Herbal Health

Infections of the urinary tract are common in children, especially amongst girls. Cause

Urinary tract infections are caused by germs which infect the urethra (the urinary opening) and sometimes the bladder. Infections are more common where there are abnormalities of the kidneys or urinary tract (such as vesico-ureteric reflux — see p. 278) where the urine collects, thereby encouraging the growth of germs.

Clinical features

Older children usually complain of classic symptoms such as pain or stinging on passing urine, or a frequent urge to run to the toilet. Sometimes they pass small amounts of urine often and have difficulty in getting started. These symptoms can be accompanied by fever, abdominal pain and blood may be present in the urine. The younger the child the less specific are the symptoms; he may have an unexplained fever, irritability and bouts of crying, go off his feeds and even vomit.

Investigations

It is impossible to diagnose a UTI on symptoms alone. It is always necessary to back up any suspicions with a urine test, performed before the child has started taking antibiotics prescribed by the doctor. Once a course of antibiotics has commenced, it is impossible to identify the germ in the urine, and this makes treatment more difficult.

If there is a chance that the cause of your child’s UTI is an underlying structural abnormality of the kidneys or urinary tract, such as vesico-ureteric reflux, then further investigations such as a micturating cystourethrogram, or a renal ultrasound may be recommended by your doctor and your child may be referred to a paediatric specialist. Most children who have a urinary tract infection need to have these tests to make sure there is no underlying abnormality.

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A one-week course of antibiotics, given by mouth, is usually effective in treating most UTI’s. The urine should be checked again after treatment to make sure the infection has cleared up completely. If tests reveal an underlying abnormality, it may need to be treated — your doctor will explain this to you.

• if your child complains of any of the symproms described above;

• if the urine is pink, red or brown in colour;

• if your child has a high, unexplained fever or is generally unwell.

Prevention

Teach your daughter to wipe from front to back, so that germs are not spread forward from the bowel. Make sure your child always drinks plenty of fluids. Only buy cotton underwear for your child, as it allows a better air flow which helps to keep the area cool, making it difficult for germs to multiply. Encourage frequent emptying of the bladder every 3-4 hours and before bedtime.

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Cause

The cause of pain on urination is most commonly a urinary tract infection. Irritation of the vulva and urethral opening by soaps or shampoos can also occasionally cause stinging and burning on urination.

Clinical features

Urination stings, burns or is painful. The child will have a frequent urge to urinate, but will find starting difficult, or will only pass small amounts even though he feels he has a full bladder.

Treatment

Encourage your child to drink a lot of fluids to help dilute the urine and ‘flush out’ the kidneys and bladder. Urinary tract infections should be treated appropriately by your doctor and followed up carefully.

When to see your doctor

Always consult your doctor if your child complains of pain on urination.

Prevention

As for urinary tract infections.

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Vesico-ureteric reflux is one of the commonest causes of urinary tract infections in children, and if not detected early can lead to scarring of the kidneys.

Cause

Vesico-ureteric reflux is due to a defect in the valve mechanism where the tube from the kidney (the ureter) joins the bladder. Normally urine flows in one direction away from the kidneys, down the ureters, into the bladder and then down the urethra to the outside. If your child suffers from reflux, whenever he passes urine, a small amount escapes backwards from the bladder and flows towards the kidneys. The stagnant urine can also lead to infection. The degree of reflux can vary from minor to severe.

Clinical features

There are no specific signs of vesico-ureteric reflux. It is usually discovered when a child is being investigated for urinary tract infections.

Investigations

A micturating cystourethrogram and a renal ultrasound are usually performed to determine the degree of reflux, and whether there has been any kidney damage.

Treatment

In mild cases, any urinary tract infections resulting from the reflux are promptly treated, and your doctor may advise a long-term course of antibiotics in small doses to prevent recurrence of infections. The kidneys and urinary tract are monitored regularly via urine tests, follow-up X-rays and ultrasound, to make sure that the situation is not worsening. Most mild cases of vesico-ureteric reflux will resolve spontaneously with age. In more severe cases surgery may be indicated. Your doctor will explain to you the preferred treatment and follow-up plan for your child.

Prevention

There is no way to prevent vesico-ureteric reflux.

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Growth occurs in predetermined phases, although there is a great deal of individual variation. For example, a baby on average will double his birthweight at about 5 months, and treble it at about 12 months of age.

The rate of growth in children (weight, length or height, and head circumference) is measured in percentiles. When you visit your doctor or nurse, your child may be measured and these measurements plotted on percentile charts. This is to check that growth is proceeding appropriately.

Percentile charts are comparative graphs of children’s growth rates. If your child’s weight is on the 50th percentile, he is the same weignt as 50% of children of his age. If he is on the 97th percentile he is heavier than 97% of children of his age; being on the 3rd percentile means he is in the bottom 3% for his age. There are different percentile charts for boys and girls.

Checking percentile charts may give the first indication that a child is ‘failing to thrive’, is overweight, too tall, or too short. Growth is most rapid in the first couple of years of life, and then again in adolescence. The latter is known as the adolescent growth spurt.

A child’s head grows in a similarly predictable manner. At birth, the baby’s skull is very soft, with two open spaces or holes at the top of the head. These are called fontanelles, and allow the bones of the skull to grow as the child grows. The one at the front, called the anterior fontanelle is the larger of the two, measuring 3-5 centimetres at birth, although again this varies considerably. Both fontanelles are closed by about one year of age.

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Surgery is a good way of tackling a few particular types of pain due to cancer. For example, pain due to a blockage of the bowel or kidney can sometimes be relieved by removing the responsible growth or bypassing the blockage. Pain due to a fracture through cancer in a bone, can often be most quickly relieved by putting a metal pin or plate in the bone. The bone is most likely to remain pain free if this surgery is followed up by radiation treatment.

Even chemotherapy is sometimes recommended for people who have painful cancer growths. The pain will be relieved only if the growth is shrunk, so consider this method of pain relief only if you have a type of cancer which is very likely to be sensitive to the chemotherapy.

If you do decide to seek pain relief by tackling the responsible cancer itself, you will still need painkillers in the meantime. The fact that your pain may be relieved by radiotherapy or surgery later doesn’t mean that you shouldn’t be getting relief with painkillers right now. The following section is important for all of you with cancer pain — those who are having anti-cancer treatment as well as those who are not.

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Vitamin C, or ascorbic acid, has occupied a lot of interest recently, not only for its effect in preventing the common cold but because of its actions generally in human nutrition.

Vitamin Ñ is widely distributed through many foodstuffs. The green vegetables, citrus fruits and potatoes contain considerable quantities.

This vitamin is necessary for the proper development of connective tissue in the body, especially the coverings of blood vessels.

Lack of ascorbic acid produces scurvy, with bleeding in the gums and other soft tissues, failure of wound-healing, and poor resistance to infection.

Infantile scurvy is seen in children artificially fed without a Vitamin Ñ supplement.

There are groups who believe that large doses of Vitamin Ñ are beneficial to health and indeed can treat or prevent a large number of illnesses.

Orthodox medical and nutritional experts do not accept this.

If you eat a proper diet, it is not likely that you’ll suffer from a Vitamin Ñ deficiency.

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For proper physical fitness, a balanced diet is essential. The body should be at the correct weight for height and age. All the essential food factors should be included in the diet.

Protein is necessary to build up body tissue and to replace wear and tear. Fat is necessary to provide essential factors. Carbohydrate provides a ready energy source but excess tends to accumulate as stored fat.

Minerals and vitamins are necessary in small doses. Bulk in the form of vegetable fibre is necessary for the proper functioning of the bowel.

Exercising three times a week is the bare minimum. Four or five times a week is better. People who are fit look better, feel better, work better, are sick less often and have less chance of developing a heart attack.

Don’t smoke, drink in moderation, eat a balanced diet and take proper exercise. Learn to relax and you may not only live longer but enjoy it more.

The message Life: Be In It applies to you. You should exercise as if your life depended on it.

It does.

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Chemotherapy, or the use of cytotoxic drugs to kill the cancer cells, is now part of the initial treatment.

As in other forms of cancer what is developing is a team approach to treatment, the surgeon, radiotherapist, and chemotherapist making joint decisions about the management of each patient.

The implantation of a silicone prosthesis to give the woman a new “breast” is now a regular procedure for many women unfortunate enough to lose their breast because of cancer. The construction of the new breast may be done at the same time as the initial operation of removal of the breast or may be delayed for some months.

If you find a lump go straight to the doctor. If it isn’t cancer you save months of worry. If it is, the earlier it is found and treated the better the result.

The breast is the commonest site of cancer in women, but the uterus or womb is the second.

Cancer may involve the cervix, or neck of the womb, or the body of the womb; and the age at which the cancers occur, the possible causes and their subsequent behaviors differ.

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Of course, not all doctors and ofher practitioners who treat cancer are as black as I have painted. I hope that your practitioners combine the best of modern scientific medicine with the art of healing. I hope they take as much care in finding out how you are feeling and what life is like for you as they do in arranging and assessing tests. I hope your practitioners place as much, or more, importance on the quality of your life as they do on its length. I hope they treat you as a whole person who happens to have cancer and not just as a cancer with a body wrapped around it!

If you don’t have this kind of practitioner, life is going to be difficult for you. Those practitioners who are least likely to make the best decisions for you are also the most difficult to get enough information from to make your own decisions. Switch to another practitioner, if possible. If not, you may have to seek information from other sources such as other practitioners, nurses, other hospital staff, books, other patients, and friends. If you make a decision that does not follow such a practitioner’s recommendation, be prepared to be told by them that you are foolish, ignorant and incapable of properly assessing the situation. Trust your own judgement and commonsense. Don’t be intimidated or cajoled into giving away control of what happens to your own body. Remember, you are the world’s greatest expert on yourself. Nobody else knows how you feel inside and what is important for you. This personal knowledge is of vital importance when it comes to deciding on treatment that could totally alter your life.

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