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Avoid sudden changes in activities. Give your child some time to effect a transition rather than taking him by surprise. If you want him to come in for dinner, don’t suddenly uemanu mat ne drop everyming anu come lmmeuiateiy, men get angry ir he doesn’t do it. Tell him that it is almost dinnertime, and that in 5 minutes he will have to stop playing and come and sit at the dinner table.

Make sure you and your partner are in agreement. Young children are expert at playing one parent off against the other. Work out your rules and strategies, and support each other in sticking to them.

Decide what the rules are in advance, and make sure your child knows them too. The limits of acceptable behaviour may vary according to the parents and the individual attributes of the child. It is very difficult to be prescriptive. Make sure that the limits are reasonable, and focus on behaviours that are dangerous to the well-being of the child, or that you find intolerable. Make sure also that the limits are broad enough to allow your child some freedom. Avoid putting yourself in a situation where you are continually saying no.

Be consistent. While nobody can be consistent all the time and in every single situation, try to keep in mind that consistency about rules makes it more likely that the child will learn what the rules are too. Conversely, children will become confused in the face of inconsistency, and their behaviour may get worse. This is because they may feel insecure and need to continue to test limits in order to reassure themselves that they exist. The perceived absence of rules and limits is very scary for young children.

Be matter of fact about discipline. Don’t scream or lose your temper. Talk to your child in a calm, direct way. Stand or sit close to him, make eye contact whenever possible, and speak to him clearly and simply.

Do not threaten your child with long-term consequences. To be threatened with not being allowed to go swimming with his father on the weekend is meaningless for a young child. Suggest short-term consequences of his continued disobedience — ‘If you don’t stop that now, I’ll put you straight in your room’.

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The working-through process may at first seem difficult and confusing, but it isn’t. Some people can feel daunted and overwhelmed by the amount of effort needed. It is worth it. Everything which is required from us during the working-through process will be given back to us in the sheer joy and total freedom of recovery.

The working-through process is the same for everyone. The only difference is our personal threshold to stress. Some people may have reached the point where they cannot tolerate even the smallest stress. Other people may have a higher threshold to stress, but it is still low enough to trigger fearful thoughts.

The time it takes people to recover will vary. The individual threshold to stress comes into account, but the amount of effort and discipline we put into our recovery is most important.

The first attack was the result of either a build-up of stress or a major life stress. In other words, the anxiety and/or attack happened when we reached the limit of our individual threshold to stress. This doesn’t mean we are weak. It simply means we have reached our limit to stress, just as most people will reach their limit to stress at one point or other in their life. Continual worry about the symptoms of anxiety and attacks only increases our stress and lowers our threshold to it.

As we begin the working-through process it is helpful if we have an understanding of how low our threshold to stress is and how high our anxiety is.

If our threshold to stress is now extremely low we may not be able to tolerate even the smallest daily stress. Our threshold to stress would be zero, while our anxiety level would be ten. At level five we would be able to tolerate the daily stress/es, but would find our anxiety level rising if there is a break in our normal daily routine. At level ten we would be able to deal with almost any stress without becoming anxious.

The working-through process means working to increase our threshold to stress back to normal levels, while decreasing our anxiety level.

It’s no use just hearing or reading about panic anxiety management skills. We have to practise them. There have been occasions when we say we’re not getting any better, and nothing has changed. If we are not getting results it usually means we are not practising enough, or even not practising at all!

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All people have biological cycles that govern their days and nights. Called “Circadian Rhythms,” these rhythms include sleeping, waking, hunger and changes in body temperature and hormones throughout the 24 hour day. The timing of these cycles is linked to the ability to fall and stay asleep instance, as we fall asleep there is a drop in our body temperature. We wake up as it starts to rise again.

Research shows that there is a natural tendency to stretch tow twenty-five hour cycle. Events in our daytime schedules—mealtime, bedtime and time of rising—serve the purpose of re-setting the cycle to fit the 24-hour day. You can probably see this happening, to a small degree, on M morning after you allowed yourself to go off your usual schedule during the weekend. This is also the experience of “jet lag”—when the event experience don’t fit with your biological clock.

Most people don’t have trouble maintaining a twenty-four hour cycle. But for children whose sleep cycles have strayed, this is asking

Sometimes we ask children to go to sleep when their bodies are not ready the sleep cycle. A child would understandably be grumpy and hard to live if his rhythms were not in sync with the clock of his world.

John just can’t seem to get to bed at a decent hour—we always battle bedtime. When he was eleven months old he wasn’t ready to go to bet 11:00 pm. We gradually got it down to 9:00 pm. Then at a year and ñ we noticed it had crept back up to 10:00 pm.

Biological rhythms influence sleep in several ways.

It may be necessary to purposefully take control of your child’s sleep if they have gotten off kilter.

Daytime routines are important to maintain biological rhythms an resulting sense of well-being.

If you implicate biological rhythms as a part of your child’s sleep pro changes need to be made in gradual increments so that a shift of cycles can occur smoothly.

When your child is sleeping better and more regularly, you can expect a happier child.

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To find out which cause applies in your case your doctor should check for other symptoms. For example, if you are coughing yellow or green phlegm it is probably infection. If you are coughing blood, it could be cancer or blood clots on the lung. If you feel more short of breath when lying flat than when sitting or standing, your heart is probably not working properly. If you or your doctor can hear whistling sounds with your breathing, you probably have some partly blocked bronchial tubes-

Often your doctor will be able to tell the cause just by taking your history, examining you and arranging a chest X-ray, but sometimes other tests, such as a lung scan, may be advisable.

Once the cause is found, it may be possible to correct it. For example, pneumonia could be treated with antibiotics, clots on the lung with drugs to thin the blood (anticoagulants) and anaemia with a transfusion.

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A headache is probably the most common symptom from which we suffer.

This is not due to the hectic pace of life in the highly developed countries, as our brothers and sisters in the underdeveloped world where the pace of life is slower suffer just as often. Even our ancestors were not free from this common disorder.

The pain in your head may be an “ordinary” headache, not dignified by having a specific name or an associated symptom, occurring along with others in the course of some illness, such as one of the infectious diseases.

Or the pain may be one of the common specific disorders, such as migraine or tension headache.

Headaches are such a common occurrence that it is usually only the severe, the persistent, the recurrent or the bizarre headaches which make us seek medical attention, or it may be the more sensitive, introspective or hypochondriacal of us who bother to take such a symptom for medical evaluation.

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Excessive bleeding from the womb may be due to a condition called metropathia hemorrhagica.

This condition is more common in the forties, although it may occur at any age during reproductive life.

It is due to an unbalanced action of the oestrogen hormone from the ovary which acts on the lining of the womb.

Usually ovulation ceases and there is an excess production of FSH, or follicle stimulating hormone, produced by the pituitary gland.

This is often called the master gland of the body and it lies at the base of the brain and produces hormones which control the other endocrine glands of the body.

FSH acts on the ovaries causing the ovum to ripen and produce oestrogen. Over-activity of this hormone may cause the development of a cyst in the ovary which in itself produces oestrogen.

These often spontaneously disappear and rarely require treatment. The oestrogen acts on the endometrium or lining of the womb, causing it to thicken and to develop a greater blood supply.

Then a drop in the level of oestrogen leads to the onset of bleeding and this may go on and on.

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The most common type of diabetes (type 2 diabetes) is the result of insulin not working properly and usually affects people over the age of 40. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) which can lead to this type of diabetes, especially when there is someone else in the family with diabetes.

Many people who live in societies which are undergoing rapid westernisation are developing this type of diabetes. Why ?

It takes time for our bodies to adapt to such major changes in diet. Because our European ancestors had thousands of years to adapt to a diet with a lot of carbohydrate, they were in a better position to cope with the changes in the G.I. factor of foods. That is why people of European extraction have a lower prevalence of type 2 diabetes compared with people whose diets have recently changed to include lots of high G.I. foods.

However, there is only so much that our bodies can take. As we continue to consume increasing quantities of foods with a high G.I. factor plus excessive amounts of fatty foods, our bodies are coping less well. The result can be seen as a significant increase in the number of people developing diabetes.

But, the most dramatic increases in diabetes have occurred in populations which have been exposed to these changes over a very much shorter period of time. In some Australian Aboriginal communities up to one person in four now has diabetes. In some groups of native American Indians and in some populations within the Pacific region, up to one adult in two has diabetes because of the rapid dietary and lifestyle changes in the twentieth century.

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In many cases, our thought patterns have been programmed by life, coming from inter-personal relationships, childhood experiences or situations of emotional trauma. The extent to which the fat loss leader needs to recognise and deal with these is covered more extensively in separate publications.7 An introductory perspective, however, can be gained from some of the more popular psychological techniques. Rational Emotive Therapy (RET) is an example of one of these. Developed by US psychologist Albert Ellis in the 1950s, this technique has now been adopted by many modem popular psychologists including Chicago University’s Professor Martin Seligman. Seligman is a psychologist who discovered, when working with animals in the 1960s and 1970s, that living organisms can have a tendency to defeatism if continually placed in powerless situations. If a rat is constantly shocked, for example, with no escape available, it eventually gives up and settles down to its fate, which is often death. Similarly, in very deprived circumstances, human beings learn helplessness—they actually regard their situation as hopeless and don’t even try.

Seligman called this experience ‘learned helplessness’ and published a book on the topic in 1974. After a 20-year gap he then published what he considered to be the antidote to this, ‘learned optimism’10 in which he utilises a lot of the techniques used by Albert Ellis in RET. Ellis’ approach was developed to counteract his own shyness as a young psychology student and his inability to communicate because of this. He reasoned that this inability was because of the anticipated anxiety he felt every time he went to make contact with another individual (in Mark Twain’s terms his life was full of ‘potential disasters’). Ellis realised that the problem was within himself, because of the way he thought about the situation; it was his belief that he was an unworthy person, because he must always succeed, other people must always treat him well and the world must be good to him. He realised, however, that these beliefs were irrational, and based on no solid, objective evidence. In a similar way, it is the belief of many fat people, that they are unworthy and that others regard them as unworthy, while in reality, others are generally too concerned about their own problems to even consider them This belief can then become self-fulfilling, exacerbating the problem of overfatness itself.

Ellis based his thesis of RET around a very simple format based on the letters ABCD. Ellis claimed: ‘We consciously and unconsciously choose to think and hence to feel in certain self-helping and self-harming ways’ and ‘Once you understand the basic irrational beliefs you create to upset yourself, you can use this understanding to explore, attack, and surrender your other present and future emotional problems’.

Beliefs, according to Ellis, can be rational or irrational. Irrational beliefs which, according to Ellis are the major problem in maladaptive behaviours, are generally associated with musts, shoulds and have to`s, and are usually ‘hot’, or charged with emotion in comparison with rational beliefs which are more ‘cool’ or ‘warm’. An example of an irrational belief would be ‘I MUST NEVER binge or I am a bad person’, or T HAVE TO always be good or I will feel miserable and horrible’.

It is easy to see how these irrational beliefs can lead one into cognitive habits, or thinking patterns, that are self-defeating, self-limiting and self-punishing. Ellis, therefore, adds D or Disputation to his program in order to help overcome these irrational beliefs. An individual should learn to systematically analyse his or her beliefs, he claims, and logically argue against these. This cannot be done by the therapist, but it may be aided. For example, the question can be asked: ‘Why must you always succeed on your diet or eating plan? It may be nice, but must it always happen? What would be the worst consequence if this did not happen? Could you live with this? What are the consequences of maintaining this irrational approach?’ The thought process is thus ‘renamed’ to provide an opportunity to reduce irrational thoughts.

RET is a relatively simplistic approach to a complex problem. It is used for a range of different psychopathologies including fear of flying, fear of spiders and many other phobias. It has potential use in body fat maintenance, although it would not be expected to be applicable under all circumstances. In many instances, such as those that lead to problems of obesity, there may be a role for a more detailed approach to the problem.

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The energy balance equation has underpinned most efforts to explain the energy dynamics of obesity. Obesity is characterised by high energy stores and usually a high energy intake and expenditure (metabolic rate). To reach a state of obesity, there needs to be a chronic imbalance between energy intake and expenditure over a long period of time. However, an initial positive energy balance will cause energy stores to increase (both fat mass and fat-free mass) which in turn causes an increase in energy expenditure, due mainly to the increased resting metabolic rate from the greater fat-free mass. At some point, the weight gain and increased energy expenditure will offset the original imbalance and a new equilibrium will be achieved.

Therefore, the energy balance equation helps to explain how a positive energy balance leads to weight gain and how a new steady state is achieved. However, it fails to answer two critical questions: why did the positive energy balance occur in the first place and why does it remain chronic over long periods? The answers to these questions may come from an understanding of the regulation of individual macronutrients (carbohydrate, protein, fat, and alcohol). However, separating out each macronutrient balance equation can only be valid if the biochemical highways do not allow a free flow of nutrients. What are the restrictions for converting one nutrient to another for storage and, in particular, are glucose and alcohol converted into fat through the process called de novo lipogenesis?

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Inhalation of a foreign body by a child may produce serious symptoms which may endanger life. Parents should not allow small children access to potentially dangerous foreign objects; this includes peanuts (shelled—one of the worst offenders), small objects such as beads, eyes from dolls and teddy bears, buttons and certain foods which are obviously hazardous. Children should be discouraged from running when eating or at any time they have objects in the mouth. Brothers and sisters should be discouraged from feeding junior when playing. It may all lead to trouble.

Often when the foreign object becomes lodged in the upper airway there is considerable coughing, choking and gagging, and emotional and physical distress. There may be inspiratory stridor, which means a wheezing noise when the child breathes in. If a large airway has been blocked, there may be cyanosis (blueness), indicating the child is not receiving enough oxygen.

Treatment

Keep your head. Do not panic. The risk of the child suffocating to death within minutes is usually not high. But prompt action is necessary. The old idea of tipping the child upside down in the hope of the foreign body dropping out is now not favoured by many doctors. Neither is back-slapping. It appears that this may dislodge the foreign body, but it may become re-lodged in a narrower part of the airways making the condition more acute and hazardous.

If a foreign body is not obviously visible (and chances of it being seen are not high), then get the child to the nearest large hospital as a matter of urgency. Telephone the hospital first to explain your problem so they may be ready to help you on arrival. Talk encouragingly to the child. Usually, after the initial stress the child tends to quieten down and the so-called ’silent period’ ensues.

At the hospital, doctors are equipped with special facilities to both investigate and treat. It is usually fairly straightforward in retrieving a foreign body from the air passages.

An overlooked foreign body may prove serious, and deaths have occurred when they have been left there indefinitely. Local infections which may smoulder on and involve adjoining organs may occur. It is important that if there is any query about the foreign body still being there, full investigation be carried out by doctors expert in this field.

X-rays are available. The doctors also have instruments for peering into throats and air passageways, and these are equipped with devices that can pick up and remove foreign objects.

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