Cause

There are numerous possible causes of diarrhoea, including food poisoning, but by far the commonest in children is a viral infection, such as in gastroenteritis. Like vomiting, diarrhoea can accompany many infections, both bacterial and viral. Less commonly it may be a signpost to more serious illness such as appendicitis.

Chronic or persistent diarrhoea commonly follows a bout of gastroenteritis, in which case the persistence of the diarrhoea is due to lactose intolerance. The lining of the wall of the bowel is (temporarily) damaged during the bout of gastro, so that it cannot absorb complex sugars (including lactose). Lactose is a component of milk and causes a watery, often sweet smelling diarrhoea which may burn the child’s buttocks. The treatment is a lactose-free milk (unless the child is still breastfed). The condition usually resolves itself within a few weeks as the lining of the bowel wall heals.

Other causes of chronic diarrhoea include Giardia, coeliac disease, and other less common conditions. Some toddlers with chronic diarrhoea may be drinking too much fruit juice. In many toddlers, no cause for the diarrhoea is found (toddler’s diarrhoea).

Clinical features

Diarrhoea is defined as the passage of large, loose, frequent or watery bowel movements. The colour may vary from brown to green, and the smell can be offensive. The most serious problem associated with diarrhoea is the possibility of it leading to dehydration.

Investigations

If the diarrhoea is due to a specific virus, germ or parasite, stool specimens (see p. 51) may reveal which organism is responsible.

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There have been scores of articles and research reports published over the years, yet still little is known about the cause of ‘colic’ and the most appropriate and effective management of it. Everybody has a different view of what ‘colic’ is, and there are many different opinions about virtually every aspect of the condition.

Cause

There have been dozens of opinions expressed as to the cause of ‘colic’, ranging from medical conditions in the baby to maternal anxiety and inappropriate handling of the baby.

Some of the medical reasons given include gastrointestinal (gastrooesophageal reflux, excess gas), infections (ear or urinary tract infections), hernias (inguinal, umbilical), neurological (irritable nervous system, neurological immaturity), allergy (mother’s diet, milk given to baby), nappy rash and other sources of irritation. Crying has been blamed on feeding techniques, either too much milk or milk given in the wrong way. Emotional problems in the mother have been blamed, as has a difficult temperament in the baby. Other babies are said to have a problem of too much wind, though this has never been proven to be a cause.

It is probable that a very small proportion of babies who are said to have ‘colic’ suffer from an identifiable medical problem. However, the common ‘diagnoses’ of too much wind or milk allergy are made far too frequently, with very little evidence that they represent real conditions in this age group. The vast majority of babies have no clearly recognisable cause for their difficult behaviour.

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HUSBAND

If having sex was as hard to do before we had kids as it is now, we would have never had kids, because we would never have had sex.

WIFE

In a sense, all sex in a crowded home becomes group sex. Privacy, quiet, and confidentiality are luxuries that few families have, and the more loving, open, and involved the family, the less likely it is that the parent can find much time to have open, free, expressive sex.

Here are some of the types of sexual adjustment to kids and parenting that I noted in the thousand couples. As you read these types, remember the words of David Lodge: “Literature is mostly about having sex, and not much about having children. Life is the other way around.”

The Sneaks: This is the couple who is ever vigilant for an opportunity to “do it” when the kids aren’t around. Their sex life ends up determined by the kids’ schedules, with husband and wife sending immediate “urgent” signals when the kids might be gone for a few hours. Unfortunately, the home schedule may be so hectic that even the “sneaks” run out of time before they run out of chores, and this involuntary “sneaking” for urgent sex can disrupt a more natural flow of sexual interaction between husband and wife.

The Parental Celibates: This couple has given up on sexuality, holding out for the time when all children are gone from the home to college or career. By mutual and usually covert agreement, they have decided that the effort to fit sex in secretly is just too tiring,

or detracts too much from enjoyment of the experience. There may be a few “celibacy slips” when sexual expression is enjoyed, but these events are few and far between.

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WIFE

As with all events in life, love changes. I mentioned earlier that every love eventually is broken by illness, separation, or death. It is the process of loving that constitutes our wellness, our ability to achieve super marital sex. The process of loving is infinite even if people aren’t.

Marion Richards, in her book Centering, writes, “The product is not what binds the artist to his craft. Nor the actor to the theater. Nor the person to his being. It is the transformations.” We should commit to process, not people, to a process of vulnerability and the sharing of self, not the struggle to keep love alive as somehow separate from us.

Remember, love is a decision and a decision is necessary to end it. Even in grieving, there comes a time when the decision to “un-bond,” must come. Unbonding does not cancel the memory, the love trace, but it requires a change in the relationship because of the loss of the physical presence of the loved person. Ending is as much a part of loving as beginning.

The love decision is never mutual. Author Zick Rubin points out that the decision to separate comes when one partner feels that the costs of being in a relationship exceed the perceived benefits and

one partner is willing to take a chance, to try for another bonding. As I discussed in Chapter Three, we all “dump” and “get dumped.” It is part of the process of loving and being loved. To believe that any relationship or bond is forever is self-deception. To remember that loving is forever is the ultimate human hope.

A bond’s end is one of the most painful of human experiences, but as writer Shirley Luthman writes, “I don’t believe people put themselves through very painful situations unless that is the only way they can learn what they need to know.” Researcher Clark Moustakas states that the very power of the loving process is its continued jeopardy of changing and ending. This is a universal truth for all living systems.

“I never thought I would hurt like this. I feel it everywhere, in every inch of my body. I’m sick, heartsick,” reported the wife. “I’m sorry I ever loved, and I would have never loved if I knew I was going to pay this price.” She should have known. It is the very nature of love to contain in its intensity its own destruction, as a star explodes from its own heat. The decision to end will never be mutual; we all end up hurt. Understanding this will not lessen the pain, but it may free us for a focus on the joy of the process, for it is the process, not the product, that is forever.

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It consists of three separate branches, the upper or ophthalmic branch covers the sensation from the forehead and around the eye, the maxillary or middle branch covers the area over the cheek, and the lower or mandibular branch covers the area of the lower jaw.

Tic douloureux or trigeminal neuralgia is a disorder where there are paroxysms of severe pain in the distribution of the nerve, usually of one branch. The cause is unknown and it tends to affect those over 50 years of age and women more than men.

The spasms of pain may occur spontaneously or may be triggered by eating, smiling or other muscular movements. There may be long remissions between attacks.

There are other causes of pain in the face but the attacks of this disorder are so typical that diagnosis is not usually difficult.

Pain-relieving drugs are of little use, as the attacks come on suddenly and then depart before any pain-relieving drug could work; but considerable relief can usually be obtained by the use of drugs to control epilepsy.

Where this fails to control the paroxysms of pain, injection of the nerve with alcohol or operations to divide the nerve may give relief.

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But the prerequisite is at least five years’ graduation and at least three years in general practice.

The universities also award post-graduate diplomas, such as the MS (Master of Surgery), the DPM (Diploma of Psychological Medicine), or the DA (Diploma of Anaesthetics). So by checking the letters after a doctor’s name one can usually determine his speciality and how well qualified he is in that branch.

The various medical colleges also conduct training courses and award fellowships to indicate a doctor has gained special knowledge and training and may be considered a specialist in that branch of medicine.

However, it is well to remember that a string of post-graduate diplomas and degrees alone does not necessary make a brilliant doctor.

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Unfortunately, in the process, many parents have been made to feel guilty.

Recent advice to parents has been that the child should stay on the breast for as long as possible, the introduction of solids should be delayed and, when baby signals he is full, feeding should be discontinued.

This is still good advice, but may not prevent obesity.

A recent Canadian trial appears to indicate that differing feeding techniques seem to have little influence on whether a child gets fat or not.

What is suggested is that fat babies, like fat teenagers and adults, seem to have less activity than their thinner contemporaries.

I know that I, along with many doctors, have indicated disbelief when confronted by a grossly overweight individual who protests: “But doctor, I really don’t eat much.” This may be true more often than we were inclined to believe.

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A child with threadworms has few symptoms. The child may complain at night of itching or burning around the anal or genital area. Threadworms can also be a cause of a sudden onset of bedwetting. If the infestation is heavy the child may have abdominal cramps. Threadworms can cause appendicitis (although this is rare), and they can work their way into a girl’s vagina and urethra (the passageway from the bladder to the outside) causing inflammation of the vagina or bladder.

Usually the diagnosis of threadworms is easily made by examining the skin around the anus at night while the child sleeps, or just after waking. Earthworms head back into the anus if disturbed by light, so the search must be done quickly. A threadworm can be mistaken for fluff on the skin; if the fluff moves, it’s a threadworm. Occasionally threadworms may be found in a bowel movement, but this is not a reliable way of making a diagnosis.

Home care

Vermifuges (worm medicines) must be obtained by prescription. When one member of a family has threadworms, all members (except infants and pregnant women) should be treated at the same time.

Precautions

• Suspect that threadworms may be the cause of recurrent inflammation of the vagina or bladder. • If one member of a family has threadworms, launder that person’s underclothes, bed linens, and towels to destroy the worm’s eggs. Also, cut and scrub his or her fingernails to remove any eggs. • Do not mistake fluff or thread for threadworms; look for movement.

• Do not blame household cats and dogs for a child’s having threadworms. These worms live only in humans.

Medical treatment

Your doctor investigates for threadworms using clear tape that will pick up any eggs that are on the skin. The tape is then examined under the microscope. If the test is positive, the doctor will prescribe worm medication for the entire family.

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