Common complaints :::
Children are exposed to infectious diseases throughout their childhood. Most infections are caused by a virus, which cannot be treated by antibiotics. But if an infection is thought to be caused by bacteria, the doctor may prescribe antibiotics for the child. Often it is difficult to make the distinction between viral and bacterial infections on clinical examination alone.
Paracetamol (eg Calpol), in an appropriate dose, remains a very good treatment to relieve pain and fever in most circumstances. Ibuprofen (eg Nurofen for children) is an alternative for other than very young children, but should be avoided in asthmatics. Aspirin (eg Disprin) should never be given to children aged under 16 years unless prescribed by a doctor.
How to get a child to take their medicine :::
It may be difficult to get children to take their medicine. This might be due to a variety of reasons, but commonly stems from the child not liking the taste of the medicine, or having difficulty swallowing it. To get around this a wide variety of preparations of medicines are often available. Medicine may be found as drops, mixtures, liquids, powders, granules, suppositories, capsules and tablets with or without coating.
The first time a child has to take medicine, it may be a good idea to consult the doctor or pharmacist to decide which type of medicine the child is most comfortable with.
Medicine for small children :::
Mixtures, liquids and drops with flavoured additives of some kind are often the types of medicine preferred by small children. Often you can mix the medicine with juice or breast milk, but it is important to be sure that the child gets the exact amount of prescribed medicine; neither more nor less. Always follow the instructions given with the medicine and ask your pharmacist for advice if you have problems.
The dose for young children may sometimes be too small to measure using a spoon, in which case you will be given an oral syringe to administer the medicine. Make sure you know what to do before using it.
Medicine for chronically sick children :::
Some children suffer from a chronic (long-term) disease such as epilepsy or asthma and so constantly need medicine. They should be able to help choose the type of medicine they prefer. Most children handle these problems very well, as long as it is explained to the child why it is necessary to take the medicine.
At every age medicine is absorbed differently by the human body. Some medicines have very strong effects on children compared with adults, and vice versa. So different guidelines may be found concerning the correct dose of medicine, depending on the child's age and weight.
Safety and medicine :::
Never give a child any medicine without first checking the directions thoroughly. Even an innocent headache tablet may have unfortunate side effects. In some cases, it may conceal a disease or symptoms of a disease, which may delay the proper treatment.
The use and storage of medicine in the home is very important. Far too many cases of poisoning happen because of children's natural curiosity. They are interested in trying the types of medicines that adults have left in the bedroom, the bathroom or the kitchen.
Always remember to keep all medicine out of children's reach.
Based on a text by Dr Per Grinsted
Saturday, March 8, 2008
Diarrhoea :::
What is diarrhoea?
Diarrhoea is the passing of increased amounts (more than 300g in 24 hours) of loose stools.
It is often caused by a virus or bacteria and can be acute (short term) or chronic (long term) - lasting more than two to three weeks.
Most people are affected by diarrhoea at some time in their lives. It is often accompanied by stomach pains, feeling sick and vomiting. It is usually due to consumption of drinking water contaminated with bacteria, undercooked meat and eggs or inadequate kitchen hygiene - in other words, an infection.
Diarrhoea normally only lasts for a few days, but it can be very stressful when it occurs.
Globally, seven children die of diarrhoea every minute, mainly due to poor quality drinking water and malnutrition, which still affects the majority of the world population.
What causes diarrhoea?
* Diarrhoea is mainly caused by bacterial and viral infections and food poisoning.
* Diarrhoea can also be caused by bacteria or viruses that have been transmitted from person to person. For this reason, it is important to wash your hands with soap and water after using the toilet.
* You cannot assess the quality of food or detect contamination by its smell or the way it looks. Food which is 'off' might be obvious but contaminated food usually looks and tastes fine.
Diarrhoea occurs when the micro-organisms irritate the mucous membrane of the small or large intestine resulting in an abnormally large quantity of water in the motions. The irritated gut becomes very active, contracting excessively and irregularly (colic). This can be accompanied by nausea, vomiting, and cold sweats. In some cases the motions may include some blood.
Food poisoning
Certain bacteria (usually staphylococci) irritate the digestive tract by producing toxins. These toxins affect the mucous membrane much sooner, a few hours after consumption, compared with bacterial infection. For this reason, people with inflammation or sores on their hands should not prepare food for others.
Other causes
When taking antibiotics, many people suffer diarrhoea, which may continue after the antibiotic course has finished. The diarrhoea occurs because the antibiotic alters the intestinal bacterial environment. It is not an allergic reaction. In rare cases it requires medical treatment.
Chronic diarrhoea
Chronic diarrhoea can be a symptom of many disorders:
* irritable bowel syndrome
* acute, recurrent or chronic intestinal infections
* chronic intestinal inflammation (ulcerative colitis and Crohn's disease)
* chronic pancreatitis, which produces fatty stools
* laxatives
* lactose intolerance
* improper diet (consumption of too much alcohol, coffee or sweets)
* metabolic disorders such as diabetes and thyrotoxicosis
* intolerance to gluten (wheat protein).
What are the symptoms of diarrhoea?
* Frequent, watery motions.
* Loss of appetite.
* Nausea, vomiting.
* Stomach pains.
* Fever.
* Dehydration.
If the diarrhoea lasts more than three weeks, it is considered chronic.
What are the warning signs?
* Blood in the motions.
* Pus in the motions (yellow mucus).
* Inability to drink liquids because of vomiting.
* Dehydration - symptoms include excreting small amounts of dark urine, drowsiness, dry mucous membranes and thirst. Dehydration as a result of diarrhoea is a particular risk for young children and the elderly.
* Pronounced drowsiness due to dehydration or intoxication.
* Acute diarrhoea in infants.
* Acute diarrhoea in very old people.
What can be done at home?
* In cases of acute diarrhoea it would be wise to drink more fluids (3-4 litres a day), preferably containing sugar and salts. Ready-mixed rehydration sachets (eg Dioralyte, Rehidrat) can be bought from the pharmacist and added to drinking water.
* A sufficient intake has been obtained when the urine becomes light yellow in colour.
* Eat something containing salt, such as crisps or soup.
* Maintain good standards of hygiene.
* Eat normally as soon as your appetite returns but if you have suffered an acute attack of diarrhoea, avoid foods containing milk for a couple of days.
When should the doctor be consulted?
* When one of the warning signs outlined above is present.
* When the diarrhoea has occurred during or following a trip abroad - travellers' diarrhoea.
* When the diarrhoea has lasted more than one to two weeks.
How is diarrhoea treated?
Diarrhoea can usually be treated safely 'at home' and normally goes away by itself within a week. Treatment with antibiotics is therefore rarely needed, and may cause side effects, such as chronic diarrhoea.
Antidiarrhoeal agents, such as loperamide (eg Imodium), may be used, except in cases where there is blood or pus in the motions or if the diarrhoea is accompanied by high fever.
It has not been proven that freeze-dried lactic acid bacteria can prevent travellers' diarrhoea.
During visits abroad, boil all drinking water, or drink water from sealed bottles only. In addition, you should only eat vegetables that have been boiled or peeled and avoid ice-cream and salads (which may have been washed with unclean water).
Based on a text by Dr Torben Nathan, Dr Carl J Brandt and Dr Ove Schaffalitzky de Muckadell, professor of internal medicine
Diarrhoea is the passing of increased amounts (more than 300g in 24 hours) of loose stools.
It is often caused by a virus or bacteria and can be acute (short term) or chronic (long term) - lasting more than two to three weeks.
Most people are affected by diarrhoea at some time in their lives. It is often accompanied by stomach pains, feeling sick and vomiting. It is usually due to consumption of drinking water contaminated with bacteria, undercooked meat and eggs or inadequate kitchen hygiene - in other words, an infection.
Diarrhoea normally only lasts for a few days, but it can be very stressful when it occurs.
Globally, seven children die of diarrhoea every minute, mainly due to poor quality drinking water and malnutrition, which still affects the majority of the world population.
What causes diarrhoea?
* Diarrhoea is mainly caused by bacterial and viral infections and food poisoning.
* Diarrhoea can also be caused by bacteria or viruses that have been transmitted from person to person. For this reason, it is important to wash your hands with soap and water after using the toilet.
* You cannot assess the quality of food or detect contamination by its smell or the way it looks. Food which is 'off' might be obvious but contaminated food usually looks and tastes fine.
Diarrhoea occurs when the micro-organisms irritate the mucous membrane of the small or large intestine resulting in an abnormally large quantity of water in the motions. The irritated gut becomes very active, contracting excessively and irregularly (colic). This can be accompanied by nausea, vomiting, and cold sweats. In some cases the motions may include some blood.
Food poisoning
Certain bacteria (usually staphylococci) irritate the digestive tract by producing toxins. These toxins affect the mucous membrane much sooner, a few hours after consumption, compared with bacterial infection. For this reason, people with inflammation or sores on their hands should not prepare food for others.
Other causes
When taking antibiotics, many people suffer diarrhoea, which may continue after the antibiotic course has finished. The diarrhoea occurs because the antibiotic alters the intestinal bacterial environment. It is not an allergic reaction. In rare cases it requires medical treatment.
Chronic diarrhoea
Chronic diarrhoea can be a symptom of many disorders:
* irritable bowel syndrome
* acute, recurrent or chronic intestinal infections
* chronic intestinal inflammation (ulcerative colitis and Crohn's disease)
* chronic pancreatitis, which produces fatty stools
* laxatives
* lactose intolerance
* improper diet (consumption of too much alcohol, coffee or sweets)
* metabolic disorders such as diabetes and thyrotoxicosis
* intolerance to gluten (wheat protein).
What are the symptoms of diarrhoea?
* Frequent, watery motions.
* Loss of appetite.
* Nausea, vomiting.
* Stomach pains.
* Fever.
* Dehydration.
If the diarrhoea lasts more than three weeks, it is considered chronic.
What are the warning signs?
* Blood in the motions.
* Pus in the motions (yellow mucus).
* Inability to drink liquids because of vomiting.
* Dehydration - symptoms include excreting small amounts of dark urine, drowsiness, dry mucous membranes and thirst. Dehydration as a result of diarrhoea is a particular risk for young children and the elderly.
* Pronounced drowsiness due to dehydration or intoxication.
* Acute diarrhoea in infants.
* Acute diarrhoea in very old people.
What can be done at home?
* In cases of acute diarrhoea it would be wise to drink more fluids (3-4 litres a day), preferably containing sugar and salts. Ready-mixed rehydration sachets (eg Dioralyte, Rehidrat) can be bought from the pharmacist and added to drinking water.
* A sufficient intake has been obtained when the urine becomes light yellow in colour.
* Eat something containing salt, such as crisps or soup.
* Maintain good standards of hygiene.
* Eat normally as soon as your appetite returns but if you have suffered an acute attack of diarrhoea, avoid foods containing milk for a couple of days.
When should the doctor be consulted?
* When one of the warning signs outlined above is present.
* When the diarrhoea has occurred during or following a trip abroad - travellers' diarrhoea.
* When the diarrhoea has lasted more than one to two weeks.
How is diarrhoea treated?
Diarrhoea can usually be treated safely 'at home' and normally goes away by itself within a week. Treatment with antibiotics is therefore rarely needed, and may cause side effects, such as chronic diarrhoea.
Antidiarrhoeal agents, such as loperamide (eg Imodium), may be used, except in cases where there is blood or pus in the motions or if the diarrhoea is accompanied by high fever.
It has not been proven that freeze-dried lactic acid bacteria can prevent travellers' diarrhoea.
During visits abroad, boil all drinking water, or drink water from sealed bottles only. In addition, you should only eat vegetables that have been boiled or peeled and avoid ice-cream and salads (which may have been washed with unclean water).
Based on a text by Dr Torben Nathan, Dr Carl J Brandt and Dr Ove Schaffalitzky de Muckadell, professor of internal medicine
Coughing :::
Coughing is a reflex action started by stimulation of sensory nerves in the lining of the respiratory passages - the tubes we use to breathe.
When a person coughs, there is a short intake of breath and the larynx (the voice box) closes momentarily. The abdominal and chest muscles used for breathing contract, which in turn increases the pressure needed to drive air out the lungs when the larynx re-opens.
The resulting blast of air comes out at high speed, scrubbing and clearing the airway of dust, dirt or excessive secretions. Coughing is a common symptom when the airways are 'tight', as in asthma.
The cough reflex is a vital part of the body's defence mechanisms. Normally, the lungs and the lower respiratory passages are sterile. If dust or dirt get into the lungs, they could become a breeding ground for bacteria and cause pneumonia or infection in the breathing tubes.
What causes coughing?
Coughing usually means there is something in the respiratory passages that should not be there. This can be caused by breathing in dust particles in the air or when a piece of food goes down the wrong way.
It could also be a sign that an infection in the lungs is making the respiratory passages produce phlegm.
Coughing can be provoked by:
* the common cold, which is a frequent cause of acute cough that usually settles in less than three weeks.
* sucking material into the breathing tubes from your mouth.
* more severe illnesses, such as pneumonia, acute heart failure or pulmonary embolism (a clot in the blood vessels of the lung).
* smoking, which often causes chronic cough (smoker's lung).
* asthma - particularly in children who may only cough and show no wheezing.
* stomach acid coming back up the gullet and spilling over into the windpipe (gastro-oesophageal reflux).
* medicines used in heart disease called angiotensin converting enzyme (ACE) inhibitors.
* bacterial or viral infections in the lungs, eg acute bronchitis, pneumonia, whooping cough, croup in children
* rarely coughing can be provoked by psychological illness
* damage to the nerves that supply the vocal chords (known as vocal chordpalsy) and chronic cough can occur.
Coughing is more efficient when preceded by a full intake of air.
For this reason, patients with weak muscles, poor coordination of airway closure and re-opening, or who have airflow obstruction (as in COPD) will have a poor cough and be susceptible to complications including infection in the lower respiratory tract and pneumonia.
How can coughing be treated?
Coughing is a symptom, not a disease. It is the underlying cause of the cough that needs to be treated.
You should consult your doctor if any of the following symptoms accompany a cough, so that possible underlying causes can be investigated and treated where necessary:
* coughing up phlegm that is green, rusty brown, yellow, blood-stained or foul smelling.
* chest pain.
* shortness of breath or wheezing.
* pain and swelling in the calf.
* recurrent night-time cough.
* whooping cough or croup.
* worsening smoker’s cough.
* sudden weight loss.
* fever and sweating.
* hoarseness of the voice with a chronic cough that doesn’t clear up spontaneously.
If you can't cough but need to, problems soon arise. Equally, when coughing is painful (for example, because of a broken rib), patients try not to cough and this can be dangerous.
Ineffective clearance of the airway can lead to a chest infection and possible pneumonia. In these circumstances, pain-relieving medicine can be useful to permit an efficient cough.
Airways infection
Infections in the breathing tubes can be caused by both bacteria and viruses, although the most common cause in children is a virus. Bacterial infections can be treated with antibiotics, but viral infections cannot.
Vaccination has greatly diminished the incidence of whooping cough (pertussis), but if this is the diagnosis, antibiotic treatment with a macrolide antibiotic such as erythromycin decreases the severity of this illness within the first week of treatment.
Asthma
Asthma may cause coughing without wheeziness. This tends to be worst through the night, disturbing sleep. It may be the first sign of asthma in children, or a warning sign that asthma is worsening or not controlled properly. Conventional asthma treatment with inhaled anti-inflammatory preventative medicines and relievers will usually relieve a cough that is due to asthma.
However, a metered-dose inhaler may itself induce cough, and you may need to use a large volume spacer device or a dry powder inhaler instead.
Gastro-oesophageal reflux
Gastro-oesophageal reflux requires treatment with antacids to neutralise the stomach acid, or H2 antagonists or proton-pump inhibitors to reduce the production of stomach acid.
Smoking
Giving up cigarettes will lessen or abolish smokers' cough in 94 per cent of people within four weeks.
ACE inhibitors
If an ACE inhibitor is the cause of coughing, switching to alternate treatment such as an angiotensin II receptor antagonist will help.
How effective are cough medicines?
In cases where a cough is particularly annoying, but not life-threatening, a simple cough mixture may be useful. There are a range of over-the-counter medicines that can be helpful in such circumstances.
Taking these can be justified when there is no special reason to suspect any serious underlying disease, such as the symptoms listed above. You should ask your pharmacist for advice on which of the many available over-the-counter cough remedies are suitable for you.
A productive, chesty cough, in which phlegm is coughed up, should be treated with an expectorant cough mixture to help loosen the phlegm and make it easier to cough up from the airways. Expectorants contain ingredients such as guaifenesin, ipecachuana or ammonium citrate.
A non-productive, dry, tickly or irritating cough, in which no phlegm is coughed up can, be treated with a cough suppressant to reduce the cough reflex. Cough suppressants include pholcodine, dextromethorphan and codeine. Other cough suppressants include simple linctus, glycerin and lemon and honey, which coat and soothe the back of the throat.
Antihistamines such as diphenhydramine and promethazine reduce the cough reflex and also dry up nasal secretions, which can be useful for coughs that are caused by a postnasal drip (mucus running down the back of the throat), or are associated with a cold.
Ipratropium bromide nasal spray also reduces watery nasal secretions that can cause postnasal drip and contribute to a cough.
Some cough remedies also contain sympathomimetics such as ephedrine, for their airway relaxing and decongestant effects, and can be useful if you have a blocked nose as well as a cough.
Patients should not treat themselves with cough mixture for any longer than two weeks. If the cough persists, a visit to the doctor is definitely required - informed medical assessment will help identify the underlying cause and allow treatment.
What if a young child has a cough?
Older children and adults usually have some idea whether their cough is caused by a foreign body, dust or smoke particles, or an infection in the breathing tubes. Clinical inspection will reveal features that may suggest a specific cause.
If a young child coughs, parents need to be able to tell whether the cough is a sign of disease or whether their child has a foreign body in their respiratory passages.
* If your child also has a fever or a cold, the cough is a sign of an infection. If nothing else seems to be wrong, wait for the cough to go away. If the coughing goes on for more than a couple of days, consult a doctor.
* If the coughing comes on suddenly, and is very forceful, it's likely your child has swallowed something that's causing the cough. This could be life-threatening for your child, who could choke. Lift your child by the legs so their head points downwards, then slap their back with a cupped hand. If this doesn't help, call an ambulance immediately.
* If at any point your child seems very ill, you should consult an emergency doctor immediately.
Diagnostic testing for chronic cough
If you suffer from a chronic cough, tests will need to be carried out to determine the cause.
* After initial assessment, a chest X-ray is taken to ensure that serious diseases such as lung cancer or tuberculosis (TB) are unlikely.
* Blood and skin tests are of little help, although they may reveal an allergic tendency.
* Sputum (phlegm) examination for bacteria, TB and cancer cells can be ordered, together with non-invasive heart tests such as an ECG or even echocardiography.
* In difficult cases, further tests can be considered, including fibre optic bronchoscopy, CT examination of the chest and sinuses and even methacholine inhalation challenge or oesophageal pH monitoring. These are only available in special centres.
Whether a particular factor is responsible for chronic coughing can be determined when treatment for a specific cause achieves some benefit for the patient.
But often there is more than one cause for the cough, in which case treating only one factor will not succeed in completely relieving the symptoms. This is frustrating for both you and your medical adviser.
In such a case, a progressive and incremental approach is appropriate. Treatment directed at a specific cause is started and the result assessed.
If there is a partial but incomplete response, other treatments are then tried in turn. Eventually, the vast majority of coughing can be successfully managed in this manner.
If treatment is fruitless with no realistic chance of working - for example in the case of advanced lung cancer, the use of powerful cough suppressants may be justified.
Based on a text by Dr Ole Davidsen, specialist
source : NetDoctor
When a person coughs, there is a short intake of breath and the larynx (the voice box) closes momentarily. The abdominal and chest muscles used for breathing contract, which in turn increases the pressure needed to drive air out the lungs when the larynx re-opens.
The resulting blast of air comes out at high speed, scrubbing and clearing the airway of dust, dirt or excessive secretions. Coughing is a common symptom when the airways are 'tight', as in asthma.
The cough reflex is a vital part of the body's defence mechanisms. Normally, the lungs and the lower respiratory passages are sterile. If dust or dirt get into the lungs, they could become a breeding ground for bacteria and cause pneumonia or infection in the breathing tubes.
What causes coughing?
Coughing usually means there is something in the respiratory passages that should not be there. This can be caused by breathing in dust particles in the air or when a piece of food goes down the wrong way.
It could also be a sign that an infection in the lungs is making the respiratory passages produce phlegm.
Coughing can be provoked by:
* the common cold, which is a frequent cause of acute cough that usually settles in less than three weeks.
* sucking material into the breathing tubes from your mouth.
* more severe illnesses, such as pneumonia, acute heart failure or pulmonary embolism (a clot in the blood vessels of the lung).
* smoking, which often causes chronic cough (smoker's lung).
* asthma - particularly in children who may only cough and show no wheezing.
* stomach acid coming back up the gullet and spilling over into the windpipe (gastro-oesophageal reflux).
* medicines used in heart disease called angiotensin converting enzyme (ACE) inhibitors.
* bacterial or viral infections in the lungs, eg acute bronchitis, pneumonia, whooping cough, croup in children
* rarely coughing can be provoked by psychological illness
* damage to the nerves that supply the vocal chords (known as vocal chordpalsy) and chronic cough can occur.
Coughing is more efficient when preceded by a full intake of air.
For this reason, patients with weak muscles, poor coordination of airway closure and re-opening, or who have airflow obstruction (as in COPD) will have a poor cough and be susceptible to complications including infection in the lower respiratory tract and pneumonia.
How can coughing be treated?
Coughing is a symptom, not a disease. It is the underlying cause of the cough that needs to be treated.
You should consult your doctor if any of the following symptoms accompany a cough, so that possible underlying causes can be investigated and treated where necessary:
* coughing up phlegm that is green, rusty brown, yellow, blood-stained or foul smelling.
* chest pain.
* shortness of breath or wheezing.
* pain and swelling in the calf.
* recurrent night-time cough.
* whooping cough or croup.
* worsening smoker’s cough.
* sudden weight loss.
* fever and sweating.
* hoarseness of the voice with a chronic cough that doesn’t clear up spontaneously.
If you can't cough but need to, problems soon arise. Equally, when coughing is painful (for example, because of a broken rib), patients try not to cough and this can be dangerous.
Ineffective clearance of the airway can lead to a chest infection and possible pneumonia. In these circumstances, pain-relieving medicine can be useful to permit an efficient cough.
Airways infection
Infections in the breathing tubes can be caused by both bacteria and viruses, although the most common cause in children is a virus. Bacterial infections can be treated with antibiotics, but viral infections cannot.
Vaccination has greatly diminished the incidence of whooping cough (pertussis), but if this is the diagnosis, antibiotic treatment with a macrolide antibiotic such as erythromycin decreases the severity of this illness within the first week of treatment.
Asthma
Asthma may cause coughing without wheeziness. This tends to be worst through the night, disturbing sleep. It may be the first sign of asthma in children, or a warning sign that asthma is worsening or not controlled properly. Conventional asthma treatment with inhaled anti-inflammatory preventative medicines and relievers will usually relieve a cough that is due to asthma.
However, a metered-dose inhaler may itself induce cough, and you may need to use a large volume spacer device or a dry powder inhaler instead.
Gastro-oesophageal reflux
Gastro-oesophageal reflux requires treatment with antacids to neutralise the stomach acid, or H2 antagonists or proton-pump inhibitors to reduce the production of stomach acid.
Smoking
Giving up cigarettes will lessen or abolish smokers' cough in 94 per cent of people within four weeks.
ACE inhibitors
If an ACE inhibitor is the cause of coughing, switching to alternate treatment such as an angiotensin II receptor antagonist will help.
How effective are cough medicines?
In cases where a cough is particularly annoying, but not life-threatening, a simple cough mixture may be useful. There are a range of over-the-counter medicines that can be helpful in such circumstances.
Taking these can be justified when there is no special reason to suspect any serious underlying disease, such as the symptoms listed above. You should ask your pharmacist for advice on which of the many available over-the-counter cough remedies are suitable for you.
A productive, chesty cough, in which phlegm is coughed up, should be treated with an expectorant cough mixture to help loosen the phlegm and make it easier to cough up from the airways. Expectorants contain ingredients such as guaifenesin, ipecachuana or ammonium citrate.
A non-productive, dry, tickly or irritating cough, in which no phlegm is coughed up can, be treated with a cough suppressant to reduce the cough reflex. Cough suppressants include pholcodine, dextromethorphan and codeine. Other cough suppressants include simple linctus, glycerin and lemon and honey, which coat and soothe the back of the throat.
Antihistamines such as diphenhydramine and promethazine reduce the cough reflex and also dry up nasal secretions, which can be useful for coughs that are caused by a postnasal drip (mucus running down the back of the throat), or are associated with a cold.
Ipratropium bromide nasal spray also reduces watery nasal secretions that can cause postnasal drip and contribute to a cough.
Some cough remedies also contain sympathomimetics such as ephedrine, for their airway relaxing and decongestant effects, and can be useful if you have a blocked nose as well as a cough.
Patients should not treat themselves with cough mixture for any longer than two weeks. If the cough persists, a visit to the doctor is definitely required - informed medical assessment will help identify the underlying cause and allow treatment.
What if a young child has a cough?
Older children and adults usually have some idea whether their cough is caused by a foreign body, dust or smoke particles, or an infection in the breathing tubes. Clinical inspection will reveal features that may suggest a specific cause.
If a young child coughs, parents need to be able to tell whether the cough is a sign of disease or whether their child has a foreign body in their respiratory passages.
* If your child also has a fever or a cold, the cough is a sign of an infection. If nothing else seems to be wrong, wait for the cough to go away. If the coughing goes on for more than a couple of days, consult a doctor.
* If the coughing comes on suddenly, and is very forceful, it's likely your child has swallowed something that's causing the cough. This could be life-threatening for your child, who could choke. Lift your child by the legs so their head points downwards, then slap their back with a cupped hand. If this doesn't help, call an ambulance immediately.
* If at any point your child seems very ill, you should consult an emergency doctor immediately.
Diagnostic testing for chronic cough
If you suffer from a chronic cough, tests will need to be carried out to determine the cause.
* After initial assessment, a chest X-ray is taken to ensure that serious diseases such as lung cancer or tuberculosis (TB) are unlikely.
* Blood and skin tests are of little help, although they may reveal an allergic tendency.
* Sputum (phlegm) examination for bacteria, TB and cancer cells can be ordered, together with non-invasive heart tests such as an ECG or even echocardiography.
* In difficult cases, further tests can be considered, including fibre optic bronchoscopy, CT examination of the chest and sinuses and even methacholine inhalation challenge or oesophageal pH monitoring. These are only available in special centres.
Whether a particular factor is responsible for chronic coughing can be determined when treatment for a specific cause achieves some benefit for the patient.
But often there is more than one cause for the cough, in which case treating only one factor will not succeed in completely relieving the symptoms. This is frustrating for both you and your medical adviser.
In such a case, a progressive and incremental approach is appropriate. Treatment directed at a specific cause is started and the result assessed.
If there is a partial but incomplete response, other treatments are then tried in turn. Eventually, the vast majority of coughing can be successfully managed in this manner.
If treatment is fruitless with no realistic chance of working - for example in the case of advanced lung cancer, the use of powerful cough suppressants may be justified.
Based on a text by Dr Ole Davidsen, specialist
source : NetDoctor
Cold (common cold) :::
What is a cold?
A cold is a contagious viral disease which infects the soft lining (mucous membrane) of the nose. There are more than 100 different viruses which can result in a cold. The characteristic symptom is a runny nose.
Usually, it is a mild condition, recovery taking place within about a week. However, sometimes the same symptoms occur with other illnesses like influenza.
It is most common during the cold winter months and affects children and adults of all ages. Most people will catch a cold two to four times a year.
How do we catch a cold?
A person is contagious from the day before the illness breaks out until one to three days after they feel better. The infection is spread by airborne droplets when the sufferer coughs or sneezes.
It can also be spread by hand if someone has the virus on their hands and then puts them close to their eyes or nose. This is possibly the most common way of catching a cold.
What are the symptoms of a cold?
* A sore throat.
* There may be pain on swallowing.
* Sneezing.
* The nose begins to run with a water-like secretion which gradually becomes thicker and more yellow.
* As the mucous membrane of the nose swells it may be hard to breathe through the nose.
* An oppressive feeling in the ears.
* Headache.
* Coughing.
* A feeling of being unwell.
* A high temperature. Children are more likely to run a temperature than adults.
What can you do to avoid catching a cold?
* If possible, stay away from people with colds.
* Avoid crowded places where the risk of infection is greater.
* Do not touch your nose or eyes after being in physical contact with somebody that has a cold.
* Wash your hands thoroughly, especially after blowing your nose.
* Keep rooms well aired.
How does the doctor make a diagnosis?
Consultations with a doctor are unnecessary, unless the cold causes other infections.
Outlook
Usually a common cold causes no serious trouble and symptoms will clear up in one to two weeks. Possible complications include inflammation of the eyes, sinusitis, inflammation of the middle ear, tonsillitis, and pneumonia. The reason for these complications may be that a germ infects the irritated mucous membrane.
How do you treat a cold ?
* There is no effective way of treating an ordinary cold. If the sufferer has no other diseases than the common cold, and it goes away in one to two weeks, there is no reason to see a doctor. Since a cold is caused by a virus, antibiotics are not appropriate.
* Symptoms such as cough, sore throat, nasal congestion and headache can be relieved by a variety of over-the-counter medicines. You can get advice from a pharmacist about which are most suitable for you and your symptoms.
* There is no need to reduce daily activities but you should expect to become tired more easily.
* The symptoms can be relieved by warm drinks.
* Nasal decongestants may ease breathing.
* Sleep with the head on a high pillow.
* Avoid smoking; it irritates the mucous membrane of the nose further.
* Throw away paper tissues after use to prevent the spread of infection.
Based on a text by Dr Hanne Korsholm, GP
Source : NetDoctor
A cold is a contagious viral disease which infects the soft lining (mucous membrane) of the nose. There are more than 100 different viruses which can result in a cold. The characteristic symptom is a runny nose.
Usually, it is a mild condition, recovery taking place within about a week. However, sometimes the same symptoms occur with other illnesses like influenza.
It is most common during the cold winter months and affects children and adults of all ages. Most people will catch a cold two to four times a year.
How do we catch a cold?
A person is contagious from the day before the illness breaks out until one to three days after they feel better. The infection is spread by airborne droplets when the sufferer coughs or sneezes.
It can also be spread by hand if someone has the virus on their hands and then puts them close to their eyes or nose. This is possibly the most common way of catching a cold.
What are the symptoms of a cold?
* A sore throat.
* There may be pain on swallowing.
* Sneezing.
* The nose begins to run with a water-like secretion which gradually becomes thicker and more yellow.
* As the mucous membrane of the nose swells it may be hard to breathe through the nose.
* An oppressive feeling in the ears.
* Headache.
* Coughing.
* A feeling of being unwell.
* A high temperature. Children are more likely to run a temperature than adults.
What can you do to avoid catching a cold?
* If possible, stay away from people with colds.
* Avoid crowded places where the risk of infection is greater.
* Do not touch your nose or eyes after being in physical contact with somebody that has a cold.
* Wash your hands thoroughly, especially after blowing your nose.
* Keep rooms well aired.
How does the doctor make a diagnosis?
Consultations with a doctor are unnecessary, unless the cold causes other infections.
Outlook
Usually a common cold causes no serious trouble and symptoms will clear up in one to two weeks. Possible complications include inflammation of the eyes, sinusitis, inflammation of the middle ear, tonsillitis, and pneumonia. The reason for these complications may be that a germ infects the irritated mucous membrane.
How do you treat a cold ?
* There is no effective way of treating an ordinary cold. If the sufferer has no other diseases than the common cold, and it goes away in one to two weeks, there is no reason to see a doctor. Since a cold is caused by a virus, antibiotics are not appropriate.
* Symptoms such as cough, sore throat, nasal congestion and headache can be relieved by a variety of over-the-counter medicines. You can get advice from a pharmacist about which are most suitable for you and your symptoms.
* There is no need to reduce daily activities but you should expect to become tired more easily.
* The symptoms can be relieved by warm drinks.
* Nasal decongestants may ease breathing.
* Sleep with the head on a high pillow.
* Avoid smoking; it irritates the mucous membrane of the nose further.
* Throw away paper tissues after use to prevent the spread of infection.
Based on a text by Dr Hanne Korsholm, GP
Source : NetDoctor
Burns :::
What are burns?
Burns are skin damage caused by contact with fire, heat, electricity, radiation, or caustic chemicals.
Burns are classified according to the depth and extent of the skin damage, in the following way.
The first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.
The kitchen is the most dangerous room in the house, and the most likely place for burns and scalds to occur.
When cooking, keep small children away from hot drinks, pans and kettles, barbecues and other open flames. Remember that barbecues can suddenly 'spit' flames when inflammable liquids are poured over them. Barbecues are a major cause of serious burns.
When there are small children in the house, fill baths by running the cold tap first.
Never throw water over oil fires, such as in a chip pan, because this will cause a fire explosion that can have severe consequences. Instead the fire should be smothered by covering the pan with a damp cloth.
Buy a proper fire-smothering blanket and keep it somewhere in the kitchen where it is easily accessible.
Based on a text by Eric Olesen, plastic surgeon
Burns are skin damage caused by contact with fire, heat, electricity, radiation, or caustic chemicals.
Burns are classified according to the depth and extent of the skin damage, in the following way.
- First-degree burns: the skin is red, painful and very sensitive to touch. The damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.
- Second-degree burns: the damage is deeper and blisters usually appear on the skin. The skin is still painful and sensitive.
- Third-degree burns: the tissues in all layers of the skin are dead. Usually there are no blisters. The burned surface can appear normal, white, black (charred), or bright red from blood in the bottom of the wound. Damage to skin nerves can mean it is quite painless. The burned skin lacks sensation to touch. A skin graft is usually necessary for significant areas.
The first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.
- The burnt area must be cooled by being placed under cold running water. The water must not be unpleasantly cold.
- The damaged area must stay under running water for at least one hour, or longer if the pain has not stopped. Up to four hours of this treatment can be beneficial.
- First-degree burns, eg mild sunburn, do not require this treatment.
- Burns that are bigger than the palm of the hand.
- Burns on the face, neck, hands, and in the groin.
- All third-degree burns.
- Most second-degree burns.
- If possible, keep pouring water over the burn on the way to the doctor, or use clean, soaking wet towels.
- Do not lance the blisters yourself.
- Never apply an ointment to burns or try other folk remedies - water is the only thing that should be used. Do not use butter or lard on burns!
- Do not forget to have a tetanus injection if you have not had a booster within the last 10 years.
- When skin is burned, it loses its ability to protect, which increases the risk of infection. So it is important that the damaged area be thoroughly cleansed within the first six hours, and that the area is kept clean while it is healing.
- Severe burns can cause scarring.
- In cases of extensive severe burns, the body may lose large quantities of fluid. This can disturb the blood circulation and cause problems with the body's salt balance. Such injuries should be assessed at your local Accident and Emergency department.
The kitchen is the most dangerous room in the house, and the most likely place for burns and scalds to occur.
When cooking, keep small children away from hot drinks, pans and kettles, barbecues and other open flames. Remember that barbecues can suddenly 'spit' flames when inflammable liquids are poured over them. Barbecues are a major cause of serious burns.
When there are small children in the house, fill baths by running the cold tap first.
Never throw water over oil fires, such as in a chip pan, because this will cause a fire explosion that can have severe consequences. Instead the fire should be smothered by covering the pan with a damp cloth.
Buy a proper fire-smothering blanket and keep it somewhere in the kitchen where it is easily accessible.
Based on a text by Eric Olesen, plastic surgeon
Bedwetting (enuresis) :::
What is Bedwetting ( sleepwetting ) ?
Is bedwetting common?
Enuresis - the medical name for bedwetting - is the involuntary passing of urine and the most common form of bedwetting among children is nocturnal enuresis, ie that which occurs at night.
Frequent bedwetting is common in children up to the age of six. The child should not be put under pressure if younger than six - children do not wet the bed on purpose.
Approximately 15 to 20 per cent of all five- and six-year-olds wet the bed and most of them are boys. With teenagers, the figure is 2 to 3 per cent up to 14 and 1 per cent at 15 or over.
Why do children wet the bed?
Most children who wet the bed have done it all their life and in many cases no reason can be found.
Often it is passed on through the family. Bedwetting also happens, or has happened, to a close relative in up to 85 per cent of cases. About 57 per cent of children who wet their beds either have a brother, sister or a parent who has experienced the same problem.
It may have a medical or psychological cause such as cystitis, diabetes, problems at school, at home, or the divorce of parents.
One explanation could be that these children are heavy sleepers who do not wake up when their bladder is full. Also, some children develop bladder control later than others.
At night, some children produce too little of the antidiuretic hormone (ADH), which controls the production of urine. Tablets containing desmopressin (eg Desmotabs) may help. The child needs to be examined by a doctor who will then decide whether treatment is necessary.
What can I do to help the child?
Try using a bedwetting alarm which makes a ringing or buzzing sound or vibrates if the child wets the bed. These are successful in curing the condition in 70 per cent of cases.
The alarm is very effective because it makes your child wake up as soon as the first drop of urine hits the underwear or the sheet. Your child is thus made aware that they are urinating and what it feels like when their bladder is full.
There are different kinds of alarms. Some have a copper net which is placed under the sheet. The net is connected to a bell, which will go off as soon as the first drop of urine hits the sheet. Others have a small sensor, which is placed in the pants, and is also connected to a bell.
Do not make the bedwetting a big issue in the family. Most children are embarrassed about wetting the bed, so it will help if the family support the child and show a positive attitude. Don't get angry with the child or punish them if they wet their bed. This could only make matters worse.
Let the child know that many other children do it too. If someone in the family has had the same problem, tell the child about it. Knowing that others have been affected in the same way will help a child deal with the problem.
Make sure the child doesn't drink very much during the two hours prior to bedtime. There is still no guarantee that the child will not wet the bed, but it may help.
Ensure the child goes to the toilet before getting into bed. Protect the bed by using a waterproof mattress, or a fitted waterproof mattress cover under the bottom sheet. This must be fastened securely to prevent any danger of suffocation. Place clean nightclothes and sheets next to the bed so the child can change if they wake up.
Let the child change the sheets; not as a punishment, but in order to learn to deal with the problem. It will also make the child more aware of the situation. If the child is in agreement, keep a calendar or diary and mark dry nights with a star. Praise the child when he or she wakes up in the morning without having wet the bed. Encouragement is often the most helpful way of dealing with the problem.
Some children take longer than others to achieve night-time dryness - initially having maybe one or two dry nights a week and gradually building up the number of dry nights over the following months.
However, if your child is persistently wet every night for a week or two he or she may not be ready to become dry. In this case, as a temporary measure, you may wish to use absorbent night-time pants rather than going back to using nappies. You could then try again in about three to four months.
Many parents have been told to wake the child in the middle of the night and make them go to the bathroom. Studies show that the positive effect of this is almost non-existent, since the child does not wake up by him or herself because of the need to urinate.
It may take weeks or months before there is any change. Training a child will take time, so patience is required from all involved. Most children naturally stop wetting the bed eventually. Do not be embarrassed to discuss further options with your doctor or health visitor if none of the above suggestions appear to be effective.
When should a child be taken to the doctor?
* If the child still wets the bed after the age of six.
* If the child suddenly starts wetting the bed without having done so earlier.
* If the child's urine has a strong smell, or if the child says that it hurts during or after urination.
* If the child starts to wet themself during the day.
* If the child urinates more than usual, day or night.
* If the child has constipation or defecates in their pants.
What will the doctor do?
The doctor will start by asking questions about the child, such as when they learnt to go to the toilet in the daytime. They will probably also ask if someone else in the family has had the same problem. After this, the doctor will examine the child, feeling their stomach and abdomen. Often, the doctor will ask for a urine sample in order to rule out a bacterial infection or cystitis. The doctor may also take a blood sample.
What kinds of medical treatment are available?
If bedwetting is caused by too little of the antidiuretic hormone (ADH), which controls the production of urine, tablets containing Desmopressin (eg Desmotabs) may help. The child needs to be examined by a doctor who will then decide whether treatment is necessary.
Imipramine, a tricyclic antidepressant medicine, has been found to be useful in some cases for reasons which are not fully understood.
Based on a text by Dr Bettina Norby
Bedwetting (or sleepwetting) is involuntary urination while asleep after the age at which bladder control would normally be anticipated.
Most children (85-90%) will consistently stay dry by age 6. By age 10, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%.
A small percentage (5 to 10%) of bedwetting cases are caused by specific medical situations. Most cases, however, do not have a specific identifiable cause. ( source : wikpedia )
Is bedwetting common?
Enuresis - the medical name for bedwetting - is the involuntary passing of urine and the most common form of bedwetting among children is nocturnal enuresis, ie that which occurs at night.
Frequent bedwetting is common in children up to the age of six. The child should not be put under pressure if younger than six - children do not wet the bed on purpose.
Approximately 15 to 20 per cent of all five- and six-year-olds wet the bed and most of them are boys. With teenagers, the figure is 2 to 3 per cent up to 14 and 1 per cent at 15 or over.
Why do children wet the bed?
Most children who wet the bed have done it all their life and in many cases no reason can be found.
Often it is passed on through the family. Bedwetting also happens, or has happened, to a close relative in up to 85 per cent of cases. About 57 per cent of children who wet their beds either have a brother, sister or a parent who has experienced the same problem.
It may have a medical or psychological cause such as cystitis, diabetes, problems at school, at home, or the divorce of parents.
One explanation could be that these children are heavy sleepers who do not wake up when their bladder is full. Also, some children develop bladder control later than others.
At night, some children produce too little of the antidiuretic hormone (ADH), which controls the production of urine. Tablets containing desmopressin (eg Desmotabs) may help. The child needs to be examined by a doctor who will then decide whether treatment is necessary.
What can I do to help the child?
Try using a bedwetting alarm which makes a ringing or buzzing sound or vibrates if the child wets the bed. These are successful in curing the condition in 70 per cent of cases.
The alarm is very effective because it makes your child wake up as soon as the first drop of urine hits the underwear or the sheet. Your child is thus made aware that they are urinating and what it feels like when their bladder is full.
There are different kinds of alarms. Some have a copper net which is placed under the sheet. The net is connected to a bell, which will go off as soon as the first drop of urine hits the sheet. Others have a small sensor, which is placed in the pants, and is also connected to a bell.
Do not make the bedwetting a big issue in the family. Most children are embarrassed about wetting the bed, so it will help if the family support the child and show a positive attitude. Don't get angry with the child or punish them if they wet their bed. This could only make matters worse.
Let the child know that many other children do it too. If someone in the family has had the same problem, tell the child about it. Knowing that others have been affected in the same way will help a child deal with the problem.
Make sure the child doesn't drink very much during the two hours prior to bedtime. There is still no guarantee that the child will not wet the bed, but it may help.
Ensure the child goes to the toilet before getting into bed. Protect the bed by using a waterproof mattress, or a fitted waterproof mattress cover under the bottom sheet. This must be fastened securely to prevent any danger of suffocation. Place clean nightclothes and sheets next to the bed so the child can change if they wake up.
Let the child change the sheets; not as a punishment, but in order to learn to deal with the problem. It will also make the child more aware of the situation. If the child is in agreement, keep a calendar or diary and mark dry nights with a star. Praise the child when he or she wakes up in the morning without having wet the bed. Encouragement is often the most helpful way of dealing with the problem.
Some children take longer than others to achieve night-time dryness - initially having maybe one or two dry nights a week and gradually building up the number of dry nights over the following months.
However, if your child is persistently wet every night for a week or two he or she may not be ready to become dry. In this case, as a temporary measure, you may wish to use absorbent night-time pants rather than going back to using nappies. You could then try again in about three to four months.
Many parents have been told to wake the child in the middle of the night and make them go to the bathroom. Studies show that the positive effect of this is almost non-existent, since the child does not wake up by him or herself because of the need to urinate.
It may take weeks or months before there is any change. Training a child will take time, so patience is required from all involved. Most children naturally stop wetting the bed eventually. Do not be embarrassed to discuss further options with your doctor or health visitor if none of the above suggestions appear to be effective.
When should a child be taken to the doctor?
* If the child still wets the bed after the age of six.
* If the child suddenly starts wetting the bed without having done so earlier.
* If the child's urine has a strong smell, or if the child says that it hurts during or after urination.
* If the child starts to wet themself during the day.
* If the child urinates more than usual, day or night.
* If the child has constipation or defecates in their pants.
What will the doctor do?
The doctor will start by asking questions about the child, such as when they learnt to go to the toilet in the daytime. They will probably also ask if someone else in the family has had the same problem. After this, the doctor will examine the child, feeling their stomach and abdomen. Often, the doctor will ask for a urine sample in order to rule out a bacterial infection or cystitis. The doctor may also take a blood sample.
What kinds of medical treatment are available?
If bedwetting is caused by too little of the antidiuretic hormone (ADH), which controls the production of urine, tablets containing Desmopressin (eg Desmotabs) may help. The child needs to be examined by a doctor who will then decide whether treatment is necessary.
Imipramine, a tricyclic antidepressant medicine, has been found to be useful in some cases for reasons which are not fully understood.
Based on a text by Dr Bettina Norby
Earache :::
What is Earache/Otalgia ?
Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear. ( source : wikipedia )
Earache is mainly due to problems in either the outer ear (from the earlobe to the eardrum) or the middle ear (behind the eardrum). In some cases, problems in the throat or the mouth, such as tonsillitis, can also cause earache.
Listed below are some common reasons for earache.
Ear wax
Ear wax can gather in the ear canal (auditory canal). Eventually it can form an ear plug, which impairs hearing and may cause pain.
Using a cotton bud doesn't help because this usually only pushes the wax further inside the ear, doing more harm than good. It also carries the risk of perforating the eardrum.
A plug can be softened with a little olive or vegetable oil. Drops can also be bought at the chemists that are designed for this purpose.
The practice nurse at your doctor's surgery may syringe the ears by flushing out the ear wax with water.
Inflammation of the middle ear
Usually earache starts further inside the ear. Inflammation of the middle ear is the most frequent cause and is often (although not always) due to an infection.
Because of increased pressure in the middle ear, the eardrum is stretched and swollen. This impairs hearing and is painful.
Mild painkillers such as paracetamol can be used if the pain is severe.
Antibiotics may also be prescribed. However, the role of antibiotics is still uncertain. They probably do not offer any benefit in the majority of people with inflammation of the middle ear, and often are associated with side effects.
Eczema
Eczema can occur in the auditory canal, causing dry, red, scaly and itchy skin. This can also become infected and painful.
Eczema sufferers should be careful about putting cotton buds into their ear because it usually only makes matters worse. Ear drops containing corticosteroids may relieve and heal the irritated auditory canal. Antibacterials or antifungals may be required if there is infection.
Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear. ( source : wikipedia )
Earache is mainly due to problems in either the outer ear (from the earlobe to the eardrum) or the middle ear (behind the eardrum). In some cases, problems in the throat or the mouth, such as tonsillitis, can also cause earache.
Listed below are some common reasons for earache.
Ear wax
Ear wax can gather in the ear canal (auditory canal). Eventually it can form an ear plug, which impairs hearing and may cause pain.
Using a cotton bud doesn't help because this usually only pushes the wax further inside the ear, doing more harm than good. It also carries the risk of perforating the eardrum.
A plug can be softened with a little olive or vegetable oil. Drops can also be bought at the chemists that are designed for this purpose.
The practice nurse at your doctor's surgery may syringe the ears by flushing out the ear wax with water.
Inflammation of the middle ear
Usually earache starts further inside the ear. Inflammation of the middle ear is the most frequent cause and is often (although not always) due to an infection.
Because of increased pressure in the middle ear, the eardrum is stretched and swollen. This impairs hearing and is painful.
Mild painkillers such as paracetamol can be used if the pain is severe.
Antibiotics may also be prescribed. However, the role of antibiotics is still uncertain. They probably do not offer any benefit in the majority of people with inflammation of the middle ear, and often are associated with side effects.
Eczema
Eczema can occur in the auditory canal, causing dry, red, scaly and itchy skin. This can also become infected and painful.
Eczema sufferers should be careful about putting cotton buds into their ear because it usually only makes matters worse. Ear drops containing corticosteroids may relieve and heal the irritated auditory canal. Antibacterials or antifungals may be required if there is infection.
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