Cause

One section of bowel slides inside another adjoining section and becomes stuck, causing a blockage. Occasionally this follows some inflammation of the bowel, such as gastroenteritis, which leaves the lymph glands enlarged, but in the majority of cases, no cause can be identified.

Clinical features

The baby suffers from severe spasms of abdominal pain; he draws his legs to his chest and screams. He may vomit initially. After an hour or so, the baby becomes exhausted, looks pale and is drowsy between spasms. He may pass a stool which has blood in it (called a redcurrant jelly stool).

Investigations

An X-ray of the abdomen, together with a barium enema, will confirm the diagnosis.

Treatment

Early diagnosis is critical and admission to hospital essential as intussusception is a medical emergency. Dehydration must be treated with an intravenous infusion. A barium enema itself may be sufficient to reduce the pressure in the affected portion of the bowel and return it to its normal position. Failing this, surgery will be necessary to relieve the blockage.

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When a piece of bowel protrudes through a weakness in the muscle wall it produces a lump or hernia which is often visible. In normal development of the foetus, the channel between the abdomen and the groin closes off after the testes or female ligaments migrate downward. If this channel remains open, the bowel can protrude through causing a lump to appear in the groin.

Clinical features

A lump becomes apparent in the groin, usually on one side, and may be tender to touch. This hernia can become trapped (obstructed) and its blood supply impaired. If this happens, your child will complain of abdominal pain, in addition to crying and being very irritable. He may also vomit.

Treatment

Surgery is generally the treatment of choice for inguinal hernias, due to the risk of them becoming obstructed. Children recover completely after this operation.

When to see your doctor

See your doctor immediately if you notice a swelling in your child’s groin.

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HAEMORRHOIDS (PILES)

Haemorrhoids are enlarged veins inside the anus, thought to be caused by long-term straining to pass stools, such as occurs with constipation. The presence of haemorrhoids is rare in children.

HICCUPS

Hiccups are common at all ages and are usually short-lived and no cause for concern. They are caused by a sudden spasm of the diaphragm (the muscle separating the chest from the abdomen) which may have been irritated. This is especially common after a meal, when the stomach has been stretched. Many ‘remedies’ for hiccups have been invented through the ages, such as holding the breath, giving the person a fright, or drinking a glass of water. We recommend you just let them pass of their own accord!

INFLAMMATORY BOWEL DISEASE

There are two types of chronic inflammatory bowel disease: Crohn’s disease and ulcerative colitis. Both are relatively uncommon in children. Characteristic signs include bleeding from the bowel and diarrhoea. The causes are uncertain. Both disorders require long-term care under a specialist.

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Cause

The small intestine is infested with a tiny parasite called Giardia lamblia. It is picked up mainly from contaminated food or water.

Clinical features

Giardia infections tend to occur more commonly in toddlers and older children. The onset of symptoms may be sudden or gradual, and usually begin with flatulence, diarrhoea and a bloated belly. The child may complain of stomach aches and may even vomit. A poor appetite due to nausea is soon followed by significant weight loss and general listlessness. Sometimes the only symptom will be chronic diarrhoea and some children may have no symptoms at all.

Investigations

Giardia infections can sometimes be confirmed on examination of the stools. If the parasites are not seen in a specimen, it does not necessarily indicate that Giardia is not present. The sample needs to be fresh and even a delay of a few hours can of the bowel and is no longer visible under rhe microscope once it has stopped moving. Several specimens may need to be examined before the diagnosis can be made. In children with diarrhoea or weight loss a duodenal biopsy may be performed to make the diagnosis.

Treatment

There are effective medications which can be used to treat Giardia infection. Strict attention should be paid to hygiene in all members of the family to prevent cross-infection.

When to see your doctor

See your doctor if your child has any of the symptoms above or if in addition to any of these symptoms he has a fever or is generally unwell.

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1. Keep a sense of humour. This is one of the most important things to remember, not only for toilet training but for parenting in general.

2. Stay relaxed and remember that it should be no big deal — the more of an ‘issue’ it becomes, the greater the manipulative power the child has over you, and the greater the chance of hassles and disappointment on both sides.

3. Wait until you and your child are both ready. For you, the parents, this means when you are logistically and psychologically ready and prepared to be committed to it, not when someone else tells you ‘It’s about time’. For example, it is not a good time to start when the bathroom is being renovated, or the family is going on a camping holiday, or you bring a new baby home.

For the child, this means not starting before about 18 months to 2 years of age — children are simply not ready physically and neurologically before this time, no matter what stories are told of youngsters being trained before their first birthday. Parents can often see clues that the child is ready. He may object to his nappy being dirty, or begin to take an interest in the parents’ or older siblings’ use of the toilet. He may begin to develop an awareness that a bowel movement is coming, sometimes revealed by his facial expression, or by his becoming very quiet, or going to a corner or another room.

4. Allow him to follow you into the toilet, and explain to him/her what you are doing. Create an interest for the child in the idea of going to the toilet.

5. Buy the child a potty chair or potty, and allow him to help in choosing it, making it very clear that it belongs to him, but downplaying at this stage any expectations that he should begin to use it immediately. A potty chair seems preferable to a special child’s toilet seat. The child is able to sit on it without the parents’ assistance, and the sitting position, with the child’s legs resting on the floor, is a better physical position for the child to open his bowels.

6. Put the potty near or next to the toilet and encourage the child to sit on it, initially fully clothed. Allow the child to sit on the potty at any time, but it is a good idea to make a point of the child accompanying a parent to the toilet and sitting on the potty while the parent sits on the toilet. Praise the child for sitting on the potty, but do not make a fuss if the child does not want to do it, or only does it occasionally, or only sits momentarily.

7. At some stage — the exact timing will vary with the child, and indeed the child may even suggest it — sit the child on the potty with his nappy off. You may wish to time this when it is likely that the child may have a bowel action. This is easier to predict in those children who are regular and predictable. After a meal is sometimes a good time to suggest it, or when the child indicates through his behaviour that a bowel movement is coming.

Again, do this with no expectations, and in a very low key and relaxed way. If the child resists it, or does it only intermittently, that is fine. Allow your child to dictate the pace.

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Anal sex, whether male-to-male or male-to-female may be associated with an increased risk of AIDS. This may be so, not only from direct spread of the virus through the semen but also because this sexual practice may impair the body’s immunity. This may occur through injury to the bowel wall allowing sperm to enter the blood stream and produce antibodies which may interfere with immunity against disease. By wearing a condom for anal sex this may greatly reduce the risk of spreading AIDS, and also the other sexually transmitted diseases such as syphilis and gonorrhoea.

There is virtually no risk to the general public who do not belong to one of the high-risk groups. The widespread alarm in the community and in specific groups appears to be unwarranted.

The number of cases of AIDS is doubling every six months in the U.S. and no doubt the same will apply here. This is a great worry for those in the high-risk groups and also for the public health bodies. It is NOT a problem for the average person.

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But be careful of flexing exercises such as touching your toes. They may play havoc with your back, particularly if you are beyond 35 and have done little exercise for some years. You can easily damage the spinal discs.

When you bend or lift, please bend your knees. You can damage your back bending over in the shower to pick up the soap. Bend your knees.

Weightlifting increases muscle mass but it does little to improve the efficiency of your heart and lungs. Isometric exercises are also useful in increasing the strength and efficiency of muscles. They do little for the heart.

Long, slow, sustained exercise is what makes the heart and lungs work and what builds up cardiopulmonary fitness.

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But what do women think? Many feel cheated that they are not awake when their babies are born. Few hospitals will allow the father to be present at a caesarean birth.

One way to overcome this is for the operation to be done under a local or regional anaesthetic. Caudal or spinal anaesthetics are increasingly used to reduce the pain of childbirth or to allow forceps procedures to be carried out.

This form of anaesthetic is a skilled procedure and not all anaesthetists are sufficiently skilled to use it routinely. If the anaesthetic is being used and a decision to do a caesar is made, the operation can be done by this means. But under emergency conditions, there may not be time to induce anaesthesia this way.

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