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It is not known why some children suck their thumb and others do not. Some continue it from infancy as a learned behaviour, and others take it up later, either spontaneously or after seeing it in a sibling or other child. Along with other rhythmic behaviours seen in childhood (head-banging, body-rocking) it is obviously soothing and pleasureable, and so continues for some time. Often it is a response to stress or insecurity, although this does not mean that there are major psychological problems present. Sometimes children who seem to have given up the habit begin it again in response to a stressful event in the family, such as the arrival of a new baby, parental arguments, separation or illness. If the child himself has been ill or hospitalised, his thumb or finger may go promptly back into the mouth.

Clinical features

Thumb-sucking is often associated with other habits, such as twisting the hair on the back of the head, or cuddling a favourite blanket or soft toy. Many parents recognise that when their child begins to suck his thumb, it is a sign that he is tired and a signal that it is bedtime or time for a nap. At other times it may be a sign of stress, although this may simply mean that the child has been rebuffed in a request by peers, siblings or parents. >

The thumb-sucking lasts for a few seconds to a few hours, and is terminated when the child has another activity that engages his attention. As the child grows older and matures, he usually finds other ways of coping with stress and frustration and comforting himself, so that thumb-sucking is no longer desirable. However, as previously mentioned, children may revert to it, either occasionally or for a prolonged period of time, after certain life events. Most children have grown out of the habit by the time they start school.

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Audiometry

This hearing test is generally suitable only for children over 4 years of age. The audiometer is connected to a set of earphones which are placed over your child’s head. Each time a note is sounded your child is asked to signal that he has heard it. The notes are played at different frequencies and volume levels, and your child’s responses are recorded. This builds up a complete profile of your child’s hearing, and the pattern can show which type of hearing loss, if any, he has. This aids in accurate diagnosis and treatment of the specific condition.

Auditory brainstem evoked response (ABR)

This is a specialised procedure which is used to test hearing in infants. It measures changes in the baby’s EEG (see above) when sound stimuli are presented. It is best done when the baby is in a quiet state, preferably asleep. An earpiece is placed in the baby’s ear, and three electrodes (special wires) are placed on his head. Sounds are presented through the earpiece, and responses are measured. The baby does not feel any pain or discomfort.

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Indigestion is the classic symptom. Regurgitation of bitter fluids into the mouth may occur, especially with belching or when bending.

Indigestion when the person lies down at night is due to the weight of the abdominal contents pushing up against the diaphragm and causing regurgitation.

An hiatus hernia may be diagnosed on the symptoms, but can be confirmed by a barium meal X-ray. For those who have had this X-ray, the reason they are strapped to the table and tilted head down is to demonstrate reflux.

Medical control is usually possible. Avoiding foods which upset, eating small meals frequently rather than large meals infrequently and antacids are usually effective. Avoiding bending, losing weight and avoiding tight clothes around the waist are useful adjuncts to treatment.

Considerable relief may be obtained by raising the head of the bed. Using several pillows is not good as the person is then bent at the waist. Raising the head of the bed and using only one low pillow offers better results. It may be necessary to raise it 10 to 20 cms.

Operative repair of the hernia is reserved for severe cases with failure of medical treatment.

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Exchange transfusions have even been done while the child is still in the womb — but is now possible to prevent this iso-immunisation by the use of anti-D gamma globulin.

This should be given to any Rh negative woman who has an Rh positive child and who has not developed antibodies. It should be given within 72 hours of the birth and will prevent formation of antibodies and so the child of the next pregnancy is protected.

An injection of anti-D gamma globulin should also be given to any Rh negative woman who aborts after the eighth week, unless it is certain that the father of the child is also Rh negative.

Anti-D gamma globulin is made by the Commonwealth Serum Laboratories from blood collected by the Red Cross Blood Banks in each State. It is made available free of charge.

When a pregnant woman first visits her doctor, her blood should be examined to determine her blood group. If she is Rhesus negative, her antibodies should also be checked. At this initial screening, it is also possible to look for other uncommon and rare antibodies.

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In cases of emotional shock, keep the patient warm and comforted. If fainting threatens or occurs, Dr Bach’s Rescue Remedy, a combination of five tinctures of herbs is recommended. Dilute and administer as directed. Gentle massage can also help, as can a dose of a sedative herb such as skullcap or valerian. Be aware that, in some cases, emotional shock can develop into clinical shock. If the patient’s pulse becomes weak or they do not regain con-ciousness after fainting, apply first aid and seek professional assistance.

Clinical shock sets in after heavy internal or external bleeding, spinal injury, heart attack, severe burning, near drowning, poisoning or as a result of an extreme allergic reaction (for example, to certain medications). The blood pressure drops and the skin becomes pale and clammy. The patient is sometimes nauseous, will feel faint and may lose consciousness. Act immediately. Loosen the clothing, and if possible, put the patient on their side, making sure all air passages are clear of the tongue or vomit. Phone for help. Keep them warm and if breathing stops, use mouth to mouth resuscitation.

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Signs and symptoms

With true flat feet, there are no arches when a child stands. The child walks on the inner edges of the feet. This practice breaks down the tops of the shoes from the inside and wears down the inner edges of the heels and soles on the shoes. The child may complain of painful feet after brief exercise.

The presence or absence of an arch at any age can best be judged when a child stands, on the tips of the toes. After age three or four, your child should no longer wear out the inner edges of the shoes.

Home care

To encourage development of the feet, children should not wear walking shoes until they start to walk unaided on hard surfaces. If a child under three or four years of age breaks down the upper portions of the shoes or wears out the inner edges of the heels before the shoes are outgrown, buy shoes with stronger counters (the inner part of the back third section of the upper shoe). If your child past age three appears flat-footed, have the child tiptoe barefoot five to ten minutes per day. A child over six to eight years of age should walk barefooted on the outer edges of the feet with the toes clenched for ten minutes daily.

Precautions

• Do not use orthopedic shoes or devices without competent professional advice. Orthopedic shoes are expensive and if not needed, they actually may harm normal feet.

• Painful feet after excessive use and exercise do not indicate abnormal feet.

Medical treatment

Your doctor will examine your child’s feet carefully while the child stands, sits, stands on tiptoes, and walks. The doctor will conduct tests for the movement of the joints of the feet, the strength of the foot muscles, and the strength of the tendons. Your doctor will examine worn shoes. Rarely will the doctor X ray your child’s feet. Considering all these factors along with the child’s age, the doctor may prescribe exercises or orthopedic shoes.

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In other words, fate is a minor factor in disease. You are a major one. If your behavior is in harmony with the way your biochemistry wants to work, you’re living a disease-free lifestyle.

So let’s get right to it: The major elements of a disease-free lifestyle are a healthy diet, regular physical activity, appropriate body weight, no smoking, controlled stress, and timely medical checkups.

Sense a little deja vu? None of those six things is what the Pentagon folks would call classified information. We’ve all heard them since childhood, with overtones of discipline. But “good” behavior isn’t the point. The issue’s much simpler. Incorporate those six guidelines into your lifestyle and you may prevent disease. Ignore them and you may create disease.

The lifestyle link to disease prevention is so strong that it begs some questions.

Why don’t we eat right? In other words, why so much animal fat (an across-the-board disease-causer) and so little fresh fruits and vegetables (risk-reducers for virtually everything)? Because, points out John Wurzelmann, M.D., clinical assistant professor of medicine at the University of North Carolina at Chapel Hill School of Medicine, “there really is such a thing as comfort food.” Fat, says Dr. Wurzelmann, has a tendency to satisfy you far more than any mere vegetable would. “That’s why you enjoy vegetables more when you put a fat dressing on them,” he says.

Furthermore, says Moshe Shike, M.D., director of the prevention and wellness program at Memorial Sloan-Kettering Cancer Center in New York City, “it’s a habit. You get used to eating hamburgers and French fries, and you don’t think about the consequences.”

Why don’t we exercise? Because we don’t need to, according to Walter M. Bortz II, M.D., clinical associate professor of medicine at Stanford University School of Medicine and author of Dare to Be 100. Of course, we do need to if we want to avoid heart disease, diabetes, and lots of cancers because that’s the way our bodies are designed. But it’s not the way our everyday life is designed-not when pizzas can be delivered at the touch of a speed dial or home theaters can be controlled at the click of a remote. “In our culture, we don’t have to move for anything,” Dr. Bortz says. “We’re the only species that doesn’t have to move even to eat.”

Why do we let ourselves get fat? Mostly because we eat too much. “There’s no doubt that caloric consumption is too high,” Dr. Wurzelmann says. “There are too many fat people in the United States.” Obesity is a different risk factor than a lousy diet, but one easily follows from the other. And inactivity leads to, and follows from, both. “If any other species had food supplied to it the way we do, it would get fat, too,” Dr. Bortz says.

Why don’t we quit smoking? It’s not that a smoker doesn’t care that more people die from tobacco use than from automobile accidents, drug abuse, AIDS, and alcohol combined. It’s that he’s probably addicted. “The nicotine receptors in the brain are very similar to the receptors for cocaine and heroin,” says Thomas Glynn, Ph.D., director of cancer science and trends for the American Cancer Society in Atlanta. What’s more, those receptors stay eager to receive years after you quit. One puff can get you back to a pack a day before you know it.

Why do we ignore stress? Probably because we’re not too sure what it is. “People don’t have a lot of knowledge about it and what to do about it,” Dr. Shike says. “I think people understand that excess stress has a negative impact on their lives.” Heart disease is one negative impact. Undermining the rest of your disease-free lifestyle is another. “Some people, when stressed, run to the refrigerator,” Dr. Shike says. “Or they smoke.”

Why do we avoid Checkups? Denial, according to Dr. Shike, “is the feeling that ‘it will never happen to me,’ only to somebody else.” In reality, all that is being denied is the possibility of early detection, which, for most men-stalking diseases, is the best bet for cure or containment.

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1) Adrenocorticoids— this is a cortisone-like medicine which is commonly used to treat an assortment of ailments.

2) Antibiotic and antibacterial drugs— these include ampicillin, bacampicillin, chloramphenicol, neomycin, penicillin, tetracycline, rifampin, and sulfa drugs.

3) Anticonvulsants— including carmazepine, phenobarbital, phenytoin, primidone, and valproic acid.

4) Antihistamines and Decongestants— this includes those found in many over- the-counter cold remedies.

5) Cholesterol-lowering drugs.

6) Headache remedies— including prescription drugs.

7) Mineral oil

Sedatives and tranquilizers— including barbiturates, chlordiazepoxide (Librium) and diazepam (Valium).

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