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A full history taken by the doctor and a complete physical examination should give him a good idea whether the condition is the usual form of bed-wetting or due to disease.

Examination of the urine by testing for protein and sugar and looking at it under the microscope is the only special test necessary.

Most cases are primary and have never been dry for longer than, at most, a month. Those secondary cases who have achieved control for months, or even years, and then relapsed are usually due to some emotional upset such as separation or the arrival of a new baby. These cases usually respond to counselling.

Lifting the child at night before the parents go to bed doesn’t cure it as the times when the child voids vary so much. But, done consistently, it certainly gives dry sheets — and there is the possibility that he will grow out of bed-wetting.

Dehydration — that is, by restricting fluids in the evening — is another method widely used but is of little benefit.

Sometimes, both the parents and the child are satisfied by a full explanation and reassurance and no further treatment is needed. They are prepared to wait until time effects a cure.

In the past, several drugs were used, but with only moderate success.

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Signs and symptoms

You will have no difficulty recognizing a nosebleed. Since the two sides of the nose join in the back, and also join with the throat and the oesophagus (which lead to the stomach), blood may flow from both nostrils or from the mouth; the child may also vomit blood.

Home care

Teach your child at an early age how to stop a nosebleed by him- or herself. Tell the child to remain calm and to sit upright with the head held high; this will decrease blood pressure in the blood vessels. Show the child how to grasp the whole lower half of the nose between his or her thumb and fingers and in this way compress both sides of the nose firmly against the septum. The child should hold the nose this way for ten minutes to allow time for the blood to clot. If bleeding recurs when the pressure is released, it probably means that a large clot in the nose is preventing the broken blood vessel from sealing. The child should blow the nose vigorously to dislodge the clot; then, after the clot has been removed, compress the nose again for ten to 12 minutes.

To prevent recurring nosebleeds, put petroleum jelly in the child’s nose morning and evening for seven to 14 days. Use a vaporizer or humidifier to add moisture to the air at night.

Precautions

• To stop a nosebleed, do not merely pinch nostrils together, but compress the entire soft portion of the nose. Otherwise, the blood will dam up and run down the throat.

• Do not lay your child down.

• Remain calm and reassure your child.

• It is not necessary to use cold compresses, pressure on the upper lip, nose drops, and other household remedies.

• Do not pack the nose with cotton or gauze.

Medical treatment

Generally, your doctor’s treatment will be the same as your home treatment, and you only need to consult the doctor when home treatment is not effective. If the nosebleed is due to an allergy or a cold your doctor will treat that condition. Your doctor will rarely need to pack the nasal passages or cauterize (seal off) the blood vessels in order to control recurring nosebleeds.

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What is it?

Inflammatory bowel disease is a blanket term that covers two major conditions, Crohn’s disease and ulcerative colitis. They are very much more common than they used to be, hospitalizing more than 100,000 people in the US every year.

At first symptoms are so mild that you ignore them: a bout of diarrhea every few months and occasional abdominal pain. As the years pass the symptoms get worse. There is either diarrhea or constipation and the stools are bloody. Fleeting abdominal pain turns into chronic pains and the person feels ill and lacking in energy.

The vast majority of medical efforts are useless in these conditions though drugs can help a few and surgery a few more.

What causes it?

No one knows for sure but there are several plausible theories.

•     Food intolerance. A group of researchers in Cambridge have found intolerance in Crohn’s disease.

•     Crohn’s disease was unknown until the 1930s, but now it affects one in every 3,000 westerners. Because there have been such profound dietary changes over this period research has been aimed at dietary factors. A German study found that patients with Crohn’s disease ‘consumed large quantities of refined carbohydrate’. Another survey of the breakfast habits of Crohn’s disease patients found that they usually ate refined breakfast cereals such as cornflakes. In a survey of sugar intake Crohn’s patients were found to eat the equivalent of ten teaspoons a day while those without the disease ate seven. Other studies have found that Crohn’s patients add 26 per cent more sugar to tea and coffee, and 13 per cent more to cereals than do people without the disease.

•    Zinc deficiency is now well recognized as part of the problem. Crohn’s patients have many dietary deficiencies, partly because they lose their appetite and eat so poorly and partly because the disease itself reduces the intestinal absorption of nutrients. Crohn’s patients have insufficient levels of protein, iron, folate, calcium and vitamin B12. Recently, though, zinc deficiency has been found to be the most important of all. Zinc controls many body systems but in Crohn’s patients its lack further heightens the poor appetite and loss of taste for food. Many Crohn’s patients have no desire to eat. Zinc is also vital for healthy skin and some people with this condition have severe skin rashes. Normal eyesight needs zinc and some Crohn’s patients have night blindness. Zinc is vital for wound healing and Crohn’s disease never fully heals.

Adults with Crohn’s disease have been found to have zinc levels 15 per cent lower than normal, and their sense of taste has been found to be 65 per cent duller than normal. Studies giving patients with Crohn’s disease zinc supplements have found that several of the abnormalities associated with the condition are eliminated.

•     Vitamin Ñ deficiency can also cause some of the symptoms of Crohn’s disease. One study found that Crohn’s patients had vitamin Ñ levels 32 per cent lower than normal. This led the researchers to suggest that all patients with Crohn’s disease should supplement their diet with vitamin C.

•      There is some evidence of a link between Crohn’s disease and psoriasis and monilia. Though there is little true scientific evidence to support it, anecdotal evidence shows that some people with inflammatory bowel disease improve on nystatin-the antifungal drug-combined with a low-yeast, low-refined-carbohydrate diet.

Prevention

There is probably no way of preventing inflammatory bowel disease from occurring in the first place but understanding the causes suggests some valuable ways of preventing the disease getting worse once it is present.

•     If you are allergic to or intolerant of any foods, don’t eat them. This could prevent unseen and unrecognized damage being done to the large bowel.

•     Eat a diet low in refined carbohydrates and rich in unrefined ones.

•     Eat less sugar.

•     Eat more dietary fibre.

•     Take zinc supplements once you start to suffer from any of the symptoms of the disease.

•     Take vitamin Ñ in large doses-1 g twice a day-if you have the condition.

•     Talk to your doctor about trying nystatin and go on to a low-yeast diet.

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