Most fractured limbs need to be splinted or put into a plaster cast. This enables the bones to unite and mend without being disturbed by any movement. If the fracture is a complicated one, or it is open to the surface, your child may require an operation under anaesthetic. Because of this, avoid giving him any food or drink until you get medical advice. Children’s bones mend rapidly, usually without any complications. Encourage the use of the affected limb after the cast has been removed — a child provides his own best physiotherapy.

If your child has a fracture of the skull, he will need careful medical attention because of the delicacy of the underlying brain tissue.

After the application of a plaster cast, care must be taken to ensure that there are no complications.

1. Keep the limb elevated (in a sling for the arm or by using crutches with a leg in plaster) for 48 hours — this is how long it takes the plaster to dry completely.

2. Encourage your child to wiggle the fingers or toes of the affected limb.

3. Return to your doctor the following day for a plaster check. This is very important in order to ensure that the plaster in the correct position.

4. See your doctor or go to the emergency section of a hospital immediately if

any of the following occur:

• swollen or blue toes or fingers;

• severe pain in the limb, not eased by painkillers or by elevating the limb;

• stiffening of the fingers or toes;

• pins and needles or numbness of the fingers and toes.

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Young babies commonly have marked bowing of their legs, especially if they are of a rather sturdy build. When the child stands with his feet together, the ankles touch but the knees are separated. This is considered to be a normal variant, caused by poor alignment of the bones of the thighs and legs during growth. Most children have bow legs to some extent in infancy and this becomes more noticeable when they start to walk. The legs usually gain realignment by the time the child starts school, and no treatment is required. If the bowing does not improve after this age, night splints may be considered where the bowing is severe.

DISLOCATION OF A JOINT

Many joints in the body are of the ball-and-socket type. When these become dislodged from each other, as a result of injury, we call this a dislocation.

Clinical features

The pain after dislocation is usually similar to that of a fracture. There is marked pain and swelling over the area of injury and deformity is usually obvious.

Investigations

The diagnosis should always be confirmed on X-ray. Sometimes a fracture will also be present. If the dislocation has to be manipulated back into place, a follow-up X-ray will be necessary.

Treatment

Under an anaesthetic, the bone is manipulated back into place. A sling is usually worn for several weeks.

Complications

If the tendons or ligaments that surround the joint are badly damaged, the dislocation may recur. A paediatric orthopaedic surgeon should be consulted if this occurs.

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Scoliosis is usually discovered during routine screening at school. It rarely causes problems during childhood, but curvature of the spine is visible in most cases. Pain may occur at a later stage.

Investigations

Most children who are thought to have scoliosis will undergo an X-ray of the spine to confirm the diagnosis. X-rays may be repeated at certain intervals to monitor the degree of scoliosis as the child grows.

Treatment

Most mild cases of scoliosis will not require specific treatment, but the child should be monitored routinely to see how the condition is progressing. A more severe curvature may require some form of temporary back brace to minimise the deformity. This will be done under the supervision of an orthopaedic surgeon. Surgery is only necessary in the most severe of cases.

When to see your doctor

See your doctor if you are concerned that your child may have scoliosis.

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The child with talipes should be referred to a paediatric orthopaedic surgeon. Treatment to correct the position of the foot is commenced soon after birth. Special splints or plaster casts are used to hold the foot in a straight position. Careful follow-up is essential, as the condition may recur. Surgery is sometimes necessary.

This condition is different from talipes calcaneovalgus (‘turned’ foot), which is more common and usually of no consequence. Here the toes are turned upwards towards the shin, and the whole foot is turned to the outside. This is the most common foot abnormality seen in the newborn. In the majority of cases, the condition corrects itself within 6 months and no treatment is required. Occasionally stretching and splinting are necessary. This condition is associated with congenital dislocation of the hips, so the hips must be carefully checked.

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• Check to see if the water in your area is fluoridated. If not, add fluoride supplements to the baby’s diet. Your dentist can recommend the correct dose and form.

• Do not let your baby or young child go to bed with a bottle in his mouth. This practice will cause dental caries, especially in the front top teeth. Use the bottle for feeding not pacifying.

• Do not put jam, honey or glycerine on your baby’ s dummy.

• Try to avoid giving your child sweet drinks or lollies. If your child does have lollies, keep them to a minimum. Don’t get into the habit of using them as rewards. Encourage your child to brush his teeth afterwards. Fruit juice or plain water is preferable to carbonated sweet drinks or cordials.

• Once your child is old enough to rinse and spit out, encourage him to brush his teeth regularly using fluoridated toothpaste on a child-size toothbrush. Parents can brush the teeth of younger children.

• Have your dentist check your child’s teeth from toddler age onwards, or earlier if you have any concerns.

A note on fluoride

Some people are concerned about fluoride being added to the water supply. These arguments are sometimes about ‘freedom of choice’, or about chemicals being added to the water. You should rest assured that the levels of fluoride added do not harm your child in any way — there is absolutely no risk of fluoride poisoning. In fact, water already contains many chemicals — from those occurring ‘naturally’ to those added to purify the water and kill any bugs which may be harmful to your health.

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I have also included one drug I have never used because it is not legally available in Australia— heroin. You will see that heroin is about the same strength, and lasts about as long as morphine. In fact, I included heroin so that you could see that there is nothing magic about it. I do not believe that legalisation of heroin would result in greatly improved pain relief for most people with cancer. What is more likely to achieve this is better education of doctors and nurses in the use of the painkillers already available.

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Lack of this vitamin — and usually wittf an associated lack of riboflavin — produces the disease known as pellagra, and this usually is seen in those whose staple diet is maize and little else.

Vitamin B6, or pyridoxine, is required for the proper functioning of nervous and skin tissue.

B6 has recently been used in relieving premenstrual tension (PMT).

Most of the B-group vitamins form part of the molecules of enzymes in the body, those chemical substances which are necessary for the build-up and break-down of all the body tissues.

Vitamin B12, or cyancobalamin, is formed in the body by the action of a chemical in the stomach acting on another chemical taken in with the food.

It is necessary for the proper development of the red blood cells and nervous tissues.

A lack of Vitamin Â12, because of degeneration of these special cells of the stomach, which produce the intrinsic factor, is the cause of pernicious anaemia.

This disease, called pernicious when it was first discovered because the anaemia does not respond to the intake of iron, is treated by giving Â12 by injection.

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Smelling salts, whose pungent odor revived them, was a most necessary constituent of any first aid kit of the time.

Syncope, a faint, a vasovagal attack, are all labels for this common condition.

A faint occurs when the blood pressure suddenly drops and the output of the heart fails, so that not enough blood is pumped to the brain.

Lack of blood and therefore, oxygen reaching the brain leads to the loss of consciousness. The person falls to the ground and then rapidly recovers.

Although the mechanism of a faint is always the same, there are many different causes of why the blood pressure should suddenly fall.

Most of these causes are simple and do not indicate underlying disease.

In a few cases there is, however, some disorder or disease process present.

The heart is a pump, pumping blood around the body through the arteries. Blood flowing in the arteries has a continuous head of pressure behind it to move it onward.

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Cancer-in-situ is also detected by the smear. This is cancer at its earliest when there is no spread into the deeper tissues.

Once a woman becomes sexually active, she should have this test. Yearly tests are recommended by some but, in most cases, a Pap smear every two years should be adequate. Repeat smears at more frequent intervals may be necessary in suspicious cases.

If the smear test is positive, it is necessary to do a biopsy. A cone of tissue is removed from the cervix and examined under the microscope. If the presence of cancer is proved, operation with removal of the womb is usual.

In younger women who have not completed their families and in whom the cancer is localised and not spreading deeper into the cervix, it may be possible, if the cone has completely removed the cancer, to leave the womb temporarily. The woman can have her children and later have a hysterectomy. Regular three-monthly Pap tests are done to watch for recurrence.

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