Caring for your child.

The First Year Infant
Weight Gain

First year is most critical as this is the time baby's development and growth become established.
It is common for baby to lose weight during the first week of life. For a larger baby, this may be as much as 1lb (450g), or for smaller babies, 6-8ozs (200g). After this, the average weight gain is about 1oz/day (28g). Average weight gain to be expected over the first year is:
6 months - twice the birth-weight
at 1 year - three times the birth-weight.

But every baby is different, so variations should be expected. If your baby is 15% below or above expected weight, seek medical advice. Failure to gain weight may be due to feeding problems or problems of absorption.

Possible causes are:

• Inadequate or poor quality breast milk.
• Unsuitable type of artificial milk.
• Wrong dilution of artificial milk.
• Intolerance of baby to lactose.
• Various rare malabsorption diseases.
• Worm infestations.

Baby may have difficulty fixing to nipple due to:

• Poorly developed nipples.
• Inverted nipples.
• Undershot jaw.
• Poorly developed suck reflex, particularly premature babies.

Mother might not produce enough milk because of:

• Poorly developed breasts.
• Inadequate stimulation of breast tissue by pituitary hormones.
• Inadequate stimulation because of poor sucking reflex.
• Insufficient intake of fluids by mother.
• Poor nutrition or overwork.

If in doubt, seek medical advice.

Breast Feeding And Bottle Feeding
Breast feeding has the following advantages:

• Cheap.
• Hygienic.
• Confers immunity, transferred from mother to baby by antibodies in breast milk.
• Breast milk more readily absorbed by baby.
• Promotes bonding.
• Satisfying to both mother and baby.

However, mother may feel breast feeding is socially unacceptable or time consuming. Poor breast development, or inadequate milk supply can also be restrictive. The advantages far outweigh disadvantages.

If mother and baby have problems, particularly if baby is failing to gain weight, the only satisfactory solution is to introduce artificially produced milk. Artificial milk may be given in addition to breast milk in order to satisfy baby, and give mother enough time to establish total breast feeding.

If artificial milk is used, certain essential principles must be applied:

• Suitable feeding bottles.
• Adequate sterilising facilities.
• Various latex nipples, with small, medium and large holes.
• Method of keeping bottles and contents at body heat.
• Suitable powdered milk.
• Refrigeration for made-up formula (no more than 24hrs).

Artificial feeding may be introduced to supplement breast milk or to replace breast feeding. The type of artificial milk will depend on advice by your doctor, midwife, or health visitor. When starting bottle formula, dilute it initially. Make up powdered milk with 1 scoop (provided in packet) to 2ozs (57g) of boiled, cooled water.

Offer the bottle to baby after breast feeding and if tolerated, up feeds to three-quarter strength, until baby is taking full concentration (i.e. 2 scoops to 2ozs (57g) of water). If the flow and quantity of breast milk becomes sufficient, baby will not take bottle formula. Should breast feeding fail, it is necessary to change to complete bottle feeds. Begin with diluted formula and up feeds to full strength as described earlier.

Regarding quantity, all proprietary powdered milk formulas contain instructions, however the following general guidelines should help you work out baby's needs:
Weigh the baby and if up to expected weight, multiply weight (in lbs) by 2.5. The total gives the amount of milk required (ozs) over 24hrs (e.g. 10lb baby needs 10 X 2.5 = 25ozs in 24hrs). If baby is slightly underweight, calculate correct weight and use this figure to make calculation. Young babies usually need 6 feedings in 24 hours. Based on the previous example, offer bottles containing 4ozs. As baby grows, weight increases with quantity of milk and should be weighed at weekly intervals.

With feeding, there are 2 different viewpoints:

1. Feed on demand. (Baby in control)
2. Feed at set intervals, say 4 hourly (Mother in control).

Demand feeding simply means feeding when baby wakes and cries. This method suits many babies and they often settle into routine, waking regularly (mothers who breast feed may find this exhausting in the first 6 weeks). A developing infant may take up to three months to drop night feeds, particularly boys.

Feeding Problems

Poor Sucking
Often occurs in premature babies. If breast feeding, gentle support of the lower jaw will often help. If bottle feeding, use a nipple with a large hole.

Vomiting
Often confused with posseting, which occurs naturally as baby regurgitates some feed when being winded. Vomiting large amounts is abnormal, particularly if it occurs after every feeding, so seek medical advice. If vomiting is projectile (i.e. vomit pumps out like a jet of water), seek medical advice urgently.

Wind
After feeding, you must bring up wind. When sucking at the nipple, the baby will suck in air. This passes into the stomach and usually forms a bubble above the milk. Put baby over your shoulder so the head and jaw rests over your shoulder. Gently pat the back or rub in a circular motion. Air is usually expelled with an obvious 'burp'.

Colic
Occurs when wind is not brought up and forms a bubble in the stomach, causing pain. Baby cries, draws its knees up to its chest and is very difficult to comfort. If in doubt, seek medical advice.

Diarrhoea
May occur if formula (artificial milk) is too strong. Breast fed babies tend to be constipated. Diarrhoea and vomiting in combination may be lethal for small babies and medical advice must be obtained.

Nappy Changing
Babies are like all animals. The act of feeding triggers the lower bowel to contract and expel waste products. Therefore, nappies must always be changed after a feeding. It is usual to clean the bottom with moist wipes and apply a cream, (e.g. zinc oxide), before using a fresh nappy. Disposable nappies are water absorbent and should be water tight, providing the correct size is used.

Nappy Rash
Usually caused by fungal infection called thrush. The skin is red over nappy area and sometimes blistered. The infection is passed from mother to baby at birth. The cells of the mother's vagina contain fungus spores called monilia albicans. The spores are ingested during the passage of the baby through the vagina and enter the baby's intestine where they multiply. During excretion, some of the spores invade baby's skin and cause the typical rash.

Application of fungicidal cream may be used to control skin condition, however re-infection occurs from the baby's intestine. Seek medical advice.

Heat Rash
Caused by overdressing baby in warm weather or by maintaining nursery at excessive temperature. The rash appears as fine small red spots around collar area and at nape of neck. Treat by dressing baby correctly and applying baby talc to infected areas. If in doubt, seek medical advice.

Waking At Night or Excessive Crying
Usually has simple causes, so check the following:

• Change nappy (usually baby is wet or has dirty nappy).
• May be hungry, so offer a feeding.
• May have wind, so 'burp' baby.
• May have snuffles (i.e. blocked nose, causing breathing problems, so use baby vapour decongestant).

If in doubt, seek medical advice.

Mouth Fungal Infections
Thrush in the mouth is recognised by white patches on the inner surface of cheeks and tongue. In severe cases, the throat can be infected, which causes pain to baby and interferes with swallowing. Seek medical advice.

Eczema
A rash which occurs behind knees and in front of arms at the elbow. The rash is itchy, often scaly and sometimes becomes  infected. Seek advice from your doctor regarding treatment.

Dummies
Pacifiers (or 'dummies'), should be avoided. They are unhygienic which is why they are one of the main causes of gastro-enteritis, often a fatal disease in young babies.

Cutting Nails
From an early age, finger nails have to be trimmed, since babies tend to scratch themselves and cause abrasions if the nails are too long. The same applies for toe nails.

Frustration
Occasionally, everybody experiences frustration with a new-born baby. Continual crying, the enormous change in lifestyle  adapting to the new addition in the family, pressures on your own relationship...

Here are a few useful tips to help you through those exasperating times:

• Put baby in a stroller or day-pack, and go outside for a walk (crying always seems much louder indoors).
• Give yourself 10mins, if baby still fusses, put it in its crib with some toys and shut the door; have a wash, make some tea and then pop up to make sure everything is alright.
• Phone someone - mother, sister, friend, whoever! A brief chat does wonders for the nerves.

Bathing
You should have seen a demonstration bathing in the maternity hospital. Remember to fill bath with water to a depth of 4 inches (10cm), no deeper and check the temperature (water must be at blood-heat temperature - around 37 degrees Centigrade, 96 Fahrenheit).
Test the water with your elbow, if it is comfortable, the temperature is correct. Now proceed by undressing baby.
Holding baby with both hands, lower into bath, always supporting the head. Baby skin is delicate, so don't use adult bubble bath, only baby soap and lotion. Use baby shampoo for hair. Remove from bath. Dry baby gently with a soft towel. Apply cream to bottom. Apply nappy and dress.

Putting To Bed
NEVER USE A PILLOW.
Wrap baby in a cotton sheet with arms folded across chest, so that the sheet is wrapped fairly tightly. This gives baby a feeling of security. If the weather is cold, wrap a crib blanket around the sheet, lie baby on side and cover with a light cover. Young babies should be kept in a temperature of 65-70F (19-21C).
In hot weather, it's a mistake to over-clothe and over-wrap as they become too hot and sweat. During the day, if baby is put out in a pram, cover pram with a net.

Mixed Feeding
At 3 months night-feeds are not normally necessary. It's important to remember that all babies require additional fluids; this may be given as VERY diluted fruit juice, preferably sugar free (see 'Dental Care').
Growth rate tends to slow a little and this is the time to try mixed-feeding. Usually a gluten-free cereal is introduced. This is mixed with some artificial milk and spoon-fed. Over the next 3 months, introduce different fruits (seedless, in a pureed form).
Gradually increase the amount of solids until at 6 months, baby is usually taking 3 bottles of milk or 3 breast feeds/day and solids. An early start at 6 to 8 weeks is to be discouraged, since baby will become overweight, which may become a life-long problem.

Weaning
Weaning can start at 6 months when baby has some teeth with which to chew (see 'Dental Care'). This should include rusks. The aim is to give 3 main meals per day. This will only be achieved slowly. There is a multitude of convenient baby foods on the market, but these tend to be very poor value. Your own food liquidised is much cheaper, nutritious and will introduce a variety of flavours.
Breakfast may consist of a gluten-free cereal, 1 or 2 rusks, pureed apple, small slices of bread dipped in egg yolk, followed by milk feeding.
Lunch could be pureed chicken, pureed potato and pureed fruit, followed by milk feeding.
An evening meal of cereal and pureed fruit will be enough. Vary diet so that by 1 year, the infant is taking 3 meals per day, with little need for a bottle or breast feeding.
From 8 months, try and teach baby to drink from a cup. Most will be able to handle a baby-beaker, but drinking from a cup requires a different skill.
Offer baby an egg cup with milk, it is surprising how quickly they learn to lift it to the mouth and drink.
Once they have mastered the egg cup, give a small cup, gradually increasing the size cup as needed.

Cot Death

Fortunately, crib deaths are rare. The cause is unknown but usually the victim is under 6 months. Research indicates that most deaths are not caused by asphyxia. It is thought to be caused by a virus infection which overwhelms the immune system. There are no obvious symptoms and can strike down a perfectly healthy baby when asleep.
Apnoeic attacks are also rare, but cause breathing to stop, and unless aroused and stimulated, may be fatal. Apnoea mattresses are available which monitor breathing and sound an alarm if breathing stops.

Milestones at birth

Before leaving hospital, a paediatrician will have performed the following examination on baby:

• Heart and lungs (by stethoscope).
• Abdomen.
• Hips (to detect dislocation).
• Baby held in ventral position.
• Moro reflex.
• Pulled to sitting.
• Establish hand and feet reflexes.

Milestones at 6 Weeks
The first developmental examination is carried out at 6 weeks and consists of:

Eye Test

• Pupils react to light, turns head towards light source.
• Stares at length at diffuse light from window.
• Will follow bright light held near face.
• Watches mother's face when feeding or when she talks.
• Blink reflex present.

Hearing And Speech Development

• Startled by sudden noise, blinks/shoots out arms and legs.
• Usually stop crying and turn towards comforting voice.
• Cries loudly when hungry or wet.
• Will make pleasurable noises in response to mother's voice from 5-6 weeks.

Play And Behaviour

• Sleeps nearly all the time, except when being fed, bathed or changed.
• Vague facial expression, usually smiles at 6 weeks.
• Starts to make noises.
• Sucks strongly.
• Hands usually closed, but when open, will grasp at finger.
• Stops crying when picked up.
• Turns face to look at person who is talking.

Milestones at 3 Months

Speech And Hearing

• Loud noises cause distress with blinking, turning away and crying.
• Smiling to sound of mother's voice.
• Making noises when hearing mother's voice.
• Crying when annoyed, hungry or wet.
• May turn eyes, and sometimes head, towards sound (may move head as though searching).
• May suck or lick lips when hearing food being prepared.
• Become excited when hearing bath-water, footsteps or familiar voices.

Play And Behaviour

• When feeding, gazes at mother with contented look.
• Becomes excited at feeding and bath-time.
• Has (hopefully) begun to enjoy bath-time and changing nappy.
• Responds to tickles with pleasurable noises.

Milestones at 6 Months

This examination is usually carried out by a doctor...

Muscular And Skeletal Development

• When flat on back, will lift head off pillow, extend legs, grasp foot and suck it.
• Sit with support, move head side to side to look around.
• Move arms in purposeful manner, holding them out to be lifted, will pull up to sit.
• Roll from front to back and back to front.
• Kick strongly, alternating legs.
• In sitting position, head erect and back straight.
• When held standing, will bear weight and bounce up and down.
• Lying prone, will lift head and chest, supported by flat hands and straight arms.

Visual Developments

• Eagerly watches everything.
• Follows mother across room and eyes move together.
• Stretches out both hands to grasp toys.
• Passes toys between hands and grasps with whole palm.
• Holds toys in both hands and transfers to mouth.

Speech And Hearing Developments

• Instantly turns to mother's voice.
• Makes tuneful noises, vowel sounds and double syllables.
• Laughs and squeals, screams when annoyed.
• Responds to baby rattle held at 18 inches (46cm) by turning to sound source.
• Grasps small toys, usually with 2 hands, sometimes with 1 passes hand to mouth.
• Friendly to strangers, but at 7 months becomes shy.
• Pats bottle when feeding.

Milestones at 1 Year

Posture And Movement

• Sits on floor for long periods.
• Rises from lying to sitting position, unaided.
• Crawls on hands and knees, or shuffles on bottom rapidly.
• Pulls to standing and walks around furniture.
• May walk unaided, but usually with aid.

Visual Development

• Picks up tiny objects between finger and thumb.
• Throws toys and deliberately watches where they land.
• Points to wanted objects.
• Watches toys pulled across floor.
• Holds 2 blocks and clicks them together.
• Watches cars and moving objects outdoors.
• Recognises familiar faces at distance.

Speech Development

• Knows own name with immediate response.
• Vocalises using most vowels and consonants.
• Uses names and responds to commands.
• May pass objects on request.
• May say 'mummy', 'daddy', 'doggy', 'bye bye', etc.

Social Behaviour

• Drinks from cup, without help and will chew.
• Holds spoon, but is not able to feed itself.
• Plays 'pat a cake' and waves 'bye bye'.
• Does not often put objects in mouth.
• Stops dribbling.
• Will rattle spoon in cup.
• Finds hidden toy.
• Pleasure at meeting friends.
• Likes to be in continuous sight and hearing of mum.

Milestones at 3 Years

Visual Developments

• Picks up small objects with 1 eye covered.
• Can build a tower of 9 blocks, and 1 or more bridges.
• Can hold a pencil in dominant hand.
• Can copy a circle.
• Can draw a man with head.
• Recognises 3 primary colours.
• Enjoys painting.
• Can cut with (safety) scissors.

Speech Development

• Can count to 10, but doesn't appreciate quantity.
• Large vocabulary, intelligible to strangers but poor grammar.
• Infantile speech sounds.
• Knows full name and sex, and asks many questions.
• Listens attentively to stories and knows some nursery rhymes (may sing them).
• 'Pretend' play.
• Makes simple conversations.

Play And Social Behaviour

• Use fork and spoon.
• Wash hands, but needs help with drying.
• Lower pants and pull them up, but unable to button up or tie laces.
• Loves 'pretend' games and takes part with other children.
• Usually dry through night.
• Helps with domestic chores.
• Beginning to understand 'sharing'.

Milestones at 5 Years

Mobility

• Plays ball games with considerable skill.
• Walks on narrow line.
• Active climbing swinging.
• Run lightly on toes.
• Move in time to music.
• Bend and touch toes, without flexing knees.
• Hop and stand on 1 foot, with arms folded.
• Grips strongly with both hands.

Vision

• Pick up very small objects.
• Threads large needles and can sew.
• Good control with pen and paint brush, colours neatly.
• Draws recognisable man and house with doors and roof.
• Name 4 primary colours and match 10 colours.

Hearing And Speech

• Usually fluent, using correct grammar.
• Loves having stories read and acts out story.
• Recites rhymes and sings.
• Enjoys jokes - especially if rude.
• Knows full name, date of birth and address.

Behaviour And Play

• Use knife and fork well.
• Wash and dry face and hands.
• Dress and undress without help.
• Elaborate 'pretend' and group play.
• General behaviour more sensible and controlled.
• Sense of humour.
• Developing sense of time.

Infant Vaccinations

You should consider vaccinations before your child attends school. This is excellent preventive medicine as theoretically the occurrence of infection becomes so low that the disease is completely eradicated. As memories fade of terrible outbreaks in the 1950's, recent studies indicate that parents are becoming too relaxed regarding immunisation.

The following vaccinations are suggested before going to school:

• Diphtheria.
• Pertussis (whooping cough).
• Tetanus.
• Poliomyelitis (polio).
• Measles, mumps, rubella (MMR).

The vaccines are commonly grouped together as follows:

• DPT, or triple vaccine (diphtheria, pertussis, tetanus) given at 2mths, 3mths and 4mths.
• MMR, or combined vaccine (measles, mumps, rubella).
• Poliomyelitis (polio) given by mouth on a sugar lump. Baby must be fit and well before vaccination and should have a prior examination by a doctor.

Immunity can be induced, either actively or passively, against a variety of bacterial and viral organisms.
Examples of active immunity include:

• Poliomyelitis.
• Measles.
• Rubella.
• BCG (anti-tuberculosis).

Examples of inactive immunity include:

• Whooping cough.
• Typhoid.

Vaccine works by stimulating the body's defences to manufacture antibodies (which fight infection). The first injection produces a small response. Additional injections lead to an accelerated response. Following a full course, the antibody level remains high for a few months or years. A booster dose will raise the antibody level rapidly.

Active vaccine (e.g. measles, mumps, rubella) provide long-lasting response after a single dose. Remember, oral or written consent must be given before each injection.

No child should be denied immunisation without serious thought to the consequences, both for individual child and the community. If there is any doubt, advice should be sought from a consultant paediatrician.

None of the following conditions should influence your decision regarding vaccination:

• Asthma, eczema, hay fever or snuffles.
• Treatment with locally acting steroids / antibiotics.
• Pregnant mother.
• Breast fed child.
• Neonatal jaundice.
• Under a certain weight.
• Over age given in schedule of vaccinations.
• History of pertussis/measles/mumps/rubella.
• Prematurity (vaccination should not be postponed).
• Stable neurological conditions (e.g. cerebral palsy, downs syndrome).
• Contact with an infectious disease.
• Homeopathy (the council of homeopathy strongly supports vaccination).
• Allergy.

Certain vaccines should not be given, but this will depend on specific circumstances. For example, oral poliomyelitis vaccine should NOT be given to brothers, sisters or household contacts of immuno-suppressed children (inactive poliomyelitis vaccine should be given).

The whooping cough vaccine has caused more controversy than any others. There is unsubstantiated evidence that the vaccine may cause brain damage. There are a few considerations with whooping cough immunisation such as acute illness (postpone vaccination), or if severe local, or general reaction to a previous dose (delay vaccination until stable). In children with problem histories, the advantages of protection against whooping cough must be very carefully weighed against the consequences of no protection.

If in doubt seek the advice of a consultant paediatrician. Some examples follow:

• Documented history of cerebral damage at birth.
• Personal history of convulsions.
• Parents, brothers, or sisters with idiopathic epilepsy (this condition may arise irrespective of vaccination).

All vaccinations, except oral poliomyelitis are given by injection, either into the muscle or deep under the skin. Sometimes the baby may have a high temperature lasting 24 hours, or a raised red swelling at the site of injection. Tepid sponging may help, but if in doubt seek the advice of a paediatrician.

The following table is a general guide to vaccinations. However, it is important to consult your paediatrician for the best schedule for your own child.

Age	Vaccination
2 months	1st DPT and polio
3 months	2nd DPT and polio
4 months	3rd DPT and polio
12 to 18 months	MMR, influenza
4 years	Booster, diphtheria, tetanus, and polio
10 to 14 years	Rubella (girls only)
10 to 14 years	Possible BCG
15 to 18 years	Booster, tetanus and polio

Infant Infectious Diseases.

The following are common infectious diseases likely to occur in children (which may also affect adults with little immunity, with much more severe symptoms):

• Measles.
• Mumps.
• German measles.
• Whooping cough.
• Chicken pox.
• Scarlet fever.
• Diphtheria.

Others, not commonly seen include:

• Meningitis (bacterial and viral)
• Poliomyelitis (polio).
• Tuberculosis.
• Tetanus.

Gastro-enteritis in children may result from bacterial or viral infection.
Upper respiratory infections and middle ear infections, although not strictly infectious diseases, are included in this section. If you suspect your child has contracted any of these diseases, it is important to seek competent medical advice.

Measles

• Develops in susceptibles.
• Time between contact and appearance of rash (incubation period) 7 to 14 days.
• High temperature.
• Sore eyes.
• Wide spread rash, starting behind ears, spreads to face and rest of body.
• White spots (shaped like millet seeds) may be visible on mouth.
• Possible coughing.

Seek medical advice immediately. Isolate child for 4 days after appearance of rash. Disease is viral and can be prevented in children by vaccination. Complications may include: bronchopneumonia, middle ear infection, severe conjunctivitis, with perforation of cornea (in malnourished), encephalitis.
If any of these complications are suspected, seek medical advice.

Mumps

• Occurs in unvaccinated children.
• Incubation period 12-21 days.
• Child unwell, often with 'flu-like' symptoms.
• High temperature.
• Swelling appears behind angle of jaw.
• Possible earache.
• Difficulty opening jaw.
• Mastication and drinking causes painful salivation.

Seek competent medical advice. Isolate child for 10 days after appearance of swelling. Often one parotid gland (the largest salivary gland) swells, followed by the opposite side a few days later.

Chicken Pox
Usually a relatively minor illness in young, well-nourished children:

• High temperature.
• Flu-like symptoms.
• Typically a rash appears as small blisters, in crops, starting on face, spreading onto trunk and abdomen.

Seek competent medical advice. Isolate child for 11-14 days, or 6 days after appearance of last crop of spots.
Pregnant women are at risk, as the infection can be passed to baby in womb and may result in miscarriage.

Rubella (German measles)
Occurs in unvaccinated children:

• Flu-like symptoms.
• Rash consisting of small fine pin-point red spots, covering entire body.
• Enlargement of small glands in posterior triangle of neck.
• Rash normally lasts for 24hrs.

Seek competent medical advice. Isolate child for 11 days from onset of illness and 4 days after rash has disappeared.

Whooping Cough
Disease which attacks lungs in children, early signs include:

• High temperature.
• Distinctive 'whoop' noise when coughing.
• Vomiting after coughing fit is common.
• Possible bleeding in eyes.

Seek competent medical advice. Isolate child for 7 days after contact, or 3 weeks after onset of disease.
Complications may occur, resulting in permanent damage to lungs, leading to chronic respiratory problems in later life. The disease can be fatal in infants.

Scarlet Fever

• High temperature, followed by sore throat.
• Widespread scarlet rash appears, followed by peeling skin of hands and feet.

Seek medical advice. Isolate child for 1 day if treated with penicillin, if untreated isolate for 11-21 days.

Diphtheria

• High temperature.
• Sore throat.
• Enlarged cervical glands.
• Grey exudate over pharynx and tonsils.
• Respiratory obstruction.

Seek competent medical advice. Infection of the skin by the diphtheria germ can occur in desert regions and may damage nerves, resulting in localised paralysis such as foot drop. Therefore, protection by vaccination is very important.

Meningitis
Less common nowadays having been controlled by vaccination.

• Raised temperature.
• Irritability.
• Change in conscious state.
• Neck stiffness and headache.
• Appearance of small purple spotted rash.

Seek competent medical advice urgently. The disease must be recognised early since if untreated, it is always fatal. Vaccine is available to protect those at risk.

Poliomyelitis
Polio is less common having been controlled by vaccination.

• Raised temperature.
• Flu-like symptoms.
• Paralysis.
• Inability to move a limb.
• Headache.
• Neck stiffness.
• Irritability.
• Difficulty breathing.

Seek competent medical advice urgently. If paralysis occurs, complete recovery is unlikely.

Tuberculosis T.B.
Less common having been controlled by vaccination. However, it must always be considered, particularly with immigrant workers. The disease is still prevalent in developing countries, but curable with the aid of drugs.
Better nutrition and accommodation have played a large part as has vaccination against the disease. The disease may present in many ways and can mimic many others.
Look for:

• Loss of weight.
• Night sweats.
• Chronic cough.
• Exhaustion.
• Anaemia.

Seek competent medical advice urgently. Transmission of the disease is by droplet spread, or unpasteurised milk.

Tetanus
Less common having been controlled by vaccination. Disease found in spore formation in soil and plants where organic manure has been used.   Look for:

• History of cut in garden or a prick with rose thorn.
• Secondary infection of wound.
• Increasing muscle spasms.
• Abnormal grin ('risus sardonicus').
• Respiratory problems.

Seek competent medical advice urgently. Vaccination gives complete protection for up to 10yrs. Booster tetanus injections at 5-10yr intervals are recommended. If full disease develops, it may be necessary to use muscle paralysing drugs and provide respiratory support mechanically.

Influenza
Occurs in epidemic form mainly during the winter months. It is a viral infection with a very short incubation period (18 hours - 3 days). Although uncomfortable, it is usually self limiting. However, in elderly patients and those with chronic respiratory and heart problems, secondary chest infections can prove fatal.
Those at risk should seek competent medical advice. Look for:

• Presence of known epidemic.
• Raised temperature.
• Headache.
• Discharge from nose.
• Generalised aches and pain in joints and muscles.

Treat with bed rest, keep warm and drink lots of fluids. Your doctor may prescribe acetaminophen or paracetamol. The illness usually lasts 4-5 days.
Complications may occur such as bronchopneumonia and encephalitis. There is a well known post viral phase when the patient may feel unwell and depressed for up to 3 weeks after the end of the disease. If in any doubt, seek medical advice.

Gastro-enteritis
May be extremely serious in small babies and, if not treated, could result in death from dehydration. Commonly contracted through food which has been contaminated by food handlers. Look for:

• Raised temperature.
• Abdominal pain.
• Vomiting.
• Diarrhoea.

Seek competent medical advice. The dual effect of diarrhoea and vomiting causes loss of fluid and dehydration. In small babies, because they have relatively small amounts of fluid in their body, dehydration develops rapidly.

Upper Respiratory Infections
Rarely fatal, but may give rise to secondary chest infections which in turn can be fatal. The whole of the upper respiratory tract becomes inflamed with outpouring of mucus and fluid from the nasal passages. Because the Eustachian tubes become inflamed, the middle ears can become infected causing acute middle ear infection.
Look for:

• Moderate rise in temperature.
• Cough.
• Sneezing.
• Runny nose.

Seek medical advice.

Nursing a sick child
Nursing sick infants and young children is mainly common sense and knowing when to call for professional help. If in doubt, seek medical advice. Typical day-to-day symptoms may include:

• Fever or raised temperature.
• Difficulty breathing (possibly asthma).
• Vomiting.
• Diarrhoea.
• Excessive drowsiness.
• Irritability.
• Abdominal pain.
• Sore throat.
• Earache.

Fever
A temperature with no other symptoms can be treated for one day only with acetaminophen or paracetamol, but be sure to follow the manufacturer's recommended dosage. If in doubt, seek competent medical advice.
NEVER EXCEED THE RECOMMENDED DOSE - IT IS VERY DANGEROUS.
Tepid sponging helps to lower a temperature but must be done correctly.
Use water which is at blood heat (similar temperature to baby's bath). With a sponge, wash forehead, trunk, abdomen and legs. If high temperature persists, seek competent medical advice.

Difficulty Breathing (Asthma)
Rarely diagnosed early enough, indications of asthma are:

• Persistent cough, particularly at night (no runny nose).
• Wheezing, particularly at night.
• Family history of asthma, or hay fever.
• History of infantile eczema.

Always seek medical advice, learn the technique of using inhalers and when to give medicine.
A good tip for a child who suffers from croup is to put them in a steamy atmosphere: Run a hot bath and sit with the child in the bathroom breathing the steamy air. This has a soothing effect and can encourage sleep when the coughing fit has subsided. Similarly a vaporiser can be placed in the bedroom, but in a safe place where a child cannot reach it.

Child Exercise

Exercise must be linked with diet. This starts after birth. Early introduction of solids before 3mths leads to excessive weight gain. A fat, bouncing baby may win beauty contests but can be destined for respiratory problems and coronary artery disease in later life.
Exercise helps to develop muscles. A baby bouncer and baby walker allows baby to exercise and gain confidence in walking without aid.
A good, balanced diet (with adequate fibre, fruit, white meat, fish, green vegetables and calcium sources) is an important requirement for normal development and growth (see 'About Your Diet'). When old enough, children should be encouraged to play with others. This provides them with enough exercise for their age.
When between 5-7yrs, teaching a child to ride a bicycle gives them plenty of enjoyment, as well as exercise.
Later, encourage them to take part in physical training, swimming and competitive sports.
Many schools in the U.K. have abolished compulsory sporting activity. This fact, combined with little regard for diet (favouring convenience food), creates unfit and overweight children. Every parent wishes the best opportunity on their off-spring. So why disable them by over-feeding and lack of exercise?

Overweight, under-exercised children can suffer:

• Increased health risk throughout their lives.
• Restricted energy and ability to perform effectively.
• Criticism and bullying from peers (this can cause life-long emotional scarring).
• Emotional rejection (difficulty attracting opposite sex).

There are no excuses, so invest in your child's future health now!

Child Abuse

Forms of abuse include: physical, mental, sexual abuse or physical neglect. It is often very difficult to discover children who are mentally or sexually abused. Very few statistics are published, since the subject is highly emotive and difficult to quantify. However, most researches agree that child abuse is alarmingly high and generally goes unreported.

This section provides simple guidelines which may help you detect child abuse. ALWAYS seek professional advice should you have cause for concern.

Physical abuse and neglect are reasonably easy to identify. Battered baby syndrome is indicated by:

• Bruising of arms, legs and trunk.
• History of frequent fractures of limbs, with visits to hospital accident departments.
• History of numerous small burns.

Neglect and privation can be normally suspected when the child is ill clothed, unkempt, dirty and undernourished. Research has shown that children are at greatest risk of sexual abuse from relatives or close family friends. Experience shows that children very rarely lie about sexual abuse.

Small clues may include:

• Aggressive behaviour, severe tantrums.
• Air of 'detachment,' or 'don't care'.
• Watchful attitude.
• Continual open self-abuse.
• Child only seems happy at school, or kept away from school.
• Doesn't join in school social activities, has few friends.
• Doesn't trust adults, particularly those who are close.
• 'Tummy pains', with no medical reason.
• Eating problems (over-eating/loss of appetite).
• Disturbed sleep, nightmares, bed-wetting.
• Running away from home.
• Suicide attempts.
• Self inflicted wounds.
• Immature behaviour.
• Depression and withdrawal.
• Secretive relationship with adult, excluding others.
• Unexpected talk about sex organs.
• Sexual knowledge, far beyond child's expected experience.

There are several preventive measures you can take to alert your children to the dangers of abuse and how to avoid it. This will require building a trusting and open relationship between you and your child. What you tell your child will depend on their age, but even young children can understand simple messages:

• Make sure they know you always believe them and that they shouldn't worry about telling you anything.
• If they don't need to be accompanied by an adult, children should always be with their peers.
• They should always take the same route home.
• Thoroughly check out baby sitters/child minders.
• They should NEVER go into public places unaccompanied (e.g. bathrooms, WC's).
• They can do anything they like when faced with danger (run away, scream, shout, kick, punch, lie) - their safety matters most.
• They should choose who to kiss, cuddle, hug, etc.
• They should remember the '3 W's' and tell you:
  a. Who they are going out with.
  b. Where they are going.
  c. When they're coming home.

Psychological Problems In The Young Adult
In the process of changing from a child to a young adult, many hormone changes occur in the maturing body. This period is known as puberty. It is a time of considerable stress and psychological problems.

Often the parents have not recognised that their child has developed into adult, and, as an adult, they require an amount of freedom and independence. For example, in young men independence often causes difficulties between father and son. The relationship must be maintained by giving more freedom and treating the person as an adult, not as a child.

There may be temper tantrums, resentment and, if not handled correctly, the young adult may become rebellious or even run away from home.

'House rules' MUST be maintained, but recognition of the needs of the young must be remembered to keep a healthy and loving relationship between parents and child.

For a young adult, this is the time of great experimentation which may involve drugs, smoking and alcohol (see 'Substance Abuse').

Drug abuse may lead to addiction and death, smoking is medically proven to be dangerous to health, alcohol can kill. A stable home environment is the best preventive measure.

Common problems include:

• Depression.
• Anxiety.
• Schizophrenia.
• Anorexia nervosa, particularly girls.
• Suicide.

Depression
Can be severe in teenagers. It arises from internal family conflicts. The desire to become independent of the family, although perhaps not a financial reality is normal.
The attitude of the teenager to rebel against authority often leads to conflict with parents. The teenager feels constrained and frustrated because they lack the confidence to lead an independent existence.
These factors, combined with the requirement of self-discipline in following higher educational training, can lead to under-performance. In turn this may cause anxiety and an inability to cope with day-to-day problems.

Anxiety may disturb normal sleep patterns leading to depression. It is important that depression is recognised at an early stage.
Look out for:

• Lack of motivation.
• Tendency to 'put things off until tomorrow'.
• Poor sleeping pattern, with early morning waking.
• Feeling of low esteem.
• Poor appetite.
• Inability to get up in the morning.
• Irritability and tearfulness.

Should any of the above occur, seek medical advice. Ignoring these symptoms may have tragic consequences.
The sufferer may feel so worthless, that he or she believes there is no point in carrying on and so attempts suicide.

Suicide
Always related to severe depression. Recognise symptoms early and seek professional advice. Symptoms may include:

• Early waking.
• Loss of 'drive'.
• Low esteem.
• Withdrawal.
• Irritability.
• Stress.

Anxiety
May result from overwork and excessive worrying. It can present itself in many different ways:

• Difficulty getting to sleep, over-active mind.
• Night sweats.
• Rapid pulse associated with palpitations.
• Over-active stomach activity, ('rumbling tummy').
• A 'sinking feeling'.
• Headaches, mainly over back of head and crown.
• Tightness in shoulder muscles.

These symptoms can be overcome by learning relaxation techniques and talking over problems with a sympathetic adviser. If in doubt, seek medical advice.

Schizophrenia
Often develops in early adulthood. The cause of this psychotic illness is unknown, although it is relatively rare. The onset of the illness is subtle and can be missed in the early stages. Some guidelines are:

• Gradual personality change, becoming more withdrawn.
• May be associated with religious mania.
• A feeling of persecution.
• Hallucinations, claiming to have visions.
• Hearing voices and acting upon them.
• Gradual withdrawal from reality.

Should any of these signs appear obtain medical advice. The illness can be controlled providing the person is prepared to keep up treatment.

One of the problems in treatment is as soon as the patient feels well, they are unable to accept there is anything wrong in the first place, and stop treatment. However, reinstatement of treatment results in control again.

Anorexia Nervosa
Formerly confined to young women and now appearing in young men. The subject starves themselves and the condition is recognised as a psychiatric illness. It's more common in young dancers and singers who have a 'fat' image of themselves. Their self-image is of obesity, which results in stringent dieting to such an extent that they become emaciated unless there is expert intervention.

The condition is often associated with low self-worth and ultimately, depression. The desire not to eat is a form of suicide as the individuals are unable to face the outside world as they see themselves.

It is not easy to recognise in its early form. Most women diet occasionally. If it appears your child is losing weight, that they pick at their food and miss many meals, seek medical advice.

Female Puberty
Puberty is the time when a child develops physically into a young adult. The age at which this occurs can vary. For girls this can start as early as 11 years when periods first start, but may be as late as 14.

Female problems in puberty include:

• Acne.
• Onset of menstruation.
• Breast development.
• Attraction to opposite sex.
• Moodiness and rebellion against authority.
• Drug abuse (see 'Substance Abuse').
• Alcohol abuse.
• Cigarette smoking.

Despite more frankness in teaching sexual development and sexual problems in schools, there is still ignorance among the young. Parents often avoid discussion with their offspring, mainly because of embarrassment and ignorance.
Menstruation is signalled by stomach discomfort and sometimes backache, followed by vaginal bleeding. If a young woman is not prepared for this, fear of this naturally occurring event may ensue. Advice regarding the wearing of sanitary towels (or tampons) should come from the parent. Menstruation is often irregular initially and it may take up to 18mths for a regular pattern to develop. The period normally lasts for 5 days and occurs every 28 days. It must be impressed on a young woman that this is a normal event. She must be encouraged to lead a normal life, attend school and take normal exercise. If pain before the onset of a period is extreme, medical advice is recommended. Sometimes at the onset of a period, bleeding may be very heavy and medical advice is required.
Breast development starts with onset of menstruation. Breasts normally fully develop by 16. At this time, a young woman may be very sensitive about her body and become shy, choosing to wear heavy baggy sweaters disguising her shape.
Advice from mother on the correct brassiere is important. An open discussion between mother and daughter to explain what is happening to her body is invaluable.
A young woman of 15 or more becomes aware of her sexuality and often feels pressured by her friends of the need for a (freqeuently disastrous) sexual relationship.

Self Abuse is a common natural occurrence.
Young people are highly fertile and information on contraceptive techniques must be available. Self-control has to be encouraged and the consequences of lack of control illustrated.

During puberty the common skin complaint acne often occurs. Small septic painful spots may appear on the face, chest and shoulders. Usually by the age of 18 the condition disappears. It is caused by the secretion of a male hormone called androgen, which makes the skin greasy. The small sweat glands of the face and shoulders become plugged by grease and sweat, often forming blackheads. These can develop into infected spots which in extreme cases can cause scarring. Cleanliness is not a factor. However cosmetics can make matters worse.
In extreme cases seek medical advice. Some antibiotics can be used as well as certain contraceptive pills.

Male Puberty
The onset of the maturing process starts later in boys, usually from 14 onwards. The first sign is the voice 'breaking' (deepening). Young males often have a very pure soprano voice, but as they develop the voice deepens. As the voice settles, hair begins to grow on the face, in the pubic area and in the armpits.
The penis and the testes become enlarged. It's not uncommon to have wet dreams.
It is quite common for the young male to have erections at the most unexpected times, frequently if in the company of the opposite sex who he may find attractive. This is a natural reaction and he soon learns to control his emotions. Many young males experiment to obtain an erection and ejaculation. This is so common that it is a natural occurrence.
It's estimated over 90% of men and 65% of women mast-urbate at some time during their lifetime. There is no medical evidence to suggest that it has any harmful effect on health. If, however, it becomes an obsession seek medical advice.

During puberty a common skin complaint, acne, often occurs and is usually more severe in young men. Small septic painful spots may appear on the face, chest and shoulders. Usually by the age of 18 the condition disappears. It is caused by secretion of a male hormone called androgen which makes the skin greasy. The small sweat glands of the face and shoulders become plugged by grease and sweat, often forming blackheads.
These can develop into infected spots which in extreme cases can cause scarring. Cleanliness is NOT a factor. In extreme cases seek medical advice. Some antibiotics can be used.

Experimentation with drugs, alcohol and tobacco are more common in young men. Most western cultures put a high social value on a young person's ability to drink excessive quantities of alcohol. Smoking was previously considered fashionable for both men and women. However, both drinking to excess and smoking are equally dangerous pursuits and carry high medical risks.

Despite more frankness in teaching sexual development and sexual problems in schools, there is still widespread ignorance among the young. Parents often avoid discussion with their offspring, because of embarrassment and ignorance.

External links
Disciplining your child and Questions about Sex from Kids Health for Parents.