foods which are difficult to digest, such as beans. Occasionally excess wind is a sign of milk intolerance, and gas is increased during bouts of diarrhoea or with marked constipation. No treatment is necessary for excess wind, except perhaps teaching your child, when he is old enough, to pass wind in a socially acceptable manner!

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Cause

There are numerous causes of vomiting, but the most common is that associated with any infection, either viral or bacterial, even the common cold. Motion sickness is another cause of vomiting. Vomiting can sometimes occur in association with more serious illnesses such as appendicitis or meningitis.

Projectile vomiting, which is a forceful throwing up of the contents of the stomach, is characteristic of pyloric stenosis.

Young babies tend to vomit up small amounts of milk after feeds. This is called posseting, and is normal. It can usually be reduced if you burp your baby a little more during feeds.

Clinical features

Vomiting is often accompanied by abdominal pain and diarrhoea. Dehydration is one of the serious risks of vomiting, especially in young babies .

Treatment

Medications against vomiting should not be used in children due to the risk of serious side effects. The most important part of the treatment of vomiting is adequate fluid replacement to prevent dehydration.

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Nausea is the feeling that you want to vomit. It is also known as being bilious or nauseated. Young children will not be able to tell you that they feel nauseated, but they may look pale and sweaty, and complain of a stomach ache. Older children will be able to describe additional symptoms such as dizziness.

Cause

There are many causes of nausea in children, but by far the most common are gastroenteritis, ear infections and motion sickness.

Treatment

Medications against nausea should not be given to children, due to the risk of serious side effects. If your child has nausea it is advisable to see your doctor.

SWALLOWED FOREIGN OBJECT

Babies and toddlers tend to explore things by placing them in their mouths and so they may swallow something which is not food. Many objects will be passed in the stools. If your child does not vomit, cough or complain of abdominal pain, simply sift the stools through a fine wire mesh for the next few days until the object appears. The commonest objects swallowed are coins and beads. Sometimes an X-ray may be taken to locate the object inside the gastrointestinal system.

If your child swallows a sharp, or poisonous object such as a battery or nails or pins, you should seek immediate medical attention. These objects can be life threatening. See also Essential first aid in Chapter 1 for Choking and poisoning.

When to see your doctor

Take your child to hospital immediately if he is choking, coughing, vomiting or having difficulty breathing, or if you are not sure what he has swallowed.

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Cause

The exact cause of pyloric stenosis is not known but it is thought to be influenced by genetic factors.

Clinical features

The classic sign of pyloric stenosis is projectile vomiting, which is a very forceful throwing up of the contents of the stomach, and results from a build up of stomach contents which cannot pass on to the intestine. The baby may also fail to gain weight and may be constipated. The baby is usually restless and cries a lot. He may wish to feed immediately after vomiting because he is hungry. If not diagnosed early, the baby is at risk of becoming dehydrated. Occasionally a lump can be felt in the upper abdomen during feeding.

Investigations

A barium meal is usually administered to confirm the diagnosis, although this may be unnecessary if the doctor can feel the lump.

Treatment

If there is a strong suspicion that your baby has pyloric stenosis, he will be admitted to hospital immediately for surgery. An operation will be performed to release the blockage by splitting the overgrown muscle fibres of the pylorus. This operation usually has no complications and the baby can be taken home after a few days.

When to see your doctor

See your doctor immediately if your baby has the symptoms described.

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Once this process has taken place, at some stage the child will begin to use the potty regularly, initially for faeces and then soon after for urine, at which point the child is essentially toilet trained. However, parents must expect that it may not go so smoothly — there may well be stops and starts, as well as frequent accidents. Again, it is important to be relaxed and low key about these as well.

There are several other points that are worth emphasising:

1. Never punish your child for any ‘mistakes’ in toilet training, or to subsequent accidents, no matter how frustrating they are to you. This will only make matters worse, and will most likely delay the completion of successful toilet training. Praise and encouragement are always a much better strategy, not only for toilet training but in all interactions with children.

2. Let the completion of toilet training be the child’s accomplishment rather than yours. You can share his pride, but it is important to allow your child to determine the timing and the pace of his toilet training.

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I know why you are anxious and frightened about the possibility of pain. You have read about, heard of, or known people who did have pain with cancer and whose pain was not controlled. You, yourself, may even have pain which is not being controlled right now. It doesn’t have to be that way for you.

We can do something about it. The most common reason for unrelieved cancer pain is simply ignorance— ignorance on the part of many doctors and nurses, as well as on the part of many people with cancer. Many doctors and nurses simply don’t know enough about the individual painkillers and how to use them most effectively. They don’t know how small the risk of addiction is when painkillers are used simply to control pain. Sometimes they don’t even know that it is realistic to aim for good control of cancer pain with painkillers.

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Sold and swallowed in large quantities to give instant energy, restore potency or prevent colds, they represent an expensive, but also a probably useless fad.

The vitamins are organic chemicals present in small quantities in food, and are necessary for the normal nutrition of the body.

Vitamins are divided into two groups — the water-soluble vitamins (the  group and Vitamin C) and the fat-soluble vitamins (A, D, E and K).

The body requires a certain minimal amount of these chemicals daily for the proper maintenance of health. If the diet contains less than the required amount for long enough, then signs and symptoms of a deficiency state will occur.

However, taking an excess quantity of vitamins — above that necessary for health — provides no extra benefit. In fact, with some of the vitamins, such as A and D, definite disease states may occur from excessive intake.

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The heart rate slows and the stroke volume — the amount pumped with each beat — increases. The coronary arteries dilate and become permanently wider.

Arteriosclerosis, or hardening of the arteries, is associated with a laying down of the atheroma or fatty tissue along the inner walls of the artery. This — like rust in a pipe — narrows the artery and can obstruct the blood flow. Widened arteries can take a great deal more build-up of atheroma before the narrowing obstructs the blood flow.

The lungs become more efficient and develop a greater capacity. But exercise also has other effects on the body.

Those who exercise regularly appear to become addicted to it. Certainly it gives a good reason for stopping smoking. You can’t really become fit while you continue to smoke.

Some experts have come up with a reason why those who push themselves hard with physical exercise seem to enjoy it despite the pain of aching limbs and a panting chest.

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