These are frightening to parents when they first experience it.

They may happen at any time from about six months to four years. They tend to develop as a result of frustration or anger in the child or they may follow a period of denial by the parent, or a fall or when the child can’t get his own way with other children.

In an attack the child breathes right out. Then comes a period when he doesn’t breathe at all. During this period his face may become congested and take on the bluish red tinge of cyanosis. Twitching of the muscles may occur and then he usually loses consciousness. There could be loss of control of the bladder at this time.

After loss of consciousness, the child starts to breathe again and quickly returns to normal. At that stage the parents are left in great panic.

Treatment consists mainly in counselling the parents, who must understand that this is an attention seeking device and that the way to overcome it is to ignore the child.

It is, of course, not easy to tell parents to walk away from the child when he is going blue in the face and losing consciousness.

Children usually grow out of this habit, but by this time a poor parent-child relationship may have developed with the child able to manipulate his parents.

The parents need counselling so that they can fulfil properly the emotional needs of the child and help him overcome his anxiety.

*15/71/1*

Signs and symptoms

The symptoms of bacterial pneumonia include a mild upper respiratory tract infection, followed by the sudden onset of high fever (40.6°C), chills, cough, rapid breathing, and sometimes pain on either or both sides of the chest. In infants the respiratory distress may cause flaring of the nostrils, retractions (pulling in) of the soft spaces of the chest, and grunting sounds when the child breathes out.

The onset of viral pneumonia is gradual, creating symptoms of headache, fatigue, fever of variable degrees (37.8°C-40.6°C), a sore throat, and a severe, dry cough.

The diagnosis requires careful examination of the chest, X rays, a complete blood count, and sometimes cultures of the blood and, in older children, the sputum (the coughed-up discharge).

Home care

Many cases of viral pneumonia are mild and are not recognized as pneumonia at all. You may assume that the child has a cold and give cold remedies. The pneumonia then clears up on its own after ten to 14 days.

If signs of respiratory distress as listed above are present, the child should be seen by a doctor.

Precautions

• Sudden worsening of a cold accompanied by high fever, cough, chills, chest pain, or rapid breathing suggests pneumonia.

• In infants, flaring of the nostrils, pulling in of the chest, and grunting breathing are serious symptoms and require immediate medical care.

• In children, sputum tinged with blood may or may not be serious, but it indicates the need for a doctor’s attention.

Medical treatment

Your doctor will diagnose pneumonia by means of a physical examination and laboratory tests. In the past a child with pneumonia was always hospitalized. Now, only the youngest and the most severely ill are hospitalized.

Most pneumonias respond to antibiotics. A patient with pneumococcal pneumonia will recover rapidly once antibiotics are begun. Another, with a streptococcal or staphylococcal infection, may require in-hospital administration of the antibiotics. Mycoplasma pneumonia responds to some antibiotics, but viral pneumonias do not. For viral pneumonias, your doctor will recommend rest, plenty of fluids, and time for the condition to run its course.

*168/84/5*

•     Noise can be a real nuisance, especially on busy roads, and electroencephalograms done on people asleep in such situations show that they are registering the noise even though they are asleep. (Some people, used to the noise of a city become insomniacs when they move to the peace of the country-they ‘can’t stand the silence’.) If you are super-sensitive to noise ear plugs are an answer, and if light rooms are a problem you can buy a mask or an eye-shade.

•     Depression must first be recognized and then treated to prevent this common cause of sleep loss.

•     Watch out for foods and drinks that give you nightmares or simply disturbed sleep.

•     Although millions of people sleep perfectly well without ever having sex there is little doubt that intercourse and/or masturbation help the average person to drop off. Unsatisfactory sex on the other hand can prevent sleep. This is especially true in women who are left unsatisfied by their partners. Such a woman can always masturbate if she is left ‘high and dry’. If she can’t masturbate, for whatever reason, she may well be able to sleep better if she doesn’t have sex.

Sex is part of a pre-sleep ritual for many. Most of us use some form of pre-sleep ritual, often without even realizing it. At roughly the same time each night we turn off the TV, put down our book or newspaper, make a hot drink, have a bath or shower, cuddle our partner, perhaps make love, and then go to sleep. Some people listen to music in bed, others pray-it doesn’t matter what it is as long as it’s a relaxing, predictable and unwinding process that prepares us for sleep. The best schedules are regular without being rigid.

•     Stop worrying. If we have effective sleep rituals, the worries of the day slip away and we don’t lie there thinking about them. Sex, or indeed any other activity that absorbs our attention, is a good antidote to worry. But often the worry is best confronted and discussed with your partner, if you have one. Try to think around the problem and then go to sleep at least having made some effort to solve it rather than trying to sleep on an unsolved problem. Serious problems can be solved at night when you are alone and peaceful and able to think. Don’t lie there worrying about not sleeping-work through the problem and see what can be done. Some people find deep breathing or forms of meditation help them let go of their insoluble problems.

Don’t worry about insomnia. No one ever died of it and it will probably have very little effect on your performance. Keep a pad of paper and a pen by your bedside and make notes of what you decide to do to sort out the problem that’s worrying you. Next day go through it rationally and implement whatever you can.

*188/72/5*