HEAD CIRCUMFERENCE

The circumference of the head in infants is often measured to detect an abnormally small or large skull, and to
allow the medical treatment of any underlying cause (eg. hydrocephalus, microcephaly) at an early stage. A tape
measure is placed around the head from front to back and manoeuvred until the maximum possible reading has
been obtained.
    Charts (see below) have been prepared which enable head circumference to be compared against a normal
standard for each age, and variations from the normal to be plotted.

HAEMOPHILUS INFLUENZAE B INFECTION

Haemophilus influenzae B (HiB) is a bacterial infection that in children causes meningitis or epiglottitis, and in
adults may affect numerous organs. It is spread by close contact and can cause infections in any age group, but is
far more serious in children.
    In children it may cause:-
          - Meningitis, which is an infection of the meninges (covering of the brain) that results in a fever,
          irritability,   lethargy,   seizures   and   coma.   The   onset   of   meningitis   may   be   so   rapid   that   the   child
          may   be   permanently   affected   (eg:   by   deafness,   learning   difficulties   and   other   forms   of   brain
          damage) before any treatment can work.
          -  Epiglottitis, which is a life threatening infection of a piece of cartilage at the back of the throat
          that may swell and block the airways.
    Blood and fluid from the spinal cord can be tested to confirm the diagnosis.
    In   children   potent   antibiotics   are   needed   for   treatment,   and   they   must   be   given   by   injection.   The   swollen
epiglottis (piece of cartilage at the back of the throat) may choke the child before the antibiotics can work, so urgent
hospitalisation and intubation (placing a tube into the throat to permit breathing) is essential.
    Good   recovery   occurs   if   the   infection   is   diagnosed   and   treated   early,   but   permanent   damage   or   death   are
possible in children if treatment delayed.
    A vaccine for infants has been available since 1993 to prevent HiB infections. It is given as three or four doses,
two months apart, starting at two months of age. It is not recommended for use in adults, but is unlikely to cause
problems if given accidentally.        Common: side effects may include redness and soreness at the injection site, while
unusual   effects   may   include   irritability,   tiredness,   sleeplessness,   diarrhoea   and   a   rash.   It   should   be   used   with
caution in fever, acute infection or immune system problems. It must not be inject into a vein.

GROWTH REDUCED

Before a parent becomes concerned about the failure of a child to grow in height or weight, they should look at
themselves. If both parents are small, it is unlikely that the child is going to reach average height. Genetics play a
vital   part   in   development   and   growth,   and   many   of   the   causes   of   abnormally   reduced   growth   are   caused   by   a
defect in the individual’s genes.
    A child that is deprived of adequate nutrition will obviously not reach his or her expected height or weight, and
anyone who suffers from a long-term illness will have his or her growth affected. Conditions as varied as severe
asthma, underactive thyroid gland, heart disease (eg. hole in the heart), kidney infections or failure, coeliac disease
(inability to digest gluten in wheat), other conditions in which food is poorly absorbed, deficiencies of vitamins or
minerals (particularly zinc), Crohn disease (thickening and ulceration of a segment of gut) and cystic fibrosis (thick
mucus in lungs and gut) are examples.
    Steroid drugs may be used to control some long-term diseases, but can affect growth as a side-effect.
    Psychiatric conditions such as anorexia nervosa may severely affect the nutrition of teenagers (particularly girls)
and prevent them from ever reaching their expected height or weight.
    The pituitary gland in the centre of the brain controls every other gland (eg. thyroid, ovary, testes) in the body. If
this becomes diseased or damaged by a tumour it will have generalised adverse effects including altered growth
rates.
    Precocious puberty is the term for a very early development of adult sexual characteristics. Growth may cease
early when this occurs, resulting in the individual being shorter than expected.
     Foetal alcohol syndrome is caused by the mother drinking excessive amounts of alcohol during pregnancy, and
results in a small baby that grows very slowly in the first few years of life. Small amounts of social drinking, and
even the occasional episode of drunkenness during pregnancy do NOT cause this problem (although they are not
advisable).
    A   large   number   of   rare   syndromes   that   affect   the   individual’s   genetic   make-up,   bodily   functions   and   general
health can affect growth and result in dwarfism. A few of these include:-
          - Bassen-Kornzweig syndrome (poor food absorption, poor coordination)
          - Cockayne syndrome (blind and deaf)
          - de Lange syndrome (intellectual disability, small head, hairy skin)
          - Down syndrome (broad face, intellectual disability, slanted eyes)
          - Hurler syndrome (abnormal facial development, inflamed joints)
          - Laron dwarfism (due to lack of somatomedin C).
          - Noonan syndrome (wide neck, prominent chest)
          - Turner syndrome (female who fails to develop sexually due to a genetic defect)

- von Gierke syndrome (low blood sugar, persistent diarrhoea)
          - Russell-Silver syndrome (uneven size of body sides).

GLUE EAR

A glue ear develops when phlegm and mucus from
the   nose   pass   up   the   thin   Eustachian   tube   into   the
middle ear. It is difficult  for  these  thick,   sticky
secretions   to   escape   through   the   Eustachian   tube   to
the back of the nose, particularly if the adenoids, which
surround   the   opening   of   the   tube   into   the   nose,   are
swollen.
There   is   a   feeling   of   blockage   in   the   affected   ear
similar to that felt when descending (more common) or
ascending   a   mountain   and   being   unable   to   pop   the
ears   clear.   The   glue   may   also   be   responsible   for   a
middle ear infections (otitis media) and deafness.
    Examination   of   the   ear   by   an   otoscope  (magnifier
and light) shows an opaque and bulging eardrum, and
special   instruments   can   measure   the   pressure   in   the
middle ear. The surgical insertion of a small tube (grommet) through the eardrum to relieve the pressure is often
necessary.  Recurrent     cases   may     require   the   surgical   removal    of  the   adenoids,    which    are   lymph    nodes    that
surround the nasal opening into the Eustachian tubes. There are very good results after appropriate treatment, but
the problem may recur after the grommets fall out.
    See also EARACHE; OTITIS MEDIA

GERMAN MEASLES

German      measles     (rubella   or  third  disease)   is  a  contagious    viral  infection caused      by  a  Togavirus,    which   is  widespread     in  the  community,      and   causes
 epidemics every few years. It spreads from one person to another with coughs and sneezes, but can be caught only once in a lifetime, although an infection in a child may be so mild that it is completely overlooked. The incubation period is two to three weeks. Infection occurs most commonly in children, and produces a fine rash over the body that lasts only two or three days, is not itchy, and is not accompanied by the sore eyes and cold symptoms associated with common measles. There are often some enlarged lymph nodes at the back of the neck, and in severe cases there may be a fever, runny nose and joint pains. If a pregnant woman catches the disease between the sixth and twelfth weeks of pregnancy, infection may cause blindness, deafness, heart damage and other serious defects to her child. As a result, an antibody blood test is sometimes done to confirm the disease or determine the immune status of a pregnant woman. Paracetamol   for   fever   and   discomfort   is   all   the   treatment   that   is   necessary.
Children must be excluded from school for four days after the rash first appears. An effective vaccine is available, and all children are now given mumps, measles and rubella as a combined vaccine   at   one   and   four   years   of   age.   Once   infected   with,   or   vaccinated   against   rubella,   antibody   levels   rise
permanently and reinfection is not possible.

GASTROENTERITIS

Gastroenteritis  is  a  viral  infection  of  the  gut.  The  rotavirus  is  one  of  the most  common  viruses  responsible, particularly in children, and it often appears in epidemics, and usually in spring or early summer. It passes from one person  to  another  through  contamination  of  the  hands  and  food.  Another  virus  that may  be  responsible  is  the
Astrovirus amongst many others.
Patients develop an uncomfortable  feeling  in  the stomach, gurgling, cramping pains and  then vomiting. A  few hours  later  the  vomiting  starts  to ease, and diarrhoea develops. The  infection  lasts  from one  to  three days and
young children may become rapidly dehydrated and require urgent hospitalisation.
Usually no investigations are necessary, but faeces tests may be performed if another cause is suspected and blood tests are sometimes necessary for dehydration.
The  treatment  involves a specific diet  to  replace  the  fluid and vital salts  that are  rinsed out of  the body by  the vomiting  and  diarrhoea,  and  then  careful  reintroduction  of  foods.  In  adults,  medications  can  be  used  to  slow diarrhoea, and paracetamol can be used for belly pain at all ages. Some children develop intolerance to milk sugar (lactose) after the infection, and this may prevent them from returning to a normal diet for weeks or months.

GASTROENTERITIS DIET
    Take small amounts of food and fluids very frequently (every hour), rather than large amounts three times a day.
    DAY 1          CLEAR FLUIDS ONLY.
                   Repalyte, Hydralyte and Gastrolyte (available from chemists and taste better if cold) are best, but
                   white grape juice, clear soups, Bonox, very dilute flat lemonade, very dilute cordial, and frozen
                   cordial may be used for a short time in milder cases. Average 50 mLs. an hour for a child, 100 mLs.
                   an hour for an adult.
                   Do NOT drink plain water.
                   Isomil, Prosobee, Infasoy etc. can be used as a milk substitute in infants.
                   Lactose free milk (“Lactaid”) may be used.
                   Breast milk is perfect for infants even with gastroenteritis.
    DAY 2          LIGHT DIET.
                   Continue clear fluids and add bread, toast, boiled rice, dry biscuits (eg: quarter slice of bread, half a
                   dry biscuit every half hour) .
    DAY 3          ADD NUTRITION.
                   Boiled vegetables, fruits, white meats (chicken breast, fish), cereals.
    DAY 4          GRADUALLY INCREASE FOOD INTAKE
                   Until return to normal.
                                                                  AVOID
             All dairy products (eg: milk, cream, cheese, butter, ice cream, custard, yoghurt), eggs, red meat,
                                            fatty and fried foods until completely better.

FUNGI

Mushrooms, the green slime that forms on stagnant pools, and tinea are all related. They are fungi. Fungi are
members of the plant kingdom, and are one of the types of microscopic life that can infect human beings in many
diverse ways.