BLEEDING DISORDERS; BOW LEGS

Blood clotting, which seems such a simple process is so complicated that some doctors have trouble remembering the exact mechanics.

Two or three routine laboratory tests can now identify most children with bleeding disorders.

Bow legs, usually associated with in-toeing, are so common as to be almost normal in a child under two.

It is often incorrectly thought that bow legs are due to the nappy forcing the baby’s legs apart.

Bowing occurs in the tibia, the main bone of the lower leg, not in the femur or thigh bone.

The cause is unknown but many doctors believe it is due to a baby’s habit of sleeping in the “knee-chest” position, that is, on his face, with his knees tucked under him and his feet turned inwards.

Most babies stop sleeping this way at around 18 months and so the condition corrects itself. However, if the bowing persists, correction may be achieved by strapping the legs together to alter the child’s sleeping posture.

In-toeing can occur when the baby sits on the floor with his knees turned in or when he sleeps on his face with his feet turned in.

There is no functional impairment from in-toeing, so correction is done only on cosmetic grounds. One way to help is to encourage the child to sit crosslegged on the floor and to avoid the other posture.

Out-toeing may be caused by sitting on the knees but with the feet turned in. Treatment is the same for in-toeing.

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CHILDREN’S HEALTH: PNEUMONIA

Symptoms

Bacterial pneumonia: mild upper respiratory tract infection; high fever; chills; cough; rapid breathing; chest pain.

Viral pneumonia: headache; fatigue; fever; sore throat; severe, dry cough.

Home care:

Viral pneumonia usually clears up on its own.

Bacterial pneumonia requires medical attention.

Precautions

-    Watch for signs of pneumonia in a child whose resistance is lowered by a cold or infection.

-    If a cold suddenly gets worse and is accompanied by high fever, cough, chills, chest pain, or rapid breathing, suspect pneumonia.

-    Flaring of the nostrils, grunting breathing, and pulling in of the chest in an infant are serious and require immediate medical attention.

-    If a child coughs up a discharge tinged with blood, consult a doctor.

Pneumonia is an infection of one or more areas of the lungs. It’s caused by bacteria or viruses. The common bacterial cause of pneumonia is pneumococcus or, less often, streptococcus or staphylococcus. The viral causes include the influenza and parainfluenza viruses, the respiratory syncytial virus, and adenoviruses. Pneumonia also may be caused by mycoplasma organisms.

In order to contract bacterial pneumonia, the child must be exposed to ê at a time when he or she is particularly susceptible. Pneumococci, streptococci, and staphylococci bacteria frequently are present in the nose and throat of a healthy child. Before these organisms can invade the lungs, however, the child’s resistance must be lowered by a cold or some other upper respiratory tract infection. Therefore bacterial pneumonia is not considered to be contagious in the usual sense.

The types of pneumonia that are caused by viruses are known as “walking pneumonias” and are contagious. The incubation period – the time it takes for the symptoms to develop once the child is exposed to the disease – for mycoplasma is one to three weeks; for most viruses it is two to five days.

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MEASURES TO PREVENT INSOMNIA

•    Jetlag and shift work are well-known promoters of insomnia. Both alter the body’s time clock and as a result sleep suffers. The effects of jetlag are worst when crossing several time zones and get much worse if the time changes 8 hours or more. It is possible to overcome the pattern by keeping to your home time but if you are going somewhere on business or for more than a day then this won’t work because you will have to fit in with the clock in the country you have travelled to. You can prepare yourself in advance, at least to some extent, by gradually altering your sleeping times in the week before you go-change them by an hour a day.

When it comes to shift work the most disruptive pattern is the combination of day and night work. Most people eventually come to terms with night work if they do it all the time-the natural body clock simply resets-but with a mixture of day and night shifts you are fighting nature all the time. Avoid such work if you possibly can.

•    Bad beds are a very common, yet preventable, cause of insomnia. Many people have a bed which is too small. Since 1920 the average height of young men has increased by 2 in and the proportion of men who are 6 ft 3 in or more has gone up from one in 250 to one in 40 today. So the old ‘standard’ bed is too small for many people, especially as the metric equivalent is even smaller than the old imperial standard size. A bed should always be at least 6 in longer than your body.

Your bed may also be too narrow. Lie down with your hands behind your head. If your elbows overlap the edges of the bed, it is too narrow. Anyone over 6 ft tall probably needs a king-size bed. Until very recently in historical terms people slept on wooden boards or on the floor or a mat. This does not mean that all mattresses are unhealthy, but many are too soft. As we pass through periods of REM sleep most muscles of the body are paralyzed. They give our bodies little or no support and a very soft bed will not support us either. Young people are not too badly affected by this but middle-aged and older people certainly are and wake up with backache and aching limbs. Replace your mattress at least every ten years.

A double bed is usually more spacious, even for two people, than two singles, but when two people share a bed there is a potential for sleeplessness. One of them may snore, toss and turn, sleepwalk, have nightmares, or get up to go to the bathroom. On the plus side cuddling someone else gives a sense of warmth and security that helps promote sleep. But sharing a bed does not mean that both have to have the same mattress. Today there are excellent zip-and-link mattresses available that enable one half of the bed to be softer and the other firmer, according to individual taste.

• Some people sleep badly because they are too hot or too cold. Old blankets become thick and matted, so that they hold the heat less well than when they were soft and fluffy. It is better to replace old blankets rather than pile more on top because the weight can be uncomfortable, especially for older people. A duvet is the perfect answer because it is light and makes bed-making so easy. Room temperature and ventilation can make a real difference to insomnia, especially at the extremes of temperature-a hot, stuffy room and a cold draughty room both make insomnia more likely.

• If your room has thin curtains, you may be woken too early on light, summer mornings. Fit heavier ones, line existing ones or fit a blind inside the curtains. This could give you two hours’ more sleep.

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