When your child falls over or knocks himself against something, the skin may become bruised. Bruising is very common in children, especially over the area of their shins, due to the rough and tumble nature of their play. Bruising is due to bleeding into the skin from blood vessels which have been damaged. Any bruising which cannot be explained by the normal activities of children, should be looked at by your doctor. Certain patterns of bruising may be found in children with a bleeding tendency, although it must be emphasised that this is rare.

Treatment

Ice packs applied to the bruise immediately for 10 minutes can help to ease the bruising and the pain. Bruises take 7-10 days to disappear, changing colour as they heal.

CALLUSES

Calluses are areas of hard skin, caused by thickening of the layers due to prolonged pressure or rubbing. They commonly appear on the hands or the feet and are not painful. They actually provide a protective layer, and occur commonly in children who run around barefoot. No treatment is necessary. If you wish to soften the callus, wet it and pare it down with a pumice stone which you can buy from the chemist. Occasionally cracks or splits appear over callused areas. These should be softened by rubbing with sorbolene with 10% glycerol cream which is available from any chemist. Exposure to the air can aid rapid healing. If cracks persist or are painful, consult your doctor.

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Water safety

This is the peak age for drownings. Children must be constantly supervised around water. If you have a swimming pool, make sure there is a Standards-approved between your house and the neighbours’ house are secure. Never leave your child alone in the bath, even for a moment. Do not rely on older children to supervise a toddler. Check the environment to make sure there are no pools of water; young children can drown in water only a few centimetres deep. Nappy buckets pose particular dangers when children are learning to walk.

Scalds

Toddlers are very much at risk for scalds, especially from cups of tea or coffee, but also in the bath or by pulling at tablecloths, the cords of electrical appliances, or knocking over saucepans or buckets containing hot liquids. Do not nurse or cuddle your toddler if you are holding a hot drink.

Burns

Make sure that there is effective sun protection when the child goes outside to play. Hats, long sleeves and blockout creams are the order of the day. A young child’s skin is very sensitive, and severe sunburn can occur even on an overcast day. Be careful of open fires, radiators and barbecues, and keep matches and cigarette lighters out of reach.

Falls

Toddlers love to climb, and may use chairs or tables to explore wardrobes or high shelves. Secure furniture such as bookshelves and dressers which can be toppled over. Put safety catches on windows.

Cuts and lacerations

Keep knives and scissors out of reach, and pad sharp edges of tables and bookshelves.

Choking

Make sure the child sits while eating. Do not give him peanuts, as they are easily inhaled, and keep beads and small parts of toys out of reach.

Poisoning

Keep medicines under lock and key (tablets can look like lollies to a young child), and store detergents, dishwasher powder and liquid and other household chemicals out of reach and preferably in a locked cupboard. Do not store household poisons in soft drink or fruit juice containers. Your toddler should travel in a Standards-approved toddler restraint in the back seat of the car. If your child can open the car door even while restrained, keep the door locked.

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Our sexual diagnostic terms reflect this same psychology orientation. A NIMH study reported that virtually no family in the nation is free of mental disorders, and that up to sixty million Americans exhibit deviant mental behavior related to schizophrenia. The same thing that has happened to our sexual health has happened to our mental health. We have been declared statistically sexually ill. Masters and Johnson indicate that over half the couples in the United States have sexual problems, and they provided the terms that, with slight modifications by the American Psychiatric Association, are the new sexual-babble of our time.

Here is a system for formulating your own “diagnostic system” from the fourth perspective. “Talking it over” is much more important than “labeling it.”

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He should have married his mother. She ran his life, runs his life, and will always try to run our marriage if he lets her. If he would have married her, it would have saved time on gas and phone bills. ,

WIFE

American marriage is under constant bombardment by extraneous influences, as is clear from the MIM factor. Work, schools, hospitals, governmental agencies, family, and neighbors continually impinge on marriages, stretching them to provide for others what the marriage can not provide for the couple itself.

When daily living was not so anonymous, so computerized, mechanical, and fast-paced, marital and family life was free to respond more to the natural cycles of life, the changes within and among people. Now the American marriage is a socially reactive unit more than it is an intimate active relationship that governs itself.

A call from school, a computer-generated message, car phones that can even let you know if you were called while you left your car, all place us under the potential continued surveillance of others. We have become a “beeperized” culture, never really out of touch as long as a little tone reminds us that a person out there needs us more urgently than the person here with us now.

Parents live longer, so responsibilities in parenting parents as well as children have emerged. In those couples who had parents living, “parenting parents resulted in obligations, distractions,” and sometimes guilt that encroached on marriage. In-laws miles away affect the marriage, with recurring themes of conflict regarding who said or did not say what to whom or who did not attend what family function or did not call enough.

It is certainly not just obligation and distraction that invades the marriage, but difficulties finding a new relationship with parents and others once we are married. Extended families require a psychological maturity that few of us attain. Sometimes it takes all of our energy to be, as one husband put it ‘just civil’. We may unconsciously resent the fact that our time which our spouse takes away from the expiring time available for relating to our parents. How much of what is done for whom relates to guilt, fear of loss, and split between loving now and loving for the past.

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This means that the air sacs are filled with fluid or thick secretions and cannot fulfil their function of exchanging gases between the blood and air.

There are pneumonias due to viruses of many types and there are the bacterial infections.

Lobar pneumonia, where one whole lobe or large segment of the lung is involved, was a more common illness than we now see. It often attacked the otherwise healthy person.

The patient was ill for many days and the high fever either settled suddenly (crisis) or the person died.

Complications were many and frequent and those who survived often were unable to work for many months.

This pneumonia is due to the pneumococcus, a germ which is sensitive to most antibiotics. Lobar pneumonia, if recognised and treated early, is no longer a serious threat.

It appears to be less common and this might be because of the wide use of antibiotics in minor respiratory infections.

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Once the correct diagnosis has been made, correct treatment can be used.

If chronic purgative abuse is the cause, it can be difficult to correct.

One of the most important points in avoiding constipation is getting into the habit of emptying the bowel at the same time each day (or less frequently if this is normal for you). Following a meal, the gastro-colic reflex stimulates the bowel to act after some 10 to 15 minutes. This should not be ignored. Set a regular time each day and then try to keep to it. Increasing the bulk of one’s diet seems to regulate the bowel.

Laxatives are all right for acute constipation and may make life more comfortable when the condition is due to some temporary upset but it is not necessary to have “a good clean out every now and then.”

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An ulcer may form on the meatus or opening of the urethra at the tip of the penis. This forms a scab which is broken away each time the boy passes urine and is associated with screaming and blood on the nappy.

Meatal ulcers are rare in the uncircumcised.

These ulcers may heal and form a contracting scar which can obstruct the flow of urine — a urethral stricture.

Circumcision is normally done around the eighth day from birth. There are several operative techniques — which one will depend on the surgeon’s preference.

Some doctors carry out a proper dissection with stitches to bring the cut ends of skin together, which is the usual method of adult circumcision. Other ways involve placing bell-like instruments over the glans and cutting around the edge. A popular method is to use bone forceps to crush the skin edges and reduce bleeding. These operations are conducted without anaesthetic, but if done on infants over four weeks of age an anaesthetic is usually given.

There are a number of risks faced by the infant, no matter what the operation: too little skin may be removed but this only affects the appearance. If too much skin is removed and the shaft of the penis denuded, it can lead to a tender scar.

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Signs and symptoms

The presence of a puncture wound usually is obvious. The important aspects of the diagnosis involve determining whether the puncture has penetrated into a deeper structure (a joint, the abdominal cavity or chest cavity, the skull, or a tendon), whether it contains a foreign body (broken needle, wood or glass splinter, or shred of clothing), and whether it is infected.

Home care

Wash the skin surrounding the puncture with soap and water and apply a non-irritating, non-stinging antiseptic such as solution – not tincture – of Merthiolate antiseptic. Be sure your child has been immunized against tetanus within the last five years. Make sure that the object that made the wound is intact and has not broken off at the tip. Inspect and feel the wound to determine if a foreign body can be detected under the skin. If no foreign body is present, cover the wound with a sterile bandage and inspect it twice a day for signs of infection (redness, discharge, swelling, increasing pain, and tenderness). Soak the wound frequently in warm water to help keep it clean. If there is a foreign body in the wound, take the child to a doctor.

Precautions

• Puncture wounds in the abdomen or chest can be very serious. Take your child to a doctor.

• Punctures of a joint may cause infectious arthritis within hours. The knee joint is particularly susceptible; a puncture near a joint, especially the knee, should be seen by a doctor. Any signs of infectious arthritis (redness, swelling, increasing pain, inability to move the joint through its full range of normal motion) should be considered a medical emergency.

• Do not remove an object from a puncture wound, not even if it is a knife blade, a nail, a splinter of wood or glass, or a needle. Let your doctor remove it. You might cause further damage if you try to remove the object yourself.

• If a puncture wound remains tender for more than one or two days, it should be seen by your doctor.

Medical treatment

A puncture wound cannot be cleaned properly, even by a doctor. Your doctor will try to determine if any foreign bodies are present by feeling the wound or by X ray. If there is anything in the wound, it may need to be removed surgically; or the doctor may wait and observe the wound for awhile, perhaps instructing you how to soak it in Epsom salts solution for five to 10 minutes four times a day. Antibiotics will be prescribed if the wound is infected, and a tetanus toxoid injection will be given if the child’s immunization is not current. If a wound has penetrated a joint, the abdomen, the chest, the skull, or a tendon, your doctor will hospitalize the child and explore the wound surgically.

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