While most simple viral infections are mild and a full recovery is assured with no treatment, a baby or young child can sometimes have a more serious illness. Sometimes, especially during the early stages of an illness, it is difficult even for doctors to pick up the signs of something more serious. Yet it is important to realise that the earlier the signs of a serious illness are detected, the sooner treatment can be started. This is particularly important for babies and very young children. Younger children can go downhill quite quickly, and early detection of serious illness is vital.

How do parents know when an illness is minor and when it might be more serious? Recent research has pointed to signs which might indicate that the baby or young child should be seen immediately by a doctor. You should watch out for:

• drowsiness

• decreased activity/lethargy

• breathing difficulty

• poor circulation

• poor feeding

• poor urine output.

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This is a test which is used to confirm the diagnosis of a genetically inherited disorder called cystic fibrosis (see p. 200). The concentration of salts in the sweat is measured. In children with cystic fibrosis, the level is much higher than normal.

THROAT SWAB

If your child has a sore throat, your doctor may suggest doing a throat swab. This is a brushing of the back of the throat with a sterile long cotton bud, which is then placed in a special container and sent to the laboratory. The sample is checked under a microscope and some is brushed onto a special culture medium and incubated for 48 hours, in an attempt to grow the germ causing the infection. Many throat infections are due to viruses but certain germs, such as Streptococcus, can also be the cause. It is definitely advisable to do a throat swab if your child has pus on his tonsils. The procedure also helps to determine which antibiotic will be effective against the specific germ found.

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1. Select an entirely new activity that neither one of you has ever done before, even in childhood. There are hundreds of possibilities.

2. Decide what type of recreation suits your “unit.” If one of you is very athletic and the other more artistic, the activity will have to stress other skills, leaving these for individual enjoyment.

3. Start the activity together and develop it together. If one or the other partner tends to “get ahead” in most things, make sure you leam together. This one activity is only for the two of you. You can still have your golf, tennis, running, or whatever other activity you may enjoy as an individual.

One wife reported, “We came up with something. It’s sailing. We both can’t swim, have never been on a boat, and don’t like the water. We couldn’t come up with anything, so we picked the one thing most unlike both of us. It’s working out slowly. He tried to be the captain and make me crew, but I think we worked that out after he fell off the boat while trying to tell me to be careful. There he was, mouth full of water, his captain’s hat floating beside him, and trying to tell me how to save him.”

4 Remember that individual activities are still important. One husband stated, “We have spouse activities that include tennis and walking. Then we have what we call ’sperson’ activities, individual things we do with other people. She golfs, I golf, but we’re at drastically different levels of ability there. I will never be the golfer she is, so we each enjoy it to our own level with other people more at our level.”

The marriage that plays together and plays separately is most likely to find super marital sex, for the joy and energizing aspects of fulfilling play can enter into the sexual relationship. As you consider this possibility, remember that a mutual involvement in a “mini-career” could also be a form of play. Noel Coward said, “Work is much more fun than fun.”

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It is caused by a dominant gene, so the children of a sufferer have a one in two chance of inheriting the disease. Unfortunately, it may not appear until a person is in his forties, so the sufferer has usually married and reproduced before being aware that he has it. It affects men and women equally.

Once the disease declares itself, the sufferer shows involuntary muscular movements, incoordination and mental degeneration.

Although it occurs in most countries of the world, it has its greatest incidence in closed communities where there is a degree of inbreeding.

Tasmania has one of the highest prevalences of Huntington’s disease in the world and this has been traced to the arrival in the last century of an affected Somerset woman who had nine affected children.

Unfortunately, there is no treatment.

Considerable research is under way to improve the outlook for sufferers. Proper genetic counselling for those who have a family history of this disorder can help a couple to decide about having a family.

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If the blood pressure continues to rise bed rest at home or admission to hospital may be necessary.

Hypotensive drugs that lower the blood pressure may also be necessary. Once pre-eclampsia has developed it does not go away, until the baby is delivered.

It can be controlled and its effects minimised until the baby is spontaneously delivered or the pregnancy is terminated by induction of labor before the due date.

If untreated pre-eclampsia may go on to the condition of eclampsia, where the blood pressure is out of control. The mother develops fits and the baby usually dies. Eclampsia is rare only because pre-eclampsia is so well managed.

An instrument called an echograph can measure the size of the baby and see its progress. This uses ultrasonic waves in the same way as sonar is used to track submarines. The placenta produces a hormone, oestriol, and this is excreted in the mother’s urine.

Measurement of the levels of oestriol give a good indication of placental function and how well nourished is the baby.

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Eczema. There are three forms of eczema, all occurring in adults, which are thought to have a strong emotional basis. These are: the so-called discoid eczema, which occurs in coin-shaped spots, mainly on the limbs, and which is extremely itchy; dyshidrotic eczema, which occurs about the fingers and toes, as small, itchy bubbles under the skin; and lichen simplex, which is a well-localized thickened area of skin which is extremely itchy. Lichen simplex may occur on any area of the body, but always in an easily accessible place. Sufferers of these forms of eczema obviously require treatment to the skin and, in addition, an understanding doctor to help them sort out, or at least talk over, the underlying problems or anxieties.

Trichotillomania. This is not such a rare condition, but it is one which frequently goes unrecognized in its minor form. Principally, it occurs in children who seek neurotic satisfaction through pulling out their own hair. Usually they select the hair of the scalp, and less often the eyebrows. The principal element in the psychodynamic of children is the turning on oneself of unexpressed rage at rejecting parents. This is the transformation of a sadistic instinct into a masochistic one. Hair pulling may be missed if it is not considered in relation to patients thought to have ringworm, alopecia areata, etc.

Adults who inflict this condition on themselves are often deeply disturbed individuals, usually with sexual conflicts which, basically, resolve around the notion that sex is dirty, filthy, and repugnant; they contrive to ’shed’ these feelings by pulling out their hair and making themselves less likely objects of sexual attention.

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BurgenTM Soy Lin, Soy and Unseed loaf (G.I. of 19) • A mixed grain bread from Tip Top Bakeries. Sydney. Available in supermarkets. It has the lowest G.I. of all mixed grain breads. Other varieties of Burgen™ bread also have a low G.I.

Cherries (G.I. of 22) • The G.I. for cherries is based on European cherries. Australian cherries which are 6.1 per cent glucose and 4.2 per cent fructose may have a higher G.L value.

Custard (G.I. of 43) • Made with milk, so provides calcium, protein and B vitamins plus a little sugar, vanilla flavouring and a starch thickener.

Doongara rice (G.I. of 59) • An Australian grown rice with a high amylose content and low G.I. Available in supermarkets and in bulk quantities from wholesalers and some Asian food stores. Fruit loaf (G.I. of 47) • Available in wholemeal and white varieties, but choose the heavy types. The G.I. of fruit loaf is probably lowered by part substitution of flour (high G.I.) with fruit (lower G.I.).

Grapefruit (G.I. of 25) • The low G.I. factor of grapefruit may be due to their high acid content which slows absorption from the stomach.

Grapes (G.I. of 46) • An equal mix of fructose and glucose and a high acid content are characteristics of fruits with a low G.I. Grapes are a good example.

Icecream (G.I. of 61) • Most dairy products have very low G.I. factors. When we eat dairy foods a protein curd forms in the stomach and slows down its emptying. This has the effect of slowing down absorption and lowering the G.I. factor.

Kiwifruit (G.I. of 52) • Kiwifruit contain equal proportions of glucose and fructose and high acidity giving a reasonably low G.I. They are also a wonderful source of vitamin C with one kiwifruit meeting the total recommended daily intake.

Legumes (G.I. range: 14 to 56) • Abo known as pulses. These include dried peas, beans and lentils, mostly have a G.L factor of 50 or less.

Canned varieties have a slightly higher G.I. than their home-cooked counterpart due to the higher temperature during processing. Soya beans (G.I. of 18) have one of the lowest G.I. values, possibly due to their higher protein and fat content. The viscous fibre in legumes reduces physical availability of starch to digestive enzymes.

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