Cause

There is no discernible cause for temper tantrums. They are seen as an inevitable consequence of a youngster’s struggle to assert autonomy and independence from his parents. The immediate precipitating cause for a tantrum is almost always frustration, either to the parent saying ‘no’ to a request so that the child is not allowed to have his way, or else the frustration that comes from the child not being able to perform some developmental task. Usually the tantrum is manipulative and directed towards the parents.

Clinical features

All parents will be only too aware of the characteristics of a temper tantrum. While the precipitating factors, intensity, duration and action during a tantrum will vary from child to child, there are certain features which are universal. In response to frustration — usually the parent saying ‘no’ — the child may scream, throw himself on the floor, vigorously flail arms and legs, often kicking toys, furniture, the floor, or the parents. Sometimes toys and other objects are thrown across the room. The episode is usually terminated by the parent, who distracts the child or gives in to the original demand, or else picks the child up.

Left to his own devices, however, the child usually loses interest in the tantrum as soon as he is deprived of an audience. Parents will observe that the child stops the tantrum momentarily at regular intervals to make sure that the parent is still in the room. In other words, the parent is clearly the target of the demonstration, and this provides the most important clue for management of temper tantrums.

Toddlers seem expert at picking the times when parents are the most vulnerable to the effects of a full-blown temper tantrum, such as when they are out shopping (‘the supermarket syndrome’), or else visiting friends. This of course makes it even more likely that the tantrum will have the desired effect, and in turn will strengthen the child’s resolve to turn it on again the next time — ‘same time, same place’.

Sometimes the child seems to lose control during a tantrum, so he becomes really worked up and genuinely distressed. What started off as a manipulative ploy then becomes a rather frightening event for the child.

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Non-acceptance means we are only making the situation worse for ourselves. We all have periods of doubt about the diagnosis. If this does happen it is important to go back and talk with our doctor.

Compounding this doubt are the anxiety symptoms and how they change. Once we get on top of one symptom, another one takes its place. Any new symptom needs to be checked by our doctor, and sometimes we may feel like a hypochondriac. However, it is more important for us to know what the new symptoms are, instead of continually worrying. If we are told the new symptom is another anxiety symptom, we need to accept the diagnosis and not get caught in the vicious circle again.

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The following is a discussion of the sleep associations that most commonly cause problems.

Feeding. The child who is nursed or fed to sleep learns to need the calming that comes from eating, sucking, and being held. If she rouses during the night, she will call for more of the same. She may also wake seeming “rested” with a burp after 20 minutes, but she will not be establishing dependable routines.

As she loses that newborn drowsiness, begin to keep her awake during feedings (easier said than done for some babies) or purposely rouse her while laying her down so that she knows she is falling asleep in her own bed, not in your arms.

Sucking. Pacifiers help some children settle themselves to sleep. Be aware that their use after ‘about three or four months means that this habit will eventually need to be unlearned.

Rocking. Rocking is a pleasant, calming experience for both child and parent, but it can be a strong sleep association. One alternative is to rock a child to soothe and lull him, but not put him into a full sleep. Or rock until it ceases to be soothing—perhaps at four or five months with the sociable child, or later, as mobility increases, when she squirms to get down to play.

Children love to “nest”—that is, move around in bed until it feels just right. If we confine them by rocking, walking, or whatever, we deny them this winding down pleasure. If you are a “pillow fluffer” yourself, you will understand.

Loveys. Many children become attached to special blankets, stuffed anim or toys. “Loveys” make it easier to sleep without parents. To avoid the pai of a lost or forgotten lovey, make more than one available (buy matchi blankets) or make it so general that a replacement might not be noticed.

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Coronary artery disease may develop in people in the early thirties but heart attacks become more common in the late forties and early fifties.

Women seem relatively immune from heart attack until after the menopause, when the incidence rises dramatically and may exceed that for men.

Gradual narrowing of the coronary arteries may lead to the condition of angina.

When the heart has to work harder with more exertion, the heart muscle requires more blood to supply its own needs. With narrowing of the arteries, not enough blood may be able to get through.

The diagnosis of angina is usually easy to make as the story is so typical, although examination may not reveal any abnormalities and even the electrocardiograph may be normal.

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The treatment is D and C.

It is worth remembering that miscarriage is an all-or-nothing business.

Should the threatened miscarriage settle down and the pregnancy proceed to term, then the baby is normal.

Some women fear that when the threat to pregnancy has been averted, an abnormal baby may be preserved. Therefore, they worry considerably and unnecessarily for the remainder of the pregnancy.

Even when a woman is unhappy with the pregnancy, miscarriage may still produce an emotional reaction. Depression is common and of course is due to a normal grief reaction.

We grieve for something lost.

At this time husbands need to be particularly understanding.

And often associated with the depression is a sense of guilt.

A woman may worry that either she did something she should have avoided, or neglected some precaution she should have taken.

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Hair follicles are finger-shaped folds of epidermis dipping into the dermis, which are responsible for hair formation. Hair then is a derivative of epidermis, arising from deep within the dermis, and composed of the protein keratin. The most superficial part of the follicle forms a duct, in which the hair stands free. Since the sebaceous duct also opens into the follicular duct, the hair shaft emerges through the same pore which secretes the sebum, ensuring its direct lubrication. In the deepest part of the follicle the follicular wall and the hair are fused. This section constitutes its root, the lowest part of which is known as the bulb.

Hair is an extremely complex structure which broadly speaking consists of a central cortex surrounded by several protective layers. Hair contains neither nerves nor blood vessels and is therefore a ‘dead’ structure. There are many different types of hair, which in one form or another cover the entire surface of the skin, with the exception of the palms and soles. In most areas the hair is short and fine, like that found on a child or on the cheeks of a woman, and is known as vellus hair. The longer, broader, and usually coloured hair, such as that on the scalp, is known as terminal hair. There is no clear distinction between these types. In fact, the same follicle may produce either type under different conditions. For example, vellus may change to terminal hair on the chin of an adolescent, or terminal may change to vellus on the scalp of a balding man. The protein-synthesizing capacity of this tissue is enormous. When one considers that scalp hair grows at the rate of 0-35 millimetre daily, and that the average number of scalp hairs is about 100000, this means that about 30 metres of hair is produced every day.

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Mary, 65 years old, was found to have diabetes two years ago. She was overweight and was told that she had to lose several kilos. Although she had been trying to do this before she developed diabetes, she had been unsuccessful. Now she felt that the extra burden of diabetes would make life impossible for her and that she could not do any more than she was already doing with her diet. Because her blood sugar levels were too high she was presented diabetic tablets.

When we looked at what Mary ate, we could see that indeed she really was trying hard and was not overeating. However, almost all of her carbohydrate foods had a high G.I. factor. For example, she was having Weet-Bix or cornflakes for breakfast morning coffee biscuits for mid-meal snacks, lots of rice with her lunch and evening meals and watermelon was a favourite fruit All these foods have a high G.I. factor. By changing to All-Bran™ or untoasted muesli for breakfast, having oatmeal biscuits or an apple, pear or orange for snacks and by adjusting the type and amount of rice the was eating, Mary was able to eat more, lose weight and improve her blood sugar levels. Eventually she stopped her diabetes tablets too.

Sometimes, despite your best efforts with diet, tablets will still be needed to obtain good blood sugar control. This is eventually the case for most people with type 2 diabetes.

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