Masturbation is extremely common in childhood. Virtually all children masturbate at some stage and it should be regarded as a developmentally normal behaviour. In younger children it is part of the exploration of their bodies, and in older children it is part of the exploration of their sexuality. It is obviously a pleasurable activity in children of all ages, and is a normal part of their physical and psychological growth.

Self-stimulation begins in infancy with nappy changing and bathing. Babies very early on discover the pleasure of touch. Accidentally at first, and then with increasing purpose, they are able to recreate this pleasurable experience, and soon discover the relationship between self-stimulation and pleasure, along with such behaviours as thumb- and finger-sucking, rocking and head-banging.

Some parents attempt to stop or prevent this activity, often out of their own embarrassment. Some sections of the community and some cultures are moralistic about masturbation, implying that it is unnatural and if not prevented may lead to subsequent problems. In fact, this is not true — the repression of masturbation may lead to later problems by making the child guilty and confused about his body and emerging sexuality.

Parents should simply accept that masturbation is universal and a perfectly normal behaviour in children. It is best ignored. Sometimes parents are embarrassed because their child masturbates in public. It is better to distract the child than telling him to stop it. Paying attention to it, and in particular, trying to prevent a child from doing it, confer on the behaviour a seriousness that is unwarranted.

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BARIUM ENEMA

This procedure is similar to a barium swallow except that the barium is administered into the rectum using an enema. Under X-ray, it highlights abnormalities of the lower part of the bowel.

BARIUM SWALLOW

A solution containing a substance called barium is drunk, usually on an empty stomach. Under X-ray, the barium becomes visible in the oesophagus, stomach and gastro-intestinal tract. The barium is excreted in the faeces, which are white and powdery for a day or two afterwards.

BIOPSY

A biopsy is the removal of a small amount of tissue, under local or general anaesthetic, for examination under the microscope. The type of cells present can be identified and an accurate diagnosis of the medical condition usually made. Biopsies can be performed on all parts of the body including the skin, lymph nodes, bowel, liver, kidney and so on.

BLOOD CULTURE

This test is done if it is suspected that a child has an infection in the bloodstream (sepsis). It is usually done in a hospital setting, as a child who is indeed septic usually needs to be hospitalised. A small amount of blood is drawn from a vein, just as in a normal blood test, but in very sterile conditions. The blood is mixed with a special culture liquid, then sent to the laboratory where it is incubated at a certain temperature to see if any germs grow. These can then be identified, and tested to see which antibiotics will be effective in treating them.

BONE AGE ESTIMATION

X-rays of the wrists in children can often be used as an indication of whether a child’s growth is in accordance with his chronological age. It can also be used to estimate ultimate height in children with short or tall stature (see p. 354-6).

BONE MARROW ASPIRATION

In this test, which is performed under local anaesthetic in a hospital setting, a needle is inserted through the skin into the hip bone and a small amount of bone marrow extracted. It is generally performed if leukaemia or other similar forms of cancer are suspected.

CARDIAC CATHETER

This test is only performed in a hospital setting, under sedation or anaesthesia. A fine catheter (tube) is passed into the heart via a vein in the thigh, and the internal pressures blood, can be measured. It provides information which is important in the assessment of various heart conditions, especially congenital heart disease.

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In letting ourselves take risks we will develop more confidence in our own ability. It doesn’t matter if we make mistakes along the way. Mistakes are a part of living. Mistakes are actually our teachers if we are willing to learn from them. If we don’t learn from them, we repeat them in one form or another.

At each step we can take what we need and let go of what we must. The development of the self is like the birth of a child. We need to be protective of it. The conscious feel of it will be so new, it will feel vulnerable.

People around us will not be able to understand our inner pressure. We are meeting the push for growth head-on, and at this stage we are doing it for our self. This is all that matters at this point. The question of selfishness may come up again. Is being free from the disorder selfish? Is wanting to develop our full potential selfish? Look what happened last time we didn’t!

This may be a time when counselling can help ourselves and our families get to know and accept the person we are becoming.

The ultimate answer and the ultimate resources are within us. It can sometimes hurt and it can sometimes be frightening. It can mean different things for all of us, but ultimately it is the path to freedom. It is the path of self determination.

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Many surgeons recommend that the two steps are carried out separately but under the same anaesthetic. For example, patients with suspected breast cancer are often asked to agree to be put to sleep, following which the surgeon takes a sample of the suspicious area. This is rapidly examined under the microscope by a process called frozen section. Once the diagnosis is made, the surgeon immediately proceeds to carry out whatever operation he or she considers best.

It is neither necessary nor best for you to do things this way. In the case of breast lumps, the diagnosis can be made pre-operatively by a needle biopsy. With most types of cancer it is possible to make the diagnosis and carry out any surgical treatment in two completely separate steps. This has two major advantages. Firstly, it allows time for the biopsy to be fully processed and examined. The rapid frozen section method used during operations is fairly accurate. However, it is not as reliable as the usual process, which takes several days. The pathologist can usually tell whether or not is cancer but it less likely to tell the exact type of cancer on frozen section. The type of cancer is often very important in determining the best type of treatment. The other big advantage making the diagnosis separately is that this gives you the opportunity to decide on the best possible treatment knowing all the important facts.

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In my experience, the sudden development of a large inguinal hernia is more likely to follow an episode where the legs are suddenly stretched apart when the person slips rather than following an episode of lifting.

Inguinal hernias are much more common in men and this is to be expected when we consider the developmental anatomy.

The only proper treatment is operation. Trusses are mentioned only to be condemned. It has been found that long-term results are better if hernias are operated on even in bedridden elderly men.

A common complication of a hernia is that a portion of the bowel in the hernial sac may become trapped, twisted and its blood supply cut off.

If the bowel is just trapped, it is called an incarcerated hernia. If the bowel is kinked and obstructed, it is a strangulated hernia and, when the blood supply is cut off, the bowel becomes gangrenous. These complications usually require urgent operation.

A small hernia with a wide neck which is unlikely to become strangulated may be left if it causes no symptoms. But the tendency is for it to get worse, so operation should not be long delayed.

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The Rhesus or Rh factor is present in all red blood cells and was detected in 1940.

It was named from the Rhesus monkey on which the experiments were conducted.

There are three pairs of Rh factors, or antigens, and these are determined by six genes — Ñ, c; D, d; E, e — carried on a pair of chromosomes. One chromosome comes from the mother and one from father.

However, it is the D antigen which alone determines whether a person is Rh positive or Rh negative. Eighty-five per cent of us are Rh positive, that is we have the D gene.

When an Rh negative woman is pregnant with an Rh positive foetus, the red cells containing this Rh factor can leak into the mother’s circulation. And stimulate the production of antibodies.

This leakage may occur at any time during pregnancy but is more likely at the time of delivery or during a spontaneous miscarriage or induced abortion.

This sensitisation is more likely if the mother’s blood and that of the baby are ABO compatible. The ABO is the main blood grouping of which there are four — À, Â, AB and O.

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Hair colouring has been practised by both men and women since the days of the Pharaohs. Primarily it is used Co conceal the onset of greying, but with the development of more sophisticated and simpler techniques the changing of hair colour has become a pursuit of fashion. Originally vegetable dyes such as henna and camomile were mainly used. These were certainly safer than, if not quite as effective as, the newer products. Metallic dyes, sometimes known as ‘colour restorers’, are mainly used by men to gradually dye grey hair. These dyes are usually made from the salts of lead (resulting in a black colour) or bismuth (resulting in a brown colour). With frequent applications, they gradually change the hair colour. They are relatively easy and safe to use.

The hair dyes most commonly used by women today are the synthetic organic dyes. There are three main types available. The temporary ones simply coat the hair shaft with pigment, without penetrating it. They are usually applied as a rinse, and may be removed by shampooing. Semi-permanent dyes are the most popular. These penetrate the hair shaft, without drastic pre-treatment, and persist tot six to ten shampoos. They are mainly nitro or azo dyes. The permanent, or oxidative, dyes are mainly para-phenylenediamine mixed with hydrogen peroxide. Their main disadvantage is that a significant proportion of people are allergic to them, and there is some as yet unconfirmed evidence that they may produce cancer in some experimental animals.

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It’s fairly easy to give a meal a low G.I. twist through dessert. This is because so many of the basic components of dessert, like fruit and dairy products have a low G.I. factor.

In discussions with people about what they eat these days, dessert is seldom mentioned. With busier lifestyles and concerns about overweight, dessert is conveniently missed. While this appears a positive change in eliminating unnecessary kilojoules from the diet there is a negative side. In many instances desserts can make a valuable contribution to our daily calcium and vitamin C intake because they are frequently based on dairy foods and fruits. What’s more, desserts are usually carbohydrate rich which means they help top-up our satiety centre, signifying the completion of eating.

The basis of a perfect dessert—low G.I. fruits and dairy foods.

Citrus. A winter fruit which is an excellent source of vitamin C. Select heavy fruit with fine textured glossy skin. Oranges are good as a snack cut into quarters and frozen. Soak segments of a variety of citrus fruit in orange juice with a slurp of brandy, scatter with raisins or sultanas and serve as winter fruit salad.

Cherries. A true summer fruit Choose plump fruit, bright red/black colour on fresh green stems. A bowl of cherries on the table is a lovely dessert to share.

Stone fruits. Apricots appear earliest in the season. Choose those with as much golden orange colour, avoiding pale or green fruit. Peaches and nectarines should be just beginning to soften. Fresh sliced peaches or nectarines are delicious with ice cream or yoghurt. Sprinkle fresh peach halves with cinnamon and try them lightly grilled.

Pears and apples. At their peak during autumn and winter, but are available all year. Preparation simply involves washing and slicing and they provide the perfect finish to a meal.

Grapes. One of the most popular fruits with children because they are so sweet and easy to eat. Grapes do not ripen after harvest so choose bunches with a deep, uniform colour on fresh green sterna. Put a bowl on the table after a meal or include them in a fruit salad.

Custard, ice cream and yoghurt. Look far low-tat varieties for a cool and creamy treat

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