PARENT/PHYSICIAN PARTNERSHIP: CHOOSING A DOCTOR

Raising a child is a big responsibility, and it’s always comforting to know that there’s someone you can turn to when you have a problem. For advice on many of your concerns about your child you can call on your own parents, your family and friends, other parents, your child’s teachers. But when it comes to your child’s health the person you need is a physician.

To get the best from your child’s doctor, you must first select the best doctor for your child. A pediatrician is a doctor who sees only children. The pediatrician has had an extra three to five years of special training in the physical, emotional, and educational needs of young people. Your family physician probably has comparable training in terms of years of study, but this study has been directed to people of all ages rather than just to children. The best pediatrician you can find should, in theory, know more about children than the best family doctor you can find.

The most important thing, however, is that you should be able to get along with the doctor who is caring for your child. If you feel more comfortable with your own family physician than with any pediatrician in your locality, you may decide to have the family physician take care of your child, too. You know what’s best for you and the child, so trust your own decision.

Your child’s doctor, who is a trained and experienced professional, should be a reliable and sympathetic source of information and advice throughout your child’s growing years. Always remember, though, that the doctor is a medical adviser, not another parent. There are decisions about your child’s well-being that only you can make, and a good doctor does not try either to make child-rearing decisions for you or to make you feel that you’re not a competent parent. A good parent/doctor relationship is one in which each partner respects the other.

How do you find a good doctor? If the child is your first, the doctor who delivered your baby can give you names of local physicians and maybe recommend someone who is well thought of by other new parents. You may have a friend or neighbor with children who can recommend someone. If you’ve moved to a new area, consult a neighbor who has children, or call the local hospital or the local branch of the state medical society. Professional organizations will not give you recommendations as such; they will give you names and expect you to make your own inquiries. However, a phone call and a visit to a doctor’s office should be enough to tell you whether or not that doctor is right for you and your child. It is also a good idea to visit the doctor even before your baby is born to become acquainted and to arrange for your baby’s medical care.

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NEWBORN BABY: FIRST MONTHS OF LIFE

Spitting up

Many babies spit up either as they are being burped or a little while after a feeding. This is normal. Check with your doctor if the baby is spitting up large amounts, is having projectile vomiting (forceful, explosive vomiting), or does not appear to be gaining weight. Consult your doctor if the baby is spitting up and also seems hungry all the time, or becomes limp and not alert.

To reduce spitting up, try burping the baby more often during a feeding, or changing the feeding position slightly so that the baby is more upright. It may help to have the baby rest quietly in an infant seat for a few minutes after feeding, rather than laying the baby down or encouraging active playing.

The pacifier (dummy)

Babies need to suck a certain amount each day. If your baby is hungry but only takes a small amount of food, he or she probably only needed to suck. If this happens consistently, a pacifier is a great help. It meets the baby’s need to suck but spares you the inconvenience of trying to feed a baby who really isn’t hungry. After about six months (remember, all babies are different and this may vary), the baby will no longer need extra sucking. Then you can take away the pacifier.

Breast-feeding

Many doctors today recommend breastfeeding, if it is possible, for a number of reasons. First, breast milk passes on to the baby some of the mother’s own resistance to infections. Second, many babies develop allergies to infant formulas, but it is rare for a baby to be allergic to the mother’s milk. Third, breast-feeding is much more convenient than bottle-feeding, because it is always available and needs no sterilizing, mixing, or refrigeration. Fourth, the experience of breast-feeding is emotionally satisfying for both mother and baby.

Even if you breast-feed, you can give the baby an occasional bottle or give one feeding a day by bottle. This can give you a chance to be away from the baby sometimes or to sleep through the night while the baby’s father gives a feeding. The breasts can be emptied with a breast pump if they become uncomfortably full.

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LIVING WITH DIABETES: HOW WAS INSULIN DISCOVERED?

The story of the discovery of insulin is a long and fascinating one and to some extent it is also the story of our understanding of diabetes itself.

As a medical condition, diabetes has been known to mankind for two thousand years and perhaps the very first known reference to diabetes is in an Egyptian papyrus thought to have been written about one thousand five hundred years ÂÑ.

Despite an awareness of diabetes and the fact that so many people have suffered from it, virtually nothing was known of the nature of the condition or its cause. Doctors had only known that it was associated with the passing of a large quantity of urine and excessive thirst and the name diabetes literally means ‘an excessive flow of fluid’.

It was not until the 17th century that an Englishman named Thomas Willis noted that the urine of persons with diabetes was sweet and tasted like honey or sugar.

Thus the name of the condition came to be ‘diabetes mellitus’, from the Latin word for honey. So it was that doctors came to realize that diabetes mellitus had something to do with sugar. The proof that this sweetness of the urine was in fact due to sugar was made by another Englishman, Matthew Dobson, and a century later. Dr Dobson also found that the blood of patients with diabetes was also sweet, and he came to the important conclusion that the sugar in the urine came because there was excessive sugar in the blood.

The next important advance was made by a French scientist, Claude Bernard. Bernard discovered that sugar was normally kept at a constant level in the bloodstream and that the regular source of sugar in the blood was derived from stores in the liver. The substance that acts as a sugar store in the liver we call Glycogen.

A most important step in our understanding of diabetes came in 1889 when a German laboratory worker called Minkowski found that removing a dog’s pancreas led to it getting severe diabetes. Thus the origin of diabetes was traced to the pancreas. This observation was taken further still in 1901 when Dr Opie in Baltimore, USA, noted that in those with diabetes certain tissue cells in the pancreas, the ‘Islets of Langerhans’, were degenerated.

In 1916 a British physiologist, Sir Edward Sharpey-Schafer, suggested that diabetes was due to a lack of a chemical substance produced by these ‘islet’ cells. This very important suggestion paved the way for the search for this chemical substance they produced.

From then on many people attempted to extract this substance from the pancreas. Dr Zuelzer, a German, treated some people with diabetes with such an extract, apparently with some response. However his experiments were not completely successful and many other people had tried the same thing and failed.

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