Toddlers and preschoolers, as well as older children, need to learn about limits. One of the developmental tasks of toddlers is to explore their surroundings. One of the tasks of parents is to consistently set limits.

Discipline is sometimes perceived as punishment — this is not correct. Discipline means parents teaching children which behaviours are acceptable, and which are not. In doing so, parents are also teaching the child to develop his own self-discipline. As he grows older, he will more easily be able to maintain limits for himself. This then becomes the precursor for self-control which is such an important quality in children (and adults).

Physical punishment

Discipline is not about physical punishment. Smacking or hitting your child should be avoided. It is possible to have a well behaved child without the threat of physical punishment. There are a number of arguments for not hitting children:

• It may teach your child that physical punishment or aggression is an appropriate way to interact with others.

• It has the danger of being an outlet for parental anger, and you will find it difficult to remain calm and in control of the situation while hitting your child.

Try to minimise or avoid the use of physical punishment. Use alternate methods of discipline.

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What did you think when you read that you need to let the attack and the symptoms of anxiety happen? Did you think ‘I can’t do that. What will happen? How can I let it happen?’ How did you respond physically? Did you feel anxious? You probably did. Most people do when they first hear this. Did the anxiety or the negative thoughts come first? It was the thoughts which came first and the symptoms which followed. Very subtle but very true.

The first time we let an attack happen there may be an increase in the intensity of the attack. This happens because we are thinking ‘what if. Go with this onrush of fear. Let this happen also. When we are able to give up the fight and give in to an attack without resisting it, it will disappear so fast it will scare us further. ‘Where is it? Where did it go?’ ‘It’ will only return if we don’t let go of our fearful thinking.

When we fight the attack it can last for over an hour. When we totally give in to it and let it happen it can disappear within thirty seconds because it is not being fuelled by our fear-provoking thoughts.

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At 3:00 am I looked at the clock and was relieved to see I had two more hours before the alarm would ring.

If you poll a group of parents, and get past the “She has always slept through the night,” you will hear a variety of comments:

When he is teething, he has a little trouble sleeping.

She seems so hungry at around 2:00 am—must be a growth spurt.

He has been waking with bad dreams.

If sleeping all night long, every night, is your expectation for your child,

you may be setting yourself up for frustration. Sleep needs and patterns

change with age, illness, and emotional or even environmental factors. Just as

with other parenting issues, our goals, expectations, and approaches must be

constantly re-evaluated.    

It is misleading to think of sleep as a state we simply fall into at night and wake from in the morning. Sleep research has shown that there are definite patterns and fluctuations during the night. They play important roles to help refresh us and can reveal some causes behind sleep disturbances.

The descriptions of these cycles can be quite technical. Because a basic understanding is crucial, an effort has been made to give a very simple explanation of what occurs and how your child might be affected.

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If fluid is the cause of the swelling, it is usually lying within the peritoneal cavity. The peritoneum is a fine double membrane that lines our abdominal cavity. Fluid can form between the two layers of this membrane (the peritoneal cavity) for example, when cancer cells start growing on it. This fluid is called ascites. Ascites can also be caused by liver diseases — both cancer and some noncancerous conditions.

Severe bloating due to wind can develop when the bowel is partly or completely blocked. Abdominal swelling can also be due to cancer itself — perhaps greatly enlarging your liver, spleen, or kidney(s).

If your swelling is due to fluid, the resulting discomfort, lack of appetite, nausea and indigestion can usually be quickly and simply relieved by draining the fluid away. This can be done under a local anaesthetic through a plastic tube inserted through the abdominal wall. Unfortunately, the relief will be temporary unless something is done to stop the fluid from forming again. Reducing your salt intake and taking tablets to help you pass urine (diuretics) may help. Treating the responsible cancer itself, say with chemo^ therapy, may be an attractive possibility if you have a type of cancer which has a good chance of responding favourably to chemotherapy.

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This is a stimulant and is responsible for the lift most people experience after drinking these beverages, but too many cups may make you tense and irritable and keep you awake if you drink them late at night.

Caffeine tends to constrict the blood vessels and, when the effect wears off, a rebound dilation of the scalp arteries may cause a throbbing headache. Many of the combination analgesic tablets and powders also contain caffeine and can relieve the headache by causing further arterial constriction.

But, when this wears off, headaches may recur.

Analgesic abuse is often related to the regular taking of analgesic tablets and powders for the “lift” experienced, then a rebound headache provides the justification for taking more analgesics.

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Even if the cause is hormonal, it can still be corrected by proper dietary advice.

Once the periods have stopped and the woman has become post-menopausal, late changes may arise from the lack of oestrogen. The bones may lose their protein matrix and, with it, some of their calcium. This is called osteoporosis and the bone is thinner and weaker.

Lack of oestrogen may cause changes in the vaginal walls. The skin lining may become thickened and less moist. This may lead to irritation, infection, a discharge or an intolerable itch. Intercourse becomes difficult.

Similar changes may involve the urethra, the tube which carries the urine from the bladder to the outside. These changes may lead to frequency and pain on passing urine. This is commonly called cystitis but is due to irritation.

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Despite some early grumbling and moaning, the players stuck to the diet almost 100 per cent during the whole two weeks of the Australian championships in Darwin in July. Ian planned the diet very carefully so that they got all the right foods at the right time—low G.I. before the game and high G.I. immediately after, along with jelly beans at half time!

He noticed that the benefits became very apparent early in the championship. The players themselves were noticing that they were not running out of energy during the game and were recovering a lot quicker than they had in the past.

About half way through the tournament other people started to wonder just where this Victorian team was getting all its energy from! Ian said:

‘At first they thought it was amusing and perhaps a little strange that we were eating Coco Pops and Rice Bubbles at the team bus in the carpark immediately after each game, but soon their amusement turned to curiosity.

People kept commenting on how fit the team was. But I knew that it wasn’t just their fitness. I had not had as much time as I would have liked to work on their fitness, and in fact I remember being concerned just before we went away that their fitness levels may not have been high enough. I knew that what I as seeing in Darwin was not just their fitness—it was the combination of fitness and a sustained energy supply. A “whole body fitness” was what we had achieved. It clearly demonstrated to me that you cannot do one without the other.

We ended up winning the championship by a relatively easy margin, and our fitness and energy levels were certainly a major contributing factor.

One of the things I liked about using the Glycaemic Index as the basis of the diet was that the players were able to very quickly understand the basic principles and by the end of the first week they knew exactly what to do.

I gave the players a questionnaire to complete at the conclusion of the tounament, and I thought you would be interested to hear some of their comments.

• ‘ I felt that when I played each game I was at my peak. I believe the diet played a major part in this.’

• ‘I found I had more energy coming into and during the game.’

• ‘Energy and glycogen levels were at perfect level.’

• ‘I never felt flat or without energy.’

• ‘Felt really good after every game, never felt run down during the game.’

• ‘Everything made me feel good before, during and after the game.’

• ‘Diet was major reason we did do well in the championships.’

• ‘Feel better after games, recovery is better, better energy in the game.’

• ‘I was never short of energy. My glycogen levels were con stantly maintained and replenished at the necessary points. I always felt fit and healthy.’

• ‘Kept my energy level high in the game and also after the game.’

• ‘After the game, recovery is far more rapid.’

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In their simplest form, habits develop as an association between a stimulus and a response. Initially, a stimulus which initiates a response is known as an unconditioned stimulus (US) resulting in an unconditioned response (UR). This stimulus is then paired with a conditioned stimulus (CS) to give a conditioned response (CR). In psychological terms this is known as ‘classical conditioning’. Perhaps the best known example is the salivary experiences of Pavlov’s dog. Ivan Pavlov was a physiologist living in Russia around the turn of the century. He discovered, not so surprisingly, that every time he presented dinner to his dog, the dog salivated. Pavlov then paired the sound of a bell to the presentation of the food and found, after a while, that the bell alone was all that was necessary to cause the salivation.

Similar principles can be applied, in a very simplistic way, to humans. An example of a typical learned response to eat in modern society would be getting up from a chair to get something to eat every time an advertisement interrupts a program on television. The association between the advertisement and eating is a surprisingly simple connection, but the kind of thing that people do every day without conscious thought. This is similar to the habits formed in getting dressed, sleeping, working, driving a car, or the myriad of other activities that are carried out automatically during the day.

Examples of eating patterns that are conditioned include:

• eating at the same time every day whether hungry or not

• reading while eating (and thus getting hungry while reading)

• always finishing off everything on the plate

• eating crisps/peanuts with alcohol.

Examples of conditioned inactivity patterns include:

• driving to the shops instead of walking

• getting someone to get something for you rather than getting it yourself

• going for a drink instead of a walk

• sleeping in on cold mornings.

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2. Obese people generally need a higher energy intake to maintain weight than lean people.

3. Lack of weight loss on a diet of <1200 kcal is generally due to under-reporting of food intake.

4. Significant fat loss is invariably accompanied by decreases in FFM and thus decreases in RMR. This will tend to reduce the rate of weight loss. Exercise during weight loss helps to preserve FFM and prevent some of the decrease in RMR.

5. A reduction in fat in the diet will result in a greater decrease in energy intake than a similar (gram for gram) reduction in other nutrients.

6. Substrate utilisation (i.e. nutrient use as energy) can be measured through the respiratory exchange ratio (RER), using the ratio of inhaled to expired air, and the means of measuring RER are becoming more and more portable.

7. Physical activity expends energy both during and after the activity. RMR appears to remain elevated after activity. However, the level and duration of increases are a function of exercise intensity, duration and frequency.

8. Wrapping and ’sweating it off will lose water, but not fat. Remember that maintenance of body heat in cold conditions is an active process requiring energy.

9. It is reasonable to use spices that increase RMR—particularly those high in the ingredient capsaicin—to add flavour to low-fat dishes.

10. Caffeine in moderation may be a possible aid to fat loss but at worst, is not likely to interfere in the fat loss process. Denial therefore is not a necessary pre-requisite for fat loss.

11. Caffeine and spicy foods may have small effects on metabolic rate, but the major opportunity for increasing metabolic rate still must be through increases in physical activity and reductions in fat in the diet.

12. Increasing incidental physical activity should be used as well as increasing planned exercise.

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Master David, usually a happy little fellow, was certainly not at his sparkling best. He slumped in the chair, looked morose and kept dabbing at his nose. Intermittently he gave a violent bark, which seemed to cause him some degree of pain in the chest.

‘I’ve got a sore throat too,’ David ventured, as I started to check him out, ‘And my skin feels all sore too.’ David was a sensible little lad, determined that I should know all the facts of his case. Very helpful.

There was little doubt about the diagnosis: an upper respiratory tract infection. Germs had obviously become established the day before, following his exposure and chilling, a common starting point. His nose was running and looked red and sore around the outer nostrils. Breathing through the nose was obviously difficult. His throat was a little inflamed, and the harsh cough had already started. As I listened to his chest with my stethoscope, I could hear a few abnormal sounds (called rales), indicating fluid was already starting to accumulate in the airways of the lungs.

‘What is the verdict?’ Jean asked as I completed my examination.

‘A straightforward case of acute coryza,’ I replied. ‘But don’t be alarmed. Its more popular name is the common cold. It is a simple upper respiratory tract infection, no doubt caused by viruses which he probably picked up yesterday when he got cold. The germs become rapidly embedded in the nasal passageways, in the linings, where they quickly multiply. This has caused a swelling of the lining and made normal nasal breathing more difficult. Against this the body’s reinforcements have been called, and the start of a mighty campaign is underway—the goodies versus the baddies. So, fluid is being secreted by the cells, and before long this turns to a pussy material as germs are killed and discharged.’

‘Sounds very gruesome,’ Jean commented. ‘What else is happening?’

‘Almost invariably the germs manage to penetrate further into the respiratory canals. So more swelling and discharges. Finally they reach the back of the nose and reach the pharynx, and track down to the next part, the larynx and voice box. Frequently a croaky voice occurs. Then they race on down the trachea into the bronchi and frequently into the lungs also. All this occurs with amazing rapidity, and before long there is a sore throat and a cough.’

‘You’re so right. It is incredible how quickly it happened,’ Jean replied. ‘David started coughing this morning, not much more than 24 hours after his drenching. Those bugs move fast,’ she continued.

‘Right,’ I answered.

‘Then, what to do? What is the advice we should follow?’

Treatment

‘First of all, he will do quite well within a few days, I feel sure,’ I started, giving a note of reassurance.

‘There are several simple measures to take which will help. We don’t have a specific mixture that will immediately kill the germs, for these are usually viruses which do not respond to antibiotics. If serious chest infections or other infections and complications occur, then we will use them. But we’ll commence with simple measures.

‘I’d suggest you put David to bed for a day or two. He’s already complaining of feeling off-colour and tingly all over, and he is running a mild fever. Bed at least gives the body a rest and helps the body to conquer the invading germs. I think he is feeling sufficiently off-colour to be happy with this for a short time. What do you say, David?’ I asked my youthful patient.

‘I’ll go to bed for a day or two. But only while I’m feeling sick,’ he replied, giving himself the opportunity to opt out early. (How typical of youngsters. I love ‘em all.)

‘Plenty of liquids is a good idea,’ I said. ‘Water, fresh fruit juices (the best, in my opinion), aerated beverages such as lemonade— although I’m not keen on fizzy sugary drinks, as you know. But for a day or two they are all right. Flavoured ice-blocks are also good, and I’m sure David would like those.’

‘That’s beaut!’ David said, listening from the sidelines.

‘A quick warm bath each morning is also a good idea. It will get rid of the sweat that accumulates and dries on the skin and makes his skin feel sore. Use a soft towel and dab his body dry afterwards. And make sure he doesn’t get a fresh chill whilst you are doing this.’

‘What about his temperature?’ Jean asked.

‘Simple paracetamol elixir is a good mixture to take. The usual dose for five-year-olds is five to ten millilitres every four hours, ideally after food. It tastes reasonable.

‘We don’t like giving aspirin to children under six years, for it is a severe gastric irritant and can cause stomach bleeding. For any colds that David catches when he is a couple of years older either paracetamol or aspirin tablets can be used for reducing fevers and relieving aches and pain, which are often severe; they can also reduce the tingly skin sensitivity which is often quite unpleasant. But in the meantime, try paracetamol elixir for David’s cold.’

‘Should I give him something for the cough?’ Jean queried.

‘Yes. Simple pholcodine elixir is good, and may be repeated if and when the cough troubles him. There are plenty of brands around. Personally I like a nice red one—it looks like raspberry, and most children love it. But use it only when necessary, for the cough is there to rid the lungs of phlegm, dead germs and unwanted fluids which could otherwise be damaging.

Home remedies

‘An easy do-it-yourself one is to squeeze a lemon into a glass. Then add half the volume of honey. Let David sip this as often as he likes. Lemon cuts back the phlegm and irritation in the back of the throat. The honey is very soothing. It is a simple old-fashioned remedy which many people still use with good effect. It is cheap too. How’s that in this overpriced world of inflation?’

‘Great, simply great,’ Jean answered, with a grin.

‘How about his blocked-up nose?’ she continued.

‘Simple steam inhalations are a good idea,’ I replied. ‘You might find that adding 15 drops of friar’s balsam to a pint of boiling water will work wonders. But if David finds it a bit messy, an alternative is simple blowing plus the use of some vasoconstrictor drops. They will reduce swelling in the nasal linings. Use the drops two to three times a day but only when necessary.’

‘Should I starve his cold?’ Jean queried.

‘No. Let David have what food he likes. Small meals attractively served is the best advice I can offer. Simply prepared foods, stewed fruits, mashed vegetables, soup, toast, eggs lightly cooked, jelly, ice-cream, that sort of thing. There is plenty to choose from. For a few days he might not be keen on food at all, so stick to fluids. Add some powdered glucose D, a teaspoon per glass, for this equals food and is an easy way of sustaining nutrition. Very soon he will come back to normal food intake, I am certain. Ideally his room is best kept warm and free from cigarette smoke—but then, of course, you don’t smoke. Great!’

‘That all sounds pretty straightforward,’ Jean said. She had been writing a few notes on a pad whilst I spoke, an excellent idea. I am happy to see parents writing down suggestions so they will not forget.

‘Anything else I should know?’

‘If there are any complications, please contact me. The germs may spread to other areas, and this could need extra treatment, such as antibiotics.’

‘How would I know when complications are setting in?’ Jean asked.

‘If pain develops in David’s ears, it could mean infected ears; under the eyes behind the cheeks, infected sinuses; a very sore throat, tonsillitis or pharyngitis or laryngitis; pains in the chest, pneumonia or pleurisy. If breathing becomes difficult or the cough really gets worse and causes distress, let me know promptly, and I’ll pop around and give you the next lot of instructions.’

‘Fine,’ said Jean.

‘Thanks, Doctor,’ echoed David, in his unhappy little voice. ‘See you round some time,’ he continued, as the pair prepared to leave.

Nice little bloke, I thought to myself … I really do like kids. So uninhibited, so honest with everybody.

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