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No investigations are necessary. Croup is a clinical diagnosis.

Treatment

The majority of children with croup do not need any specific treatment. You can manage the symptoms in exactly the same way as for a cold. Antibiotics are not necessary because the condition is caused by a virus. Some children seem to benefit from steam, and you may want to take the child into the bathroom with a hot water tap running in the shower. Be very careful to avoid scalding the child if you decide to try this treatment. There is little information available to suggest it makes any significant difference.

A small minority of children with croup will need admission to hospital for observation, to ensure that the breathing tube does not become blocked to the point where they are unable to breathe.

When to see your doctor

• if your child has difficulty breathing;

• if the stridor is easily heard even when he is resting quietly;

• if you are worried.

Prevention

There is no way we can prevent children from getting croup.

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Twins may be identical (homozygous) if they come from the same egg, or non-identical (heterozygous) if they come from separate eggs.

If you are pregnant with twins, you will notice a rapid weight gain early on in your pregnancy, and your final weight will be greater than if you had only had one baby. Careful monitoring of blood pressure, weight and urine are important because of the increased risk of hypertensive disease of pregnancy. It is important to get adequate amounts of rest. Most twins are delivered at 38 weeks, and labour is generally no longer than it is with a single baby. Complications may arise if the babies are in an unnatural position, and in this case Caesarian section may be advised. In addition twins are usually smaller than single babies, and the incidence of prematurity is higher, so they may need special care.

Triplets, quadruplets, quintuplets and so on are uncommon, and usually occur after use of certain fertility drugs and in-vitro fertilisation techniques. In the same way as twins, these babies can be identical or non-identical, or both types may occur in one set (for example, in triplets one baby may develop independently from an adjacent pair of identical babies).

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ANSWER: One of my other patients once asked why her husband yawned so loudly. The answer to that question is the same as the answer to this one. We all express ourselves differently. The words that bother you so much are just expressive sounds. They mean nothing about you or her; they are reflexes just like any other. Such expression is arousing or exciting to some people, but if these words bother you, suggest the words you might like to hear. It will take some time, but such words might work their way into her’ ‘reflexive vocabulary.” Remember that the words are reflexes, not messages, and maybe you won’t be so bothered. It’s a compliment to you, really, that she feels comfortable and safe enough to let loose, to be free in her sexual reflex vocabulary.

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Let me give you an example which proved to be what we all might regard as a suitable solution to a difficult problem.

A husband came home and found his wife in bed with another man. Following an angry scene, he developed a paralysis of his right arm. The paralysis was a symptom of hysteria.

Psychotherapy revealed that it served two purposes. The man’s cultural background led him to believe that he should, as a man wronged, kill both his wife and her lover, but his own ethical standards would not accept this.

The paralysed arm prevented him from carrying out this unacceptable act and, at the same time, led his wife to feel guilty for having caused his paralysis.

In treating such a case it is important not to overcome his paralysis without giving him time to accept some other solution, otherwise he could have been forced into a corner where he had to carry out that action.

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But iron deficient anaemia remains the commonest of the anaemias, and fortunately it is the easiest to treat.

A woman, during her reproductive life, is always potentially anaemic because the blood lost with each period not only represents the blood lost from the body, but also a loss of iron and therefore her intake of iron has to be adequate to make good this loss.

With a man, there is usually no loss of iron from the body except where he also may be losing blood, such as with bleeding haemorrhoids or a peptic ulcer which is slowly bleeding.

Iron is a fairly common constituent of many foods and it is rare for an inadequacy of intake to occur except where there may be poor absorption, or illness, leading to a reduced intake of food, poverty or the development of certain food fads.

All these factors may lead to a deficient intake.

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Usually these warts last 3 to 6 months and are found on the fingers near the nails. They are infectious and other children can easily catch them. The best treatment is thuja taken internally as a tincture or thuja extract applied to the wart twice daily until it disappears. Echinacea can be taken internally. The white sap of the dandelion flower can also be applied to the wart twice daily until it disappears.

Beware of caustic lotions which burn the surrounding skin and sometimes cause the warts to spread. These will burn the face and the genital areas.

Plantar warts need specialist attention as they grow larger and become intensely painful. They may disappear spontaneously after a few months or last for a number of years. The base of the wart is embedded in the soles of the feet, or toes and may be single or multiple. They are firm and round with a rough surface. If this is cut off, dark spots can be seen —blood vessels supplying the wart.

The person suffering with plantar warts should wear socks and slippers around the house and have their own bath towel and bath mat. If the individual is an athletic person, plastic socks can be purchased for use in the communal shower room or in the swimming pools.

Genital warts are sexually transmitted. They can be visible around the labia of a woman or the penis of a man, or they can be inside the vagina. They look like cauliflower growths and can irritate the sufferer. Any sign of infection should be treated as quickly as possible. They are highly contagious and are related to incidence of cervical cancer in women. They have been related to cancer of the throat in cases where oral sex has taken place with an infected person over a long period of time.

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Next day, the treated skin appeared inflamed and was covered with large blisters, a reaction that did not respond to cortisone. Over the next few days he became feverish and lost all of the skin, fat, and underlying connective tissues down to the muscles (which became fully exposed) at all of the treated sites. His kidneys were permanently injured, too. During his year-long hospital stay, he needed repeated surgery to clean the “burned” sites and repair them with full thickness skin grafts.

The moral of this story: Read the labeling of all medicines and follow the instructions carefully.

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Head lice cause itching of the scalp and sometimes a red, scaly rash on the back of the neck at the hairline. Scratching may cause sores on the scalp. The lymph glands at the base of the skull may be enlarged.

Unless hundreds are present, it is difficult to see lice in a child’s hair. Look for the small but easily visible nits attached to the shafts of the hairs. Though nits are about the same color and size as flakes of dandruff, they can be easily distinguished from dandruff. Flakes of dandruff can be blown or brushed away; nits can be removed with the fingernails only with difficulty.

Home care

Apply two tablespoonfuls of a 1-percent gamma benzene hexachloride shampoo (which your doctor will prescribe) to your child’s dry hair. Work it into lather, and leave it on four minutes. Then rinse well with water. Be very careful not to get this shampoo into the child’s eyes or mouth. After rinsing, fine-comb your child’s hair to remove the nits. If necessary, use a vinegar rinse to loosen the nits before combing. Repeat the shampoo and combing only once, four to seven days later. This procedure kills both the lice and the eggs. Clean combs and hairbrushes with the gamma benzene hexachloride shampoo. To kill stray lice, clean hats and pillowcases by washing and ironing or by dry cleaning.

Lice can also be killed by applying a 25-percent benzyl benzoate lotion (available over the counter) to the hair and scalp; shampoo after 12 to 24 hours. Repeat the procedure in four to seven days.

Precautions

• Gamma benzene hexachloride is lindane, a white powder used chiefly as an insecticide. It is poisonous if swallowed or absorbed through the skin. It can also harm the eyes. Do not let it come in contact with the eyes or mouth. Do not leave it within your child’s reach. Do not apply it more than twice.

• If one person has head lice, all family members except infants and pregnant women should be treated once with the shampoo.

• If the lice are accompanied by infected sores on the scalp or enlarged tender glands at the base of the skull, consult your doctor.

Medical treatment

Your doctor will ordinarily treat head lice as you would at home. If there are infected sores and infected lymph glands, your doctor may culture the sores and will usually prescribe an oral antibiotic for five to ten days.

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