By 6 weeks of age, babies are awake for longer periods during the day, as they begin to take an increasing interest in their environment and interact with their care-givers. By 6 months their sleep is less linked to feeding patterns. Rather than sleeping for most of the time, they are awake for longer periods and seem to have several naps during the day. Some infants, to the great delight of their parents, are already sleeping through the night.

Between 6 months and 1 year of age, sleep patterns change considerably. The typical baby will sleep 10-12 hours at night and have two naps during the day. A greater number of babies sleep right through the night. Some may wake several times but will often go back to sleep with a minimum of fuss. This is also the time when they begin to establish more regular and predictable patterns of sleep and feeding and playing. There is still variation, depending on temperament and other factors. This is also the time when patterns are easily disrupted by illness. Many sleep problems have their genesis during this period, with parents unwittingly interfering with their babies’ sleep cycles, for example waking him for a feed. It is important that your baby be allowed to develop his own sleep patterns with minimal parental interference.

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Falls on the extended hands of young adults often fracture a bone in the wrist, known as the scaphoid. This will produce tenderness and pain near the base of the thumb. Although the wrist may still be used, this fracture is often missed and is regarded as “just a sprained wrist.”

It is a serious condition and requires at least 12 weeks in plaster. If neglected and not immobilised for at least two or three weeks, the bones may not heal quickly and could require five or six months in plaster, or even an operation at the end of that time.

Elderly people, particularly women, when they fall on the wrist, may break the lower part of the radius, the main forearm bone. This is obvious by the formation of a particular type of swelling at the lower part of the forearm, just before the wrist. It looks like and is in fact called the “dinner-fork deformity.” As the two broken ends may be driven one into the other (impacted), there is often still considerable mobility left in the wrist, and it doesn’t just hang limp. Put the arm in a sling and seek medical aid.

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The main use, then, of CDC, is in those with cholesterol stones for whom surgery is a considerable risk or who have stones in inaccessible areas such as deep inside the liver.

While the concept of dissolving gallstones is an intriguing idea and seems more attractive to sufferers than operation, it is a possibility for only a few and operation remains the most effective treatment.

Most sufferers lose all their symptoms following removal of the gall bladder and can function satisfactorily. The bile is produced at a constant rate and drips down into the duodenum rather than being concentrated and entering in spurts.

Unfortunately, a few people will not lose their intolerance to fatty food and we are not sure why.

My advice is that, if your gallstones are causing trouble, you will be better if you and your gallbladder are parted.

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A frequent finding, particularly in young women, is that the lump is due to a fibroadenoma.

These are benign, that is, non-cancerous tumors which consist of both fibrous and glandular tissue. They are smooth, hard and freely moveable in the surrounding breast tissue and rarely become larger than a pea.

The doctor may be confident of the diagnosis, yet breast cancer is so common, so feared, and its treatment has such poor results if the diagnosis is made late, that most surgeons agree all breast lumps should be examined.

Small cysts may form in the breast and these can both be diagnosed and treated by inserting a needle into the cyst and withdrawing fluid for examination.

Even before removing what appears to be a benign lump, the surgeon will talk to his patient to find out her wishes should he discover that the tumor is malignant.

The normal procedure is to operate, remove the lump and subject it to frozen section.

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As you probably know, the bowel, or intestinal, system really begins at the mouth. From the mouth is a continuous canal to the far end, to an opening we call the anus. It is actually a single tube which we arbitrarily divide into segments and call by different names.

The oral cavity is guarded by gums and teeth in front, and the tongue sits in the lower part. A baby is born with gums but no teeth in sight. That’s fortunate for the breast-feeding mum. Have you ever thought how terrible it would be breast-feeding a baby with the full component of twenty sharp milk teeth? Ouch! No, several months pass before the baby is endowed with a first set of teeth.

The oral cavity leads directly into the pharynx, passing the two red tonsils on each side, and the pharynx gives way to the oesophagus, or food pipe. This leads to the stomach via a small valve.

Digestion starts when food mixes with saliva in the mouth. But in the stomach it receives a major boost—the wall is lined with many glands which pump potent acid and some other digestive chemicals, called enzymes, into the mass of food. It tends to become a mixed-up mass, largely fluid in nature.

The stomach is merely a dilated part of the bowel. It houses the food until the valve at the far end allows it to pass into the next part, called the duodenum.

At regular intervals, the stomach valve (called the pyloric valve) opens and the fluid starts its long trek down the bowel. Firstly it traverses the duodenum, which then leads into the small bowel (firstly named the jejunum, and later the ileum) Here various extra enzymes are added, and much of the nutritional elements of the food is absorbed by the bowel wall for use in the body.

At the far end of the small bowel (named ‘small’ not because of its length, for it is very long, but because it is narrow in diameter), it dilates into an area called the caecum. This is where the small bowel connects to the large bowel (‘large’ because it is very wide in diameter, although it is quite short in length, in contrast).

Here the appendix occurs as a small worm-like organ (about the thickness of a pencil). It has an opening where it joins the caecum. It is several centimetres long and has a blind, closed far end; if its opening, or mouth, becomes blocked then trouble looms, for germs can easily establish a foothold and set up an acute infection which we refer to as acute appendicitis.

In the large bowel, fluid (mostly water) is reabsorbed by the walls, making the contents much firmer. From the large bowel, the canal continues as the rectum. There, in the rectum, the residue of the bowel contents is stored until a suitable time when it can be passed. When this occurs, it gently passes down a much narrower tube, called the anal canal.

At the end of this is a valve, called the anal sphincter. When this releases, the final, unwanted debris is expelled from the digestive system via an aperture called the anus. Afterwards, the valve re-closes, and stays closed until another bowel movement is made.

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Baby’s actions start to become a little more smooth. If sitting up, the head still tends to flop but there is greater firmness of the neck muscles; the head can be kept erect for longer periods. The baby instinctively realizes the necessity of keeping the head clear and free from being buried in pillows or objects if lying on the floor. So, at all times there is an increasing effort to hold the head up, at about 45 degree angle. The baby often tires after a few minutes, but this skill gradually improves. Even when lying on the back, the baby often tries to hold the head slightly upwards.

Limb movements (arms and legs) may be less jerky, and much smoother.

Noises may startle the baby, and he or she may twitch involuntarily in the hands and feet if disturbed or if there is a sudden noise.

Objects, such as a toy or your finger, placed in the baby’s hands may still be grasped reflexively; but a tentative effort may be made to knowingly grasp at things. Often the baby will hold objects for short periods before dropping them.

He or she may strike out at near objects, such as mother’s face, if coming within close range.

Talk

The 2-month-old baby still does a lot of crying. This is a good thing, for it helps aerate and expand the developing lungs. The throaty noises of the first month are continued, but the baby will also start cooing in a soft manner. The noises are baby talk, and nothing like a grown child or adult, at this stage.

Mind

Mental development starts to become apparent. Much of the waking time is spent staring at the walls or objects within range. Eye movements wander around in a circular fashion. If there is some object, such as a bright toy, or a light, this will be followed; the baby becomes capable of following an object from one side to the middle line and gradually towards the opposite side, but it then tends to be lost. Things fairly close can be focused on, and the attention kept for increasing lengths of time.

Sudden noises or distractions will cause an obvious body reaction. The baby’s face may show a reaction, such as recognition or possible fear.

Lights, bright colours and moving objects gain the baby’s attention, which may be maintained for a short time. Attention may be fixed on one or two single objects, rather than several consecutively.

The baby tends to grasp for an object that has his or her attention or may strike at it. At this age the baby is able to grasp and retain an object, such as a light toy, for a while but then often drops it. This action tends to be made under control, rather than the automatic reflex it previously was.

The baby becomes stimulated at seeing familiar objects, such as a toy, and happy and often excited at seeing faces he or she recognises such as mother, father, brothers and sisters—and may stare at them intently, often bursting into a smile (as every joyous mother knows) when recognition dawns on baby’s face. Individuals start to be associated with certain favourable actions; for instance, mother and food become synonymous. The baby begins to show a preference for people over inaminate objects. Will often stare at a face intently, giving an impression of profound wisdom. This may end in a happy smile of recognition.

The baby may commence to show a preference for the right or left side, tending to grasp with the right hand, for instance; may sleep on the same side.

Shadows passing over the face, such as waving his own hand in front of him, will make him blink.

Objects as well as moving humans are regarded with a quizzical, intent gaze.

Actions are often repeated over and over, apparently for the sake of movement rather than for any productive end point. Tends to do one thing at a time.

The baby starts to distinguish between different persons, voices, objects.

Relationships

Personality is starting to develop, and the baby starts showing happiness, unhappiness or distress. If upset, he may suck his fingers, thumb or hand to calm himself down. Often he will use this method for slipping off to sleep.

Tends to give a smile of recognition at members of the family. Will react similarly with others. May show signs of stimulation and happiness when seeing people he or she knows. Will intently look at the person. Or will physically react by actively moving the limbs, breathing in and out rapidly with anticipation and excitement, or gurgling and making baby talk. If crying, may stop when seeing a familiar face, or if held or nursed.

However, the baby usually likes being handled and enjoys eating. These are more important than the social aspect of being with others.

If there are others present, the baby will often stay awake for longer periods of time. If encouraged, will ‘perform’, often for hours, and this usually means difficulty settling down to sleep. Pre-sleep-time excitement is often a major problem after these unwise incidents.

Night feeds tend to lessen, to one only.

Bowel actions are often associated with feedings, and the bowel reflex commences. Often there are two actions a day.

The sleep programme tends to change. The baby may sleep for up to seven hours at night and may remain awake for nine to ten hours a day. There may be several sleep periods during the day.

Baby enjoys the warmth of a bath each day, and finds this a very happy occasion as shown by physical movement.

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The plant has been used beneficially for glaucoma treatment and pain relief.

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A lumbar puncture, also known as a spinal tap, is the method used to obtain a sample of cerebrospinal fluid for testing. Cerebrospinal fluid is a clear liquid that surrounds the brain and the spinal cord. In a lumbar puncture, which is usually done in the hospital, a needle is used to penetrate into the spine at the lower end, between two spinal bones called lumbar vertebrae, and draw out the fluid. The pressure in the spinal column can be measured at the same time. The fluid is examined to see if it is clear or cloudy and to see if it contains any blood. It is then tested for viruses, bacteria, and other signs of infection.

A lumbar puncture may be done to test for meningitis, encephalitis, brain hemorrhage (bleeding in the brain), polio, and other nervous system disorders. Under the usual circumstances, there is no risk from a lumbar puncture. If the spinal fluid is under extreme pressure, however, the procedure carries some risk of complications; a different technique is then used to minimize risk.

Cat scan

A CAT scan is a sophisticated type of X ray. The initials stand for Computerized Axial Tomography. In a CAT scan, a series of special X rays are made of a part of the body such as the head or the torso. The patient is placed in a tunnel-like opening in the machine, and does not have to be repositioned for each picture as is done for ordinary X rays. This way, pictures can easily be taken from many different angles. A computer then assembles those X rays into a single picture which shows a cross-section of that part of the body. The whole process takes only a few seconds. CAT scans are used to find abnormal growths or other problems in areas that are inside the body and therefore difficult to see without time-consuming and potentially dangerous exploratory surgery. For example, the brain can be examined for an abnormal growth without opening up the skull.

CAT scans are usually done in a hospital. The equipment for the procedure is expensive, and a limited number of scanners is available. Sometimes a patient must be transported to another hospital, or even to another town, for this test, because a scanner is not available in his or her home town.

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