Murtagh general practice pdf


 

The Diversity and Commonality of Cells. Cells come in an amazing variety of sizes and shapes d_c01_ Fundamentals of Electric Circuits (5th ed). John Murtagh's General Practice, 6th Edition () [PDF]. John Murtagh's General Practice, 6th Edition () [PDF]. 26 MB PDF. John Murtagh, Jill Rosenblatt, Justin Coleman, Clare Murtagh Part 1: The basis of general practice. Part 2: Diagnostic perspective in general practice.

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Murtagh General Practice Pdf

GENERAL PRACTICE 6E. **AUSTRALIAN AUTHOR**. John Murtagh's General Practice 6th Edition is the book for all GPs, registrar and student GPs. This text is . This tried-and-tested resource provides GPs general practice nurses registrars EBOOK JOHN MURTAGH'S PATIENT EDUCATION 7E (PDF). Murtagh's Practice Tips 6e John Murtagh AM MBBS, MD, BSc, BEd, FRACGP, DipObstRCOG Emeritus Professor in General Practice, School of Primary Health .

Following a comprehensive postgraduate training program, which included surgical registrarship, he practised in partnership with his medical wife, Dr Jill Rosenblatt, for 10 years in the rural community of Neerim South, Victoria. He was appointed to a professorial chair in Community Medicine at Box Hill Hospital in and subsequently as chairman of the extended department and Emeritus Professor of General Practice in until retirement from this position in He combines these positions with part-time general practice, including a special interest in musculoskeletal medicine. He achieved the Doctor of Medicine degree in for his thesis The management of back pain in general practice. In he was awarded the Member of the Order of Australia for services to medicine, particularly in the areas of medical education, research and publishing. In the same year, he was named as one of the most influential people in general practice by the publication Australian Doctor. John Murtagh was awardedthe inaugural David de Kretser medal from Monash University for his exceptional contribution to the Faculty of Medicine, Nursing and Health Sciences over a significant period of time. Membersof the Royal Australian College of General Practitioners may know that he was bestowed the honour of the namesake of the College library. Today John Murtagh continues to enjoy active participation with the diverse spectrum of general practitionerswhether they are students or experienced practitioners, rural- or urban-based, local or international medical graduates, clinicians or researchers. His vast experience with all of these groups has provided him with tremendous insights into their needs, which is reflected in the culminated experience and wisdom of John Murtaghs General Practice. People are more interested than ever before in the cause and management of their problems, and for this reason access to information in aneasy-to-follow presentation is very beneficial. Furthermore, patients need and deserve the best possible access to informationabout their health. The material presented in this book is not intended to be used as an alternative to the verbal explanations given by the doctor during the consultation but as complementary information to be taken home. Experience has shown that better understanding of a problem or potential health problem leads to better cooperation and compliance with treatment. The author has produced patient education information to fit onto one sheet, which can be handed to the patient or person seeking health information.

These sheets should have considerable value in undergraduate courses for doctors, nurses and other health professionals. The catalyst for the initial production of this material came from two sources. The Royal Australian College of General Practitioners, through its official publication Australian Family Physician AFP , encouraged the author to write patient education material as a service to general practitioners and their patients.

The strategy was to present information on the most common problems presenting to general practitioners, each on a single A4 sheet and in the lay persons language.

Patient education sheets have been a feature of monthly publications of AFP since , and doctors have ordered them in vast quantities. Thisconcept has also been promoted by Australian Doctor, which commissioned the author to write a series of patient educationinformation in that popular publication.

We have not simply featured illnesses, but have also included preventive advice and health promotion wherever possible. The other impetus for this project came from the members of the Monash University Department of Community Medicine and General Practice, who realised the importance of this material for the education of medical students. Apart from providing valuable learning material for the students, it gave them the basis for illness and preventive advice to patients during the consulting skills learning program.

Following a rather indifferent response to the initial production of material in AFP, it is interesting to now discover that since the launch of the first edition of Patient Education the use of this material is rising very rapidly.

It is now a much requested inclusion in computer programs for doctors and is blossoming on the Internet. These trends reinforce the perceived value of this form of health education. The author believes that the subject matter in this book covers common everyday problems encountered by doctors and hopes that the dissemination of this information will benefit both health-care providers and people who are interested in their health.

Also, my colleagues in the Department of Community Medicine, Monash University, have provided valuable assistance. Professor Neil Carsons far-reaching vision of general practice training includes the value of this educational medium. Thanks also to Dr Kerri Parnell and the Editor of Australian Doctor who have agreed to permit publication of selected patient education material that appeared in Australian Doctor in this book.

Other reference material includes Better Health patient information Victorian Government and patient information conditions from Patient Co, United Kingdom. Repeat this procedure about 5 times each morning. A simple treatment. Before breastfeeding. After the baby is born. Not drying the nipples thoroughly after each feed and wearing soggy breast pads are other contributing factors.

Place the thumbs or the forefingers opposite each other at the edge of the areola on the imaginary horizontal line. How are sore nipples managed? It is important to be as relaxed and comfortable as possible with your back well supported and for your baby to suck gently. Check that your baby is correctly positioned on the breast. It usually takes only 1 to 2 days to heal. When the areola is squeezed. The crack is either on the skin of the nipple or where it joins the flat.

Untreated sore nipples may progress to painful cracks. They can observe and teach the correct technique. Cracked nipples Cracked nipples are usually caused by the baby clamping on the end of the nipple rather than applying the jaw behind the whole nipple.

Make sure each position is correct. During pregnancy. In the vertical position. Never pull the baby off the nipple. Press in firmly and then pull the thumbs or fingers back and forth to stretch the areola.

If the blues last longer than 4 days. All you really need is encouragement and support from your partner. It is important to get plenty of help and rest until they go away and you feel normal. Exhaustion from lack of sleep. It is most important to consult your doctor and explain exactly how you feel. Your problem can be treated and cured with appropriate support.

You need help. Support groups There are some excellent support groups for women with postnatal depression. Take your baby to the childhood centre for review. The depression ranges from mild to severe. Some or all of the following may occur: There are two possible separate. Postnatal depression About 1 in 8 mothers develop a very severe depression within the first 6 to 12 months usually in the first 6 months after childbirth.

This is a very serious problem if not treated. It is caused by the marked hormonal changes of pregnancy. Postnatal depression It is quite common for women to feel emotional and flat after childbirth. There may be risks to you. The onset is usually in the first 3 days after childbirth. You must be open and tell everyone how you feel. Both the mould and its cause should be eliminated. Some reactions are caused by food additives such as colourings. Respiratory system includes nose.

What is the management? Feeding Breastfeeding of allergy-prone babies for the first 6 months might diminish eczema and other allergic disorders during infancy.

Get advice from your doctor or infant welfare nurse. If breastfeeding is not possible. Is allergy inherited? Allergy cannot be inherited directly by children from their parents.

The correct diagnosis is a matter for your doctor. Be alert! Vacuuming regularly and keeping pets outside will reduce the problem. The allergic reaction to dairy products. Read labels carefully to check ingredients in products. As a result the body produces naturally occurring inflammatory chemicals called IgE antibodies. Particular care should be taken when starting foods that most commonly cause allergic reactions dairy products. Symptoms may be any of the following: Allergies are common in babies and children.

Other allergies Many babies and children develop allergies to house dust and animal hair. Allergies are not infectious and cannot be transmitted from child to child. The condition is also called atopy. What are the causes? Common causes of allergic reaction are foods and airborne irritants. How to tell if a baby has an allergy An allergic reaction might take hours or even days to develop and can affect almost any part of the body.

They should be avoided during the first 6 to 9 months. Start one food at a time. Allergy in your baby What is allergy? Damp and poorly ventilated homes are subject to mould. What happens when solids are introduced? Unlike most of the common childhood illnesses such as measles and chickenpox.

Air bedding regularly. Digestive system includes stomach and intestines: They usually disappear as the child grows older. New foods should be introduced at least several days apart. The quantity can be increased the next day if no reaction occurs. In an emergency Call an ambulance if your child is: Asthma in children What is asthma? What is the medicine for asthma? Asthma is a common chest condition that affects the small air passages bronchi of the lungs.

How long does an attack last? It may last from a few hours to a few days. This can be done using a: About 1 child in 4 or 5 may wheeze and at least half of these have only mild asthma.

There are medicines that really help children with asthma. These symptoms should be checked out by your doctor. If your child is having asthma attacks more than once a month. Three types of medications used in children are: They are plastic chambers that make delivery easier to manage and allow the medication to get well into the lungs. Often it is difficult to know what has caused an attack. It is usual to use spacer devices.

The cough is most likely to occur during the night usually in the early hours of the morning. Most children are normal between attacks. The Asthma Action Plan Ask your doctor or asthma nurse educator to provide you with an Asthma Action Plan for an acute attack or for an emergency situation.

Remember to keep a smoke-free environment at home and in the car. A persistent cough may be a symptom of asthma. This makes it harder for the air to flow in and out of the lungs.

A guide to what to do is as follows: What causes asthma? Asthma is brought on in different ways for each child. In infants and toddlers a face mask attached to the spacer is used to help deliver the aerosol to the lungs. How do I know if my child has asthma?

The main symptoms are a cough. During an asthma attack these breathing tubes become narrow from the spasm of the muscles in the wall and the secreting of mucus. While waiting for the ambulance. In infants it usually starts on the face and scalp. The child may be very irritable and uncomfortable. It is not contagious. Medical help Your doctor.

Atopic eczema What is atopic eczema? It is not a dangerous condition. The relationship of diet to eczema is controversial and uncertain. Alpha Keri and a bland cleansing agent e. It tends to be coarse. Many children have outgrown it by late childhood.

It tends to improve from 1 to 2 years. No particular cause has been found. Contact with herpes simplex cold sores can produce nasty reactions. Typical sites of infantile eczema What things appear to aggravate eczema? Eczema or atopic dermatitis refers to a red. Use sorbolene or paraffin creams e. The value of allergy testing is doubtful.

Egozite baby cream or others that help. Soaps and detergents Rough and woollen clothes Animal fur Abrasive surfaces e. What ages are affected?

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What about skin tests and injections? Eczema usually starts in infants from any age. Atopy refers to an allergic condition that tends to run in families and includes problems such as asthma. Medication The use of medicines for ADHD is controversial but there are effective medications available.

It affects about 1 in 20 to 30 children and is far more common in boys. How does the child with ADHD affect the family? ADHD is a developmental disorder of children with the key features of problematic behaviour. What is the outlook? As a rule children do not grow out of ADHD. It is usually present from early childhood. Not all children with ADHD are overactive and not all children who are inattentive.

Having ADHD does not imply that the child has an illness or is not intelligent. There has to be a consistent pattern to the behaviour and not an occasional breakdown in attention span or impulsive acts. It is very important to accurately diagnose ADHD before putting such a label on the child—there are no foolproof diagnostic tests.

The child should be assessed by an expert in the area. If the prescribed drug proves helpful. The patience of all members of the family can be stretched to breaking point. The strategies include positive parenting and teaching behaviour strategies. There are many things that can be done to help children and their families.

What are other features? Day-to-day problems can include some or all of the following: The child needs much understanding and support from the family. Parents usually come in looking exhausted and frustrated with the comment.

What is the cause of ADHD? The cause is not clearly known but many experts believe that it has a hereditary basis. The symptoms must be present in at least two situations.

Is a special diet recommended? It is always valuable to encourage a good. Your doctor will be able to advise on the best option. A special exclusion diet such as avoiding junk foods. Symptoms range from mild to severe.

Your doctor can make an assessment of the child and arrange a referral. Although many symptoms can improve with time. The three characteristic features are: Autism, described first by Kanner in , is a developmental disorder commencing in the first 3 years of life.

The main features are: There is no medical treatment for autism, although some medications may help for some of the symptoms. Best results are obtained by early diagnosis, followed by a firm and consistent home management and early intervention program. Later the child will benefit from remedial education, either in a specialised facility or in a regular school with specialist backup.

Speech therapy can help with language development, and nonspeaking children can be taught alternative methods of communication. Most difficult behaviours can be reduced or eliminated by a program of firm and consistent management. Parents and siblings usually need support and regular breaks. What is the cause? The cause of autism is unknown and no one particular anatomical, biochemical or genetic disorder has been found in those who suffer from it. It now appears to have multiple causes.

The problem appears to lie in that part of the brain responsible for the development of language. Many autistic children appear physically healthy and well developed. However, they may show many disturbed behaviours. As infants they may cry a lot and need little sleep. They resist change in routine and often refuse to progress from milk and baby food to a solid diet.

They avoid eye contact and often behave as if they are deaf. Normal bonding between mother and child does not occur and prolonged bouts of crying do not respond to cuddling.

As the children get older and more agile they may show frequent tantrum behaviour, destructiveness, hyperactivity and a disregard for danger, requiring constant supervision to prevent harm to themselves or their environment.

The diagnosis is best made by a team of experts observing the child, but remains difficult under the age of 2 even 3 years. There are no laboratory tests available. Behavioural and emotional problems may get worse in adolescence, especially during sexual development. Most autistic children have some degree of mental retardation, although some may have normal or superior intelligence. Most require at least some degree of lifelong support in order to remain within the community and enjoy a good quality of life.

As their life expectancy is normal, this represents a considerable commitment from their families and community support services. Autistic people have an increased risk of developing epilepsy, and many suffer psychiatric complications such as anxiety, depression and obsessive-compulsive disorder as they get older. These require appropriate medical treatment. Where to seek advice Consult your general practitioner, who may refer you to a paediatrician or child psychiatrist.

Assistance can also be obtained from autism associations in each state, or the national organisation Autism Spectrum Australia, which can provide full information regarding assessment and diagnostic services, management programs and family support services. It is a developmental disability and is due to a difference in the way the brain develops, leading to particular difficulties in processing certain types of information. What are the typical features? They tend to interpret language in very concrete and literal ways e.

They also: What social difficulties do they have? The narrow focus of their interests, and their desire to discuss these interests at length with little understanding of how others are responding, can lead to avoidance or rejection by others. Their distress at interruption of their routines and rituals can lead to outbursts of anger that may seem unpredictable and unwarranted to others. There is usually no significant delay in the child developing speech and many will have quite advanced verbal abilities for their age.

There can, however, be limitations in how much they understand of the content and implications of what they say. They have difficulty comprehending and manipulating abstract concepts and the abstract use of language, for example in idiom, metaphor, humour and sarcasm. They may also be unaware of, or confused by, the complex interplay of language content, tone of voice, facial expression, body language and social context that comprise a communication message, and so may misinterpret what is said or be misunderstood by others.

What is their intellectual ability? There are particular patterns seen on psychometric testing that help in making a diagnosis. They usually demonstrate an ability to memorise organised data but do not have good powers of imagination. How is it diagnosed?

John Murtagh’s General Practice 7th Edition

There are no specific blood or imaging tests. The diagnosis is made after assessment and testing by skilled paediatricians, psychiatrists or psychologists. No specific genetic markers have yet been found. A diagnosis leads to understanding and facilitates access to support groups and further sources of information. The basis of intervention is helping the person and their family and friends understand their difficulties, and to explicitly teach specific social rules, behaviours and skills as required.

Bed-wetting enuresis What is nocturnal enuresis bed-wetting? It refers to bed-wetting at night in children or adults at a time when control of urine could be reasonably expected. What is normal? Bed-wetting at night is common in children up to the age of 5. Bed-wetting after a long period of good toilet training with dryness is called secondary enuresis.

What causes it? There is usually no obvious cause, and most of the children are normal in every respect but seem to have a delay in the development of bladder control. Others may have a small bladder capacity or a sensitive bladder. It tends to be more common in boys and seems to run in families. Most bedwetting episodes occur in a deep sleep, and so the child cannot help it.

The cause of secondary enuresis can be psychological; it commonly occurs during a period of stress or anxiety, such as separation from a parent or the arrival of a new baby. In a small number of cases there is an underlying physical cause, such as an abnormality of the urinary tract.

Diabetes and urinary tract infections may also be responsible. It does tend to run in families. Yes; this is quite important, as it will exclude the rare possibility of any underlying physical problem such as a faulty valve in the bladder that might cause bed-wetting. What are the treatment options? Many methods have been tried, but the bed-wetting bell and pad alarm system is generally regarded to be the most effective. If the child has emotional problems, counselling or hypnotherapy may be desirable.

Drugs can be used and may be very effective in some children, but they do not always achieve a long-term cure and have limitations. An agent called desmopressin Minirin , which is sprayed into each nostril at night, seems to be very effective if the alarm system is ineffective. Bed-wetting clinics are available in major centres. The bed alarm There are various types of alarms: A lead connects to the buzzer outside the bed, which makes a loud noise when urine is passed.

The child wakes, switches off the buzzer and visits the toilet. This method works well, especially in older children. Key points Bed-wetting: How should parents treat the child? If no cause is found, reassure the child that there is nothing wrong, and that it is a common problem that will eventually go away. There are some important ways of helping the child adjust to the problem. When should you seek professional help? Seek help if there is: Birthmarks What is a birthmark?

A birthmark is any area of discoloured skin present from birth or very soon after birth and persists for at least several months. The common type of birthmark is called a naevus. The naevus is usually a collection of tiny blood vessels in the skin called a vascular naevus or a collection of dark pigment called a pigmented naevus. It is a flat red or pink patch of dilated capillaries that appears on the nape of the neck or on the face, especially on the eyelids, the bridge of the nose and adjacent forehead.

No treatment is required. The strawberry naevus The proper medical name for a strawberry naevus is haemangioma of infancy. It is a very bright red raised area that can occur on any part of the body. At birth it is so small it may be the size of a pinhead that it is not noticed for a few days, then it grows rapidly for a few weeks, increasing in size up to 20 weeks in proportion to the growth of the baby. When the baby is about 6 months small white-grey areas appear in the naevus and gradually spread to eventually replace the red tissue so that the lump becomes flatter and smaller.

The naevus usually disappears substantially by the time the child reaches 4 years or school age and completely by about 8 years of age. Occasionally the naevus may bleed either following a knock or spontaneously, but applying firm pressure with a finger over a small dressing usually stops the bleeding.

In most cases no treatment is required. Sometimes if the naevus is large and disfiguring on the face or interfering with orifices such as the eye, ear or genitals, your doctor will refer the child to a specialist clinic for treatment. The port wine stain The proper medical term for this is capillary malformation because it is a patchwork of tiny swollen capillaries that appear as a purplish-red discolouration anywhere on the body, especially on the face and limbs.

About 1 in babies will be born with the stain. It may not be obvious at birth and so may not be diagnosed for several weeks. With time the stain becomes raised and thicker but it does not grow in size except in proportion to body growth. It usually persists into adult life and remains unchanged although it may fade slightly. In the past it was difficult to treat or remove and cosmetic creams were used to conceal the stain.

Now it can be treated best in the first 2 years by specialised laser treatment. Pigmented birthmarks A pigmented birthmark is a discolouration on the surface of the skin due to a dark pigment called melanin. It is usually seen as a flat coffee- or black-coloured spot. The correct medical term is a melanocytic or pigmented naevus or mole.

One child in is born with a pigmented birthmark. Nearly all children will develop them after the age of 2 and it must be emphasised that they are usually completely harmless. As a rule the birthmark becomes more raised and perhaps hairy as the child grows. Generally there are only one or two small spots but in some cases the spots can be many or very large. Some infants are born with pigmented birthmarks that have hair growing out of them. In some older children a halo of paler skin may appear around it which is called a halo naevus.

The mark may become itchy or swollen from time to time. Pigmented birthmarks are generally permanent but can be removed by plastic surgery if necessary for cosmetic reasons. This is best done before starting school. Mongolian blue spots These are pigmented bluish irregular flat patches usually found over the lower back, sacrum and bottom. They can be mistaken for bruises but are harmless and become less obvious as the child grows. They are more common in babies of dark-skinned parents.

Bow legs and knock knees Bow legs and knock knees are relatively common in infants and children but are usually no cause for concern. They are stages that children pass through and it is important to remember that most legs are perfectly straight by the teenage years.

Bow legs genu varum Bow legs are very common up to the age of 3 years. In fact, they are quite normal up to the age of 2 or 3. This means that when the ankles are touching the knees are apart. The bend in the legs often causes the child to walk pigeon-toed with feet pointing inwards. Bow legs usually correct themselves when the child starts walking, so much so that from about the age of 4 there is a tendency for the child to develop knock knees.

Braces or special shoes do not help straighten any better than natural development. Knock knees Knock knees are also normal in children and most have these between the ages of 3 and 8 years. Running can be awkward, but improves with age. The rule for normal 3-year-olds is: These invariably straighten nicely after 8 years. How can you check progress? For any concerns about the degree of knock knees, measure the distance between the ankles DBA.

It should be checked by your doctor if the DBA is greater than 8 cm after the age of 8 years and not improving. Keeping a photographic record is also helpful.

If you are concerned about the extent of the bow legs, the problem can be monitored by measuring the distance between the knees DBK. If this is greater than 6 cm and not improving at 4 years and older, it is advisable to have them checked by your doctor. Comparing progress can also be helped by taking serial photographs every 6 months.

In summary It is normal for children to have: Bronchiolitis What is bronchiolitis? Bronchiolitis is a chest infection in which there is inflammation of the bronchioles, which are the smallest branches of the respiratory tree of the lungs. This results in narrowing and blockage of the small air passages with mucus, leading to a negative effect on the transfer of oxygen from the lungs to the bloodstream. Bronchiolitis can be confused with bronchial asthma or the effects of an inhaled foreign object.

What is the cause of bronchiolitis? It is caused by one of the common respiratory viruses, especially respiratory syncytial virus. The virus appears to have a particular tendency to target the bronchioles in infants. It is a contagious condition that is usually spread from droplets released into the air by coughing. It can also be spread by hand contact with secretions from the nose or lungs. Bronchiolitis usually occurs in the winter months.

Who gets bronchiolitis? It typically affects babies from 2 weeks to 12 months, especially under 10 months of age. At first the infant usually develops symptoms of a mild common cold with a runny nose, fever and cough for about 48 hours. As the infection progresses over the next day or so, the following irritations develop: These more severe symptoms last about 3 to 5 days.

In a very severe episode there are: What is the expected outcome? The wheezing usually lasts for about 3 days only, and as it settles the child gradually improves. Most babies can be treated at home and are usually better in 7 to 10 days.

The cough can last up to a month or so. Does bronchiolitis recur? It usually occurs once only but can recur. Some infants can have recurrences in the first 2 years and some develop bronchiolitis after every cold, especially if there is an underlying tendency to asthma. Some infants with. However, most infants with recurrent wheeze will not develop asthma. What are the risks or complications?

In some cases the infection is severe and the children become depleted in essential oxygen and fluids. Dehydration is a problem because of drinking difficulty from constant coughing. They require hospitalisation. Complications, including secondary bacterial pneumonia, are uncommon. There is no particular medicine, including antibiotics, that cures bronchiolitis because it is a viral infection. It gets better naturally but care is required. Home management Milder cases the majority can be managed at home.

Give 1 to 2 extra bottles a day or more frequent breastfeeds. If feeding is difficult, give smaller quantities more often. Hospital management More severe cases with respiratory distress need to be admitted and given oxygen and special feeding. When to seek help Seek help if any of the following occur: Reproduced with permission of Australian Doctor. Bullying of children What are the facts about childhood bullying?

Research indicates that bullying of children is common and widespread wherever children are grouped together.

It is increasing, and is prevalent in every school, with long-lasting consequences. What are the forms of childhood bullying?

John Murtagh's General Practice, 4th Edition

What are the effects of bullying? Bullying not only affects the child being bullied but also the audience witnessing the anti-social behaviour. Even the bully, if unchecked and not counselled, will possibly develop social problems and have communication problems in their teen and adult years.

There is evidence that child bullies and those bullied as children have the potential to become bullies in adulthood. What are the signs to indicate bullying? One or more of the following indicators will be present in the child: Why are children bullied?

The perpetrators tend to pick on anyone around them but seem to target those who seem vulnerable and easy to hurt. This includes those children who: How to tackle the problem: Make a list of the facts and approach the school authorities preferably with a friend or another affected parent in a very businesslike manner. Be prepared to name names and the circumstances—places, times and methods.

Be persistent until the problem is adequately attended to. Getting help The following are possible people or agencies where you can get help: After recovery. Exclusion from school Children should be kept at home for 7 days or until all the pocks are dried and covered by scabs. It is caused by a virus that can also cause shingles herpes zoster. Scarring Most people worry about this. At first they resemble red pimples. The site of the rash The pocks are concentrated on the chest.

In general. Recovery occurs naturally. Typical spread of chickenpox What are the risks? It is usually a mild illness with complete recovery.

A concerned pregnant woman should discuss this with her doctor. Chickenpox varicella What is chickenpox? Chickenpox varicella is a mild disease. Adults have an influenza-like illness. At home it would be sensible to expose other children to the infected person so that the illness can be contracted before adulthood. General Children are not very sick. Pregnancy If chickenpox is acquired in the first 20 weeks of pregnancy or at the time of delivery.

Give regular sips of water and consider icy poles. The rash The pocks come out in crops over 3 to 4 days. Patients are infectious for 24 hours before the pocks erupt and remain so until all the pocks are covered by scabs and no new ones appear.

The blisters are very fragile and soon burst to leave open sores. Put on cotton mittens if necessary. How infectious is chickenpox? Avoid giving aspirin to children. Drink ample fluids. Do not be alarmed if they appear in or on the mouth. Pat dry with a clean. Ask your doctor for information. A severe reaction occurs rarely if aspirin is used in children. Chickenpox affects mainly children under the age of Solugel is an effective preparation.

The incubation period is about 12 to 21 days. They can be very itchy. False plugs should be inserted into all power points that are not in use. Toilet cleaners and deodorants also should be locked away. They should never be stored in old drink bottles.

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In the playroom Any object smaller than a cent piece may choke a child: Never leave children unattended in a bath. Do not use tablecloths. Select close-fitting clothes. In the pool Five centimetres of water in a pool can drown a toddler. Keep pool chemicals. Do not pin dummies to clothing. Any type of fire should have a guard around it.

In the car and on the road Place your child in the car first. Preschool children can easily choke on peanuts and small hard foods. In the bathroom Poisons and burns are also the main bathroom hazards. Do not leave ladders around. Children will crawl and fall over veranda edges and steps unless these are fenced off. Train your children to sit in the back on the passenger side so that they get out on the kerb.

All children should be placed in approved child restraints. A pool not in use should be made safe from wandering children—at least covered and preferably fenced off—and children should swim only with adult supervision.

Know the local Poisons Information Centre telephone number. Put all spray cleaners. Child accident prevention in the home In the kitchen The most dangerous place for children is in the kitchen— poisons and burns are the dangers.

In the yard Insecticides. Never drink anything hot while holding a baby. Keep jars containing small items such as buttons out of reach. Do not allow saucepan handles to stick out into the kitchen from the top of the stove.

In general Floor-to-ceiling glass doors and windows should have two stickers on them one at your eye level. In the bedroom Remove the plastic cover from a new mattress. Prepare your house now. Always put hot food and drinks in the centre of the table. Tablets and medicines may be fatal for children: Short stakes in the garden should be removed. Electric jugs with cords dangling down are very dangerous. Bar radiators and children do not mix. Any operation carries a risk of complications and some.

Doctors may argue that it is unnecessary on medical grounds and any unnecessary operations should be avoided. The decision to circumcise It is important to weigh up the pros and cons for circumcision and then discuss it with your doctor. In older boys and some adults. As time goes by the foreskin frees up so that by the age of 5 years it can usually be fully retracted. This may well mean that circumcision will be necessary. It is a routine ritual in some religions or cultures.

Method of circumcision. This leads to a very small opening. Some people argue and there is evidence from some African countries to support this that it protects against the spread of HIV and other sexually transmitted infections and also reduces the risk of urinary infection.

As a rule the foreskin should only be retracted by its owner! Who needs circumcision? In some boys the foreskin may be very tight this is called phimosis and prone to infection. Doctors usually advise against operating on newborn babies and point out that there is no hurry to operate because it is best performed when the baby is not wearing nappies. When can the foreskin be fully pulled back? The foreskin of all newborn babies is tight. Rarely the foreskin cannot be pulled back easily and may get stuck in some older boys.

When it is pulled back. Redness and discharge as well as pus when passing urine indicate infection. In Australia today. Circumcision Who gets circumcised? Circumcision is performed on baby boys for a number of reasons.

If it is not possible to fully pull back the foreskin by the age of Why are doctors generally against circumcision? A policy statement from the Paediatrics and Child Health Division of the Royal Australian College of Physicians does not generally recommend routine circumcision.

It is a controversial issue. Some parents want the operation so that the child can be just like his father. The foreskin has a protective function for the delicate glans tip of the penis. Sometimes an infection can cause the skin to become too tight. Avoid foods that are obvious e. The treatment is by a special diet.

The exact reason is unknown. Coeliac disease in children What is coeliac disease? It is a hereditary disorder of the small intestine caused by a sensitivity to gluten in food. It is important to get the advice of a dietitian.

This allows the bowel lining to recover. It is present in most of our breakfast cereals. It affects 1 in people. The condition is also called gluten enteropathy and non-tropical sprue. Children can have stunted growth which can be permanent if not treated and have an increased risk of infection.

In children the response can be dramatic. A gluten-free diet is not necessarily dull. These include: This shows the flat lining of the intestine. Supermarkets now sell many tasty products. It excludes gluten—no wheat. The problem can be dormant for years. In some children there are no symptoms and when present they vary from one person to another. Appearance of lining of normal intestine Appearance in coeliac disease What is gluten?

Gluten is a type of protein present in most grains. Both adults and children can get anaemia due to the poor absorption of nutrients.

With this special diet there is a gradual improvement in abdominal swelling and muscle bulk. It is useful to contact a coeliac disease support organisation such as the Coeliac Society in your state. Any iron and vitamin deficiency should be corrected with tablets—ask your doctor. There is no cure for coeliac disease but it can be controlled. A low-lactose diet may be advised for a short period. Normally the lining of the small intestine has a fluffy velvety texture but with coeliac disease it becomes smooth and flat.

The intestine simply cannot tolerate gluten in food because the gluten damages its lining. This reduces its ability to absorb nutrients including sugars.

The symptoms can come on slowly. Breakfast cereals containing rice and maize corn can be eaten. Generally it is not a serious disorder when diagnosed early but otherwise can have serious consequences.

Who gets the disorder? Coeliac disease is a relatively common condition that seems to affect mainly people of European descent.

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Other considerations There is no restriction to general activities. Children usually develop it between 9 and 18 months of age following the introduction of solids into the diet. These children need to be in hospital to have specialised treatment and occasionally an airway tube inserted. Humidified air It is important for you to stay calm and keep the child calm by comforting them on your lap or wrapping them in a blanket if it is cold and carrying them outside.

It tends to occur in the winter months. Medication The modern method is to give the child steroids cortisone by mouth or by spray for the more troublesome attacks where stridor is a feature.

It is a special problem in children. A harsh. Croup usually begins as a normal cold. Watching television can help the child relax. What is the danger? Croup is usually a mild infection and settles nicely. The traditional method of using steam danger of burns and vaporisers is no longer favoured by most doctors. The symptoms are worse if the child is upset and may last for 3 or 4 days. Attacks of croup usually occur at night. When should you seek immediate medical help?

Call your doctor or take your child to hospital urgently if: A stridor a high-pitched wheezing or grunting noise with breathing may develop. The cough. Croup What is croup?

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