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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Technological developments in the area have led to a number of different machines now being available for directly or indirectly measuring body fatness. Some of these are extremely expensive and would not be used in the normal day-to-day counseling situation. Others are now becoming more portable and more accessible and provide at least an opportunity for adding to other measures. The current range of machines include: underwater weighing, bio-impedance analysis, dual energy X-ray absorptiometry, etc.

Dual energy X-ray absorptiometry (DEXA). In 1987 the first commercially available dual energy X-ray absorptiometer (DEXA) was designed to measure the bone mineral content of the skeleton, especially at the spine, hips and wrist because they are common sites for osteoporosis. The machines, however, can accurately measure three body components (bone, fat and lean body tissue) both regionally and for the whole body and are now common in most hospitals. The method enables measurement of total fat as well as regional body composition. They use a very low dose of X-ray and scan a person in 20-40 minutes. DEXA is taking over from underwater weighing as the validation standard in fat measurement and body fat research, largely because of its accuracy, comparative ease of use, and widespread availability.

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HOW THE NERVOUS SYSTEM AND MUSCLES WORK

Did you know your child was lucky enough to own his own computer? What is more, he can also operate it! How’s that for competence, without any formal training, and without having to purchase anything?

In fact, his computer was given to him by you at birth. What is more, it will last him for the rest of his life, and it will keep working, year in and year out, until he dies from old age. It is the human brain. This wondrous bit of machinery, plus the electrical hook-up that goes with it, forms the nervous and muscular system of the body.

The computer is carefully locked up in a strong-room; its walls are made of solid bone, which is almost as strong as concrete. This is aimed at protecting it from injury throughout life.

From the lower back part, a thick tail extends downwards, through a canal formed by adjoining holes in the bones that make up the backbone, or spinal column. This thick, rope-like structure is called the spinal cord. As it descends down the back, it becomes gradually thinner. At regular intervals, where the vertebral bones join each other, a nerve is given off from the main cord. This tracks out and divides into many smaller divisions. Each goes to a certain part of the body or to a group of muscles.

In the head region, these are called the cranial nerves. At the level of the arms, large ones are given off and these supply the upper limbs. Lower down, huge nerves branch off to form the giant sciatic nerve which supplies the lower limbs.

All activities must start somewhere, and the beginning is the brain. Here, ideas are quickly translated into messages that are instantly conveyed to the appropriate part of the brain. Electrical impulses are then sent to the muscles concerned; the muscles contract and movement takes place. All this can happen with the speed of lightning.

The body is very fussy that the brain system be kept clean and free from germs or injury. For this reason it is covered with a thin sheet of tissue called the meninges—an important protective layer. Also, the brain is bathed in fluid called cerebro-spinal fluid. This helps protect it from sudden jarring movements which could otherwise damage it.

The entire spinal cord is made up of microscopic strands which commence in the brain and end in various muscles and organs of the body. (It is very similar to telephone cables which carry thousands of individual wires that extend from the exchange to a person’s telephone in the home. Each is capable of carrying an enormous number of messages, and the exchange knows exactly where the individual messages are headed for.)

The telephone system

But just as things can go wrong with the telephone system, so disorders may occur in the nerves. The brain itself may become diseased, as germs penetrate the coverings and produce brain damage that may be serious or even life-threatening. Also, the insulating material of the nerves may become impaired or diseased, causing short-circuits. This is represented by certain so-called demyelinating disorders.

Sometimes the brain is damaged before birth, and severe defects may occur, such as spina bifida or hydrocephalus. The electrical system of the brain may be defective, causing epilepsy. These disorders may occur before birth. Some develop afterwards, and indeed some may take place at any time during life.

Nerves frequently extend to muscles. Each muscle is made up of millions of tiny individual fibres, and each has a nerve attached to it. If an electrical impulse reaches the muscle, it causes it to contract or shorten. When thousands of these act together, it makes the entire muscle shorten, and in this way movement is possible. By shortening the muscles of the arm, for example, we can bend the arm, the hand, or the fingers. Impulses from the brain can be sent to other groups of muscles in the body at the same time. This is how we are capable of moving about and performing normal activities.

But just as the nerves can be diseased for various reasons, so the muscle fibres may suffer from various defects. Fortunately they are not very common in infancy and childhood.

Some nervous system disorders are common in infancy, but most are fairly uncommon. Convulsions during a fever are frequent, and epilepsy is also fairly common. Developmental anomalies are rarely seen by family doctors.

We will discuss some of the more probable disorders so that you may recognise them. At all times, any suspected abnormality of the brain or nervous system should prompt quick medical attention from the doctor. Today, many serious disorders may be successfully treated. The sooner this commences, the better.

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