Health Guide

Constipation and Abdominal Pain

Other names :
Bound up.


Introduction :
Difficulty in passing firm faecal motions.


Types :
What are considered to be normal bowel habits varies dramatically from one person to another. Some consider it normal to pass a motion three times a day, others once a week. Provided there are no symptoms or complications, neither of these extremes requires treatment.


Cause :
There is no doubt that the most common causes of constipation are poor diet and poor toiletry habits. The excess intake of junk foods with little or no fibre and excess sugars, leaves nothing for the lower bowel to work on, and constipation results. The repeated postponement of nature’s call can lead to excessive distension of the lower gut, and dry hard stools. Once the gut becomes distended, the urge is reduced, and the problem becomes self perpetuating. Other causes of constipation vary from dehydration, inactivity (invalids in bed for long periods), pregnancy and the side effects of many medications (eg: codeine), to diseases as diverse as an underactive thyroid gland, gut tumours, psychiatric conditions and diabetes.


Incidence :
Everyone suffers from this problem at some time, but some more so than others. The incidence gradually increases with age and is far more common in the elderly than the young. To get some idea of how common the problem is in the community, just check a chemist’s shelves. There are scores of treatments available for the management of constipation.


Revention :
Once the constipation is relieved, preventing its recurrence is important. The best time to go to the toilet is after a large meal, because there is a reflex (the gastro-colic reflex) that stimulates the large bowel after the stomach is filled. Setting aside the time after the main meal of the day on a regular basis can often improve personal habits, and prevent considerable discomfort.


Investigations :
In severe cases, special x-rays of the lower gut, or a colonoscopy (passing a flexible tube through the anus into the gut) may be performed.


Course :
To be medically significant, constipation must cause discomfort in the abdomen, pain around the anus, bleeding, tears (both pronunciations of the word are appropriate), piles or some other problem.


Treatment :
The best way to deal with the problem is to change the diet. This involves avoiding white bread, pastries, biscuits, sweets and chocolates. Fibre containing foods such as cereals, vegetables, fruit and plenty of fluids should be taken. If dietary measures are not successful, fibre supplements may be used. These are available in tablet, liquid and granule form. Laxatives are the next step, but these should be used cautiously, particularly in children, as dependence can rapidly develop. Thesemedications vary in effectiveness and strength, but the weakest one to work is the best one to use. Paraffin, other oils, senna and cascara should be tried first. As a last resort, enemas may be used to clear out the lower gut, but once again, these should be used as infrequently as possible.


Complications :
Chronic constipation should not be ignored, but must be assessed by a doctor to ensure that there is no serious underlying cause. If a cause is found, that is treated; if no cause is found, the constipation itself is relieved.

What I need to know about Constipation

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Eczema in Babies

Eczema
Skin is dry, irritable and itchy and reacts adversely to scratching. Most affected areas are on the face and areas that rub when baby crawls. More often than not a hereditary problem.

To prevent:

• Prevention may not be possible if condition is hereditary. Your doctor's advice should be sought.
• Avoidance of woollen and synthetic clothes and chlorinated swimming pools is preferable.

• Your doctor's recommendation may involve cortisone creams, moisturisers and a change of diet.

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Cradle Cap in Babies

Cradle cap
Either crusty sores or wet patches. Are more prevalent on the scalp of very young babies. May be caused by an accumulation of dust or dirt or by excessive amounts of the scalp's natural oils. "Seborrhoea" can also affect eyebrows, ears and skin creases around the nose, neck, armpits, umbilicus and groin.

To prevent:

• Prevention is not possible but cradle cap is not harmful, just unattractive.

• Soften crusts with a gentle massage using sorbolene and glycerine or petroleum jelly pre-bedtime. Gently wash with soap and water next day. Repeat until all crusts have been removed.

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Prickly Heat in babies

Prickly heat
During hot humid weather the pores of a baby's skin can become blocked preventing the sweat from evaporating. Rashes can then appear on the neck, in the creases behind the knees, inside the elbows, under the arms, the groin and on the back and chest.

To prevent:

• Apply an anti-rash baby product at nappy change time.
• Avoid over-dressing or over-heating your baby.

• A soothing bath followed by a suitable anti-rash baby product

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Nappy Rash in Babies

At birth a baby's skin is delicate, supple and sensitive having been carefully protected in the mother's womb. After birth this fragile skin comes into contact with the harsh elements of the environment and the way each baby reacts to these external influences as well as internal ones varies greatly.

Nappy rash
Nappies create a moist warm environment which is in direct contact with a baby's skin. Wet warm skin is easily affected by irritants associated with the baby's motions and urine, and friction, chafing and harmful bacteria.

To prevent:

• Change nappies frequently - a new baby will need changing at least six times every twenty-four hours
• Clean baby's bottom well especially in the folds of the skin
• Allow nappy-free time whenever possible
• Apply a moisturiser or barrier cream

• A doctor or pharmacist should check any rash as diarrhoea, medication, food intolerance or a thrush infection could be the cause

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Colic In Babies

Other names :
Infantile colic, six week colic.


Introduction :
Intermittent spasms of the intestine causing crying in babies.


Cause :
There are many arguments about infantile colic, whether it really exists, what causes it, what (if anything) should be used to treat it, and if it is a disease restricted to western society rather than infants of all economic and ethnic backgrounds. It is probably caused by a spontaneous spasm of the small intestine, but no reason for this spasm has ever been proved. Changes in diet and formula, different foods for the mother of breast fed infants, alterations to feeding times and positions, vitamin and naturopathic supplements, increases or decreases in the degree of attention paid to the child have all been tried to ease the problem. Some experts blame anxiety in the mother, particularly with a first child in a family without extended family support, for causing anxiety in the infant, and subsequent gut spasms. Mothers of babies who have suffered are in no doubt that it is a real entity.


Incidence :
A very common problem between 1 and 4 months of age.


Prevention :
Mothers who have sufficient physical and emotional support, and are relaxed about their mothering, seem to have babies who suffer less colic.


Investigations :
There are no tests that can be performed to confirm the diagnosis, and there are no clinical examinations that can be considered objectively.


Course :
As a new mother begins to establish a routine in her management of her infant, the pattern may be rudely shattered by the onset of six week colic. The baby starts screaming for no apparent reason, draws the legs up and looks pale. After a few minutes, the attack subsides, and although a little reticent, the infant appears quite normal again. After another short interval, the screaming starts again. This pattern can repeat itself for quite some time, several times a day. Eventually, usually at 12 to 16 weeks of age, the colic eases, the mother relaxes, and the treatment being tried at that time is credited with a miraculous cure.


Treatment :
Changing the feeding position, rate of feeding, frequency of feeding, and time of feeding may all help. If these ideas do not help, numerous gut antispasmodics (see Medication Table) of varying efficacy are available over the counter from chemists. Paracetamol drops are often the most effective and safest treatment. Anxiety in the mother can be transmitted to the baby, and this often exacerbates the problem. If mother and/or child are very distressed, doctors can treat the mother's anxiety with appropriate medications.


Diet :
Changing the formula is rarely beneficial, but breast fed babies are less likely to develop colic than bottle fed ones.


Complications :
These babies should be checked by a doctor to ensure that there is no more serious cause for their apparent stomach pain


Outcome :
Infantile colic always goes away in due course, and assistance from family and friends in caring for the baby can often give a new mother a little free time for herself, to gather her composure, and prepare for the next interrupted night of intermittent screaming.


Further information:
Maternal and Child Welfare clinics are run by state governments in many suburbs of major cities, and most country towns. Residential accommodation is available for mother and their babies who are having serious problems coping.


Related conditions
Irritable Bowel Syndrome.

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What is Cleft Lip

Cleft Lip

What is other name :
Hare lip.


Introduction :
One or two off centre splits in the upper lip that may involve the palate (roof of the mouth).


Types :
Can vary from a barely noticeable notch in the upper lip, to a complete wide split of the upper lip and full length of the palate.

Cause :
From four to seven weeks after conception in the womb, each of us has a double cleft lip; and from the fifth to twelfth weeks, each of us has a cleft palate. For virtually everyone, these clefts of the lip and palate close naturally before we are born. Closure does not occur naturally in late pregnancy or after birth.


Incidence :
In about one person in 800, the clefts in the lip and palate do not close naturally before birth.


Investigations :
Sophisticated x-rays and CT scans of the face and skull will be undertaken before any surgical repair to accurately gauge the extent of the problem.


Screening :
May sometimes be detected late in pregnancy by an ultrasound scan of the foetus.


Treatment :
These children need special medical, dental and speech therapy treatment, especially during their early development. The aims of the team of specialists treating these people are threefold. Firstly, and most importantly, to ensure that the developing child has good speech through to adult life. Secondly, to enhance facial attractiveness; and thirdly, to produce the best possible jaw function and dental bite. The reason for good speech having the highest priority during treatment is that no matter how facially attractive a person may be, if that person cannot speak clearly and well, his/her social and personal development will be severely restricted. Directly related to good speech is good hearing. Most children with a cleft palate need careful monitoring to ensure their hearing is adequate. It is important that these children maintain good general health, and particularly to avoid infections or surgery to their tonsils and adenoids. Surgical repair of the cleft lip is normally done between two and six months after birth. Infants with a double cleft lip must have special dental treatment to reshape their upper jaw prior to surgical repair of the lip. The dental treatment starts immediately after birth, and requires a high degree of cooperation from the parents. This period is very emotional and demanding for the parents, but becomes most rewarding after the lip repair is done. The palate repair is normally done at about one year of age, and this is the critical operation for the child's speech. Most children with a cleft palate have an upper jaw which does not grow is well as the lower jaw, thus special dental and orthodontic care is necessary until the child has finished growing, to ensure the jaws and teeth develop in the correct relationship to each other. The vital periods for correct specialist care are when the adult teeth appear at seven or eight years, and during the rapid growth stage between 11 and 13 years. The ability to bite, chew and smile effectively are essential for both comfort and appearance. An attractive face and clear speech are added benefits of good care.


Outcome :
Modern surgery now makes it possible to correct poor speech in people who have a cleft palate, no matter how old they are. Older patients who have a poor bite because of a too small or too large upper or lower jaw can also be helped by this surgical technique. Cleft palate and lip are no longer the gross social stigmas of earlier years.


Further information:
Parents and children can benefit from the assistance offered by support groups such as Cleft-Pals that exist in most capital cities.

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