YOUR CHILD’S CARE: GROWTH AND DEVELOPMENT

All babies and children are different, each with his own unique set of individual characteristics that makes him special. Yet growth and development do progress along pathways that are predictable. The stages and milestones described in this chapter are ones that most children go through and achieve at around the ages specified.

Remember, however, that there is a good deal of variation between children. The times and stages described here serve only as a guide to the range at which most children achieve milestones. Just because your child does not exactly coincide with these times does not mean that anything is wrong. Please do not worry if your child is different.

On the other hand, if you do have any concerns about your child’s growth and development, do not hesitate to seek professional advice. Do not wait — see your doctor or nurse who will be able to reassure you and give you appropriate advice.

Growth and development take place in the context of a continuing transaction between the child and his environment. Both intrinsic factors within the child and environmental influences (such as nutrition, stimulation, family interactions) are important.

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DEFINITIONS OF SOME EXPRESSIONS YOUR DOCTOR MAY USE - TACKLING THE CAUSE OF PAIN DIRECTLY (INTRODUCTION)

Let’s start at the beginning. Let’s say that the cause has been checked and your pain is due to your cancer. It may be possible to tackle this cause directly, but this would not necessarily be the best approach. You will have to weigh up the costs and benefits, just as for any other treatment.

In general, radiation is the form of anti-cancer treatment most likely to control cancer pain, especially that due to secondary cancer in the bones. This may entail only a few treatments and very little side effects. Pain due to cancer in other parts of the body, especially if the growth is large, generally requires longer treatment and higher doses and, even then, radiation is less likely to result ill good pain control. Ask your doctor just What your proposed treatment would involve and how likely it is to work.

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VITAMINS – VITAMIN A; D; K

An excess of Vitamin A is recognised to cause certain illnesses, and some explorers in the Arctic and Antarctic who have eaten the livers of seals and polar bears — which contain an enormous quantity of Vitamin A — have died from the effects of this.

Vitamin D is found in fish oils, dairy products, eggs. It is also produced in the body by the action of ultraviolet light on substances in the skin. And so in Australia a deficiency of this vitamin is rare.

Vitamin D is necessary for the calcium and phosphorous metabolism of the body and, so, the normal structure of bone. As with Vitamin A, an excess intake can cause serious symptoms.

Vitamin Ê also is a fat-soluble vitamin, and it is used in the liver in the manufacture of prothrombin, an essential factor in the clotting of blood.

Vitamin Ê occurs in green vegetables, and also some of the bacteria which normally live in the bowel manufacture this vitamin which we absorb and use.

An excess of Vitamin Ê has not been shown to cause any serious side-effects.

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EXERCISE - WALKING

Walking is good exercise. To reach and maintain physical fitness, it is necessary to walk 5 km in less than 45 minutes five times a week. The same result is obtained by running 2% km in less than 12 minutes four times a week.

If this is too fast for the middle-aged man or woman, run 3 km in less than 20 minutes, four times a week.

If you prefer to ride a bicycle, you should ride 8 kms in 20 minutes, six times a week.

Swimming is an excellent way of exercising your heart and lungs. Try 750 metres in 20 minutes, five times a week.

If you are competitive and wish to play squash, IV2 hours squash at least three times a week is necessary to maintain fitness.

If you exercise only twice a week, you cannot hope to get fit or maintain fitness. If you exercise only once a week, this is more dangerous to your heart than no exercise at all.

Exercise burns up energy and will slowly burn up excess weight. It may take a long time to burn off those extra kilos of fat but, combined with a proper diet, it can trim you down to an ideal weight.

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CANCER OF THE BREAST - OPERATION

Most doctors believe immediate operation following positive biopsy gives better results than closing the wound and operating again later. Psychologically it may be distressing to a woman to face a second operation.

There has been little improvement in the results of treatment of this condition over the last 30 years, despite enormous advances in treatment of other forms of cancer.

Operation remains the treatment of choice. In the past the operation was a radical mastectomy. This removed the affected breast, a large portion of overlying skin, the underlying muscles of the chest wall and the lymph glands under the arms.

The result is disfiguring and makes it hard to fit a prosthesis (breast substitute) under the clothes.

Despite arguments to the contrary suggesting lesser procedures, removal of the breast and the lymph glands is necessary. It is no longer considered necessary to remove the muscles of the chest wall.

Simple mastectomy (removal of the breast alone followed by radiation treatment to the glands under the arm) is advocated by some as an alternative.

Removal of the lump only, the so called lumpectomy, so as to leave a woman with her breast has, in my opinion, no part to play in the proper management of cancer of the breast. The risk of local recurrence is so high, about 60 per cent, that it is not justified.

Apart from operation there is often need for radiation treatment either in the initial treatment of breast cancer or in treatment of recurrences or spread of the tumor.

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LETTING THE EXPERTS DECIDE? (PRACTITIONER’S POWER)

Some practitioners are simply unable to tell their patients that control of their cancer is beyond the practitioner’s power. To advise not having, or stopping, anti-cancer treatment would be to admit that this is so. Thus these practitioners keep on recommending highly potent and unpleasant treatments when they are either known to be extremely unlikely to do any good or are experimental. Or course, these practitioners justify their actions to themselves, their colleagues and the patient’s relatives. When questioned they say: ‘I can’t tell that patient that I can do nothing because that would be cruel — it would take all hope away.’ This sort of statement actually confirms my claim that these practitioners are solely concerned with fighting cancer, not with treating whole people. When there is no effective anti-cancer treatment available, they say they can do nothing. When there is no hope of curing the cancer they say that stopping treatment would take all hope away. Practitioners who care for whole people would never think or say that they can do nothing. They know that treating symptoms, giving time, care, reassurance and a sympathetic ear are all doing something! Practitioners who care for whole people know that cure of their cancer is not the only thing that patients hope for. They recognise and try to fulfill other hopes—hopes for relief of pain, for time to spend at home with family and loved ones, for realistic information that will allow time for goodbyes and grieving.

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THE G.I. FACTOR: THE EFFECT OF FAT AND PROTEIN ON THE G.I. FACTOR

High fat foods that have a low G.L factor may appear in a falsely favourable light because increases in fat and protein tend to slow the rate of stomach emptying and therefore the rate at which foods are digested in the small intestine. High fat foods will therefore tend to have lower G.I. factors than their low-fat equivalents. For example, potato crisps have a lower G.I. factor (54) than potatoes baked without fat (85). Many sweet biscuits have a lower G.I. factor (55 to 65) than bread (70). But this is not a consistent finding. New boiled potatoes have a lower G.I. factor (62) than French fries (75), despite the latter’s fat content.

Remember, however, we need to eat a low-fat diet, not a high fat one. So, high fat foods of any sort, whether low or high in their G.I. factor, should only be eaten in limited amounts.

Why does pasta have a low G.I. factor? The starting point for making pasta is semolina or cracked wheat, not wheat flour. Durum wheat makes the best pasta because the grain is extremely hard and the wheat breaks cleanly into distinct small pieces. The large particle size of semolina means that starch gelatinisation is more difficult and thus enzyme attack is slowed down. The typical shape of pasta also appears to play a role in slowing down digestion. That’s why pasta of any shape and size has a fairly low G.I. factor (30 to 50). Cracked wheat and couscous used in Middle-Eastern cooking have intermediate G.I. factors.

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FAT LOSS: RISKS OF HIGH INTENSITY EXERCISE

Irrespective of the arguments presented above, there are limitations to the prescription of intensive exercise for overfat people, which make high intensity exercise prescription for fat loss both impractical and irresponsible. Because of the inverse association between body fat and cardiovascular fitness, high intensity activity in people with low cardiovascular efficiency may be potentially dangerous, even fatal. Strenuous exercise is uncomfortable and it may result in overfat people becoming totally disenchanted with physical activity as a fat loss technique. It may also help explain the failure of the fitness industry to attract significant numbers of the almost 1 in 2 people requiring weight control services in Western countries.

A further argument given for high intensity activity is that, given a set period of available time, more vigorous activity provides more ‘bang for the buck’ in terms of body fat utilisation. If the time is extensive enough to allow for adequate fat utilisation, however, a fat unfit person is unlikely to be able to complete an exercise session at a high (e.g. 70-80 per cent V02) level of intensity. Even if it were possible, it is a diminishing effectiveness of response in relation to fat utilisation with longer duration which would defeat the purpose of the exercise. Because exercise at such a high intensity may also be uncomfortable for such a person, he or she is not likely to want to do it on a regular basis, as is necessary for optimal fat loss.

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LEVELS OF FATNESS IN POPULATIONS

The prevalence of overfatness in the modem world is related to Westernisation. With industrialisation comes ease of accessibility to foods, especially processed and fatty foods. Some industrialised countries have a higher level of overall fatness than others, with Eastern Europeans currently topping the charts. The United States is at the top of the fatness tree amongst Western nations, but Australia, New Zealand and the United Kingdom are not far behind.

Fatness is even more prevalent in certain ethnic groups such as Australian Aborigines, Pacific Islanders and American Indians. It has been suggested that these people may have a genetic makeup (’thrifty genotype’) which enables them to store more fat during times of ‘feast’ and/or use less energy during times of famine’. It is proposed that the harsh conditions and inconsistent food supply would have preferentially selected those people with the ‘thrifty genotype’ by giving them a survival advantage. To date, no genes have been found which endower a major propensity for fat storage and it seems unlikely that the genetic predisposition to obesity will be pinpointed to one or a few genes. Nor have any genetic markers for obesity been found in ethnic groups with high rates of obesity.

What is well known is that ethnic groups like the Aboriginal people suffer from a high rate of obesity-related diseases such as adult onset diabetes. In Nauru, for example, where super phosphate has made the population rich and the island poor, Professor Paul Zimmett of the WHO has estimated that around 20-30 per cent of the adult population have diabetes. The Pima Indians of Arizona, who have been acculturated to the modem American diet, have extreme levels of obesity and the highest rate of diabetes in the world at 50 per cent of the adult population (compared to around 3 per cent in the White community).

This picture of an obese Western world might suggest that people are indifferent to their growing corpulence. Yet the figures show otherwise. Surveys carried out in the US suggest that at least 25 per cent of men and 40 per cent of women are trying to lose weight at any one time. Over the course of a year, the number of people who attempt to lose weight at least once rises to around 40 per cent for men and 80 per cent for women. The average man wants to lose 22kg to weigh 80kg and the average woman 22.5kg to weigh 60kg. Only 27 per cent of those who see themselves as overweight admit to not currently trying to slim. Perhaps as expected, the majority are using diet as the main method—76 per cent of men and 85 per cent of women. Around 60 per cent of both men and women use increased physical activity as a means of reducing weight.

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MIRACLE FOODS FROM THE BEES: TWO REMARKABLE CASES OF RECOVERY

Mrs. Jytte Elmgaard, 35, from Denmark, was stricken by leuco-encephatalis—an organic nerve disease with epileptic attacks—in 1950. The disease is considered incurable. During the next ten years her condition grew progressively worse, until by 1961 she was totally paralyzed and bedridden. She had up to 40 epileptic attacks a day, became blind and could not move any part of her body. She lost weight and was fading away fast. No one expected her to survive . . . except her husband who didn’t want to give up.

A Danish doctor suggested trying pollen. He obtained a German pollen preparation in liquid form. Mrs. Elmgaard felt some improvement, but not much. A Swedish specialist was consulted and he advised trying Cernitin T.60 in the form of injections. Injection treatments started in May, 1963, first given by the doctor, then continued by Mr. Elmgaard. The Danish Medical Society gave permission to use these injections and the treatment was at all times under her doctor’s supervision. Later, several other pollen preparations were included in the treatment, such as Cernimult, Cernilton, Pollitabs, Polloton 25.

Swedish health magazine Tidskrift for Halsa, reported three years later that Mrs. Elmgaard has miraculously returned to life. Her condition has been steadily improving. Her vision has returned, she can sit up in her bed and talk, and her paralysis has been disappearing gradually from various parts of her body. Even her weight has become normal. She has to continue with the pollen injections, which in her case seem to have the similar effect that insulin has on a diabetic. The injections keep her free from attacks and improve her general condition.

Doctors were amazed by the “miracle.” They could not believe that she was still alive. Her case was reported and widely discussed in medical literature. Doctors suggested, of course, that “certain cases of leucoencephatalis for some unknown reason can heal spontaneously.”

Another case is the dramatic case of U.S. Air Force Lt. Col. Thomas J. Tretheway. During World War II, Col. Tretheway spent nine months in a Japanese prison camp as a prisoner of war. His health was in a deplorable state and his weight dropped from 175 pounds to only 85 pounds.

One night he managed to escape. But he was lost in the jungle and finally, after about three days of wandering and with gangrene on his feet, he succumbed to weakness and malnutrition. He was found unconscious by natives of a Chinese jungle tribe.

The natives brought him to the village and treated him for several weeks with a diet rich in pollen and honey. They also coated his feet with pollen and honey. After a few weeks his strength was restored and he was able to walk. The natives guided him to the English lines. An English doctor in Calcutta told him that it was pollen and honey he was to thank for his life and the use of his feet.

Col. Tretheway reported that the natives who saved his life collected pollen from the surface of the water where it had been carried by the wind. They made cakes from it, mixing it with honey—this was their staple diet. They were tall and lean, had perfect teeth, and both children and adults seemed to be in excellent health.

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