The theory of management of temper tantrums in young children is straightforward and, when put into practice, always works; it is putting it into practice that is difficult. The principles of management are no different from the management of most other developmental problem behaviours in childhood — reinforce wanted behaviours and ignore unwanted behaviours.

However, most parents, for reasons that are perfectly natural and understandable, have difficulty in applying these principles in a consistent way. The reasons for this are many. Often there is disagreement between the parents as to the best way to manage problematic behaviours. It is usually the father who takes a softer line, generally because he does not perceive the problem to be as severe as the mother. In most families it is the mother who is the primary care-giver, so that the father tends to assume less responsibility for day to day care. He sees that the child seems better behaved for him, having fewer tantrums. When the mother suggests a behaviour modification plan, often the father thinks that she is overreacting. It is vitally important that a management plan for children with frequent temper tantrums, or any other behaviour problems for that matter, be agreed on (and adhered to) by both parents, otherwise it is bound to fail.

Temper tantrums are best ignored. As soon as the child begins to have a tantrum, you should immediately leave the room, or turn your back. It is important that the child be paid no attention whatsoever. That is more easily said than done, of course, yet that is the mainstay of successful management. The details of behaviour modification, which is used in the management of most behaviour problems in childhood, are described elsewhere.

The frequency and duration of temper tantrums are inversely related to how much attention the parents give to the child during the tantrums. If you can accept that they are a normal part of the child’s functioning at a particular developmental phase, and not turn them into a power struggle (which, by the way, the child will always win, one way or the other) then they will simply disappear over time. Unfortunately, many parents, despite their best intentions, get drawn in, virtually guaranteeing that tantrums and often other associated problem behaviours will continue and intensify.



Another important point is our motivation. If it has dropped, we need to look at why. A drop in motivation also means a drop in the will to take power. Sometimes our lack of motivation can be caused by fears of change and of growth.

The working-through process means we are getting in touch with ourselves, perhaps for the first time. We become aware of how we think and react on a day-to-day basis, which usually gives us insights into ourselves which we have not had before.

Sometimes these insights can be quite threatening, as they could signal the need for changes in our life.

The drop in motivation may mean we are avoiding these insights. Everyone wants to recover, but many of us want recovery to mean we will return to our former self. The working-through process means we are getting in touch with ourselves, with feelings, needs and desires we may never have known existed. These will need to be integrated and their integration will mean not a return to the old, but the birth of the new.

Have a look and see if fear of change has caused the drop in motivation. Become aware of how those fears are holding you back.



Is there a time of day or night that you dread? Maybe it’s the fight at naptime, or that first early morning call, or the inevitable middle-of-the-night visit.

Take a minute to look at your trouble spots. Certainly a child can show more than one problem at more than one time of day, but the first step is to figure out “what is happening when?” In this chapter we will break down the day into segments where sleep is likely to become an issue. There are new ways to think about things and some tips to try. Some ideas apply primarily to infants, others are more applicable to older children. Feel free to focus on what fits your child and family the most.

To fall asleep means to be separated from those you love and trust. It is no easy task and is especially hard during times of developmental upheaval. Sleep problems often show themselves when separation anxieties are an expected part of development. A child might think the following:

When I close my eyes, it’s dark—everything is gone. I wonder where I am going…and I wonder where you are.

A parent’s job is to find the balance between being supportive and being firm, to be sure in her own heart that nothing bad will happen to the child while he sleeps—then to communicate that in a cheerful, confident manner.

Let him borrow some of your confidence until he develops his own. Reassure him you are nearby. Call to him or visit occasionally if that helps. Tell him what you do while he sleeps (something boring). After rest time, point out that he woke safely and you were there.

Dr. Spock recommends that parents of children who are experiencing peak separation issues sit in a chair next to their beds until they fall asleep. Don’t over-coddle, but don’t abandon him to tough it out on his own. Because he really needs to see you, letting him cry-it-out at peak separation times will only escalate the fear and crying.



Extreme agitation and restlessness are not always due to nervous tension. These symptoms can be caused by certain drugs — antinausea drugs, some sedatives, some cough mixtures and medicines designed to dry up phlegm, and corticosteroids. So, if you get these symptoms, especially if they start quite suddenly, ask your doctor to check through your medicines for any that could be causing it. The culprit will usually be one you have just started taking.

This is another area where nurses, physiotherapists and occupational therapists are likely to be of very much more practical help than doctors. If you actually already have developed, or do develop, a pressure sore, you will certainly need this help to get it healed. But don’t leave it until then to ask for advice. If you can’t move around freely and easily, ask these people for help with choosing and getting into good positions, with ways to keep dry, with easy to manage ways of padding your danger points and with ideas of what to rub on any sore spots. You are unlikely to develop any pressure sores if you follow their advice.



The drug trinitrin is widely used to treat angina and it may even help in the diagnosis.

These tablets are placed in the mouth and sucked or chewed but not swallowed. The drug is absorbed through the mucous membrane of the mouth directly into the blood stream and works immediately. Should a clot form on an atheromatous plaque in one of the coronary arteries, it will block the artery. This is a coronary occlusion.

If the heart muscle supplied by that artery is deprived totally of its blood supply, death of the muscle will occur — a myocardial infarct.

Ischaema is the term given to impaired blood supply of any tissue. Myocardial ischaema may be temporary, as in angina, or prolonged, as in coronary occlusion.

The pain from an occlusion is of the same type as angina but is not produced by exertion and is unrelieved by rest. The pain may persist for hours and only be relieved by giving strong pain-relieving drugs like morphine and its derivatives.



Pregnant women and their doctors often read about the hazards to the foetus of taking any drug during pregnancy.

The anti-morning sickness tablet, marketed in Australia as Debendox, came under notice because of a court case in America. It must be stressed that this drug had been used widely in Australia for more than 20 years and there is no evidence that it increases the risk of foetal abnormalities.

Just because a woman who has taken a drug during early pregnancy has a child with an abnormality does not prove cause and effect.

Congenital abnormalities occur in one in 40 births and, so, are common.

Because of the costs involved in defending this drug in the courts, the makers have withdrawn it from the market.

Of even more importance is: what should epileptic women do when they become pregnant? Most are taking at least one, sometimes two, drugs to control their epilepsy.

Some recent reports have indicated that there is an increased incidence of foetal abnormalities in the children of these women, particularly the risk of hare lip or cleft palate.



A nail consists of the nail plate and the tissues which surround and underlie it. The nail plate has three parts; the matrix which is concealed within the skin; the fixed portion which adheres firmly to the nail-bed, and the free edge of the nail. The active growth area is the epidermis of the matrix, which underlies the skin of the nail-fold. Sealing off the potential space between the nail and the nail-fold is the cuticle, which has an important protective function. Under normal conditions, the nail plate is firmly attached to the nail-bed. (This may, however, change as a result of various disease processes.) The nail plate exhibits various colour tones ranging from white to pink, which are the result of reflected light from the tissue beneath the colourless nail. The whitish-grey colour of the free edge is due to the air underneath it. Nail is composed of hard keratin, the same protein from which hair is derived. Like hair, the nail plate has no nerves or blood supply, and is a ‘dead’ structure. Under natural conditions nails would extend indefinitely unless cut or worn away with use. Unlike hair growth, which is periodic, nail growth is continuous. The daily rate of extension is about one third of hair, or approximately 0-1 millimetre. It takes about 100 days for the fingernail of a healthy young person to be restored after removal.



At 50 years of age, Helen had tried many times to lose weight. Her neighbours had started walking on a regular basis but she felt tired all the time and had no energy to do anything more than what she had to. Being 95 kilograms and only 168 centimetres tall ruined her morale. Her mother had diabetes and she knew being overweight put her at greater risk, but every time she lost weight she ended up regaining it. Finally, it was no surprise to her when she was diagnosed with diabetes. In fact it was some relief, here at last was a reason for her tiredness.

On her doctor’s suggestion, Helen saw a dietitian for help with her diet. At first glance what Helen was eating appeared reasonable. Breakfast was a slice of wholemeal toast or a wholemeal cracker with margarine and black tea. Lunch was a light meal such as celery, lettuce, a slice of cheese, a slice of cold meat, an egg and a couple of crackers, spread with margarine. For dinner she was having soup and a piece of steak with vegetables. She limited herself to a small cocktail potato. The meal was finished by a piece of fruit.

A closer look at her food record, showed that Helen’s diet was in fact poorly balanced. It was dominated by protein and fat foods and contained insufficient carbohydrate. It didn’t contain enough food to provide a good range of nutrients. What’s more, Helen herself was struggling with it and often felt hungry since she had cut lollies and biscuits out of her diet.

To improve things, we first looked at the frequency of eating. Helen kept to three meals a day because she had been brought up to believe that was better for her. She agreed to trying a small snack of fruit or a slice of bread between meals. Even though she wasn’t on medication for diabetes, the effect of spreading her food intake more evenly across the day, between small meals and snacks, could help to stabilise her blood sugar level and help her lose weight.

We then revised the amount of carbohydrate that she ate, and listed a range of low G.I. carbohydrate foods that were to be her first priority at each meal. The filling value of the carbohydrate left her with less space for the proteins that used to dominate her diet Helen’s new diet looked more like this:

Breakfast began with a fresh orange, juiced, and a bowl of oats with sultanas and low-fat milk Helen added a slice of Burgen™ or raisin toast if she was still hungry.

Lunch was usually a sandwich on Burgen™ bread with a slice of lean meat and salad and a piece of fruit or a muffin to finish. Sometimes she had a vegetable soup or pasta with a vegetable sauce and salad.

The proportion of foods on her dinner plate was rearranged, shrinking in the meat department and filling out on the vegetable side. She began to think of carbohydrate food as the basis of the meal and varied between pasta, rice and potato. Twice a week she made a vegetarian dish with legumes like a minestrone soup or a vegetable lasagne. An evening snack was usually a yoghurt or fruit.

After a month on her new eating plan Helen felt better—in fact she felt well enough to tackle some exercise. Taking a serious look at her day, she decided to commit the half hour after dinner to a walk, five nights a week.

Over the next six months Helen’s weight dropped from 95 kilograms to 80 kilograms. Her blood sugar levels were mainly within the normal range. She no longer struggled with hunger and felt good about the food she was eating.



Weight. Weight is a measure of the force of gravity acting as the total mass of an object. As such it reflects not only the overall size of the body but also the density of the combination of body tissues, including bone, muscle and body organs. Fat is lighter than water and therefore adipose tissue is lighter than muscle and organ tissue (which are mainly water) and both are lighter than bone. Increases in weight might therefore mean an increase in fat mass, muscle mass and/or fluid (remember, glycogen is stored with three times its weight in fluid). Over the long term, it’s true that changes in weight generally reflect changes in body fat, but in the short term the use of scales is not recommended as a measure of success of a fat loss program. Weight scales also vary significantly, from a sensitive bar balance or high quality electronic scale to the less sensitive but more often used bathroom-type scales.

The validity of weight as a measure of body fatness then is only fair, especially in certain types of individuals such as mesomorphic (muscular) males and elite athletes. Reliability of the measure on the other hand is quite high. Sensitivity is also reasonably high (i.e. around 0.8) detecting small changes in body mass. But, of course, this is not sensitive to fat as distinct from changes in other body tissue. Weight, therefore, is limited as a measure of fatness, except where combined with some other measures.

Myth-information. Weight loss through heat treatments such as saunas and steam baths represents fluid losses through sweat. These techniques have no permanent effect on fat loss.



In girls occasionally an irritation occurs in the vaginal region. Called vulvovaginitis, it may affect the vulva at the vaginal opening. There are many causes, ranging from a lack of hygiene, to infections from germs, to threadworms (which may have journeyed from the back passage and become lost in the vagina), to hormonal deficiencies. It sometimes indicates early diabetes.

There may be no symptoms at all. Or there may be a discharge from the vagina, or itch or irritation. The discharge may be whitish, or clear or stringy and slimey. Sometimes it is pussy if there is an infection present. A bloodstained discharge may indicate a foreign object has been pushed into the vaginal canal— this is not uncommon with youngsters.


Any symptoms in this region should receive medical attention. With a few simple tests, the doctor can often diagnose the cause and order the correct treatment. Frequently, adequate cleanliness and hygiene will prevent these problems from taking place.