• if the rash has not improved after 3-4 days, despite all the above measures;

• if blisters, crusts, or pimples appear;

• if your child is very distressed and not sleeping;

• if your child has an unexplained fever;

• if the rash is spreading;

• if the end of your child’s penis is red and swollen, or has a scab on it.

Complications

Secondary infection can sometimes occur, especially a fungus or yeast called thrush (Candida albicans). These bugs are normally present on the skin, but are real opportunists and multiply when the chemical balance has been disrupted in their favour. Thrush appears as bright red and shiny areas in the napkin area; they have clearly defined borders and also affect the skin folds. Numerous red dots (satellite lesions) may be studded beyond the outer edge of the rash.

Treatment is with an antifungal cream which will be prescribed by your doctor. As opposed to a simple nappy rash, which clears up quickly, thrush can take longer to clear, and has a tendency to recur. Treatment can be prolonged, and sometimes very frustrating.

Prevention

If used consistently, the simple measures outlined above should help prevent nappy rash. Keep the nappy areas clean and dry, and use protective creams (often containing a zinc oxide base).

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Babies need particular attention to cleaning in order to prevent them from picking up germs. Areas which need to be kept as clean as possible are the nappy region and the umbilicus (navel or belly button) (see opposite). Most babies enjoy their bathtime, which can be relaxing for both parents and baby. Your maternal and child health nurse can explain to you in detail exactly how to go about bathing your wriggling newborn, but here are a few pointers:

• make sure you are comfortable by positioning the bath in a convenient place;

• make sure that the room is warm and the water temperature in the bath is around 28-29°C;

• fill the bath with cold water first, to prevent accidental scalds;

• test the temperature with your elbow before placing the baby in the bath;

• you only need to wash your baby’s hair once or twice a week;

• wash the face with a soft damp cloth;

• do not try to clean inside the ears or nose;

• stay with your baby the entire time he is in the bath.

• take the phone off the hook, or ignore it if it rings.

Babies can drown even in shallow water.

Fingernails

Trim your baby’s fingernails once a week to prevent him from scratching himself. This can be done immediately after a bath when the nails are soft, or when your baby is asleep, using a nail clipper or fine baby scissors.

It helps if both parents do this together, one cutting while the other holds the finger.

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“I thought it would be a romantic song. I thought sure we’d get something like the theme from Love Story,” said her husband. “We got ‘Love Lifts Us Up Where We Belong’ from the movie where that guy fights with his drill sergeant. What does that say about us anyway?” He laughed, but the words they copied from the song and learned by heart continue to be special for them. “Every time I hear that song on the radio, every time I even see Joe Cocker, I think of us. Is that strange or is that strange?”

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Wife: “I sort of remember where. We were in the drive-in, of all places. We never really necked or anything there. It cost too much to get in, so we thought we should watch the movie. The bucket seats were impossible. The backseat was full of junk like hubcaps and I think some large part of a transmission. The car always smelled like oil.

“I remember looking over at him watching the movie. It was some type of horror thing, and he looked ready to jump. I had to go to the bathroom so bad it hurt, but I hated those dirty bathrooms. Early in our courting, I sort of went to ‘freshen my makeup,’ usually with two or three other girls on a secret signal known only to women. Now I just said it. I don’t know why. I said I had to pee. I surprised even myself.

“He seemed relieved at the distraction from the movie. Before, he might have said okay and sort of let me go. This time, he climbed out of the car. I mean climbed, because this was in the days when boys somehow modified the car so it was about five feet off the road. He came to my side, opened the door, reached behind my seat, and took out a small stepstool that he had made just for me.

My own exit stool from his magic chariot. As silly as it sounds, I was moved. He seemed embarrassed, but walked me to the bathroom, waited for me, walked me back, and helped me climb back onboard. I just remember from that time on, things seemed different. Very romantic, isn’t it. I still use that dumb stool to reach the top cupboard.”

HUSBAND: ‘ ‘It was at a wedding. I remember clearly. I never thought of it until now. I was the best man, she was the maid of honor. I never saw her looking so beautiful. She looked more like a woman than ever before. It sort of struck me how very mature and beautiful she was.

“It was one of those dances when the bride and groom start out and the wedding party follows, one couple at a time. When it was our turn, I sort of felt shaky when I took her in my arms. She looked right into my eyes. Everyone was looking. It was like everyone in the room saw it happen. I fell in love right there. It seemed like we were the bride and groom.”

Two different times for this couple, but each person was able, with some encouragement and questioning from me, to discover their’ ‘bonding imprint.” It happened to you, even if you are having marital trouble or feel that maybe you never really fell in love. If you “paired up,” you bonded, at least for a while. Try to recount your bonding imprint for your present relationship. Taping it or writing it down seems to make it more real for most couples.

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In most cases where scoliosis is developed well before puberty a rapid deterioration may take place in the two to three years before the onset of puberty. But, if a child is first seen at puberty with only a mild scoliosis, then it is unlikely that her condition will ever become severe. However, she still requires regular and frequent assessment.

Conservative measures are the first line of treatment and this usually involves exercise under the experienced care of a physiotherapist, but, if the condition is rapidly deteriorating, more energetic treatment is indicated.

A plaster cast can be applied which involves the whole trunk. By means of metal clamps, and then cuts and wedges in the plaster, the spine can be made to grow straight.

There are special external braces which the child can wear to correct the deformity, or maintain the proper position after operation.

Modern operative techniques have given excellent results. These usually involve some form of internal splinting applied to the spine and metal rods and wire are used.

This may be the sole treatment, or it may be combined with fusion, or joining of the bones together.

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It is a disease where the sufferer needs to know as much as the doctor so he can manage on his own and lead a normal life.

To help him in this, he needs an interested and well-informed doctor, and he may obtain help, advice and encouragement from the Diabetic Association or Foundation, branches of which are in every State.

Diabetes mellitus is not really one disease but a variety of related disorders of metabolism which have in common an increased level of sugar in the blood and the presence of sugar in the urine.

The fuel of the body is glucose, a sugar all the cells need for nutrition. It is transported through the body via the bloodstream.

It is stored in the liver and released into the blood when the level there drops. A variety of hormones and other chemicals stimulate the liver to release the glucose. If a real shortage develops, the liver can even be stimulated to break down protein and fat and make glucose from them.

Insulin is concerned with moving the glucose out of the blood into the cells. It therefore has the effect of lowering the level of glucose in the blood.

Diabetes may be regarded as a condition of relative lack of insulin.

Both the production of insulin and of a chemical which stimulates the liver to release glucose occurs in special cells of the pancreas, an organ which lies high up on the back wall of the abdomen behind the stomach. It produces enzymes which pass along a duct to the duodenum, or first part of the small bowel and help to digest food.

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I suppose we have grown up with the idea that anyone who has become a home for little bugs must be unclean.

Unfortunately, this is not so. The parasitic mites are no respecters of rank, socio-economic status or standards of personal hygiene.

Scabies and lice have been rare for about 25 years but are now enjoying a resurgence. In fact, we have an epidemic of these parasites.

It’s not clear why. It may be related more to the life cycle of these minute insects than to changing social mores or levels of cleanliness in the community.

There are three forms of lice — the head louse, the body louse and the pubic louse.

Body lice are uncommon and usually seen only on derelicts, but the other two are now very common in our community.

The body louse is important in that it can carry serious diseases such as typhus fever, trench fever and relapsing fever which are not seen in Australia.

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Regardless of one’s reason for eating a lot of liver, the danger is the same — it can provide too much vitamin A. Because liver is an animal’s storehouse for vitamin A, we can acquire much more of it than we can handle if we eat a lot of liver nearly every day.

In extreme cases, when hungry explorers have eaten nearly all of the liver of a shark or of a polar bear, both of which contain exceptional amounts of vitamin A (many thousands of times the recommended daily allowance for humans), sudden death from brain swelling has occurred. In the more usual cases, when people have eaten beef or chicken liver several times a week, the illness is much less dramatic.

Typically, Emergency Medicine (17#8:105) reports, the symptoms of milder and more usual cases of vitamin A intoxication include long-lasting headaches and blurring of vision. Victims also sometimes complain of a momentary loss or sudden dimming of vision lasting but a second or two.

Another fairly common symptom is a pulsating swishing or ringing noise in the ears. There may also be nausea and vomiting in some cases, but these symptoms are less common and occur, in addition to the other symptoms mentioned above, only when the blood vitamin A level suddenly rises even further above normal following ingestion of a vitamin tablet.

Proof of this diagnosis is simple and involves simply taking a blood sample and sending it to the laboratory for measurement of the vitamin A level. Since prevention is better than cure, avoid this problem by eating liver only in moderation. For instance, giving a baby a can of ground chicken liver every day might well provide him with too much.

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