Cause

There are three main causes of anaemia. By far the most common is a deficiency of iron in the body. Iron is essential for the formation of haemoglobin, the part of the red blood cell which carries oxygen around the bloodstream. Far less common causes are decreased production of red blood cells (aplasia — for example, in certain chronic diseases), or excessive destruction of red blood cells (haemolysis — for example, in some acute severe infections).

Iron deficiency in children is most often due to inadequate iron intake. Normally a baby has enough iron stores from his mother to last for the first 6 months of life, although if he was born prematurely or has been sick, the stores will be exhausted before then. After that he requires iron to be part of his diet. Usually at around 6 months of age, the baby is introduced to solids such as cereals, vegetables, eggs, and later on, meat, all of which contain iron. However, babies who are on cow’s milk and who drink excessive quantities often have insufficient iron in their diet. Cow’s milk is a poor source of iron, and in addition if a baby drinks too much milk his appetite for solids is diminished. This problem rarely occurs in breastfed babies, or those who are on formula feeds (because these contain iron).

Clinical features

The child with anaemia will appear very pale. A toddler may exhibit lethargy, but this may not be obvious, given his usual high energy levels. Some babies and toddlers with iron deficiency are irritable and difficult to manage. If the anaemia is caused by something besides iron deficiency, then specific features of that condition may be present.

Investigation are essential in any child with anaemia to find out its cause. Usually blood tests are all that is necessary, but sometimes other tests are performed as well.

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The most common reason for a young child walking on tiptoes is that of sheer habit. Rarer causes include tight heel ligaments present from birth, and cerebral palsy. If your child is toe walking out of habit, you can play an important role in improving his gait by playing games like walking on the heels or heel-to-toe walking. This condition usually improves with time and does not require treatment. If you are at all concerned, consult your doctor.

SPRAINS

A sprain is an overstretching or tear of a ligament and can be very painful. It can result from a fall or a sporting injury. Although common in adults, sprains are less likely to occur in children due to greater flexibility of their ligaments and a fracture should always be suspected if your child has an area of swelling and tenderness over a bone after injury. First aid treatment until you get him to a doctor includes placing an ice pack over the affected area to reduce the swelling and pain, splinting the limb and keeping in elevated.

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The main aim of treatment is to allow your child to lead as normal a life as possible. For this to happen, pain needs to be kept to a minimum and the joints kept functioning to the best of their ability. Muscle strength must be maintained with specific exercises. Bed rest is advised only during periods when the illness flares up. Physiotherapy is essential, and night splints may be fitted to help prevent the joints from becoming frozen in awkward positions. Massage and hydrotherapy can also ease pain and encourage flexibility. Pain relief is vital and may be aided by the use of painkillers or anti-inflammatory medication. The short-term use of steroids is sometimes recommended for severe flare-ups. Use of these drugs should always be under medical supervision. If your child has certain deformities due to the illness, an occupational therapist can assist with specific aids and can suggest helpful modifications in the home.

The general outlook for children with Still’s disease is, on the whole, good. The illness does not usually continue into adulthood, and rarely leaves severe long-term deformities.

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Cause

The cause for Still’s disease is unknown.

Clinical features /

Although the joints are most often affected in Still’s disease, there may also be inflammation of the eyes, and a characteristic pink rash on the face, limbs and trunk. At the onset of the illness your child may have swelling of one or two large joints, such as the knees, wrists or elbows. He may complain of pain and stiffness in these joints especially upon waking in the morning. He may also have a mild fever and feel generally unwell or weak. Lymph glands, especially in the neck , may be swollen. Smaller joints such as those in the fingers sometimes become swollen and painful.

When to see your doctor

• if your child has unexplained pain or swelling in one or more joints which lasts for more than 2-3 days;

• if your child has an unexplained fever or rash and is generally unwell.

Investigations

X-rays, blood and urine tests are usually performed in order to confirm the diagnosis of Still’s disease.

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Most babies are babbling soon after 6 months of age, and will then begin to form repetitive sounds such as ‘ma-ma-ma’ or ‘da-da-da’ over the next few months, especially if this is reinforced by others. Parents will often talk or sing to babies, and this sort of stimulation is very important in ensuring that babies fulfil their language potential. The next stage of language development for babies is to begin to use single words meaningfully. Often the first real words are ‘mama’ or ‘dada’, followed rapidly by other commonly used and simple words such as ‘bye’, ‘doggy’, ‘drink’, and so on. First words are frequently mispronounced and difficult to understand, and the progressive acquisition of vocabulary is dependent to some extent on reinforcement and stimulation by parents and other family members.

Toddlers then string several words together in meaningful phrases, and this is soon followed by sentences. By about 3 years of age they will have acquired some of the rules of grammar and language that form the basis of mature adult speech.

A child’s comprehension of language parallels speech development. Both speech and comprehension are dependent on adequate hearing. If a child is deaf or has a permanent or fluctuating hearing problem, then language may be absent or delayed, or there may be problems of articulation or intelligibility .

The rate ot language development will depend on a host of factors, to do with both the child and the environment. Girls generally tend to be slightly more advanced than boys in their language development. Second and later born children may have advanced development (because they have older siblings to model themselves on) or else may be a little slower (because their siblings will do their talking for them and make their needs known to parents). The temperament of a child may influence language usage — a shy, introverted child will tend to hold back in communication, whereas the reverse is true for a more confident, outgoing child.

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Doctors often recommend that you take a painkiller only ‘when you need it’ (whatever that means)! People who are told to do this often wait until their pain is excruciating before taking the next dose. This is a very bad way to take painkillers since, if you do this, you will never have good pain control. You will spend most of your time feeling frightened and anxious because you know that the pain is going to come back, and it will take a bigger dose to control it when it does. It is much better to work out how long it is before your pain just starts to come back and to take your painkiller regularly that often.

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Vitamin B2, or riboflavin, is found in dairy products and green vegetables, but is widely distributed throughout most natural foodstuffs.

A lack of riboflavin affects the skin and mucous membranes.

Nicotinamide, or Vitamin B7, is also widely distributed in most foodstuffs.

Lack of this vitamin — and usually with an associated lack of riboflavin — produces the disease known as pellagra, and this usually is seen in those whose staple diet is maize and little else.

Vitamin B6, or pyridoxine, is required for the proper functioning of nervous and skin tissue.

B6 has recently been used in relieving premenstrual tension (PMT).

Most of the B-group vitamins form part of the molecules of enzymes in the body, those chemical substances which are necessary for the build-up and break-down of all the body tissues.

Vitamin B12, or cyancobalamin, is formed in the body by the action of a chemical in the stomach acting on another chemical taken in with the food.

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Hypotensive drugs, that is those used to control hypertension or high blood pressure, may cause giddiness or even fainting when the person suddenly changes posture from the sitting or lying to the standing position.

No matter what the cause of the syncope or faint, one common factor is the standing position.

Sudden loss of blood, such as may occur from a severed artery in an accident or from a miscarriage, or even with a heavy period or a severe nosebleed may lead to fainting.

Bleeding may occur from a duodenal ulcer and the rapid loss of one or two pints of blood may lead to fainting.

Conversely, reversing this, that is making a person lie flat, will rapidly prevent or lead to recovery from the faint.

Deep breathing, sitting, or putting one’s head between one’s knees, are inadequate means of preventing a fainting attack.

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For most cancers, the earlier they are detected, the better the results of treatment.

This applies to the commonest cancers in women and the means of early detection are available. Mahy women are either unaware of the available facilities or are just not motivated to use them.

Many women suffer discomfort in their bladder. It is usually called cystitis.

Yet it may not be the bladder itself which is involved in this most common of urinary problems.

The kidneys are on the back wall of the abdomen, just below the ribs, and lie one on either side.

They have several related functions concerned with the excretion of waste products and with the salt and water balance in the body. As blood flows through the filters of the kidney, a fluid is collected. As this fluid passes along the collecting tubule in the body of the kidney, some substances are reabsorbed and others are excreted into it.

The resulting fluid, urine, then leaves the kidney by a thin tube, the ureter, and flows down into the bladder, where the urine is stored until passed to the outside through another tube, the urethra.

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No sophisticated research or statistical methods would be necessary if we were looking only for major improvements in treatment. It is a fact that the greatest advances in cancer treatment have been made simply by trying a completely new type of treatment in a series of patients. Here are some examples concerning chemotherapy.

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