The British Medical Association

DOCTOR
HOME ADVISER

FAMIL Y

NEW

The British Medical Association

DOCTOR
HOME ADVISER
Medical Editors

FAMIL Y
DR TONY SMITH & DR SUE DAVIDSON

NEW

A Dorling Kindersley Book

LONDON, NEW YORK, MUNICH, MELBOURNE, DELHI

BRITISH MEDICAL ASSOCIATION
CHAIRMAN OF THE COUNCIL Dr Ian Bogle TREASURER Dr W J Appleyard CHAIRMAN OF THE JOURNAL COMMITTEE Sir Anthony Grabham

AND CONSULTANTS MEDICAL EDITORS Tony Smith MA BM BCH, Sue Davidson MB BS MRCP MRCGP DRCOG MEDICAL CONSULTANTS Sir Peter Beale KBE FRCP FFCM FFOM DTM&H, Peter Cantillon MSc MRCGP, Mark Furman MRCPCH, Stephen Hughes MRCPCH, Warren Hyer MB ChB MRCP MRCPCH, Penny Preston MB ChB MRCGP, Andrew Shennan MB BS MRCOG MD, Frances Williams MA MB BChir MRCP DTM&H MRCPCH

MEDICAL EDITORS

DORLING KINDERSLEY EDITORIAL MANAGER Andrea Bagg SENIOR ART EDITOR Marianne Markham SENIOR EDITORS Mary Atkinson, Nicki Lampon, Andrew Macintyre EDITORS Jolyon Goddard, Katie John, Janet Mohun, Teresa Pritlove, Hazel Richardson ART EDITORS Janice English, Chris Walker DESIGN ASSISTANCE Sara Freeman DTP DESIGNERS Julian Dams, John Goldsmid, Jason Little, Louise Paddick PICTURE RESEARCH ASSISTANT Marie Osborn PRODUCTION MANAGER Michelle Thomas OUT-OF-HOUSE TECHNICAL SERVICES MANAGER Nicola Erdpresser
SENIOR MANAGING EDITOR Martyn Page MANAGING ART EDITOR Louise Dick ART DIRECTOR Bryn Walls

DK INDIA MANAGING EDITOR Prita Maitra MANAGING ART EDITOR Shuka Jain PROJECT EDITOR Atanu Raychaudhuri EDITORS Chandana Chandra, Sudhanshu Gupta PROJECT DESIGNER Sabyasachi Kundu DESIGNER Sukanto Bhattacharjya DTP COORDINATOR AND SOFTWARE TRAINER Jacob Joshua DTP DESIGNER Shailesh Sharma
HEAD
OF

PUBLISHING Anita Roy

The British Medical Association New Family Doctor Home Adviser is not a substitute for medical diagnosis. You are advised always to consult your doctor for specific information on personal health matters. The naming of any organization, product, or alternative therapy in this book does not imply BMA endorsement; the omission of any such names does not indicate BMA disapproval.
First published in Great Britain in 1986 by Dorling Kindersley Limited, London First published in paperback in 1989, reprinted 1990 Second edition 1992, reprinted 1992, 1994, 1995, 1996, 1997 Third edition 2001 Published in the United Kingdom by Dorling Kindersley Limited 80 Strand, London WC2R 0RL A Penguin Company 4 6 8 10 9 7 5 3 Copyright © 1986, 1992, 2001 Dorling Kindersley Limited, London All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. A CIP catalogue record for this book is available from the British Library. ISBN 0-7513-2168-0 Colour reproduction by Colourscan, Singapore Printed and bound in Spain by AGT, Toledo

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Most of us realize that the majority of common. This book will give you the information you need to make the best use of your doctor. In general. People now expect that treatment of even the most serious disorders is likely to be successful. an urgent appointment. people are more knowledgable about health. or just a routine one. minor illnesses such as a cold or an attack of diarrhoea do not need expert medical assessment or complex drug treatments. For how long does a sensible person deal with the problem at home? When should you call your doctor or talk to an information service such as NHS Direct? And when do you need to make an urgent visit to the hospital’s accident and emergency department? Following the easy-to-read charts in this book will help you to tell the difference between minor problems and conditions that need immediate medical attention. DR TONY SMITH & DR SUE DAVIDSON MEDICAL EDITORS . No book can teach you how to make a medical diagnosis. the charts tell you whether you need emergency help. and this is not a guide to being your own doctor. an appointment within 24 hours. At the same time. If you do need to see a doctor. When they or their children become ill. we are now more self-reliant. is to tell you when and for how long you may safely wait for things to get better naturally. It gives practical advice on the use of home remedies and over-the-counter drugs and so encourages self-reliance when that makes sense. they want to know the likely cause of their symptoms and how quickly they may expect to get better. We hope that this book will make an important contribution to giving people more control over their own health. even if no treatment is given. The problem for people without medical training is that some symptoms such as a headache or a cough may be the first warning of a serious illness. What it does do.FOREWORD Attitudes to illness have changed enormously in recent years. These disorders are self-limiting – we can expect to get better. however. The charts in this book have been developed by doctors and reviewed by medical experts. Few events can be more alarming or make a parent feel more helpless than the sudden illness of a child – especially in children too young to describe their symptoms clearly.

.................. 85 Dizziness.. 124 Abnormal-looking faeces.................. 125 Urinary problems...... 29 Alcohol....... 23 The growing child........................................ 19 Female reproductive system......... 100 Painful or irritated ear............................ 37 Feeling unwell....... 42 6 .................................................. 90 Clumsiness..... 114 Eating problems....................... 144 HEALTHY LIVING...................................................... 136 Limping... 93 Behaviour problems............................... 156 Headache................ 49 CHILDREN: 1 2 3 4 5 6 7 8 BABIES UNDER ONE . 122 Constipation..... 84 Lumps and swellings................................................................................................................................ 15 Digestive system............................................................ 10 Muscles.... 138 ADOLESCENTS........................ 70 Growth problems............. 60 Slow weight gain.............. 142 Problems with puberty in girls.............. 66 Tiredness.............. 58 Feeding problems............................................................... 152 Fever....................................................................... 31 Drugs........................................... 68 Sleeping problems in children........................................................................... 147 Loss of weight............................ 21 The newborn baby....................................................CONTENTS CONTENTS HOW TO USE THIS BOOK........................ 146 Tiredness....... 96 Eye problems.................. 76 Rash with fever.................................................. 64 ALL AGES.............. 12 Respiratory system............. 35 Health checks and screening............. 8 SYMPTOM CHARTS 43–288 HOW TO USE THE CHARTS........................ 154 Excessive sweating............. 134 Foot problems................................................................... 160 Dizziness............................... 17 Lymphatic system................ 46 Symptom-by-symptom chartfinder.......................... 88 Confusion and/or drowsiness................ 28 Exercise.... 32 Stress.......... 39 Endoscopy........................................................................................................................................................................... 18 Male reproductive system......................... 26 CHARTS FOR CHILDREN 49–144 Contents..... 80 Hair......................... 48 Skeleton............................................ 20 Conception and pregnancy............................................................ 106 Sore throat...................................... 28 A healthy diet... 35 Visiting your doctor...... and nail problems.................................................................. 145 56 57 58 59 60 61 62 63 64 65 Healthcare throughout life............................................................. 16 Endocrine system..................................................................................... 11 Cardiovascular system.................. 140 Problems with puberty in boys.......................... 162 MEDICAL TESTS................................... 86 Headache......................................................... 35 Contents................ 150 Difficulty in sleeping......................... 102 Adolescent weight problems............................................................................................... 120 Diarrhoea in children................................................................................. 62 Skin problems in babies........... 143 Adolescent skin problems..... 36 Immunization............................................................................. 107 Coughing.............................. 98 Disturbed or impaired vision.. and seizures........ 128 Genital problems in boys.......................................... 112 Teeth problems......................................................................................................................................................... 139–144 YOUR BODY AND HEALTH 9–42 YOUR BODY............................................. 133 Joint and back problems............................................................................................................................. 118 Abdominal pain................... 38 Physiological tests......................... 52 Fever in babies........................................................................................................ 94 School difficulties................ 92 Speech difficulties................................................... 54 Vomiting in babies.............................................................. 38 Testing samples............................ 33 GENERAL CHARTS FOR ADULTS 145–240 PROFESSIONAL HEALTHCARE.................................. 74 Fever in children. 31 Sex and health.............. 82 Itching................... 30 Tobacco..................................................................... 17 Urinary system...... 66–138 CHILDREN: 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 CHILDREN: 51 52 53 54 55 Feeling generally unwell..... 10 System-by-system chartfinder.............................................................. 132 Painful arm or leg.......... 32 Safety and health............. 50 Excessive crying..................................... 13 Nervous system. 39 Imaging tests......... 24 Growth charts.......................................................... 126 Toilet-training problems..................... 139 Adolescent behaviour problems................................... 14 The senses................................................ 116 Vomiting in children.. 44 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Hearing problems..... 56 Diarrhoea in babies............................. 148 Overweight. 104 Runny or blocked nose........................................ 78 Skin problems in children........................... 72 Excessive weight gain.......... scalp.............. fainting...... 108 Breathing problems...... 50–65 Sleeping problems in babies................................................. 130 Genital problems in girls......... 158 Feeling faint and passing out....... 110 Mouth problems.

................ 294 Cardiopulmonary resuscitation (CPR)... 178 Skin problems affecting the face....................... 285 CHARTS FOR MEN 241–254 149 Breast problems and pregnancy.................. 216 102 Swollen abdomen................ 186 Disturbed or impaired vision........ 311 for women....................... 290 ABC of resuscitation.... 249 125 Low sex drive in men......................... 280 144 Abdominal pain in pregnancy................................................................. 262 132 Painful periods... 235 116 Foot problems................... 197 Coughing... 263 133 Irregular vaginal bleeding........................ 256 129 Bladder control problems in women.................. 190 Noises in the ear..... 224 109 Painful urination..... 163 Forgetfulness and/or confusion............................................. 175 Hair and scalp problems............................. 281 145 Skin changes in pregnancy............... 226 in women...................... 220 105 Constipation..... 301 Fractures............ 188 Hearing problems...... 172 Lumps and swellings................................ 230 112 Painful arm.......... 219 104 Diarrhoea.............................. 228 111 Painful shoulder............ 244 121 Erection difficulties......................................................................... 300 Spinal injury.................................... 195 Hoarseness or loss of voice.................................... 222 107 Anal problems......................................................... 298 Severe bleeding............ 284 148 Recognizing the onset of labour..... 279 143 Vaginal bleeding in pregnancy................................................... 164 Twitching and/or trembling.................................................... 269 137 Painful intercourse in women.. 252 127 Contraception choices for men.................... 276 141 Nausea and vomiting in pregnancy.. 174 Itching............................. 214 101 Recurrent abdominal pain............. 240 142 Weight problems and pregnancy.......... 232 114 Painful knee............................................................................ 302 Bites and stings........................ 170 Anxiety................. 196 Wheezing.................................. 254 CHARTS FOR WOMEN 255–288 Contents................. 236 117 Back pain....... 221 106 Abnormal-looking faeces......................... 209 Vomiting......CONTENTS 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Numbness and/or tingling...... 299 Severe burns..................................................... 282 146 Swollen ankles in pregnancy.................. 260 131 Heavy periods.. 298 Anaphylactic shock.... 241 119 Bladder control problems in men..................... 234 115 Swollen ankles.......... 270 138 Low sex drive in women...... 305 USEFUL ADDRESSES.................... 242 120 Problems with the penis.............................................. 296 Shock...................................................................................................................... 248 124 Painful intercourse in men...................... 272 139 Fertility problems in women.... 300 Major seizures......................................................................................................................................................................................... 255 128 Breast problems...................................... 212 110 Painful joints.............................. 278 INDEX & ACKNOWLEDGMENTS........... 250 126 Fertility problems in men................................................................................................... 180 Skin discoloration and moles. 304 Using drugs safely.................................................. 247 123 Testes and scrotum FIRST AID 289–302 AID.... 176 General skin problems. 193 Runny or blocked nose............................................................................................................................ 198 Shortness of breath. 304 A–Z of drugs...................................................... 314 7 ........................................ 258 130 Absent periods.......................... 274 140 Contraception choices How drugs affect you................................................................................... 166 Pain in the face.................. 200 Chest pain..................... 194 Sore throat............... 202 Palpitations. 286 150 Depression after childbirth........................................................... 182 Rash with fever.............................. 210 Recurrent vomiting..................................................................................................................................... 185 Painful or irritated eye... 301 Swallowed poisons..................................................................................... 218 103 Wind...................................................................... 304 100 Abdominal pain...... 184 Nail problems. 167 Difficulty in speaking...................................................................................................... 223 108 General urinary problems....... 283 147 Back pain in pregnancy................................ 288 Contents........................ 264 134 Abnormal vaginal discharge.......................................... 169 Depression. 204 Teeth problems.... 268 136 Lower abdominal pain DRUGS GUIDE AND USEFUL ADDRESSES 303–313 DRUGS GUIDE.............................................. 266 135 Genital irritation........ 208 Difficulty in swallowing....................................................................................................................................................................... 302 FIRST problems.......................... 238 118 Painful or stiff neck....... 168 Disturbing thoughts and feelings................................................ 299 Unconsciousness................................................................................ 291 Recovery position.............................. 246 122 Ejaculation problems........................................ 293 Choking.............................................................. 231 113 Painful leg......... 206 Mouth problems................................................................................................................ 292 Artificial respiration........................................................... 290 Action in an emergency................................................... 192 Earache............................................................

34). and can also be and re-apply it every 2 hours. This condition is usually due to infection and is rare in women who are not breast-feeding. start with a thus promoting mental The body requires a range two adjacent bones. MEDICAL Testing samples TESTS Tests on body fluids Tests may be performed on body fluids from wounds or abnormal areas of skin. before theyfrom cells. Background information on how the body works and how to keep it Your body and health You will find general information about the body and health in this highly illustrated section. Listening to the chest The doctor uses a stethoscope to listen to sounds within the chest. peas Energy production. Cells may be obtained from body fluids such are ill and are also involved cansome vibration Lung function be tested in various ways. or by tapping areas and listening to the sounds produced (percussion). CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. One type is with machinery certain melanin. are fixed.HOW TO USE THIS BOOK HOW TO USE THIS BOOK healthy precedes the charts. at the start of each group of charts. daily activities such as foods. If necessary. X-ray images are often used to assess bone injuries such as fractures or disorders such as arthritis. and the symptomby-symptom chartfinder (p. In rare cases. other causes include lack of square on theuse of change. Wearing a nipple shell inside your bra during pregnancy may help to draw the nipple out in preparation for breast-feeding. Naturally lumpy breasts do not require treatment and do not increase the risk of breast cancer. If there is a chance you might be pregnant. meat. To become fitter or lose weight. Muscular organs. a cancerous or noncancerous growth affecting a milk duct is the cause. of arm Many muscles are found in pairs. and boneschemicalpelvis. in some cases.41) and aspiration (see ASPIRATION OF A BREAST LUMP. mood swings. • If heat does not provide relief. Do both your breasts feel lumpy? NO YES POSSIBLE CAUSE AND ACTION Some women have lumpier breasts than others. resulting in the spinal column gradually becoming hard and inflexible). This technique can identify whether or not the lump is cancerous. Stand up straight. Food groups YOUR Skeleton BODY limited amounts shape. or from internal areas such as the inside of a joint or around the brain and spinal cord. begin exercising Muscles are controlled by signals from the nervous system. and also covers pregnancy. Diet has a major influence on health. Consult your doctor. followed This type of movements to old bone with new material. Fibula Heart and lung tests Looking after your health involves not only following a healthy Before your first appointment with a new doctor. containing a varietyGloves help give a definitive diagnosis for many of cells. edible fish bones Eggs. Y O U R B O D Y A N D H E A LT H Y O U R B O D Y A N D H E A LT H Y O U R B O D Y A N D H E A LT H The major part of this book consists of 150 question-andanswer symptom charts. Some of the main skeletal muscles are disease 15–20 mg Vitamin B3 minerals. Try to keep completely still while waiting for an ambulance. show lung capacity (to check for needle and syringe. of Tests on faeces Samples of faeces may be tested for infectious microorganisms or for evidence of digestive disorders. Glance at the victim’s chest. You have your lifestyle. Your employer stick into a sample of urine to or BS2724 and give maximum protection show the presenceyou concentration should the presence of infectious of any risks and of specific substances. When you find a likely practice. • Do not eat fried foods or excessive amounts of chocolate. shoulder blades. such as an apple. carrots. This from may be carried out if the doctor suspects that test debris there may be bleeding in the digestive tract. CONSULT Lifting safely Bend your knees when you pick up an object. The recommended amount is at least 30 minutes of moderate exercise. X-rays may also be used in other imaging techniques. support. do not move the victim 4 Lift your mouth away. heart. Many chemicals are toxic the middle of the day.41) to confirm the diagnosis. a urine sample. normal aging may also cause a nipple to become indrawn. In addition. The axial skeleton –minerals spine. Drivers should of the squares. or of a larger sample of tissue Heart rhythm and rate can be asked to fill in which the electrical lifestyle but also making effective use of the healthcare system. but occasionally affected milk ducts may need to be removed surgically. U D G G D DD 8 . test results Nearly all accidents are chemicals in clothing and sunscreens. In addition. CHARTFINDERS The system-by-system chartfinder (pp. damage to the spinal cord may be the cause. In addition. posture. fish. joints. ACTION In hospital. gland and eyes. clothing.32) or take up an exercise such as yoga. X-rays pass through the breast tissue onto the plate. disorders needle diagnosed and treated by general practitioners asking questions.minerals because these substances alertness. Types of Some tests are used to establish whether nerves are able to conduct contrast X-ray include barium contrast X-rays (p. t Examining your breasts Keeping your fingers flat. In some cases. dairy products. 128 Breast problems breast cancer can often be successfully treated. care not powerfully. ACTION Your doctor may arrange for you to have either mammography (opposite) or ultrasound scanning (p. the lump can be diagnosed as a breast cyst. such as those quickly and to overexertbut can so that you are in pain or feel ill. The improve mood branching. you will be examined and will probably have tests such as CT scanning (p. due to poor posture while sitting at a desk. After reactions amount of time. Samples are taken by biopsy. Sunglasses used to assess kidney function.if you are up to date with immunizations and screening. may need to be collected during a hospital procedure. which moves the limbs and body. • Rest in bed if the pain is severe. Heart cardiovascular. formed by bacteria in intestines Leafy green vegetables. such as eczema. Follow self-help measures for relieving back pain (opposite). The procedure takes about 20 minutes and is painless. or violent movement? NO Are any of the danger signs in the warning box (right) present? NO YES WA R N I N G DANGER SIGNS Call an ambulance if you have back pain or have recently injured your back and you develop problems with either bladder or bowel control. such of long. Did the pain come on suddenly after an extended YES stay in bed or confinement to a wheelchair. 5 µg 10 mg 70 µg 200 µg at least 800 mg 14 mg Dairy products. Two sitting. maintains the body in an upright position. However. Ligaments STRUCTURE OF BONE Toe bones (phalanges) Abductor of big toe FRONT VIEW BACK VIEW Biceps contracts BENDING THE ARM Feet rest flat on the floor 10 11 34 35 Symptom charts The Symptom Charts are grouped according to age and/or sex – there are charts for children of different ages. road trafficaaccidents result in shows possible thousands of deaths and is put into young children wear protective When a dipstick injuries each year. Different types your diet Swimming Tennis Blood tests Blood tests can be used to find information about the blood itself and to assess the function of other parts of the body. hair. If The skeleton provides form. p. You have the right to see your own or your child’s records. tests show howwhich are transferred if you change to another GP. try using an ice pack (or a wrapped pack of frozen peas). You may also wish to ask if you can choose a female doctor rather than a male doctor (or vice versa). there are cross-references to take you to pages with further information. Semimovable joints. alcohol. the genital and urinary tracts. The samples are then usually sent to a laboratory for analysis. typesmuscle damage. more oxygen from each Temporoparietal Occipitofrontal Temporoparietal hips down and forwards to Shoulder blade (scapula) Breastbone (sternum) Vitamin D meat or other animal products (the usual Vitamin E source of this vitamin). parallel fibres the body’s while the other The supply of blood to work at maximum strength the correct protective equipment. PET. fall. such as infection in the lungs. p. proteins. Most tests on body samples are carried out in a laboratory. ears. as you do information as the skin (see SKINdebris.217) or a contrast X-ray of the kidneys (see INTRAVENOUS UROGRAPHY. It is also crucial in weight control. including plenty of carbohydrates and fibre. it is important that you try to remain active and take weight-bearing exercise. POSSIBLE CAUSE Osteoarthritis of the spine is probably the cause of your symptoms. such as the liver or kidneys. others by a doctor. to measure of level of cholesterolor heavy objects may put you at risk in the blood. If the lump is solid. If your backache is severe or is no better within 2 days. nervous External system intercostal Red blood cell formation.227) to look for an underlying cause. and some of urinary asbestos. in many substances apart start to the long term. found in the walls of the digestive tract. Leafy green vegetables. Most urine hazards include loud noise and tests are dipstick tests. in the body. dorsi arms. Nervous system tests HEALTHCARE Urine tests Microscopic studies of individual cells. X-ray machine X-rays Compressed breast X-ray machine Plastic cover Most people have at least one episode of back pain during their lives. physiotherapists. which may be due 38 to factors such as demanding situations or poor relationships with colleagues. and blood samples by the doctor in his or her surgery. that doctors and other healthcare professionals can provide. and a test of nervous reflexes. If diagnosed early enough. eggs.301). you will be prescribed antibiotics. such as those made by the heart and lungs. breast cancer is a possibility that needs to be ruled out. and they usually recover without needing medical help. and online sites of support groups for different conditions and sources for additional health information. dairy products. organ meats. Protecting children’s skin can be performed at home (see HOME PREGNANCY your . flexors bend 1 mg Vitamin stretches are shown here. Over-the-counter painkillers should help to relieve your symptoms. Types of joint Walking A N D H Most people know that exercise is an important part of a Y O U R B O D Y(briskly) H E A LTHH Yoga H healthy lifestyle. Other or diabetes. and avoid large amounts of salt. and some practitioners of complementary therapy. It consists of 33 bones called vertebrae. you will have to wait for an appointment that is not urgent. The Collarbone supplements. NHS Direct. or if you have any health concerns. such as the liver. Two of the most common physical conditions are lower back pain. muscles. so some tests are available that use other forms of energy. Foods in the larger segments of the chart should form a greater part of your diet than those in the smaller slices. (cells that Overexposure to the sun may lead to sunburn. Press gently with the pads of your fingers AREA TO BE EXAMINED Monitor Needle Does the skin around a nipple look abnormal? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION You may have a slipped disc (a ruptured disc of cartilage between the vertebrae) that is irritating a nerve where it leaves the spinal cord. Using thyroid gland. If you are particularly worried. accurate heart are recorded vibration. You are asked to look at a screen and press a button when you see flashes in different areas of the screen. used to image impulses normally. a bacterial infection of a kidney. Another and intravenous urography (p. Tongue depressor such as saliva. you should seek medical advice immediately. moves the skeleton. it pulls Triceps on the bones to move them. If you have never exercised regularly before. Imaging tests In imaging tests. and fluid-filled areas. and can marrow in the bones of the heartbeat women need extra(clavicle) for the folic acid Milk. Repeat the process with the other breast. Raise arm POSSIBLE CAUSES You may have a skin condition. there is a contents list of the charts in that group. ask your employer for help in minimizing these hazards. you can use a height and weight chart such as the one shown below. If your doctor suspects Paget’s disease. Pedestrians should use pavements or footpaths. effects of check and exercise ECG (below). such as B2. Vitamins D and K can bones are living tissue with cells that are constantly replacing be made in mineral physical changes that of the heart. small circular movements. They should ensure that their lights work properly. Most appointments last 7–10 minutes. Although the majority of breast problems are not serious. you could also ask friends and neighbours if they can recommend anyone. and repetitive strain injury (RSI). you may be prescribed corticosteroid creams. and ribcage – consists of 80 bones and protectsof vitamins known as synovial joints. breast cancer is one of the most common cancers in women. Keep babies out a In Testing with dipstick ofcertain substance the sun. p. The tests may involve looking for infectious microorganisms.105). Regular exercise benefits most of body. and increase muscle strength. but it usually takes less than a minute to carry out. are also run on the basis of self-referral. • Reduce your salt intake. provides advice on health by telephone or on the internet (see USEFUL ADDRESSES. you will probably be referred for tests such as mammography (above). but some may be performed in a doctor’s surgery or even at home. but you should consult your doctor. liver. peanuts. peas. He or she may also check for abnormalities by listening to organs with a stethoscope (auscultation). In addition. ACTION Your doctor may arrange for blood tests and an X-ray (p. Skull minerals. consult your doctor. p. X-ray detector POSSIBLE CAUSES A noncancerous growth or cyst are the most likely causes of breast lumps. calcium. bananas Blood formation. A risks to protect yourself and to grow ensure urine pregnancy to safety produced in pregnancy is the basis of thethat you conformtest.32). These physiological tests are commonly used to assess vision and hearing. medications. muscles breath and supply more Splenius oxygen to Orbicular of eyethe body head of How muscles thigh. One common test is the faecal occult Helmet blood test. and water. head. and the heart and lungs. help blood to clot). but do not stay in bed for more than 2 days. pregnant with every Meat. Y O U R B O D Y A N D H E A LT H Y O U R B O D Y A N D H E A LT H HEALTHY A healthy diet LIVING Meat. such as sperm in a sample of semen. margarine Teeth and bones This pie chart shows the five main food groups and the proportion of your diet that each group should form. housework. p. Abnormalities may be the result of something the digestive tract. warming-up routine and the brain. p. some tests can reveal the presence of diseasecausing microorganisms. potatoes. put one arm behind your head. in many cases as a result of tasks such as lifting excessively heavy weights. can activity in the heart muscle is recorded: electrocardiography (p. Feel around the whole breast. but it can give rise to various health problems. If there is no path. If your pain is severe or if it has not improved within 48 hours. 39) to detect abnormal areas of breast tissue. and charts specifically for men and women. body. and wear reflectors or bright clothing to make them visible to other road users. CROSS-REFERENCES Throughout the book. they should walk on the same side of the road as oncoming traffic.work. treatments that you are pass through it tohad. Severe back pain may be due to pressure on a nerve or. a high-fat diet increases your risk of heart disease. Your doctor may refer you for physiotherapy to help you strengthen the muscles that support the spine.systems. skin. Blood carries if necessary. If you then visit your doctor with a disorder or unexplained symptoms. • Take over-the-counter nonsteroidal antiinflammatory drugs. serious problems such as skin cancer. quickly the lungs fill and health education. the higher the dust. Safety on the road Having a liver biopsy Healthcare providers Electrode including practice nurses. and care and clinics for immunizations and for minor surgery such as wart a core of liver is removed. You will also be referred to a physiotherapist. which is the maximum rate at which you can (shinbone) records. are illustrated below. such as the thyroid are outdoors. one on each side of a joint. Calcium pregnant women should avoid foods that contain high levels of vitamin A Iron because of potential harmful effects PLANE JOINT on the developing fetus. there are detailed instructions on how to use the charts. your back Does the pain prevent you from moving. or discs of START HERE Did the pain YES follow an injury. strong. compressing a nerve or a disease such as diabetes mellitus. and you should aim to drink at least 8 glasses (2 litres) a day. In Biopsy NHS addition. interlinked fibres that gentle These types of routine involve collarbones. Child seats medications they are taking A car seat for a child should cushion will not cause them to feel the child from possible injury and drowsy. D. eggs. Consult your doctor. Eggs. Recurrent mastitis may need surgical treatment to remove affected milk ducts. consult your doctor.256). These cells are then sent to a laboratory to be examined under a microscope. and pasta are high in fibre. Breast lump YES Are you female and pregnant? NO YES Bone densitometry This technique uses low-intensity X-rays (p. or are you over 60? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have a crush fracture of a vertebra as a result of osteoporosis. a prolonged period of immobility will also lead to the development of osteoporosis. Continued on next page Go to chart 147 BACK PAIN IN (p. such as swimming.101). the tongue may block the throat and prevent air from reaching the airways to the lungs. In addition. checking for changes in the size or shape of your breasts. surfaces such as the cervix (see CERVICAL SMEAR TEST. Treadmill Mobile table Your medical history Having an X-ray You are positioned on or against a Drawer containing film cassette Control panel Triceps contracts Internal oblique of abdomen Long adductor of thigh Gracilis Biceps relaxes Abductor of finger Sartorius Rectus of thigh Anterior tibial Popliteal Biceps of thigh Gastrocnemius Posterior tibial Long flexor of big toe Soleus Achilles tendon Short extensor of toes STRAIGHTENING THE ARM Young children should have car seats that are appropriate for their size and weight.205). your medical history can help him or her to reach a diagnosis. Infants 292 Drugs guide and useful addresses The Drugs Guide tells you how drugs work and how to use them safely and includes concise profiles of over 35 major drug groups. GP practices provide a range of services. The procedure is uncomfortable but lasts only a few seconds. If fluid is withdrawn into the needle instead of cells. such as silica (found in sand factor. This process. and nuts are rich in protein. SELF-HELP Premenstrual syndrome Premenstrual syndrome is a group of symptoms. Wear a wideor have other harmful effects such brimmed hat. while ligaments and muscles stabilize it and control movement. but may also be taken from capillaries (tiny blood vessels) by a finger prick or occasionally from an artery. and encloses and protects the spinal cord. and cola. and flying BIOPSY about increasingly intense exercise. They can form a fairly large part of your diet. ranging from giving artificial respiration to someone who has stopped breathing to how to staunch severe bleeding. most PIVOT JOINT B1 Blood pressure is reduced. which regulations for TEST p. Dipstick tests are usually performed in aequipment. organisms. questions is known as a medical history. and measure not hesitate to ask questions about your take cells from the During a visit. Eat plenty of high-fibre foods. correctly across his or her body. X-rays to having or have a cassette disorders that could run in your family. cells will be collected in the needle. and put your hands Bones maintain produced by the interaction of Latissimus on Keep your their strength and skeletal the floor.190. foot on the Kneel. consult your doctor. by feeling (palpation). In addition. and VISION TESTING IN CHILDREN. density so that they and body are less prone to joints. To do this. and aspects of to keep still during the procedure so from image such as diet and exercise. can evidence rocks) and Apply it 15–30 Urine is most commonly tested fordamage the lungs if tract infections minutes before you go outside inhaled. eggs. fish.257). stretch the back work Semispinalis of head Trapezius Repeat for the other thigh. However.203). Consult your doctor. Rarely. and should cross roads at pedestrian crossings.239). improve joint mobility (increase flexibility). it has to be regular. abductors people’s diets supply the recommended Jawbone and this decrease helps while you Rest your hands surrounded by spongy bone. Treatment is often not necessary. or reveal the presence of abnormal substances or abnormal levels of normal substances. can be collected Swab by the individual. Once your back pain has cleared up. To minimize the riskthe sun damage. such as a brisk walk. Consult your doctor. abnormal cells such as cancerous cells. these tests range from conventional X-ray procedures to the computerized technique of CT scanning. INDEX If you still cannot find what you need. water is vital for life. Sit with your back straight and feet on the floor. Some forms of sunscreen with a suitable sun protection factor (SPF). 39 Having a physical examination When you see your doctor. Object directly in front of you During the procedure A fine needle is attached to a syringe and inserted into the breast lump. are often the first investigations requested by a doctor before making or confirming a diagnosis. supply protective doctor’s office. Planning an exercise routine For exercise to be beneficial. in which bones throughout the body become thin and weak. dry beans. p. Hospital clinics for the treatment of sexually transmitted infections. Techniques are described for treating babies. essential for building and repairing cells. For breast problems during pregnancy or after giving birth. You can also assess your weight by calculating your body mass index (BMI). offer. vitamins. supports the head. It is wise to find out about any potential risks associated with your work and take action to prevent them. must come from food. The charts help you find a possible cause of many symptoms that may affect you or your child and tell you what steps you should take. FIRST AID Recovery position The recovery position is a secure position in which to place a person who is unconscious but breathing. or dimpled skin. theneedle helpline. Consult your doctor.314–319) covers every subject within the book. Tests on samples of faeces are Ear usually carried out in a laboratory. and tiredness. The procedure is painful. ribs. They can also be high in fat. will ask further questions and Fracture On your first visit. others display measure how well sounds of varying pitch and volume can be heard or. Use a as burning the skin. all the pages in this section have a red bar running down the edge. A stethoscope is also used to listen to sounds made by the intestines or by blood flowing through vessels. In some cases. ask about their opening hours and how long. spindle-to which is in turn surrounded by cardiovascular hips Fish. The visits. Blood cell tests include try to with stressful situations. cardiac muscle. and vegans need spine. fatty material tiring. a serious cause is unlikely. you will become familiar with their normal appearance and feel and find it easier to notice changes. At the start of the charts section. In some cases. aligned. if there is evidence that you are at risk of developing certain disorders. Safety at work 29 Both office work and manual jobs can involve certain risks to health. . Y O U R B O D Y A N D H E A LT H The samples are usually taken from a vein. It comprises short. Cellscheckups during childhood and later in life. Other tests involve assessing cells or other substances that are normally found in the fluid. green vegetables (mandible) daily allowances (RDAs) of vitamins and to or hold up parts of move your pull limbs outwards. The examination usually begins with a check of external areas. Allthat occur in the (the of the processes stress. X-rays carry the risk of exposure to harmful radiation. you should take steps to prevent a recurrence by following the self-help advice for taking care of your back (opposite). on at least 5 days of the week. nuts Dairy products. There is a range of tests for hearing. POSSIBLE CAUSES A change in a nipple may be a sign of breast cancer. which involve dipping a chemically treated should have British Standard mark extreme temperatures. Treatment of noncancerous lumps is often unnecessary. The disorder is most common in women who have passed the menopause. and do you feel generally unwell with a temperature of 38°C (100°F) or above? NO POSSIBLE CAUSE You may have damaged your spinal cord. Mammography is offered every 3 years from age 50 to 65.H E L P Breast self-awareness If you examine your breasts regularly.227). whether it involves professional help or selfhelp. Push your extra vitamin B12 because they do not eat manufactures blood cells. For example. ACTION Initial treatment for the pain is with painkillers. sitting on your heels.48) alphabetically lists all the symptoms and can direct you to the appropriate chart. such as the lungs. often including bloating. it may be due to a problem with an internal organ such as a kidney. and K. The contrast medium blocks X-rays and makes the area appear white on the image. who will examine your breasts to make sure that there are no individual lumps that require investigation. called aspiration. p. These include Tibia peak flow rate (p. it is associated with other symptoms of premenstrual syndrome. Did the pain come on after lifting a heavy object or after undertaking an unusually strenuous exercise? NO During the procedure The X-ray generator and detector move along the length of the spine. measuring the numbers of red and white blood cells theseof platelets or seek help resolve and problems. Follow self-help measures for relieving back pain (opposite). If you are not pregnant. the colours and impair drivers’ judgment. You aretests can measure the levels of these substances. Aspiration of a breast lump Aspiration involves removing cells or liquid from a breast lump using a needle and syringe. records the electrical activity produced in the brain and is useful for the diagnosis of disorders such as epilepsy. ACTION Your doctor will examine you and arrange for a urine test. and ultrasound scanning uses sound waves. keeping your hands in place to maintain the victim’s head position. larger lumps may be surgically removed. empty early signs of disease. their functions. Medical Tests covers procedures that doctors may use to diagnose and assess disorders. Sit in a position that maintains good posture and enables you to use the keyboard comfortably. and some vitamins and minerals. Specific treatment for osteoporosis depends on the underlying cause. ACTION Your doctor will examine you and arrange for you to have a blood test and X-rays (p. Some large practices also have other healthcare providers need to stay in bed for up to 6 hours. in the upper arm the triceps contracts to pull Ulnar the arm straight and extensor the biceps contracts of wrist to bend the arm. which can have a lot more energy for ordinaryand smooth muscle. and Extensor produce opposing movements. find out about If the to Apply sunscreentest suggests an infection. the nervous system. Do not take SADDLE JOINT more than the recommended amounts Vitamin K of vitamins A. a type of muscle strain caused by repetitive movements such as typing. WA R N I N G If you suspect a spinal injury (p. and certain vitamins. dentists.40) to look for the site and extent of any damage. E. consult your doctor. and avoid wearing high-heeled shoes.5 mg Vitamin B2 BALL-ANDjoints. changes occur that skeleton has 126 bones and consists of the limb bones. The breast is positioned in the X-ray machine and compressed so that the breast tissue can be easily seen on the X-ray. bones. Be aware of your posture when sitting at a desk (see SAFETY AT WORK. Each experience. such as the mouth. teeth. such as the bladder. you should make sure that your work space is well ventilated and is well lit. Bones the body. Has your YES back gradually become stiff as well as painful over a period of months or years? NO POSSIBLE CAUSE You may have ankylosing spondylitis (inflammation of the joints between the vertebrae. Some samples. peas. you can find information on dealing with major emergencies. However. you can find out how to stay healthy and minimize the risks of common disorders. t EMERGENCY! CALL AN AMBULANCE Do you have a tender. However. from mucous membranes such as those of the nose and throat. Regular exercise protects physical and mental health. equipment safely breasts (see ASPIRATION OFget the most from what professional healthcareEASURING BLOOD health and treatments. and ensure that The chart the UK. spinal cord. More complex may also be withdrawn from the body using a screening tests to identify risk factors and (to detect narrowed airways). muscles 1. Aim to eat at least five portions a day. which is inflammation in the breast. such as mood changes and bloating. Tests on cells are often used to diagnose cancer or other professional healthcare workers provide ambulatory electrocardiography (p. leafy green vegetables HINGE JOINT Humerus Rib Spine Ulna Radius Wrist bones (carpals) Hand bones (metacarpals) Finger bones (phalanges) Kneecap (patella) Muscles become stronger Erector Greater pectoral and more efficient so that of spine they can work for longer Deltoid of time periods Joints become stronger and more flexible and mobile as Biceps a result of exercise of arm 28 Cervical vertebrae (7 bones) The spine The spine. if you have a strong preference in this matter. If pain is severe or no better within 48 hours. ACTION The self-help advice for premenstrual syndrome (opposite) may reduce breast tenderness. and feel confident about Under local anaesthesia. such as coffee. • Try taking the recommended daily allowance of a vitamin B6 supplement. surgery may be needed.6–7) lists every symptom chart as well as the main headings in the other sections of the book. advice over the telephone. Deeper to form and thigh stretchwork for Hip sheets.260). However. ACTION Your doctor will examine your breasts. intestines. you will have to exercise harder. Stretch muscles to contract. Response button X-rays Exercise Muscles Bread. The main types of and footwear for your sport. lb 210 190 WEIGHT 170 150 130 110 90 kg 100 90 80 70 Height/weight graph for men and women OVERWEIGHT Fitness benefits of different activities Activity Fitness benefits Stamina Aerobics HHHH HHHH HHHH HHH HHH H HHH HHHH HHHH HH Flexibility HHH HHH HH H HHHH HH H HH HHHH HHH H HHHH Strength HH HH HHH HEALTHY WEIGHT 60 50 40 144 57 Basketball Cycling (fast) UNDERWEIGHT 150 59 156 61 162 63 65 168 174 180 71 186 73 192 75 cm 77 in Climbing stairs Dancing (aerobic) Golf Hiking Jogging HHH H H HH HH HHHH HH H H Milk and dairy foods provide protein. Do you have pain in one side of the small of your back just above the waist. ACTION The doctor will examine your breasts and may arrange for mammography (above) to exclude an abnormality in the underlying breast tissue. which help you determine the possible cause of a symptom and what to do. dense tissues such as bone let few rays through and appear white on the image. and long trousers or skirt. However. The ability of the rays to penetrate tissues depends on the density of those tissues. your doctor will suggest preventive measures or screening to detect early signs. symptoms. X-rays are passed through the body. and breast X-rays are used to screen women for breast cancer (see MAMMOGRAPHY. Most a hollow can be ECG trace is inserted into the liver through a small (GPs). A BMI figure under 20 indicates that you are underweight. A major cause the squares along the stick of errors in driverscause a colour react and is alcohol abuse. starches. Many tests use X-rays. Rarely. Do you have a single lump in a breast? NO m YES POSSIBLE CAUSE AND ACTION Mastitis. the doctor can gather information about other areas apart from the one being examined. It is therefore important to familiarize yourself with the look and feel of your breasts (see BREAST SELF-AWARENESS. YES POSSIBLE CAUSE AND ACTION You have probably strained some of the muscles and/or ligaments in your back. If you are found to have ankylosing spondylitis. In this condition. are usually collected with a swab – a sterile cotton bud on a plastic stick. Finally.183) or the liver (below). known as EEG. and provide B vitamins and minerals such as iron. after them. Do you have a discharge YES from a nipple? NO POSSIBLE CAUSES Nipple discharge is usually due to hormone changes and is no cause for concern. feel around the whole breast and armpit area in small circles. or of oxygen (see M has to OXYGEN. skull.260). which shows the urinary tract. Anyone who has young children should ensure that Bright clothing they learn about road safety. For example. divide your weight in kilograms by the square of your height in metres. Each safely and vessels. protectors loud noise Cell and tissue tests cut out Safety in the sun H H H Very good H H H H Excellent effect effect PROFESSIONAL should be eaten in muscle has a different function and consists of fibres of a particular Healthcare throughout life Visiting your doctor X-rays are a form of radiation that can pass through body tissues to leave an image on photographic film. and improve KEY Fatty foods. Motorcyclists and cyclists need helmets and clothing that will protect them from adverse weather conditions and injury. ligaments. and producing Necessary for Food sources Vitamin or RDA skeletal muscles not only move parts of the body but also form a network within the walls jogging. consult your doctor before starting an exercise routine. you may be X-ray machine Orbicular of mouth Maintaining cell membranes Blood clotting. by a seriesof muscle help to maintain the posture when a person is standing. natural sugar. The results of tests on body samples can provide information on the function of certain organs. and lungs. skull. Regular gentle exercise may strengthen your abdominal and back muscles and help Upper body you lose any straight excess weight. p. in all cases. and adults. such as cell and tissue samples and certain body fluids. place it over the painful area for 15 minutes every 2–3 hours. Conscious your arms above your head. You will then removal. Cells or fluid are then carefully withdrawn. but certain people may need steady yourself the skin illustrated more blood shaped fibres that are connected denser compact bone. a pigment dangerous. Skeletal muscle. During the procedure Your breast is compressed between the plastic cover and X-ray plate. The images can also show disorders in some soft tissues. Paget’s disease. make sure that your wrists are supported while you work. especially high risk if you have red or blond hair and greento detect kidney. such as slow body). which shows blood vessels. the heart.264). such as the heart. Brakes must be checked regularly for wear and tear Intervertebral disc Vertebra Gastrocnemius Areas where ribs are attached Sacrum (5 fused bones) Coccyx (4 fused bones) THORACIC VERTEBRAE Triceps relaxes Foam-rubber rest supports the wrists for typing Tyres should be inflated to the right pressure Ankle bones (tarsals) Foot bones (metatarsals) Long extensor of toes Short extensor of big toe Your work station Arrange your desk and equipment so that they are positioned correctly for you. Your doctor will probably prescribe antibiotics to treat infection. limit foods with a high fat or sugar content. You should have a supportive mattress on your bed. a pale-coloured tongue may be a sign of anaemia. with further support from as those in the skull. Your doctor may recommend either physiotherapy or manipulation of the spine. POSSIBLE CAUSE AND ACTION You have probably bruised or strained your back. Another common problem is psychological stress (p. nervous system Extensors straighten joints. and D. it may be a sign of damage to the joints. the greater the protection it gives you. which can reveal tiny amounts of blood invisible to the shields head naked eye. appear grey. energy is directed at or introduced into body tissues and detected by machines to produce images of internal structures. such as osteopaths. ask whether the practice offers home visits. It can also reduce your risk of developing Types of muscle long-term disease. aerobic exercise. nervousmore superficial muscles are shown on the right. left) to rule out breast cancer. services provided by other healthcare professionals such as nurses. ACTION Your doctor will examine your breasts and will probably arrange for tests such as mammography (above) to exclude a problem deeper in the breast. you should see the chest fall as air leaves the lungs. blood everyone should stay out of the sun in chemistry tests are performed to see injury. Other imaging tests include radionuclide scanning. do blood levels disorders that cause the lungs lungs. Vision and hearing tests The most common vision tests measure the ability to focus (see VISION TESTING. and nails. spine. treatment when you in for genetic disorders. fish. One end of theand respiratory systems. If your injury or symptoms are not severe. For a balanced diet you need the correct amounts of carbohydrates. birth. Non-breast-feeding women who are affected are usually smokers. In contain a soft. keep moving and carry out your normal daily activities. Take you are not fit. a long-sleeved shirt. you can obtain a list of doctors in your area from your Community Health Council or local library. but try to choose low-fat varieties so that you maintain a healthy weight 67 69 HEIGHT Tests that are carried out on samples of body fluids. a rare form of breast cancer. Tissues containing air. Every occupant of a should allow the seat belt to fit car should wear a seat belt. below) so that you will be able to detect any changes. These functions are the type of cause tooth decay. such as blood or urine. It is used as a screening test to detect signs of breast cancer and is also carried out to investigate breast lumps. SOCKET JOINT stronger and food through the digestive tract. shopping. • Avoid drinks containing large amounts of caffeine. examples of one portion include one medium-sized fruit. In some cases. you should consider waiting to see your GP or contact NHS Direct. musculoskeletal. Physiological tests Certain investigations that do not involve testing samples (opposite) or imaging internal structures (see IMAGING TESTS. and special services. which ensure that they are not tired indicate the concentration or under the influence of of substances in the urine. This is particularly likely if you are over 50 and you are overweight. start by setting realistic goals. Having a swab taken Fluids from wounds or from body cavities. such as bone densitometry (p. Technician X-ray plate POSITION OF BREAST START HERE Are both breasts tender or painful? NO YES Is your period due within the next 10 days? YES NO POSSIBLE CAUSE Breast pain before a period may be due to changes in hormone levels. carry out a home pregnancy test (p. The names of some muscles suggest 1 mg Vitamin A canstretchcontinually without typical work your muscles. This type of muscle is able to contract slowly and build up gradually. maintain its and sugary and work internal organs such as heart. surgery to stabilize the spine may be required. see chart 149. consult your doctor. stick tests for a different These factors can delay a specified chemical. Femur Fibula Tibia Lumbar vertebrae (5 bones) Soft core Fibrous covering Gluteus maximus Compact Spongy bone bone Bone marrow SECTION OF INTERVERTEBRAL DISC Cycling safety Cyclists should wear helmets to protect the skull and fluorescent or bright clothes to make them easily visible. although it may make breast-feeding difficult. Lumps are usually more obvious before a period. fish. Look at your breasts in a mirror. Your doctor may also request bone densitometry (below). for example. you need to maintain your weight within the range considered normal for your height. breads. • Try taking evening primrose oil. make sure to protect your skin in the neck. BREAST PROBLEMS AND PREGNANCY (p. rarely. tea.39) of your back and pelvic areas. in a car. that some women experience in the days leading up to a period. changes to your nipples.286). YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR BACK PAIN IS SEVERE OR IF THE NATURE OF LONG . Most muscles connect one damage and diseasebone to another and cross a joint. Knees raised to keep the spine flat X-ray beam POSSIBLE CAUSE The lump is probably a fibroadenoma. Office work rarely poses risks to your physical safety. p. and feel the breast on that side with firm. especially the Long. and SPECT. Most skeletal muscles connect the brain is increased. If you are self-employed. in children. or abnormal levels of certain chemicals. which use radioactive substances introduced into certain tissues. which forms the walls effect of the effect part of your daily routine. You may also need to have an abdominal ultrasound scan (p. Continued on next page SELF-HELP Taking care of Are you aged under 20? YES NO S E L F .41). and pelvis The lungs can take in Many fruits and vegetables Body’s use of iron. also known as the vertebral column. • Try relaxation exercises (p. and Exercising performed by three different types of muscle (right). opposite) to determine the cause of the abnormality. red area in one breast? NO SEE YOUR DOCTOR WITHIN 24 HOURS Continued from previous page YES YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Pyelonephritis. or at home. and child development. you may be able to find out about local practices by looking on the internet. move freely. and their absorption is interpreted by a computer and displayed as an image. whole grains. oily fish ELLIPSOIDAL JOINT Vegetables. The most common blood tests performed are blood cell tests and blood chemistry tests. you may have a physical examination to assess your state of health. You need to do activities that work the heart and lungs (build stamina). If you do find a change in your breast. while a figure over 25 shows that you are overweight. and their planes of movement. These mobility exercises are an essential part of the treatment for this disorder and can be supplemented by other physical activities. cartilage (a tough. If an infection is confirmed. To help you find the first-aid information quickly. p. p. such as the eyes. joints between the vertebrae in the spine are progressively damaged. and keep your back straight while lifting it. is likely. then give another 11⁄ 2second breath. and all improve mood. Deep flexor of fingers Gluteus minimus Quadrate of thigh Thoracic vertebrae (12 bones) Pelvis Movement occurs when signals Lower back stretch from the nervous system cause Kneel. while lying or standing. Joints and discs of fibrous tissue between most of the vertebrae make the spine flexible. and. To avoid overexertion or injury. because the body stores these substances and they Folic acid can become toxic if excessive amounts build up in body tissues. Then.39) to measure the density of bone. charts for all adults. Useful Addresses provides addresses. The usual way to obtain hospital care is by referral from a GP. the sample may be sent to a laboratory possible specific test for a hormone uncovered areas and identify the microorganism. you will probably be given nonsteroidal antiinflammatory drugs. The book concludes with useful information on drugs and how to contact support groups or find further health information. However. yourself Skeletal muscle can be controlled consciously. and. Y O U R Hollow orA N D H E A LT H B O D Y fluid-filled structures do not show clearly on plain X-rays but can be imaged by introducing a contrast medium into the area before taking the X-ray. Tissue tests are used to detect areas of abnormal tissue such When using tools such as a drill. In addition. To avoid physical problems. such as walking. X-rays X-RAY OF LOWER LEG To A BREAST LUMP. This is especially likely if you are between 20 and 40. whole grains. B12. Another test defines the visual field (the area that each eye can see independently). and they tend to have repeated episodes. you need to be aware of the options for you and your Blood pressure as cirrhosis of the liver or tumours. child care. which covers and H Small H H Good which fibrous Muscles are are high bundles of tissue that move the body. to shrink). so can form a large proportion of Joints are formed where two or more bones meet.39) to confirm the diagnosis. of fingers For example. and erectors raiselower the risk of on your knee can pump It is composed of short.5 mg Vitamin B6 below. grains. m POSSIBLE CAUSE AND ACTION Breast tenderness may be the first sign of pregnancy.of film. the health the prevent muscle cramps and stiffness and minimize the risk of injury. back straight called bone marrow. it will help to lose weight (see HOW TO LOSE WEIGHT SAFELY. the measuring add notes to your medical During later simplest is doctor will important elements as sputum (fluid coughed up from the lungs) or scraped from tissue of preventive healthcare.189. When you first visit a doctor. Your Body shows how major body systems function. meat. you will need further tests such as aspiration (see ASPIRATION OF A BREAST LUMP. and chemical muscle pumps blood around finish with a cooling-down routine to and The appendicular Good sources of vitamins and minerals a flexible cord of fibrous tissue called a benefit mentalother isby also tendon. meat. If you are faced Open window provides ventilation Upright seat back aids posture Shoulders relaxed and not hunched Computer monitor is level with line of sight Babies and children are at high The of sunburn because of risk intensity of each colour their shows the concentration of delicate skin. A D U LT S : G E N E R A L A D U LT S : G E N E R A L Continued from previous page A D U LT S : W O M E N A D U LT S : W O M E N 117 Back pain cartilage in the spine. you should go straight to an accident and emergency department in a hospital for treatment. you will probably find that you in energy. If an unconscious victim is left lying on his or her back. if you have a severe accident or a serious problem such as heavy bleeding. the index (pp. or confirm or rule out a diagnosis. and breast tenderness. or one dessert bowl of salad Assessing your weight To avoid diseases associated with being overweight or underweight. bend Deltoid movements of the body are forwards. show the ability to hear speech (see HEARING TESTS. fats. 1 µg Vitamin B12 SKELETAL MUSCLE and the system prolonged periods. Small lumps may not need treatment. test. The test may also be used to screen for colorectal cancer. reducing attached by a tendon or by a sheet of connective tissue. including antenatal incision between the right lower ribs. When a muscle contracts. in Consulting your doctor you need clothing and equipment family and to learn how to make the best use Exercise ECG of the services cuff which a small piece of tissue is removed from parts of the body such Provide your GP with Electrical signals from your that protect you from noise. look for abnormalities. such as glucose. • Eat little and often. including the nipple and armpit. cereals. right) can be performed to assess the function of organs or systems. due to human error rather than mechanical faults. and blood chemistry at affect your health. If you do a lot of typing. it also occurs in men. you may have MRI (p. then put one health of the fetus. When you of muscle are skeletal muscle. However.46–47) groups the charts by body system or process. which is divided into four parts. let most of the X-rays through and appear black on the film. called STI clinics or genito-urinary medicine clinics. angiography (p. This situation is life-threatening because the breathing Artificial respiration Finding information You can find the information that you need from this book in several ways: CONTENTS LISTS The comprehensive contents (pp. Take a breath yourself. Always maintain your bicycle in good working order. orinform from ultraviolet light.40). The three types make exercise a your quality of life in later years. whole grains. consult your doctor. If you of if a gland. telephone numbers. keep stress to a minimum. makes cyclists Cycle helmet protects head from impacts clearly visible to other road users Choosing a doctor If you are looking for a new GP. liver Eyes. which is a noncancerous growth. Two X-rays are usually taken of each breast. skin. Smooth muscle carries Keep your Meat. children. removal of the lump is advised. particularly in the days before your period. heatstroke. If you are overweight. and/or does it shoot down one leg? NO Improving your posture and taking care to lift heavy objects safely can help you avoid back problems. The information gatheredthat thethese will be clear. MRI uses magnetism and radio waves.body. and minerals. parallel fibres. If you discover a lump or any changes in the breast. nervous system muscles are shown on the left of each image 1. alcohol. and HEARING TESTS IN CHILDHOOD. along with two types of “chartfinder” to help you find the most appropriate chart for a particular symptom. and inflammation. Working carried out that absorbs ultraviolet light. for short periods of time. and check that any are compared to a chart. The heart affluent countries such as the UK.151). increase your life expectancy. fibrous material). Try the following: • If possible. and information is displayed on a monitor. is a possibility. Osteoporosis is symptomless unless a fracture occurs. leafy Nervous system. monitored by tests in a questionnaire about your health and lifestyle. bloodgardening. but the other vitamins. p. It can muscle is attached by synovial joint. and bladder.STANDING BACK PAIN SUDDENLY CHANGES . Controls and Test bowl Some show how well sound is touch-screen conducted through the ears. is formed which skeletal muscle makes up theHow exercise benefits health greatest bulk. Mammography Mammography uses X-rays (p. Consult your doctor. and muscles.40). including their main side effects. is often used to and immunizations to help prevent certain infectious diseases. and caffeine.284) PREGNANCY X-ray generator ACTION Your doctor will examine you and will probably arrange for tests such as ultrasound scanning (p. The computer calculates the average bone density and compares it with the normal range for the person’s age and sex. Is one of your nipples drawn into the breast? NO Has this developed recently? YES NO YES POSSIBLE CAUSE AND ACTION If your nipple has always been drawn in. Every time you exercise. The following measures may help to prevent or relieve your symptoms: • If possible.197). is producing abnormal amounts of a hormone. • Place a heating pad or wrapped hot-water bottle against the painful area. bone formation Smaller pectoral Fetal nervous system. such as hormones. It can affect your risk of developing many diseases. Consult your doctor. Using the internet If you are new to an area and need to register with a GP. and protection for the of joint allow for differing degrees of movement. Lights must be used at night. and metabolism play vital roles in growth providing pleasure. Solid. are These tests are used or blue Many and of manual work eyes because your skin contains a low level of bone disorders. immune system 40–60 mg Vitamin C floor in front of you. In Healthy Living. such as family planning clinics. If the pain is severe. Visual field test This test is used to map the visual field. If you have a skin condition. 238 239 256 257 First aid Here you will find step-by-step instructions for dealing with major emergencies. Are you over 50? NO YES SELF-HELP Relieving back pain Most back pain is the result of minor sprains or strains and can usually be helped by simple measures. It consists of 206 bones. yeast Blood formation. keeping Internal cells and blood healthy intercostal Bones. The majority of Make sure that you use only Vitamins and the in the types work automatically. What to expect when you see your doctor and other healthcare professionals is covered in Professional Healthcare. on average. for example. Back pain is often due to poor posture. Otherwise.201). so eat them only in moderation Fruit and vegetables are high in fibre (which aids digestion). A few joints. breathe out. your doctor Doctors and screen to reduce disorders. this is not a cause for concern. who will teach you exercises to help keep your back mobile. Some samples. If an abnormality is detected. breads Energy production.311). To find out if you are within this range. Samples of urine and faeces can usually be collected easily by the patient. this is out functions such as moving becomes Eggs. may be the cause of these symptoms. provide stability and some flexibility. adductors move limbs towards the body. bones or lying down. you will special table or surfaceyour allows be questioned about that present and past health.

The final parts of the section describe how you can make the best use of the help that health professionals offer and how medical problems are investigated should they occur. It then looks at how you can modify your lifestyle to prevent health problems from developing. This section starts by explaining the structure and function of the major body systems.Y O U R B O D Y A N D H E A LT H YOUR B ODY & H EALTH Understanding how your body works and how to look after yourself are essential if you want to stay healthy. 9 .

Joints and discs of fibrous tissue between most of the vertebrae make the spine flexible. A few joints. and protection for the body. also known as the vertebral column. move freely. skull. and ribcage – consists of 80 bones and protects the brain. Bones Skull contain a soft. heart.Y O U R B O D Y A N D H E A LT H YOUR Skeleton BODY Types of joint Joints are formed where two or more bones meet. and bones of the pelvis. spine. maintains the body in an upright position. The appendicular skeleton has 126 bones and consists of the limb bones. All bones are living tissue with cells that are constantly replacing old bone with new material. ribs. The axial skeleton – the skull. It consists of 206 bones. fibrous material). collarbones. Different types of joint allow for differing degrees of movement. The majority of joints. and pelvis manufactures blood cells. (mandible) which is in turn surrounded by denser compact bone. with further support from cartilage (a tough. The main types of synovial joint. supports the head. this is Jawbone surrounded by spongy bone. and lungs. and their planes of movement. The Collarbone (clavicle) marrow in the bones of the spine. and encloses and protects the spinal cord. Semimovable joints. It consists of 33 bones called vertebrae. spinal cord. Femur Fibula Tibia Lumbar vertebrae (5 bones) Soft core Fibrous covering Compact Spongy bone bone Bone marrow SECTION OF INTERVERTEBRAL DISC Intervertebral disc Vertebra Areas where ribs are attached Sacrum (5 fused bones) Coccyx (4 fused bones) THORACIC VERTEBRAE Ankle bones (tarsals) Foot bones (metatarsals) Ligaments STRUCTURE OF BONE Toe bones (phalanges) 10 . such as those in the spine. known as synovial joints. are fixed. while ligaments and muscles stabilize it and control movement. shoulder blades. Shoulder blade (scapula) Breastbone (sternum) PIVOT JOINT BALL-ANDSOCKET JOINT SADDLE JOINT ELLIPSOIDAL JOINT Humerus Rib Spine Ulna Radius Wrist bones (carpals) Hand bones (metacarpals) Finger bones (phalanges) Kneecap (patella) Pelvis Thoracic vertebrae (12 bones) Cervical vertebrae (7 bones) PLANE JOINT HINGE JOINT The spine The spine. such as those in the skull. support. provide stability and some flexibility. The skeleton provides form. are illustrated below. fatty material called bone marrow.

parallel fibres work at maximum strength only for short periods of time. of which skeletal muscle makes up the greatest bulk. bones. For example. maintain its posture. When a muscle contracts. These functions are performed by three different types of muscle (right). adductors move limbs towards the body. Skeletal muscle can be controlled consciously. the blood vessels. Most muscles connect one bone to another and cross a joint. branching. strong. spindleshaped fibres that are connected to form sheets. Conscious movements of the body are produced by the interaction of skeletal muscles. Deeper muscles are shown on the left of each image and the more superficial muscles are shown on the right. flexors bend joints. abductors pull limbs outwards. It is composed of short. Many muscles are found in pairs. Some of the main skeletal muscles are illustrated below. Muscles are controlled by signals from the nervous system. parallel fibres. sitting. intestines. or lying down. Triceps contracts Internal oblique of abdomen Long adductor of thigh Gracilis Gastrocnemius Long extensor of toes Short extensor of big toe Abductor of big toe FRONT VIEW BACK VIEW Biceps relaxes Abductor of finger Sartorius Rectus of thigh Anterior tibial Popliteal Biceps of thigh Gastrocnemius Posterior tibial Long flexor of big toe Soleus Achilles tendon Short extensor of toes STRAIGHTENING THE ARM Gluteus maximus Triceps relaxes Biceps contracts BENDING THE ARM 11 . Most skeletal muscles connect two adjacent bones. the other is attached by a tendon or by a sheet of connective tissue. and erectors raise or hold up parts of the body. Skeletal muscle. Heart muscle pumps blood around the body. It comprises short.Y O U R B O D Y A N D H E A LT H Muscles Muscles are fibrous bundles of tissue that move the body. which moves the limbs and body. This type of muscle is able to contract quickly and powerfully. which forms the walls of the heart. Each type of muscle has a different function and consists of fibres of a particular shape. and smooth muscle. interlinked fibres that form a network within the walls of the heart. while the other types work automatically. one on each side of a joint. and can work for SKELETAL MUSCLE prolonged periods. and produce opposing movements. but can Long. Occipitofrontal Orbicular of mouth Smaller pectoral Greater pectoral Internal intercostal External intercostal Biceps of arm Deep flexor of fingers Deltoid Erector of spine Temporoparietal Orbicular of eye Splenius of head Types of muscle The three types of muscle are skeletal muscle. One end of the muscle is attached by a flexible cord of fibrous tissue called a tendon. The names of some muscles suggest their functions. cardiac muscle. which covers and moves the skeleton. in the upper arm the triceps contracts to pull the arm straight and the biceps contracts to bend the arm. This type of muscle can work continually without tiring. and bladder. it pulls on the bones to move them. and joints. Smooth muscle carries out functions such as moving food through the digestive tract. found in the walls of the digestive tract. The skeletal muscles not only move parts of the body but also help to maintain the posture when a person is standing. Temporoparietal How muscles work Semispinalis of head Trapezius Deltoid Latissimus dorsi Triceps of arm Extensor of fingers Gluteus minimus Quadrate of thigh Ulnar extensor of wrist Movement occurs when signals from the nervous system cause muscles to contract. is formed of long. and the genital and urinary tracts. and work internal organs such as the heart. Extensors straighten joints.

where it releases oxygen and nutrients through capillary walls. then passes into a lower chamber (ventricle). muscular layer ARTERY VEIN Deoxygenated blood coming from the lower body Heart Oxygenated blood going to the lower body 12 . carbon dioxide and other wastes pass from the tissues into the blood. muscular layer Elastic layer One-way valve Thin. Arteries carrying blood from Aorta the heart branch into Pulmonary smaller vessels and then artery into capillaries. The right side of the heart pumps blood into the pulmonary arteries and so to the lungs. The heart is a hollow. muscular organ that pumps all the body’s blood – roughly 5 litres (9 pints) – around the body about once Jugular vein a minute and faster during Common exercise. Veins return blood to the heart. Deoxygenated blood coming from the upper body Deoxygenated blood going to the lungs Oxygenated blood going to the upper body Oxygenated blood coming from the lungs Capillary network in lungs Arteries and veins Arteries have thick. They have thinner walls that stretch easily. elastic walls to withstand the high pressure of blood pumped out of the heart. The pulmonary circuit takes deoxygenated blood to the lungs. The linings of many large veins have folds that act as one-way valves to stop blood from flowing the wrong way. Blood flow through the chambers is controlled by one-way valves. and the deoxygenated blood is returned to the heart. allowing them to expand and hold large volumes of blood when the body is at rest. and the left side pumps blood into the aorta and around the body. where it absorbs oxygen and releases carbon dioxide (a waste gas) through a network of capillaries. On each side. muscular. the oxygenated blood is then returned to the heart. Aorta Superior vena cava Ligamentum arteriosum Coronary artery Pulmonary arteries BLOOD SUPPLY TO THE HEART Pulmonary veins Pulmonary arteries Pulmonary veins Left atrium Right atrium Aortic valve Mitral valve Left ventricle Heart muscle (myocardium) Descending aorta Right ventricle Pulmonary valve Tricuspid valve Inferior vena cava Blood circulation The heart pumps blood into two linked circuits: the pulmonary and the systemic. taking oxygen and nutrients to body tissues and removing waste products. Blood flows through carotid artery a network of vessels that Superior vena cava reaches all parts of the body. Thick. The systemic circuit takes oxygenated blood to body tissues. which Brachial in turn join a network vein of veins that return Heart blood to the heart. which pumps the blood into the arteries.Y O U R B O D Y A N D H E A LT H Cardiovascular system The cardiovascular system transports blood around the body. blood flows through veins into an upper chamber (atrium). Pulmonary vein Brachial artery Hepatic artery Renal artery Radial artery Inferior vena cava Common iliac artery Femoral artery Popliteal artery Anterior tibial artery Peroneal artery Posterior tibial artery Dorsal artery of the foot Small saphenous vein Dorsal vein of the foot Femoral vein Great saphenous vein Popliteal vein Anterior tibial vein Posterior tibial vein Hepatic vein Renal vein Common iliac vein Structure of the heart The heart is a double pump consisting mainly of muscle called myocardium.

To breathe in (inhale). Breathing is powered by the diaphragm (a muscle) and the intercostal muscles. The tonsils and the adenoids in the pharynx help to fight infection. the diaphragm and the muscles between the ribs contract. The larynx contains the vocal cords. the main waste product. and passes from the alveoli (tiny sacs) into blood vessels called capillaries. The bronchioles end in sacs called alveoli. In the capillaries in tissues. while carbon dioxide is absorbed into the plasma. causing the chest to enlarge. the muscles relax. causing air to leave the body. Alveolus Oxygen leaves the alveolus to bind with haemoglobin in red blood cells Red blood cell Carbon dioxide passes from the plasma into the alveolus GAS EXCHANGE IN LUNGS Oxygen is released and passes into the body cells Oxygenated blood travelling via heart Plasma Red blood cell Capillary Deoxygenated blood travelling via heart GAS EXCHANGE IN BODY CELLS Waste carbon dioxide leaves the body cells and dissolves in the plasma 13 .Y O U R B O D Y A N D H E A LT H Respiratory system Respiration is the process by which the body obtains oxygen. Air breathed in through the nose or mouth passes down the trachea (windpipe) into the bronchi (lower airways). The epiglottis seals the trachea during swallowing. which are surrounded by blood vessels. Here. As a result the air pressure in the lungs decreases so that it is lower than the atmospheric pressure. Lung Air flow Each lung increases in volume as the ribcage expands Flattened diaphragm X-RAY OF CHEST DURING INHALATION The diaphragm contracts and moves down The ribs rise and swing outwards The intercostal muscles. The respiratory system also includes the pharynx (throat). relax BREATHING OUT Bronchiole Diaphragm Intercostal muscle Gas exchange in the body The body’s tissues constantly take up oxygen from the blood and release carbon dioxide back into the blood. where it binds to a substance called haemoglobin in the red blood cells. To breathe out (exhale). then into bronchioles (smaller airways) in the lungs. between the ribs. oxygen passes into the blood and carbon dioxide enters the lungs to be breathed out. contract BREATHING IN ALVEOLI Nasal cavity Larynx Air flow Each lung decreases in volume as the ribcage becomes smaller Lung Domed diaphragm Mouth Trachea Bronchus Heart Lung X-RAY OF CHEST DURING EXHALATION Rib The diaphragm relaxes and moves up The ribs move down and inwards The intercostal muscles. The flow of air in and out of the body occurs because air moves from areas of high pressure to areas of low pressure. Blood vessel Alveolus Bronchiole Adenoids Tonsil Pharynx Epiglottis Vocal cords How breathing works Breathing is the act by which the body takes in and expels air. carbon dioxide passes from the blood plasma (the fluid part of the blood) into the alveoli to be breathed out. which it uses to produce energy. which vibrate to produce sounds. decreasing the volume of the lungs. and air is drawn into the lungs. between the ribs. and expels carbon dioxide. larynx (voicebox). At the same time. and epiglottis. The air pressure in the lungs becomes higher than that in the atmosphere. the red blood cells release oxygen. Oxygen is breathed into the lungs.

It controls vital body functions and interacts with the outside world. different parts govern specific activities such as speech and vision. processes and coordinates nerve signals. which comprises the brain and spinal cord. Thoracic nerves Lumbar nerves Sacral nerves MAJOR SPINAL NERVES Grey matter Various aspects of behaviour and personality are controlled here Information from the ears is processed here Brainstem EXTERIOR OF THE BRAIN Spinal nerve White matter Structure of the spinal cord The spinal cord is made up of grey matter. The spinal cord forms the link between the brain and the rest of the body. are transmitted through the nervous system from the brain to the rest of the body and vice versa. and sexual behaviour. which contains nerve cells and supporting cells. and white matter. such as maintaining body temperature. For example. descend through the spinal cord. which transmits the signals. A network of nerves Spinal peripheral nerves reaches all cord parts of the body. Voluntary movement is controlled in these areas Speech is controlled in these areas Sensory information is processed in these areas Visual information is processed in these areas Brainstem CROSS SECTION OF THE BRAIN Cerebellum Organization of the nervous system The central nervous system. the brain is capable of complex processes such as learning. which generates and processes nerve signals. which is made up of nerves that branch from the brain and spinal cord to all areas of the body. It has more than 100 billion nerve cells and billions of pathways. which contains nerve fibres. It also receives information from the nerves about the environment and the condition of other parts of the body. Motor pathways. thought. Cerebellum Meninges 14 . memory. analyses. grouped in bundles. while Brain sensory pathways from the skin and other sensory organs ascend through the spinal cord carrying messages Cervical to the brain. which carry messages from the brain. Signals. and emotion. Each nerve is formed from hundreds of nerve fibres. In addition. and unconscious functions. The brain is protected by the skull and by membranes called meninges. There are two parts: the central nervous system. Vein White matter of cerebrum Meninges Cerebral cortex (grey matter) Cerebrum Skull Corpus callosum Pituitary gland Hypothalamus Structure and function of the brain The brain is the most complex organ in the body. A structure at the base of the brain called the cerebellum controls balance.Y O U R B O D Y A N D H E A LT H Nervous system The nervous system gathers. Clear cerebrospinal fluid cushions the brain and spinal cord from injury. and posture. The cerebrum controls conscious thought and movement and interprets sensory information. The largest part of the brain is the cerebrum. the nerves leading from the eyes register visual information and nerves beneath the surface of the skin transmit sensations such as pain. The cord is enclosed by protective membranes called meninges. and can instruct the body to act on the basis of these processes. which controls vital functions such as respiration. The inner layer consists of white matter. in the form of tiny electrical impulses. and the peripheral nervous system. sleep. These divide into smaller and smaller nerves throughout the torso and the limbs. The brain is connected to the spinal cord by the brainstem. such as movement. It is divided into two halves (hemispheres). stores. The outer layer (cerebral cortex) consists of tissue called grey matter. Thirty-one pairs of nerves branch off the spinal cord. comprising the brain and spinal cord. and transmits information. which project from nerve cells. coordination. The brain controls almost all activities – both conscious activities. which are connected by a bundle of nerve fibres called the corpus callosum. which links the nervous system and the endocrine system and helps to regulate body temperature. Just above the brainstem is the hypothalamus.

Free nerve ending Merkel’s corpuscle Skin surface Meissner’s corpuscle Pacinian corpuscle 15 . and Pacinian corpuscles detect deep pressure and vibration. middle. respond to touch. The receptors transmit signals via nerve fibres to the olfactory bulb. with most – about 10. which leads to the eardrum. Smell Smells are detected by specialized receptor cells in the roof of the nasal cavity. which passes the signals to the brain. saltiness at the front. These receptor cells detect odour molecules in the air and convert the information into tiny electrical impulses. where it is then analysed. in combination with these four basic tastes. The iris alters the size of the pupil to control the amount of light reaching the retina. Each taste is detected by taste buds in a specific area of the tongue: bitterness is registered at the back. that allows us to differentiate a great range of more subtle flavours. At the back of the retina is the optic disc. These sensations are detected by two types of receptor under the surface of the skin: free (uncovered) nerve endings. pressure. Vision The organs of vision are the eyes. It is our sense of smell. Structure of the ear Outer ear The outer ear comprises the pinna (the visible part) Pinna and the ear canal. Middle ear Inner ear Touch The sense of touch includes sensations such as pain. changes in temperature. and the sensory nerves in the skin allow us to feel physical contact (touch). sourness at the sides. sour. where nerve fibres converge to form the optic nerve and where blood vessels enter the eye. whereas the middle of the back has fewer receptors. causing it to vibrate. where they are converted into electrical signals. This photograph was taken through an ophthalmoscope. In each case. Light rays entering each eye are focused by the cornea and the lens so that they fall on the retina. Tongue Taste hair Tongue surface View of the retina The cells in the retina register colour and light intensity. the fingertips are highly sensitive and have many receptors.000 different odours. Merkel’s and Meissner’s corpuscles detect light touch. the nose and tongue respond to different smells and tastes respectively. Optic disc Blood vessel Cornea Sclera (white of eye) Lens Choroid Retina LOCATION Cilia Mucus Taste Pupil Iris Optic nerve Retinal blood vessel CROSS SECTION OF AN EYE Tastes are detected by the taste buds. Free (uncovered) nerve endings. pain. they stimulate cilia (tiny hairs) attached to receptor cells in the roof of the nasal cavity. Different types of nerve ending or corpuscle monitor particular sensations. Cells in the retina convert this image into electrical impulses that pass along the optic nerve to the brain. which magnifies and illuminates the inside of the eye. and temperature. producing an upside-down image on it. These structures are located in the mouth and throat. and pain. The eyes provide visual information. They can distinguish only four basic tastes: sweet. Taste bud structure Substances in the mouth come into contact with tiny hairs projecting from taste buds in the tongue. which contains Eardrum the sensory receptor for Nerve hearing. LOCATION Receptor cell Nerve fibre Hearing and balance The ear is concerned not only with hearing but also with balance.000 – on the upper surface of the tongue. allowing us to detect more than 10. near the skin surface. where they are analysed. The human sense of smell is highly sensitive. The signals pass along nerve cells to the brain. vibration. Olfactory bulb Nasal cavity Nerve fibre Support cell Receptor cell Smell receptors When odour molecules enter the nose. pressure. the ears detect sound and also aid balance.Y O U R B O D Y A N D H E A LT H The senses Our senses enable us to monitor all aspects of our environment. where they are analysed. and temperature. where they are decoded to create vision. and bitter. and sweetness at the tip. Blood vessels in the retina and a layer called the choroid supply the eye with nutrients. The disc contains no light-sensitive cells and is called the “blind spot”. and inner parts. information about the environment detected by the sense organs is transmitted by nerves to the brain. The bones of the middle ear transmit these vibrations to the inner ear. It has outer. The middle ear contains three tiny bones that connect the eardrum to a membrane separating the Ear canal middle and inner ears. allowing us to stay upright and move without falling over. Touch receptors Touch is detected by various receptors at different levels within the skin. The outer ear directs sound waves to the eardrum. salty. These impulses are transmitted along the olfactory nerve to the olfactory bulb (the end of the olfactory nerve) and then to the brain. The number of receptors varies around the body: for example. and structures Cochlea that regulate balance. The inner ear also contains structures that aid balance by detecting the position and movements of the head. and enclosed nerve endings called corpuscles. These hairs generate nerve impulses that travel along nerve fibres to a specialized area of the brain. The inner ear houses the cochlea.

Y O U R B O D Y A N D H E A LT H Digestive system The digestive system consists of the digestive tract and its associated organs. down the throat into the oesophagus. where it is stored until it is released through the anus as a bowel motion. gallbladder. Here. To move a piece of food (bolus) forwards. known as a bolus. The associated digestive organs include three pairs of salivary glands. When you swallow. Mouth and oesophagus The process of digestion begins in the mouth. in the upper abdomen. Large intestine Mouth Pancreas Tongue Teeth Salivary glands Oesophagus Peritoneum Small intestine Pharynx Stomach Food moves down the oesophagus into the stomach. the soft palate closes off the nasal cavity. The digestive tract is a convoluted tube about 7 m (24 ft) long through which food passes while it is being broken down. soft pieces for swallowing. the liver. and pancreatic juices are released directly into the duodenum. moves to close off the larynx. At the same time. Small intestine Chyme enters the duodenum (the first part of the small intestine) and is further broken down by digestive juices from the liver and pancreas. a small flap of cartilage at the back of the tongue. Large intestine After nutrients have been absorbed in the small intestine. The liver uses the products of digestion to manufacture proteins such as antibodies (which help to fight infection) and blood clotting factors. Bile from the liver and gallbladder passes down the bile duct. pass straight through the stomach and into the intestine in a few minutes. oesophagus. and the gallbladder. It also breaks down worn-out blood cells and excretes the wastes as bile. which is stored in the gallbladder and plays a part in the digestion of fats. the muscles in the walls contract and relax in a sequence known as a peristaltic wave. while substances in the saliva start to break down carbohydrates in the food. rectum. The digestive system breaks down food into simpler components that can be used by the cells of the body and eliminates the remaining substances as waste. digestive juices released from the intestinal walls split nutrients into chemical units small enough to pass through the wall of the intestine into the surrounding network of blood vessels. stomach. secrete digestive juices into the duodenum. The action of the teeth and tongue during chewing breaks food into small. 16 . which are released into the duodenum when food enters it. gallbladder. small and large intestines. the pancreas. The final stage of digestion takes place in the rest of the small intestine. such as water and alcohol. The digestive organs The liver. they help to break down nutrients into substances that are absorbed into the blood and carried to the liver. and the semi-solid waste that remains is called faeces. Together with digestive juices produced by the intestinal lining. It moves down into the rectum. the remaining material passes into the large intestine. Food bolus Tongue Soft palate Tongue Soft palate raised Food bolus Epiglottis lowered Larynx closed off Oesophagus DURING SWALLOWING Gallbladder Duodenum Pancreas Peristalsis Food is propelled along the digestive tract by a continuous sequence of muscular contractions known as peristalsis. Swallowed fluids. and pancreas The liver. The walls of the digestive tract are lined with smooth muscle. The pancreas secretes powerful digestive juices. and pancreas. Liver Gallbladder Stomach Pancreas Liver Small intestine Large intestine Appendix Rectum Anus Bile duct Oesophagus Stomach Liver. and pancreas all help to break down food chemically. and anus. There. The peritoneum A folded membrane called the peritoneum lines the inside of the abdominal wall and covers all of the digestive organs. pharynx (throat). The tract consists of the mouth. the muscle behind the food contracts while the muscle in front relaxes. The entry of food into the duodenum (the first part of the small intestine) stimulates the gallbladder to release the bile into the duodenum via the bile duct. and the epiglottis. it may spend up to 5 hours being churned and partially broken down by digestive juices until it becomes a semi-liquid substance called chyme. the tongue pushes the mixture of food and saliva. gallbladder. Most of the water content is absorbed back into the body. Contracted muscle Direction of food movement Relaxed muscle Bolus of food Epiglottis Larynx Oesophagus BEFORE SWALLOWING Peristaltic wave To move pieces of food through the digestive tract.

and other areas of lymphatic tissue. and thyroid glands. responses to stress. Oestrogen also encourages the development of some female sexual characteristics. Each gland has a cortex (outer layer) and a medulla (core). Lymph nodes. It also releases the hormones insulin and glucagon. Lymph helps to maintain the body’s fluid balance by collecting excess fluid from the tissues and returning it to the bloodstream. It also carries white blood cells. The lymphatic system helps to defend the body against infection and also to maintain the balance of body fluids. Ovaries The ovaries lie on either side of the uterus. a sugar that forms the body’s main energy source. such as enlargement of the breasts. Its precise function has yet to be clarified. Lymphatic system The lymphatic system consists of a network of lymph vessels that runs throughout the body. the volume of urine passed. Calcium is vital for healthy bones and. Other organs and tissues. such as facial hair. and also acts as a link between the nervous and endocrine systems. Glands. such as the Pituitary gland pituitary. the gland is known to produce a hormone called melatonin. clumps of bean-shaped lymph nodes (commonly called lymph glands). The medulla secretes epinephrine (adrenaline) and norepinephrine (noradrenaline). plays an important part in nerve and muscle function. This hormone is responsible for the onset of puberty and the development of male secondary sexual characteristics. Clusters of nodes are found in many parts of the body. are organs whose Thyroid and only function is to produce parathyroid glands specific hormones. including the neck. and groin. They produce sperm and secrete the male sex hormone testosterone. filter infectious organisms from the lymph. such as Peyer’s patches in the wall of the intestine. Adrenal gland Pancreas Testis Ovary the development of certain male sexual characteristics.Y O U R B O D Y A N D H E A LT H Endocrine system The endocrine system produces hormones – chemicals that are carried in the bloodstream and control processes in other parts of the body. armpits. The cortex produces corticosteroid hormones. adrenal. It secretes hormones called releasing factors that control the function of the pituitary. a type of white blood cell. Lymph vessel Axillary lymph nodes Thoracic duct Thymus gland Spleen Peyer’s patch in intestine Vessels and nodes Lymph vessels carry a fluid called lymph around the body. They are packed with lymphocytes. It produces digestive juices that help to break down food. heart. Testes The testes hang in a bag of skin and muscles called the scrotum. Pineal gland The pineal gland is situated deep inside the brain. The hypothalamus is a part of the brain that is linked to the pituitary gland. behind the thyroid. such as the ovaries. Popliteal lymph nodes Adrenal glands The adrenal glands lie on top of the kidneys. Cervical lymph nodes MALE Pituitary gland and hypothalamus The pituitary gland lies at the base of the brain. which lowers the blood level of calcium. The spleen also breaks down worn-out red blood cells. and kidneys. These cells produce antibodies. and tiny amounts of male sex hormones. and the contraction of the uterus during labour. testes. They release eggs and produce the female sex hormones progesterone and oestrogen. Deep inguinal (groin) lymph nodes Spleen and thymus The spleen and the thymus gland produce certain types of lymphocytes (white blood cells). which is thought to be associated with the daily cycle of sleep and waking. Pancreas The pancreas lies behind the stomach. with phosphate. produce a hormone that controls blood levels of calcium and phosphate. It is known as the “master gland” because it produces hormones that stimulate and control endocrine tissue in other glands and organs. in the neck. Hypothalamus The system comprises glands Pineal gland and other hormone-producing cells. whose roles include helping to regulate blood levels of salt and glucose. which fight infection. However. Some thyroid cells also secrete the hormone calcitonin. growth. which increase the heart rate and blood flow to the muscles in response to stress (a reaction called the “fight or flight response”). The four parathyroid glands. which regulate the menstrual cycle. which help to destroy infective organisms. It also secretes hormones that control growth. which play an important part in regulating the level of glucose. the spleen. Such processes include metabolism (the chemical reactions constantly occurring in the body). also contain hormoneproducing cells. and sexual development. which promote 17 . produces hormones that control metabolism. Thyroid and parathyroid glands The thyroid gland. the thymus gland. situated at junctions between lymph vessels.

which open into the renal pelvis.Y O U R B O D Y A N D H E A LT H Urinary system The urinary system filters wastes from the blood. bean-shaped organs lying at the back of the abdomen. are reabsorbed into the bloodstream as necessary. The capillary walls have pores that allow water and small particles (such as salts) to pass through. enters the renal tubule. one on either side of the spine. the bladder. Urine from these ducts passes into minor calyces and then into major calyces. a special cell involved in filtration Nephron Glomerulus Renal tubule Proximal convoluted tubule Cortex Capillary GLOMERULUS Nephron Medulla Renal artery Renal artery Renal vein Renal pelvis Bladder Ureter Prostate gland Urethra Urethra FEMALE Major calyx Minor calyx Protective capsule How urine is made Urine is composed of substances that have been filtered from the blood in the nephrons. Blood first passes through the glomerulus. the urine is funnelled into the ureter. The fluid that has been removed from the blood. called filtrate. women are more prone to urinary infections than men. The kidneys are red-brown. The male urethra is longer than the female urethra and also provides an outlet for semen (fluid that contains sperm and that is released during sexual activity). while retaining larger particles. This has three parts: the proximal convoluted tubule. The cortex contains functional units called nephrons. Because the female urethra is shorter and opens close to the vagina and anus. From here. the ureters. and a renal tubule. such as proteins and red blood cells. and the distal convoluted tubule. which connect each kidney to the bladder. the medulla (middle layer). through which the resulting waste fluids pass as they are turned into urine. This muscle can be relaxed voluntarily to allow urine to be expelled through the urethra. A kidney has about a million nephrons. Filtrate Blood entering the glomerulus Water and substances filtering out of blood Reabsorption of water and nutrients Proximal convoluted tubule Loop of Henle Blood flow Reabsorption of water and salts Distal convoluted tubule Urine-collecting duct Secretion of unwanted substances Urine from a number of nephrons passing to the renal pelvis URINE FORMATION IN A NEPHRON 18 . The system consists of a pair of kidneys. which then passes down the ureters into the bladder. the loop of Henle. and the renal pelvis (inner region). The bladder is kept closed by a ring of muscle (a sphincter) around its lower opening. there are three regions: the cortex (outer layer). the tube through which urine leaves the body. Each nephron consists of a glomerulus. It also regulates body fluid levels and maintains the body’s acid–alkali balance. where water. and other useful substances such as glucose and salts. The medulla consists of groups of urine-collecting ducts. eliminating them together with excess water as urine. and the urethra. Podocyte. They contain units called nephrons that filter the blood circulating through the kidneys and produce urine. Adrenal gland Cortex of the kidney Medulla of the kidney Kidney Peritoneum (membrane lining the abdomen) Ureter Renal vein Ureter Bladder Structure of the kidney Inside the kidney. Each consists of a cluster of tiny capillaries called a glomerulus and a tube called the renal tubule. a cluster of specialized capillaries in which the blood is filtered.

the testes. Mature sperm are stored in a coiled tube called the epididymis. Three glands – a pair of seminal vesicles and the prostate gland – secrete fluids to transport and nourish the sperm. a coiled tube that lies behind each testis. starts to secrete hair hormones that stimulate the testes to produce the male sex hormone testosterone. The sperm are stored in the epididymis. the erectile tissue in the penis fills with blood. which in turn is connected to the urethra. Pubic This hormone stimulates hair changes such as enlargement Enlarged of the genitals and the genitals growth of body hair. The sperm are eventually ejaculated during sexual activity or are reabsorbed into the body. at the base of the Chest brain. connects each epididymis to an ejaculatory duct. making the penis lengthen and stiffen in order to enter the woman’s vagina. Another tube. The sperm develop around the walls of the seminiferous tubules. muscular contractions force semen along each vas deferens. which make sperm. and the scrotum. At orgasm. point towards the centre of the tubules. and. Each testis is packed with seminiferous tubules. In boys.Y O U R B O D Y A N D H E A LT H Male reproductive system The male reproductive system produces sperm – cells that can fuse with eggs from a woman to form offspring. Developed later. their tails. sperm are manufactured continuously in the testes at a rate of about 125 million each day. which enable them to swim. the vas deferens. the secretions and sperm form a fluid called semen. Prostate gland Changes in boys during puberty Puberty is the period during which sexual characteristics develop and sexual organs mature. in which the testes are suspended. During sexual activity. puberty usually begins between the ages Facial of about 12 and 15 and lasts hair for 3–4 years. sperm production muscles and increased sex drive. The pituitary gland. down the urethra. Developing sperm Erectile tissue Penis Sperm tails Tubule wall Rectum Foreskin Anus Muscle Scrotum Epididymis Testis Urethra Centre of tubule SPERM INSIDE A SEMINIFEROUS TUBULE 19 . BEFORE PUBERTY AFTER PUBERTY Artery Bladder Vas deferens Urethra Vas deferens Penis Epididymis Erectile tissue Scrotum FRONT VIEW Testis Urethra SECTION THROUGH THE PENIS Seminiferous tubule Ejaculatory duct Seminal vesicle Prostate gland Pubic cartilage Vas deferens CROSS SECTION OF A TESTIS Sperm production Once puberty has been reached. It also makes the male sex hormones needed for sperm production and for sexual development at puberty. and out of the penis. situated behind each testis. The male genitals consist of the penis.

a passage with muscular walls. Fimbriae Ovary Changes in girls during puberty Puberty is the period during which sexual characteristics develop and sexual organs Armpit hair mature. collectively known as the vulva. the time when it is released from its follicle. include the sensitive clitoris and folds of skin called the labia. The external structures. connects the uterus to the outside of the body. which secrete a fluid for lubrication during sexual intercourse. These hormones Pubic hair prompt physical changes such as enlargement of the breasts and Thicker hips and the growth of pubic and thighs underarm hair. Later. The cycle is regulated by four sex hormones. a woman’s body is prepared for the possibility of pregnancy.Y O U R B O D Y A N D H E A LT H Female reproductive system The internal structures of the female reproductive system – the ovaries. which propels it towards the uterus. Follicle-stimulating hormone and luteinizing hormone. The cycle lasts about 28 days but this can vary from month to month and from woman to woman. cells that can fuse with sperm from a man to form offspring. the fimbriae guide the egg into a fallopian tube. Changes during the menstrual cycle MENSTRUATION PREOVULATION OVULATION POSTOVULATION CHANGES IN THE OVARY Egg growing in follicle Developing egg Mature egg Egg released from follicle Empty follicle Shrinking follicle Dying follicle A complete menstrual cycle The chart shows changes that occur in the endometrium (uterus lining) and the ovary during a menstrual cycle. uterus. which make the uterus lining thicken. together with blood and cells from the lining. The ovaries contain follicles that store eggs. fallopian tubes. and vagina – lie in the lower third of the abdomen. CHANGES IN THE ENDOMETRUM Unfertilized egg Blood vessels Shed lengthen blood and cells Endometrial glands enlarge Thickened lining Unfertilized egg 0 2 4 6 8 10 12 14 DAYS 16 18 20 22 24 26 28 20 . puberty begins between the ages of about 10 and Enlarged 14 and lasts for 3–4 years. In girls. they stimulate BEFORE PUBERTY AFTER PUBERTY ovulation and menstruation. it embeds itself in the lining. Each month an egg matures and is released from an ovary. Fallopian tube Uterus Fallopian tube Ovary Cervix Uterus Bladder FRONT VIEW Vagina Cervix Pubic cartilage Immature egg follicle Blood vessel Empty follicle Mature egg follicle Egg Vagina Clitoris Labia Pelvic floor muscles Rectum CROSS SECTION OF AN OVARY The menstrual cycle During the menstrual cycle. during menstruation. The egg can be fertilized by a sperm at ovulation. cause an egg to mature in a follicle and be released. If an egg is fertilized. The egg and its follicle secrete oestrogen and progesterone. which protect the entrances to the vagina and the urethra. which are secreted by the pituitary gland. The vagina. If it is not fertilized it passes out of the body. The breasts pituitary gland starts to secrete hormones that stimulate the Wider ovaries to produce the female hips sex hormones oestrogen and progesterone. Just inside the vaginal entrance lie the Bartholin’s glands.

The rest of the cells. It usually occurs between the ages of 45 and 55. The menopause may also result in long-term physical changes. the cell cluster reaches the uterus. From this moment onwards. After 5–7 days. which open on to the surface of the nipple. hormonal changes make the breasts enlarge further and. brittle bone LOCATION A single cell called a zygote is formed if an egg fuses with a sperm Fallopian tube Osteoporotic bone The sex hormone oestrogen is needed to give bones strength. while chemical changes in the egg stop any more sperm from entering. Thin. and once a woman has reached the menopause she is no longer fertile. Fatty tissue Lung The menopause The menopause is the time when menstrual cycles cease. become an embryo. produced by the ovaries in women. such as osteoporosis. the cells develop into a baby. vaginal dryness. they try to pierce its coating. When the cell cluster reaches the uterus. If the sperm meet an egg. The dark area surrounding the nipple is called the areola. if a sperm penetrates and fertilizes an egg. together with fat and connective tissue. propelled by the muscular action of the tube’s walls. Conception and pregnancy All organisms reproduce. but their main role is to produce milk for babies. hormone changes produce symptoms such as mood swings. the man’s and woman’s DNA combine to form new cells. They are brought together by sexual intercourse. During pregnancy. If a sperm succeeds. it sheds its tail and fuses with the nucleus of the egg. which is called a morula. The zygote begins to divide soon after it has been formed The cluster of dividing cells. the zygote divides itself repeatedly to form a cluster of cells. it contains hundreds of cells. The rest of the breast tissue is mostly fat. and night sweats. As a result ovulation and menstruation end. In human beings. grows as it travels along the fallopian tube An embryo starts to form once the cluster of cells has embedded itself in the lining of the uterus wall Breast structure The breasts consist mainly of lobules and milk ducts. then swim up through the uterus and into the fallopian tubes. In the years just before and after the menopause. the pregnancy is properly established. the cells start developing into an embryo. which helps to support the breasts.Y O U R B O D Y A N D H E A LT H Role of the breasts Breasts play a part in sexual arousal. produced by the testes in men. Tail of sperm Head of sperm Surface of egg Blood vessel Areola Ampulla Sperm penetrating egg The head of the sperm pushes through the egg’s outer coating in order to reach the nucleus. During puberty the hormone oestrogen causes the breasts to grow and develop. Conception occurs when these cells embed themselves in the uterus. combining DNA from the man and the woman. During pregnancy. which will nourish the developing baby. One part of the cell cluster grows into the endometrium and becomes the placenta. their number doubles every 12 hours. hot flushes. and eggs. Rib Muscle AREA OF BREAST TISSUE Fertilization During sexual intercourse. Low oestrogen levels after the menopause can result in osteoporosis. from which the baby will grow. Lining of the uterus 21 . It embeds itself securely in the endometrium (the lining of the uterus) and continues to grow. Once embedded in the uterus lining. At the same time. the zygote starts its journey along the fallopian tube towards the uterus. with a small amount of connective tissue. In this way a new cell is formed. a condition in which the bones lose density and may become thin and brittle. as shown in this microscopic image. Milk is released through the nipple. The ovaries stop responding to follicle-stimulating hormone and produce less of the female sex hormones oestrogen and progesterone. sperm are expelled into the woman’s vagina. An unfertilized egg is released from an ovary Ovary From egg to embryo As the cells passing along the fallopian tube divide. in late pregnancy. which lasts for about 40 weeks (9 months). These cells each contain half a set of DNA (genetic material). These glands are connected to ducts that lead to channels called ampullae. called a morula. Nipple Milk duct Lobule Beginning of pregnancy The cell produced by the fusion of the egg and sperm is called a zygote. stimulate milk production in glands called lobules. reproduction involves two types of cell: sperm. Within 2 days of fertilization.

In addition. Her appetite may increase. The villi extend into areas containing blood from the mother.5 cm (12 in) long 22 . head. each about 3 months long. The milk-producing lobules in the breasts enlarge. In the first trimester. They are enclosed by the chorion. and a need to pass urine frequently. In the third trimester. a membrane through which nutrients and other substances pass. By 18–20 weeks the fetus starts to make noticeable movements. the baby is known as an embryo. From week 8. Umbilical cord 18 cm (7 in) long 30. During the second trimester. It is cushioned by amniotic fluid and nourished by blood from the umbilical cord. The uterus eventually becomes so large that the top reaches almost to the mother’s breastbone. and to remove its waste products. The mother’s arteries provide oxygen. and there may be discharge from the nipples. specific changes occur in each trimester. ready for birth. producing fluttering feelings in the mother’s abdomen. The enlarging uterus may press on the mother’s bladder. In the first 8 weeks. there are few visible changes. heartburn. Areola Enlarged milkproducing lobule Milkproducing lobule The mother’s veins carry wastes away from the fetus Placenta Umbilical cord Blood vessels in the placenta Where the blood vessels from the umbilical cord meet the placenta. although they do not actually mix. the mother’s heart rate increases by about 8 beats per minute in order to increase the blood circulation. and bladder can cause symptoms such as mild breathlessness. and antibodies against infection. Foot 6 cm (21⁄ 2 in) long 2. most of the organs form. In the last weeks the fetus changes position so that it is lying with its head pointing downwards. intestines. Mother at 12 weeks The mother’s breasts are tender and the areola (the area that surrounds the nipple) darkens. nutrients. the mother may begin to experience backache due to the weight of the fetus. the mother rapidly gains weight as the fetus undergoes a growth spurt. Ear Eye with eyelids Arm Developing fingers Leg 8 WEEKS Developing head Umbilical stalk Developing arm Developing leg 4 WEEKS Uterus Fetus Fetus Bladder Uterus Amniotic fluid around fetus Cervix Bladder Compressed lung 7 mm ( 5⁄ 16 in) long Face Ear Hand Developing toes Umbilical cord 12 WEEKS Mother at 24 weeks The mother’s abdomen starts to swell as the fetus and uterus grow. Changes in hormone levels may cause symptoms such as nausea. During this time the limbs. nutrients. and the heart begins to beat. During pregnancy. The body structures continue to develop throughout the pregnancy. The baby’s development The baby develops in a sac in the uterus. an organ that is attached to the uterus lining and is connected to the baby by the umbilical cord. The most noticeable are the swelling of the abdomen as the baby grows and the enlargement of the breasts as they prepare to produce milk. and facial features appear.5 cm (1 in) long Sense of hearing is developing Compressed intestine Fetus can suck its thumb Umbilical cord Fetus’s head positioned just over cervix Compressed bladder Fingers are fully developed Protective layer of fat has formed under skin 16 WEEKS 28 WEEKS Mother at 36 weeks Compression of the lungs. In the placenta.Y O U R B O D Y A N D H E A LT H How the baby is nourished An unborn baby depends on its mother to supply it with oxygen. the baby is called a fetus. and antibodies for the fetus Mother’s blood Fetus Substances transferred to fetus Substances transferred to mother Chorion Villus Umbilical cord LOCATION OF PLACENTA Changes in the mother’s body Pregnancy is divided into three stages (trimesters). stomach. the mother’s and baby’s blood supplies are brought close together. the mother’s body undergoes major changes. These substances pass between the mother’s blood and the baby’s blood inside the placenta. they form structures called villi. However.

Others may be relics from a more primitive stage of human evolution. the fetus’s heart pumps blood around the body and to the umbilical cord. A newborn baby also shows certain basic patterns of behaviour that aid his or her survival. the task of adding oxygen to the blood and filtering out waste gases is done by the placenta. The body systems can carry out the basic functions necessary for life. the baby’s body has to adapt in order to breathe air and function independently of the mother. instinctive movements designed to protect and to aid survival. causing the two openings in the heart to close so that all blood from the rest of the body then flows through the pulmonary arteries to the lungs to be oxygenated. Oxygenated blood to lower body Circulation in the fetal heart An opening called the foramen ovale and a channel called the ductus arteriosus divert most blood away from the pulmonary arteries.Y O U R B O D Y A N D H E A LT H The newborn baby A newborn baby has to cope with dramatic physical changes as it leaves the total protection of the mother’s uterus. Deoxygenated blood from upper body Oxygenated blood to upper body Open ductus arteriosus Pulmonary artery Blood from lungs Minimal blood to lungs Closed ductus arteriosus Deoxygenated blood to lungs Closed foramen ovale Oxygenated blood to upper body Arms and hands are stretched open Open foramen ovale Oxygenated blood from placenta Oxygenated blood to lower body Oxygenated blood from lungs Deoxygenated blood from lower body Startle (Moro) reflex If a baby is startled. so that all blood from the heart passes to the lungs to be oxygenated. In particular. With a baby’s first breath the lungs expand and take in air. such as breathing and passing urine and faeces. a protective movement occurs in which the baby flings the arms wide and stretches the legs out. this triggers changes in the heart and circulation. Legs make “stepping” motion 23 . The reflex actions. Walking reflex If a newborn baby is held upright with the feet on a firm surface. The baby can see. are eventually replaced by voluntary. There are several soft areas called fontanelles. and involuntary actions such as passing urine. such as sucking and “rooting” (searching for the mother’s breast). and crying to gain attention and care. and others are reflex actions. such as finding the mother’s breast. It may also be covered with a greasy substance called vernix. but only to a distance of 20–25 cm (8–10 in) Reflex actions and movements Babies are born with certain automatic patterns of behaviour. he or she will make movements that resemble stepping or walking. the umbilical cord is clipped and cut to leave a small stump. but most of the blood bypasses the pulmonary arteries (the vessels leading to the lungs) by flowing through two special openings in the heart. which are gaps between the bones The nails may be long. and may also appear red and swollen Right after delivery. whose babies had to cling to their mothers as they were carried. Some reflex actions. but they continue to develop and mature throughout childhood. sucking. Before birth. controlled actions as the baby’s nervous system and muscles mature. The heart before and after birth In the fetus. which disappears after about a month The head may be temporarily misshapen due to pressure on the skull bones during birth. obviously aid survival. obtaining oxygen from the lungs. for example. responding to stimuli such as noise. Premature babies may be covered with downy hair called lanugo hair. Some of these activities are involuntary actions. the grasp reflex is thought to have originated with our ape ancestors. but at birth the baby has to start breathing. and the ends may flake off by themselves Babies born in hospital are fitted with an identification bracelet The genitals are large in proportion to the rest of the body. The skin may be blotchy. which protected the baby’s skin in the uterus The baby’s hands may be clenched into fists Many babies are born with hair. Two typical reflex responses are shown below. The stump falls off within 10 days The edges of the lips may develop white blisters due to vigorous sucking as the baby feeds The eyelids are puffy. Circulation in the heart at birth The foramen ovale and ductus arteriosus close.

and lengthen as the child grows older. In the first 6 years. NEURAL NETWORK Long bone in a child Growth and ossification (bone formation) take place in the ends of the long bone. and is also influenced by factors such as diet and general health. and social development. much of the skeleton consists of tissue known as cartilage. At birth. The limbs. How the skull and brain develop A newborn baby has a full set Fontanelle of neurons (nerve cells). during which a person grows from a dependent baby into a mature. and this cartilage then turns to bone. mental. these areas bones are separated by sutures (seams) and fontanelles (soft gaps). are small in relation to the body and head. The growing body Growth in childhood is controlled by hormones. but the rate of growth varies depending on the stage of life: the most rapid overall growth occurs during infancy and puberty. In addition. Changing shape from birth to adulthood PROPORTION OF TOTAL BODY HEIGHT 1 7⁄ 8 3⁄ 4 5⁄ 8 1⁄ 2 3⁄ 8 1⁄ 4 1⁄ 8 Birth 2 6 AGE (YEARS) 12 18 24 . Children acquire many of the necessary physical. A child’s body grows continuously. Brain and skull at 6 years The brain is almost full size and the network of nerves has become much denser. neural network. The body finally reaches its full size at around age 18. Long bone in an adult All of the cartilage inside the bone has ossified. with bone tissue only in the shafts of the largest bones. the brain grows and the neural (nerve) network rapidly becomes more complex. but the learning process continues throughout life. although it may go on developing as a person continues to learn. gradually turn to bone. A layer of cartilage protects the ends of the bone. some parts of the body develop faster than others. as the face becomes larger in relation to the rest of the skull. while the epiphyses (ends) are made of cartilage. The rate of growth is fastest during the first year of life. In the long bones of the limbs. while the legs comprise about a half. To NEURAL allow for this expansion. during infancy. areas called growth plates produce more cartilage to extend the bones. the child learns skills that allow him or her to interact with other people and with the environment. self-sufficient individual. the NETWORK cranium (the part of the skull Brain and skull at birth covering the brain) grows at soft The neural network is only gaps called fontanelles and at partially developed. During the rest of childhood the brain. the transition from childhood to adulthood. During childhood. The neural network is mature. Epiphysis Secondary ossification centre Growth plate Diaphysis (shaft) Blood vessel Marrow cavity Epiphysis Growth plate Blood vessel Marrow cavity Diaphysis (shaft) Long bone in a newborn baby The diaphysis (shaft) is made of bone. but the Suture Cranium network of pathways between these cells is not yet mature. The fontanelles are closed and the skull bones are fixed at the sutures. The facial features change during childhood. The skull seams called sutures. and skull develop at a slower rate.Y O U R B O D Y A N D H E A LT H The growing child Childhood is a time of dramatic physical. the head represents only about an eighth of the body length. causing the body proportions to alter as the child grows. the cartilage is gradually replaced by bone – a process called ossification. allowing a child to learn a wide range of skills and behaviour. with especially rapid growth occurring during puberty. and social skills during their first 5 years. and there is another period of rapid growth at puberty. the head makes up about a quarter of the total body length. By the beginning of adulthood. and until about age 6 it continues to grow quickly. ossification is complete and the skeleton has reached its full size. mental. By this time. In addition. Suture Brain How bones grow and develop At birth. Brain Cranium NEURAL NETWORK Articular cartilage Ossified epiphysis Ossified growth plate Blood vessel Marrow cavity Suture Adult brain and skull The brain and skull have reached full size.

The ability to learn particular skills. babies turn towards voices and respond to sounds by cooing. hear. Startled by loud sounds Says “dada” and “mama” to parents Turns towards voice Squeals Can point to parts of the body Can talk in full sentences Says “dada” and “mama” to anyone Knows first and last names Can define seven words Can put two words together Makes cooing noises Starts to learn single words Can eat with a spoon and fork Mimics housework Plays peekaboo Eats with fingers Looks at own hands Can name a colour Can eat with a knife and fork Social behaviour and play The first social skill that babies master is smiling at people. stand. and movement. The four main areas of development are physical skills. before acquiring certain complex skills. Can lift head to 45° Can roll over Can walk without help Can stand without help Can throw a ball Can kick a ball Can catch a bounced ball Can crawl Can stand by hoisting up own weight Can bear weight on legs Can balance on one foot for a second Can sit unsupported Can walk up stairs without help Can walk holding on to furniture Likes to scribble Can pedal a tricycle Can copy a circle Can hop on one leg Manual dexterity and vision Children have to learn how to coordinate their hand movements and vision so that they can perform tasks such as picking up objects or drawing shapes. In addition. perform reflex actions (such as sucking). balance. and run. language. these occur in a certain order and at roughly predictable times. From birth to about age 5. such as bladder and bowel control. Children also acquire practical skills such as feeding and dressing themselves. They later learn how to crawl. They later learn to form sentences. walk. 0 0 Smiles spontaneously Separates easily from parent Can dress without help Can undress without help Stays dry in the day Can drink from a cup Stays dry at night 2 4 6 8 10 12 1 14 16 18 20 AGE (MONTHS) 22 24 2 AGE (YEARS) 30 36 3 42 48 4 54 60 5 25 . Developmental milestones AGE (YEARS) 0 1 2 3 4 5 Physical skills The most important skills are control of posture. then to sit up. depends upon the maturity of the child’s nervous system. Holds hands together Plays with feet Can build a tower of four bricks Can draw a straight line Can copy a square Passes rattle from hand to hand Reaches out for a rattle Can pick up a small object Can grasp object between finger and thumb Can draw rudimentary likeness of a person Hearing and language Early on. Babies first learn how to lift and turn their heads. and social behaviour. children need to develop a lesser ability first. babies must learn to stand before they can walk. children can speak their first word and begin to understand the meaning of words. although the exact age at which they are reached varies from one child to another. At about 1 year. manual dexterity.Y O U R B O D Y A N D H E A LT H Gaining skills during the first 5 years Newborn babies can see. They later learn to play with other children and tolerate separation from their parents. for example. young children learn a range of other essential skills. Achievement of these skills occurs in well-recognized steps known as “developmental milestones”. and cry to gain their mother’s attention.

Y O U R B O D Y A N D H E A LT H Growth charts Children have regular health checks during which their rate of growth is assessed. or weight on the left of the chart and follow a horizontal line across. The weight and height (or. The 2nd percentile line marks the lower limit of the normal range The shaded band shows the normal range of growth The vertical axis shows height. or (as here) weight. length and head circumference). ask him or her to take off his or her shoes and stand against a wall. there may be a problem. head circumference. in a child under 2 years. There are different charts for boys and girls. the points will form a curve showing your child’s growth. are plotted on charts with a shaded band to show the normal range of growth. If you plot these points at regular intervals. then find the height. Using the charts Find your child’s age on the bottom of the chart and follow a vertical line up. and the age. in metric and imperial units The horizontal axis shows the age – in this case. Measuring your child’s height To measure your child. vertically on your child’s head. if they fall outside. Most children’s measurements fall inside the band. Mark the point at which these lines cross. such as a book. using measurements from the clinic. Rest a flat object. in months lb 36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 The 50th percentile line marks the middle of the range The 98th percentile line marks the upper limit of the normal range kg 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 0 2 4 Boys’ weight (0–2 years) 98th percentile WEIGHT 50th percentile 2nd percentile 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) Children’s head circumference 0–2 years in 22 21 20 HEAD CIRCUMFERENCE 19 18 17 16 15 14 13 12 cm 56 54 52 50 48 46 44 42 40 38 36 34 32 30 0 2 4 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) 13 12 Boys’ head circumference (0–2 years) 98th percentile HEAD CIRCUMFERENCE in 22 21 20 19 18 17 16 15 14 cm 56 54 52 50 48 46 44 42 40 38 36 34 32 30 0 Girls’ head circumference (0–2 years) 98th percentile 50th percentile 2nd percentile 50th percentile 2nd percentile 2 4 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) Children’s weight 0–2 years lb 36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 kg 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 0 2 4 Boys’ weight (0–2 years) 98th percentile lb 36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 50th percentile 2nd percentile kg 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 0 2 4 Girls’ weight (0–2 years) 98th percentile WEIGHT WEIGHT 50th percentile 2nd percentile 6 8 10 12 14 16 18 20 22 24 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) AGE (MONTHS) 26 . for babies. head circumference. Mark where the base meets the wall. Measure the distance from the mark to the floor. You can also plot your child’s growth yourself by measuring his or her height or.

Y O U R B O D Y A N D H E A LT H Children’s length 0– 2 years in 40 38 36 34 32 LENGTH 30 28 26 24 22 20 18 16 14 cm 105 100 95 90 85 80 LENGTH 75 70 65 60 55 50 45 40 35 0 2 4 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) 40 38 Boys’ length (0–2 years) in cm 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 0 2 4 Girls’ length (0–2 years) 98th percentile 36 34 32 30 28 26 24 22 98th percentile 50th percentile 50th percentile 2nd percentile 20 18 16 14 2nd percentile 6 8 10 12 14 16 18 20 22 24 AGE (MONTHS) Children’s weight 2–18 years lb 240 220 200 180 160 WEIGHT 140 120 100 80 60 40 20 0 40 30 20 10 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 AGE (YEARS) kg 110 100 90 80 70 60 50 WEIGHT Boys’ weight (2–18 years) lb 240 220 200 180 160 kg 110 100 90 80 70 60 50 40 30 Girls’ weight (2–18 years) 98th percentile 140 120 100 80 98th percentile 50th percentile 2nd percentile 60 40 20 0 50th percentile 20 10 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 AGE (YEARS) 2nd percentile Children’s height 2–18 years in 80 75 70 65 HEIGHT 60 55 50 45 40 35 30 cm 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 AGE (YEARS) 80 75 70 Boys’ height (2–18 years) in cm 210 200 190 180 170 Girls’ height (2–18 years) 98th percentile HEIGHT 65 60 55 50 160 150 140 130 120 98th percentile 50th percentile 2nd percentile 45 40 35 30 110 100 90 80 70 2 3 4 5 6 7 8 9 10 11 12 13 50th percentile 2nd percentile 14 15 16 17 18 AGE (YEARS) 27 .

eggs. for example. whole grains. and all minerals. pregnant women should avoid foods that contain high levels of vitamin A because of potential harmful effects on the developing fetus. nervous system Nervous system. such as B2. leafy green vegetables Necessary for Eyes. teeth. examples of one portion include one medium-sized fruit. fish. whole grains. essential for building and repairing cells. should be eaten in limited amounts Bread. For example. potatoes. In addition. calcium. Good sources of vitamins and minerals Vitamin or mineral Vitamin A Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B6 Vitamin B12 Vitamin C Vitamin D Vitamin E Vitamin K Folic acid Calcium Iron RDA 1 mg 1 mg 1. and minerals. fish. edible fish bones Eggs. but try to choose low-fat varieties so that you maintain a healthy weight Food groups This pie chart shows the five main food groups and the proportion of your diet that each group should form. muscles. vitamins. fish. but the other vitamins. liver Meat. a high-fat diet increases your risk of heart disease. meat. nervous system Blood formation. muscles 28 . eggs. and K. peas Meat. dry beans. nuts Dairy products. must come from food. and vegans need extra vitamin B12 because they do not eat meat or other animal products (the usual source of this vitamin). B12. meat. Milk and dairy foods provide protein. and some vitamins and minerals. keeping cells and blood healthy Bones. organ meats. pregnant women need extra folic acid for the health of the fetus. and pasta are high in fibre. fats. natural sugar. which can cause tooth decay. and D. breads. and nuts are rich in protein. carrots.5 mg 1 µg 40–60 mg 5 µg 10 mg 70 µg 200 µg at least 800 mg 14 mg Food sources Eggs. peas. and caffeine. margarine Leafy green vegetables. and provide B vitamins and minerals such as iron. D. most people’s diets supply the recommended daily allowances (RDAs) of vitamins and minerals. grains. yeast Many fruits and vegetables Dairy products. whole grains. nervous system Red blood cell formation. Eat plenty of high-fibre foods. It is also crucial in weight control. leafy green vegetables Fish. eggs. immune system Teeth and bones Maintaining cell membranes Blood clotting. In addition. They can form a fairly large part of your diet. and water. oily fish Vegetables. so can form a large proportion of your diet Vitamins and minerals The body requires a range of vitamins and minerals because these substances play vital roles in growth and metabolism (the chemical processes that occur in the body). skin Blood formation. starches. Vitamins D and K can be made in the body. Do not take more than the recommended amounts of vitamins A. such as an apple. cereals. and certain vitamins. skin. and you should aim to drink at least 8 glasses (2 litres) a day. formed by bacteria in intestines Leafy green vegetables. They can also be high in fat. hair. It can affect your risk of developing many diseases. limit foods with a high fat or sugar content. bones Energy production. bone formation Fetal nervous system. peanuts. Aim to eat at least five portions a day. nervous system Body’s use of iron. For a balanced diet you need the correct amounts of carbohydrates. E. meat.Y O U R B O D Y A N D H E A LT H HEALTHY A healthy diet LIVING Meat. but certain people may need supplements. muscles Energy production. proteins. dairy products. fish. bananas Milk. peas. water is vital for life.5 mg 15–20 mg 1. because the body stores these substances and they can become toxic if excessive amounts build up in body tissues. which are high in energy. Fatty foods. breads Eggs. alcohol. so eat them only in moderation Fruit and vegetables are high in fibre (which aids digestion). or one dessert bowl of salad Diet has a major influence on health. In affluent countries such as the UK. Foods in the larger segments of the chart should form a greater part of your diet than those in the smaller slices. and sugary foods. dairy products. and avoid large amounts of salt.

such as slow jogging. and improve your quality of life in later years. clothing. and respiratory systems. reducing stress. and footwear for your sport. The recommended amount is at least 30 minutes of moderate exercise. you will have to exercise harder. Make sure that you use the correct protective equipment. bend forwards. It can also benefit mental health by providing pleasure. Rest your hands on your knee to steady yourself back straight while you move your hips How exercise benefits health Regular exercise benefits most of the body’s systems. Blood pressure is reduced. Repeat for the other thigh. Regular exercise protects physical and mental health. you will probably find that you have a lot more energy for ordinary daily activities such as shopping. lb 210 190 WEIGHT 170 150 130 110 90 kg 100 90 80 70 Height/weight graph for men and women OVERWEIGHT Fitness benefits of different activities Activity Fitness benefits Stamina Aerobics ★★★★ ★★★★ ★★★★ ★★★ ★★★ ★ ★★★ ★★★★ ★★★★ ★★ ★★ ★ Flexibility ★★★ ★★★ ★★ ★ ★★★★ ★★ ★ ★★ ★★★★ ★★★ ★ ★★★★ Strength ★★ ★★ ★★★ HEALTHY WEIGHT 60 50 40 144 57 Basketball Cycling (fast) UNDERWEIGHT 150 59 156 61 162 63 65 168 174 180 71 186 73 192 75 cm 77 in Climbing stairs Dancing (aerobic) Golf Hiking Jogging ★★★ ★ ★ ★★ ★★ ★★★★ ★★ ★ ★ 67 69 HEIGHT Exercise Most people know that exercise is an important part of a healthy lifestyle. Swimming Tennis Walking (briskly) Yoga KEY ★ Small ★★ Good ★★★ Very good ★★★★ Excellent effect effect effect effect Exercising safely To avoid overexertion or injury. and producing physical changes that improve mood. Keep your arms. head. divide your weight in kilograms by the square of your height in metres. start by setting realistic goals. You can also assess your weight by calculating your body mass index (BMI). improve joint mobility (increase flexibility). Every time you exercise. and gardening. A BMI figure under 20 indicates that you are underweight. and chemical changes occur that improve mood The heart becomes stronger and can pump more blood with every heartbeat Hip and thigh stretch Kneel. it has to be regular. Push your hips down and forwards to stretch the back thigh. and increase muscle strength. start with a warming-up routine and finish with a cooling-down routine to prevent muscle cramps and stiffness and minimize the risk of injury. Two typical Keep your stretches are shown here. such as a brisk walk. If you are not fit. while a figure over 25 shows that you are overweight. sitting on your heels. on at least 5 days of the week. and this decrease helps to lower the risk of cardiovascular disease The supply of blood to the brain is increased. Joints become stronger and more flexible and mobile as a result of exercise 29 . especially the cardiovascular. housework. increase your life expectancy. child care. thus promoting mental alertness. When you make exercise a part of your daily routine. Stretch your arms above your head. Take care not to overexert yourself so that you are in pain or feel ill. If you have never exercised regularly before. To become fitter or lose weight. followed by a series of movements to stretch your muscles. You need to do activities that work the heart and lungs (build stamina). To do this. begin exercising slowly and build up gradually. you need to maintain your weight within the range considered normal for your height. Planning an exercise routine For exercise to be beneficial. and put your hands on the floor. It can also reduce your risk of developing long-term disease. or if you have any health concerns.Y O U R B O D Y A N D H E A LT H Assessing your weight To avoid diseases associated with being overweight or underweight. musculoskeletal. then put one foot on the floor in front of you. To find out if you are within this range. These types of routine involve gentle aerobic exercise. The lungs can take in more oxygen from each breath and supply more oxygen to the body Muscles become stronger and more efficient so that they can work for longer periods of time Bones maintain their strength and density so that they are less prone to damage and disease Lower back stretch Kneel. consult your doctor before starting an exercise routine. and body aligned. you can use a height and weight chart such as the one shown below.

excessive drinking can cause intoxication and hangovers. but drinking more than this amount will increase the risk of cardiovascular disease The liver may become inflamed (hepatitis) by excessive consumption of alcohol. abv 40%) 30 . In adults.Y O U R B O D Y A N D H E A LT H Exercising at different ages Most people. so that the more you drink. the longer it takes for your body to break down the alcohol. each equal to 1 unit. the smaller the volume equivalent to 1 unit. it has been used socially for centuries. The box below shows a selection of alcoholic drinks. and women no more than 2 units. and can also be fun.5–4%) (75 ml/3 fl oz. excessive drinking can also lead to alcohol dependence and social problems including domestic violence and vagrancy. in excess. balance. men should drink no more than 3 units a day. The higher the abv. However. exercise has different benefits for people at different stages of life. psychological. Alcohol is broken down by HALF A PINT OF BEER SMALL GLASS OF WINE SMALL GLASS OF SHERRY SINGLE MEASURE OF A SPIRIT (250 ml/10fl oz. Volume of drink equal to 1 unit of alcohol Harmful effects of alcohol Although moderate alcohol consumption makes you feel relaxed and can have a beneficial effect on health. if you take alcohol with food. the liver at an average rate of about 1 unit per hour (see VOLUME OF DRINK EQUAL TO 1 UNIT OF ALCOHOL. This level depends on factors such as your weight and whether you have drunk the alcohol with food or on an empty stomach. Long-term drinking raises the risk of high blood pressure Safe alcohol limits Pregnant women During pregnancy. In the long term. reaching its maximum concentration in the blood 35–45 minutes afterwards. In older people. and coordination. stomach cancer is a risk Sexual performance may be impaired by alcohol. improves coordination. Measures served at home or in bars may be larger than those shown here. and stamina. strength. Activities for children Games such as football can improve physical aspects such as strength. When you have a drink. and social problems. the alcohol is absorbed into the blood through the stomach and small intestine. Long-term drinking can seriously damage the liver and cause diseases such as cirrhosis and cancer The stomach and the duodenum (the first part of the small intestine) may become ulcerated as a result of long-term drinking. alcohol may cause loss of control over behaviour and in the long term. such as loss of bone density. it helps to build strong bones and muscles. you should limit your intake. Such games can also be fun and enable children to make new friends with the other players. abv 3. Alcohol consumption is measured in units. physical. gentle swimming can allow you to stretch and exercise your muscles while the water supports your weight. whatever their age. alcohol damages most body systems. In the longer term. For this reason. In children. abv 13%) (50 ml/2 fl oz. Alcohol Alcohol is a drug that alters your mental and physical state. If you drink heavily at night. Regular. Try to keep within these limits and have at least one or two alcohol-free days a week. abv 20%) (25ml/1 fl oz. In the short term. reducing tension and facilitating social interaction. This situation can be dangerous if you plan to drive a vehicle or operate machinery. In addition. excessive use of alcohol over a long period can result in serious health problems. fertility may be reduced Drinking alcohol makes the blood vessels in the skin widen. causing the body to lose heat. it helps to slow processes associated with aging. and enables people to stay mobile for longer. your body will absorb the alcohol at a slower rate. in general. can derive physical and mental benefits from exercise. exercise helps to minimize the risk of heart disease. Current guidelines in the UK set by the medical profession state that. The volume of a drink containing 1 unit depends on the percentage of alcohol by volume (abv). To drink alcohol safely. Older people Activities such as walking can help to lessen the effects of aging by maintaining your bone and muscle strength and joint flexibility. Your body cannot alter this rate. Apart from the overall improvements to your flexibility. The brain’s control of inhibitions and coordination is impaired by alcohol. Long-term drinking damages brain cells that control learning and memory The heart may be protected against disease by one or two drinks a day. below). you may still be intoxicated the next morning. Regular exercise can also enable pregnant women to cope better with the demands of pregnancy and childbirth.

Y O U R B O D Y A N D H E A LT H

Tobacco
Tobacco is most commonly smoked in cigarettes but can also be smoked in cigars and pipes, inhaled as snuff, or chewed. However it is used, tobacco is harmful to health. In the UK, smoking is one of the main causes of death in people under the age of 65. Smoking also damages the health of “passive smokers”, who inhale other people’s smoke. The only way to avoid these health risks is to avoid smoking or coming into contact with other people’s smoke.

Giving up smoking
You can help to prevent heart or lung disease by not smoking or by giving up before you begin to develop the diseases. No matter how long you have been smoking, you can prevent further damage to your health by giving up. If you need help in giving up, consult your doctor for advice. If you want to try on your own, list the reasons why you want to stop smoking, then work out the reasons why you smoke. Plan ways to cope with temptation and ask your family and friends for support. Telephone helplines staffed by ex-smokers can be helpful. Choose a fairly stress-free day on which to stop smoking completely and throw away cigarettes, lighters, and ashtrays. You may have withdrawal symptoms, such as irritability, and crave nicotine. Aids such as nicotine patches or gum can help to stop cravings. If you relapse, work out why it has happened, refer to your reasons for giving up, and try again.
Nicotine patch in place

Health hazards of smoking
Tobacco smoke contains many substances damaging to health, such as tar, carbon monoxide, and nicotine. Tar irritates the airways; carbon monoxide attaches itself to red blood cells, reducing their ability to carry oxygen; and nicotine is addictive. Tobacco smoke also contains cancer-causing substances that can harm the lungs and other organs. Inhaling smoke from smokers’ cigarettes and exhalations is known as passive smoking. The smoke can irritate the eyes, nose, and throat. In the long term, it may cause lung cancer and cardiovascular disease. In children, exposure to smoke increases the risk of infections, such as ear infections, and can trigger asthma and allergies. Babies born to mothers who smoke are likely to be smaller than average and at greater Mouth and tongue cancers risk of sudden infant death may be caused syndrome (cot death).
The airways to the lungs are irritated by smoke. In the long term, smoke can cause disorders such as lung cancer and emphysema The risk of cardiovascular disease is increased by smoking Smoke can irritate the stomach lining, leading to ulcers. Long-term smoking may cause stomach cancer Bladder cancer may result from smoking Cancer of the cervix may develop as a result of smoking by irritants in smoke

Using a nicotine patch
Nicotine patches deliver a constant supply of nicotine through the skin, helping to stop cravings for cigarettes.

The pharynx (throat) and larynx (voice box) may develop cancer due to smoking

Drugs
A drug is any chemical that alters the function of an organ or a biochemical process in the body. Drugs that are used to improve body functions or to treat diseases and disorders are known as medicines. Certain drugs, such as the sleeping drug temazepam, may be both used as medicines and abused for recreation. Other drugs, such as ecstasy, have no medicinal value and are used only for recreational purposes. Drug abuse can cause serious physical and mental problems, particularly if the abuser becomes dependent on a drug or takes an overdose, and may even cause death. In addition, the use of recreational drugs is illegal.

Effects of drug use on the body
People use recreational drugs to alter their mood. The main types of drug are classified according to the usual mood change that they cause, but often they have a mixture of effects. Stimulants, such as cocaine, increase mental and physical activity; relaxants, such as marijuana and heroin, produce a feeling of calm; intoxicants, such as glue, make users feel giggly and dreamy; and hallucinogens, such as lysergic acid diethylamine (LSD), alter perception and cause hallucinations (seeing or hearing things that do not exist).

FEMALE

Smoking and lung cancer
This graph shows that male and female smokers are, respectively, over 20 and 10 times more likely to develop lung cancer than those who have never smoked. Exsmokers have a much lower risk than current smokers; 15 years after giving up, they will have reduced their lung cancer risk by more than half.
25x 20x RELATIVE RISK 15x 10x 5x 0

Risk of lung cancer
KEY
Males Females

Extreme reactions and risks of drugs
Drugs pose serious health risks. Overdoses of drugs such as heroin and cocaine can be fatal; other drugs, such as ecstasy, can also cause death. Some drugs affect vital functions; for example, heroin can slow breathing and heart rate. In addition, extreme reactions or adverse interactions with substances such as alcohol may occur. Another common effect is dependence, a condition in which users experience physical and mental cravings when they do not take a drug. Some problems may arise soon after taking a drug (even for the first time); others are associated with long-term abuse. Injected drugs carry additional risks associated with the use of nonsterile needles, such as HIV infection, hepatitis B or C, or blood poisoning. If you or someone close to you abuses drugs, ask your doctor for information on health risks and advice on counselling and treatment.

Current smokers

Exsmokers

Non smokers

SMOKING STATUS

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Y O U R B O D Y A N D H E A LT H

Sex and health
Puberty, when the body makes the change from childhood to adulthood, prepares you physically for sexual activity and reproduction. The development of emotional maturity often takes much longer, and involves both learning about yourself and gaining experience in dealing with other people. Sex can be an intensely pleasurable experience that boosts the feeling of wellbeing. In addition, regular sex can improve cardiovascular fitness and help prolong life. However, you should be aware of the health risks of sex, such as unwanted pregnancy and diseases, called sexually transmitted infections (STIs), that are spread only or mainly by sexual intercourse.

Stress ratings of different life events
Very high
Death of a spouse Divorce or marital separation Personal injury or illness Loss of job Moving house

High
Retirement Serious illness of family member Pregnancy Change of job Death of close friend

Moderate
Big mortgage Legal action over debt Trouble with in-laws Spouse begins or stops work Trouble with boss

Low
Change in work conditions Change in schools Small mortgage or loan Change in eating habits Christmas or other holidays

Sexual relationships
Sexual fulfilment depends on a blend of physical and psychological factors, and what is right for one person or couple may not suit another. You and your partner should be happy with the frequency of sexual activity, and should be able to discuss which activities you enjoy or find unappealing. Anyone in a sexual relationship should be aware of transmitted infections (STIs) and understand how to minimize the risk of exposure to such conditions by practising safe sex (below). In addition, to avoid an unwanted pregnancy, you should be familiar with the Physical and emotional benefits options for contraception (see Good sexual relationships fulfil CONTRACEPTION CHOICES FOR both partners’ needs for comfort MEN, p.254, and CONTRACEPTION and closeness as well as satisfying CHOICES FOR WOMEN, p.276). their physical desires. It is common to experience a temporary lack of sexual desire or inability to perform sexually (see LOW SEX DRIVE IN MEN, p.250, and LOW SEX DRIVE IN WOMEN, p.272). Such problems are often due to stress or emotional difficulties, or to the use of alcohol, recreational drugs, or certain medications. Disorders such as diabetes mellitus can cause longer-term sexual problems. It is important to discuss concerns with your partner. Talk to your doctor if the problem is persistent.

Sources of stress
Stress may result from external events or circumstances, your personal reactions to pressure, or a combination of these factors. Major external sources of stress include long-term problems, such as an unhappy relationship, debilitating illness, or unemployment; major changes, even desirable ones, such as marriage or moving house; and a build-up of everyday stresses, such as being late for work or getting caught in a traffic jam. Behaviour patterns that cause or aggravate stress include impatience and aggression, lack of confidence, and suppressing feelings of tension or anxiety.

Recognizing signs of stress
If signs of stress are recognized early, action can be taken to prevent health problems. These signs may include having less energy than usual, a reduced appetite, or eating more than you do normally. You may have headaches, mouth ulcers, or be unusually susceptible to minor infections, such as colds. If you feel very stressed, you may be anxious, tearful, irritable, or low in spirits. Sleep may be disrupted, and relationships may suffer. To distract yourself, you may rely on alcohol, tobacco, or drugs. If stress is causing any of these problems, seek help from your family, friends, or doctor.

Making lifestyle changes
If your lifestyle is stressful, try to minimize the harmful effects that stress may cause. Find time to keep up with your family and friends, and take up leisure activities. Exercising regularly can help to relieve physical tension, as may learning to relax your body consciously (see RELAXATION EXERCISES, below). Break stressful tasks down into small, easy parts. Concentrate on important tasks and limit the number of less urgent ones to conserve your time and energy. If people make heavy demands on you, try to set limits on these demands.

Practising safe sex
Sexually transmitted infections (STIs) are usually spread by contact with infected skin or body fluids such as semen, blood, and vaginal secretions. Many STIs are uncomfortable but fairly minor problems, but some, such as HIV infection, are life-threatening. You can take simple steps to protect yourself. If you have sex with someone whom you do not know to be free of infection, use a condom, which gives protection against most STIs (apart from genital warts and pubic lice, which can affect body areas that are not covered by a condom). If you develop an STI, you should avoid sexual activity until you have been treated and are free of infection.

Relaxation exercises
If you are under stress, your muscles tighten, the heart beats more rapidly, and breathing becomes fast and shallow. Relax both your mind and body by learning simple relaxation routines that slow down your body’s stress responses. The breathing technique shown here may help to reduce stress. For more information, ask your doctor if he or she can recommend any relaxation classes. Breathing to relax
Breathe slowly and deeply, using your diaphragm and abdominal muscles. Rest one hand on your chest and one on your abdomen: the lower hand should move more than the upper one.

Stress
Stress is a physical or mental demand that provokes certain responses in us, allowing us to meet challenges or escape from danger. A moderate amount of stress can improve your performance in situations such as sports and work, but excessive stress can harm your health. You can minimize harmful stress by identifying situations that you find stressful and developing ways to cope with them.

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Safety and health
Your environment, like your personal habits, can affect your health but can be modified to some extent. Accidents are a major cause of death and serious injury, particularly in elderly people and small children. Other health hazards include factors such as certain weather conditions and features of your environment at home or work. However, you can easily avoid many risks to health and safety, whether at home, at work, or when travelling, by identifying potential hazards and taking steps to avoid them.

Safety in the garden
The greatest risks associated with gardens are from ponds or pools, poisonous plants and chemicals, garden tools, barbecues, and play equipment. Ponds can pose a risk to small children, who can drown even in shallow water. Take care to supervise children when they are playing around these areas. Toxic plants may cause symptoms such as skin irritation and, if swallowed, internal irritation and vomiting. A few plants may be lethal. Teach children that touching or eating plants may be dangerous. If a child does eat anything poisonous, call your doctor immediately, or take the child to hospital together with a sample of the plant. If you use poisonous garden chemicals, store them in a locked shed or cabinet. Consider safe alternatives, such as removing weeds by hand or applying chemical-free pesticides. Never leave dangerous machines or sharp tools where children can find them. When using such equipment yourself, wear the necessary protective clothing. Insects such as bees, wasps, and mosquitoes can bite or sting. The venom may cause an allergic reaction. An extreme allergic reaction (anaphylaxis) can be life-threatening. To protect yourself, keep your arms and legs covered, and apply insect repellent to your skin.
Goggles Ear protectors

Home safety and health
Accidents are a major hazard to health. Almost half of all serious accidents happen in the home, with elderly people and young Smoke detectors children having the highest rates are usually fitted of injury. Elderly people are on ceilings particularly vulnerable to falling, while children are at significant risk from poisoning by toxic household substances. Fire is another hazard. A significant risk to health is posed by poor kitchen hygiene, which can lead to food poisoning. To prevent falls, install bright lighting, make rugs and mats secure, and keep floors tidy. If you have a small child, fit stair gates to stop the child from Fitting smoke detectors falling down the stairs. Fit smoke detectors on every storey Poisonous substances include of your home. Take care to keep drugs, cleaning fluids, carbon them free of dust and test the monoxide (a gas that is released batteries once a month. by burning fuels), and lead. You should keep toxic substances out of reach of children. To prevent the build-up of carbon monoxide, have chimneys, heating systems, and gas appliances inspected yearly, and never run machines with petrol engines in a closed garage. To prevent lead poisoning, have lead pipes replaced and lead-based paint removed professionally. Use fire or hot items with care; for example, if you are a smoker, be sure to put out cigarettes and matches once you have finished with them. To prevent electrical fires, do not overload electrical sockets. Store flammable materials, such as paints, in a shed or a garage. In addition, keep a fire blanket or extinguisher in the kitchen, and fit smoke detectors throughout your home, in case a fire breaks out. To avoid food poisoning, keep your kitchen clean, cook food thoroughly, and store perishable foods in a refrigerator. Keep food in airtight containers, and use it by the recommended expiry date.
These width adjusters allow the gate to fit any size of stairway Vertical bars help to prevent a child from climbing over the gate

Thick gloves

Protective gear
Wear protective gear when using machinery such as a hedge cutter. For example, wear thick gloves, shield your eyes from flying debris with goggles, and use ear protectors to block out noise.

Pets and safety
Animals can cause allergies, and some infections and infestations may spread to people. Cat and dog faeces may contain dangerous organisms such as the eggs of the toxocara worm. If ingested, these eggs may cause toxocariasis, a disease that may lead to blindness. Cat faeces may also contain toxoplasma protozoa, which may cause serious harm to fetuses in pregnant women. Worm your pets regularly and dispose of their faeces hygienically. Teach children to wash their hands after touching animals. Because pets such as dogs can bite, they should never be left alone with young children. Handling dogs safely
Teach children how to approach and stroke dogs correctly. Even a normally friendly dog may bite if provoked.

Using a stair gate
If you have young children, fit gates at both the top and the bottom of staircases to help prevent falls. Check that the gates are too high for your children to climb over.

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Y O U R B O D Y A N D H E A LT H

Safety in the sun
Overexposure to the sun may lead to sunburn, heatstroke, and, in the long term, serious problems such as skin cancer. You are at especially high risk if you have red or blond hair and green or blue eyes because your skin contains a low level of melanin, a pigment that absorbs ultraviolet light. To minimize the risk of sun damage, everyone should stay out of the sun in the middle of the day. If you are outdoors, make sure to protect your skin and eyes. Wear a widebrimmed hat, a long-sleeved shirt, and long trousers or skirt. Use a sunscreen with a suitable sun protection factor (SPF); the higher the factor, the greater the protection it gives you. Apply it 15–30 minutes before you go outside and re-apply it every 2 hours. Sunglasses should have British Standard mark BS2724 and give maximum protection from ultraviolet light.
Apply sunscreen to uncovered areas

Protecting children’s skin
Babies and children are at high risk of sunburn because of their delicate skin. Keep babies out of the sun, and ensure that young children wear protective clothing and sunscreens.

with stressful situations, try to resolve these problems, or seek help if necessary, before they start to affect your health. Many types of manual work are dangerous. Working with machinery or heavy objects may put you at risk of injury. Many chemicals are toxic or have other harmful effects such as burning the skin. Some forms of dust, such as silica (found in sand and some rocks) and asbestos, can damage the lungs if inhaled. Other hazards include loud noise and extreme temperatures. Your employer should inform you of any risks and supply protective equipment. If you are self-employed, find out about possible risks to protect yourself and ensure that you conform to safety regulations for your work.

Helmet shields head from debris Ear protectors cut out loud noise Gloves help to reduce effects of vibration

Using equipment safely
When using tools such as a drill, you need clothing and equipment that protect you from noise, vibration, and flying debris.

Safety on the road
In the UK, road traffic accidents result in thousands of deaths and injuries each year. Nearly all accidents are due to human error rather than mechanical faults. A major cause of errors in drivers is alcohol abuse; other causes include lack of experience, use of medications, and tiredness. These factors can delay reactions and impair drivers’ judgment. Drivers should ensure that they are not tired or under the influence of alcohol, and check that any Child seats medications they are taking A car seat for a child should cushion will not cause them to feel the child from possible injury and drowsy. Every occupant of a should allow the seat belt to fit car should wear a seat belt. correctly across his or her body. Young children should have car seats that are appropriate for their size and weight. Motorcyclists and cyclists need helmets and clothing that will protect them from adverse weather conditions and injury. They should ensure that their lights work properly, and wear reflectors or bright clothing to make them visible to other road users. Pedestrians should use pavements or footpaths, and should cross roads at pedestrian crossings. If there is no path, they should walk on the same side of the road as oncoming traffic. Anyone who has young children should ensure that Bright clothing they learn about road safety. makes cyclists
Cycle helmet protects head from impacts clearly visible to other road users

Safety at work
Both office work and manual jobs can involve certain risks to health. It is wise to find out about any potential risks associated with your work and take action to prevent them. If necessary, ask your employer for help in minimizing these hazards. Office work rarely poses risks to your physical safety, but it can give rise to various health problems. Two of the most common physical conditions are lower back pain, due to poor posture while sitting at a desk, and repetitive strain injury (RSI), a type of muscle strain caused by repetitive movements such as typing. Another common problem is psychological stress (p.32), which may be due to factors such as demanding situations or poor relationships with colleagues. To avoid physical problems, you should make sure that your work space is well ventilated and is well lit. Sit with your back straight and feet on the floor. If you do a lot of typing, make sure that your wrists are supported while you work. If you are faced
Open window provides ventilation Upright seat back aids posture Shoulders relaxed and not hunched Foam-rubber rest supports the wrists for typing Computer monitor is level with line of sight

Cycling safety
Cyclists should wear helmets to protect the skull and fluorescent or bright clothes to make them easily visible. Lights must be used at night. Always maintain your bicycle in good working order.
Brakes must be checked regularly for wear and tear

Tyres should be inflated to the right pressure

Your work station
Arrange your desk and equipment so that they are positioned correctly for you. Sit in a position that maintains good posture and enables you to use the keyboard comfortably.

Feet rest flat on the floor

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Y O U R B O D Y A N D H E A LT H

PROFESSIONAL

HEALTHCARE
Before your first appointment with a new doctor, you may be asked to fill in a questionnaire about your health and lifestyle. On your first visit, your doctor will ask further questions and check if you are up to date with immunizations and screening. During later visits, the doctor will add notes to your medical records, which are transferred if you change to another GP. You have the right to see your own or your child’s records. During a visit, do not hesitate to ask questions about your health and treatments. Most appointments last 7–10 minutes.
Consulting your doctor
Provide your GP with accurate information about symptoms, and feel confident about asking questions.

Healthcare throughout life Visiting your doctor
Looking after your health involves not only following a healthy lifestyle but also making effective use of the healthcare system. Doctors and other professional healthcare workers provide treatment when you are ill and are also involved in some important elements of preventive healthcare. These include health education, checkups during childhood and later in life, screening tests to identify risk factors and early signs of disease, and immunizations to help prevent certain infectious diseases. To get the most from what professional healthcare has to offer, you need to be aware of the options for you and your family and to learn how to make the best use of the services that doctors and other healthcare professionals can provide.

Healthcare providers
Most disorders can be diagnosed and treated by general practitioners (GPs). GP practices provide a range of services, including antenatal care and clinics for immunizations and for minor surgery such as wart removal. Some large practices also have other healthcare providers including practice nurses, dentists, physiotherapists, and some practitioners of complementary therapy, such as osteopaths. In addition, the NHS helpline, NHS Direct, provides advice on health by telephone or on the internet (see USEFUL ADDRESSES, p.311). The usual way to obtain hospital care is by referral from a GP. However, if you have a severe accident or a serious problem such as heavy bleeding, you should go straight to an accident and emergency department in a hospital for treatment. If your injury or symptoms are not severe, you should consider waiting to see your GP or contact NHS Direct. Hospital clinics for the treatment of sexually transmitted infections, called STI clinics or genito-urinary medicine clinics, are also run on the basis of self-referral.

Your medical history
When you first visit a doctor, you will be questioned about your present and past health; treatments that you are having or have had; disorders that could run in your family; and aspects of your lifestyle, such as diet and exercise. The information gathered from these questions is known as a medical history. If you then visit your doctor with a disorder or unexplained symptoms, your medical history can help him or her to reach a diagnosis. In addition, if there is evidence that you are at risk of developing certain disorders, your doctor will suggest preventive measures or screening to detect early signs.

Choosing a doctor
If you are looking for a new GP, you can obtain a list of doctors in your area from your Community Health Council or local library; you could also ask friends and neighbours if they can recommend anyone. When you find a likely practice, ask about their opening hours and how long, on average, you will have to wait for an appointment that is not urgent. In addition, ask whether the practice offers home visits, advice over the telephone, services provided by other healthcare professionals such as nurses, and special services, such as family planning clinics. You may also wish to ask if you can choose a female doctor rather than a male doctor (or vice versa), if you have a strong preference in this matter. Using the internet
If you are new to an area and need to register with a GP, you may be able to find out about local practices by looking on the internet.

Having a physical examination
When you see your doctor, you may have a physical examination to assess your state of health, look for abnormalities, or confirm or rule out a diagnosis. The examination usually begins with a check of external areas, such as the eyes, ears, skin, and nails, and a test of nervous reflexes. In some cases, the doctor can gather information about other areas apart from the one being examined; for example, a pale-coloured tongue may be a sign of anaemia. He or she may also check for abnormalities by listening to organs with a stethoscope (auscultation), by feeling (palpation), or by tapping areas and listening to the sounds produced (percussion). Listening to the chest
The doctor uses a stethoscope to listen to sounds within the chest, such as those made by the heart and lungs. A stethoscope is also used to listen to sounds made by the intestines or by blood flowing through vessels.

35

Y O U R B O D Y A N D H E A LT H

Health checks and screening
Health checks provide an opportunity to discuss with your doctor or health visitor your or your child’s general health. In the UK, children are offered routine checks that focus on healthy growth and development. In adults, health checks usually are given after registering with a new doctor, for insurance purposes, or when starting a new job. In addition, pregnant women and those with a long-term illness, such as diabetes mellitus, are offered regular checks. Health checks for adults usually involve a physical examination (p.35) and basic screening, such as blood pressure measurement. Screening is important in preventing disease by looking for factors that increase the risk of disease and in detecting disease at an early stage when there is the greatest chance of treatment being successful. In some cases, screening may also be used to detect a rare inherited disease that may affect you or your children. Some tests may only be appropriate at certain ages: for example, newborn babies are screened for certain metabolic disorders; and the faecal occult blood test, which screens for colorectal cancer, is being used increasingly often for people over the age of 50.

levels, which also affect your risk of heart disease and stroke, and eye pressure measurement, to check for glaucoma, a disorder that may cause blindness if left untreated. People with long-term disorders are usually offered regular screening to detect early signs of complications. For example, people with diabetes mellitus have regular screening for kidney disease, cardiovascular disorders, nerve damage, and problems in the blood vessels of the eye, which left untreated may lead to blindness.
Sphygmomanometer, a device that measures blood pressure Stethoscope Inflatable cuff wrapped around upper arm and connected to the sphygmomanometer

Screening babies and children
In the uterus, babies may be tested for genetic disorders such as Down’s syndrome. Immediately after birth, a baby’s appearance and responses are checked for abnormalities, and a few days later, a blood sample is taken from the heel to look for hypothyroidism (underactivity of the thyroid gland) and phenylketonuria (a metabolic defect that can cause brain damage). In early childhood, the acquisition of certain skills, known as developmental milestones, is monitored Blood (see GAINING SKILLS DURING THE FIRST 5 smeared on YEARS, p.25), and, throughout childhood, a test card growth is checked (see GROWTH CHARTS, pp.26–27). Children should also have regular eye and ear tests (see VISION TESTING IN CHILDREN, p.101, and HEARING TESTS IN CHILDREN, p.105). Heel-prick test
The baby’s heel is pricked with a small needle and a few drops of blood are smeared on to an absorbent card. The card is then sent to a laboratory for analysis. The results are available within a week or two.

Blood pressure measurement
To measure blood pressure, the doctor wraps an inflatable cuff around the upper arm and inflates it. The cuff is slowly deflated while the doctor listens to blood flow through an artery by using a stethoscope.

Bulb for inflating and deflating cuff

Common screening tests
Test
Heel-prick test (left); a blood sample is taken from the baby’s heel Blood pressure measurement (above) Blood cholesterol test; involves giving a blood sample for analysis Cervical smear test (p.264); a sample of cells is scraped from the cervix Faecal occult blood test; involves providing a sample of faeces for testing Mammography (p.257); an X-ray of the breasts is taken Screening for glaucoma (p.188); the pressure inside the eye is measured

When recommended
Shortly after birth

What it screens for
Hypothyroidism and phenylketonuria (a rare metabolic disorder) Hypertension (high blood pressure) High blood cholesterol

Every 5 years from about age 20 Every 5 years from about age 20

Every 3–5 years for women between the ages of 20 and 64 Every year from age 50 on request from doctor

Precancerous changes in cells of the cervix or cancer of the cervix Colorectal cancer

Screening adults
Some screening tests are offered to adults at stages of life when the risk of certain diseases increases. For example, screening for early signs of breast cancer and cancer of the cervix is offered on the NHS to women in specific age groups (see COMMON SCREENING TESTS, right). Screening tests for other cancers, such as colorectal cancer and prostate cancer, are available, but these tests are not yet offered routinely in the UK. One of the most common screening tests is blood pressure measurement. Usually, high blood pressure, or hypertension, does not produce symptoms but is a major risk factor for heart disease and stroke. Other screening tests that are recommended for adults include tests to check blood cholesterol

Every 3 years for women between 50 and 64 years old Every 2 years from age 40; carried out by an optician

Breast cancer

Glaucoma

36

If you are planning to travel. Immunizations for adults The immunity given by some immunizations wears off after several years. In addition. The immunization schedule begins shortly after birth because it is important to protect babies against infectious diseases that may be life-threatening in infancy. Most vaccines involve several injections over a period of months or years to build up adequate protection. state of health. and purpose of your travel. These immunizations are usually offered because these groups are at increased risk of developing a serious illness if they become infected. such as the one for the viral infection poliomyelitis. However. necessary if you will be working with animals or travelling in remote areas Areas with poor sanitation Parts of Africa and South America Hepatitis B 3 injections over 6 months Arm held still during injection Immunization Most immunizations are given by injection. Brazil. mumps. to those who have reduced immunity. For example. immunization certificate needed if travelling to Mecca Areas where rabies is endemic. always obtain current information. and the duration. proteins that help to destroy the organism or toxin if encountered in the body. You should keep records of all your immunizations and those of your children in case a doctor other than your GP needs to know about your immune status. Most countries do not require visitors to have specific immunizations. HIV infection. specific groups of people may need to be given immunizations that are not normally offered to most people. A vaccine contains a tiny amount of either a killed or modified infectious organism or a modified toxin (poison produced by bacteria). immunizations against influenza and pneumococcal pneumonia are commonly given to people over the age of 65. the bacterium responsible for this disease is very common in the environment and you are at risk of infection if you sustain a dirty or deep cut. Sub-Saharan Africa. Routine immunizations Most routine immunizations are given during infancy and childhood according to an immunization schedule (below). necessary if you may need to receive medical or dental treatment in a developing country Rural areas of the Indian subcontinent. rubella (MMR) Tuberculosis (BCG) *Given as one vaccine to babies up to 4 months 3 4 12–15 Age (years) 3 injections over 4 weeks 1 or 2 injections or 3 oral doses 1 injection Typhoid Yellow fever 3–5 10–14 16–18 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓† Immunizations for special cases In some circumstances. China. make sure that you have been immunized for poliomyelitis if you missed out in childhood. serious side effects are extremely rare. a viral infection that can cause severe jaundice. Consult your doctor or local travel clinic about necessary immunizations at least 8 weeks before you travel because some immunizations require more than one dose to become effective. make sure that you have been immunized against tetanus and poliomyelitis. so it is important for adults to have repeat doses known as boosters. In addition. ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ †If not given previously 37 . but some may ask for a certificate showing that you have been immunized for yellow fever. Immunizations are often given to adults who are travelling to areas where certain diseases are common (see TRAVEL IMMUNIZATIONS. such as people with diabetes mellitus. Advice on immunizations for foreign travel changes frequently. Immunizations may have side effects. type. you need a booster immunization for tetanus every 10 years. people who work with animals may need to be vaccinated against the virus that causes rabies. Japanese B encephalitis Meningitis A and C Rabies 2–3 injections 1–2 weeks apart 1 injection Routine immunization schedule Disease Timing of immunization Age (months) 2 Diphtheria* Tetanus* Pertussis* Poliomyelitis Haemophilus influenzae type b (Hib) Meningitis C (Meningococcus C) Measles. are given orally.Y O U R B O D Y A N D H E A LT H Immunization Immunization protects you from infectious disease for several months or years. Travel immunizations The immunizations that you need before travelling depend on your destination. For example. such as mild fever. Immunoglobulins contain antibodies taken from the blood of a person or animal who has overcome a certain infection and give useful short-term protection. below) or if there is a high risk of an infectious disease for health or work reasons (see IMMUNIZATIONS FOR SPECIAL CASES. The table below shows the most common travel immunizations. below). but a few. Needle and syringe Common travel immunizations Disease Diphtheria Hepatitis A Dosage 1 injection 1 injection (immunoglobulin) 2 injections (vaccine) Destination Former USSR or developing countries Mediterranean or developing countries (single visit) Mediterranean or developing countries (frequent visits) Areas where hepatitis B is endemic. or AIDS. Once inside the body. and have booster doses if necessary. and current immune status. or even for life. For example. and the Far East Saudi Arabia. Southeast Asia. Nepal. some people may need immunization if their type of work puts them at increased risk of an infectious disease. the vaccine stimulates the immune system to make antibodies. It can be conferred by using either vaccines or immunoglobulins. and to those with long-term heart or lung disease.

Samples are taken by biopsy. or abnormal levels of certain chemicals. The samples are then usually sent to a laboratory for analysis.260). some tests can reveal the presence of diseasecausing microorganisms. After a specified amount of time.264). can give a definitive diagnosis for many disorders. This test may be carried out if the doctor suspects that there may be bleeding in the digestive tract. is often used to take cells from the lungs. The samples are usually taken from a vein. Cells may be obtained from body fluids such as sputum (fluid coughed up from the lungs) or scraped from tissue surfaces such as the cervix (see CERVICAL SMEAR TEST. are usually collected with a swab – a sterile cotton bud on a plastic stick. and muscle damage. which can reveal tiny amounts of blood invisible to the naked eye. such as cell and tissue samples and certain body fluids. In addition. in which a small piece of tissue is removed from parts of the body such as the skin (see SKIN BIOPSY. or reveal the presence of abnormal substances or abnormal levels of normal substances. Biopsy needle Urine tests Urine is most commonly tested for evidence of urinary tract infections or diabetes. The most common blood tests performed are blood cell tests and blood chemistry tests. or from internal areas such as the inside of a joint or around the brain and spinal cord. and can also be used to assess kidney function. Blood cell tests include measuring the numbers of red and white blood cells and of platelets (cells that help blood to clot). Most tests on body samples are carried out in a laboratory. which can be performed at home (see HOME PREGNANCY TEST. Tongue depressor such as saliva. are often the first investigations requested by a doctor before making or confirming a diagnosis.183) or the liver (below). thyroid gland. Having a liver biopsy Under local anaesthesia. Tests that are carried out on samples of body fluids. abnormal cells such as cancerous cells. One type is carried out to measure the level of cholesterol in the blood. a hollow needle is inserted into the liver through a small incision between the right lower ribs. such as sperm in a sample of semen. Dipstick tests are usually performed in a doctor’s office. but may also be taken from capillaries (tiny blood vessels) by a finger prick or occasionally from an artery. 38 . p. which indicate the concentration of substances in the urine. Cells may also be withdrawn from the body using a needle and syringe. such as hormones. and blood chemistry tests can measure the levels of these substances. Samples of urine and faeces can usually be collected easily by the patient. such as the mouth. The intensity of each colour shows the concentration of a certain substance The chart shows possible test results Testing with a dipstick When a dipstick is put into a urine sample. the colours of the squares. Cell and tissue tests Microscopic studies of individual cells. Other tests involve assessing cells or other substances that are normally found in the fluid. and a core of liver is removed. but some may be performed in a doctor’s surgery or even at home. The tests may involve looking for infectious microorganisms. These tests are used to detect kidney. Tests on samples of faeces are usually carried out in a laboratory. such as the liver. called aspiration. p.Y O U R B O D Y A N D H E A LT H MEDICAL Testing samples TESTS Tests on body fluids Tests may be performed on body fluids from wounds or abnormal areas of skin. p. This process. Blood tests Blood tests can be used to find information about the blood itself and to assess the function of other parts of the body. and inflammation. Each square on the stick tests for a different chemical. can be collected Swab by the individual. which involve dipping a chemically treated stick into a sample of urine to show the presence or concentration of specific substances. such as blood or urine. If the test suggests an infection. is producing abnormal amounts of a hormone. from mucous membranes such as those of the nose and throat. Some samples. such as the liver or kidneys. One common test is the faecal occult blood test. such as glucose. Tests on cells are often used to diagnose cancer or screen for genetic disorders. the sample may be sent to a laboratory to grow and identify the microorganism. and blood samples by the doctor in his or her surgery. or breasts (see ASPIRATION OF A BREAST LUMP. Tests on faeces Samples of faeces may be tested for infectious microorganisms or for evidence of digestive disorders. such as the thyroid gland in the neck.256). or the presence of infectious organisms. Having a swab taken Fluids from wounds or from body cavities. blood chemistry tests are performed to see if a gland. or of a larger sample of tissue containing a variety of cells. A specific test for a hormone produced in pregnancy is the basis of the urine pregnancy test. may need to be collected during a hospital procedure. certain bone disorders. liver. You will then need to stay in bed for up to 6 hours. chemicals in the squares along the stick react and cause a colour change. in the body. Most urine tests are dipstick tests. The test may also be used to screen for colorectal cancer. are compared to a chart. others by a doctor. In addition. Tissue tests are used to detect areas of abnormal tissue such as cirrhosis of the liver or tumours. p. Blood carries many substances apart from cells. The results of tests on body samples can provide information on the function of certain organs. Some samples.

Muscular organs. others display measure how well sounds of varying pitch and volume can be heard or. These physiological tests are commonly used to assess vision and hearing. More complex tests show how quickly the lungs fill and empty (to detect narrowed airways).257). and HEARING TESTS IN CHILDHOOD. dense tissues such as bone let few rays through and appear white on the image. which is the maximum rate at which you can breathe out. right) can be performed to assess the function of organs or systems. The images can also show disorders in some soft tissues. Types of contrast X-ray include barium contrast X-rays (p. p. such as bone densitometry (p. X-rays may also be used in other imaging techniques.40). which shows the urinary tract. Exercise ECG Electrical signals from your heart are recorded as you do increasingly intense exercise. p. The simplest is measuring peak flow rate (p. p. Another test defines the visual field (the area that each eye can see independently). Control panel Drawer containing film cassette 39 . and ultrasound scanning uses sound waves.105). show the ability to hear speech (see HEARING TESTS. appear grey.203).Y O U R B O D Y A N D H E A LT H Physiological tests Certain investigations that do not involve testing samples (opposite) or imaging internal structures (see IMAGING TESTS.40). Heart and lung tests Heart rhythm and rate can be monitored by tests in which the electrical activity in the heart muscle is recorded: electrocardiography (p. ECG trace Blood pressure cuff Fibula X-ray machine Fracture Tibia (shinbone) X-RAY OF LOWER LEG X-rays Electrode Treadmill Mobile table Having an X-ray You are positioned on or against a special table or surface that allows X-rays to pass through it to a cassette of film. which use radioactive substances introduced into certain tissues. and measure blood levels of oxygen (see MEASURING BLOOD OXYGEN. MRI uses magnetism and radio waves. p. Hollow or fluid-filled structures do not show clearly on plain X-rays but can be imaged by introducing a contrast medium into the area before taking the X-ray.201). Controls and Test bowl Some show how well sound is touch-screen conducted through the ears. and VISION TESTING IN CHILDREN. and fluid-filled areas.101). There is a range of tests for hearing. PET. Imaging tests In imaging tests.227). Other imaging tests include radionuclide scanning. angiography (p. such as the heart. X-rays carry the risk of exposure to harmful radiation. The contrast medium blocks X-rays and makes the area appear white on the image. Visual field test This test is used to map the visual field. so some tests are available that use other forms of energy. used to image the digestive tract. in children. records the electrical activity produced in the brain and is useful for the diagnosis of disorders such as epilepsy. Nervous system tests Some tests are used to establish whether nerves are able to conduct impulses normally. Vision and hearing tests The most common vision tests measure the ability to focus (see VISION TESTING. show lung capacity (to check for disorders that cause the lungs to shrink).189. energy is directed at or introduced into body tissues and detected by machines to produce images of internal structures.190. Abnormalities may be the result of something compressing a nerve or a disease such as diabetes mellitus. and the heart and lungs. Another test. and breast X-rays are used to screen women for breast cancer (see MAMMOGRAPHY. such as the lungs. such as the bladder. ambulatory electrocardiography (p. and exercise ECG (below). Lung function can be tested in various ways.239). which shows blood vessels. The ability of the rays to penetrate tissues depends on the density of those tissues. Response button X-rays X-rays are a form of radiation that can pass through body tissues to leave an image on photographic film. You are asked to look at a screen and press a button when you see flashes in different areas of the screen. known as EEG.205). Many tests use X-rays.197). X-ray images are often used to assess bone injuries such as fractures or disorders such as arthritis. such as infection in the lungs. Solid. p. and SPECT. and intravenous urography (p. these tests range from conventional X-ray procedures to the computerized technique of CT scanning. the nervous system. Tissues containing air. For example. You have to keep still during the procedure so that the image will be clear. p. let most of the X-rays through and appear black on the film.

Coronary angiography (below) shows the arteries supplying the heart muscle. The images show a wide range of tissues of varying densities that do not show clearly on plain X-rays. A radiographer. Contrast medium is injected into the artery.233) shows arteries in the legs. called a barium swallow. which pass through you to a detector. a catheter is inserted into an artery some distance away and passed through the body. Barium drink Contrast medium Image of oesophagus Coronary artery Tip of catheter Aorta CONTRAST X-RAY OF OESOPHAGUS Coronary artery Aorta POSITION OF TIP OF CATHETER ROUTE OF CATHETER Catheter entry site Femoral artery Lead apron Normal coronary artery Radiologist X-ray machine Narrowed area of coronary artery Coronary angiography Under local anaesthesia. in another room. A series of X-rays is taken as the medium passes through the arteries. First. a thin. CT scanning is painless. If the oesophagus. the barium is given as an enema. Scanner X-ray source Liver X-rays Spine Kidney Loop of intestine Manual control panel CT SCAN OF ABDOMEN Having a CT scan A motorized bed moves you through the scanner. which pass through the body to a detector on the other side of the machine. X-ray detector Motorized bed 40 . until it reaches the artery to be imaged. which is a contrast medium (a substance that blocks X-rays). If the colon is to be viewed. data from the scans can be used to create three-dimensional images. then passed into the heart until its tip lies in a coronary artery. and a series of X-rays is taken.Y O U R B O D Y A N D H E A LT H Barium contrast X-rays Parts of the digestive tract that are not visible on plain X-rays (p.39) can be imaged with barium contrast X-rays. as well as abnormalities such as tumours or scar tissue inside organs. is introduced into the tract. stomach. The scanner moves around the body. CT scans reveal the anatomy of organs and other body structures. uses a computer to control the procedure. This X-ray detector transmits data to a computer.39) and reveal problems such as narrowed areas. which blocks the passage of X-rays. Hollow or fluid-filled areas usually appear black on the images but can be shown with a contrast medium. These X-rays can reveal abnormalities such as tumours and narrowed or blocked areas. one section emits X-rays. Femoral angiography (p. then an X-ray is taken. The machine rotates around you. a procedure known as a barium swallow or meal. CT scans are most commonly used to investigate the brain or the solid abdominal organs but may also be carried out to view the lungs. which creates an image that is shown on a monitor or reproduced on X-ray film. or duodenum is to be investigated. In some cases. flexible catheter is inserted into the femoral artery. Barium sulphate. Vertical X-ray table CORONARY ANGIOGRAM CT scanning Computerized tomography (CT) scanning is an X-ray-based technique that produces detailed cross-sectional images of the body. so that it is not diluted by the blood. The dye is injected through the catheter directly into the vessel. a dye is introduced into arteries to make them visible on X-rays (p. under X-ray control. the barium is swallowed in a drink. Oesophagus Angiography In angiography. one section emits X-rays. Arch of aorta Tip of catheter Catheter Having a barium contrast X-ray In the test shown here. you drink a barium suspension while a series of X-rays is taken or the movement of the barium is viewed on a monitor.

The device is then moved across this area. inaudible sound waves). Ultrasound gel Computergenerated image Transducer Radionuclide scanning Radionuclides are radioactive substances. you lie on a motorized bed that positions you over the gamma camera. images are created using ultrasound waves (high-frequency. usually by injection. A device called a transducer is moved over the skin or. The scanner contains two powerful magnets and a radiofrequency source. Some people find the machine claustrophobic. and several scans are taken. and sends ultrasound waves into the body. is used to detect problems such as narrowed arteries or clots in veins. inserted into a body opening such as the vagina or rectum. then taken up by a specific type of tissue. In radionuclide scanning. and if you feel nervous. the transducer picks up the echoes and passes them to a computer. MRI is often used to examine the brain and spinal cord. Doctors often use ultrasound to look at fetuses in the uterus (see ULTRASOUND SCANNING IN PREGNANCY. iodine is taken up by the thyroid gland. A computer interprets this as an image. you may be allowed to have someone with you. which shows the direction and speed of blood flow. A technique called Doppler ultrasound scanning (p. or to detect abnormalities such as cysts and kidney stones. It is also used to investigate sports injuries such as torn tendons. which creates an image on a monitor. which emits radio waves Patella (kneecap) End of femur (thigh bone) Fat Cartilage within joint End of tibia (shinbone) MRI SCAN OF KNEE JOINT Scanner Manual control panel Companion for patient Motorized bed Having an MRI scan A motorized bed moves you into the scanner. Magnet that creates powerful magnetic field Ultrasound scanning In ultrasound scanning. The images of the internal structures appear on a monitor. p. which shows the tissue as areas of colour. which causes hydrogen atoms throughout the body to line up. such as in tumours. The radiofrequency source emits radio waves that briefly knock the atoms out of alignment. The higher the level of cell activity in the tissue. Receiving magnet Skin Radiofrequency source. Normal kidney Damaged kidney Having a radionuclide scan Once your body has absorbed the radionuclide. You may be given earplugs because the machine is noisy. and the radiation they emit can be used to create images.235). a tiny amount of the radionuclide is introduced into the body. the more radiation is emitted and the more intensely coloured the area appears. As the atoms realign. or where tissue meets fluid. Information about the signals is transmitted to a computer. which detects the radiation from the radionuclide. Radionuclide scans can show areas where cell activity is abnormally high. Gamma camera Motorized bed 41 . A device called a gamma camera detects the radiation and transmits data to a computer. or abnormally low. The images are updated continually so that movement can be seen. for example. which produces an image on a monitor. the waves are reflected. they emit signals (resonance) that are picked up by the other magnet placed around the area being scanned. MRI can reveal fine details and abnormalities more clearly than other forms of imaging. in some cases. SCAN OF KIDNEYS Colour image Counterbalance for gamma camera Having an ultrasound scan A gel is applied to the skin to improve contact with the transducer. such as in damaged organs or cysts. Where tissues of different densities meet.Y O U R B O D Y A N D H E A LT H MRI Magnetic resonance imaging (MRI) uses magnetic force and radio waves to create images of internal structures and tissues.280) or the walls and valves of the heart. One magnet creates a powerful magnetic field.

The instrument is inserted through a natural opening such as the mouth or anus. The view may be seen directly through an eyepiece or shown on a monitor. In both. PET uses a Area of radionuclide attached to glucose high brain activity or other molecules essential to cell metabolism and can show the functioning of individual cells within tissues. such as the mouth. These endoscopes are often used for viewing inside the digestive and respiratory tracts. which includes a fibreoptic light source and magnifying lenses. In some procedures. endometriosis gas may be pumped into the abdomen to create more space Uterus and provide a better view. sprayed on to the back of the throat. very fine instruments can be passed down the tube. Flexible endoscopes A flexible endoscope has a long. Endoscope Oesophagus Upper digestive tract endoscopy Before the procedure. Instruments may be passed down the endoscope or they may be introduced through separate incisions made in the skin. Such operations are usually better for the patient than conventional surgery because the patient recovers faster and spends less time in hospital. Ovary Probe Cartilage POSITION OF INSTRUMENTS Image of knee joint Endoscope Probe View of endometriosis Endometriosis. It may be introduced through an incision in the skin and used to examine areas such as the abdominal cavity or the inside of joints. Rigid endoscopes may also be inserted into natural orifices. such as the rectum. and the radiation emitted is detected by a scanner. Image of digestive tract lining Endoscope Rigid endoscopes A rigid endoscope is a short. The low brain technique can show blood activity flow within organs and is PET scan of normal brain used to assess if they are In this cross section of the brain. The endoscope is then passed into the body through the mouth. the functioning normally. you may be given a sedative. In this view through the endoscope. allowing the doctor to view structures either directly through an eyepiece or on a video screen. SPECT uses radionuclides that emit photons (a form of energy). often referred to as minimally invasive surgery. can be treated endoscopically. The view may be recorded on videotape. Endoscopic treatments include removal of intestinal polyps or diseased tissue (such as an inflamed gallbladder) and laser surgery to treat endometriosis. and enter deep into the body. Endoscopy of the knee Small incisions are made on either side of the knee. These treatments may even occur at the same time as the endoscopy is being used to make a diagnosis. The endoscope is inserted through one incision. The probe is used to move tissues so that certain structures can be viewed more clearly. and the doctor can use the view from the tip as a guide during the procedure. Blood pressure cuff Site of sedative injection Stomach Tip of endoscope in duodenum ROUTE OF ENDOSCOPE Endoscopy Endoscopy is a procedure in which a doctor views internal structures using a tube-like instrument called an endoscope. such as laparoscopy Area of Probe (investigation of the abdomen). If procedures. a radionuclide (radioactive substance) is introduced into the body and taken up by tissues.41).Y O U R B O D Y A N D H E A LT H PET and SPECT scanning Positron emission tomography (PET) and single-photon-emission computerized tomography (SPECT) are forms of radionuclide scanning (p. It is mainly used to assess the heart and the brain. in which tissue from the uterus lining grows outside the uterus. The doctor uses the endoscopic view as a guide during the procedure. such as the oesophagus and the colon. but local anaesthesia may sometimes be used. and lungs. and a probe is inserted through the other. Endoscopy may be used for diagnosis or for treatments. The endoscope incorporates a system of lights. a probe holds tissues out of the way in preparation for laser surgery. straight metal viewing tube. heart. Procedures involving rigid endoscopes introduced through skin incisions are usually performed under general anaesthesia. where the structures to be viewed are near the surface of the skin. such as taking tissue samples. SPECT yellow and red patches are highly is chiefly used to assess the active areas and the blue and black brain. patches are less active areas. for example. liver. need to be carried out. Patella (kneecap) Endoscope Ligament Endoscopic treatments Endoscopy can be used for surgical treatments. whose movements can be Area of traced by the scanner. A rigid or flexible endoscope may be used. The tip of the endoscope is passed through a natural body opening. The view from the tip of the endoscope allows the doctor to detect abnormalities in the lining of the digestive tract. and optical fibres. and usually a video camera at the tip. or a small incision in the skin. depending on the area to be examined. lenses. the person undergoing the procedure is first given a sedative or a local anaesthetic. thin tube that can be steered round bends in internal passages. The surgery is performed by using instruments passed down the endoscope. 42 .

The information at the beginning of the section explains how to use the charts most effectively and how to identify the most appropriate chart for your symptom. 43 . charts for all adults. and charts specifically for men and for women. tell you when to seek medical help.SYMPTOM CHARTS SYMPTOM C HARTS The charts help you identify the possible causes of a symptom. The section consists of charts for children of different ages. if appropriate. suggest how you can treat the symptom or its cause yourself. and.

and your child will be prescribed antibiotics. p. opposite).275). YES • Be aware of red 24 HOURS MAKE A DIAGNOSIS FROM THIS CHART.227) to look NO S E L F . Consult your doctor. Consult fibroadenoma. The computer a viral you lose any 117 Have you ever been Most people have at least one episode of back pain during treated with anticancer their lives. may damage the vas deferens. further tests. and steam baths can increase diagnosis. mood swings.275). Are you whole previous penis. To use a chart. such as eczema. give a kidney. joints between weak. Theseintrauterine (artificial) cyst are the most likely causes of it can be used for cells are then or standing. usually due todisplayed as an image. Most people have at least one episode of back pain during their lives. each group indicated by a different colour bar down the edge of the page. However. COUNT problem with an internalsurgerysuchthe a kidney.284) to a bacteria or a virus. to check whether there the this condition. FERTILITY PROBLEMS IN WOMEN (p. confirmed. (see BOSSIBLE CAUSE Pyelonephritis. is possible. or help to relieve your symptoms. YES do not treatment and one of the lumpy? Consult your doctor. p. Look at your breasts in a tests. a change in the for in women who have passed the menopause. it is associated with other symptoms of premenstrual syndrome. and cola.41) to confirm the diagnosis.77). surgery to stabilize times a week – will also help.275). Technician X-ray plate POSITION OF BREAST START HERE Are both breasts tender or painful? NO YES Is your period due within the next 10 days? YES NO POSSIBLE CAUSE Breast pain before a period may be due to changes in hormone levels. call your doctor. SEE YOUR DOCTOR WITHIN 24 HOURS ACTION Your doctor will examine your child’s throat and may take a throat swab to confirm POSSIBLE CAUSE Your child may have a urinary the diagnosis. Discontinue RASH. Flat. ligaments.41) to confirm the diagnosis. semen analysis (above). of your back advice on underweight. it may be due to a problem with an internal organ such as a kidney. it also occurs in men.108). Consult your doctor. p. If it is raised. less excessively conceive. Yes and No options You can leave each question box by answering either YES or NO. POSSIBLE CAUSE AND ACTION Mastitis. way between is most or unwell with a improve sperm production. function or reduce are progressively damaged. such as coffee. and further 24 HOURS YES POSSIBLE CAUSE AND ACTION You may have a slipped disc (a ruptured disc of cartilage between the vertebrae) that is irritating a nerve where it leaves the spinal cord. Take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. the chance of sperm being present to have a discharge POSSIBLE fertilize is released is reduced. recommended safeif the pain YES Needle is severe. Follow self-help EMERGENCY! a healthy diet. Paget’s inflammatory drugs. or at home. if your child develops difficulty in breathing. if self-help measures are appropriate. a problem deeper in the breast. He or she may prescribe tract infection (p. take steps to CTION Your doctor will arrange for semen of anysexual intercourse – ideally at least three to of cold drinks. if measures for relieving back pain (opposite). X-rays are passed through the body. you will be examined and will probably have tests such as CT scanning (p.the moving and carry out Sperm count • Try relaxation exercises (p. unnecessary. which is placed in the ear. X-ray beam 238 Is your child’s breathing faster than normal? See CHECKING YOUR CHILD’S BREATHING RATE (p.39) to confirm the POSSIBLE CAUSE Tight-fitting underwear or drugs X-ray of the kidneys (see INTRAVENOUS UROGRAPHY. occurring (p. a cause is not found. partner has still not conceived within a further 3–6 months. NO YES not it may be possible to extract sperm from area in small circles. However. breast and armpit gradually becoming hard and inflexible). often including bloating. • General charts for adults: problems that can affect both men and women • Charts for men: specific problems affecting men • Charts for women: specific problems affecting women. in a car. YES YES AREA Your follow an signs in the warning ACTION TO BE doctor will examine you and with the pads condition. YES Continued from previous page SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION You may have a slipped disc (a ruptured disc of cartilage between the vertebrae) that is irritating a nerve where it leaves the spinal cord. it may be a sign of damage to the joints. are not Do you have a single smokers. If your diseases you you have changed your drinking habits. or treatments. damage to the spinal cord may be the cause. and theyof the vas deferens. It is therefore important to familiarize yourself with the look and feel of your breasts (see BREAST SELF-AWARENESS. If pain is severe or no better narrowed due to a viral infection. but do a grid to help count the number of sperm Eat little and often.30)? is especially likely if you are between 20 and 40. During the procedure Your breast is compressed between the plastic cover and X-ray plate. Then. opposite).54). damage toS E L F . He or be due toarrange for semen analysis LOW SPERM NORMAL SPERM hernia repair. Try the following: regularly often she may also refer some tests you had organ on as spondylitis (inflammation of the joints Does the skin around a between keep • If possible. Consultwill be examined and her CALL YOUR DOCTOR NOW YES of the small of stay in bed or increase your chance of conception. Be aware of your posture when sitting at a desk (see SAFETY AT WORK. p. but it usually takes resultor ultrasound scanning (p. In some cases. If over a longallowance of a vitamin B6 supplement. If your child is overas monthsuseosteoporosis. lie him or her in you use saunas or underlying cause. Do you a week. for semen AGES A POSSIBLE CAUSE AND ACTION You have probably will probably arrange for semen analysis other physical activities. requireanalysis is usuallydo not the first tests that increase the riskcarried out. He ARE UNABLE TO MAKE A DIAGNOSIS or she will normal FROM THIS A CTIONAND YOUR BACK CHART Follow the self-help measures for range for the antibiotics preventing dehydration in children person’s age and sex.29). who will teach you exercises POSSIBLE CAUSE AND place it over the painful areaprescribed corticosteroid creams. such as a cold. urine sample will be sent for analysis. preventspots that do not fadesperm production. may be the cause of child. rarely. FEVER IN BABIES (p. ACTION In hospital. If you are Did your SEL previous page POSSIBLE CAUSE You may have damaged your chance of conception. This is the spine the production of NO temperature. and they usually recover without needing medical drugs or radiotherapy? help. in the breast.32) or take up cases. carry See also chart 126.H E L P may be able to advise you or refer you to a within 48 hours. Lifting safely NO Bend your knees when you pick up an object. In some cases. ACTION Your doctor and DIAGNOSIS THIS for this disorder and can be supplementedRby N :doctor. surgery to stabilize the spine may be required. Has your child been exposed to hot sunshine YES or high temperatures? Using an aural thermometer Hold the thermometer in your child’s ear for the recommended time. you has POSSIBLE CAUSES AND ACTION Many types will not conceived within 1 year. or at home. Knees raised to keep the spine flat NO need to be admitted to hospital for monitoring SEE YOUR DOCTOR WITHINtreatment. prescribed antibiotics. Consult youris no better testes. analysis (above).SYMPTOM CHARTS HOW TO USE THE CHARTS until it leads to a possible cause or causes (there may be several possible diagnoses for a given set of symptoms) and action. opposite). Over-the-counter painkillers should painkillers.39). and/or does it shoot down one leg? NO Improving your posture and taking care to lift heavy objects safely can help you avoid back problems. X-ray machine X-rays Compressed breast X-ray machine Plastic cover For breast problems during pregnancy or after giving birth. If you arethe temperature within the scrotum. including symptoms during pregnancy. compares it with the be admitted to hospital immediately. BREAST PROBLEMS AND PREGNANCY (p. keep stress to a minimum. your back. and avoidincrease in the temperature within the and pregnant? Continued moving. The disorder is most common and do you paracetamol. Many charts have boxes that give further self-help advice or provide information about disorders.straight or after OSSIBLE (p. you have MRI (p. Heat exposure can alsoaboveto a raised lead the waist. a recurrence analysis (above) to confirm the diagnosis. inyou to a specialist for breasts Do yousimple measures. The sample must establish whether the tubes leading from your then be kept at body temperature and testes are blocked. o o Thermometer placed in ear Does your child have any of the following? • Pain on passing urine • Frequent passing of urine • Bedwetting or daytime wetting after being dry • Offensive-smelling or cloudy urine NO 239 General adults’ charts Continuation box On two-page charts. which are usually mid. including the nipple and over 50? YES transport sperm from the testes to thepage ACTION Your doctor may arrange for you is withdrawn into the needle instead of cells. In some cases. POSSIBLE ACTION You DOCTOR NOW information is displayed on a monitor. NO POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible. Rarely. you wear underpants pain is with smoking tests and an X-ray (p. You can also try self-help excess weight. Does your child have diarrhoea? calculates the average bone density and X-ray detector will with a fever. or violent movement? NO Are any of the danger signs in the warning box (right) present? NO YES WA R N I N G DANGER SIGNS Call an ambulance if you have back pain or have recently injured your back and you develop problems with either bladder or bowel control.151). S E L F . If you have sex less than three times POSSIBLE CAUSE AND ACTION If your nipple has viewed under a microscope to assess the NO always been drawn in. inflammation muscles and help such symptoms. Try to keep completely still while waiting for an ambulance. the testes. it is important ACTION Your chance of conception may be prescribed drug. scrotum and reduce sperm production. Mammography is offered every 3 years from age 50 to 65. If you are particularly worried. In the meantime. next page A convenient method of taking your child’s CALL YOUR DOCTOR NOW NO Object directly in front of you SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Pharyngitis or tonsillitis. POSSIBLE CAUSE Overheating. over a period of Raise arm your back and pelvic areas. Naturally lumpy breasts deferens. Do the other armpit. and keep your back straight Does your child have a while lifting sore throat?it. especially liver CAUSES Some ambulance. breasts and will probably arrange for tests are p. (p. this is not a cause for shape and activity levels of the sperm and to concern.286). suchNOwalking. may hot and sweaty. 1 in 5 normally fertile couples take Have you had a sexually transmitted infection in the past? Is one of your nipples YES drawn into the breast? NO recently? semen is measured. by This technique can identify a microscope. surgery to Has this developed 2 hours. NO have a supportive mattress on your bed. breast cancer is one of the most common cancers in women. and sponge his or her steam baths cases. It may take a few months for Do you have a gaining weight safely (p. consult your doctor. This • Rest in bed • NO (p. The two main causes of infertility aremen are insufficient spermpregnant. opposite). If the come on after diagnosis is confirmed.is over 6 months old. which reduce on lift heavy objects safely can confusion YES SEE YOUR DOCTOR WITHIN CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO allow air to circulate more freely. A fever is an abnormally high body temperature of 38˚C should take his or NO temperature (see TAKING YOUR CHILD’production. box (right) present? amounts of chocolate. CAUSES Nipple discharge is usually from a nipple?an egg when itYES due to hormone changes and is no cause If possible. but occasionally Most back pain is the result of minor sprains affected milk ducts may need or strains and can usually be to be removed surgically.274). • Place a heating pad or wrapped hot-waterform your doctor. 50 and you the testes. and breast tenderness. HOW osteoporosis depends on the Undress your child. nipple low sperm count is defined as fewer than 20 million sperm per millilitre. your child be given urgent treatment with and may need intensive care. surgery may be needed. inflammatory drugs. takes OF LONG . It is usually a signyour the body is fighting TEMPERATURE. Call your doctor if a rash develops. You may also need to have an abdominal ultrasound scan (p. breast. Rarely. resulting in the spinal column prostate gland? flat. Haveheavyhad surgery you weights. Stand stop taking you fromon pressure (see CHECKING A RED doctor. you will probably be given nonsteroidal antiPOSSIBLE CAUSE In adolescents and adults. a prolonged period of immobility will ACTION Youroverweight. the tubes that circular movements. If your is the cause. If an infection is confirmed. NO SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. In rare cases. Prostate surgery often results in semen flowing Repeat the process with you have sex less YES NO to have either mammography (opposite) the lump can be diagnosed as a breast cyst. ACTION If your doctor confirms the diagnosis.79) back problems. Did you have mumps movement? ACTION Your doctor will examine of • If heat does not provide relief. The chartfinders on pages 46–48 will help you find the chart you need for your symptom. pain in one side an extended consumption to a minimum may all help to comfortable and lessens the likelihood of aCAUSE You may have cloth ACTION POSSIBLE febrile convulsion a crush fracture YES reduce sperm S In hospital.40) to look for the site and extent of any damage. You will also be referred to the mumps the can cause inflammation of Your doctor will examine you and NO virus NO chance of conception Are you outside the may be for can impair sperm production. may be needed to look for any associated problems. consult your doctor. in many cases as a result of tasks such as lifting excessively heavy weights. and be long-standing illness? child does not feel well.H E L P Maximizing the YES alcohol after the age of 12? ACTION an ice pack (or a wrapped breasts. Small lumps healthy weight range 15 minutes or overweight to help keep your back mobile. frozen have a skin condition. strenuous ACTION Your doctor may give your child an inhaled corticosteroid drug to ease his or her exercise? Does your child have breathing. indrawn. If your pain is severe or if it has not improved within 48 hours. YES temperature is with an aural thermometer. Your doctor However. consult your doctor. NO Recurrent mastitis may need surgical treatment to remove affected milk ducts. and avoid wearing high-heeled shoes. If you have had prostate surgery.STANDING BACK PAIN The procedure If your child has diarrhoea for more than 20 minutes SUDDENLY CHANGES .149). who may arrange for semen from a breast lump using a needle and shape of your breasts. what you can do yourself. and NO is always at the bottom of a box Pathway The arrowed pathways lead you from one question to the next and eventually to a possible diagnosis Do you have pain in one side of the small of your back just above the waist. it mayTreatment ofanoncancerous lumps is (opposite). you will damage Try taking evening primrose oil. Consult your are over ACTION Your doctor will examine you and arrangeyour sperm. about infection. • Avoid drinks containing large amounts months or years? NO back and you develop problems with either are found to have ankylosing spondylitis. vitaminself-help group. the tubes that should consult your doctor. use of any saunas or steam baths for a while. larger to have a baby. who will examine POSSIBLE CAUSE Sexually transmitted infections Semen analysis ACTION Your doctor will examine your (see SEXUALLY TRANSMITTED INFECTIONSyour breasts to make sure that there IN MEN. and a sample is then YES Aspiration of a drugs. your doctor your weight? you your pain is severe or if it has not improved Continuedself-help steps that you can take to maximize from WEIGHT SAFELY. it will be repeated. that some women experience in the days leading up to a period. an unusually within 48 hours. Did the pain Are any of the danger WA R N I N G urine for use in assisted conception stiff Press gently START POSSIBLE CAUSES You may have a skin NO • Take over-the-counter nonsteroidal antibecome (p. YES Do you have sperm production to return to normal after rich foods. any may also need to have an You also lead to the development of osteoporosis. such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. and this may permanently affect probably arrange for tests such as A fine needle is attached to a syringe and YES alcohol consumption continues NO your suspects ultrasound scanning (p. inseminationbreast lumps. YES Did the pain come on after lifting a heavy object or after undertaking an unusually strenuous exercise? NO YES POSSIBLE CAUSE AND ACTION You have probably strained some of the muscles and/or ligaments in your back. particularly fertility. Continued from which is inflammation in the breast. such as certain hormone the following symptoms: NO wearing tight-fitting may refer you for physiotherapy to help you head and body with tepid water. you your doctor. woman’s fertile days. prescribed drugs? R N I N G a ACTION Initial treatment for the sexual • Severe headache intercourse. the woman should lie can be repeated every 4 hours.40) to look for the site and extent confinement plenty or her 2 is probably the cause of using bones throughout the body become thin and recreational P RINGING DOWN A FEVER. YES p. will examine yoube surgically removed. fall and sperm in particularly likely if you doctor. this chart deals only with possible problems in men.127).55).217)YES contrast or and/or using recreational drugs. see chart 149. a rare of breast cancer. Severe back pain may be due to pressure on a nerve or. IF YOU YES CONSULT YOUR DOCTOR Your child may also vomit. If excessive will peas). They say whether to call an ambulance or how quickly to get in touch with your doctor POSSIBLE CAUSES Many viral infections. (p. Consult your doctor. but you and in many cases. POSSIBLE waiting for anillnesses. or have YES POSSIBLE CAUSE You may have ankylosing Breast lump COUNT • If possible. ACTION The self-help advice for premenstrual syndrome (opposite) may reduce breast tenderness. Occasionally. The doses of both ibuprofen temperature of abdominal ultrasound scan (p. Women’s charts Men’s charts A D U LT S : G E N E R A L A D U LT S : M E N A D U LT S : W O M E N A D U LT S : W O M E N SELF-HELP Taking care of your back Does the pain prevent you from moving.118). partners. Two X-rays are usually taken of each breast. rarely. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSE Pyelonephritis. it NO may be a sign of damage to the joints. you pack of If you • Try taking the recommended daily During the procedure spinal cord may be the cause. WA Does your 38°C (100°F) START Do trousers. or has there such Once your back pain has (opposite) to assess sperm production. If you discover a lump week changes of tasks such YES The in the spine. Raised densitometry (below). choose the chart that deals with the symptom that bothers you the most. In addition. If CALL AN AMBULANCE try to lose weight (see HOW TO LOSE 257 256 following the self-help advice for taking care have difficulty cutting down. below).107). a sore throat (p. The groups are: • Charts for children: problems affecting children of all ages. follow the WORK.6 C (1 F) to a reading from the armpit. the majority of which are healthy. below) so that you will be able to detect any changes. In that back just A reduce it CAUSES YES (p. Lifting safely Bend your knees when you pick up an object. Rarely. dark your spots • and/or does it shoot next page Abnormal drowsiness NO that do not fade on • A severe headache posture when sitting at a desk (see SAFETY AT down one leg? EMERGENCY! POSSIBLE CAUSE A viral or bacterial While waiting for medical help. The man is asked to ejaculate is of breast cancer. checking for changes in the size or doctor. leading to a rise in body temperature. X-rays pass through the breast tissue onto the plate. alcohol limitstay in bed for more than 2 days. is POSSIBLE CAUSE AND ACTION Breast tenderness previous page NO likely. in all frequently? YES that you a cool • Dislike of bright lights YES underwear or trousersroom. 126 Fertility problems in men Do you have a tender. If you have back pain or have recently injured your which is a noncancerous (p. such as a NO to prevent or relieve your symptoms: Examining your be due to pressure on a nerve or. Cells or fluid • the time. You can also use a standard thermometer placed in the armpit or in the mouth. suddenly after a temperature will helpSEE YOUR DOCTOR WITHIN 24 HOURS Drink and keeping alcohol Lowering your child feel more Wet face For children under 1. If waslump is solid. Non-breast-feeding out a home women who are affected in usually Fertility problems affect 1 in 10 couples who want children. ligaments. If you have more than one symptom. while lying or collected in the needle. or dimpled skin. and do you feel generally unwell with a temperature of 38°C (100°F) or above? NO YES POSSIBLE CAUSE AND ACTION You have probably bruised or strained your back. Try to keep completely still whileA healthy diet with plenty of fresh.been as swimming.103). If an abnormality is detected. Your doctor may also request bone Go to chart 15 RASH WITH FEVER (p.donor may be an option (see ASSISTED small Consult your doctor. as well as charts specifically for babies under one and adolescents. a coupleare you the may miss over 60? If the fever doesn’t fracture occurs. follow the advice for bringing down a fever (above) and call your doctor. You should pressure (p. Back pain is often due to poor posture. POSSIBLE CAUSE You may have damaged your spinal cord. Each of the 150 charts in this section covers a symptom or group of related symptoms and is similar to the example below. ACTION Take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. sent to a laboratory to beOtherwise. he or she may a barking cough? antibiotics. p. Make sure you eat cleared up. or discs of Question boxes These boxes ask for further information about your symptoms and can be answered YES or NO. you will be prescribed antibiotics. or discs of Back pain If NO at least 1 year to conceive. an Go to chart 147 BACK PAIN IN X-ray generator infection of the throat or the tonsils. and keep your back straight while lifting it. You can also try YES ACTION Your doctor will test a sample of your self-help measures for soothing your child’s child’s urine. fall. may be the cause of these symptoms. Regular gentle exercise may strengthen your abdominal and back muscles and help Upper body you lose any straight excess weight.34). There are also several straightforward a sudden change in should take steps to prevent by Meanwhile. ACTION Take steps to reduce your child’s temperature by removing any excess clothing and moving him or her to a slightly cooler (though not cold) place. However. consult your doctor. If you do find a change in your breast. surgery may successfully treat thefeel around the Sperm are viewed under a microscope with an exercise such as yoga. 128 Breast problems breast cancer can often be successfully treated. tests. Failure to conceive YES production episodes.123) PAIN IS SEVERE OR IF THE NATURE and treating gastroenteritis in children (p. infection of can recreational drugs can impair sperm the vertebrae in an infection. p. saunas. consult your become familiar with their normal NO appearance and feel and find it easier to doctor. back gradually and the proportion of abnormal sperm.39) to measure This technique uses low-intensity Meningitis. inflammation During the procedure Regular gentle exercise may strengthen your and/or is he or she of the membranes surrounding the brain A pain Did the CTION Your doctor will examine your The X-ray generator and detector move the density of bone. If fluid whether or not the lumpp. bladder or bowel control. and he NO into a clean container (semen collected from or she may refer you to a specialist for tests to a condom is not suitable). is a problem with the required. breasts feeltestes to the penis. and is painless. including plenty of Has your whole condition. plenty of rest.NO cause of your child’s symptoms. After as well. reduce your alcohol intake. If a blockage is Keeping your fingers to of the lump is advised.39) of possibility. such as mood changes and bloating. and make sure he or she drinks plenty of fluids.110). Consult your doctor. try to have intercourse with your E N E R A L A D U LT for concern. and give him or her plenty to drink.Drowsiness or • may may strengthen the muscles that support the spine.126). a bacterial infection of a kidney. breast. and they usually recover without needing medical help. although it may make breast-feeding count the number of sperm. Osteoporosis is symptomless unless a a wheelchair.either Taking your Your doctor may recommend H E L Pphysiotherapy or manipulation of the spine. Otherwise. is the most likely cause of diarrhoea ACTION If meningitis is suspected. consult your doctor. men should avoid TO LOSE WEIGHT SAFELY. is a POSSIBLE CAUSE injury. tea. follow the(opposite). your nipple look abnormal?normal daily activities. a bacterial A high analysis (opposite)In some cases. If you are overweight.H E L P Relieving and may arrange for mammography (above) back pain to exclude an abnormality in the underlying breast tissue. and some hormone disorders. The volume of analysed within relieve the blockage may be possible. is cancerous. can cause a cough and runny nose.217) or a contrast X-ray of the kidneys (see INTRAVENOUS UROGRAPHY. who may want to arrange for initial involving the testes. Specific treatment for Cooling your child HERE maximum number of sperm to enter the DANGER SIGNS Call an ambulance if your the head forward a rash? your back overweight. changes to your analysis (opposite). It is used as a screening test to detect signs of breast cancer and is also carried out to investigate breast lumps.try to remain active and take weight-bearing improved if you wear loose-fitting underwear treatments Improving your posture and taking care to • A seizure lasting more than 5 minutes and immunosuppressants. it such as CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO probably be referred for tests can permanently may not need If you are planninglumps may treatment.34). do not up straight. If an infection is confirmed. However. Try to stop Are you taking any of the following? ACTION Your doctor may arrange for blood likely if intercourse occurs at this time. If pain is severe or no better within 48 hours. normal Lumps are usually more obvious before aging may also cause a nipple to become a period. breast cancer is insemination. If diagnosed early enough. The following measures may help LUMP. consult your doctor. Stand up straight. If the pain is severe. If there infection and is rare in women who are is a chance you might be pregnant. Continued on next page 76 77 Children’s charts 44 . a cancerous or S: G POSSIBLE CAUSE AND ACTION Infrequent intercourse is a common cause of failure to conceive. Monitor 24 hours. Consult your doctor. Mammography Mammography uses X-rays (p. Remove your child’s clothes and giveor of Regular will probably have tests such as CT scanning CAUSE Osteoarthritis of the spine of a vertebra a result Do you smoke him Fan (100˚F) or above. doctorperiod of Paget’s disease. surgery to the groinfeel the breast on that side with firm.41). and a blockage tend to have repeated Your doctor will probably lump in a breast? transport the spermantibiotics to treat infection. or if there is no improvement within 48 hours. to the groin. in a car. If a sperm sample syringe. may be the cause of these symptoms. mirror. OSSIBLE CAUSES ruled out. Feel around the Continued from CONCEPTION. surgery may be needed. Treatment is often not necessary. Another box appears on the second page in a matching colour to tell you where to pick up the pathway Instructions for obtaining urgent medical help These instructions tell you what to do when you need prompt medical help rather than a routine appointment with your doctor. and and their absorption is interpreted by a computer and POSSIBLE CAUSE Gastroenteritis. try usingPOSSIBLE CAUSE Heavyyour consumption caffeine. A new disposable tip should be attached for each use. START HERE Have you and your partner been trying to conceive for less than 6 months? NO YES Continued on next page SELF-HELP POSSIBLE CAUSE AND ACTION Breast Are youfor a couple to take more than 6 months to aged under 20? YES It is quite normal self-awareness Premenstrual syndrome is a group of symptoms. fall. as Does the • Flat. abdominal and back YES tugging at either ear? due to an infection. NO come on spinal cord. In some cases. red area in one breast? SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE AND ACTION Some P MEN A D U LT S : OSSIBLE CAUSES A change in a nipple may women have lumpier breasts than others. The action tells you what your doctor may do or what might happen in hospital and. can permanently notice changes. pregnancy test (p. hospital admission is necessary.260). You should also try self-help NO noisy breathing and/or YES measures for relieving a cough (p. In some cases. antibiotics for the infection. your partner should both see your doctor to ASSESSING YOUR WEIGHT. However. This condition is usually due to may be the first sign of pregnancy.79) CALL AN AMBULANCE Is your child infection of the middle ear is a possible advice for bringing down a fever (p. Consult your doctor. or violent bottle against the painful area. The breast is positioned in the X-ray machine and compressed so that the breast tissue can be easily seen on the X-ray. For the correct result. In some cases. YES 253 POSSIBLE CAUSE X-rays (p. ACTION Your doctor will examine you. it will help to lose weight (seetemperature can reduce sperm production. If your child’s symptoms are severe. are then carefully withdrawn. growth. ACTION The doctor will examine your breasts S E L F . you should seek medical advice immediately. opposite) to determine the cause of the abnormality. 39) to detect abnormal areas of breast tissue. the carbohydrates and fibre. in many cases as a a on average? reducing fertility. consult your doctor. Severe back pain may ASPIRATION OF A BREAST aspiration (see as lifting than a minute to carry out. spine may bequantity or quality of is less frequent. If your partner you examine your breasts regularly. you and for your height (see exercises are an essential part of the treatment may reduce If yourfertility. in whichPOSSIBLE POSSIBLESmoking and/oryour symptoms. be a sign of breast cancer. ACTION Your doctor will examine you and arrange for a urine test. put one arm behind your head.252 complaining of earache. is the most likely cause. are the most likely causes. A child with a fever will feel generally unwell cause seizures (febrile convulsions) in young children.227) to look for an underlying cause. drink more thanYES the vertebrae. Make sure that you read the questions carefully START HERE Did the pain YES follow an injury. backache is severe or mammography (above). These mobility substantially underweightevery 2–3 hours. Consult your doctor. p. see chart 3.H E L P Taking Reluctance to bend 10–15 minutes. Follow self-help measures for relieving back pain (opposite). and radiotherapy of anticancer breast lump any abnormality. you will be are doctor may arrange for Does your child have periods. Read the box first before working through the chart A D U LT S : G E N E R A L 117 Starting point The starting point for each chart is always located in the top left corner of the page Back pain cartilage in the spine. left) to CTION Your doctor will examine you and A rule out breast cancer. The infection may be due PREGNANCY (p. give him feel generally your child treatment for the underlying condition may a urine test.151). do NO POSSIBLE CAUSE child has a fever that is associated with any of AND ACTION Some types of uterus. However. If you not breast-feeding.FROMwithinarrange consult your doctor.41)Consult your doctor. Do not put a glass thermometer in the mouth of a child aged under 7. or any and cartilage procedure is painful. Consult your involves removing cells or liquid SEMEN ANALYSIS. as • Reduce your salt intake. opposite). your prescribed drugs. Wearing a nipple shell inside your semen normally contains at least 50 millionduring pregnancy may help to draw the bra sperm. which will include a sperm count (see Aspirationdamage sperm production. Your doctor may recommend either physiotherapy or manipulation of the spine. may be the result of a problem affecting either one or both prescribe to the penis during ejaculation. lifting she may prescribe painkillers and/or CAUSE AND CALL YOURhave probably a heavy NO Upper body of the digestive tract. you CTION Your doctor will arrange for semen discuss the planning of a healthy pregnancy p. ConceptionNO her the recommended dose ofHowever. Back pain is often due to poor posture. removalcheck for a blockage. this allows the child have or above? • care of down for that are tight-fitting.OSSIBLE CAUSES A noncancerous growth P nipples.78)for an underlying cause. semen investigation. bruised or strained your back. YES is always to the right of a box. if intercourseor or her the recommended dose of drugs? fever damage. Although the majority of breast problems are not serious. If your child’s temperature has not returned to normal within an hour. In some Continued on cases. EXAMINED • Do not eat fried foods or excessive well HERE DANGER SIGNS Call an ambulance if you The lump is probably a as painfulyour fingers of arrange for you to have a blood test and X-rays disease. follow the pathway of questions with yes/no answers Warning box This box highlights danger signs that need urgent medical attention or provides key information. How the charts are organized The charts are divided into four groups. him old. If the diagnosis is confirmed. exercise. a serious cause is unlikely. consult your doctor. the painF . inserted into the breast lump.245) can result in a blockage of the vas no individual lumps that require such as mammography (above) to exclude Do both your the tubes that transport sperm from If a couple has fertility problems. The procedure is uncomfortable but lasts only a few seconds. Consult your you avoid because these garments Are cause an pain dark red you female help made of natural fibres such as cotton. ACTION Being a physiotherapist. Follow self-help measures for relieving back pain (opposite). Follow self-help measures for relieving in which the throat becomes swollen and undertaking back pain (opposite). your CHART. cells will be the stored before the treatment started. add 0. he or along the length of the spine. these boxes show that the pathway continues on the second page. You should have a supportive mattress on your bed. wearing high-heeled shoes. If the test shows SELF-HELP partner more often (see MAXIMIZING THE NO noncancerous growth affecting a milk duct CHANCE OF CONCEPTION. often than three times backwards into the bladder during ejaculation. Each millilitre of difficult. helped by Premenstrual syndrome Object directly in front of you Continued on next page 14 Fever in children t Bringing down a fever 238 Bone densitometry t Does your child have a cough and/or a runny nose? NO YES and/or ligaments in object measures for relieving earache strained some of thePmuscles CAUSE A condition such as croup. If the temperature may child’s pain is severe. you will need further tests such as aspiration (see ASPIRATION OF A BREAST LUMP. in the days before your period. examined under and a possibilityPthat needs to be Rarely. C HMAKE AE CHILDREN: ALL AGES ILD A L L who may 2 days. A out in preparation for breast-feeding. you may have MRI (p. he or she will probably prescribe antibiotics and may arrange for a chest X-ray (p.

you will usually be told to consult your doctor. and information is displayed on a monitor. such as 48 hours. Are you female and pregnant? NO YES Bone densitometry This technique uses low-intensity X-rays (p. • If heat does not provide relief. Knees raised to keep the spine flat X-ray beam SEE YOUR DOCTOR WITHIN 24 HOURS During the procedure The X-ray generator and detector move along the length of the spine. In this condition. keep moving and carry out your normal daily activities. If you are overweight. This is especially likely if you are between 20 and 40. If your backache is severe or is no better within 2 days. If you cannot get in touch with your doctor within 1 hour. by taking body temperature during a fever A D U LT S : G E N E R A L Continued from previous page Are you over 50? NO YES SELF-HELP Relieving back pain Most back pain is the result of minor sprains or strains and can usually be helped by simple measures. X-ray detector CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR BACK PAIN IS SEVERE OR IF THE NATURE OF LONG . additional information can be found in the A–Z of drugs (pp. Once your back pain has cleared up.SYMPTOM CHARTS Action Possible cause or causes This text tells you which condition or conditions are most likely to be responsible for your symptoms and whether you should consult your doctor This text tells you what can be done for your condition. Osteoporosis is symptomless unless a fracture occurs.STANDING BACK PAIN SUDDENLY CHANGES . Did the pain come on suddenly after an extended YES stay in bed or confinement to a wheelchair. it will help to lose weight (see HOW TO LOSE WEIGHT SAFELY. going by car to the accident and emergency department of the nearest hospital may be a better option. and their absorption is interpreted by a computer and displayed as an image.312) for advice. the best way to achieve this is by calling an ambulance so that you can be given medical care in transit. it will tell you about tests you may have and likely treatments. a prolonged period of immobility will also lead to the development of osteoporosis. Self-help box This type of box may outline practical measures that you can take to relieve symptoms or cope with your problem. there may be advice on how to assess the severity of a symptom. If medical help is needed. ACTION Your doctor may arrange for blood tests and an X-ray (p. However. Even if it is the middle of the night or the weekend. However. Your condition may be life-threatening unless given immediate medical attention in hospital.39) to confirm the diagnosis. X-rays are passed through the body. try using an ice pack (or a wrapped pack of frozen peas). This is particularly likely if you are over 50 and you are overweight. POSSIBLE CAUSE Osteoarthritis of the spine is probably the cause of your symptoms. place it over the painful area for 15 minutes every 2–3 hours. helping you to find the chart you want more easily Instructions for obtaining urgent medical help If your symptoms suggest that you need urgent medical attention rather than just a routine appointment with your doctor. you will probably be given nonsteroidal antiinflammatory drugs. but a short delay is unlikely to be damaging. for example if an ambulance cannot reach you quickly. resulting in the spinal column gradually becoming hard and inflexible). for example. some information boxes have key facts on a disease or extra detail of anatomy that is relevant to the chart 45 . you will be given a suggested time. Telephone your doctor and ask for an urgent appointment within the next 24 hours or contact NHS Direct (see USEFUL ADDRESSES.151). In addition. There are three different levels of urgency. Monitor Drug treatments If a type of drug. Your doctor may also request bone densitometry (below). or are you over 60? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have a crush fracture of a vertebra as a result of osteoporosis. In some cases.312) or go to the accident and emergency department of your nearest hospital. it is important that you try to remain active and take weight-bearing exercise. ACTION Your doctor will examine you and arrange for you to have a blood test and X-rays (p. You will also be referred to a physiotherapist. information may be given on what you can do yourself Colour bar Each group of charts is identified by a colour bar. For other urgent cases. you should call your doctor immediately. joints between the vertebrae in the spine are progressively damaged. If you are found to have ankylosing spondylitis. such as walking. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW Your symptoms may indicate a serious problem that needs urgent medical assessment. in all cases. Consult your doctor.284) X-ray generator 239 Consult another chart These instructions send you to another chart in the book that may be more appropriate for your symptoms or may give you additional information Cause not identified If you have not been able to find an explanation for your symptoms.39) of your back and pelvic areas. Specific treatment for osteoporosis depends on the underlying cause. • Place a heating pad or wrapped hot-water bottle against the painful area. within which to consult your doctor if symptoms are no better Information box This type of box gives further information on what is involved in having a test or treatment mentioned elsewhere in the chart. Consult your doctor. Has your YES back gradually become stiff as well as painful over a period of months or years? NO POSSIBLE CAUSE You may have ankylosing spondylitis (inflammation of the joints between the vertebrae. • Rest in bed if the pain is severe. In the most urgent cases that are potentially lifethreatening. Over-the-counter painkillers should help to relieve your symptoms. you will be told to call an ambulance. In some cases. The disorder is most common in women who have passed the menopause. such as swimming. Try the following: • If possible. You need prompt medical attention. The instructions are fully explained below. failing that. If medical help is not necessary. but do not stay in bed for more than 2 days.305–310) Go to chart 147 BACK PAIN IN PREGNANCY (p. you should take steps to prevent a recurrence by following the self-help advice for taking care of your back (opposite). p. These mobility exercises are an essential part of the treatment for this disorder and can be supplemented by other physical activities. Usually. ACTION Initial treatment for the pain is with painkillers. such a painkiller or sleeping drug. phone for an ambulance. He or she may visit you at home or want to see you at the surgery immediately. Your doctor may refer you for physiotherapy to help you strengthen the muscles that support the spine. consult your doctor. go by car or taxi. If possible. The procedure takes about 20 minutes and is painless. p. call NHS Direct (see USEFUL ADDRESSES. The computer calculates the average bone density and compares it with the normal range for the person’s age and sex. • Take over-the-counter nonsteroidal antiinflammatory drugs. Alternatively. p. the instructions at the end of a pathway will tell you what to do. is in italic typeface. in which bones throughout the body become thin and weak.39) to measure the density of bone. who will teach you exercises to help keep your back mobile. you will be told to get help from you doctor either at once or within 24 hours.

....... However................................ such as ear and hearing symptoms or pregnancy and childbirth symptoms....................... 156 Lumps and swellings................ 238 118 Painful or stiff neck...................... fainting.. 76 Rash with fever (children)............................... 197 Shortness of breath......... 204 SKIN................... 88 Confusion and/or drowsiness (children)................. 147 Fever. 148 Overweight....... at the start of each group of charts. 235 116 Foot problems......... 160 Dizziness.... Feeding problems (babies).................................................. 107 Coughing (children)................................................. 163 Forgetfulness and/or confusion.......................................................................... 182 Rash with fever.............................. 62 Growth problems (children)... and seizures (children).... 78 Skin problems in children..... 164 18 55 75 76 77 78 79 80 81 Slow weight gain (babies).......................................... 54 ................................... 184 Painful arm or leg (children)............................................. 78 Lumps and swellings (children).............. 84 Adolescent skin problems........ 231 113 Painful leg..... 154 Excessive sweating......................... 198 110 Painful joints..................... 234 115 Swollen ankles.................................................... This alphabetical list covers all the symptoms in the book and can direct you to the page of the right chart.......................... 134 Foot problems (children).... In addition.... 136 Limping (children).............. 194 Sore throat................................................ 200 Chest pain.... 138 Runny or blocked nose (children).. System-by-system chartfinder GENERAL (WHOLE-BODY) SYMPTOMS 2 3 6 9 10 14 15 19 37 56 57 61 62 74 80 BONE..................................... 232 114 Painful knee........... 174 Rash with fever............... 64 Rash with fever (children)........... such as charts for children........................................ 68 Fever in children....... You should use this chartfinder if you know the affected body system but cannot clearly define your symptom. 162 Numbness and/or tingling.......................................................................... 80 Hair............ 85 Eating problems (children).............. 240 HEART 34 90 92 93 94 AND LUNG SYMPTOMS Breathing problems (children)................................ 86 Headache (children)...................................................................................................................... 82 Itching (children)................................... 236 117 Back pain................................................ 158 Feeling faint and passing out................................................ 178 Skin problems affecting the face..... 116 Feeling unwell.... and................................ 110 Wheezing...................................... 184 Nail problems..... you should use the symptom-bysymptom chartfinder (p............................................SYMPTOM CHARTS CHARTFINDERS To help you find the chart you need.......................................... scalp.................................................................................... 52 Fever in babies..... and nail problems (children)................................ there is a list of the charts in that group....... 150 46 ............................... 108 Runny or blocked nose............ 60 Feeling generally unwell (children)... 146 Tiredness............... 228 111 Painful shoulder...................... AND NAIL SYMPTOMS Skin problems in babies............................... 133 Joint and back problems (children)..................................... the charts have been listed here in two ways............................... 66 Tiredness (children).... 185 23 63 64 65 66 67 BRAIN 20 21 22 AND NERVOUS SYSTEM SYMPTOMS WEIGHT 7 12 13 51 58 59 AND GROWTH PROBLEMS Dizziness.. 230 112 Painful arm.......6–7) has a complete list of the symptom charts................................... The system-by-system chartfinder (below) groups the symptom charts under the affected body part or process............................................ 106 Sore throat (children). 180 Skin discoloration and moles......................................... 47 48 49 50 JOINT.. if you can identify your symptom............................ 8 15 16 17 HAIR.............. 195 Hoarseness or loss of voice. 92 Headache.............. 175 Hair and scalp problems....... AND MUSCLE SYMPTOMS NOSE 31 32 33 87 88 89 91 AND THROAT SYMPTOMS Excessive crying (babies)........................................................... 90 Clumsiness (children).......... 202 Palpitations........... the contents (pp....... 144 Itching.. 176 General skin problems.......48)...... 196 Coughing... 72 Excessive weight gain (children)....... 74 Adolescent weight problems............................................ 139 Loss of weight..........................

.. 56 Diarrhoea in babies............................................. 186 Disturbed or impaired vision.. 167 Difficulty in speaking...... 120 Diarrhoea in children.... 172 FEMALE 46 54 REPRODUCTIVE SYSTEM SYMPTOMS Genital problems in girls.............................................................. 244 121 Erection difficulties.......... 279 143 Vaginal bleeding in pregnancy.................... 272 139 Fertility problems in women........ 50 Sleeping problems in children............................ 143 100 Abdominal pain.................. 96 Toilet-training problems............. 98 Disturbed or impaired vision (children). 212 123 Testes and scrotum problems......... 278 142 Weight problems and Painful or irritated ear (children)........................................... 221 106 Abnormal-looking faeces.................................................. 278 women......................................... 142 in men...................... 276 108 General urinary problems................................................................... 282 146 Swollen ankles in Genital problems in boys.......... 266 135 Genital irritation.......................................................... 206 Mouth problems.......... 169 Depression..................................... 102 Hearing problems (children)......................................................................................... 132 Problems with puberty in girls........ 193 in women................................ 70 Speech difficulties (children)........................................................................................................ 223 136 Lower abdominal pain 128 Breast problems...................... 224 109 Painful urination........... 128 Adolescent behaviour problems...................................... 254 Sleeping problems in babies....................... 260 131 Heavy periods............................................ 246 122 Ejaculation problems.. 128 Teeth problems................ 152 Disturbing thoughts and feelings...... 286 150 Depression after childbirth.......... 288 in women.... 170 Anxiety........ 118 Abdominal pain (children)............... 222 107 Anal problems................. 274 EYE 27 28 82 83 AND VISION SYMPTOMS Eye problems (children)......... 128 women............................SYMPTOM CHARTS 68 69 70 Twitching and/or trembling....................... 124 Abnormal-looking faeces (children).................. 262 132 Painful periods... 281 145 Skin changes in pregnancy....................................112 pregnancy......... 168 36 38 39 40 41 Teeth problems (children)............................................................................................................ 216 102 Swollen abdomen............................... 270 138 Low sex drive in women................ 209 Vomiting.................. 104 Hearing problems........................................... 288 47 ..................... 100 Painful or irritated eye............................... 140 Difficulty in sleeping.................................. 93 Behaviour problems (children)......... 188 URINARY 43 44 SYMPTOMS 140 Contraception choices for Urinary problems (children).............................................. 122 Constipation (children). 130 Problems with puberty in boys........... 218 103 Wind........................ 256 130 Absent periods............ 114 Vomiting in children................................................................................. 58 Mouth problems (children).................................................................................................................................. 94 School difficulties....................................... 242 pregnancy...... 219 104 Diarrhoea.................. 263 133 Irregular vaginal bleeding.................... 284 148 Recognizing the onset of ABDOMINAL SYMPTOMS 4 5 35 AND DIGESTIVE 119 Bladder control problems 120 Problems with the penis............................................ 210 Recurrent vomiting.......... 268 136 Lower abdominal pain in 150 Depression after childbirth.................................................................................................... 125 Toilet-training problems............................................................... 250 126 Fertility problems in men................. 126 Toilet-training problems.................................... 190 Noises in the ear......................................................................... 264 134 Abnormal vaginal discharge.......................... 192 Earache.................................................. 258 pregnancy............ 208 Difficulty in swallowing................................... 242 129 Bladder control problems pregnancy.............. 249 125 Low sex drive in men.............. 214 101 Recurrent abdominal pain.......................... 166 Pain in the face........ 252 127 Contraception choices BEHAVIOURAL 1 11 24 25 26 44 52 60 71 72 73 AND PSYCHOLOGICAL SYMPTOMS 42 44 95 96 97 98 99 for men. 285 149 Breast problems and Vomiting in babies............................................... 220 105 Constipation....... 283 147 Back pain in pregnancy..... 280 MALE 45 53 REPRODUCTIVE SYSTEM SYMPTOMS 144 Abdominal pain in pregnancy.. 247 labour........... 248 124 Painful intercourse in men........... 269 141 Nausea and vomiting women................... 269 137 Painful intercourse in in pregnancy............................................... 226 119 Bladder control problems PREGNANCY SYMPTOMS AND CHILDBIRTH 141 Nausea and vomiting in EAR 29 30 84 85 86 AND HEARING SYMPTOMS in men.........................

.................................................................. 232 in children............................................ 194 in children..................... 280 Vaginal discharge................................ 249 in women.............................................. 208 in children. in children............................. 132 Vision.................................................... in children............................................................. 116 Arm............ 216 arm.......................... 54 in children.. 206 in children..................... loss of.................................................................................................... 52 U–W Urinary problems................. 120 abdominal................ 222 in children....... 223 from nose........ painful or stiff............... 56 in children.......................... 92 Confusion........ 266 Vaginal irritation.... 185 in children......... 106 Numbness and/or tingling...... 248 Seizures............................................................ 280 Blocked nose................................................... 86 Drowsiness........................................................... 224 bladder control problems in men... in children............................... swollen.... 264 in pregnancy. in children............................................................................... 76 rash with.. 166 C Chest pain......... 236 in children.............. 102 eye................................................ 133 Excessive sweating............. in children........... 102 Earache............. in children...................................................................... 196 Vomiting.. 282 swollen ankles in............ 240 period......................... 152 Sore throat...... 212 Weight excessive gain... 228 Knee... 285 Leg..................................................... 286 nausea and vomiting in................................................................................. 120 lower....... 169 Dizziness........... 193 ear..... 112 Nail problems.. Abdomen.......................... 132 Growth problems.... 288 Diarrhoea.................................... 186 problems................................................................................ 188 in children.................................. 86 Sex drive........... 200 Breathing problems... 194 in children....... 264 Irritated ear..................................................... 180 Faeces............................. 84 T Teeth problems............................ 82 Headache.................................................... 164 in children...................................... 78 Foot problems.................................. 80 Runny nose.................................... 242 in women..................... 100 Disturbing thoughts and feelings. 134 back........... sore......... in children.......................... excessive.......... 269 in pregnancy.............. 194 in children............. 228 joint.................. in children........................ 223 Ankles...... 279 Puberty............... 283 G–I Genital irritation........................... 188 in children................. 178 itching...................... 279 slow gain... recognizing onset of................................. in children. in babies....................................... 247 Erection difficulties............................. in children.... 125 Fainting...................... difficulty in............................... 74 loss of.......... 164 Nausea and vomiting in pregnancy.............................. 232 leg................. 147 in children.... 130 Periods absent................... 186 Itching........ 176 in children.............................................................. 202 Clumsiness......................................................... 138 Loss of voice.................................................................... 174 in children.......................... 278 recurrent...................................... 238 back........ 143 B Back pain.. in pregnancy.................................... 163 Overweight.................... 283 Anxiety.......... 180 problems................................. 93 Spots...................................... 175 in children.............................. 163 Tiredness..................... in children....... in children............. 110 Shoulder............................. 168 Speech difficulties........................ 134 in pregnancy................. 242 bladder control problems in women. shortness of.. 249 during intercourse.................................................................................................................................................................................................................. 281 back pain in....................................... 285 skin changes in............................... 128 Tongue............................ 231 arm.................................. 118 in pregnancy.... 122 Disturbed vision..... disturbed or impaired........................................... 282 discoloration and moles................. 102 Irritated eye......... 156 Swellings.................... 231 in children.............. 264 vaginal...... 50 in children................................. 280 weight problems and................................... 202 ear..................................... 286 Breath................................ in children....... 85 R–S Rash with fever........... 230 during urination....................................... 281 recurrent.............. 226 Vaginal bleeding irregular.............................. 250 in women........ in babies................ 234 leg........................ 214 in children..............................134 knee........... in children......... 133 back........... 107 Tingling..... 190 in children........... 150 P Pain abdominal.................................................................... 162 in children..................... runny or blocked........................... 262 painful......................... 100 Voice... 72 Hair problems. 114 Testes problems.................................................. in children.............................................................. 82 48 ................................................ in children.... painful................ 276 Coughing................... 146 in children............................ 258 Bleeding from anus. in children............ 195 in children... 260 heavy.................................... 263 shoulder.... 74 Eye painful or irritated........... 200 M–O Moles.............. 154 in babies......... 98 F Face pain in................................................................... 126 painful urination........... 167 skin problems affecting..................... 96 Scrotum problems............ 66 Fertility problems in men......................... 281 abdominal......................... swollen.... 235 in pregnancy... painful................................ 246 Excessive crying....... 268 Vaginal problems in girls................ 218 Swollen ankles...................... 210 in babies................ 254 for women... sore........................ 167 headache..................................... 248 Throat..................................... 268 Genital problems in boys....... 142 in girls.............................. loss of...................... 139 problems and pregnancy........................ 219 D–E Depression. in pregnancy.. in women.................................. 94 Bladder control problems in men... 104 Hoarseness............SYMPTOM CHARTS Symptom-by-symptom chartfinder A Page No.. 140 in children.......................................................................... in children.... 106 Scalp problems................................................................... 62 Wheezing............................... 158 in children................. 182 general problems.......... in babies........... in adolescents.......................... 284 chest... 174 in children.. 283 vaginal bleeding in.... difficulty in........ 176 in children....................... 193 Eating problems........................... recurrent................... 220 in babies........ in children...................................................... 84 problems.. 184 rash with fever.................................. painful in men.................................. 116 Ejaculation problems............................................... 80 Swallowing............. 107 Speaking.... 130 in girls........ 270 joint........................ 88 during intercourse...... 270 Irregular vaginal bleeding.......... 214 abdominal........................................................................... 184 in children.................... 100 Intercourse........................................... 194 vaginal........ 192 painful or irritated............ in babies........... in women................. 148 Lumps.......................... 272 Shortness of breath......... 216 Anal problems............ in children.......... 188 in children.................................................. 197 Wind. 208 Twitching and/or trembling...................... 158 headache...................... abnormal-looking................... in children....... 284 breast problems and............................................. 269 neck.............. 124 Contraception choices for men.... 258 in children...... 198 in children.......... 196 Loss of weight... 184 rash with. 244 in boys.......... 88 Hearing problems...................................... 182 Mouth problems.................................................................... 80 rash with fever.................... in children.. abnormal.............................................................................................................................................................................................................. 160 in children.. 170 after childbirth............. in adolescents. 86 Feeding problems............................. 78 Sleeping problems in babies................................. in children... 238 in children........................ 172 Appetite.................................... 136 Forgetfulness..... in babies.............. 230 Skin changes in pregnancy................ 234 Labour.......................... 274 Fever...... in children................................................... 284 Back problems..................... 148 overweight............................................................ 278 Neck................................................. 90 Constipation.......... 82 School difficulties......... 278 onset of labour.................... 85 Swollen abdomen. painful....... 221 in children............................................................................ 186 face......................................................... 263 Pregnancy abdominal pain in........... 240 Nose......................................... 64 problems............................ 108 Crying......... women........................................ in children.. 156 Excessive weight gain.............. 52 J–L Joint problems................. 150 problems.... 134 Joints... in pregnancy........................................... 58 in children..... irregular......................... in children... painful....... 144 problems affecting the face........................ problems with in boys............................ 218 Abdominal pain.............................. low in men...................... 68 Toilet-training problems............. 204 Penis problems................................................................. 195 in children.... 252 in women.. 256 and pregnancy.. in men............................. 235 in pregnancy............133 lower abdominal............................ in children............................... 106 Breast problems......................... 196 Impaired vision.................... 175 itching.......................... 60 Feeling unwell................. 90 Ear noises in.... 134 Behaviour problems in adolescents..................................................... children.................... 78 Rashes.. in children.. 133 Limping... painful..... 209 Sweating..................................................................... 226 Palpitations...................... excessive.............. in women.................. 70 difficulty in sleeping...................

. 66 Tiredness.................. 52 Fever in babies.... 64 ALL AGES................... 92 Speech difficulties......... fainting................. 132 Painful arm or leg.......................... 144 49 ...................................................................... 124 Abnormal-looking faeces...................................................................... 140 Problems with puberty in boys... 82 CHILDREN: 51 52 53 54 55 Adolescent weight problems................ 85 Dizziness...... 122 Constipation... 68 Sleeping problems in children.............................................................. 138 ADOLESCENTS....... 133 Joint and back problems................................................................. 143 Adolescent skin problems................................. 125 Urinary problems............................................... 139–144 Sleeping problems in babies.................................... 126 Toilet-training problems................................... and seizures............................. 78 Skin problems in children.. 114 Eating problems......... 104 Runny or blocked nose. 50 Excessive crying....... 134 Foot problems......... 93 Behaviour problems....... 74 Fever in children............................................... 96 Eye problems..................................CHILDREN CHARTS FOR CHILDREN CHILDREN: BABIES UNDER ONE....................................................... 76 Rash with fever. 90 Clumsiness......................... 108 Breathing problems............ 98 Disturbed or impaired vision........................................................................................................................ 80 Hair................................................................................ 50–65 1 2 3 4 5 6 7 8 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Itching.................... 116 38 39 40 41 42 43 44 45 46 47 48 49 50 Vomiting in children.................. scalp........................................................................................ 54 Vomiting in babies............................ 130 Genital problems in girls...... 107 Coughing................. 94 School difficulties.............. 66–138 CHILDREN: 9 10 11 12 13 14 15 16 17 Feeling generally unwell........................ 60 Slow weight gain............ 88 Confusion and/or drowsiness......................................................................................... 56 Diarrhoea in babies.................. 118 Abdominal pain......................................................... 142 Problems with puberty in girls.... 139 Adolescent behaviour problems....... 136 Limping.. 110 Mouth problems.................. 102 Hearing problems................................................... 70 Growth problems................. and nail problems.................................. 84 Lumps and swellings.............. 112 Teeth problems........................................ 72 Excessive weight gain.............. 86 Headache......... 100 Painful or irritated ear..................................................... 120 Diarrhoea in children............................................ 128 Genital problems in boys. 62 Skin problems in babies......... 58 Feeding problems.... 106 Sore throat.....

try expressing milk so that your partner can sometimes give the baby a bottle at night. background noises (together with movement) tend to promote sleep rather than hinder it. and there is no point in trying to force a START HERE Is your YES baby under 4 months old? NO Does your baby cry YES excessively in the evenings. or if a baby who has previously slept well starts to wake during the night. by offering supplementary bottles of milk in the evening – are usually unsuccessful. your baby should be encouraged to sleep more at night by establishing a clear difference between day and night. If you think that lack of sleep is affecting your general health or is making you resentful of your baby. or HELPING OLDER BABIES TO SLEEP. If you feed or change your baby at night. Never add extra formula to your baby’s milk. Being taken on a car journey or pushed in a pram will almost always settle a young baby to sleep. Consult this chart only if you think your baby is waking more frequently than is normal for him or her. Also follow self-help measures for helping your baby to sleep (see HELPING YOUNG BABIES TO SLEEP. IN CHILDREN For children over 1 year. and try to avoid chatting to or playing with the baby. The need for frequent feeds is normal in babies of this age. see chart 11. If your baby is breast-fed. if you have difficulty settling your baby at night. Does your baby often wake in the night but go back to sleep once fed? NO YES Does your baby seem to sleep less than other babies of the same age? NO YES POSSIBLE CAUSE AND ACTION Some babies naturally need less sleep than others. making it difficult for you to settle him or her for sleep? NO POSSIBLE CAUSES There are many reasons why your baby may be crying excessively. At this age. ACTION Attempts to prevent a young baby from waking at night through hunger – for example. the most that you can do to help your baby sleep is to ensure that these basic needs are met. Has your baby always followed this sleeping pattern? Does your baby sleep a lot during the daytime and less at night? NO YES NO POSSIBLE CAUSE AND ACTION Younger babies will sleep at any time of day. After the age of 2–3 months. Most babies wake at regular intervals through the day and night for feeds during the first few months of life. opposite).70). Go to chart 2 EXCESSIVE CRYING (p. 50 . he or she will need less sleep. Try to take rests during the day when your baby is asleep. SLEEPING PROBLEMS (p. Try to keep your baby entertained when he or she is awake by providing plenty of things to look at and toys to play with. consult your health visitor. below. keep curtains open during the day and avoid having bright lights on in the baby’s room at night.CHILDREN: BABIES UNDER ONE 1 Sleeping problems in babies baby of this age into a routine that is more convenient for you. Try to reduce the length or number of naps in the day so that your baby sleeps better at night. keep the light dim or use a night-light. This is perfectly normal. To do this. Helping young babies to sleep SELF-HELP Is your baby used to having daytime naps? NO YES Continued on next page Babies up to about 4 months of age generally sleep when they are fed and comfortable. YES POSSIBLE CAUSE AND ACTION As your baby grows older.52) POSSIBLE CAUSE Hunger is probably causing your baby to wake.

Place baby on his or her back Firm mattress Could your baby be waking because he or she is hungry? NO YES POSSIBLE CAUSE AND ACTION As your baby grows. since he or she cannot wriggle under the bedclothes. Consult your doctor or health visitor for advice. This position is the safest. • Do not place your baby’s cot close to a radiator or other type of heater. However. so that bedding cannot cover the face. • Use a firm mattress with no pillow. Alternatively. Try to stick to a bedtime routine (see HELPING OLDER BABIES TO SLEEP. • Do not be too ready to go to your baby if you hear whimpering in the night. also known as cot death. otherwise. but you are not so likely to be disturbed by less urgent sounds. Sleeping safely Lay your baby down on his or her back at the foot of the cot. but make sure that your baby understands that he or she will be put back in the cot. settle him or her as quickly and quietly as possible. If you can. ACTION It may take some time to reassure your baby. Reducing the risk of SIDS SELF-HELP There are things you can do to reduce the risk of sudden infant death syndrome (SIDS). Helping older babies to sleep SELF-HELP Babies older than about 4 months are past the stage of needing frequent night feeds and benefit from a bedtime routine. offer a drink and a cuddle. Could your baby be too cold or hot during the night? NO YES POSSIBLE CAUSE Being too hot or cold may be causing your baby to wake in the night. Many babies are restless sleepers and. such as fever. even if your own life is unsettled. try to keep your baby’s routine as stable as possible. 51 . POSSIBLE CAUSE AND ACTION A need for the reassurance of your presence is the most common explanation for waking at night when a baby is past the stage of needing night feeds. but this should not prevent bedtimes from being fun. or vomiting. If your baby kicks off the bedclothes and gets cold. • Do not smoke in the presence of your baby. When your baby wakes at night. try dressing him or her in a sleep suit at night. ACTION If possible. it is more likely that you will be overaware of your baby’s movements during sleep and may think that the little noises that babies often make in their sleep are signs of wakefulness. It is unlikely that you would fail to hear a true cry. Letting your baby get too hot may increase the risk of sudden infant death syndrome. consult the relevant chart in this book. if left undisturbed.CHILDREN: BABIES UNDER ONE Continued from previous page Does your baby sleep in the same room as you? YES NO POSSIBLE CAUSES You may find that sharing a room with your baby results in disturbed nights for both you and your baby. • Provide a night-light if your baby seems frightened of the dark. Increasing feeds in the evening may stop your baby waking at night. there is a danger that the baby will get into the habit of waking during the night and expecting to play (see HELPING OLDER BABIES TO SLEEP. The problem may be that you make sounds that disturb your baby. Here are some tips for problem-free nights: • Avoid too much excitement in the hour or so before bed. ACTION Try to keep the temperature in your baby’s room at about 18°C (65°F). Is your baby waking repeatedly at night after YES previously sleeping well? NO Does your baby seem unwell in any way? NO YES POSSIBLE CAUSES AND ACTION If your baby has specific symptoms. Do not overwrap the baby. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. or SIDS (left). Your baby should need no more covers than you would in similar circumstances. • Do not overwrap your baby in bedclothes. above). If there are no specific symptoms but your baby continues to seem unwell. move your baby into a different room. It is best to be consistent and firm. you may need to start weaning your baby (p. Your baby needs reassurance that separation from you at bedtime is not a punishment. • If your baby cries at night. They are: • Always put your baby to sleep on his or her back near the foot of the cot. above). you should contact your doctor. will continue to sleep. he or she will need more food.63) if you have not already done so. He or she may be making noises while asleep. diarrhoea. Has there been any recent domestic upheaval or possible cause of anxiety? NO YES POSSIBLE CAUSE Babies sense anxiety or stress in their parents and can be disturbed by it.

or eliminating dairy products from your diet if you are breast-feeding. Ask neighbours or friends to look after your baby for an hour so that you can relax. may be the cause. offer him or her extra drinks of cooled. 52 . Does your baby vomit after feeds and begin to cry? NO YES POSSIBLE CAUSE AND ACTION Wind trapped in the stomach after feeds is a possible cause of discomfort and crying in young babies (see DEALING WITH WIND. If there is no one to ask. Your doctor will examine your child in order to make a diagnosis and to determine the appropriate treatment. you may be advised to seek medical help. and leave him or her for half an hour or so. ACTION Your doctor will examine your baby to exclude other causes. Does burping seem to make your baby feel better? NO YES POSSIBLE CAUSE AND ACTION Thirst is a possible reason for a young baby’s crying. or in pain. Follow the self-help measures for dealing with wind (opposite). upset. Continued on next page SELF-HELP Coping with crying Help with caring for your baby Ask a neighbour or friend to look after your baby for a while if you have problems coping with his or her crying. this is uncommon in breast-fed babies or infants under 4 months of age. but it may be due to trapped wind in the intestine. Most babies grow out of this condition by the age of 1. These bouts of crying usually occur in the early evening and are more common in breast-fed babies. spending more time sitting in a baby chair may help. or rubbing your baby’s abdomen. until you feel better. Does a drink of cooled. If your baby is old enough. opposite). try thickening his or her feeds with cornflour or carob-seed powder. boiled water stop your baby from crying? NO SELF-HELP Dealing YES with colic Some young babies have long periods of inconsolable crying known as colic. Your doctor may also suggest a drug that increases the muscular activity of the oesophagus. Many parents find it very stressful and feel unable to cope if their baby cries for hours on end. Most parents soon learn to recognize the most common START HERE Is your baby crying in a way that is unusual for him or her? NO YES Did your baby take the last feed as normal? NO YES POSSIBLE CAUSE AND ACTION If your baby is feeding normally. Crying is a young baby’s only means of communicating physical discomfort or emotional distress. If your baby is bottle-fed or if the weather is hot. try rocking or walking with your baby. close the door. Call your doctor if your baby becomes reluctant to feed or if he or she continues to cry excessively. put the baby in his or her cot and call your doctor. in which the stomach contents leak back into the oesophagus. You may also want to try using anti-colic teats if you are bottlefeeding. or a self-help group (see USEFUL ADDRESSES. boiled water. If the crying becomes unbearable and you are afraid that you might hit or shake your baby. he or she probably only has wind. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Gastro-oesophageal reflux. taking him or her for a ride in the car. giving one of the over-the-counter colic medicines containing simethicone. In some cases. CALL YOUR DOCTOR NOW POSSIBLE CAUSES AND ACTION Your baby may have one of a number of conditions. Affected babies often draw up their legs as though in pain. You may be advised to put your baby to sleep on his or her side with the head higher than the feet. Such feelings are normal and do not mean that you are a bad parent. If your baby is bottle-fed. health visitor.311). The cause of colic is not known. p. put your baby safely in his or her cot. Being left for a short while will not harm your baby. however. some of which may be serious. To help to relieve colic. or the mother’s tiredness and tension. and some babies occasionally cry for no obvious reason. hunger. You should consult this chart if your baby cries more often than you think is normal or if your baby suddenly starts to cry in an unusual way. wet. All babies sometimes cry when they are hungry.CHILDREN: BABIES UNDER ONE 2 Excessive crying causes of their baby’s crying and are usually able to deal with them according to need. Colic almost always clears up by 4 months of age.

Gently rub or pat his or her back to encourage the wind to come up. ACTION Cuddle your baby as much as he or she seems to want. may help. Wind may be worse if your baby cries just before a feed or feeds greedily.37). Once your baby seems content. hold him or her in an upright position. Is your baby under 4 months old? NO YES Does your baby usually stop crying when picked up and given your full attention? NO YES POSSIBLE CAUSE The need for attention and physical comfort is a common cause of crying. make sure that the hole in the teat is the right size. Here are some tips that may prevent wind from occurring or may help to release the wind: • If your baby is bottle-fed. Has your baby been immunized recently? NO YES SELF-HELP Dealing with wind Burping your baby To burp your baby. A towel will help keep you clean Baby held over shoulder Has there been a recent major domestic upheaval or other stressful event? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. some self-help measures may give you and your baby temporary relief (see DEALING WITH COLIC. such as a teething ring cooled in the refrigerator. ACTION There is no effective cure for colic. try to find ways of reducing any strain you are under. and your baby will be happier as a result of an increased feeling of security. All babies swallow air when feeding. there is no danger of “spoiling”. • Support your baby in a semi-upright position when feeding so that swallowed air rises to the top of the stomach. If he or she has a fever. consult your doctor. opposite). p. It usually starts when a baby is about 6 weeks old and ceases by the age of 4 months. • Burp your baby at intervals during each feed. The main priority for parents is to find a way of coping with a constantly crying baby (see COPING WITH CRYING.115). causing discomfort. follow the advice for dealing with fever after immunization (p. ACTION Your baby will need more attention and reassurance than usual but should settle down within a week or so. An older baby may be content if placed in a bouncing cradle or propped up on some cushions where he or she can see you. Some babies are quite happy when left alone in their cot or playpen. ACTION Take your baby’s temperature (p. particularly if the mother is affected. This air may then get trapped in the intestine. even if other aspects of life are changing. If you think that your baby’s crying could be a reaction to your own tension.55). POSSIBLE CAUSE Even young babies can be upset by increased tension in the home. opposite). POSSIBLE CAUSE AND ACTION Teething can cause babies some discomfort. You can also give the recommended dose of painkillers to relieve the discomfort (see TEETHING. At this age. Gently rub or pat his or her back to help release trapped air. Try to keep your baby’s routine as stable as possible. However. Hold your baby upright against your shoulder or on your lap. you can try putting a young baby in a carrying sling while you go about the house. but others need the constant reassurance of their parents’ presence. To enable you to get on with your everyday chores.54). The precise cause of colic is not known. cooled object to chew on.CHILDREN: BABIES UNDER ONE Continued from previous page Does your baby seem content for most of the day but cry a great deal during the late afternoon and evening? NO YES POSSIBLE CAUSE Colic is the term often used to describe this common type of crying. Your doctor or health visitor may be able to suggest ways of helping. 53 . Could your baby be teething? NO YES POSSIBLE CAUSE Some babies may feel uncomfortable or have a mild fever in the week after a routine immunization (p. If your baby does not have a fever and his or her crying is still worrying you. A hard. you should avoid fussing over him or her.

77).78) SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A viral or bacterial infection of the middle ear is a common cause of a raised temperature in babies over the age of 6 months. p. p. p. you can use an aural thermometer. You must never place a glass thermometer in a baby’s mouth. Your baby’s treatment may include antibiotics. If your baby has a fever. which you place in the baby’s ear (see TAKING YOUR CHILD’S TEMPERATURE. ACTION Your doctor will examine your baby and may arrange for him or her to be admitted to hospital for tests.76). A baby that has a fever will have a hot forehead and is likely to seem unhappy and fretful. A fever is an abnormally high body temperature of 38ºC (100ºF) or above.103) and bringing down a fever (p. p.77). a viral infection of the small airways in the lungs. follow the self-help advice for relieving earache (p.76). the doctor may prescribe antibiotics. which is a medical emergency (see FEBRILE CONVULSIONS IN BABIES AND CHILDREN.77). It is also important to encourage your baby to drink plenty of fluids.CHILDREN: BABIES UNDER ONE 3 Fever in babies (see TAKING YOUR BABY’S TEMPERATURE. If you think your baby may be unwell. dark red spots that do not fade on pressure (see CHECKING A RED RASH. and/or has he or she been sneezing? NO YES POSSIBLE CAUSES Your baby’s fever is probably due to a viral illness. Middle ear infection is particularly likely to be the cause of your baby’s symptoms if he or she has recently had a cold. such as X-rays (p. For children over 1. take steps to reduce your baby’s temperature (see BRINGING DOWN A FEVER. A high fever may cause a baby to have a seizure. add 0. In some cases. take steps to reduce it (see BRINGING DOWN A FEVER. p. If measles is the cause of your baby’s fever. take his or her temperature START HERE Is your baby YES less than 6 months old? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES Your baby may have a viral or bacterial infection.39) and measuring of blood oxygen levels (p. such as a cold.6°C (1°F) to the temperature shown. ACTION Until you see the doctor. call your doctor. Continued on next page 54 . a viral or bacterial infection of the air spaces in the lungs. or pneumonia. WA R N I N G DANGER SIGNS Call an ambulance if your baby has a fever accompanied by any of the following symptoms: • Abnormal drowsiness • Flat. but do not worry about solids. Alternatively. If your baby develops a rash or shows no signs of improvement within 24 hours. Does your baby have a clear discharge from the nose. opposite). In addition. are both possibilities. Measles is a less likely possibility. below). blotchy. a flat. p. see chart 14. and/or has he or she been tugging at either ear? NO Go to chart 15 RASH WITH FEVER (p. a fever can sometimes follow an immunization (opposite). ACTION The doctor will examine your baby and may prescribe antibiotics. Alternatively. For an accurate reading.77). and consult this chart. Admission to hospital may be advised if your baby is particularly unwell or the cause of the fever is unclear.201). FEVER IN CHILDREN (p. ACTION Carry out measures to reduce your baby’s temperature (see BRINGING DOWN A FEVER. The doctor will examine your baby in order to determine the cause of the fever.110)? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES Bronchiolitis. place the bulbous end in the armpit. Thermometer in armpit Is your baby’s breathing YES abnormally fast (see CHECKING YOUR CHILD’S BREATHING RATE. YES Taking your baby’s temperature SELF-HELP To take your baby’s temperature using a standard thermometer.79) • A seizure that has lasted for longer than 5 minutes • Has refused feeds for more than 3 hours (babies under 3 months) or more than 6 hours (3 months and over) Does your baby have a rash? NO YES Has your baby woken suddenly in the night crying inconsolably. red rash will develop within 2–3 days. Using a standard thermometer Hold the thermometer in the baby’s armpit for 3 minutes.

and/or is he or she in warm surroundings? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.37) are usually given at the ages of 2. Does your baby have diarrhoea? NO YES Has your baby been immunized recently? NO YES POSSIBLE CAUSE Some babies may feel uncomfortable or have a mild fever in the week after a routine immunization (p. may be the cause of these symptoms.57). try to reduce his or her temperature by sponging with tepid water. you should follow the selfhelp advice for reducing his or her fever (see BRINGING DOWN A FEVER. He or she may also give you advice on preventing dehydration in babies (p. dark red spots that do not fade on pressure (p. mention it to your doctor or health visitor before the next immunization is due. He or she will be given urgent treatment with antibiotics and may need intensive care. ACTION Your doctor will check whether your baby is dehydrated. often at the onset of a feverish illness. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Gastroenteritis. p. Call your doctor if your child has a convulsion.77). 55 . although frightening.77) and call your doctor. to prevent injury. He or she can advise you on how to deal with any symptoms that may develop. it should be postponed until he or she is better. Convulsions may be avoided by keeping your child’s temperature down (see BRINGING DOWN A FEVER. Febrile convulsions are rarely an indication of epilepsy in later life. can result in a fever. During a convulsion. an infection of the digestive system. call an ambulance. Most affected children stop having convulsions at about 5 years of age. t EMERGENCY! CALL AN AMBULANCE Fever after immunizations Some babies and young children develop a mild fever after an immunization. inflammation of the membranes surrounding the brain due to infection. Is your baby very warmly dressed. POSSIBLE CAUSE Overheating. He or she may fall asleep shortly afterwards. If your baby’s temperature is not down to normal within an hour. ACTION Follow the advice for dealing with fever after immunization (right).77). A baby’s cot should never be placed next to a radiator. About a third of children who have had a febrile convulsion have another one within 6 months. Remove any excess clothing and move the baby to a slightly cooler (though not cold) place. Routine immunizations (p. your baby will be admitted to hospital immediately.79) NO YES ACTION If meningitis is suspected. especially if your baby is also vomiting. place your child in the recovery position (p. which may result in a bluish tinge to the skin • Pass urine and/or faeces • Roll back his or her eyes Febrile convulsions usually last for less than 5 minutes and. 3. 55 Cooling your child If your child has a febrile convulsion. remove excess clothes. It is triggered by an abrupt rise in body temperature. follow the advice for reducing a fever (p. If your child has been unwell after having an immunization. You should also call your doctor if self-help measures are not successful in reducing your child’s temperature. 4. the child may: • Lose consciousness • Shake or jerk violently • Stop breathing temporarily or breathe shallowly. Call your doctor immediately if your child’s temperature rises above 39ºC (102ºF) or if he or she has other symptoms.37).292). If he or she does have a febrile convulsion. and surround him or her with soft objects. After the seizure has finished. is the most likely cause of these symptoms. If it lasts more than 5 minutes.59) and self-help measures for treating gastroenteritis in babies (p. such as pillows. such as an unusual or highpitched cry. caused by too much clothing or by being in excessively warm surroundings. p. ACTION A baby does not need to wear much more clothing than an adult would in similar conditions and will be comfortable in a room temperature of 15–20ºC (60–68ºF). are not often serious. If your child has a fever at the time when an immunization is due. remove clothing and bedcovers to cool him or her down. and 12–15 months. Febrile convulsions in babies and children A febrile convulsion is a type of seizure that affects some children aged 6 months to 5 years.CHILDREN: BABIES UNDER ONE Continued from previous page POSSIBLE CAUSE Meningitis. Does your baby have any of the following? • Abnormal drowsiness • Restlessness • A high-pitched or abnormal cry • Flat. If your child develops a fever after an immunization.

Go to chart 3 FEVER IN BABIES (p. However. This can lead to dehydration. are particularly susceptible to gastroenteritis. If your baby is bottle-fed. spending more time sitting in a baby chair may help. p. vomiting with a fever may be due to an infection. which may indicate an illness. in which the stomach contents leak back into the oesophagus. Does your baby have any of the following? • Abnormal drowsiness • Restlessness • A high-pitched or abnormal cry • Refusing feeds • Flat. ACTION Your doctor will examine your baby. ACTION If meningitis is suspected. p. POSSIBLE CAUSE In a baby. it is easy for parents to confuse vomiting. For children over 1 year. in which thickened muscle narrows the outlet from the stomach. and this is unlikely to be a cause for concern. such as ultrasound scanning (p. is common in babies and is a likely cause. You may be advised to put your baby to sleep on his or her side with the head higher than the feet. your baby will be admitted to hospital.79) NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Gastro-oesophageal reflux. may cause forceful repeated vomiting. inflammation of the membranes surrounding the brain due to infection. and is he or she vomiting after all or most feeds? NO YES Is milk brought up effortlessly? NO YES WA R N I N G DANGER SIGNS Call an ambulance if your baby’s vomit is yellowish-green or if the vomiting is accompanied by any of the following symptoms: • Flat. • Make sure that any water you give to a baby aged under 6 months has been boiled and cooled. • Keep a separate towel for your baby.53). dark red spots that do not fade on pressure (see CHECKING A RED RASH. may be the cause of these symptoms. ACTION Your doctor will examine your baby to exclude other causes. dark red spots that do not fade on pressure (p. However. always make sure that everything is washed thoroughly in warm.41). Your doctor may also suggest a drug that increases the muscular activity of the oesophagus. may be the cause of your baby’s symptoms. and before preparing his or her feeds. • Although you can stop sterilizing feeding equipment from about 6 months onwards. see chart 38. if you are concerned. It is not true vomiting and is seldom a cause for concern in an otherwise well baby. He or she will be given urgent treatment with antibiotics and may need intensive care. with regurgitation (posseting). caps.54) POSSIBLE CAUSE Meningitis. soapy water before sterilizing them. after changing your baby’s nappies. The condition is usually the result of trapped air in the stomach (see DEALING WITH WIND. persistent vomiting in babies can be a sign of an underlying problem. Most babies grow out of this condition by the age of 1 year. In young babies. your baby will be admitted to hospital immediately. START HERE Is your baby less than 2 months old.118). The following precautions can help you to decrease the risk of infection: • Always wash your hands after going to the toilet. try thickening his or her feed with cornflour or carob-seed powder. 56 . consult your doctor. Is your baby’s temperature 38°C (100°F) or above? NO YES Is only a small amount of milk brought up? NO YES Continued on next page Preventing gastroenteritis SELF-HELP Babies. may be carried out to confirm the diagnosis. and teats in warm. especially if they are bottle-fed. sometimes known as posseting. If the baby is old enough. Almost any minor upset can cause a baby to vomit once. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE AND ACTION Regurgitation. and wash it often. (babies under 3 months) or more than 6 hours (babies 3 months and over) • Abnormal drowsiness • Sunken eyes and/or dry tongue • Black or bloodstained faeces SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Pyloric stenosis (opposite).79) • Has refused feeds for more than 3 hours. • Wash and scrub all bottles.CHILDREN: BABIES UNDER ONE 4 CHILDREN Vomiting in babies the effortless bringing up of small amounts of milk. VOMITING IN (p. soapy water. If he or she suspects pyloric stenosis. Dehydration will be treated and further tests. Treatment involves surgery to widen the outlet from the stomach. • Sterilize all feeding equipment and dummies regularly and thoroughly by using sterilizing chemicals or steam sterilizers or by boiling equipment in a pan of water.

Was your baby playing energetically just before vomiting. give only rehydrating solutions at first. IF YOUR BABY VOMITS MORE THAN ONCE IN A DAY OR SEEMS OTHERWISE UNWELL.201). the stomach contents build up until repeated. ACTION Your baby may be admitted to hospital. surgery will be necessary. Treatment for intussusception usually involves an enema to force the displaced intestinal tissue back into the right position.YES green? NO Does the vomiting only occur during or after travel in a vehicle? NO POSSIBLE CAUSE Intussusception. In this condition. may be the cause. In some cases. Without treatment. Giving rehydrating solutions Rehydrating solutions should be prepared with cooled.59) and treating gastroenteritis in babies (above). although these do not always affect the severity of the symptoms. CALL YOUR DOCTOR NOW Does your baby have diarrhoea? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Gastroenteritis. try to avoid boisterous games. ACTION Your baby will probably be admitted to hospital. he or she may need antibiotics to prevent the spread of the infection. Go back to giving rehydrating solutions. POSSIBLE CAUSES Bronchiolitis.122) may be the cause. in which the thickened muscle is cut to widen the stomach outlet. This is no cause for concern and will be less of a problem as your baby grows older.CHILDREN: BABIES UNDER ONE Continued from previous page SELF-HELP Treating gastroenteritis in babies Does your baby have a cough? NO YES Gastroenteritis does not need treatment with drugs such as antibiotics. the muscles around the top of the stomach are relatively lax compared with those of older children. particularly after feeds. HOWEVER. Treatment involves surgery. forceful vomiting occurs. boiled water and can be flavoured to encourage the baby to drink. is a possibility. or were you playing boisterously YES with him or her? NO POSSIBLE CAUSE AND ACTION Travel sickness is probably the cause. If the enema is not successful. t EMERGENCY! CALL AN AMBULANCE YES Pyloric stenosis Pyloric stenosis is an uncommon disorder that occurs in babies under 2 months and is more common in boys. If whooping cough is diagnosed. a viral infection affecting the small airways in the lungs. then on the second day give feeds that are half rehydrating solution half milk. where his or her blood oxygen levels can be measured (p. and call your doctor. If your baby is breast-fed. follow the advice for preventing gastroenteritis (opposite). POSSIBLE CAUSE AND ACTION In babies. in which the intestine telescopes in on itself. where he or she can be fully examined and an exact diagnosis made. at any stage. To prevent future attacks. If your baby is bottle-fed. causing an obstruction. If bronchiolitis is diagnosed. follow the advice on coping with travel sickness (p. Because the stomach cannot empty into the intestine. Is your baby’s vomit yellowish. 57 . the ring of muscle forming the outlet from the stomach into the small intestine becomes narrowed and thickened due to overgrowth of the muscle tissue. diarrhoea recurs. treatment may include bronchodilator drugs and oxygen. some babies are particularly susceptible. Although uncommon in children under the age of 1 year. If. ACTION Your doctor will check whether your baby is dehydrated and will give you advice on preventing dehydration in babies (p. temporary lactose intolerance (p. For self-help measures. The baby should be able to resume normal feeding within 2–3 days and have no permanent ill effects. you should gradually reduce the amount of rehydrating solution given as he or she gets better. a baby may also develop a fever. Gradually return to normal feeding over the next 24 hours. an infectious disease that causes bouts of severe coughing. AN ISOLATED ATTACK OF VOMITING IS UNLIKELY TO BE A SIGN OF A SERIOUS PROBLEM IN AN OTHERWISE WELL BABY. The cause is unknown. giving rehydrating solutions will prevent dehydration (p. The condition may run in families.119). and enthusiastic playing may cause vomiting. In the meantime. or whooping cough (pertussis). the baby will lose weight and develop potentially life-threatening dehydration.59) and aid recovery. an infection of the digestive system. CALL YOUR DOCTOR. is the most likely cause of these symptoms.

For children over 1 year.122). Such intolerance usually develops in the first year of life. If the symptoms clear up. which is found in most formula milk. Call your doctor before the next dose of the drug is due to ask if you should stop giving it to your baby.57). He or she will probably recommend excluding all cows’ milk products from your baby’s diet for a trial period of 2 weeks. In babies. Your doctor may also give you advice on preventing dehydration in babies (opposite) and treating gastroenteritis in babies (p. inflammation of the digestive tract. ACTION If you are taking over-the-counter drugs. WA R N I N G DANGER SIGNS Call an ambulance if your baby’s diarrhoea is accompanied by any of the following symptoms: • Abnormal drowsiness • Sunken eyes and/or dry tongue • Black or bloodstained faeces • Has refused feeds for more than 3 hours (babies under 3 months) or more than 6 hours (babies 3 months and over) If your baby is bottlefed. Cows’ milk protein intolerance Some children cannot tolerate cows’ milk protein. If you suspect that your baby’s diarrhoea may be due to your diet. which your doctor will prescribe. avoid spicy foods. Do not stop taking them unless advised to do so by your doctor. If you are on prescribed drugs. ACTION Your doctor will examine your baby and check whether he or she is dehydrated. If your baby does have diarrhoea. cows’ milk can be gradually reintroduced into the diet. stop. a small amount of cows’ milk may then be reintroduced under medical supervision.CHILDREN: BABIES UNDER ONE 5 CHILDREN Diarrhoea in babies faeces up to 6 times a day. To prevent future attacks. follow the advice for preventing gastroenteritis (p. Have you recently introduced fruit juice into your baby’s diet or increased the amount of fruit juice you give to your baby? NO YES ACTION Always dilute orange juice for babies. and have you recently started taking any prescribed or over-thecounter drugs or eaten unusually spicy foods? NO YES POSSIBLE CAUSES Your baby’s diarrhoea may be due to your drugs or the spicy food passing into your breast milk and affecting your baby. ACTION Always follow the manufacturer’s instructions exactly when making up your baby’s feeds. and results in diarrhoea and vomiting. have you added sugar to the feeds? NO YES POSSIBLE CAUSE An inability to digest sugar may be the cause of the problem. Is your baby taking any YES prescribed drugs? NO POSSIBLE CAUSE AND ACTION Drugs. such as antibiotics. give him or her plenty of fluids to prevent dehydration (see PREVENTING DEHYDRATION IN BABIES. opposite). POSSIBLE CAUSE The natural sugars in fruit juice can cause diarrhoea in babies. consult your doctor. and never add sugar. Sugary drinks and foods do not contribute to your baby’s nutrition and are best avoided because they can lead to tooth decay. can cause diarrhoea. and this situation should not be mistaken for diarrhoea. making sure that you follow the instructions on the label. The condition usually disappears by the age of 3 years. most often due to a viral infection. between a week and several months after starting on the milk. A child who does have cows’ milk protein intolerance needs a diet free of cows’ milk products and should be supervised by a dietitian. follow the advice on preventing dehydration in babies (opposite). It is normal for a breast-fed baby to pass soft START HERE Does your baby have any of the following? • Fever • Reluctance to feed • Vomiting NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Gastroenteritis. If you suspect your child has the condition. Are you breast-feeding. Your child will be tested again for the condition every 3 months. Continued on next page 58 . excessive sugar has a laxative effect that can cause diarrhoea. such as one made with soya. Diarrhoea is the frequent passing of abnormally loose or watery faeces. or use drinks designed for babies. consult your doctor to see if the drugs could be affecting your baby. The diagnosis is confirmed if the symptoms recur. is the most likely cause of diarrhoea accompanied by any of these symptoms. see chart 40. If the intolerance has disappeared.56). Children under 1 year will require an alternative formula milk. Until the diarrhoea clears up. DIARRHOEA IN (p.

such faeces may result from a gastrointestinal infection. the faeces change to a greenish-brown colour. The cause may be either a food intolerance. and there may be visible mucus. While your baby still has symptoms. and has it persisted since returning home? NO YES POSSIBLE CAUSE AND ACTION A sudden change in your baby’s diet can cause temporary diarrhoea. or a disorder such as cystic fibrosis. such as cows’ milk protein intolerance (opposite). vomiting. Bottle-fed babies pass bulkier and more substantial faeces than breast-fed babies. you should consult your health visitor for advice. see your doctor within 24 hours. Within a day or two. POSSIBLE CAUSE AND ACTION Some babies normally produce very soft faeces but do not have diarrhoea (see BABIES’ FAECES. which is a sticky greenish-black substance consisting mainly of mucus and bile.CHILDREN: BABIES UNDER ONE Continued from previous page Babies’ faeces The first faeces that a baby passes are known as meconium. ACTION Go back to giving your baby rehydrating solutions while he or she has diarrhoea.26)? NO YES Has your baby’s diarrhoea lasted for more than 2 weeks? NO YES POSSIBLE CAUSES Your baby may not be absorbing food normally. Consult your doctor or health visitor if several foods appear to upset your baby’s digestion. If diarrhoea recurs again. For a breastfed baby. POSSIBLE CAUSE AND ACTION Your baby may have acquired an infection abroad. Consult your doctor. Most babies pass faeces several times a day. there is probably nothing wrong. rather like the faeces of an adult.57). Have you just started to reintroduce milk into your baby’s diet after a bout of gastroenteritis? NO YES Preventing dehydration in babies SELF-HELP Are your baby’s height and weight within the normal range for his or her age (see GROWTH CHARTS.oz 18 21 26 32 37 42 48 53 GIVE YOUR BABY PLENTY OF FLUIDS .oz) of cooled. Introduce new foods slowly. the diarrhoea can recur. Rehydrating solutions can be made up using powders bought over the counter or by dissolving 2 level teaspoons of sugar in 200 ml (7 fl. Your doctor will advise a lactose-free diet until your baby recovers. Then gradually reintroduce milk (see TREATING GASTROENTERITIS IN BABIES. Baby’s weight kg Under 4 4 5 6 7 8 9 lb Under 9 9 11 13 15 18 20 Over 22 Daily intake of rehydrating solution ml 500 600 750 900 1050 1200 1350 1500 fl. POSSIBLE CAUSE Temporary intolerance to lactose (p. They may smell of sour milk. p. 59 . p. Breast-fed babies can pass faeces very frequently. a potentially life-threatening condition in babies. like mustard. then settle to a regular colour. Green faeces are a sign that food has passed through the intestines very rapidly. boiled water. The faeces are usually light brown and smell strongly. As long as your baby seems well. Your baby may be referred to a specialist to establish the underlying cause. which is a natural sugar found in milk. above). see the table below for the total amount to give per day. Over 10 Daily intake of rehydrating solution Use this table to determine the appropriate total daily intake of rehydrating solution for your baby’s weight. It is therefore important to give your baby extra fluids before a breastfeed or instead of a bottle-feed if he or she has any of these conditions. or fever can cause dehydration. If milk is reintroduced into your baby’s diet too soon after an episode of gastroenteritis. or have you introduced new foods into his or her diet? NO YES Did the diarrhoea begin abroad. ACTION Your doctor will examine your baby and may arrange for his or her faeces to be tested for evidence of an infection. with only one new food each week. give him or her frequent feeds of rehydrating solution. Has your baby recently started on solid foods. and make sure that you mention your foreign travel. AND SEE YOUR DOCTOR WITHIN 24 HOURS . Diarrhoea. If you are not sure whether or not your baby’s faeces are normal. Consult your doctor. but in a bottle-fed baby. is a possible cause of recurrent or persistent diarrhoea. although some can go for a few days without passing any.122). The faeces are very soft and usually orange-yellow. green faeces may be normal.

63). • Feed expressed milk not formula. Does your baby cry soon after starting to suck? NO YES POSSIBLE CAUSES Frequent feeding is normal in breast-fed babies under 2 months old. and gaining weight at the expected rate. ACTION If you are getting tired from disturbed nights and your baby is not ready for weaning.116). However. If you think your baby may need weaning. your doctor may advise you to clean your baby’s nostrils.CHILDREN: BABIES UNDER ONE 6 Feeding problems hungry crying. or ask your health visitor for advice. which may help him or her to breathe while feeding. Make sure that you are not distracted. • Ask someone else to offer the bottle when you are not in the room. he or she may need to be weaned. alert. or is over 3 months old and has refused feeds for more than 6 hours. He or she will treat any underlying cause and may advise you on feeding your baby. If a cold is the problem. YES ACTION Your doctor will examine your baby and may arrange for tests to look for any cause of your baby’s feeding problem. ACTION Your doctor will examine your baby to exclude an underlying illness. or try a differently shaped teat. in which milk is not immediately released when your baby starts to suck. use expressed milk. below). Call your doctor immediately if your baby is under 3 months old and has refused feeds for more than 3 hours. Is your baby feeding more frequently than you think is normal? Is your baby mainly breast-fed? NO NO YES POSSIBLE CAUSES A number of different underlying illnesses may cause a continuing reluctance to feed and poor weight gain. column 2 SELF-HELP Bottle-feeding a breast-fed baby Bottle-feeding a baby It may be easier to get your baby to take a bottle if someone else offers it. However. Consult your doctor. Young babies who refuse to feed may become dehydrated. For children over 1. EATING PROBLEMS (p. especially if he or she is several weeks old and has never had a bottle or a dummy. The following suggestions may help: • Try offering the bottle while walking around the room with your baby. Continued on next page. like some adults. not formula. • Try a silicone teat instead of rubber.26)? NO YES POSSIBLE CAUSE AND ACTION Some babies. constant START HERE Is your baby reluctant to take feeds? NO YES Does your baby normally feed well? NO YES POSSIBLE CAUSES Reluctance to feed is most often due to a minor illness. see chart 37. ACTION Try to relax while breast-feeding. If possible. Is your baby gaining weight at the expected rate (see GROWTH CHARTS. POSSIBLE CAUSE A delayed “let down” reflex. p. It is often difficult to get a breast-fed baby to take a bottle. and swallowing too much air. it may also be caused by a more serious illness. if it persists. such as in public places. Providing that your baby is happy. This chart deals with most of the common problems that may arise. try expressing milk so that someone else can give your baby a bottle (see BOTTLE-FEEDING A BREAST-FED BABY. there is no cause for you to be concerned. Such problems may include a reluctance to feed. 60 . eat less than others. column 1 Continued on next page. if your baby is 4 months old or more. and avoid feeding your baby in circumstances that make you feel uncomfortable. leading to regurgitation. introduce small amounts of solids once a day (see WEANING YOUR BABY. There may also be special problems for mothers who are breast-feeding. p. Stimulating the nipple just before your baby latches on may also help. may be the cause. Feeding problems are a common source of irritability and crying in young babies as well as concern in their parents. such as a cold.

column 1 Continued from previous page. POSSIBLE CAUSES Your baby may dislike the new texture or taste of the food. Try it again at a later date. column 2 Does your baby cough at the start of the feed or pull away from the breast? NO YES POSSIBLE CAUSE The initial rush of milk from the breast that occurs when your baby starts to feed may be causing him or her to choke. If your baby refuses to eat one particular food. This is normal and not a cause for concern.53).63). spending more time sitting in a baby chair may help. and this is not a cause for concern. try using a different teat. preferably at breakfast time when your baby is less likely to be tired. may be the cause. Does your baby refuse to take a bottle? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Does your baby cry and YES vomit after a feed? NO POSSIBLE CAUSE The hole in the teat may be the wrong size for your baby. If this does not seem to help. If your baby is old enough. in which the stomach contents leak back into the oesophagus. spending more time sitting in a baby chair may help. Have you given your baby a new food recently? NO YES POSSIBLE CAUSE Babies are often not keen to move on to solid food. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. If your baby still refuses a bottle. However. You may be advised to put your baby to sleep on his or her side with the head raised. Most babies grow out of this condition by the age of 1. causing milk to be released too quickly or too slowly. consult your health visitor. if the symptoms only occur occasionally. Make sure the food is smooth and not too thick. they may be due to wind (see DEALING WITH WIND. ACTION Initially. SEE YOUR DOCTOR WITHIN 24 HOURS Is your baby mainly bottle-fed? NO Does your baby cry and YES vomit after a feed? YES NO POSSIBLE CAUSE Gastro-oesophageal reflux. If your baby is old enough. ACTION Check the flow of milk through the hole in the teat. p. stop offering it to him or her.53). He or she may also be less willing to eat something new if he or she is tired. ACTION Stop giving your baby the new food for a while. Most babies grow out of this condition by the age of 1. ACTION Try to vary your baby’s diet. and gradually introduce a wider variety of tastes and textures. This is particularly likely to occur during the first feed in the morning after there has been a long gap between feeds. in which the stomach contents leak back into the oesophagus. Have you recently started your baby on solids? NO Does your baby cough or cry at the start of the feed? YES NO POSSIBLE CAUSE Breast-fed babies are often very reluctant to take a bottle unless it is introduced at an early stage. YES ACTION Follow the self-help advice for bottlefeeding a breast-fed baby (opposite). 61 . consult your doctor or health visitor. However. POSSIBLE CAUSE It is not uncommon for older babies to suddenly take a dislike to a food they previously ate happily. ACTION Your doctor will examine your baby to exclude other causes. You may be advised to put your baby to sleep on his or her side with the head higher than the feet. p. ACTION Your doctor will examine your baby. they may be due to wind (see DEALING WITH WIND. If the flows seems too quick or too slow.CHILDREN: BABIES UNDER ONE Continued from previous page. try using a feeder cup. if you are concerned. p. ACTION Try expressing a little milk before starting to feed your baby. Gradually provide a wider variety of tastes (see WEANING YOUR BABY. may be the cause. try giving your baby small amounts of solid food once a day. and reintroduce it at a later date. Your doctor may also suggest a drug that increases the muscular activity of the oesophagus. as will thickening his or her feeds with cornflour or carob-seed powder. if the symptoms only occur occasionally. Your doctor may also suggest a drug that increases the muscular activity of the oesophagus. However. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Gastro-oesophageal reflux.

babies benefit from supplements of vitamins A. consult your health visitor. consider weaning your baby (opposite). Your baby will be weighed and measured regularly at your local baby START HERE Does your YES baby seem unwell – for example. ACTION Try feeding your baby whenever he or she cries. carbohydrate. C. even if that means sometimes offering a feed when he or she is not hungry. If your baby still seems hungry. growth is faster than at any other time and key body systems such as the nervous system are developing rapidly. p. your baby should start to gain weight again. 13 g 14 g 4g 4g 4g 4 mg 8 mg 9 mg 1200 cal. below). Your health visitor will be able to advise you. Many babies. is he or she slow to feed or does he or she seem lethargic or irritable? NO POSSIBLE CAUSE AND ACTION Slow weight gain may be a symptom of an underlying illness. ACTION Increase your calorie intake. and his or her growth will be plotted on growth charts (see GROWTH CHARTS. Do not attempt to diet while you are breast-feeding. If your baby does not start putting on weight normally within 2 weeks. consult your health visitor. he or she may be ready to be weaned. who will examine your baby and may arrange for tests to determine the diagnosis and appropriate treatment. In the first year of life.26) so that any problems can be detected early. opposite).CHILDREN: BABIES UNDER ONE 7 Slow weight gain clinic. Many babies. ACTION Try feeding your baby whenever he or she cries. column 1 Continued on next page. who may suggest feeding your baby more often in order to stimulate your milk supply. column 2 Nutritional requirements of babies Babies need a diet relatively high in energy (calories). and offer both breasts each time. Do you feed your baby at set intervals? NO YES POSSIBLE CAUSE You need to eat more than you did before you were pregnant to make sure that your baby gets enough nourishment. A vegan diet without supplements is not nutritionally complete for a baby. Protein 13 g Fat 4g Iron 2 mg POSSIBLE CAUSE Your baby may need feeding more often than you realize and may not be getting enough nourishment. and low in salt. If your baby does not start to gain weight normally. Consult this chart if you are worried that your baby is gaining weight too slowly. After this. If your baby is over 4 months old. especially young ones. If your baby is not putting on weight normally within 2 weeks. nutrition is particularly important at this time (see NUTRITIONAL REQUIREMENTS OF BABIES. ACTION Make sure you are eating well. and D. and this is not usually a cause for concern. Is your baby mainly breast-fed? NO YES Are you dieting or not eating well? NO YES Is your baby mainly bottle-fed? NO YES Do you feed your baby at set intervals? NO YES POSSIBLE CAUSES You may not be producing enough milk to satisfy your baby. 3–6 6–9 9–12 700 cal. low in fibre. If you are vegetarian. feed irregularly. For this reason. and calcium. POSSIBLE CAUSE Your baby may need feeding more often than you realize and may not be getting enough nourishment. feed irregularly. It should contain enough protein for growth and carbohydrate for energy. 20 g 62 . You should eat 500–600 calories a day more than before you were pregnant. Consult your doctor. Once better. you can bring your baby up on the same type of diet as yourself but need to be careful to include sufficient iron. especially young ones. if your baby is over 4 months. For children over 1. From 4 weeks of age. Alternatively. consult your health visitor. see chart 12. This is most conveniently achieved by using vitamin drops available from baby clinics. Most babies lose some weight in their first week of life (see WEIGHT LOSS IN THE NEWBORN.72). Age in months Approximate daily requirements Energy Up to 3 530 cal. 800 cal. GROWTH PROBLEMS (p. even if that means sometimes offering a feed when he or she is not hungry. babies should put on weight at a steady rate. Try to eat an extra small meal a day or snack on foods that contain plenty of protein. consider bottle-feeding to supplement your baby’s feeds. and rest as much as possible. high in fat. Continued on next page.

his or her appetite will increase.CHILDREN: BABIES UNDER ONE SELF-HELP Weaning your baby Eating from a spoon As part of the weaning process. such as bananas. You can also offer finger foods. Age 4–6 months By the time your baby is 4–6 months. Do not give eggs. If your baby is over 4 months. Most babies start to gain weight by the 5th day and are usually back to their birth weight by about 10 days after delivery. introduce your baby to the idea of taking food from a spoon. Once your baby has regained his or her birth weight. POSSIBLE CAUSE As your baby grows. vegetables. column 2 POSSIBLE CAUSE If there is too little powder or too much water in the feed. If your baby does not start putting on weight normally within 2 weeks or if you have trouble getting him or her to take solid food. he or she may be ready to start on solids (see WEANING YOUR BABY. and he or she may need more food than you are now offering. Do not give cows’ milk. If you think that your baby is thirsty. boiled water. Your baby can now have the same diet as the rest of the family. and offer food or milk whenever your baby seems hungry. including eggs (as long as they are hard-boiled). Does your baby always finish all the feed in the bottle? NO YES Weight loss in the newborn Your baby may lose weight in the first week of life. a baby should have roughly doubled his or her birth weight. column 1 Continued from previous page. ACTION Offer your baby milk in addition to solid foods (see WEANING YOUR BABY. or fatty foods until your baby is at least 6 months old. POSSIBLE CAUSE It is very difficult for newly weaned babies to get sufficient nourishment from solid food alone. or bits of hard cheese. citrus fruits. If your baby does not start to gain weight normally or if you need further advice on weaning. Start by introducing your baby to puréed fruit or vegetables and baby rice. cubes of apple.or breastfeeding since weaning your baby? NO Could the feed be made up incorrectly? YES NO YES ACTION Always follow the manufacturer’s instructions exactly when mixing feeds. above). If your baby does not start putting on weight normally within 2 weeks. 63 . or foods containing nuts until he or she is at least 12 months. ACTION Follow the advice for weaning your baby (above). and rice. He or she may need more nourishment. particularly if they are breast-fed. this is unlikely to be a cause for concern. Gradually introduce other foods and textures. such as peas and chopped carrots. however. and let your baby feed until he or she is satisfied. Never add extra powder to your baby’s feeds. but do not add salt or sugar when preparing it. including fruit. may lose up to 200 g (7 oz) in the first few days after delivery. If your baby does not start putting on weight normally within 2 weeks or if you are not sure what foods he or she should have. rather than have it supplied through the placenta. but avoid salt and sugar. You can now give mashed or minced food. such as toast. Your baby will probably be weighed by the midwife or health visitor about three times a week for the first 2 weeks. above). Have you continued bottle. your baby should gain approximately 170 g (6 oz) a week. Introduce more variety into the diet. For the first 3 months. he or she should continue to put on weight at a steady rate. consult your health visitor. By about 6 months. and provide food that contains small pieces. and absorb their food. consult your health visitor. Your own food can be sieved or puréed. milk feeds are still essential. Try giving him or her a taste after a milk feed. digest. rather than semi-skimmed. ACTION Offer more milk than usual. even if you are giving the recommended amount for your baby’s age. Suggested weaning programme Offer your baby yoghurt and puréed foods. consult your health visitor. pulses. Most babies. newborn babies need to adjust to life outside the uterus and now have to take in. fish. milk. POSSIBLE CAUSE Check that you are giving your baby the right foods for his or her age. honey. and chicken. and give him or her fullcream. give him or her cooled. wheat-based foods. your baby will not be receiving enough nourishment. In addition. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. This weight loss is normal and is partly due to the relatively small amount of food they take in initially. Weaning is the gradual transfer from a milk-only diet to solid foods. and continue to offer feeds as normal. consult your health visitor. such as wheat cereals. he or she should be ready to be weaned. 6–9 months 9–12 months Over 12 months Continued from previous page.

Usually. especially if your baby seems unwell. The skin of newborn babies is very sensitive and can easily become irritated from rubbing on clothes or bedding. Does your baby have an inflamed. Birthmarks may alarm parents. A strawberry mark does not usually develop until later in the first month of life but is still considered to be a birthmark (see BIRTHMARKS. Other rashes and skin abnormalities that occur for no apparent reason or that persist longer than a few days should be brought to your doctor’s attention. One START HERE Does your baby have a rash of dark red spots that do not fade on pressure (p. harmless disorder that affects greasy areas of skin. They will not fade but may be improved by laser treatment. is a possible cause. If the condition fails to clear up or if you are concerned. may be the cause of this type of rash in a baby who is unwell. They often grow rapidly during the first months of life. which can be treated easily. YES POSSIBLE CAUSE Seborrhoeic dermatitis. baby lotion. can be used to clean and moisturize your baby’s skin. red or purple marks can be found anywhere on the body. a diagnosis is made before the newborn baby is discharged from hospital. available from pharmacists. t EMERGENCY! CALL AN AMBULANCE Was the skin problem present at birth or very soon after? NO YES Does your baby have a birthmark? NO YES POSSIBLE CAUSE AND ACTION In some rare cases. Some birthmarks disappear or become less noticeable in time. Stork marks Stork marks are flat. raised marks can occur anywhere on a baby’s body. you will have been given advice on what to expect. Mongolian blue spots These bruise-like marks sometimes appear on the back and buttocks of dark-skinned babies and disappear before the second birthday. If the rash does not improve within a week or if you are still concerned.CHILDREN: BABIES UNDER ONE 8 Skin problems in babies of the most common skin problems in babies is nappy rash. and. although some birthmarks remain for life. Continued on next page 64 . ACTION If meningitis is suspected. and usually disappear without scarring by the age of 8. pink patches on the face and back of the neck. right).78). opposite). Avoid using soap. They usually fade in the first few months or are covered by the hair. flaking rash in two or more of the following places? • Neck • Behind the ears • Face • Groin • Armpits NO POSSIBLE CAUSE AND ACTION Many babies are born with one or more birthmarks. consult your doctor as soon as possible because early treatment can prevent it growing and interfering with your baby’s vision or feeding. consult your doctor. consult your doctor. see chart 15. or a babybath solution. consult your doctor. Birthmarks Most babies have a few moles or pigmented marks. Port wine stains These flat. If not. but most are harmless. your baby will be admitted to hospital immediately. these fade or disappear completely within the first few months or years. treated with laser surgery. If your child has a strawberry mark near an eye or a lip. an emollient lotion. In some cases. He or she will be given urgent treatment with antibiotics and may need intensive care. RASH WITH FEVER (p. ACTION Pay special attention to washing and drying the folds of skin in the affected areas. in these situations.79)? NO YES Are all areas of the body affected? NO YES POSSIBLE CAUSE Meningitis. Such minor skin problems are usually no cause for concern. a generalized skin condition due to a genetic abnormality may be the cause. a common. POSSIBLE CAUSE AND ACTION Most newborn babies have harmless skin irritations that usually clear up by themselves within the first month of life (see NEWBORN SKIN. but then start to shrink in the second year. who may prescribe a mild corticosteroid cream. Instead. Marks that do not clear up can be hidden with cosmetics or. inflammation of the membranes surrounding the brain due to infection. If your baby has a rash with a temperature. in some cases. Strawberry marks These bright red.

YES ACTION If the diagnosis is confirmed. which affects most babies at some time. If the rash does not clear up within a few days or if it becomes worse. There are several harmless skin problems that commonly affect babies. and avoid using biological detergents. No treatment is needed. ACTION You can soften the crusts by rubbing your baby’s scalp with baby or olive oil at night and then washing off the crusts the next morning. often on the face and chest. Consult your doctor. Some babies seem more susceptible than others. a form of seborrhoeic dermatitis. SELF-HELP Nappy rash • Change your baby’s nappy often. Water is usually sufficient for cleansing the nappy area. The spots clear up without treatment within the first couple of weeks. dry it carefully. Does your baby have yellowish-brown crusts on the scalp? NO YES Does your baby have a red. • Apply a water-repellent cream such as zinc and castor oil or petroleum jelly. consult your doctor. Consult your doctor. • Urticaria – a rash of spots with a white centre and red halo. • Make sure that you dry the creases in your baby’s skin thoroughly. He or she may also prescribe a corticosteroid cream. • Heat rash – small red spots. Has your baby got an inflamed area of skin on his or her bottom with or without spots spreading from it? NO YES Is the skin broken or ulcerated? NO YES POSSIBLE CAUSE AND ACTION Your baby may have nappy rash that has become infected. It is particularly common after diarrhoea but can also develop if the skin becomes irritated from wearing a wet or soiled nappy for a long time. or behind the knees? NO POSSIBLE CAUSE Your child may have atopic eczema. These include: • Blotchy skin partly due to blood vessels being visible because there is little fat below the skin and partly because circulation is not mature. Are there several red spots outside the main area of the rash? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A skin infection with the fungus that causes thrush is a possibility. Nappy rash affects most babies at some time. consult your doctor. Newborn skin A newborn baby’s skin is very delicate and easily irritated. • Milia – white spots on the nose and cheeks caused by blocked sebaceous glands in the skin. an allergic condition. 65 . your doctor will advise you on dealing with atopic eczema (p. follow the advice on treating nappy rash (below). inside the elbows. or ulcerated or if it does not clear up within a few days. Do not use soap or wipes to clean your baby until he or she is at least 6 weeks old because these can dry the skin. weepy. If the rash is widespread or weepy. • If you use cloth nappies. and a few drops of baby oil in the bath water will help avoid dry skin. harmless condition. the condition usually clears up by itself within a few weeks. ACTION Follow the advice on treating nappy rash (left). ACTION Your doctor will probably prescribe an antifungal cream and will possibly also prescribe a corticosteroid cream. • Wash the baby’s nappy area with water. who may prescribe a corticosteroid cream to reduce the inflammation. particularly when they have diarrhoea. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.80). It may accompany nappy rash and oral thrush.CHILDREN: BABIES UNDER ONE Continued from previous page POSSIBLE CAUSE Your baby may have cradle cap. This diagnosis is most likely if any other family members also suffer from eczema or other allergic conditions. Gently rub emollient lotion into the affected areas. You can help clear up your baby’s nappy rash by following these steps: • Leave your baby to play without wearing a nappy as often as possible – preferably at least once a day. Alternatively. Make sure that your baby is not too warm. POSSIBLE CAUSE Your baby probably has nappy rash. and avoid scented wipes. special shampoos to treat the condition are available over the counter. Many children with atopic eczema grow out of it by the age of 8. Consult your doctor if the rash becomes blistery. itchy rash on the face. who may prescribe an anti-infective cream or a corticosteroid cream. make sure they are thoroughly rinsed. • Peeling or flaking skin on the hands and feet. resulting in uneven blood flow. It is a common. However. In the meantime. If it does not or if you are concerned. your child should see the doctor within 24 hours. which clears up quickly without treatment.

TIREDNESS (p.76) Go to chart 15 RASH WITH FEVER (p. If the diagnosis is confirmed.78) Has your child been vomiting and/or had diarrhoea? NO YES POSSIBLE CAUSES Abdominal pain may occur in a child for a variety of reasons.68). Go to chart 39 ABDOMINAL PAIN (p.56) 5 DIARRHOEA IN BABIES (p. may be needed to look for any associated problems. such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. further tests. It may be the result of an infection such as gastroenteritis. YES Does your child have two or more of the following symptoms? • Unexplained weight loss • Increased thirst • Passing more urine than usual • Excessive tiredness NO Go to chart or chart 4 VOMITING IN BABIES (p. you may suspect that your child is unwell if he or she seems quieter or more irritable than usual. Continued on next page 66 . In some cases.127). Your doctor will also advise you on your child’s diet and lifestyle (see DIABETES MELLITUS. For unusual or excessive tiredness in a child. At other START HERE Is your child’s temperature 38°C (100°F) or above? NO YES Does your child have a rash? NO YES WA R N I N G DANGER SIGNS Call an ambulance if your child has any of the following symptoms: • Abnormal drowsiness • Blue-tinged lips or tongue • Flat. A child may sometimes complain of feeling unwell without giving you a clear idea of what exactly the matter is.58) or chart 38 VOMITING IN CHILDREN (p. and your child will be prescribed antibiotics. Use this chart to look for specific signs of illness.126).54) POSSIBLE CAUSE Your child may have an infectious disease. Such signs may lead you to a more specific chart within this book or to consult a doctor. ACTION Your doctor will test a sample of your child’s urine. p.118) YES or chart 40 DIARRHOEA IN CHILDREN (p. ACTION Your doctor will take blood and urine samples to check your child’s blood sugar level. dark red spots that do not fade on pressure (see CHECKING A RED RASH. p. This condition is caused by insufficient production of the hormone insulin.79) • A seizure lasting longer than 5 minutes • Reluctance to bend the head forward • A severe headache with a fever POSSIBLE CAUSE A raised temperature in a baby or a child is often one of the first signs of an infection. p. He or she will be taught how to inject the insulin and monitor his or her blood sugar level.CHILDREN: ALL AGES 9 Feeling generally unwell times. see chart 10. Go to chart 3 FEVER IN BABIES (p. such as measles. a urine sample will be sent for analysis.149).122) Does your child have any of the following? • Pain on passing urine • Frequent passing of YES urine • Bedwetting or daytime wetting after being dry • Offensive-smelling or cloudy urine NO SEE YOUR DOCTOR WITHIN 24 HOURS SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have a urinary tract infection (p. POSSIBLE CAUSE These symptoms may be due to diabetes mellitus. your child will probably need insulin injections for life. or chart 14 FEVER IN CHILDREN (p. which is needed by the body to get energy from sugar and carbohydrate foods.120) Does your child complain of stomach ache or cry and draw up his or her legs? NO POSSIBLE CAUSE A digestive upset is the most likely cause of these symptoms. If the diagnosis is confirmed.

Your child may be referred to a specialist. or is another child in the house ill? NO YES POSSIBLE CAUSE Some children are easily unsettled by changes around them. consult your doctor. contact your doctor immediately. If he or she is under 3 months and has refused feeds for 3 hours or is under 12 months and has refused to drink for 6 hours. Many children express anxiety by behaving in different ways than they normally do. You should also talk to his or her teachers to see if there is a problem you are not aware of. Some children find it hard to express feelings and may seem unwell instead. If your child is still feeling unwell after 48 hours and there is no obvious cause. They may express this by changes in behaviour or feeling unwell. and there is no obvious cause. • Let your child help prepare drinks or ice lollies. such as a house move. • Offer small drinks frequently. consult your doctor. Has your child been feeling unwell for several weeks or more? NO YES Are your child’s height and weight within the normal range for his or her age (see GROWTH CHARTS. ACTION Do not worry about your child’s refusal to eat as long as he or she is drinking plenty (see ENCOURAGING YOUR CHILD TO DRINK. POSSIBLE CAUSE AND ACTION Your child may be unhappy or worried rather than physically ill. ACTION If your child develops any other symptoms. refusing to drink can lead to dehydration. or ”grownup” cups to add interest. Does your child seem to be better at weekends? NO YES POSSIBLE CAUSE Your child may be in the very early stages of a childhood infectious disease. above). Take time to talk to your child. it is better to concentrate on encouraging him or her to drink rather than worrying about a poor appetite. your child may be anxious about the other child but also jealous of the extra attention given to him or her. ACTION Talk to your child to find out what the problem is. The following measures may encourage your child to drink: • Offer him or her interesting drinks. including treats such as sweets that would normally be appealing? NO YES If your child is unwell. rather than plain water. If your child still feels unwell. Has there been a recent domestic upset. An illness in another child in the family may cause conflicting feelings. POSSIBLE CAUSE A refusal to eat is common in a child who is unwell for any reason. who may arrange for tests to look for an underlying cause and determine the appropriate treatment. bright or unusual cups. consult your doctor. such as chickenpox. such as a story. However. Consult your doctor. such as a urinary tract infection. consult your doctor. if your child is still not eating after 48 hours. • Offer him or her ice lollies or ice cubes to suck. if necessary. who may refer him or her to a specialist. such as bullying.CHILDREN: ALL AGES Continued from previous page SELF-HELP Encouraging your child to drink Eating ice lollies If your child is reluctant to drink. Your doctor will examine your child to establish the cause. NO 67 . such as exams. Encourage your child to drink (above). • Use straws. consult your doctor. such as fruit-flavoured squashes. offer him or her an alternative such as a flavoured ice lolly instead. If your child continues to complain of feeling unwell. However. Has your child been in contact with an infectious illness within the past 2–3 weeks? NO Is your child also refusing to drink? NO YES YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION A sore mouth or throat is likely. It is common for children who are coming down with an infectious disease to feel unwell and listless for 2 or 3 days before any specific symptoms develop. p.26)? CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR CHILD IS NO BETTER IN 48 HOURS . and. consult the relevant chart in this book. Is your child refusing all food. YES POSSIBLE CAUSE AND ACTION Your child may have an underlying disorder. POSSIBLE CAUSE Your child may be anxious about something at school. Encourage your child to drink before an activity. Extra reassurance may help. ACTION Talk to your child to find out what the problem is.

there may be an underlying medical problem.62) 7 SLOW For children 1 year or over. and has it lasted more than 3 weeks? NO Continued on next page POSSIBLE CAUSE AND ACTION It is normal for a child to feel “washed out” for a week or two after a severe infectious illness. ACTION Your doctor will arrange for a blood test to confirm the diagnosis. in which there is too little of the oxygencarrying pigment haemoglobin in the blood. such tiredness is short-lived and may be the result of a recent infection. Is your child failing to grow or gain weight normally (see GROWTH CHARTS. In many cases. go to chart WEIGHT GAIN (p. Try exercising together by going swimming or playing games. ACTION Your doctor will take a blood sample to check your child’s blood sugar level.72) Has your child recently had a viral illness. For unusual drowsiness. see chart 22. Your child may be referred to a specialist.CHILDREN: ALL AGES 10 DROWSINESS Tiredness seems tired most of time or tiredness is preventing him or her from taking part in social activities or keeping up at school. which is needed by the body to get energy from sugar and carbohydrates. You should discuss the situation with your child’s teachers. He or she will be taught how to inject the insulin and monitor his or her blood sugar level. opposite). SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have anaemia.26)? NO YES For babies. Consult your doctor.149). If there is still no improvement after 1 month. In children. Make sure that he or she is getting enough rest. consult your doctor. Does your child have two or more of the following symptoms? • Unexplained weight loss • Increased thirst • Passing more urine than usual • Excessive tiredness NO YES Does your child have one or more of the following symptoms? • Shortness of breath YES on exercise • Paler than normal skin • Episodes of feeling faint NO POSSIBLE CAUSE Your child may have chronic fatigue syndrome. 68 . In some cases.90). ACTION Your doctor will examine your child and may arrange for tests to rule out other illnesses. your doctor will probably prescribe an iron supplement and advise you on your child’s diet (see IRONDEFICIENCY ANAEMIA. It is normal for a child to be tired if he or she has slept badly the night before or had a particularly long or energetic day. you should consult your doctor to rule out a more serious problem. anaemia is often due to a lack of iron in the diet. it is normal for some children to prefer sitting quietly rather than running around. If you are still concerned about your child’s level of activity. POSSIBLE CAUSE A quiet child may appear to be tired if he or she is not very active. may be preceded by a viral illness. p. p. Your child should continue to go to school if at all possible so that his or her schoolwork and friendships are not disrupted. It is also common for children to need more sleep than normal during growth spurts and at puberty. who will suggest a programme to encourage your child to gradually increase his or her level of activity. such as glandular fever? NO YES Is the tiredness so severe that it stops your child YES from getting out of bed or going to school. However. that in some cases. go to chart 12 GROWTH PROBLEMS (p. a collection of symptoms including severe fatigue. If your child has iron-deficiency anaemia. If the diagnosis is confirmed. ACTION Make sure your child gets enough exercise. CONFUSION AND/OR (p. However. Your doctor will also advise you on your child’s diet and lifestyle (see DIABETES MELLITUS. If your child START HERE Has your child always seemed less active than other children of a similar age? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Diabetes mellitus is a possibility. consult your doctor. but not all. further tests will be necessary to determine why anaemia has developed. This condition is caused by insufficient production of the hormone insulin. your child will probably need insulin injections for life.

he or she may have enlarged tonsils or adenoids (p. Consult your doctor. if your child’s tiredness persists or becomes severe. consult your doctor.107). If he or she is old enough. ACTION The doctor will examine your child and prescribe appropriate treatment.50) YES or go to chart 11 SLEEPING PROBLEMS (p. Offer your child plenty of iron-rich foods. Most children adjust to increased levels of activity at school within a term. Ask your doctor for advice. ACTION Your doctor will examine your child’s throat. If your child is already receiving treatment for a condition such as asthma or eczema. Consult your doctor. can cause tiredness as a side effect. which may be blocking the airway during sleep. and be firm with your child (see GETTING YOUR CHILD TO SLEEP. However. Try to make green vegetables look attractive to encourage your child to eat them. such as some breakfast cereals. are fortified with iron and are useful if your child will not eat other iron-rich foods.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSE AND ACTION Certain drugs. your child should sleep better. POSSIBLE CAUSES Children often snore if they have a cold. POSSIBLE CAUSE It is likely that your child is overdoing things due to long days or pressure to take part in various activities. However. if your child snores all the time. Consult your doctor. such as antihistamines and anticonvulsants. Is your child taking any YES prescribed drugs? NO Does your child snore? NO YES Does your child sleep badly? NO YES Is your child’s sleep disturbed by symptoms such as a cough or itchy skin? NO YES POSSIBLE CAUSE Symptoms of conditions such as asthma or eczema that do not bother a child during the day can disturb his or her sleep.70) IN CHILDREN POSSIBLE CAUSE A lack of sleep is one of the most common causes of tiredness. Could your child be getting too little sleep because of going to bed late or rising early? NO Go to chart 1 SLEEPING PROBLEMS IN BABIES (p. Meanwhile. talk about any worries he or she may have. it may need to be adjusted. playing quietly. ACTION Talk to your child about dropping or rotating any optional activities. Do any of the YES following apply? • Your child is one of the youngest in his or her school year • Your child has recently started going to a play group or school • Your child has increased his or her after-school activities NO Iron-deficiency anaemia In children. Once the symptoms have been treated. Mild anxiety or depression can often be cleared up with extra reassurance and support. In some cases. Try to get your child to eat green vegetables and red meat. and this is nothing to worry about. persistent problems may be the result of a behavioural problem. p. iron-deficiency anaemia is usually caused by a lack of iron in the diet. ACTION Impose a regular bedtime routine. A child that is not eating solids by 6 months of age may need a formula milk with additional iron. Encourage him or her to spend more time at home. If your child is still not sleeping properly within a few weeks. Certain foods. your doctor may refer your child to a specialist. although this may be difficult. Surgical removal of the tonsils and adenoids may improve the situation. 69 .70). ACTION Try to discover and deal with any underlying worries that your child has. Difficulty in getting your child to sleep is usually temporary and caused by lack of a fixed bedtime routine or anxiety. make sure your child does not stop taking his or her prescribed drugs. However. Providing an iron-rich diet CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR CHILD ’ S TIREDNESS IS PERSISTENT OR SEVERE . consult your doctor. Has there been a recent upset at home or at school? NO YES POSSIBLE CAUSE Tiredness may be one sign of anxiety or depression as the result of a temporary upset.

ACTION Try to discover and deal with any worries that your child has. see chart 1. If your child wakes during the night. ACTION Try to stick to a regular bedtime routine. If your child is still not sleeping better after a few weeks of the new routine. However. SLEEPING PROBLEMS (p. Otherwise. CONSULT YOUR DOCTOR OR HEALTH VISITOR IF YOU ARE UNABLE TO IDENTIFY A CAUSE FOR YOUR CHILD ’ S SLEEPING PROBLEM FROM THIS CHART. Repeat this procedure until your child falls asleep.) Go into the room to make sure nothing is wrong. (A child who is only whimpering may drift back to sleep. and/or does he or she cry when YES you leave the room? NO Has this problem begun recently.50). Has your child always slept poorly since he or she was a baby? NO POSSIBLE CAUSE Difficulty in settling is often the result of anxiety over a temporary upset. consult your doctor or health visitor. Your child will probably settle more easily once the upset is over. including physical illness.CHILDREN: ALL AGES 11 IN BABIES Sleeping problems in children or performance at school. A number of factors. your child should sleep through the night. The amount of sleep a child needs at night varies from about 9 to 12 hours according to age and individual requirements (see SLEEP REQUIREMENTS IN CHILDHOOD. If your child is still not settling properly within a few weeks. POSSIBLE CAUSE AND ACTION Children vary widely in the amount of sleep they need (see SLEEPING REQUIREMENTS IN CHILDHOOD. A night-light or leaving the bedroom door open may help. refusal to go to sleep at what you think is a reasonable time and/or waking in the middle of the night can be disruptive and distressing for the family if it occurs regularly. Lack of sleep rarely affects health but may affect behaviour during the day START HERE Does your child seem to YES need less sleep than other children of a similar age? NO POSSIBLE CAUSE A problem sleeping that goes back to when your child was a baby may be due to lack of a bedtime routine. nightmares. the problem may be lack of a fixed bedtime routine. may cause such sleeping problems. consult your doctor or health visitor for advice. for example by locking all outer doors. However. such as a bath and then a story. Often. resisting the urge to stay. This problem can be solved by a night-light or leaving the bedroom door open. and leave the room. SELF-HELP Getting your child to sleep Reassure your child briefly and then leave again. There is no need to worry as long as you ensure that your child is safe. If your child’s sleeping patterns are causing you difficulties. If your child still cries. and has there YES been an upset at home or at school? NO POSSIBLE CAUSES Your child may be afraid of the dark or of being left alone. say goodnight. reassure your child. If your child cries. emotional upset. Has your child been waking during the night? YES NO Has this problem begun recently. Try to establish a regular pattern that is followed every night. and does your YES child seem unwell? NO Does your child sleepwalk sometimes? NO YES Continued on next page POSSIBLE CAUSE AND ACTION An unwell child is unlikely to sleep through the night. settle him or her. consult your doctor or health visitor. The time needed will shorten each day. there is unlikely to be anything wrong. If you have difficulty in getting your child to sleep. leave him or her for a few minutes before returning. POSSIBLE CAUSE AND ACTION Sleepwalking is most common between the ages of 6 and 12. consult your doctor. try the method above. If your child is not sleeping well. consult your doctor. Do not try to wake your child. only get up if he or she is truly crying. YES Is your child difficult to settle at night. A regular bedtime routine may also make your child feel more secure. and follow the other self-help advice for getting your child to sleep (below). Provide extra reassurance and support. He or she will eventually settle back to sleep. but guide him or her back to bed if necessary. if your child is still not sleeping better in a few weeks. Children usually grow out of it by age 12. If your child seems well. 70 . and lack of a regular bedtime routine. children do not sleep well because they are afraid of the dark. consult the relevant chart in this book. ACTION Reassure your child. opposite). and leave again. If your child has specific symptoms. right). For children under 1 year. Once better.

CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSE Symptoms of conditions such as asthma or eczema that do not bother a child during the day can disturb his or her sleep. Does your child share a bedroom with you or another child? NO YES POSSIBLE CAUSE Your child may be being disturbed by others in the room. children sleep less as they grow up. However. such as some used to treat asthma.126) YES Sleep requirements in childhood Children vary in the amount of sleep that they need. However. In some cases. Bad dreams are common in children aged 5–6 and may be triggered by a frightening experience or events on television or in stories. consult your doctor. from about half in a newborn to about a fifth in a teenager. he or she may be able to share a room again without waking up at night. The proportion of sleep spent dreaming also goes down. once one has started. the most common cause is drinking too many fluids. follow the self-help advice for getting your child to sleep (opposite). After a few weeks. Is your child’s sleep disturbed by symptoms such as a cough or itchy skin? NO Go to chart 43 URINARY PROBLEMS (p. do not stop giving your your child his or her prescribed drugs. Consult your doctor. POSSIBLE CAUSE AND ACTION Children are often ready to start their day earlier than their parents and may go through a phase of early waking. it may need to be adjusted. Meanwhile. place your child in a separate room to sleep so that he or she is able to sleep through the night without being disturbed. Consult your doctor. Age Up to 3 months Does your child wake several times a night to pass urine? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. If he or she has frequent night terrors. If your child is old enough. consult your doctor. it may help to talk about the dream. Night terrors are most common in 4–7 year olds. can cause disturbed sleep as a side effect. although he or she is actually asleep and will not remember the incident in the morning. you may wish to leave him or her to play quietly instead. ACTION Comfort your child until he or she manages to go back to sleep. Average total sleep per 24 hours 16 hours 14 hours 13 hours 12 hours 11 hours 101⁄2 hours 10 hours Is your child taking any prescribed drugs? NO 3–5 months YES 5–24 months 2–3 years Does your child seem to YES be having bad dreams? NO Is your child impossible to comfort at the time but has no memory of YES the event the following morning? NO 3–5 years 5–9 years 9–13 years Amount of sleep according to age This table shows the average number of hours of sleep needed by babies and children at different ages. Once the symptoms have been treated. a urinary tract infection. ACTION You may be able to prevent a night terror by waking your child in the restless period that often precedes it. You should only worry about your child’s sleeping if he or she seems unwell or if excessive sleepiness interferes with his or her activities. a condition in which a child seems to be awake and terrified. POSSIBLE CAUSE Your child is probably having night terrors. Does your child want to play on waking? NO YES POSSIBLE CAUSE Your child is probably having nightmares. POSSIBLE CAUSES Waking more than once or twice during the night to pass urine may be a sign of an underlying disorder – for example. If your child’s nightmares are persistent or frequent. ACTION If possible. CONSULT YOUR DOCTOR OR HEALTH VISITOR IF YOU ARE UNABLE TO IDENTIFY A CAUSE FOR YOUR CHILD ’ S SLEEPING PROBLEM FROM THIS CHART. Nightmares may be caused by anxiety. your child should sleep better. 71 . Night terrors usually occur about 2 hours after falling asleep. ACTION Your doctor will examine your child and prescribe appropriate treatment. In general. and it is normal for some children to sleep more than others of a similar age. there is little you can do except stay with your child. If you want your child to go back to sleep. Night terrors will become less frequent as your child grows older. If your child is already receiving treatment for a condition such as asthma or eczema.

Monitor your child’s growth. your child will need to go on to a gluten-free diet.26). If cystic fibrosis is diagnosed. This condition is caused by insufficient production of the hormone insulin. bulky stools that smell particularly unpleasant? NO YES POSSIBLE CAUSE An inability to absorb nutrients from food due to a disorder such as cystic fibrosis (opposite) or coeliac disease. and serious disorders affecting growth START HERE Are you YES mainly concerned about your child’s weight? NO Is your child’s weight above the normal range for his or her age (see GROWTH CHARTS. This is particularly likely if at least one parent is also slim. can interrupt normal growth. ACTION Your doctor will probably arrange for tests. For children under 1. Consult your doctor. ACTION Make sure that your child is eating a healthy. For weight problems in adolescents. Many parents worry that their child is too short or too thin.117).62). so as long as he or she seems happy and healthy. see chart 7. and/or has he or she lost weight? NO Does one or more of the following apply to your child? • Increased thirst • Passing more urine than usual • Excessive tiredness NO YES Has your child had a serious illness or infection recently? POSSIBLE CAUSE AND ACTION Your child’s weight is within the normal range. Continued on next page POSSIBLE CAUSE AND ACTION Your child may just be naturally thin.149). in which the intestine is damaged by a gluten allergy. Your doctor will also advise you on your child’s diet and lifestyle (see DIABETES MELLITUS. there is unlikely to be an underlying medical problem. others worry that their child or is too tall or has put on too much weight. particularly one in which your child is confined to bed for any length of time. or if your child fails to grow in height as much as expected.139).CHILDREN: ALL AGES 12 Growth problems are rare. If coeliac disease is diagnosed. Does your child have pale.116) Does your child have a poor appetite? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE These symptoms may be due to diabetes mellitus. Is your child’s YES weight below the normal range for his or her age (see GROWTH CHARTS. p. p. However. and consult your doctor if your child does not start to gain weight within 4 weeks. ACTION Your doctor will take a blood sample to check your child’s blood sugar level. Consult this chart if your child is losing weight or is gaining weight at a much slower rate than you would expect. p. 72 .26)? NO YES Go to chart 13 EXCESSIVE WEIGHT GAIN (p. p. which is needed by the body to obtain energy from sugar and carbohydrate foods. p. treatment will include drugs to aid digestion. If the diagnosis is confirmed. YES NO POSSIBLE CAUSE A serious illness or infection. and consult your doctor if your child seems unwell or if you continue to feel concerned. ADOLESCENT WEIGHT PROBLEMS (p. some children are naturally smaller or bigger than average. He or she will be taught how to inject the insulin and monitor his or her blood sugar level.74) Go to chart 37 EATING PROBLEMS (p. However.26). you should consult your doctor to rule out a serious underlying cause. your child will probably need insulin injections for life. may be the cause. SLOW WEIGHT GAIN (p. The best way to avoid unnecessary anxiety is to keep a regular record of your child’s height and weight so that you can check that his or her growth rate is within the normal range (see GROWTH CHARTS. see chart 51. balanced diet (see HEALTHY EATING IN CHILDREN. Monitor your child’s weight.

and drugs to aid digestion now enable most affected children to survive well into adulthood.26)? Is your child’s height above the normal range for his or her age (see GROWTH CHARTS. Is your child’s weight above the normal range YES for his or her age (see GROWTH CHARTS.117). He or she may also arrange for tests to look for an underlying cause. ACTION Your child should start to grow normally again once he or she has recovered from the illness. Meanwhile. poor growth may be due to a hormone deficiency. POSSIBLE CAUSE Your child may simply be short for his or her age. bulky. This results in a range of problems.CHILDREN: ALL AGES Continued from previous page Cystic fibrosis Cystic fibrosis is a genetic disorder in which secretions from the glands are abnormally thick. Regular chest physiotherapy performed by a parent. Rarely. strong-smelling faeces. p. monitor his or her height. Is your child’s height below the normal range YES for his or her age (see GROWTH CHARTS. Consult your doctor. but if you are still concerned about your child’s growth. The sweat is then collected and analysed. ACTION Your doctor will probably weigh your child and measure his or her height. although their eventual adult height is usually within the normal range. p. A small. painless electric current is applied to the skin to induce sweating. This is particularly likely if at least one of your child’s natural parents is also tall. during which time the lungs may have become damaged. The condition is present from birth but is sometimes undetected for months or years. ACTION Your doctor will probably need to know the heights of both parents. p. taken in high doses or over long periods of time can interfere with growth. particularly one in which your child is confined to bed for any length of time. such as corticosteroids. Consult your doctor. in particular. However. can interrupt normal growth. dietary advice may be all that is needed (see HEALTHY EATING IN CHILDREN. antibiotics. This is especially likely if at least one parent is also short. POSSIBLE CAUSE AND ACTION Certain drugs. IF YOU CANNOT MAKE A DIAGNOSIS FROM THIS CHART AND ARE STILL CONCERNED ABOUT ANY ASPECT OF YOUR CHILD ’ S GROWTH .26)? NO YES NO POSSIBLE CAUSE Overweight children are often taller than average. No specific action is needed.5 cm (1 in) in the last 6 months? NO Has your child had a serious illness or infection recently? NO YES POSSIBLE CAUSE AND ACTION Your child is probably just tall for his or her age. consult your doctor. and/or has he or she grown less than 2. If you are concerned that your child is markedly taller than other children of the same age. p. Is your child taking any YES prescribed drugs? NO POSSIBLE CAUSE A serious illness or infection. Children with cystic fibrosis frequently fail to grow normally and are often underweight. Abnormal secretions from the pancreas interfere with the child’s ability to digest food and cause him or her to pass pale. your doctor may arrange for blood tests and refer your child to a specialist for further tests and treatment.26). thick mucus in the lungs causes a persistent cough and recurrent chest infections. do not stop your child’s prescribed drugs. CONSULT YOUR DOCTOR . Sweat testing Cystic fibrosis results in higher than normal levels of salt in sweat. If a hormone deficiency is suspected as a cause. Technician Electrical source Electrode attached to arm Are you mainly concerned about your child’s height? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. and consult your doctor if the child does not seem to be growing as you would expect. 73 . Consult your doctor.

However. Meanwhile.117) differ from those of adults. can cause weight gain as a side effect. It is extremely rare for excess weight to be due to a hormone problem. Try the self-help measures for helping your child reach a healthy weight (opposite). YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Fluid retention due to a potentially serious kidney disorder may be the cause. Being overweight carries health risks and may contribute to emotional and social problems (see THE DANGERS OF CHILDHOOD OBESITY. POSSIBLE CAUSE Bottle-fed babies sometimes gain too much weight because they drink a lot of milk as a result of thirst rather than hunger. Continued on next page POSSIBLE CAUSE AND ACTION Your child’s weight gain is probably due to eating more than he or she needs. and was he or she smaller than expected at birth? NO YES Is your child taking any prescribed drugs? NO YES Has your child gained weight rapidly over the last 2 months? NO YES Does your child have any of the following? • Swollen ankles • Puffy face. Is your child under 2 years old. You may find that your baby now takes less milk each feed. and consult your doctor if these measures do not help or if your child is severely overweight. Consult your doctor. Is your baby entirely bottle-fed? NO YES POSSIBLE CAUSE Children who are smaller than expected at birth need to put on extra weight initially in order to catch up to the normal weight of children of their age. consult your health visitor. such as corticosteroids. p. 74 . ACTION Try giving your baby cooled. boiled water between feeds. He or she should be at the normal weight by about age 5.26). and there is no need to worry. especially in the morning • Swollen abdomen NO POSSIBLE CAUSE AND ACTION Certain drugs. POSSIBLE CAUSE AND ACTION Breast-fed babies often gain weight quickly between 2 and 4 months. your child should not stop taking his or her prescribed drugs. Appearance is not always a reliable sign of obesity because babies and toddlers are naturally chubby. If he or she still seems to be putting on excess weight. A heart or liver disorder. causing a build-up of fluid.CHILDREN: ALL AGES 13 Excessive weight gain way of ensuring that you notice any weight problem in your child is to keep a regular record of your child’s growth (see GROWTH CHARTS. An unbalanced diet can adversely affect growth and development. It is extremely uncommon for breast-fed babies to be overweight. opposite). ACTION Your child’s weight will be monitored to make sure that he or she is catching up to the normal weight for his or her age but not putting on excess weight. except on the advice of your doctor. if you are concerned. The best START HERE Is your child less than 1 year old? NO YES Is your baby entirely breast-fed? NO YES WA R N I N G SPECIAL DIETS Children’s dietary needs (see HEALTHY EATING IN CHILDREN. consult your doctor or health visitor. Increasing appreciation of the dangers of obesity in adults has led to a growing awareness that the problem often starts in childhood. Drugs are usually prescribed to treat both the symptoms and the cause. You should never put your child on a diet or restrict his or her intake of specific food groups. He or she may also refer your child to hospital for further tests to determine the underlying cause. This is perfectly normal. It is therefore important to be alert to the possibility of excessive weight gain in your child. when bad eating habits are established. is a less likely possibility. Consult this chart if you think your child is overweight. ACTION Your doctor will examine your child and will probably arrange for blood and urine tests. p.

for example.5 kg (1 lb) per week. To help your child lose weight. although genetic factors may also play a part. Children who are overweight are likely to remain overweight as adults. Low self-esteem. 75 . such as back or knee pain. are a healthy way to relieve hunger. ACTION Monitor your child’s weight. POSSIBLE CAUSE Overeating when under stress is common and can cause weight gain.CHILDREN: ALL AGES Continued from previous page Are other members of the family overweight? NO YES POSSIBLE CAUSE Overeating within the whole family is the most likely cause. Allow him or her to stop eating. Overweight adults are also more likely to suffer from joint problems. follow the advice for losing weight in adults (see HOW TO LOSE WEIGHT SAFELY. and let him or her take responsibility for losing weight. ACTION Look at the way the whole family eats. By changing your own eating patterns. so that the temptation is removed. Consult your doctor if these measures do not help or if your child is severely overweight. as a result of childhood teasing. • Encourage your child to take up active leisure pursuits that he or she enjoys.151) as well as the following measures: • Make sure your child does not lose weight too quickly. instead of mostly watching TV or playing computer games. Try the self-help measures for helping your child reach a healthy weight (below). such as chocolate and fizzy drinks. If necessary. and consult your doctor if these measures do not help or if your child is severely overweight. Follow the advice for helping your child reach a healthy weight (right). and consult your doctor if these measures do not help or if your child is severely overweight. such as football or dancing. • Encourage and reward your child for losing weight. Follow the advice for helping your child achieve a healthy weight (below). even if there is some food left. He or she should lose a maximum of 0. and consult your doctor if these measures do not help or if your child is severely overweight. Many overweight children also suffer from teasing or bullying from other children. because of stressful events at home or school? NO Helping your child reach a healthy weight SELF-HELP YES Most overweight children eat more food than they need. ACTION Never force your child to eat. Eating healthily High-fibre foods. especially in girls. Has your child been overweight for less than 6 months? NO YES POSSIBLE CAUSE AND ACTION Your child’s weight gain is probably due to eating more than he or she needs. which may compound the weight problem as well as contribute to poor fitness. • Stop buying high-fat and high-calorie foods. and serve smaller portions to avoid waste. If he or she does not grow in height to balance the weight gain. follow the advice for helping your child reach a healthy weight (right). Diabetes is more common in people who are overweight. Excess weight tends to reduce physical activity. including life-threatening heart and circulatory disorders. ACTION Try to discover and deal with any underlying worries that your child has. Try the selfhelp measures for helping your child reach a healthy weight (right). Has your child been overweight since early childhood? NO YES Is your child always made to finish all the food on his or her plate? YES NO POSSIBLE CAUSE Your child is probably eating more than he or she needs. Follow the advice for helping your child reach a healthy weight (below). such as a stroke or heart attack. p. POSSIBLE CAUSE Erratic weight gain is common just before a growth spurt. Could your child be comfort eating. • Involve your child. you can encourage your child to lose weight. POSSIBLE CAUSE AND ACTION Your child’s weight gain is probably due to eating more than he or she needs. and consult your doctor if these measures do not help or if your child is severely overweight. often persists into adulthood. and consult your doctor if these measures do not help or if your child is severely overweight. The dangers of childhood obesity Being overweight can have a wide range of negative effects. talk to your child’s teachers. such as wholemeal bread and muesli bars. making them insecure and unhappy. as are some forms of cancer. putting them at increased risk of various disorders in later life.

add 0. o o Is your child’s breathing faster than normal? See CHECKING YOUR CHILD’S BREATHING RATE (p. and make sure he or she drinks plenty of fluids. If it is raised. which is placed in the ear. You can also try self-help measures for relieving earache (p. such as a cold. For children under 1.79) • Abnormal drowsiness • A severe headache While waiting for medical help. You can also use a standard thermometer placed in the armpit or in the mouth. opposite).103). It is usually a sign that the body is fighting an infection. ACTION Take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. Thermometer placed in ear POSSIBLE CAUSES Many viral infections. he or she may need to be admitted to hospital for monitoring and further treatment. or if there is no improvement within 48 hours. Do not put a glass thermometer in the mouth of a child aged under 7. A fever is an abnormally high body temperature of 38˚C (100˚F) or above. Continued on next page 76 . dark red spots that do not fade on pressure (see CHECKING A RED RASH. if your child develops difficulty in breathing. opposite). below).CHILDREN: ALL AGES 14 Fever in children and be hot and sweaty. he or she will probably prescribe antibiotics and may arrange for a chest X-ray (p. see chart 3. You should also try self-help measures for relieving a cough (p.54). Using an aural thermometer Hold the thermometer in your child’s ear for the recommended time. hospital admission is necessary. A high fever can cause seizures (febrile convulsions) in young children. Take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. p. If your child does not feel well. FEVER IN BABIES (p. Occasionally.78) WA R N I N G SIGNS Call an ambulance if your child has a fever that is associated with any of the following symptoms: • A seizure lasting more than 5 minutes • Flat. is possible. A convenient method of taking your child’s temperature is with an aural thermometer. CALL YOUR DOCTOR NOW POSSIBLE CAUSE A condition such as croup. YES and/or is he or she tugging at either ear? NO POSSIBLE CAUSE A viral or bacterial infection of the middle ear is a possible cause of your child’s symptoms. Heat exposure can also lead to a raised temperature. and give him or her plenty to drink. DANGER SEE YOUR DOCTOR WITHIN 24 HOURS Is your child complaining of earache.77). can cause a cough and runny nose. Does your child have a cough and/or a runny nose? NO YES Does your child have noisy breathing and/or a barking cough? NO YES Taking your child’s temperature SELF-HELP CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible. take steps to reduce it (see BRINGING DOWN A FEVER. in which the throat becomes swollen and narrowed due to a viral infection.6 C (1 F) to a reading from the armpit. A child with a fever will feel generally unwell START HERE Does your child have a rash? NO YES Go to chart 15 RASH WITH FEVER (p. NO YES ACTION If your doctor confirms the diagnosis. If your child’s symptoms are severe. Call your doctor if a rash develops.110). you should take his or her temperature (see TAKING YOUR CHILD’S TEMPERATURE. For the correct result. opposite). ACTION Your doctor may give your child an inhaled corticosteroid drug to ease his or her breathing. follow the advice for bringing down a fever (p. A new disposable tip should be attached for each use. he or she may prescribe painkillers and/or antibiotics. ACTION Your doctor will examine your child. If the diagnosis is confirmed.108).39).

call your doctor. If your child’s temperature has not returned to normal within an hour. Remove your child’s clothes and give him or her plenty of cold drinks.126). p. may be the cause of such symptoms. is the most likely cause of diarrhoea with a fever.79) NO Lowering a temperature will help your child feel more comfortable and lessens the likelihood of a febrile convulsion occurring (p. He or she will be given urgent treatment with antibiotics and may need intensive care. 77 .127). ACTION Follow the self-help measures for preventing dehydration in children (p.118). The doses of both drugs can be repeated every 4 hours. ACTION If meningitis is suspected.CHILDREN: ALL AGES Continued from previous page SELF-HELP Bringing down a fever Wet face cloth Drink Fan Does your child have any of the following? • Severe headache • Reluctance to bend the head forward • Dislike of bright lights YES • Drowsiness or confusion • Flat. ACTION Take steps to reduce your child’s temperature by removing any excess clothing and moving him or her to a slightly cooler (though not cold) place. POSSIBLE CAUSE Meningitis. an infection of the throat or the tonsils. may be needed to look for any associated problems. If your child has diarrhoea for more than 24 hours. If your child is over 2 months old. a urine sample will be sent for analysis. He or she may prescribe antibiotics for the infection. POSSIBLE CAUSE Overheating.123) and treating gastroenteritis in children (p. dark red spots that do not fade on pressure (p. your child will be admitted to hospital immediately.107). give him or her the recommended dose of paracetamol. follow the advice for bringing down a fever (above) and call your doctor. The infection may be due to a bacteria or a virus. further tests. leading to a rise in body temperature.55). is the most likely cause. Your child may also vomit. lie him or her in a cool room. t EMERGENCY! CALL AN AMBULANCE Does your child have a sore throat? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Pharyngitis or tonsillitis. such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. usually due to a viral infection. Has your child been exposed to hot sunshine YES or high temperatures? NO SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Does your child have any of the following? • Pain on passing urine • Frequent passing of urine • Bedwetting or daytime wetting after being dry • Offensive-smelling or cloudy urine NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have a urinary tract infection (p. inflammation of the digestive tract. If the fever doesn’t fall and your child is over 6 months old. Cooling your child Undress your child. If the diagnosis is confirmed. Does your child have diarrhoea? NO YES POSSIBLE CAUSE Gastroenteritis. and sponge his or her head and body with tepid water. You can also try self-help measures for soothing your child’s sore throat (p. give him or her the recommended dose of ibuprofen as well. ACTION Your doctor will examine your child’s throat and may take a throat swab to confirm the diagnosis. In some cases. and your child will be prescribed antibiotics. are the most likely causes. inflammation of the membranes surrounding the brain due to an infection. YES ACTION Your doctor will test a sample of your child’s urine.

CHILDREN: ALL AGES 15 Rash with fever that needs urgent medical attention. is a possibility. Make sure that your child drinks plenty of fluids (see ENCOURAGING YOUR CHILD TO DRINK. In children. Consult this chart if your child develops a rash anywhere on the body associated with a temperature of 38˚C (100˚F) or higher. Continued on next page POSSIBLE CAUSE AND ACTION Rubella. Follow the advice for bringing down a fever (p.67). but if your child has a sore mouth. There is no specific treatment for this condition. your child will still be at risk of developing a number of less serious infections and may even develop a mild form of diseases against which he or she has been immunized. Does your child have a severe sore throat? NO YES Does your child have red eyes. especially if your child has swollen glands. which can lead to scarring. dark red spots that do not fade on pressure (see CHECKING A RED RASH. may be the cause of these symptoms.77). 78 . this is usually a mild disease. a bacterial throat infection. t EMERGENCY! CALL AN AMBULANCE WA R N I N G DANGER SIGNS Call an ambulance if your child has a rash and a fever with any of the following symptoms: • A seizure lasting more than 5 minutes • Abnormal drowsiness • A severe headache • The rash consists of or is accompanied by flat. Consult your doctor if the symptoms are severe. is the likely cause of these symptoms. such as meningitis. He or she will be given urgent treatment with antibiotics and may need intensive care. but. Itching may be relieved by adding baking soda to your child’s bath water and by applying calamine lotion to the spots. and/or a dry cough? YES Does your child have a red or pink mottled or blotchy rash? NO NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Measles is the most likely cause of these symptoms. Make sure your child drinks plenty of fluids (see ENCOURAGING YOUR CHILD TO DRINK. even if your child has been immunized against the disease. feet. especially if your child is also vomiting and has a rash that is particularly prominent in the folds of the skin. in which case. your child will be admitted to hospital immediately. POSSIBLE CAUSE AND ACTION Your child may have hand. in some cases. p.113). However. is a likely cause of these symptoms. Follow the advice for reducing a fever (p. ACTION If meningitis is suspected. You do not need to consult a doctor unless your child has been in contact with a pregnant woman. a runny nose.77).77). Take steps to reduce your child’s fever (see BRINGING DOWN A FEVER. In children. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Scarlet fever.79) While waiting for medical help. START HERE Does your child have any of the danger signs listed in the box on the right? NO YES POSSIBLE CAUSE Meningitis. who will confirm the diagnosis. this combination of symptoms is often caused by a viral infection. the diagnosis should be confirmed. and follow the advice for bringing down a fever (p. p. such as the armpits. an infectious disease caused by the herpes zoster virus. Are the blisters confined to the hands. p.77) and also for relieving a sore throat (p. p. ACTION Keep your child’s fingernails short to discourage scratching. it can be caused by a serious bacterial infection. ACTION Your doctor will examine your child to confirm the diagnosis.67) to prevent dehydration. ACTION Your doctor will examine your child to confirm the diagnosis.77). take steps to relieve the pain (see RELIEVING A SORE MOUTH. He or she may prescribe antibiotics. follow the advice for bringing down a fever (p. and YES the inside of the mouth? NO Does your child have a rash of small blisters? NO YES POSSIBLE CAUSE Chickenpox. also known as German measles. and mouth disease.107). Consult your doctor. He or she may prescribe antibiotics. p. inflammation of the membranes surrounding the brain due to infection. and most children feel unwell for only the first few days. a mild viral infection. foot. Routine immunizations will protect your child against most serious infections.

and does he or she have any of the following? • Swollen hands and feet • Dry. is a possibility. If the rash is visible through the glass. POSSIBLE CAUSE AND ACTION Your child may have erythema infectiosum. most obvious in skin folds Until 5 days after the rash develops Roseola infantum (variable) Until 5 days after the onset of the symptoms From 1 week before the rash develops until 5 days after the rash develops or until the rash disappears Until the prescribed course of antibiotics is completed Rubella (14–19 days) Scarlet fever (2–5 days) Is your child under 2 years old. If you or your child has a nonfading rash. Follow the advice on reducing a fever (p. and inside of mouth Cough. whose symptoms can be more severe than children’s. YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Kawasaki disease. ACTION Your doctor will examine your child to determine the cause of the symptoms. This viral condition is usually mild. a rare condition of unknown cause. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. cracked and swollen lips • Red palms and soles • Red eyes • Swollen glands NO POSSIBLE CAUSE AND ACTION Your child may have roseola infantum. the child is usually better. which is caused by bleeding under the skin and may occur in meningitis. By the time the rash appears. red eyes. it may be a form of purpura. also known as slapped-cheek disease or fifth disease. and mouth disease (4 days) Measles (7–14 days) Mild fever. which can damage the heart and joints.CHILDREN: ALL AGES Continued from previous page Viral infections that cause a rash Many viral infections cause a fever and a rash. flat pink mottled or blotchy rash. where his or her condition can be monitored and treatment given to reduce the risk of heart complications. the rash is still visible when the glass is pressed against the skin – a sign that it may be caused by an illness such as meningitis. swollen glands in the neck. mainly on trunk Does your child have a bright red rash on the cheeks with or without a lacy rash on the trunk? YES NO Erythema infectiosum (4–20 days) Hand. a common early childhood infection. NO YES Is your child under 6 years old. severe sore throat. The more serious ones. lightred rash on the trunk. lacy rash. If you suspect your child has this condition and he or she still has a fever. Has your child taken any new drugs within the last week? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES Your child may have an allergy to the prescribed medicine. Many of these infections can Disease (incubation period) Chickenpox (7–21 days) also affect adults. your doctor will be able to tell you whether your child should avoid this drug in future. check whether they fade on pressure by pressing a clear glass against them. first on the face. your child will be admitted to hospital. consult your doctor. mottled or blotchy red rash. or he or she may have a viral illness unrelated to the drug. mainly on face and trunk Bright red cheeks. If your are worried or if your child is no better in 48 hours. vomiting. and did he or she have a high fever for 3–4 days before a rash developed on his or her body. mainly on face and trunk High fever. swollen glands in the neck Mild fever. 79 . rash of small blisters For duration of blisters on hands. such as measles. ACTION If your doctor suspects that your child has Kawasaki disease. foot. Period when infectious From 2 days before the rash develops until all the blisters have scabs Until 1 week after the rash develops Symptoms Crops of raised. The diagnosis should be confirmed by your doctor if your child has been in contact with a pregnant woman. red rash on body. Checking a red rash If you or your child develops dark red or purple blotches. He or she will examine your child and may do tests to exclude more serious problems. If your child does have a drug allergy. then trunk and arms High fever followed by flat. The incubation period is the time between acquiring an infection and first developing symptoms. Checking a rash Here. call your doctor. call an ambulance. This condition is difficult to diagnose before the rash appears as the fever is the only symptom.77). have become much less common as a result of routine immunizations. runny nose. feet. red. itchy spots that turn into blisters and then scabs.

a rash associated with a fever START HERE Does your YES child have a temperature of 38˚C (100˚F) or above? NO Go to chart 15 RASH WITH FEVER (p. such as egg. DANGER Is the skin itchy. Some fungi infect warm. ACTION Your doctor will probably prescribe an antifungal cream for your child and may also prescribe antifungal tablets. and use an emollient bath oil. but. moist areas between skin folds. If your child has eczema. Continued on next page.79) and seems unwell. Does your child have areas of red. see chart 8. inflamed skin. This diagnosis is most likely if other family members also suffer from eczema or other allergic conditions. but an over-the-counter antihistamine drug may help to relieve itching. inflamed skin with clearly defined. an allergic reaction also known as hives. SKIN (p. your doctor may prescribe a corticosteroid or antibiotic cream.64). and/or is your child scratching? YES NO Does your child have one or more raised. no treatment is necessary. Discourage your child from scratching. An over-thecounter antihistamine drug or calamine lotion may relieve the itching. while others affect the limbs or the trunk. an allergic condition.79). • Try to identify triggers. it may be part of a more widespread allergic reaction. Consult your doctor if urticaria persists for more than 24 hours or if it recurs frequently. the following measures may help ease the symptoms or reduce the number of flare-ups: • Your child should bath in warm water. • Make sure your child wears cotton clothing next to the skin to reduce irritation. The cause of the condition is often unknown. Consult your doctor if the spots have not cleared up within a few days because he or she may need to exclude scabies as a cause. itchy spots? NO YES POSSIBLE CAUSE AND ACTION Your child may have been bitten by insects. in one or more of the following places? • Inside the elbows • Behind the knees • Inside the wrists • Face • Ankles NO POSSIBLE CAUSE Your child may have atopic eczema. is a possibility. column 2 The itchy rash of eczema usually affects the skin on the insides of joints such as the elbows and knees. Many children with atopic eczema will grow out of it by 8 years of age. A rash without a fever or a feeling of being unwell is probably no cause for concern. THAT CAUSE A RASH. bright-red patches of skin? NO YES POSSIBLE CAUSE Urticaria. If swelling or affects the mouth or tongue. • Apply emollient cream several times a day. • Your child should avoid coming in contact with cold sores. Also follow the self-help measures for relieving itchiness (p. especially if the spots have a visible centre. Childhood spots and rashes are usually due to irritation or inflammation of the skin as a result of a local problem such as an allergic reaction. consult your doctor. dark red spots that do not fade on pressure (see CHECKING A RED RASH. such as fleas or mosquitoes. However. • Provide your child with a soap-free cleansing agent such as aqueous cream. scaly edges? NO YES SELF-HELP Atopic eczema Does your child have YES red. Follow the self-help measures for dealing with atopic eczema (right) and also for relieving itchiness (p. Does your child have one or more raised. call an ambulance. Consult your doctor. ACTION If the diagnosis is confirmed.84).CHILDREN: ALL AGES 16 Skin problems in children may be due to a generalized infection (see VIRAL INFECTIONS p. is likely. 80 . Call an ambulance if a rash is accompanied by difficulty breathing and/or facial swelling. which may blister or weep. Rarely. Consult your doctor. column 1 Continued on next page. POSSIBLE CAUSE A fungal infection. such as ringworm. ACTION Usually. then discuss an avoidance diet with your doctor. p.78) WA R N I N G SIGNS Call an ambulance if your child has flat. PROBLEMS IN BABIES For skin problems in children under 1. not hot. which may cause a serious viral skin infection. because these symptoms can be associated with meningitis. such as in the groin or the armpit.84). if it is itchy or sore.

ACTION If your doctor confirms the diagnosis. The condition often improves if the scalp is treated with an over-the-counter dandruff shampoo or a shampoo containing ketocanazole. Everyone else in the household will need to be treated at the same time. you will probably be advised to wash the crusts away gently with warm water. you should make sure that your child keeps a separate towel and other wash things to avoid infecting others. it is usually best not to treat the condition. oral antibiotics. He or she may suggest other treatments. and nose. consult your doctor. Meanwhile. pearly pimples up to 5 mm (1⁄ 4 in) in diameter. POSSIBLE CAUSE Seborrhoeic dermatitis. but this may take up to 2 years. ACTION Most warts disappear naturally in time. If the rash does not improve within a week or if you are concerned. use an emollient. However. ACTION Your doctor will probably prescribe a treatment lotion. but because the treatment may be painful and may leave a scar. Stop giving your child any over-the-counter drugs and consult your doctor. is a possible cause of these symptoms. 81 .CHILDREN: ALL AGES Continued from previous page.144) YES Is your child taking any prescribed or over-the. such as the hairline. Scabies mites burrow under the skin between the fingers and at the wrists and can cause a widespread rash. column 2 SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Scabies. do not stop giving your child any prescribed drugs. which is very common during adolescence. such as aqueous cream. Is your child intensely itchy with or without grey lines between the fingers or on the wrists? NO YES Does your child have inflamed or weeping skin that dries to form gold-coloured crusts? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have impetigo. which may affect the palms of the hands and soles of the feet in babies. which you will need to apply to the whole of your child’s body from the neck down. such as freezing. Individual pimples can be treated by your doctor. Keep your child away from other children while he or she is infected. Your doctor may also prescribe an antibiotic cream or. It often occurs in oily areas of skin. column 1 Continued from previous page. and does he or she have any of the following? • Blackheads • Inflamed spots with white tops • Painful red lumps under the skin NO Go to chart 55 ADOLESCENT SKIN PROBLEMS (p. a parasitic infection. but this may take months or years. but the itching may continue for up to 2 weeks. The pimples clear up without treatment. and clothing and bedding also need to be washed. each with a central dimple? NO YES POSSIBLE CAUSE Your child may have acne. Until the infection clears up. is likely. ACTION Avoid using soaps or other bath products on the affected areas. who may prescribe a corticosteroid cream. a bacterial skin infection that commonly affects the face. may be causing your child’s symptoms. POSSIBLE CAUSE AND ACTION Molluscum contagiosum. to clean and moisturize the skin. if a wart persists after you have treated it or if it is painful. Meanwhile. Does your child have several raised. a harmless skin disorder. Scabies is very contagious. Does your child have patches of red. which are caused by a viral infection of the skin. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Instead. Is your child over 10 years old. they may catch on clothing and look unsightly.YES counter drugs? NO POSSIBLE CAUSE AND ACTION Certain drugs can cause skin problems as a side effect. consult your doctor. eyebrows. The mites should die within 3 days of treatment. Over-the-counter wart treatments may speed up the process. inflamed skin that is also flaking? NO YES Does your child have one or more small lumps of rough skin? NO YES POSSIBLE CAUSE These may be warts. A wart that grows into the sole of the foot is known as a verruca and may be painful. a harmless but contagious viral skin infection. if the condition is widespread.

Short nails are also easier to keep clean. Has your child’s hair become generally thin? NO YES POSSIBLE CAUSE Alopecia areata. Use a soft hairbrush on a young child’s START HERE Has your child YES developed bald patches recently? NO Is the scalp scaly and/or inflamed in areas where YES the hair has been lost? NO POSSIBLE CAUSE Ringworm. your child will probably be prescribed a course of antifungal drugs. a condition in which the body’s immune system attacks the hair follicles. Consult your doctor. Keep your child’s nails short to prevent accidental scratching of him.or herself. new. NO Looking after your child’s hair and nails To keep your child’s hair looking clean and healthy. Consult this chart if your child has any problems affecting the hair. ACTION If your doctor confirms the diagnosis. particularly those used to treat cancer. If the condition does not improve. Rubbing on bedclothes or a baby seat can cause the loss of this delicate first hair to be marked in some areas. the most common hair problems needing treatment are fungal infections and head lice. Use blunt-ended scissors. eating a well-balanced diet will help keep your child’s hair and nails strong and healthy. Over the next few months. or toenails. p. ACTION Your doctor will check your child’s general health. scalp. the new hair may be a different colour from the baby hair. In general. the hair growth cycle should return to normal within 6 months. In children. may cause bald patches when it affects the scalp. the condition usually gets better without treatment. Allow it to dry naturally. the hair should grow back. and comb the hair through gently while it is still damp. avoid braiding it tightly or using uncovered rubber bands to tie it back. stronger hair will grow in its place. 82 . Hair growth often returns to normal when the drugs are stopped or treatment finishes.176). although it may be fine and downy at first. If your child’s hair is long. can cause hair loss as a side effect. Your child should wear a hat when outdoors to protect the scalp from sunburn. In some cases. Is your child under 1 year old. a fungal infection. Meanwhile. Is your child under 1 year old? Continued on next page YES POSSIBLE CAUSE AND ACTION Certain drugs.CHILDREN: ALL AGES 17 Hair. usually resulting in a noticeable thinning of the hair for a brief period. Consult your doctor. If your child hates having his or her hair washed. POSSIBLE CAUSE AND ACTION Most baby hair is lost during the first year. wash it about twice a week. and are the YES bald patches at the sides or the back of the head? NO POSSIBLE CAUSE AND ACTION Most baby hair is lost during the first year of life and gradually replaced by thicker hair. ACTION In children. and trim the fingernails in the shape of the finger tip and the toenails in a line straight across the toe. fingernails. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. resulting in many hairs being lost at the same time. Rinse the hair thoroughly to remove all the suds. if possible. try using a shampoo shield that fits over the head or a non-sting shampoo. Hair loss resulting from cancer treatment will regrow. your child should not stop taking any prescribed drugs. your doctor may treat it with corticosteroid creams. Consult your doctor. scalp. Is your child taking any YES prescription drugs? NO Has your child had a prolonged or serious illness recently? NO YES POSSIBLE CAUSE A long illness or an operation can disrupt the normal hair growth cycle (see HAIR STRUCTURE AND FUNCTION. is a possibility. Consult your doctor. New hair should grow over the next 6–9 months. Once the infection has cleared up. and nail problems hair because it can be easily damaged. As long as your child is now in good health.

who may prescribe an antifungal cream. Alternatively. p. try coating the hair in conditioner and combing it through with a nit comb daily. by combing through the hair with a finetoothed nit comb. 83 . head lice prefer clean. Go to chart 49 FOOT PROBLEMS (p. POSSIBLE CAUSE Acute paronychia. a flaking scalp may also be due to other conditions. treat everyone in the household and wash all combs and towels in hot water to prevent reinfestations. Nail-biting is common in children and is not a risk to health. hair. which is a form of seborrhoeic dermatitis often associated with a fungal scalp infection. Head lice can be treated with an over-the-counter lotion or shampoo. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Draw your child’s attention to the habit when you see him or her doing it. ACTION An over-the-counter dandruff shampoo or a shampoo containing ketocanazole should clear up the condition. consult your doctor. ACTION Your doctor may prescribe antibiotics as a cream or as tablets. ACTION Head lice can be treated with preparations available from your pharmacist (above). However. If pus has formed. Is the scalp flaking? NO YES POSSIBLE CAUSES Your child probably has dandruff. known as nits. Whichever method you use.136) Is it only a big toe that is affected? NO YES Has the pain and swelling developed rapidly within the last 24 hours? NO YES Does your child bite his or her nails? NO YES POSSIBLE CAUSE Nail-biting may be copied from other children or it may arise as a nervous habit (see HABITUAL BEHAVIOUR. but try not to nag because this may make the habit worse. Consult your doctor. Consult your doctor. Over-the-counter preparations that can be painted on the nails to make them taste unpleasant may be worth trying. broken skin on the finger tips may become infected by bacteria from the mouth.CHILDREN: ALL AGES Continued from previous page SELF-HELP Treating head lice Removing lice and eggs Carefully combing through your child’s hair with a finetoothed nit comb will remove eggs and dead lice. POSSIBLE CAUSE An ingrowing toenail is the most likely cause of these symptoms. and then remove the dead lice and their eggs. Keep your child’s hands out of water as much as possible until the condition clears up.95). Follow the directions on the packet. In rare cases. However. Their white eggs (nits) can sometimes be seen attached to hair shafts. or try using a batteryoperated comb that electrocutes the lice. it may need to be drained under local anaesthetic. may be the cause. a bacterial infection of the skin adjacent to a nail. POSSIBLE CAUSE AND ACTION A fungal infection around the nail may be the cause. painful area around YES one or more nails? NO POSSIBLE CAUSE An infestation of head lice is possible. bitten nails may feel sore or look unsightly. not dirty. such as psoriasis. Fine-toothed nit comb Does your child have an itchy scalp? NO YES Contrary to popular belief. If your child’s scalp is no better within 4 weeks. Consult your doctor if the skin around the nails becomes red or inflamed because an infection may have developed. ACTION Try to keep your child’s nails trimmed and smooth. Comb your child’s hair over a sheet of white paper using a fine-toothed comb to confirm that lice are present. Lice are transmitted by close contact. Does your child have a red. These tiny black insects are less than 2 mm (1⁄16 in) long.

The mites should die within 3 days of treatment. 84 . POSSIBLE CAUSE Skin irritation as a result of sensitivity to particular chemicals can cause widespread itching. All members of your family should be treated to prevent reinfection. scratching can lead to an infection or changes in the skin. If the symptoms persist. Have your recently changed your washing product or laundry powder? SELF-HELP YES Relieving itchiness NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Scabies. may be causing your child’s symptoms. A tendency to have dry skin may run in families and is also common in children who swim regularly or use strong soaps. which can. such as aqueous cream. and follow the other self-help measures for relieving itchiness (left). ACTION Avoid using perfumed products and biological washing powders. consult your doctor. leading to intense irritation of the anus and genital area. Make sure that your washing is always rinsed thoroughly. or the feet? NO YES or go to chart 46 GENITAL PROBLEMS IN GIRLS (p. These tiny. ACTION Your doctor will examine your child. the genital area. and use an emollient bath oil. and clothing and bedding also need to be washed. There are several measures that can help to relieve itchiness in your child: • If your child has dry skin. Scabies mites burrow under the skin between the fingers and can cause a widespread rash. a parasitic infection. not hot. If your child swims regularly.82) or go to chart 45 GENITAL PROBLEMS IN BOYS (p. including external irritants or infestation by parasites. SCALP AND NAIL PROBLEMS (p. he or she should wear cotton gloves at night. which may affect the palms of the hands and soles of the feet in babies. lead to further itching. Is your child intensely itchy with or without grey lines between the fingers or on the wrists? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Itching is a common and distressing symptom for a child and can have a variety of causes. because if it persists. Use an emollient. should be applied to the skin twice a day. in turn. • To prevent scratching. If threadworms are diagnosed.CHILDREN: ALL AGES 18 Itching with any disorder that produces itching. they may be passed on from one person to another or picked up from contaminated food. Consult your doctor. An emollient. and does it occur mainly at night? NO YES Does your child’s skin seem dry? NO YES POSSIBLE CAUSE AND ACTION Dry skin is often itchy. about 1 cm (1⁄ 2 in) long. ACTION Your doctor will probably prescribe a treatment lotion. • Make sure your child wears cotton clothing. Scabies is very contagious and often affects a whole family. It is important to deal promptly START HERE Is the skin in the itchy area inflamed. such as aqueous cream.132) or go to chart 49 FOOT PROBLEMS (p. or does your child have a rash or spots? NO YES Go to chart 16 SKIN PROBLEMS IN CHILDREN (p. he or she should shower afterwards and apply a moisturizer.80) Go to chart 17 HAIR. but the itching may continue for up to 2 weeks. provide an emollient bath oil instead of soap and follow other self-help measures for relieving itchiness (left). Make sure your child takes extra care to wash his or her hands thoroughly after going to the toilet and before eating.130) POSSIBLE CAUSE Your child may have threadworms. he or she will prescribe drugs that will kill the worms. If your child has dry skin. which you will need to apply to the whole of your child’s body from the neck down. Everyone else in the household will need to be treated at the same time. keep your child’s fingernails short and. if necessary. • Over-the-counter antihistamines may help control severe itching. on your child’s skin. white worms. Is the itching confined to the scalp. he or she should bath in warm water. infest the intestines and lay eggs around the anus at night.136) Is the itching confined to the anal area. Although harmless.

CHILDREN: ALL AGES 19 Lumps and swellings glands. bites. Consult your doctor. in some cases. if the swelling is itchy. commonly known as START HERE Are there swellings in two or all of the following places? • Neck • Armpit • Groin NO YES POSSIBLE CAUSE The swellings are probably enlarged lymph nodes caused by a viral infection such as glandular fever. your doctor may suggest that you see a specialist to discuss an operation to repair the hernia. Does your child have tender swellings in his or her neck with or without a sore throat? NO YES ACTION Your doctor will examine your child’s throat and may take a throat swab to confirm the diagnosis. A persistent lump or swelling should always be examined by a doctor so that the cause can be established. or if it persists for longer than a few days. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Consult your doctor. p. Insect bites usually clear up on their own. such as a boil. If you can see no obvious cause for the swelling. ACTION Your doctor will examine your child to determine the diagnosis. An umbilical hernia may disappear without treatment. who may prescribe antibiotics or drain the pus under local anaesthetic. follow self-help measures to soothe it (p. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Enlarged lymph nodes in the neck are often a symptom of a throat infection (pharyngitis) and/or an infection of the tonsils (tonsillitis). or boil. Does your child have a red. consult your doctor. that have enlarged in response to an infection. however. Consult this chart if your child has lumps or swellings on any area of the body. If the swelling becomes hard or tender. see chart 45. ACTION Most boils disappear on their own. there is rarely cause for serious concern in a child. see your doctor. For lumps and swellings in the scrotum. tender swelling on the skin? NO YES POSSIBLE CAUSES Your child may have a boil caused by a bacterial infection or. ACTION Your doctor will examine your child and may arrange for blood tests to establish the cause and appropriate treatment. ACTION Your doctor will examine your child to confirm the diagnosis. or stings.215). If a hernia becomes hard or tender. call your doctor immediately.130). This condition is particularly common in black infants. If a boil has not improved in 48 hours or if your child is unwell. call your doctor immediately. POSSIBLE CAUSE Your child may have an umbilical hernia. POSSIBLE CAUSE AND ACTION A swelling in the groin area may be lymph nodes that have swollen in response to a local infection. GENITAL PROBLEMS IN BOYS (p. the body fights off the infection on its own and the swelling subsides. He or she may prescribe antibiotics. in which a part of the intestines protrudes through a weak area in the muscles of the abdominal wall near the navel. graze. However. if any.107). Other lumps and swellings may be due to injuries. he or she may have been bitten by an insect. 85 . The infection may be due to a cut. In most cases. Consult your doctor. Lumps and swellings under the surface of the skin are often lymph nodes. hernias in the groin should be repaired surgically (see HERNIA REPAIR. This diagnosis is particularly likely if your child also has a fever. Does your child have a swelling around or near the navel? NO YES Does the swelling get bigger when your child coughs or cries? Does your child have a swelling in the groin? NO YES NO YES POSSIBLE CAUSE Your child may have a type of hernia in which a section of the intestines protrudes through a weakened area in the muscles of the abdominal wall near the groin. Because of the risk of the intestine becoming trapped. If your child’s throat is sore.

anger. There are several possible causes for a seizure. or frustration in a child under 3 years of age. the seizures are not usually serious. try self-help measures for dealing with faintness (opposite). administer it to your child while you wait for the ambulance to arrive. which is an extremely low blood sugar level. p.55). If your child feels faint again. may have caused your child to lose consciousness. Do not try to give an unconscious child anything to eat or drink. In some cases. Your doctor will examine your child and try to find a cause for the fever. fainting. consult your doctor or health visitor. p. However. and did he or she have a high fever YES before the episode? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your child has had a seizure. ACTION If the child has not had a seizure before. your child may need to be admitted to hospital. These seizures are often brought on by an infection that causes a raised temperature. Although frightening. some of which need urgent treatment. who may do tests to find out if he or she has anaemia. Children often become dizzy as a result of START HERE Did your YES child lose consciousness? NO Did your child do any of the following? • Make jerky arm and leg movements • Pass urine • Bite his or her tongue NO YES WA R N I N G SIGNS Call an ambulance if your child has lost consciousness and any of the following apply: • The loss of consciousness followed a head injury • Consciousness has not been regained within 3 minutes • Breathing slows down or stops. p. if you are concerned about your child’s behaviour. Continued on next page POSSIBLE CAUSE AND ACTION Your child probably fainted due to a temporary reduction in the amount of blood reaching the brain. If your child has regular episodes of dizziness or has a seizure.CHILDREN: ALL AGES 20 Dizziness. and seizures games that involve spinning or fairground rides. or it is irregular or noisy While waiting for medical help to arrive. Try to keep an accurate account of the episode and any related symptoms as this will help your doctor establish the cause. consult your doctor. ACTION While waiting for medical help. follow the appropriate first-aid advice (see UNCONSCIOUSNESS. Such attacks usually result from pain. ACTION If you have been given glucagon for injection. the child may be having a seizure. take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. it is rarely a cause for concern. if the loss of consciousness is accompanied by abnormal movements. but dizziness for no obvious reason could be due to problems with the balance mechanism in the ear. Your child’s blood sugar will not return to normal without immediate treatment. which may be due to epilepsy. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Did any of the following apply? • Hot or airless conditions • Prolonged standing • Lack of food in recent hours • Stress or anxiety NO POSSIBLE CAUSE AND ACTION Your child may have had a breath-holding attack (opposite). your doctor will examine him or her and may arrange for an EEG test to record the electrical activity in the brain. However. Epilepsy will not be diagnosed until the child has had two or more seizures. A brief loss of consciousness in a child is usually due to fainting and is seldom serious. DANGER Is your child being given treatment for diabetes? NO YES Did your child hold his or her breath and turn blue before losing consciousness? NO POSSIBLE CAUSE Severe hypoglycaemia. If your child does have epilepsy. A child who has frequent fainting attacks should be seen by a doctor. such as jerking limbs.77).300). he or she may be prescribed drug treatment with anticonvulsants to prevent further attacks. The best way to deal with an attack is to ignore it as much as possible. t EMERGENCY! CALL AN AMBULANCE Is your child under 5 years old. Fainting occurs most often in early puberty but can occur at any age. 86 . YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your child may have had a febrile convulsion (see FEBRILE CONVULSIONS IN BABIES AND CHILDREN.

call an ambulance and administer first aid (see UNCONSCIOUSNESS. consult your doctor or health visitor.300). Consult your doctor. Your doctor may prescribe antiemetic drugs to relieve the nausea and dizziness. try to ignore him or her as much as possible. However. these symptoms may be due to a high blood sugar level. Consult your doctor if your child has frequent fainting attacks. if you are worried. POSSIBLE CAUSE It is possible that your child is abusing drugs or solvents (see RECOGNIZING DRUG AND SOLVENT ABUSE. POSSIBLE CAUSE Faintness in children with diabetes may indicate a low blood sugar level. your doctor may arrange counselling or suggest selfhelp groups (see USEFUL ADDRESSES. 87 . give him or her something very sweet to eat or drink. and is rarely a cause for concern. Your child should lie down with his or Relieving faintness Lying down with the legs raised increases the flow of blood to the brain and usually quickly relieves feelings of faintness. or if the child is particularly stressed or anxious. YES Is your child taking any YES prescription drugs? NO Does your child feel unsteady or faint? NO YES Have you noticed changes in your child’s behaviour recently? NO YES POSSIBLE CAUSE AND ACTION These symptoms may be the side effects of a drug. Call your doctor before the next dose of the drug is due to ask if it could be the cause and if you should stop giving it to your child. offer him or her a sweet drink in order to raise the blood sugar level. a viral infection of the part of the ear concerned with balance (see HOW YOU KEEP YOUR BALANCE. and/or appears confused. and most children grow out of it by the age of 4 years. the doctor may need to determine whether your child has anaemia. particularly if the symptoms come on suddenly. and loosen the child’s clothes.141). Do not try to stop the seizures by shaking or slapping your child. he or she may be more comfortable lying down and remaining still. p. Once consciousness is lost. normal breathing will resume automatically.311). if he or she has been standing for a long time. This should correct a low blood sugar level and will do no harm if the sugar level is too high. hungry. p. Does your child have episodes in which he or she seems unaware of the surroundings for a few moments? NO YES If your child suddenly turns pale. or anxious. A child may hold his or her breath until he or she passes out. If your child is attempting to get his or her way by breath-holding. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. This can be in response to pain. If your child cannot cooperate or is no better within 10 minutes. if necessary. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Your child may have labyrinthitis. While your child is experiencing symptoms. he or she may be feeling faint. Follow self-help measures for dealing with faintness (above).CHILDREN: ALL AGES Continued from previous page SELF-HELP Dealing with faintness her feet raised to improve the blood flow to the brain. A nervous system problem is also a rare possibility.162). If your child loses consciousness and does not regain it within 3 minutes. p. if your child has not eaten. p. Make sure plenty of fresh air is available. POSSIBLE CAUSE AND ACTION Feeling faint is not uncommon in children. Your doctor may refer your child for an EEG test to record the electrical activity in the brain.41) to exclude a nervous system problem. If drug or substance abuse is the problem. Breath-holding is not harmful. but it can also be an attempt to manipulate parents. a type of epilepsy (formerly known as petit mal). ACTION Your doctor will examine your child and may refer him or her for tests such as MRI (p. ACTION If your child is sufficiently alert. Less commonly. He or she may advise drug treatment with anticonvulsants to control the condition. especially if they are in a stuffy atmosphere. Is your child suffering from any of the following? • The sensation that everything is spinning • Loss of balance • Nausea or vomiting NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION These may be generalized absence seizures. Is your child being treated for diabetes? NO YES Breath-holding attacks Young children sometimes hold their breath for up to 30 seconds. This condition is more likely if the atmosphere is hot or stuffy. If you are sure that your child is fully conscious. complains that his or her vision is closing in. call a doctor at once.

• If your child is hungry. Watch him or her closely. POSSIBLE CAUSE Your child’s head injury may have resulted in damage to the brain. Headache relief Encouraging a child to have a sleep or a rest. dark red spots that do not fade on pressure (see CHECKING A RED RASH. 40 per cent of children have had a headache. If he or she seems unwell. these conditions are extremely rare. POSSIBLE CAUSE Feverish illnesses are often accompanied by headaches. He or she will be given urgent treatment with antibiotics and may need intensive care. Headaches are a very common complaint. ACTION Your doctor may arrange for your child to be seen urgently in hospital for tests such as MRI (p. such as a biscuit and a drink of milk.CHILDREN: ALL AGES 21 Headache infection that causes a fever. p. He or she may want to go to sleep for a while. Headaches often occur on their own but may accompany any START HERE Does your child have a fever? NO YES Has your child had a head injury within the last 24 hours? NO Does your child have YES any of the following? • Severe headache • Pain in the neck on bending the head forward • Dislike of bright lights • Drowsiness or confusion • Flat. ACTION If meningitis is suspected. However. or if other symptoms develop.76) Is the headache present on waking. inflammation of the membranes surrounding the brain due to infection. t EMERGENCY! CALL AN AMBULANCE 88 .79) NO WA R N I N G DANGER SIGNS Call an ambulance if your child has a severe headache accompanied by any of the following symptoms: • Loss of consciousness • Seizures • Abnormal drowsiness • Flat. call an ambulance. or recurs frequently. Try the following self-help measures to relieve the pain. after first taking a painkiller. By the age of 7. quiet.40) to establish the cause and appropriate treatment. dimly lit room. offer him or her a snack. seems drowsy. persistent. such as meningitis or a brain tumour. if your child seems very unwell. and this figure rises to 75 per cent by the age of 15. If the headache persists for more than 4 hours. dark red spots that do not fade on pressure (p. • Encourage your child to rest in a cool. your child will be observed closely and may have tests such as CT scanning (p. Consult this chart if your child complains of a headache with or without other symptoms. call your doctor. or if this is the first time that your child has had a particular type of headache. • Give liquid paracetamol.40) to determine the treatment. vomits. or has your child vomited? NO Continued on next page POSSIBLE CAUSE A mild headache for a while after a bump on the head is not usually a cause for concern. Are any of the danger signs in the warning box YES (above) present. or develops any of the danger signs listed above.79) • Reluctance to bend the head forward YES POSSIBLE CAUSE Meningitis. will often help to relieve his or her headache. ACTION Give your child paracetamol for the pain. Parents may worry that the pain is due to a serious condition. may be the cause of these symptoms. SELF-HELP Relieving a child’s headache Most childhood headaches can be treated without the need for medical help.41) or CT scanning (p. t EMERGENCY! CALL AN AMBULANCE Go to chart 14 FEVER IN CHILDREN (p. your child will be admitted to hospital immediately. or does it wake your child in the night? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Headaches with these characteristics may be an indication that there is a serious brain disorder. Always consult your doctor if a headache is severe. They can also be a symptom of a number of relatively minor disorders. ACTION Once in hospital.

who will try to establish a cause for the headaches. ACTION Give your child paracetamol for the pain. I F THE HEADACHE IS SEVERE . CALL YOUR DOCTOR NOW. it may be an indication of a serious brain disorder that needs urgent investigation. if a vision problem is found.41) or CT scanning (p. Take your child to an optician for an eyesight test. drinking plenty of fluids. but your doctor will want to rule out the possibility of an underlying disorder.CHILDREN: ALL AGES Continued from previous page Is your child completely YES well between attacks? NO POSSIBLE CAUSE A severe headache associated with these symptoms may be a migraine. such as taking a painkiller and an antiemetic (drug that relieves nausea). Steam inhalation (see TREATING A CHILD WITH A COLD. Is your child taking any YES prescription drugs? NO POSSIBLE CAUSE AND ACTION You should bring any frequent or unusual headaches to your doctor’s attention. are they becoming more YES frequent. ACTION Your doctor will examine your child and may arrange for him or her to be seen urgently in hospital for tests such as MRI (p. and see if you can identify a pattern to the headaches. Are your child’s headaches frequent. Does your child have recurrent headaches with or preceded by any of the following? • Nausea or vomiting • Abdominal pain • Seeing flashing lights • Pale appearance NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE If your child is not well between headaches or his or her performance at school has worsened recently. If your child is no better after 2 days. p. Children under 8 are rarely affected as their sinuses have not yet developed. see your doctor within 24 hours. the optician will refer your child to the doctor.40) in order to establish the cause. ACTION Your doctor will probably examine your child to exclude other possible causes. and resting in a darkened room. particularly if other members of the family also suffer from migraines. p. such as a food or an activity (see REDUCING THE FREQUENCY OF MIGRAINE. Do headaches occur mainly after reading or using a computer? NO YES POSSIBLE CAUSE Previously unrecognised eyesight problems may sometimes cause a child to develop a headache after activities such as these. POSSIBLE CAUSE Anxiety is one of the most common causes of headaches in children. especially if your child recently had a cold or a runny or blocked nose. ACTION The optician will carry out a full sight test and. Could your child be anxious or under stress at home or at school? NO YES POSSIBLE CAUSE AND ACTION Certain drugs can cause headaches as a side effect.159). or has the nature of the headaches changed? NO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Consult your doctor if you and your child cannot sort out the problem or if the headaches are frequent. Consult your doctor. Do either of the following describe your YES child’s headache? • Felt mainly in the forehead and face or teeth • Worse when bending forward NO POSSIBLE CAUSE Sinusitis (inflammation of the membranes lining the air spaces in the skull) may be the cause of this type of headache.106) may also help. They are unlikely to be serious. You should also try to discover whether there are any specific triggers. ACTION Discuss your child’s problems and worries with him or her. your child may need antibiotics. your child should not stop taking the prescribed drugs. will prescribe appropriate glasses for your child. Consult your doctor. Symptoms can often be eased by self-help measures. If vision is normal. Approach teachers for further information. 89 . Meanwhile.

follow the first-aid procedure for swallowed poisons (p. If the diagnosis is confirmed. Children who are confused may talk nonsense. ACTION Take steps to reduce the fever (see BRINGING DOWN A FEVER. such as meningitis. Your doctor will examine your child. Insulin will be needed for life. Encephalitis. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSE Diabetes mellitus (p. While you are waiting for medical help to arrive. may be the cause of these symptoms. or see and hear things that are not real.79) • Severe headache • Vomiting Also call an ambulance if your child becomes unconscious or is difficult to wake. appear dazed or agitated. t EMERGENCY! CALL AN AMBULANCE WA R N I N G SIGNS Call an ambulance if your child is drowsy or confused and also has any of the following symptoms: • Slow or irregular breathing • Flat. Try to find the container or a sample of the substance that your child has swallowed to take with you to the hospital.CHILDREN: ALL AGES 22 Confusion and/or drowsiness illness. ACTION Your doctor will take a blood sample to test your child’s blood sugar level. Consult this chart if your child appears confused or if he or she suddenly becomes unusually sleepy or unresponsive or is difficult to rouse from sleep. dark red spots that do not fade on pressure (see CHECKING A RED RASH. your child may need to be admitted to hospital for tests to determine the cause and treatment needed. Your child will be fully examined in hospital and may need tests such as a skull X-ray (p. Does your child have one or more of the following? • Unexplained weight loss • Increased thirst • Passing more urine than usual NO YES POSSIBLE CAUSE AND ACTION Your child’s symptoms may be due to poisoning. However.149) is a possibility. such as pneumonia or a urinary tract infection.77). and if there is an obvious site of infection. or it may be a symptom of a serious disease. he or she may prescribe antibiotics.79) YES NO POSSIBLE CAUSES Meningitis. He or she may need to stay in hospital for monitoring. dark red spots that do not fade on pressure (p. This is a serious symptom that requires immediate medical attention. Otherwise.40). t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSES Your child’s confusion may be the result of a severe infection. your child may need to be admitted to hospital for insulin injections and intravenous fluids until the condition is controlled. p. This condition is caused by insufficient production of the hormone insulin. ACTION If meningitis is suspected. it may be an indication of a serious brain injury or be associated with bleeding between the skull and the brain. Continued on next page 90 .39) or CT scanning (p. your child will be admitted to hospital immediately. inflammation of brain tissue as a result of a virus infection. which is needed by the body to get energy from sugar and carbohydrate foods. DANGER Does your child have a temperature of 38˚C (100˚F) or above? NO YES Might your child have swallowed any of the following? • Drugs prescribed for an adult • Poisonous plants or fungi • Cleaning products NO Does your child have any of the following? • Severe headache • Reluctance to bend the head forward YES Dislike of bright lights • • Flat. Drowsiness may be the result of a lack of sleep or a minor START HERE Has your child injured his or YES her head in the past few days? NO POSSIBLE CAUSES In many cases. confusion following a head injury is short-lived.302). p. and make sure your child drinks plenty of fluids. inflammation of the membranes surrounding the brain due to an infection. He or she will be given urgent treatment with antibiotics and may need intensive care. ACTION Do not give your child anything to eat or drink while waiting for the ambulance. is also a possibility. Encephalitis often gets better by itself but may need treatment with an antiviral drug.

for example has your child done either of the following? • Bitten his or her tongue • Wet him. Advice and support is also available from many self-help groups (see USEFUL ADDRESSES. If your child cannot cooperate or is no better within 10 minutes. ACTION If your child is sufficiently alert. giving your child fluids at home will treat the dehydration and prevent it worsening (see PREVENTING DEHYDRATION IN CHILDREN. Sponge him or her with tepid water. 91 .CHILDREN: ALL AGES Continued from previous page Is your child being treated for diabetes? NO YES POSSIBLE CAUSE AND ACTION If your child has had an epileptic seizure. call an ambulance. Has your child been exposed to hot sunshine or high temperatures recently? NO YES POSSIBLE CAUSE Your child’s symptoms may be due to heatstroke. Is there evidence that your child has had a seizure. call an ambulance.300). However. ACTION While waiting for help. While waiting for help. he or she may need to be admitted to hospital. it may have left him or her drowsy or confused. particularly if the symptoms have come on suddenly. Could your child be using recreational drugs YES or inhaling solvents? NO CALL YOUR DOCTOR NOW IF YOUR CHILD IS DROWSY OR CONFUSED AND YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Is your child taking any prescription drugs or YES over-the-counter drugs? NO POSSIBLE CAUSE Your child may be intoxicated or have alcohol poisoning. lay your child in a cool place and remove all his or her outer clothing. p. POSSIBLE CAUSE Drug or solvent abuse may cause drowsiness or confusion. these symptoms may be the result of a high blood sugar level and may have developed gradually. with or without vomiting. in which a high temperature and dehydration can cause confusion and drowsiness. If your child is able to cooperate. follow the first-aid procedure for unconsciousness (p. you should call an ambulance if your child becomes unconscious. you should call your doctor immediately if your child has not previously been diagnosed as having epilepsy: he or she needs to be assessed promptly. In most cases. However. If your child becomes unconscious. consult your doctor. offer him or her cool drinks. If you think your child is becoming dependent on drugs. call your doctor at once. including antihistamines and anticonvulsants. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION Drowsiness or confusion may be a side effect of some drugs. Delay discussing the problem with your child until he or she is well enough to understand. if your child is very unwell or unable to drink sufficient fluids to treat the dehydration. in the past 24 hours? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your child’s symptoms may be due to dehydration.123). p. If your child is taking a prescribed drug. ACTION Watch your child carefully while he or she seems confused or drowsy. If your child has been diagnosed as having epilepsy. If your child becomes unconscious. consult your doctor because your child’s treatment may need adjusting. give him or her something very sweet to eat or drink. ask your doctor’s advice before the next dose is due. Could your child have been drinking alcohol? NO YES ACTION Encourage your child to drink plenty of water. Less commonly. and wait for the effects to wear off. ACTION Your doctor will examine your child to assess how severely dehydrated he or she is. However. This should correct a low blood sugar level and will do no harm if the sugar level is too high. Your child should stop taking any overthe-counter drugs.or herself NO YES Has your child had diarrhoea.311). POSSIBLE CAUSES Confusion or drowsiness in children with diabetes may indicate a low blood sugar level.

also improve balance. and may often accidentally knock things over. Some children naturally acquire these skills later than others. p. Avoid letting anyone be openly critical of your child’s clumsiness. jigsaws. Your doctor may arrange for your child to be seen in hospital for tests to determine the diagnosis and appropriate treatment. especially some prescribed for epilepsy. such as ballet. physical coordination. You can help your child by encouraging him or her to take up sports and hobbies that improve physical skills (see IMPROVING COORDINATION. Moving to music Dancing is a fun way to help a child learn to coordinate body movements. later on. 92 . may cause clumsiness. ACTION Provide your child with plenty of enjoyable opportunities to improve his or her physical skills (see IMPROVING COORDINATION. right). hopping. scribbling on scrap paper is an important stage in the development of writing and drawing skills. or to an underlying disorder of the muscular or nervous system. Consult your doctor. Athletic skills Running. Improving coordination SELF-HELP Some children learn physical skills easily and are naturally better coordinated than others. Explain the dangers and give support. You and your child may be taught special exercises to do together to improve your child’s coordination and dexterity. Clumsiness may also result from drug or solvent abuse. Has your child had unexplained headaches or vomiting since the onset of the clumsiness? YES NO POSSIBLE CAUSES AND ACTION Certain drugs. Disciplined forms of dancing. They have difficulty in carrying out delicate tasks.141). Is your child taking any prescribed drugs. although poor vision can be an unrecognized cause. physical grace. you can help your child develop coordination and manual dexterity to the best of his or her abilities by providing opportunities for varied physical activities. do not stop any prescribed drugs. Such clumsiness is START HERE Is your child under 3 years old? NO YES POSSIBLE CAUSE Most children under 3 years old are still developing physical coordination skills. POSSIBLE CAUSE A natural tendency to mild clumsiness is a characteristic that some children are born with and is likely to be more noticeable when they are anxious. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Consult your doctor. Swimming and ball games are good exercises for children of any age. CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION A potentially serious nervous system disorder is a possibility. a condition also known as developmental coordination disorder. consult your doctor or a self-help group (see USEFUL ADDRESSES. Children vary greatly in their levels of manual dexterity. and agility. or do you think your child could be taking recreational drugs or YES inhaling solvents? NO ACTION Do not scold your child for his or her clumsiness because this is likely to make things worse. Some children are slower to develop these skills than others. Other toys that are good for improving hand–eye coordination include building blocks. such as sewing or woodwork. and some computer games. Games and hobbies Placing cut-out shapes in a frame helps young children develop the hand–eye coordination needed to learn manual tasks.311). However. These often result in a marked improvement. Does the clumsiness significantly interfere with his or her school performance or day-to-day activities? Has your child always been clumsy? NO NO YES YES POSSIBLE CAUSES Severe clumsiness may be due to dyspraxia. If you suspect this (see RECOGNIZING DRUG AND SOLVENT ABUSE. ACTION Your doctor may refer your child to an occupational therapist or other specialist to be assessed.CHILDREN: ALL AGES 23 Clumsiness unlikely to be a sign of an underlying disease. p. such as tying shoelaces. Similarly. and jumping help young children to improve their coordination. talk to your child to try to find out if he or she is abusing drugs. This is hardly ever a cause for concern. below). Severe clumsiness that has come on suddenly or that follows a head injury may result from a serious problem with the nervous system and needs urgent medical attention. and agility. Meanwhile. If your child is unwilling or unable to stop or denies drug usage.

ACTION Your doctor will assess your child’s hearing and general development. By age 2. POSSIBLE CAUSES Children under about 2 years who talk late or little are usually just late developers (see SPEECH DEVELOPMENT. Boys are often slower than girls. • Try not to speak too quickly. YES Is your child’s speech hesitant. Consult your doctor. In some cases. ACTION Your doctor will assess your child’s hearing and general development. Consult this chart if your child has any problem with his or her speech. and/or does he or she lisp? NO POSSIBLE CAUSES Delayed understanding of speech and language may be due to a hearing problem or generally delayed development. such as “Give teddy to mummy”. such as “z” and “th”. you will be given advice on encouraging your child to talk (below). Older children may be reluctant to speak because of an emotional problem. By about 1 year of age. or does he or she stutter? NO YES POSSIBLE CAUSES There is a wide variation in the age at which sounds are produced clearly (see SPEECH DEVELOPMENT. speech difficulties may cause behaviour and school problems. • Use actions to help your child associate words with objects and events. In some children. it is wise to seek START HERE Are you YES worried that your child is late in starting to talk or talks too little for his or her age? NO Does your child seem to understand as much as other children of a similar age? NO YES Speech development Language skills vary widely among children. lack of understanding may be caused by a language disorder. Your child may be referred to a speech therapist and may need treatment if he or she has a hearing problem. Consult your doctor. Your doctor may refer your child to a speech therapist to learn strategies that will help improve his or her speech. lack of clarity. If not addressed early. a child’s pronunciation is usually clear enough for most of his or her speech to be understood by a stranger at age 3. such as cerebral palsy. such as a delay in starting to talk. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. try to encourage your child to talk (below). Minor difficulties in producing certain speech sounds are normal in children up to the age of 7. he or she may request a more detailed assessment from a speech therapist. delayed speech is due to a hearing problem or a disorder that affects speech production.CHILDREN: ALL AGES 24 Speech difficulties the advice of your doctor or health visitor. or stammering. If necessary. but. SELF-HELP Encouraging your child to talk Helping a baby talk It is important to talk to your baby as often as possible because babies learn by imitating the people around them. • Let your child mix with children and adults. Do strangers have difficulty understanding your child. However. unclear speech may occasionally be due to a problem with the mouth or with hearing. • Look at your child when you speak. A speech therapist will usually be able to improve your child’s ability to communicate effectively. such as anxiety. talk to your child frequently. In a few children. ACTION Your doctor will assess your child’s hearing and examine his or her mouth. most children can use simple sentences and have a good basic vocabulary. your child will be referred to a speech therapist for specific advice and treatment. Some children are slower to speak and develop vocabulary than others. Some children may need a specific programme of speech therapy. Such difficulties often improve with time. and by age 3. Meanwhile. most children are able to recognize a few phrases and can say single words. POSSIBLE CAUSE AND ACTION Hesitant and stuttering speech is common between the ages of 2 and 4 and does not usually need treating: most children will grow out of their speech difficulties given plenty of reassurance and encouragement. some sounds. • Use simple books and nursery rhymes to extend your child’s vocabulary. may still not be pronounced clearly until the child is about age 7. in which verbal information cannot be processed or produced normally. above). above). 93 . defects in pronunciation. Although. • Try not to interrupt your child when he or she is speaking. you should consult your doctor regardless of the age of your child. Consult your doctor. If there is no obvious cause for your child’s speech delay and he or she appears to be a late developer. are usually understood. However. The following measures should help to stimulate and encourage your child to speak: • From birth. in most cases. simple instructions.

most of these problems are outgrown. If you are upset by the tantrums. However. Perception of what constitutes a behaviour problem varies widely between parents. ACTION Try to discover and deal with any underlying worries that your child has. Also try to ignore other people who appear to be disapproving. and such problems are unlikely to persist. POSSIBLE CAUSE Drug or substance abuse often results in behaviour problems. during which he or she has violent temper tantrums if his or her wishes are frustrated. This is normal. consult your doctor. It will help you to decide if help from your doctor is advisable. many others need to be educated in special schools. p. it is also a good idea to tell your child’s teachers if there are problems at home. consult your doctor. unless he or she could be injured. ACTION Talk to your child to try to find out whether there is an underlying problem. Autism varies in severity. Try not to get aggressive or angry. Your child may have periods of self-assertion. ACTION Provide your child with love and support. At some stage.141)? NO YES POSSIBLE CAUSE If your child seems to fall into this category and also has difficulty relating to other people. It is often a time of alternating moods. even if it is by doing something as minor as nail-biting (see HABITUAL START HERE Is your child over 12 years old? NO YES Go to chart 52 ADOLESCENT BEHAVIOUR PROBLEMS (p. 94 . he or she may have a form of autism.140) Go to chart 26 SCHOOL DIFFICULTIES (p. most children will behave in a way that causes their parents concern. Although some children can be helped by speech and language therapy. but. Your child will grow out of this phase. Giving your child support may provide him or her with the self-confidence to stop. If your child’s behaviour does not improve after a few weeks. try to keep calm and to ignore the behaviour.311). and check with your child’s school to make sure that there are no particular problems there. opposite). consult your doctor or health visitor for advice and support. if you feel unable to cope with his or her behaviour. p. This condition is more common in boys and is usually apparent by 3 years of age. ACTION Your doctor may refer your child to a specialist for an assessment. These may alternate with periods when he or she feels insecure and refuses to be separated from you. is necessary. Such behaviour can make the “terrible twos” a very trying time for parents. Continued on next page SELF-HELP Coping with the “terrible twos” If your child has temper tantrums. If you think your child is becoming dependent on drugs. in the meantime. who will advise you whether further help.CHILDREN: ALL AGES 25 Behaviour problems BEHAVIOUR. such as the arrival of a new baby or parental separation. Seek support from other parents of similar-aged children. The period around the age of two years is a time during which children are beginning to appreciate that they have a separate identity and are able to influence their environment. such as the arrival of a new baby? YES NO YES Do any of the following apply to your child? • Avoids eye contact • Engages in repetitive behaviours • Has poor language skills NO Could your child be using recreational drugs or inhaling solvents (see YES RECOGNIZING DRUG AND SOLVENT ABUSE. such as referral to a child guidance clinic. can often have a temporary effect on a child’s behaviour. Consult your doctor. it is better to leave the room than to show signs of distress yourself. If your child’s behaviour does not improve with time and extra support. consult your doctor. YES Has the problem started recently? NO Has there been a recent change at home. This chart covers some of the more common or serious behaviour problems that parents have to cope with. Advice and support are also available from many self-help groups (see USEFUL ADDRESSES. POSSIBLE CAUSE Children often go through phases of upsetting behaviour. If your child is at school. but provide him or her with plenty of love.96) Is the behaviour problem mainly connected with schoolwork or with behaviour at school? NO POSSIBLE CAUSE Anxiety over a recent event.

Many young children also go through a period of particularly difficult behaviour known as the “terrible twos”. Consult your doctor. Children are often unaware of habitual behaviour. Children with this condition need extra support and help both at home and in school. Although the disorder often continues through adolescence. You may be taught various techniques to improve your child’s behaviour. or behave violently or aggressively? NO YES POSSIBLE CAUSE Children are often rebellious. who are constantly active and disruptive may have attention deficit hyperactivity disorder (left). disruptive. consult your doctor or health visitor. ACTION Your doctor will probably refer your child to a specialist to confirm the diagnosis. and unable to concentrate may have attention deficit hyperactivity disorder (ADHD). Is your child easily bored. Has your child become unusually withdrawn and lost interest in activities that he or she previously enjoyed? NO YES Is your child unruly. Children with ADHD often have low self-esteem because of frequent scolding or criticism. noisy. However. habits such as breath-holding attacks (p. draw your child’s attention to it when it occurs. To stop a habit. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND AN EXPLANATION FOR YOUR CHILD ’ S BEHAVIOUR ON THIS CHART AND YOUR CHILD CONTINUES TO BEHAVE IN A WAY THAT WORRIES YOU . and your child may be given drugs that will help calm him or her. a habit that may persist into adulthood. often unaware that they are doing so. Rarely. However. Is your child under 4 years old? NO YES Attention deficit hyperactivity disorder Young children are normally very active. ACTION Your doctor may refer your child to a specialist for assessment. Your child may also benefit from being taught in small groups. such as anger. Does your child steal. when they should be persuaded to stop to prevent the adult teeth being pushed out of position. follow the advice for coping with the “terrible twos” (opposite). Consult your doctor. and try to remove or reduce any sources of stress that may be contributing. behavioural problems may become less severe if the treatment is started early enough. and aggressive and may also have difficulty making friends. If you are worried. impulsive. he or she may have a condition known as a conduct disorder. restless. who will assess your child’s behaviour and may refer him or her to a child psychologist. consult your doctor. lie. Children with ADHD (usually boys) may be destructive. this can lead to hair loss. but do not get angry. you feel that you cannot cope. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND AN EXPLANATION FOR YOUR CHILD ’ S BEHAVIOUR ON THIS CHART AND YOUR CHILD CONTINUES TO BEHAVE IN A WAY THAT WORRIES YOU . and/or disruptive? NO YES POSSIBLE CAUSE Although this type of behaviour is normal in small children. Meanwhile. About a third of children bite their nails.87) may be used to manipulate parents. 95 . Such behaviour is very hard to deal with and requires patience and understanding. Some may continue up to the age of 6 or 7. at any stage. If you suspect that your child may have ADHD. and some also need drug treatment. They may provide comfort from stress or be a means of expressing emotion. and disobedient? NO POSSIBLE CAUSES Both depression and anxiety can cause these symptoms. If. Twirling the hair Children of all ages may play with their hair. Offer support and encouragement.CHILDREN: ALL AGES Continued from previous page Habitual behaviour Childhood habits. such as nail-biting. POSSIBLE CAUSE It is normal for small children to test the rules and disobey their parents. a child who is excessively restless. Thumbsucking is common in children under 3. long-standing behaviour problems may be difficult to change. YES ACTION Talk to your child to see if there is a reason for his or her behaviour. if your child is persistently antisocial. consult your doctor. unable to concentrate. child psychiatrist. If your child’s symptoms persist for more than 2 weeks or worsen. irritable. or violent. particularly boys. impulsive. ACTION All children grow out of this behaviour. or paediatrician. are common and rarely do any serious harm. Child guidance or family therapy will probably be needed. consult your doctor. schoolage children. In some cases. However.

spreading unpleasant stories. Your doctor may liaise with the school medical services. Discuss the problem with your child’s teachers. If your child is a bully. Occasionally. Has your child’s general school performance declined over the past few weeks or months? NO YES Has there been a recent change at home. Speech and occupational therapy may also be helpful. The bully needs help. In some cases. In many cases. If your child’s work does not improve with time and extra support. Continued on next page Bullying Bullying can take many forms. It is also a good idea to tell your child’s teachers if there are problems at home. He or she may not want to go to school. who may be able to reassure you. consult your doctor. consult your doctor. extra support in school may be necessary. and excluding children from groups. physical disorders. A child who is being bullied is singled out for attention by the bully and may become very unhappy and insecure. such as referral to a child guidance clinic. For example. are also possibilities. such as a new baby or parental separation. If your child is being bullied. POSSIBLE CAUSE Upset over a change in a child’s home circumstances. your doctor may advise further discussions with your child’s teachers before arranging specialist help. too. who will advise you whether further help. Schools should have a policy on bullying. and those concerned with behaviour. Further tests may be arranged. or which may arise from a general developmental problem. such as poor eyesight or an unrecognized illness.CHILDREN: ALL AGES 26 School difficulties difficulties. Bullying is especially common in primary school. ACTION Your doctor will probably examine your child and check his or her hearing and eyesight. such as reading. 96 . namecalling. often has a temporary effect on a child’s schoolwork. it is important that you make it clear that this behaviour is harmful and unacceptable while trying to find the cause. such as worry about bullying (below). including classroom behaviour and reluctance to go to school. it includes teasing. is necessary. and then consult your doctor. such as impaired hearing. Most slow learners can be helped with extra teaching. it is vitally important that you reassure him or her that the bullying is not his or her fault. whether of a specific subject or of schoolwork in general. as will children with physical problems. difficulty in reading and writing is known as dyslexia (opposite). Build up your child’s self-esteem. is not contributing to your child’s difficulties. As well as physical violence. it may be necessary for a child to attend a special school. such as YES the arrival of a new baby? NO Does your child have difficulties in only one or two specific areas. POSSIBLE CAUSE A child whose general development is normal for his or her age but who has problems in one area is said to have a specific learning difficulty. or social factors. If no physical disorder is found. which may be the result of emotional problems. or maths? NO YES POSSIBLE CAUSES A sudden decline in school performance for no obvious reason may be the result of a physical problem. Your family doctor and the school medical services may also be able to help. Consult this chart if your child has any such START HERE Is your child’s YES difficulty with school mainly or solely concerned with learning? NO Has your child YES always been a slow learner compared with other children of a similar age? NO POSSIBLE CAUSES Some learning difficulties may simply be due to late development. in which case your child will probably catch up with other children over the next few years. and talk to his or her school. ACTION Your doctor will probably examine your child to make sure that a physical problem. Work with your child’s school to encourage your child as much as possible. If your child does not appear to be keeping up. Children who have emotional problems will be slower to learn. and his or her schoolwork may suffer. ACTION Discuss your child’s progress with his or her teachers. such as a deterioration in hearing or eyesight. and consult your doctor. who will examine your child and may arrange a developmental or psychological assessment. ACTION Try to discover and deal with any underlying worries that your child has. spelling. Discuss the problem with your child’s teachers initially. bullying is an expression of an underlying problem such as a need for attention. School difficulties fall into two main groups: those related mainly to learning. Discussion with school staff usually helps the situation. Social distractions or anxiety.

a dislike of school may progress into a refusal to attend school. by anxiety over separation from his or her parents. Talk to your child’s teachers and your doctor. Adjustments may need to be made to your child’s schoolwork so that it meets his or her needs more closely. They should be able to arrange for a formal assessment of your child and subsequent support (see also USEFUL ADDRESSES. such as stealing. Your child’s school should have a policy for dealing with bullying. Dyslexia Dyslexia means difficulty with words. it may be necessary for your child to receive extra teaching or help through a child guidance clinic. In the meantime. leading to boredom. restless. opposite). For example. is more common in adolescents. In some cases. Is your child’s behaviour at home acceptable? NO YES Reading Children with dyslexia need extra support and patience when learning to read. If not tackled. There may be a problem at school. YES • Money or belongings are frequently “lost” at school. It is also wise to discuss the problem with your child’s teachers. SCHOOL DIFFICULTIES THAT HAVE NOT BEEN DESCRIBED ON THIS CHART SHOULD BE DISCUSSED WITH YOUR CHILD ’ S TEACHERS . in a young child. it may be necessary to refer your child to a child guidance clinic. it is due to bullying (opposite) or the influence of friends. and you can help by building up your child’s confidence. Early signs include difficulty in learning to read. In some cases. Has your child become reluctant to go to school? NO YES Does your child resist all attempts to get him or her into school? NO YES Have teachers complained about your child’s behaviour YES at school? NO POSSIBLE CAUSES Dislike of school may be caused by a variety of factors. refusal to go to school is caused by anxiety at home or. Depending on the cause of the problem. unable to concentrate. If you think your child may be dyslexic. ACTION If problems persist despite intervention at school. Dyslexia is not linked to low intelligence.311). ACTION Try to discover the underlying cause of your child’s refusal to go to school so that it can be dealt with. talk to your doctor and your child’s teachers. ACTION Try to find out the cause of the problem. • He or she comes home with broken belongings. and discuss your child’s feelings with his or her teachers so that they can watch out for signs of bullying (opposite). Y OUR DOCTOR ’ S ADVICE MAY ALSO BE HELPFUL IN SOME CASES . poor behaviour at school may be due to bullying (opposite). Children with this condition need extra support at home and in school. Long-standing behaviour problems may be difficult to change. Your child may be having difficulties with work at school or be afraid of certain teachers or pupils. school-age children who are constantly active and disruptive may have attention deficit hyperactivity disorder (p. Occasionally. Do not keep your child at home.CHILDREN: ALL AGES Continued from previous page Has your child been playing truant? NO YES Do any of the following apply to your child? • He or she often comes home with unexplained bruises or cuts. and some need drug treatment. NO POSSIBLE CAUSE Truancy combined with other antisocial behaviours. even if your child is initially reluctant to admit it (see BULLYING. POSSIBLE CAUSES School refusal may be a sign that something is seriously wrong. or it may be too difficult. and make every effort to ensure that your child attends school. Bullying or other violence at school should be taken very seriously.94) 97 . possibly because of an unrecognized learning difficulty. discuss the problem with your child’s teachers. and speak to his or her teachers. or a failure of the school to meet the child’s needs. Is your child easily bored. He or she may recommend you seek help for your child through a child guidance clinic. resulting in loss of interest. POSSIBLE CAUSE This type of problem may be due to bullying. ACTION Talk to your child to try to uncover the cause of the problem. ACTION Talk to your child about the situation. ACTION Your doctor will probably refer your child to a specialist to confirm the diagnosis. Consult your doctor. In some cases. Go to chart 25 BEHAVIOUR PROBLEMS (p. and spell. such as bullying (opposite). impulsive. Bad behaviour may also be the result of rejecting authority. p. and/or disruptive? NO YES POSSIBLE CAUSE Although this type of behaviour is normal in small children.95). children starting a new school may be anxious. If the situation does not improve. POSSIBLE CAUSES Bad behaviour that is confined to school can be due to a number of problems. Schoolwork may be too easy. write. consult your doctor. help through a child guidance clinic may be arranged by your doctor.

opposite). DISTURBED OR (p. keep him or her away from other children and do not let him or her share face cloths or towels until the symptoms have cleared up. may cause pain. as in most cases the ducts open naturally by the time a child is 1 year old. and/or discharge from one or both eyes. such as arthritis. the injury will be assessed. You should also seek medical help if home treatment is not effective. POSSIBLE CAUSE AND ACTION An eye injury always requires immediate medical attention because there is a risk of permanent damage. inflammation of the coloured part of the eye. Blocked tear ducts are common in babies. or if the eye remains sore for more than an hour after removing the foreign body. Wash your hands thoroughly. While waiting for the ambulance. are unsuccessful. This is inflammation of the membrane covering the white of the eye and the inside of the eyelids due to infection by bacteria. In children. carry out self-help measures (see TREATING EYE INJURIES. redness. Iritis needs immediate treatment with corticosteroid eye drops or tablets to prevent permanent damage to vision. These are narrow passages that lead from the inner corner of the lower eyelid to the inside of the nose. pus-like discharge from the eye? NO YES Does the white of the eye look bloodshot? NO ACTION Your doctor will probably prescribe antibiotic eye drops or ointment. 98 . such as a piece of grit or sand. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Iritis. redness. itching. To prevent your child spreading conjunctivitis. the doctor may refer your child to a specialist for treatment. In some cases. If a blocked tear duct has not opened by the age of 1 year. Excess tears drain away through the tear ducts. This is inflammation of the membrane covering the white of the eye and the inside of the eyelids due to allergy. surgery will be needed. Is there a sticky. He or she may also advise you on self-help measures for coping with conjunctivitis (opposite). and carry out self-help measures for treating eye injuries (opposite). see chart 28. chemical irritation. The duct may have to be opened with a thin probe under a general anaesthetic. is a possibility. you should consult your doctor. IMPAIRED VISION For blurred vision in children. However.CHILDREN: ALL AGES 27 Eye problems cases. t EMERGENCY! CALL AN AMBULANCE SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Bacterial conjunctivitis is likely. ACTION Your doctor will refer your child to a specialist for a detailed eye examination and for other tests to look for disorders that sometimes occur with iritis. In most START HERE Has your child had an injury causing obvious damage to the eye? NO YES Is there a foreign body. This is not a cause for concern. in the eye. Repeat the massage three or four times a day for 1 or 2 weeks. Try to stop your child rubbing the eye. in the eye? NO YES POSSIBLE CAUSE AND ACTION A foreign body. it is reasonable to treat these problems at home initially. One or both tear ducts may be blocked at birth. and watering. This chart deals with pain. If these measures are not possible. such symptoms are most commonly the result of infection or local irritation. Always seek immediate medical advice about injury to the eye or for any foreign body in the eye that cannot be removed by simple self-help measures. you should seek medical help immediately. tears cannot drain away normally and the eye waters. This technique may help the tear duct to open. Blocked tear duct Tears are produced continuously to clean and moisturize the front of the eye. If a tear duct becomes blocked. such as a piece of grit. or a viral infection. YES Is vision in the affected eye as good as normal? NO Continued on next page YES POSSIBLE CAUSE Nonbacterial conjunctivitis is likely. Massage may help unblock a tear duct.100). and use a forefinger to massage the skin just below the inner corner of the eye in a gentle circular motion. Once in hospital. if you are not sure that conjunctivitis is the cause or if your symptoms persist for more than 48 hours. ACTION The inflammation will usually clear up on its own.

if it is embedded in the eye or rests on the coloured part of the eye. To prevent infection spreading. use a clean piece of cotton wool moistened with warm water to clear away the discharge. which is easily spread. Treating the scalp with an over-the-counter antidandruff shampoo may also result in an improvement in the eyelids. If pus is released. Keep the unaffected eye uppermost to prevent chemicals being washed into it. is the most likely cause of itchy. If your child has conjunctivitis. Do not press down on it. ACTION Your doctor will probably prescribe an ointment to apply to the eyelids. you should try to stop him or her from touching the affected eye. Keep the victim as still as possible while you are waiting for medical help to arrive. Remove the discharge from your child’s eye with warm water and cotton wool as often as necessary. Chemicals in the eye Gently run cold water over the eye for 10 minutes. A foreign body floating on the white of the eye is usually easily removed (right). This condition is often associated with dandruff. POSSIBLE CAUSE A blocked tear duct may be causing your baby’s symptoms. Take the person to hospital. moist handkerchief Foreign bodies in the eye Gently ease the eyelid away from the eye. opposite). It will either burst. scaly eyelids. If there is a visible wound. Consult your doctor. nonfluffy material gently over the eye. ACTION You may be able to help a blocked duct to open by gentle massage (see BLOCKED TEAR DUCT. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. lay the victim down with his or her head elevated and place a pad of clean. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. do not attempt to remove it. releasing pus. Consult your doctor if a stye fails to heal within a week or if styes recur often. try to discourage your child from touching the affected eye. This condition is common in babies and usually corrects itself without treatment by the end of the first year. ACTION A stye will usually clear up within a week without special treatment. Clean. SELF-HELP Treating eye injuries Gloves to protect hands from chemicals You should seek prompt medical attention for a blow to the eye or an eye wound. In rare cases. inflammation of the lid margins. Is there a tender red lump on one eyelid? NO YES Cleaning your child’s eye Do one or both eyes water continuously? NO YES Is your child less than 1 year old? NO YES Gently wipe from the inside to the outer edge of the eye. damp cotton wool Are the eyelids red and itchy? NO YES POSSIBLE CAUSE A stye. Clean. wiping towards the outer side of the eye. If chemicals have splashed into someone’s eye. However. a boil-like infection at the root of an eyelash.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSE Blepharitis. Keep your child away from other children until his or her symptoms have cleared up. 99 . Use a clean piece of damp cotton wool each time. the duct does not open and an operation is needed. but this must be followed by treatment in hospital. immediate self-help treatment (far right) can help minimize damage to the eye. Lift the foreign body off the surface of the eye using the corner of a clean. You can help prevent other family members from catching conjunctivitis by having a separate towel and face cloth for your child. is likely. moist handkerchief. Coping with conjunctivitis SELF-HELP A common cause of conjunctivitis in children is a bacterial infection. or gradually disappear.

Fortunately. Continued on next page. Your child’s vision should be completely normal once the discharge has been gently cleared away from the eyes (see COPING WITH CONJUNCTIVITIS. Consult your doctor. the injury will be assessed and tests. Has your child suddenly lost all or part YES of his or her vision? NO POSSIBLE CAUSE A squint can cause double vision. POSSIBLE CAUSE AND ACTION Sudden loss of vision is always a serious symptom. column 1 Continued on next page. which needs urgent medical assessment. However. you may suspect that your child has an undetected problem with his or her eyesight if he or she squints or always holds books very close to the face. If a squint is not corrected. When your child begins school. disorders causing a sudden disturbance of vision are rare in childhood.302) while waiting for the ambulance to arrive. ACTION In hospital.CHILDREN: ALL AGES 28 Disturbed or impaired vision classroom. t EMERGENCY! CALL AN AMBULANCE SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Blurred vision may be caused by a discharge due to conjunctivitis. pus-like discharge. inflammation of the coloured part of the eye. If iritis is diagnosed.41). ACTION Your doctor will probably prescribe antibiotic eye drops or ointment. Your child may also be admitted to hospital for tests. he or she should receive urgent medical assessment. A head injury resulting in a vision problem or an eye injury always requires immediate medical attention. Serious defects in a child’s vision are usually picked up during a routine eye test. This is because the images relayed to the brain from the eyes are not the same. such as skull X-rays (p. Could your child have taken drugs prescribed for an adult or have eaten poisonous plants or fungi? NO YES POSSIBLE CAUSE AND ACTION Poisoning caused by taking certain drugs.99). which is a bacterial infection. ACTION Your doctor will examine your child’s eyes and will probably refer him or her to an eye specialist. Your child’s eyes will need to be examined by a specialist. the brain will suppress the image from one eye and vision will then fail to develop normally.39) and MRI scanning (p. even if it only lasts a few minutes or affects only one eye. This is a serious symptom. may be carried out in order to determine the appropriate treatment. such as antidepressants. or by eating some types of plants and fungi can cause blurred vision. your child will need urgent treatment with corticosteroid eye drops or tablets to prevent permanent damage to his or her sight. a teacher may notice that he or she performs less well sitting at the back of the START HERE Has your child YES had a recent head injury or an injury to the eye? NO POSSIBLE CAUSE A head injury can affect the part of the brain that is responsible for vision. If your child develops a sudden problem with his or her vision. t EMERGENCY! CALL AN AMBULANCE Has your child been suffering from double vision? NO YES Is there a sticky. Consult your optician if you suspect a problem with your child’s eyesight. and is normal YES vision restored when the eye is cleaned? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE Iritis. t EMERGENCY! CALL AN AMBULANCE WA R N I N G SUDDEN LOSS OF VISION Call an ambulance if your child complains of a sudden loss of sight in one or both eyes. Carry out the firstaid measures for swallowed poisons (p. where it may be difficult to see the board. p. who will explain the different treatment options used to correct a squint (opposite). is possible. which will need to be applied for several days. Is your child’s vision blurred at all distances? YES NO Are one or both eyes red and painful? NO YES ACTION Your doctor may refer your child to a specialist for an eye test and to look for associated disorders such as arthritis. column 2 100 .

your doctor may prescribe painkillers for your child to take during attacks. Retinoscope Lens Letter card held at a set distance Elastic of eye patch Retinoscopy The test is performed in a darkened room. Each eye is tested separately. a vision test also includes careful examination of the retina. column 1 Continued from previous page. 101 .CHILDREN: ALL AGES Continued from previous page. Older children are often tested by being asked to identify letters on cards held at a distance. Consult an optician. The effect of different lenses on the beam of light determines whether vision is normal. Call your doctor to ask whether you should stop giving the prescribed drug. Has this happened in the past. As a result. POSSIBLE CAUSE Longsightedness (difficulty seeing close objects) or shortsightedness (difficulty seeing distant objects) is likely. If a squint is not treated in childhood. Consult your doctor. surgery on the eye muscles may be needed. This may cause double vision or lead to the stronger eye being used in preference to the weaker one. Letter matching test The tester points to a letter and asks the child to identify a matching letter. column 2 Squint A squint is a condition in which only one eye looks directly at the object being viewed. Vision testing in children Simple vision tests are routinely carried out in babies as part of their developmental checks. It is common in babies until the age of 3 months. when their eye muscles and vision improve. Consult your doctor. may begin in childhood. the brain receives different images. which is the lightsensitive membrane at the back of the eye. the vision centres in the brain will fail to develop normally.or long-sighted. A patch worn over the good eye for 1–2 hours a day will ensure that the weaker eye is used. ACTION If migraine is diagnosed. POSSIBLE CAUSE AND ACTION Certain drugs can cause blurred vision as a side effect. Further tests may be recommended if a problem is suspected. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOUR CHILD HAS A VISION PROBLEM AND YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Treatment later in life will not be able to improve vision. Try self-help measures for relieving a child’s headache (p. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOUR CHILD HAS A VISION PROBLEM AND YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. YES ACTION Your doctor will examine your child’s eyes and will probably recommend that your child receives a complete vision assessment carried out by an optician. your child may need glasses and/or referral to a specialist for further treatment. eye drops are given to dilate the pupil. If your child is short. he or she may need to wear glasses. Is your child taking any YES prescribed drugs? NO Does your child have difficulty seeing either near or distant objects? NO POSSIBLE CAUSE A severe focusing disorder may cause blurred vision at all distances. Depending on the results. and has a severe YES headache followed? NO POSSIBLE CAUSE Migraine.88) and for reducing the frequency of migraine (p. Your child may need to wear glasses. so that they do not work together. which will also correct the squint. An instrument called a retinoscope is used to shine a beam of light through a lens into each of the child’s eyes in turn. below). recurrent severe headaches. Has your child been seeing flashing lights or floating spots? NO YES ACTION The optician will examine your child’s eyes and check his or her vision (see VISION TESTING IN CHILDREN. At all ages. In infants.159). Occasionally. A squint in children over 3 months may be due to an imbalance in the eye muscles or short or long sight in one eye. A beam of light is then shone into each eye in turn using an instrument called a retinoscope. Vision tests for babies and children vary depending on their age. This is especially likely if the condition affects one or both of the parents.

If the pain persists for longer than this. Can you see a red lump inside the ear? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE A viral or bacterial infection of the middle ear is a possibility. Fortunately. Does your child have a cold or a sore throat? NO POSSIBLE CAUSE An infection of the outer ear canal is the likely cause. This action keeps the eustachian tubes open. Air travel is a common cause. ACTION If your doctor confirms the diagnosis. Babies should be bottle. the boil will burst. who will check for ear infection. or pull at the affected ear. It occurs if the eustachian tubes. If the earache worsens or persists. You may accidentally damage the eardrum. Earache is common in children and can be very distressing. Continued on next page POSSIBLE CAUSE AND ACTION Barotrauma.104). such as a bead. Consult your doctor. is possible. YES ACTION If your child has an infection of the outer ear. easing the pain. However. Wake your child for take-off or landing. Barotrauma is most likely to occur during take-off or landing. It can be prevented or minimized by swallowing or by blowing through the nose while holding the nostrils closed. A child who is not old enough to tell you that he or she has an earache may wake unexpectedly in the night and may cry inconsolably. In most cases. shriek loudly. Meanwhile. Avoiding barotrauma SELF-HELP Barotrauma is damage to the eardrum resulting from a pressure difference between the middle and outer ear. such ear infections become less common as children grow up. HEARING (p. Meanwhile. The pain usually improves within 24 hours. see chart 30. However. For hearing problems in children. he or she may prescribe a course of antibiotics. earache is caused by an infection spreading from the back of the throat to the ear (see STRUCTURE OF THE START HERE Does your child complain YES of severe earache or pull at his or her ear? NO Does your child seem unwell or feverish? NO YES WA R N I N G DAMAGE TO THE EARDRUM Never put anything. such as a cotton wool bud. Did your child suddenly develop earache during or immediately after a flight in an aircraft? NO YES POSSIBLE CAUSES The eardrum may be mildly inflamed. which links the throat to the middle ear (see STRUCTURE OF THE EAR IN CHILDREN. opposite). your child may need antibiotics. 102 .or breast-fed during take-off and landing to encourage them to swallow. follow the self-help measures for relieving earache (opposite) to ease your child’s pain. This should relieve the pressure. consult your doctor who will examine your child’s ear. in some cases a problem in the throat can cause pain to be felt in the ear. which connect the ears and throat. in most cases. damage to the eardrum resulting from a pressure difference between the middle and outer ear. POSSIBLE CAUSE A boil in the outer ear canal can cause severe pain. Consult your doctor. ACTION Try self-help measures for relieving earache (opposite). If the child’s ears start to feel uncomfortable. ACTION Your doctor will examine your child. encourage him or her to blow through the nose or suck a sweet.CHILDREN: ALL AGES 29 PROBLEMS Painful or irritated ear EAR IN CHILDREN. become blocked. Preventing barotrauma Tell your child to blow through the nose while holding the nostrils closed. follow the selfhelp measures for relieving earache (opposite). consult your doctor. The infection may have spread via the eustachian tube. opposite). If an infection is confirmed. your doctor may prescribe ear drops that contain a corticosteroid drug and/or an antifungal drug. into a child’s ear in an attempt to clean it or to remove a foreign body. Self-help measures for relieving earache (opposite) should help to make your child more comfortable.

Do not put cotton wool in the ear: this could prevent a discharge from draining out. Hold a warm cloth against a baby’s affected ear. If a skin disorder is diagnosed. Self-help measures for relieving earache (below) may relieve your child’s pain. Consult your doctor. he or she will refer your child to hospital to have it removed. Resting with the affected ear facing downwards will allow any discharge to drain out.CHILDREN: ALL AGES Continued from previous page Structure of the ear in children From the outside. the eustachian tube. The following self-help measures may help to ease the pain of your child’s earache: • Give the recommended dose of painkillers. such as eczema or seborrhoeic dermatitis. The eardrum will heal within a few days. ACTION Your doctor will examine your child’s ears. This relieves the pressure built up within the ear. is shorter and more horizontal than in adults. such as liquid paracetamol or ibuprofen. Your doctor will examine your child and may prescribe antibiotics. In addition. SEE YOUR DOCTOR WITHIN 24 HOURS CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION Your doctor will examine your child’s ears and skin. p. allowing infections to reach the middle ear more easily. preventing drainage and increasing the risk of infection. POSSIBLE CAUSE AND ACTION An infection of the middle ear may have caused your child’s eardrum to rupture. • Encourage your child to sit or lie with his or her head raised on pillows (lying flat may worsen the pain). ACTION Your doctor will examine your child’s ear. he or she may prescribe ear drops containing an antifungal drug and/or a corticosteroid drug. Alternatively. lymphatic tissue that lie close to the back of the throat. Try to stop your child scratching the ear or the surrounding skin. You should also follow the self-help advice for relieving earache (below). There will be no lasting effect on your child’s hearing. Do not put ear drops or olive oil into your child’s ear unless advised otherwise by your doctor. which could prolong the condition and cause infection. Consult your doctor. tend to be larger in children. children’s ears look the much the same as those of adults. If the doctor cannot remove it. they can readily block the eustachian tubes. which connects the middle ear to the back of the throat. However. POSSIBLE CAUSE Certain skin disorders. it may be possible for your doctor to wash it out. Inner ear Middle ear Outer ear Is there a discharge from the affected ear? NO YES Ear canal Eardrum CROSS SECTION OF THE EAR Eustachian tube Does your child have itching or irritation inside the ear? NO Is the pain much worse when you gently pull on YES your child’s ear lobe? YES NO POSSIBLE CAUSE An infection in the outer ear canal may cause a discharge as well as pain and irritation. Easing earache Resting the ear against a covered hot-water bottle with the head slightly raised may help to ease the pain of earache. such as a bead or small piece of food. he or she may prescribe corticosteroid ear drops. 103 . If there is an insect or any other foreign body in the ear canal. into his or her ear. may affect the skin lining the inside of the ear. Consult your doctor.107). If there is an outer ear canal infection. an insect may have flown or crawled into the ear. the adenoids (see TONSILS AND ADENOIDS. Is the skin around the child’s ear red and inflamed? NO YES SELF-HELP Relieving earache POSSIBLE CAUSES Your child may have pushed a small object. • Give your child a hot-water bottle wrapped in a towel to hold against his or her ear.

ACTION Your doctor will probably suggest that you soften any obvious wax using overthe-counter ear drops or olive oil for several days. but this usually lasts for only a few hours. There is a temporary reduction in hearing after short exposure to loud noises. Does your child have. which connects the middle ear to the back of the throat. Other people should not be able to hear the music. your doctor may prescribe an anti-allergy drug.102). This should always be brought to your doctor’s attention. it is likely that the volume is too high. Consult your doctor. Using a personal stereo safely Your child should not turn the volume too loud on a personal stereo. if hearing loss persists. Hearing problems are often not noticed in a child. he or she may be tempted to turn up the volume – for example. If your child always needs to have the television or radio on louder than you think necessary or there is a sudden deterioration in your child’s school performance. p. He or she may recommend that you simply wait for the ear to clear itself. Hearing can be damaged even if the volume is not causing pain. If your child is using headphones. damage to the eardrum resulting from a pressure difference between the middle and outer ears is possible and can lead to a temporary loss of hearing. a blocked or runny nose. consult your doctor. a hearing problem may be the cause. If your child is well. the usual self-help measures for preventing barotrauma should be sufficient (see AVOIDING BAROTRAUMA. However. your doctor may refer your child to a hospital to have it removed. repeated exposure over a long period progressively damages the hair cells in the inner ear that transmit sounds to the brain. POSSIBLE CAUSE Blockage of the outer ear canal by earwax. may be the cause of your child’s hearing loss. However. You should then be able to wash the wax out under a warm shower. such as an antihistamine. so the fact that your child insists that the volume is not uncomfortably high is not a reliable way of judging that the level is safe. Did your child develop hearing loss during or just after a flight in an aircraft? NO YES POSSIBLE CAUSE Barotrauma. If a foreign body is the cause. There may be an accumulation of fluid in the middle ear or debris in the ear canal. Hearing loss and loud music Many older children and adolescents enjoy listening to loud music at concerts or through headphones. or has he or she recently had. ACTION The symptoms of barotrauma normally clear up within a few hours without treatment. Consult your doctor. hearing returns to normal within 2 or 3 weeks without any specific treatment. to exclude external noise.CHILDREN: ALL AGES 30 Hearing problems at routine developmental checks by your health visitor or doctor. consider asking your pharmacist for decongestant nose drops if you need to travel by plane when your child has a cold. they need to be made aware of the potential danger to hearing that this can present. If an allergy is the cause. Consult your doctor if your child’s hearing loss persists or worsens. A useful guide is that if others in the room can hear the music when your child is wearing headphones. or possibly by a foreign body. However. Continued on next page 104 . but you may be the first to notice that your baby is not responding to sounds or learning to speak as quickly as you think he or she should. As barotrauma is more likely to develop if your child has a blocked nose. Hearing problems in babies are often detected START HERE Has hearing loss come on recently? NO YES Does your child have earache at the moment? YES NO Go to chart 29 PAINFUL OR IRRITATED EAR (p. or has he or she been sneezing? NO YES POSSIBLE CAUSE AND ACTION Blockage of the eustachian tube. ACTION In most cases. as a result of a cold or an allergy such as hay fever may account for your child’s hearing loss.102) Did your child have an earache when hearing loss began? NO YES POSSIBLE CAUSE An infection of the outer or middle ear can cause temporary hearing loss that may persist for some time after the infection has cleared up.

p. did you come into contact with someone who had rubella or did you have a fever with a rash? NO YES LOCATION Eardrum Grommet Middle ear Outer ear canal Are you worried that your child has never been able to hear properly? NO YES Grommet in place POSSIBLE CAUSE Your child may have an inherited hearing problem. your doctor may recommend surgical removal of the adenoids and/or the insertion of a tiny tube through the eardrum to drain the fluid (see TREATING GLUE EAR. the child is shown various toys and is asked to identify pairs of toys that have similar sounding names. 105 . allowing air to circulate normally in the ear. The grommet is left in place and usually falls out after 6–12 months. he or she will need additional help with language development at school and home. If your child is found to have a problem with hearing. which measures how loud sounds of various frequencies need to be for the child to hear them. most children are able to cooperate with a simple form of audiometry (p. resulting in reduced hearing. causing hearing problems. The operation to insert a grommet is usually performed under general anaesthesia as day surgery and rarely needs to be repeated. which connects the middle ear and the back of the throat (see STRUCTURE OF THE EAR IN CHILDREN. He or she may suggest anti-allergy drugs such as antihistamines. Hearing tests in childhood Tests to assess hearing are performed throughout childhood as part of routine developmental screening. This type of hearing problem is most likely if there is a family history of such abnormalities. to confirm the diagnosis. in which fluid builds up in the middle ear. For example. Newborn babies can be assessed using tests such as otoacoustic emission. the type of test depends on the age of the child. called a grommet. By age 4. including tympanometry (see HEARING TESTS IN CHILDHOOD.190). Card prevents child lip-reading Child selects toy The McCormick test The doctor prevents the child from lip-reading by covering his or her mouth and then asks the child to identify various toys. through the eardrum.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSES Your child may have glue ear (chronic secretory otitis media). right). ACTION Your doctor will probably arrange for hearing tests. fluid builds up in the middle ear. below). The eardrum then heals. Speech discrimination tests can be used to detect hearing loss in young children who have a simple vocabulary.190) is a test that is also used for adults. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. normal hearing is restored. Tympanometry (p. Although grommets relieve hearing problems caused by fluid build-up. The grommet inserted into the eardrum provides a channel between the middle and outer ear. This condition may be due to an allergy or to persistently enlarged adenoids blocking the eustachian tube. It measures movement of the eardrum in response to sound and is useful in detecting a build-up of fluid in the middle ear. Consult your doctor. such as tree and key. POSSIBLE CAUSE Exposure of the unborn child to rubella and certain other infections can damage hearing. in which a sound is played into the ear and an ear piece measures the resulting echo from the inner ear. in the McCormick toy discrimination test. The grommet allows air into the middle ear and fluid to drain away. ACTION Your doctor will probably arrange for your child to have hearing tests (below). they do not prevent future ear infections. If the fluid persists. ACTION Your doctor will arrange for your child to have hearing tests (below) and may refer him or her to a specialist for assessment. Consult your doctor. which improves hearing. The condition may be treated surgically by inserting a tiny plastic tube. Treating glue ear In the disorder glue ear (chronic secretory otitis media). possibly due to abnormal development of the inner ear or the nerve that transmits sounds to the brain. Do any of the following YES apply to your child? • Suffers from recurrent ear infections • Has a persistently runny or blocked nose • Snores NO During pregnancy.103). In most cases.

your doctor may refer your child to a specialist to see whether it is necessary to remove the adenoids.77). and keep him or her away from areas of long grass. • Give liquid paracetamol. The following measures may help: • Encourage your child to drink fluids. Relieving congestion Inhaling steam from a bowl of hot. All children have a runny or blocked START HERE Has your child YES had a runny or blocked nose for more than 1 month? NO POSSIBLE CAUSE Your child may have enlarged adenoids (see TONSILS AND ADENOIDS. Oral antihistamine drugs may help and are available over the counter.194). antiallergy drugs may help. A runny nose can be irritating for a child. If they do not or if your child develops other symptoms. In some cases. such as a bead or a peanut. Consult your doctor. but in some cases antibiotics are needed to treat it. consult your doctor. may be lodged in your child’s nose and may have caused an infection. If your child has a fever. but not boiling. The infection should then clear up by itself. take steps to reduce it (see BRINGING DOWN A FEVER. p. Your child’s symptoms should begin to improve after a few days. ACTION Your doctor will examine your child and may arrange for hearing tests as enlarged adenoids can cause hearing difficulties. take steps to reduce it (see BRINGING DOWN A FEVER. if the foreign body is difficult to reach. ACTION If possible. ACTION Never try to remove a foreign body from your child’s nose yourself. • Apply a barrier cream. POSSIBLE CAUSE A common cold or other viral infection is probably the cause. Is the discharge from one nostril only? NO YES POSSIBLE CAUSE A foreign body. consult your doctor. This condition is caused by an allergy to pollen and usually occurs in the spring or the summer. This is common in children and is often the result of an infection or allergies. POSSIBLE CAUSE Seasonal allergic rhinitis (hay fever) is a possibility. Consult your doctor. 106 . keep your child inside when the pollen count is high. such as petroleum jelly. watery discharge from both nostrils? NO YES Treating a child with a cold SELF-HELP Children often have 4–6 colds a year until their bodies start to build up immunity to the numerous viruses that can cause a cold.77). If these measures do not help. consult your doctor.107). If they do not or if your child develops other symptoms. Towel keeps vapour in Bowl of hot water Are your child’s eyes itchy? Does your child have a green or yellow discharge from the nose? YES NO NO YES POSSIBLE CAUSE A common cold or other viral infection is probably the cause. try giving him or her the recommended dose of children’s nose drops before a feed. If your child gets a nosebleed from picking or blowing a blocked nose. ACTION Follow the self-help measures for treating a child with a cold (right). and. Children should always be supervised. p. your child may need to be admitted to hospital for a minor operation under general anaesthetic to remove it. ACTION Follow the self-help measures for treating a child with a cold (right). • If your baby has difficulty feeding because of a blocked nose. • Keep the air in your child’s room moist by placing wet towels near a radiator or by using a humidifier. Infections are particularly common after a child joins a playgroup or school. and a blocked nose can be distressing for a baby because it makes feeding difficult. • Try to teach your child to blow his or her nose one nostril at a time. The adenoids shrink as a child grows and are rarely a problem after the age of 8. If your child has a fever. around your child’s nose and upper lip to prevent soreness. Does your child have a clear. Your child’s symptoms should begin to improve after a few days. a common cold is responsible. If the symptoms are severe. in most cases. follow the treatment advice for nosebleeds (p. water can help clear a blocked nose. because you may only force it further into the nose. but neither symptom on its own is likely to be a sign of serious disease. p. Your doctor may be able to remove the obstruction. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. However.CHILDREN: ALL AGES 31 Runny or blocked nose nose from time to time (often accompanied by sneezing).

ACTION Your doctor may take a swab of your child’s throat to confirm the diagnosis. Treatment is with antibiotics. the following measures may help to reduce discomfort: • Give your child as many cold. such as milk. In addition. Children may also vomit. • Offer your child throat lozenges if he or she is old enough to suck them safely without choking or swallowing them whole.106). In children. The rash is often most obvious in the folds of the skin. although selfhelp measures for bringing down a fever (p. antibiotics may be needed to treat a bacterial infection. 107 . The tonsils are situated on either side of the back of the throat. however. An older child will usually tell you if his or her throat hurts. Your doctor will examine your child and may prescribe antibiotics. non-acidic drinks. Consult your doctor if your child is no better within a few days. Tonsils and adenoids The tonsils and adenoids are part of the lymphatic system (p. If your child’s symptoms have not improved within a few days. such as the armpits. try self-help measures for soothing your child’s sore throat (below). Now. ACTION Follow the self-help measures for soothing your child’s sore throat (left). teach him or her to gargle with warm. as he or she wants. and does he or she appear unwell? NO YES POSSIBLE CAUSE AND ACTION Inflammation of the throat (pharyngitis) and/ or tonsils (tonsillitis) is likely. a viral infection that causes swollen glands. In a baby or a young child. which helps to guard against infection. and/or does he or she have a runny nose? NO YES Eustachian tube opening Tongue Tonsils LOCATION OF TONSILS AND ADENOIDS POSSIBLE CAUSE Inflammation of the throat as a result of a minor viral infection or irritation is the likely cause of your child’s sore throat. Soothing your child’s sore throat SELF-HELP If your child has a sore throat. In a few cases. In the past. SEE YOUR DOCTOR WITHIN 24 HOURS Does your child have a red rash affecting the trunk and limbs? NO YES POSSIBLE CAUSE Scarlet fever. this procedure is only carried out if a child has severe recurrent infections. There is no specific treatment for glandular fever. may cause a sore throat. Using a straw may make drinking easier. consult your doctor. • Offer ice cream and ice lollies to eat.17). a bacterial throat infection is possible. Most sore throats are the result of minor viral infections that clear up within 2–3 days without the need for medical treatment. Has your child been sneezing.CHILDREN: ALL AGES 32 Sore throat by swallowing. ACTION Follow the self-help measures for treating a child with a cold (p. The inflammation is due to a bacterial or viral infection. POSSIBLE CAUSE A cold or other viral infection may be causing your child’s sore throat.77) and soothing a sore throat (below) may help to relieve symptoms. the adenoids are at the back of the nose. Sore throats are common in childhood. he or she may arrange for a blood test to confirm the diagnosis. the first sign you may have that something is wrong may be a reluctance to eat because of the pain caused START HERE Does your child have a temperature of 38°C (100°F) or above? NO YES Does your child have tender lumps or swellings in the armpit and/or groin? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Glandular fever (infectious mononucleosis). Tonsils and adenoids naturally tend to shrink with age. • Give liquid paracetamol. ACTION If your doctor suspects glandular fever. the tonsils and/or adenoids were often removed. inflammation of one or both of these tissues due to an infection is common. • If your child is old enough. near the openings of the two eustachian tubes. salty water. Adenoids Nasal cavity SEE YOUR DOCTOR WITHIN 24 HOURS Is your child reluctant to eat solid foods.

39). and you should consult your doctor if you are concerned. can be a symptom of asthma. • Moisten the air in your child’s room by hanging a wet towel in front of a radiator. If the results indicate that your child has asthma. your child may need to go into hospital for the object to be removed. A runny nose can cause a cough.CHILDREN: ALL AGES 33 Coughing airways. These may be given via a pressurized inhaler. Coughing is a normal protective reaction to irritation of the throat or lungs. follow the first-aid measures for choking (p. placing a bowl of water in the room. Is your child’s breathing abnormally noisy or rapid (see CHECKING YOUR CHILD’S BREATHING YES RATE. Continued on next page 108 . In babies under 6 months. such as an X-ray (p. In older children. • An older child may cough less during the night if he or she sleeps propped up on two or three pillows. Once in hospital. and does he or she seem very unwell? YES NO ACTION Your doctor will examine your child and may arrange for a chest X-ray (p. p. This may involve your child having a general anaesthetic. such as colds. Is your child less than 1 year old. the doctor may initially prescribe bronchodilator drugs. such as a bead. Small children will need a face mask to help them inhale the drugs effectively.39). and monitoring. POSSIBLE CAUSE Your child may be choking on an inhaled foreign body. or pneumonia.110) Relieving a coughing fit in a young child Sit your child on your lap and gently pat his or her back in order to loosen any sputum.294). or by using a humidifier. p. your child will be examined and any foreign body will be removed. infection of the air spaces in the lungs. If a foreign body is lodged in an airway. YES POSSIBLE CAUSE Coughing under these circumstances is likely to be due to asthma. coughs are unusual and can be a sign of a serious lung infection if the child is also unwell. causing severe irritation. A cough at night. ACTION Your doctor will examine your child and may assess his or her breathing (see MEASURING PEAK FLOW RATE. The object may have lodged in an airway. ACTION Your doctor will examine your child and may arrange for him or her to go into hospital for tests. even if it is not accompanied by wheezing. If your child has a troublesome cough. the vast majority of coughs are due to minor infections of the throat or upper START HERE Did your YES child’s cough start suddenly within the last few minutes or hours? NO Is your child YES distressed and/or coughing continuously? NO WA R N I N G DANGER SIGNS Call an ambulance if your child is coughing and he or she develops any of the following symptoms: • Abnormal drowsiness • Blue-tinged lips or tongue • Inability to speak or make sounds CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your child may have inhaled a foreign body. a viral infection of the small airways in the lungs. possibly under general anaesthesia. Treatment may include giving oxygen and antibiotics.197). ACTION While waiting for help to arrive. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSES Bronchiolitis.110)? NO SELF-HELP Relieving a cough Does your child’s coughing occur under any of the following circumstances? • At night • After exercise • When out in the cold NO POSSIBLE CAUSES Noisy or rapid breathing in a child may be the result of a potentially serious lung problem. you may find one or more of the following measures helpful in providing relief: • Give your child plenty of warm drinks. particularly at night as fluid drips down the back of the throat and causes irritation. are possibilities. Go to chart 34 BREATHING PROBLEMS (p. Consult your doctor.

ACTION Take steps to lower your child’s temperature (see BRINGING DOWN A FEVER. but symptoms are rarely severe enough for the child to need hospital admission. If these do not help. which are more likely in children aged under 1 year. POSSIBLE CAUSE AND ACTION A smoky atmosphere and smoking itself will irritate a child’s throat and lungs. consult your doctor. removal of the tonsils and/or adenoids is advised. a mild attack of whooping cough (pertussis). Does your child always have a runny nose? NO YES Does your child have any of the following? • Frequent ear infections • Nasal speech • Snoring • Poor hearing NO YES Does your child have a temperature of 38˚C (100˚F) or above and/or YES a runny nose? NO POSSIBLE CAUSES A common cold or other viral infection is a possibility. may be the cause. Antihistamines. causing a persistent cough. and follow the self-help measures for treating a child with a cold (p. 109 . POSSIBLE CAUSE Perennial allergic rhinitis may be the cause. who may prescribe alternative drug treatment. may provide relief. uncontrollable coughing. or mold spores causes symptoms all year round. ACTION Your doctor will probably prescribe antibiotics to reduce the chance of your child passing the infection on to others. an infectious disease that causes bouts of severe. may result in permanent damage to the lungs. In this condition. an infectious disease that causes bouts of coughing. you should persuade him or her to stop. Consult your doctor. they should avoid smoking in the home.107). animal fur.105) or refer your child to a specialist. If your child develops a rash or is no better within 2 days. If your child has begun to smoke. This is especially likely if he or she has not been vaccinated against measles. although symptoms often improve as the child grows up. Episodes of coughing may persist for several months. Adenoids rarely cause a problem in children over 8 years. The infection is much less serious in children who have been immunized than in those who have not. if a rash also develops. Consult your doctor. Coughing may persist for several weeks.77). which can block the airway. your child may have measles. In some cases. your doctor may send your child to hospital for treatment. an allergic reaction to substances such as house dust. Does anyone in the home smoke. Does your child have bouts of uncontrollable coughing followed by a noisy intake of breath. ACTION If you think you know the trigger for your child’s allergy. Severe cases of whooping cough. If the condition is severe. consult your doctor. and/or is coughing often accompanied by vomiting? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE Your child may have whooping cough (pertussis). If family members continue to smoke. which are available over the counter. POSSIBLE CAUSES Your child may have enlarged tonsils or adenoids (p. The longer he or she smokes. However. ACTION Your doctor will probably prescribe antibiotics for your child to reduce the chance of him or her passing the infection on to others.CHILDREN: ALL AGES Continued from previous page Has your child been immunized against whooping cough? NO YES POSSIBLE CAUSE Even though your child has been immunized. try to limit his or her contact with it. p.106) and relieving a cough (opposite). the more difficult it will be to give up. ACTION Your doctor will examine your child and may arrange for hearing tests (p. or could your child have been smoking? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

Your child may be admitted to hospital for tests including a chest X-ray (p. Selfhelp measures for relieving a cough (p. t EMERGENCY! CALL AN AMBULANCE WA R N I N G DANGER SIGNS Call an ambulance if your child’s breathing problem is accompanied by any of the following symptoms: • Blue-tinged lips or tongue • Abnormal drowsiness • Inability to speak or make sounds Are any of the danger signs in the warning box (right) present? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION Bronchiolitis. ACTION Your child will need emergency admission to hospital for treatment with oxygen and antibiotics. a viral lung infection. follow the first-aid measures for choking (p. Any child who starts to wheeze needs to be seen by a doctor. Does your child have harsh. t EMERGENCY! CALL AN AMBULANCE Is your child less than 1 year old? NO YES Is your child dribbling or unable to swallow? NO Checking your child’s breathing rate SELF-HELP YES A child whose breathing is unusually rapid when resting or asleep may need medical attention. and oxygen may be given to ease breathing. which is the cause.CHILDREN: ALL AGES 34 Breathing problems that make him or her breathless. in which the throat becomes swollen and narrowed due to a viral infection.39).294). ACTION Your child will be examined in hospital and may have tests such as a chest X-ray (p. POSSIBLE CAUSE Your child’s breathing problems may be due to a serious condition that needs urgent medical attention. The underlying cause will be treated. This condition is now rare because of routine immunization against the Haemophilus influenzae type b (Hib) bacterium. Breathing problems that occur suddenly also need immediate attention. Age of child Up to 2 months 2–12 months CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION Croup. Your doctor may give your child inhaled corticosteroid drugs. Continued on next page 110 . Place your hand on his or her chest or back to feel the breaths. particularly if the problem started while he or she was eating. ACTION While waiting for help to arrive. may have resulted in blockage of the airway. shortness of breath may be less noticeable because a child may simply avoid activities START HERE Have your child’s breathing problems started within the last few minutes? NO YES POSSIBLE CAUSE Your child may be choking on an inhaled foreign body. Check your child’s breathing rate by counting the number of breaths he or she takes in 1 minute. Breathing problems in children include excessively noisy or fast breathing and shortness of breath. Although rapid or noisy breathing is usually obvious. your child will be examined and any foreign body removed. Babies normally breathe faster than older children. In hospital.39) and tests for measuring blood oxygen (p. is a possible cause. noisy breathing YES and/or a barking cough? NO Maximum breathing rate (breaths per minute) 60 50 40 POSSIBLE CAUSE Epiglottitis. is the likely cause.108) may also help. Treatment for the condition may include giving oxygen and bronchodilator drugs. inflammation and swelling of the cartilage flap that prevents food entering the main airway.201). such as a piece of food or a small object. Your child should be resting and not crying. and a child with severe difficulty in breathing needs urgent attention. t EMERGENCY! CALL AN AMBULANCE 1–5 years 5 years and over 30 Assessing your child’s breathing Place your hand on your child’s chest or back and count the breaths in 1 minute. Compare your child’s breathing rate with the normal maximum breathing rate for his or her age. as shown in the table below.

ACTION While waiting for help. • Try to stay calm and keep your child calm. leaning forwards slightly. with his or her forearms supported on a table or the back of a chair. Occasionally.201) and physiotherapy provided. he or she will probably prescribe antibiotics and may arrange for a chest X-ray (p. p.39). you should: • Help your child to sit upright.197). p. If your doctor suspects asthma. He or she may be given oxygen and bronchodilator drugs as well as oral corticosteroids to ease his or her breathing. he or she may suggest treatment with inhaled bronchodilator drugs to relieve the symptoms and may also prescribe inhaled corticosteroids. ACTION Your doctor will examine your child and will probably arrange for tests. While waiting for help to arrive. to determine the cause of his or her rapid breathing and the appropriate treatment.CHILDREN: ALL AGES SELF-HELP Easing breathing in an asthma attack Easing breathing Sit your child upright with his or her arms supported. Once in hospital.197). ACTION Your doctor will examine your child and may measure his or her peak flow rate (see MEASURING PEAK FLOW RATE. your child will be examined and his or her blood oxygen levels measured (see MEASURING BLOOD OXYGEN. POSSIBLE CAUSE Your child may be having a first asthma attack. If the results indicate that your child has asthma. hospital admission is necessary so that a child’s blood oxygen levels can be measured (p.77). your child will be examined. in some cases. your doctor may also prescribe inhaled corticosteroids. In hospital. such as a chest X-ray (p. Is your child wheezing now? NO YES CALL YOUR DOCTOR NOW IF YOUR CHILD HAS A BREATHING PROBLEM NOT DEALT WITH IN THIS CHART. Do not leave him or her alone. he or she may initially be prescribed bronchodilator drugs. CALL YOUR DOCTOR NOW POSSIBLE CAUSES Rapid breathing may be due to a serious heart or lung disorder or.201). It will be easier for your doctor to make a diagnosis if he or she sees your child when the symptoms are present. Do not leave your child alone. Try to keep other people from crowding around your child to prevent him or her from becoming more anxious. 111 .39). call an ambulance. your child will be prescribed bronchodilator drugs or inhaled corticosteroids to ease his or her breathing. POSSIBLE CAUSE AND ACTION These symptoms may be due to mild asthma. If the diagnosis of asthma is confirmed. it may be caused by anxiety. give your child the number of puffs of his or her relieving inhaler or nebulizer according to his or her treatment plan and carry out the self-help measures for easing breathing in an asthma attack (left). p. ACTION If your doctor confirms the diagnosis. Continued from previous page Is your child also wheezing? NO YES Has your child been diagnosed as having asthma in the past? NO YES Is your child’s YES breathing abnormally rapid (opposite)? NO t EMERGENCY! CALL AN AMBULANCE Does your child have a temperature of 38˚C (100˚F) or above? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is a possible cause of these symptoms. small children may be given the drugs through a face mask. If your child is having severe difficulty in breathing. Take steps to reduce your child’s temperature (see BRINGING DOWN A FEVER. carry out self-help measures for easing breathing in an asthma attack (above). Consult your doctor. and make sure he or she drinks plenty of fluids. If the cough or intermittent wheezing persists. ACTION While waiting for help. who will examine your child and measure his or her peak flow (p. • Make sure any prescribed reliever drugs for asthma have been taken according to the treatment plan. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE A severe attack of asthma is a possibility. Has your child had episodes of any of the following? • Wheezing • Coughing at YES night • Coughing after exercise • Coughing when out in the cold NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your child may have asthma. In some cases.

apply an over-thecounter corticosteroid cream sparingly to the skin around the lips for a few days to reduce the inflammation. POSSIBLE CAUSE Your child may have cold sores. Do the sores have honey-coloured crusts? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE Impetigo. He or she may also prescribe an antibiotic cream to apply to the affected areas or oral antibiotics. scolding your child about the habit may make it worse. If the gum disease is severe. Continued on next page POSSIBLE CAUSE AND ACTION An erupting tooth can cause a tender swelling on the gum (see TEETHING. Does your child have red. a bacterial skin infection that commonly affects the skin around the mouth.114). cooled teething ring to chew. To prevent your child from spreading the virus. ACTION Cold sores usually clear up on their own. After the initial infection. these areas are susceptible to minor injuries and infections. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. the dentist may prescribe antibiotics. below). Allergies can cause swelling of the mouth or tongue. TEETH PROBLEMS (p. You may be able to help your child give up the habit that is causing the condition by drawing his or her attention to it when it occurs.CHILDREN: ALL AGES 35 Mouth problems and delicate. Offer a baby a hard. If the swelling continues. which are caused by previous infection with the herpes simplex virus. ACTION The dentist will probably scale and polish your child’s teeth and advise you on caring for your child’s teeth and gums. over-the-counter antiviral creams may speed up the process if they are used at the first sign of symptoms. then use petroleum jelly to protect the skin. However. see chart 36. For problems specifically relating to the teeth. The swelling may be due to a severe allergic reaction. However. Until the infection clears up. try to discourage him or her from kissing others while the blisters are present. p. the herpes virus can lie dormant for months or years and may be reactivated by cold weather or exposure to strong sunshine.115). which can be serious (see WARNING. Are the lips and surrounding skin red and cracked? NO YES POSSIBLE CAUSE Your child may have lick eczema. Keep your child away from other children as impetigo is contagious. Because the lining of the mouth and the skin of the lips are thin START HERE Does your YES child have sores or cracks on or around the lips? NO Do the sores look like small blisters? NO YES WA R N I N G SWELLING MOUTH OR TONGUE Call an ambulance if your child’s mouth or tongue suddenly starts to swell. Younger children often pick up infections affecting the mouth and lips because they tend to put objects into their mouths. a condition in which the gums become red and swollen. Give the recommended dose of a painkiller if necessary. ACTION Your doctor will probably advise you to remove the crusts with cotton wool and warm water. your child should use a separate towel and other wash items to avoid spreading the infection. Consult your dentist. it can cause breathing difficulties that may be life-threatening. ACTION Twice a day.114). painful gums? NO YES Do the gums bleed when YES your child brushes his or her teeth? NO POSSIBLE CAUSE Your child may have the gum disease gingivitis. (p. is likely. Consult this chart if your child complains of a painful mouth or has sores in the mouth or on the tongue or lips. Gingivitis usually develops as a result of poor oral hygiene. Over-the-counter teething gels applied to the gums may help. a rash around the mouth and lips caused by saliva from excessive licking of the lips or thumb sucking. 112 .

CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION If the child’s mouth is so sore that he or she is unable to drink. Does your child have YES one or more shallow. ACTION There is no specific treatment for this condition. below). Make sure your child drinks plenty of fluids (see ENCOURAGING YOUR CHILD TO DRINK. right). give your child the appropriate dose of a painkiller. Ice cream is ideal because the coldness helps to numb the mouth. To prevent reinfection. POSSIBLE CAUSES The most likely cause is infection with the herpes simplex virus. In less severe cases. relieving pain. grey. below). • Offer soft foods. encourage your child to rinse his or her mouth with a solution of bicarbonate of soda. such as paracetamol. Mouth ulcers can be painful but are not serious. such as damage from a toothbrush. to prescription drugs.oz) of warm water. consult your dentist. If prescription drugs are thought to be the cause they will be stopped. a fungal infection. p. • If your child is old enough to cooperate. but take care near the sore areas. • Avoid giving acidic foods and drinks. the virus that causes cold sores. ACTION Your doctor will probably prescribe antifungal gel or lozenges to clear up the infection.67). If an ulcer does not heal within 10 days or your child has several ulcers at the same time. If the blisters burst and form ulcers. Does your child have creamy yellow or white patches inside the mouth and/or on the tongue? NO YES Does your child also have blisters on the palms of the hands and the soles of the feet? NO YES POSSIBLE CAUSE Your child may have hand. The blisters on the hands and feet often appear about 48 hours after the ones in the mouth. POSSIBLE CAUSE AND ACTION A new or jagged tooth may cause enough friction to make your child’s cheek or tongue sore. This condition is most common in young babies or in older children whose immunity has been lowered by certain diseases or drug treatments. SELF-HELP Relieving a sore mouth Easy-to-eat foods Soft foods are easy for a child with a sore mouth to eat. in some cases. such as ice cream. who may be able to smooth a rough edge. • Try to continue brushing your child’s teeth twice daily. below). 113 . Similar symptoms can be due to other viruses or.CHILDREN: ALL AGES Continued from previous page SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Oral thrush. ulcerated patches or blisters in the mouth? NO Does your child have a fever and/or seem generally unwell? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have mouth ulcers. • Serve drinks with drinking straws to keep liquids away from sores on the lips. bottle teats. consult your doctor. foot. Overthe-counter treatments can also relieve pain and may help the ulcers to heal. sterilize any dummies. is a possibility. The following self-help measures may help to relieve the pain of a sore mouth: • If necessary. your doctor will recommend self-help measures (see RELIEVING A SORE MOUTH. your doctor may recommend hospital admission. If the sore persists or appears to be cause by a jagged tooth. When babies or young children have a first infection with this virus they may be unwell and have a very sore mouth. Take steps to relieve the pain (see RELIEVING A SORE MOUTH. such as oranges or fruit juices. he or she should rinse the mouth hourly with 1⁄ 4 teaspoon of bicarbonate of soda dissolved in 100 ml (31⁄ 2 fl. a mild infection caused by a virus. Consult your doctor. and mouth disease. These often develop for no apparent reason but tend to recur in times of stress or at the site of a minor injury. Give your child the recommended dose of a painkiller if necessary (see RELIEVING A SORE MOUTH. Does your child have a sore area inside a cheek or on the side of the tongue? NO YES ACTION Rinsing the mouth with a solution of bicarbonate of soda may help relieve the pain (see RELIEVING A SORE MOUTH. and teething rings that your child uses.

The head of the brush should be as small as possible. the tooth should tighten itself again. which. if untreated. A milk tooth may remain loose or fall out early. If only part of the tooth is broken off. Once the infection has cleared up.CHILDREN: ALL AGES 36 Teeth problems checkups. Cleaning a young child’s teeth Use only a pea-sized amount of toothpaste on a soft toothbrush. place a gauze pad over it. Your child’s teeth are constantly at risk of decay. contact your dentist. Caring for your child’s teeth and gums SELF-HELP Sugar in the diet is the main cause of tooth decay. thereby lowering the risk of decay. or has part of a tooth broken off? NO Is it a permanent tooth (not a milk tooth)? NO YES CALL YOUR DENTIST NOW ACTION If the gum is bleeding. a permanent tooth will erupt to fill the space (see THE ORDER IN WHICH TEETH APPEAR. Brush your child’s teeth from behind Continued on next page 114 . Find the tooth. the tooth may need to be removed. In young children. but handle it as little as possible and do not clean it. make an appointment with your dentist.207). fluoride is added to the water supply. ACTION If your child has a dental abscess. CALL YOUR DENTIST NOW POSSIBLE CAUSE Your child may have a dental abscess. A knocked-out milk tooth cannot be grafted back into the gum. and tell your child to bite down hard. Minimizing the amount of sugarcontaining foods that your child eats is the most important step you can take to keep his or her teeth healthy. Fluoride is a naturally occurring mineral that increases the resistance of teeth to acid attack. If your child has toothache or an accident needing urgent dental treatment and your dentist is unavailable. If the tooth is lost much earlier than normal. If symptoms of decay. such as toothache. Teach your child the correct way to brush teeth (see CARING FOR YOUR TEETH AND GUMS. In many areas. other teeth may fill the space. develop between START HERE Has a tooth been knocked YES out. in which pus forms in or beneath a tooth as a result of an infection. If a permanent tooth is still loose after a few days. If part of the tooth has broken off. Your child should have regular dental checkups from about 3 years of age. causing serious damage. call the casualty department of a local hospital for details of an on-call dentist. If the amount of fluoride in your drinking water is low. and tell your child to bite down hard. This can cause problems with the eruption of permanent teeth. Does your child have continuous toothache YES with or without a fever? NO ACTION An accidental bump or knock can loosen a tooth. your child may need further dental work to treat the underlying cause. because the acid in all fizzy drinks also damages teeth. who may advise removal of the remaining fragment. and take it to the dentist with your child. below). you should consult your dentist. it may be possible to reattach it. Has a tooth become loose as the result of an accident? NO YES ACTION If the gum is bleeding. but if it is left alone. opposite). You should also limit the amount of fizzy drinks. make sure that your child’s toothpaste contains fluoride and ask your dentist about fluoride supplements. pain associated with the teeth may be due to teething (opposite). p. Brush them for the child or supervise until he or she is able to manage alone. Your dentist may be able to graft a knocked-out permanent tooth back into your child’s gum. which is usually no cause for concern. place a gauze pad over it. In most cases. Regular brushing can help prevent decay (see CARING FOR YOUR CHILD’S TEETH AND GUMS. your dentist may prescribe antibiotics to treat the infection. In rare cases. Put it in a glass of milk. Try to find the knocked-out tooth or broken piece to ensure it has not been inhaled or swallowed. that you give your child. including “diet” drinks. can spread to central parts of the tooth.

POSSIBLE CAUSE Aching in several teeth can be a symptom of sinusitis (inflammation of the membranes lining the air spaces in the skull). The gums may become inflamed as the teeth erupt. set. There are 20 teeth in the first. UPPER TEETH LOWER TEETH 1st molars (13–19 months) 2nd molars (25–33 months) Canines (16–22 months) POSSIBLE CAUSE Your child’s second molars may be beginning to emerge (see THE ORDER IN WHICH TEETH APPEAR. The recommended dose of a painkiller can also be given if necessary. This may be due to tooth decay. Steam inhalation may help (p. The sequence in which they erupt is more Central incisors (8–12 months) Lateral incisors (9–13 months) Does your child have tender gums behind the back teeth? NO YES important than the age of eruption. By the age of 13. This is especially likely if your child also has bouts of throbbing tooth pain not brought on by food or drink. known as the wisdom teeth. Does your child feel pain when he or she YES bites on a tooth that has been filled recently? NO POSSIBLE CAUSE AND ACTION It is quite common for a tooth to feel uncomfortable for a while after a filling has been put in. or adult. especially if the filling is large. Children under the age of 8 are rarely affected because their sinuses have not yet developed. give your child the recommended does of a painkiller.CHILDREN: ALL AGES Continued from previous page Does the pain last only a few seconds? NO YES Teething The eruption of a tooth. However. Central incisors (7–8 years) Lateral incisors (8–9 years) Canines (11–12 years) 1st molars (6–7 years) UPPER TEETH LOWER TEETH CONSULT YOUR DENTIST IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. while others still have none at a year old. Overthe-counter local anaesthetic gels can be soothing if gently applied to the affected gums. hard object. ACTION Give your child paracetamol for the pain. Consult your dentist if the pain is severe or if it is no better within 48 hours. Does your child have pain in several of the teeth in the upper jaw? NO YES The order in which teeth appear The ages at which teeth appear vary from child to child. ACTION If necessary. If the pain gets worse or if your child is no better within 48 hours. If no abnormality is found. 3rd molars – wisdom teeth (Over 17 years) 2nd molars (12–13 years) 2nd MILK (PRIMARY) TEETH The ages at which teeth appear The figures in brackets indicate the average ages at which the teeth erupt. he or she may advise that your child brushes with a toothpaste for sensitive teeth and rubs a small amount over the teeth afterwards. to teething. but this is usually short-lived. he or she may need treatment with antibiotics. Consult your dentist. especially if your child has recently had a cold or a runny or blocked nose. ACTION Your dentist will examine your child’s teeth and treat any decay. However. A baby may have flushed cheeks. never appear. Consult your doctor if your child’s symptoms are no better within 48 hours. Babies who are teething often seem to like chewing on a cold. who will check the filling and adjust it if necessary. such as a fever or diarrhoea. right). can be uncomfortable and may make your child irritable and restless. You may be able to feel the emerging tooth if you run your finger over the gum. such as paracetamol. In some people. premolars (10–12 1st premolars PERMANENT (SECONDARY) TEETH years) 115 . be less willing to feed. A few children have one or more teeth at birth. Does your child feel pain in his or her teeth when they are exposed to hot or cold foods? NO YES SEE YOUR DENTIST WITHIN 24 HOURS POSSIBLE CAUSE Your child may have decay deep within a tooth or in a crack in a tooth. consult your dentist. the third molars.194). the primary teeth have usually fallen out and most of the 32 permanent. such as a chilled teething ring or a raw carrot. and may sleep poorly when teething. POSSIBLE CAUSE Teeth can become sensitive to extremes of temperature if their protective surfaces become thin or damaged. ACTION Your dentist will examine your child’s teeth and may need to remove and fill any decayed areas. or primary. neither early nor late eruption is a cause for concern. teeth have erupted. you should not attribute other symptoms. particularly a molar.

Some children may refuse to eat to gain their parents’ attention or control. a refusal to eat may be part of a behavioural problem. • Do not persist in offering rejected foods. cut it into decorative shapes or create pictures on the plate.CHILDREN: ALL AGES 37 Eating problems smaller appetites. If you think that your child is refusing food to gain attention or control. Ensure that your child drinks plenty of fluids (see ENCOURAGING YOUR CHILD TO DRINK. such YES as a fever. there are some self-help measures you can take to encourage your child to eat: • Keep mealtimes relaxed. • Do not give your child snacks and numerous drinks between meals. Most children alternate between active periods. As long as your child is well and is growing normally (see GROWTH CHARTS. Others may be particularly fussy eaters. eats a reasonably healthy diet (see HEALTHY EATING IN CHILDREN. POSSIBLE CAUSES AND ACTION It is uncommon for a well child to refuse food. However. p. when children are growing rapidly. he or she may have a minor viral infection. Does your child seem unwell? NO YES Does your child have specific symptoms. you should consult your doctor. This is relatively common in young children. If this is not successful or if your child is already dehydrated. then try again. see chart 6. The appetites of children are more closely governed by their body’s energy requirements than are the appetites of adults.139). For children under 1 year. for example. Keep them off the menu for a week or two. ACTION As long as your child is well. they usually grow out of it. try not to make food an issue and try to be as unconcerned as possible when he or she refuses food (see COPING WITH FOOD FADS. Some children naturally burn up less energy than others and have START HERE Is your child refusing all foods? NO YES Is your child also refusing drinks? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES A child can go without eating very much for several days and not come to any harm.67). ACTION Your doctor will examine your child to ensure that he or she is not dehydrated and to look for an underlying cause.26). during which they have large appetites. a refusal to eat may be a symptom of the potentially life-threatening disorder anorexia nervosa (see EATING DISORDERS. or vomiting? NO POSSIBLE CAUSE AND ACTION An underlying illness can often cause a temporary loss of appetite. • Serve small portions. p. p. diarrhoea. In older children and adolescents. their appetites will be larger than usual. there is no need for concern. such as toys or television. there is no cause for concern. Occasionally. p. a child may start to refuse foods as a means of gaining your attention or control. Some older children may decide that they want to become vegetarian or vegan. however. If your child spends time away from you during the day.139). during mealtimes. If your child continues to refuse food or begins to lose weight. Do not insist your child eats everything on his or her plate. Alternatively. right). FEEDING PROBLEMS (p. Sometimes a child will refuse only one or two foods or will accept foods only if they are prepared in a particular way. • Avoid distractions. • Be imaginative when preparing food. he or she may need to be admitted to hospital. but refusal to drink can lead to dehydration within hours.60). An older child genuinely not wanting to eat may be depressed or suffering from the eating disorder anorexia nervosa (see EATING DISORDERS. and is not losing weight. In addition. A child may refuse certain foods. Continued on next page 116 . Such variations in appetite are normal and are not a problem as long as your child seems well and is growing normally. POSSIBLE CAUSE AND ACTION If your child is generally unwell but has no specific symptoms. The child may claim to dislike foods that he or she previously enjoyed. when they eat much less. and inactive periods. Is your child refusing to eat one or more specific foods? NO YES POSSIBLE CAUSES Children’s tastes change over time. Your doctor will probably give you advice on encouraging your child to drink (p. You should see your doctor if your child is no better in 24 hours. giving second helpings if requested. Consult the relevant chart in this book and follow the advice given. he or she may be eating then.67). particularly in hot weather or if the child has a fever. opposite). even if he or she has previously eaten them. SELF-HELP Coping with food fads Most children become faddy eaters at some stage.

CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Consult your doctor. yoghurts. If it is appropriate. Is your child over 12 years old? NO YES POSSIBLE CAUSES Your child may have an underlying illness such as an intestinal disorder that is causing a loss of appetite and poor growth. fats. POSSIBLE CAUSE Your child may be anxious or upset about a recent event. The eating disorder anorexia nervosa (see EATING DISORDERS. 117 . and dried fruit. Consult your doctor. This can often lead to a loss of appetite. If your child’s appetite does not improve or if he or she seems unwell. and carbohydrates such as bread will provide your child with the nutrients he or she needs (see A HEALTHY DIET. meats. your child will be less likely to become overweight or suffer from diet-related health problems in later life. If you establish sensible eating habits now. there is no cause for concern. Is your child taking any prescribed drugs? NO POSSIBLE CAUSES Your child may have an underlying illness such as an intestinal disorder that is causing a loss of appetite and poor growth.139) need to be considered. and show as little concern as possible when your child refuses food. vegetables. Alternatively. YES Has your child been eating less than you think is appropriate for longer than 3 months? NO ACTION As long as your child seems well and happy and is not losing weight. Healthy meals Encourage your child to enjoy healthy eating by providing a range of tasty. an assessment by a psychiatrist may be suggested. as fats are high in calories and are important for the development of nerves. Keep fried and sugary foods to a minimum. children need to eat more food than adults because they need fuel for growth and are more active. an assessment by a psychiatrist may be suggested. Give your child healthy snacks. Does your child refuse YES to eat when at home but eat well at school or other people’s homes? NO POSSIBLE CAUSES AND ACTION When away from home. just over a third. and proteins. p. YES POSSIBLE CAUSE AND ACTION Certain drugs can interfere with appetite. it is quite common for peer pressure to lead a child to eat foods he or she would not normally eat. ACTION Your doctor will examine your child and may arrange for tests to exclude an underlying disorder. if your child begins to lose weight or fails to grow normally. p. p. but introduce healthier foods into your child’s diet gradually. provide a balance with plenty of fresh fruit and vegetables. a child may refuse to eat at home as a means of gaining your attention. such as muesli bars. If it is appropriate.CHILDREN: ALL AGES Continued from previous page Are your child’s height and weight within the normal range for his or her age (see GROWTH CHARTS. Follow self-help measures for coping with food fads (opposite). If the pressures of time mean that you often buy convenience foods. fresh foods are better than processed. do not stop your child’s prescribed drugs. However. Children under 2 should have full-cream milk. the remainder. On the whole. proteins. dieting or the eating disorder anorexia nervosa (see EATING DISORDERS.26)? NO YES POSSIBLE CAUSE Your child’s appetite may be reduced if he or she is in a phase of slow growth or is taking less exercise then previously. Consult your doctor. However. p. Has there been a recent change or upset at home or at school? NO Healthy eating in children YES Relative to their size. Meanwhile. children should eat carbohydrates.28). nutritious meals. ACTION Try to discover and deal with any underlying worries your child has. A varied diet that includes fruit. Children under 5 need more fats. rather than semi-skimmed. It may help to talk to your child’s teachers in case there are problems at school that you are unaware of. Over the age of 5.139) may develop in children under 12 years of age but is not common. Do not give your child tea or coffee or put salt on his or her meals. ACTION Your doctor will examine your child and may arrange for tests to look for an underlying illness and determine the appropriate treatment. Try not to make food an issue. you should consult your doctor. in some cases by causing mild nausea as a side effect. consult your doctor. dairy products. and fats in the same proportions as adults: carbohydrates should make up roughly half of the diet.

vomiting can be a symptom of a serious condition needing urgent treatment. In a child aged under 2 years. an infectious disease that causes bouts of severe coughing. resulting in bleeding in or around the brain. ACTION If meningitis is suspected. He or she may need surgery to look for and treat the cause of the symptoms. If the condition is severe. even if your child has been immunized against it. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE AND ACTION A serious head injury. He or she will be given urgent treatment with antibiotics and may need intensive care. call your doctor. is a possibility at any age. A strangulated hernia. your child may need treatment in hospital. For children under 1 year. see chart 4.CHILDREN: ALL AGES 38 BABIES Vomiting in children the body. p. ACTION Do not give your child painkillers or anything to eat or drink while waiting for help. These do not relieve the symptoms but reduce the chance of the infection being passed on. make sure he or she drinks plenty of fluids to avoid dehydration (see PREVENTING DEHYDRATION IN CHILDREN. Does vomiting follow bouts of coughing? NO YES Continued on next page 118 .79) • Abnormal drowsiness • Sunken eyes and/or dry tongue • Black or bloodstained faeces • Severe abdominal pain that has lasted for more than 4 hours Is your child’s vomit greenish or yellow? NO YES Does your child seem unusually drowsy? NO YES Has he or she had a head injury within the past few days? NO YES POSSIBLE CAUSE Your child may have an intestinal obstruction. Repeated vomiting is most likely to be due to an infection of the digestive tract. • Do not give any solid food on the first day of illness. • Do not give your child any milk to drink for the first 2 days of illness. Your child will probably be admitted to hospital. this may be due to intussusception. • Give your child frequent small drinks (see PREVENTING DEHYDRATION IN CHILDREN. starting with toast or plain biscuits. VOMITING IN (p. Infections elsewhere in START HERE Has your child had continuous abdominal pain for more than 4 hours that has not been relieved by vomiting? NO YES POSSIBLE CAUSE A serious abdominal condition. this is usually caused by overeating or an emotional upset and is rarely due to a serious disorder. in which part of the intestine pushes through a weak area in the abdominal wall and becomes trapped. In many cases.123). • Your child should then have a light diet for 2 or 3 days and gradually return to a normal diet. When a child vomits only once. p. where his or her condition can be closely observed and tests carried out. it is vital to replace fluids that are lost through vomiting and diarrhoea. dark red spots that do not fade on pressure (see CHECKING A RED RASH. This is particularly likely if your child also has a fever. such as appendicitis. is possible. p. t EMERGENCY! CALL AN AMBULANCE Treating gastroenteritis in children SELF-HELP If your child has gastroenteritis. can also cause vomiting in children. in which the intestine telescopes in on itself. However. your child will be admitted to hospital immediately. If your child is vomiting. ACTION Do not give your child painkillers or anything to eat or drink while waiting for help. ACTION Your doctor will probably prescribe antibiotics. but there will usually be other symptoms as well.123).56). Your child will probably be admitted to hospital for tests such as CT scanning (p. A drink given soon after vomiting has more chance of being absorbed before the child next vomits. may be the cause. Your child will probably be admitted to hospital for tests and may need surgery. t EMERGENCY! CALL AN AMBULANCE SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Whooping cough (pertussis). An operation is sometimes necessary.40) and for observation. often followed by vomiting. • Gradually reintroduce food. your child will recover if you follow the measures listed below. such as in the urinary tract. if your child is not getting better after 24 hours. Rarely. POSSIBLE CAUSE Vomiting and abnormal drowsiness are serious symptoms that may be caused by meningitis (inflammation of the membranes surrounding the brain due to infection). may be the cause. t EMERGENCY! CALL AN AMBULANCE WA R N I N G DANGER SIGNS Call an ambulance if your child’s vomit is greenish or yellow or if vomiting is accompanied by any of the following symptoms: • Flat.

149). • Try to travel at night to encourage your child to sleep through the journey. ACTION Your doctor will arrange for a blood test to confirm the diagnosis. This condition is caused by insufficient production of the hormone insulin. If the diagnosis is confirmed and your child is vomiting. games that encourage him or her to look out the window may help. ACTION Your doctor will test a sample of your child’s urine.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSE Gastroenteritis. In some cases. • Keep a car window open. keep your child’s eating utensils and towels separate. Does your child have two or more of the following symptoms? • Fever • Pain on passing urine • Bedwetting or daytime wetting after being dry • Offensive-smelling or cloudy urine NO YES Is your child passing pale faeces and unusually dark urine. Looking out of the window If your child suffers from travel sickness.127). IF YOU ARE CONCERNED OR THE VOMITING IS RECURRENT. p. in which a viral infection causes inflammation of liver cells. Coping with travel sickness SELF-HELP If your child suffers from travel sickness. • Provide plenty of distractions. • Be prepared. ACTION When your child travels. such as the first day at school. call your doctor. He or she may also refer your child to hospital for further tests. If the diagnosis is confirmed. bring a change of clothes for your child. If your child is at school. ACTION Your doctor will take a blood sample to check your child’s blood sugar level. and help him or her to find ways of coping with stressful situations. his or her teachers may also be able to help.126). Was your child very excited or upset just before vomiting? NO YES POSSIBLE CAUSE Vomiting when excited or before stressful events. Your doctor will also advise you on your child’s diet and lifestyle (see DIABETES MELLITUS.123) and treating gastroenteritis in children (opposite). Most children become less susceptible to travel sickness as they grow older. • Discourage your child from reading during your journey. usually due to a viral infection. If your child has not started to recover after 24 hours or if he or she develops further symptoms. such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. a urine sample will be sent to a laboratory for analysis. To prevent the infection from spreading within the family. Talk to your child about his or her feelings. follow selfhelp measures for coping with travel sickness (above). OCCASIONAL BOUT OF VOMITING IS COMMON DURING CHILDHOOD AND MAY OFTEN HAVE NO OBVIOUS PHYSICAL CAUSE . H OWEVER . may be needed to look for any associated problems. and/or are your child’s skin and whites of the eyes yellow? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE Your child’s symptoms may be due to a urinary tract infection (p. inflammation of the digestive tract. CONSULT YOUR DOCTOR . and your child will be prescribed antibiotics. such as tapes of stories and songs. is the most likely cause and may be associated with abdominal pain. Does your child have diarrhoea? NO YES ACTION Follow the self-help measures for preventing dehydration in children (p. For example. Your pharmacist can advise you. Does your child regularly vomit during or soon after travelling? YES NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have a liver problem such as hepatitis. further tests. • Try giving your child an over-the-counter travel sickness remedy before the journey. is common in children. AN POSSIBLE CAUSE Travel sickness is the probable cause of your child’s vomiting. which is needed by the body to get energy from sugar and carbohydrate foods. he or she will probably need to be admitted to hospital. 119 . some of the following suggestions may help: • Give only light meals or snacks before and during your journey. Does your child have two or more of the following symptoms? • Unexplained loss of weight • Increased thirst • Passing more urine than usual • Excessive tiredness NO CALL YOUR DOCTOR NOW YES POSSIBLE CAUSE These symptoms may be due to diabetes mellitus. The condition tends to run in families. Your child will probably need insulin injections for life and will be taught how to inject the insulin and monitor his or her blood sugar level. Your doctor may recommend that other members of the family are immunized against the disease. ACTION Be sympathetic: the vomiting will have made your child feel even worse. p.

39). Follow the advice for relieving abdominal pain (opposite). the testis is untwisted. most cases. consult this chart for advice. emergency surgery is needed. in which the intestine telescopes in on itself causing an obstruction. such as appendicitis. an operation to remove the obstruction will be needed. It can be difficult to decide START HERE Has your child been in severe pain continuously for more than 4 hours? NO YES POSSIBLE CAUSE A serious abdominal condition.215). ACTION Give your child sips of water but nothing else to drink or eat. A child with a strangulated hernia must have the hernia repaired. If your child has stomach ache or if his or her behaviour causes you to suspect abdominal pain. needs medical attention or whether to wait and see. follow the self-help measures for preventing dehydration in children (p. He or she will probably need an operation to relieve the obstruction and treat the cause. in some cases. ACTION Your child will be admitted to hospital for tests such as X-rays (p. and/or has he or she passed faeces containing red matter? NO YES POSSIBLE CAUSE AND ACTION Gastroenteritis (inflammation of the digestive tract). t EMERGENCY! CALL AN AMBULANCE WA R N I N G DANGER SIGNS Call an ambulance if your child has severe abdominal pain lasting for more than 4 hours or if pain is associated with any of the following symptoms: • Swelling in the groin • Swelling in the scrotum • Greenish-yellow vomit • Black or bloodstained faeces Do not give your child painkillers or anything to eat or drink while waiting. If he or she still has diarrhoea after 24 hours or if further symptoms develop. and if the pain is still there after 4 hours. call your doctor. that needs urgent medical attention. and is the vomit greenish yellow? NO YES POSSIBLE CAUSE Your child may have an obstruction in the intestine. and both testes are then anchored to the wall of the scrotum to prevent the problem from recurring. p. or does passing faeces relieve the pain? NO YES Is your child under the age of 2. in which a testis twists inside the scrotum. However. ACTION Your child will probably be admitted to hospital. is possible. is possible. In. This condition is uncommon in children over 2. Does your child have a swelling in either the groin or the scrotum? NO YES Does the pain get worse YES when you gently press the child’s abdomen? NO POSSIBLE CAUSE This type of pain may be the first sign that your child has appendicitis or another condition in which the lining of the abdominal cavity becomes inflamed. Do not give him or her painkillers or anything to eat or drink while you are waiting for help. If your child has diarrhoea. or strangulated.123). which may correct the problem. t EMERGENCY! CALL AN AMBULANCE Continued on next page 120 . ACTION In both cases. Your child may need surgery to identify and treat the cause of the pain. POSSIBLE CAUSES A swelling in the groin may be due to a hernia (protrusion of part of the intestine through a weak area in the muscle wall of the abdomen) that has become trapped. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE A condition known as intussusception (opposite). Swelling in the scrotum may be due to torsion of the testis (p. is the most likely cause. t EMERGENCY! CALL AN AMBULANCE Does your child have diarrhoea. particularly a young child. If it does not. Watch your child carefully. Is your child vomiting.CHILDREN: ALL AGES 39 Abdominal pain whether abdominal pain in a child. such as appendicitis. ACTION Your child will be admitted to hospital for tests and an enema.131). In the operation to treat torsion of the testis. where his or her condition can be closely observed and tests carried out. abdominal pain is short-lived and disappears on its own without treatment. most commonly due to a viral infection. there may be a serious physical cause. call your doctor. This procedure involves replacing the intestine and repairing the weakness in the muscle wall (see HERNIA REPAIR.

or if your child still has abdominal pain the next day. Call an ambulance if severe pains lasts more than 4 hours. which may be due to swollen lymph nodes. If the diagnosis is confirmed. call your doctor. POSSIBLE CAUSE Your child may have a food intolerance. Consult your doctor. give the child painkillers and encourage him or her to drink (p.38) to exclude other disorders. part of the intestine telescopes into itself. vomiting. In children under age 8. in which symptoms such as abdominal pain. or a runny nose? NO Does your child have any of the following? • Pain on passing urine • Frequent passing of urine • Bedwetting or daytime wetting after being dry • Offensive-smelling or cloudy urine • Fever NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have a urinary tract infection (p. Talk to your child to try to find out if anything is worrying him or her. If the pain worsens or is no better within 24 hours. If your doctor suspects that your child has intussusception. until the pain eases. ACTION Your doctor will examine your child and may arrange for tests such as a urine test (p. but it may occur during viral infections. This may also correct the problem by forcing the intestine back into position. ACTION Unless your child shows any of the signs mentioned in the warning box (opposite). Call your doctor if other symptoms develop. SEE Relieving abdominal pain SELF-HELP The following measures may help to relieve mild abdominal pain in a child: • Let your child hold a wrapped hot-water bottle against the abdomen.127).126). such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. YOUR DOCTOR IF THE PAIN PERSISTS FOR MORE THAN 24 HOURS AND YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. follow the advice for relieving abdominal pain (left). In some cases. and your child will be prescribed antibiotics. POSSIBLE CAUSE AND ACTION Recurrent unexplained abdominal pain is common in childhood and is unlikely to have a serious cause. holding a well-wrapped hot-water bottle against his or her abdomen. your child will be admitted to hospital and may be given intravenous fluids. and/or diarrhoea occur whenever a certain food is eaten.67). if the pain is severe. Consult your doctor. The cause is unknown. During an episode. YES LOCATION Trapped small intestine Large intestine Has your child had repeated episodes of abdominal pain? NO Does your child seem completely well while complaining of pain? YES NO Appendix YES Obstruction due to intussusception This cut-away diagram shows how the last part of the small intestine pushes into part of the large intestine to cause an obstruction. emergency surgery may be needed to relieve the obstruction and remove any damaged intestine. ACTION Your doctor may suggest excluding possible problem foods or food groups from your child’s diet for a trial period.122). An enema will probably be given to confirm the diagnosis. Covered hot-water bottle Do any close family members suffer from migraines. If you need to exclude a food permanently from the diet. Do the symptoms typically occur within 2 hours of eating a particular type of food. such as lactose intolerance (p. and pale appearance? NO POSSIBLE CAUSE AND ACTION The episodes of pain may be an expression of anxiety or stress. 121 . ACTION Your doctor will test a sample of your child’s urine. You should call your doctor if the pain is severe or if your child is still unwell the next day. further tests. If the enema does not help. causing an obstruction. the symptoms often include recurrent episodes of abdominal pain instead of the one-sided headaches that are typical of migraine in older children and adults. p. a cough. you may be referred to a dietician for advice. YES POSSIBLE CAUSE Your child may have migraine. and/or are episodes of pain accompanied by nausea. a urine sample will be sent for analysis. Intussusception In intussusception. may be needed to look for any associated problems. • Give your child only water to drink and nothing to eat while he or she is in pain. Small intestine Does your child also YES have a sore throat. see your doctor.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSES These symptoms are often associated with abdominal pain in childhood. such as dairy products? NO YES Easing abdominal pain Let your child lie down quietly. vomiting. Taking painkillers should help to relieve the symptoms. Consult your doctor if the pain recurs frequently. If the pain worsens or is still present the next day.

If the diagnosis is confirmed. If the symptoms have not cleared up within 3 days. If any of the danger signs in the warning box (above) develop. These are longterm disorders in which there is recurrent inflammation of the digestive tract. The treatment may include antidiarrhoeal drugs. Permanent lactose intolerance is an inherited condition and is rare except in those of African or Asian descent. and drinking plenty of fluids (see PREVENTING DEHYDRATION IN CHILDREN. consult your doctor. If you suspect lactose intolerance.222). CALL YOUR DOCTOR NOW CALL YOUR DOCTOR NOW POSSIBLE CAUSE A bacterial or parasitic infection of the digestive tract may be the cause of these symptoms. If your child has diarrhoea repeatedly for more than 24 hours or if he or she develops further symptoms. Has your child had similar episodes of diarrhoea with abdominal pain before? YES NO POSSIBLE CAUSE Excitement or anxiety due to an event such as a party or a school exam can cause diarrhoea in an otherwise well child. ACTION Reassure your child. with one or more of the following? • Fever • Abdominal pain • Vomiting NO YES WA R N I N G DANGER SIGNS Call an ambulance if your child’s diarrhoea is accompanied by any of the following symptoms: • Abnormal drowsiness • Sunken eyes and/or a dry tongue • Severe abdominal pain lasting for more than 4 hours Is your child particularly excited. corticosteroid drugs may also be needed. ACTION Your doctor will examine your child and arrange for a sample of faeces to be tested. DIARRHOEA IN (p. in older children. drug treatment is inappropriate. Your doctor may refer you to a dietician for advice.58). Your child may also be referred to hospital for tests such as colonoscopy (p. ACTION Follow the self-help measures for preventing dehydration in children (opposite) and treating gastroenteritis in children (p. is called lactose intolerance. avoiding food. most often due to a viral infection. opposite) is the best course of action. which occurs in diary products. Is there blood in your child’s faeces? NO YES Continued on next page Lactose intolerance An inability to digest the sugar lactose. You should be very careful about hygiene so that other family members do not become infected. Avoiding dairy products prevents the symptoms developing and is needed for as long as the condition persists. START HERE Did the diarrhoea begin in the last 24 hours? NO YES Is your child feeling unwell. People who have this condition suffer from diarrhoea and abdominal pain whenever they drink milk or eat diary products.118). In most cases. anxious. ACTION Your doctor will examine your child and may arrange for faeces to be tested for infection. call your doctor. it is unlikely to be a cause for concern. For children under 1 year. While diarrhoea can be serious in babies. and explain that the diarrhoea is likely to improve when the event is over or when he or she has calmed down. Diarrhoea is the frequent passing of abnormally loose or watery faeces. in some cases. and. 122 . treatment will probably be with antibiotics. consult your doctor. call an ambulance. Lactose intolerance is usually temporary and may follow an intestinal infection. POSSIBLE CAUSES Your child may have Crohn’s disease or ulcerative colitis. see chart 5. so that the intestines are rested. or stressed at the moment? YES NO POSSIBLE CAUSE Gastroenteritis. He or she may test a sample of faeces for unabsorbed sugar.CHILDREN: ALL AGES 40 BABIES Diarrhoea in children The most common cause of diarrhoea in children is a viral infection of the digestive tract. is the most likely cause. inflammation of the digestive tract.

and have you noticed any soiling of your child’s underclothes? NO YES POSSIBLE CAUSE Your child may have chronic constipation blocking the rectum. This condition is usually temporary. Fruit-flavoured rehydrating fluids may be more pleasant to drink Does the diarrhoea always occur after your child has milk or other dairy products? NO YES Is your child taking any prescription drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. consult your doctor or health visitor for advice. POSSIBLE CAUSE AND ACTION Toddler diarrhoea. It can be made up from powders bought over the counter or by dissolving 2 level teaspoons of sugar in 200 ml (7 fl. vomiting. your child may be referred to hospital for further tests. He or she should also drink soon after vomiting.26)? NO Is your child under 3 years. This may be due partly to your child not being able to chew his or her food enough. ACTION Your doctor will examine your child and will probably arrange for initial tests.73) or coeliac disease. call your doctor. If cystic fibrosis is suspected. AND SEE YOUR DOCTOR WITHIN 24 HOURS . Preventing dehydration in children SELF-HELP If your child has diarrhoea. GIVE YOUR CHILD PLENTY OF FLUIDS . If your child is lactose intolerant. p. POSSIBLE CAUSE AND ACTION Some children routinely produce soft faeces that can be mistaken for diarrhoea. boiled water. The most suitable fluid to give your child is oral rehydrating solution. however.CHILDREN: ALL AGES Continued from previous page POSSIBLE CAUSE Lactose intolerance (opposite). Has the diarrhoea followed a period of constipation. Consult your doctor. Are your child’s height and weight within the normal range for his YES or her age (see GROWTH CHARTS. offer your child drinks at frequent intervals. a common condition in which a young child fails to digest food properly. If you are not sure whether or not your child’s faeces are normal. a potentially life-threatening condition. in which the body cannot digest lactose. unsweetened fruit juice as an alternative to the sugar solution. he or she may refer your child to a specialist. but avoid giving him or her milk. ACTION If your doctor suspects lactose intolerance. p. it is important to give him or her plenty of fluids to prevent or treat dehydration. Treatment depends on the cause but may include drugs to aid digestion or a special diet with vitamin and mineral supplements. in which the intestine is damaged by a gluten allergy. can cause diarrhoea. you will need advice from a dietitian on a lactose-free diet. may be the cause. the natural sugar found in milk. It is not a danger to health. He or she should drink 1–11⁄ 2 litres (35–53 fl. and/or a fever. If your child vomits. Call your doctor before the next dose of the drug is due to ask if it could be the cause and if you should stop giving it to your child. Replacing fluids Encourage your child to sip rehydrating solution or diluted fruit juice at least once an hour while symptoms last. give him or her a drink soon afterwards to replace the lost fluid. bulky faeces? NO YES POSSIBLE CAUSE An inability to absorb nutrients from food due to a disorder such as cystic fibrosis (p. ACTION Your doctor may initially prescribe a laxative to clear the blockage. The soiling is due to the overflow of liquid faeces past the blockage. If your child still has diarrhoea after 24 hours.oz) of fluid per day.124). While the symptoms last. 123 . He or she will probably also recommend adding extra fibrerich foods to your child’s diet (see AVOIDING CONSTIPATION. he or she will probably arrange for a sample of your child’s faeces to be tested to detect undigested sugars. may be the cause. you should consult your doctor so that he or she can make sure an infection is not the cause. Consult your doctor. is likely. such as antibiotics. You can also give your child diluted. and does the diarrhoea contain any recognizable pieces of food? NO YES Is your child passing pale.oz) of cooled. If your doctor suspects that the condition is caused by an underlying physical or behavioural problem.

wholegrain cereals. ACTION Encourage your child to drink plenty of fluids (see ENCOURAGING YOUR CHILD TO DRINK. consult your doctor.120) Has the weather been hot. Some children have a bowel movement several times a day. There is a wide variation in the normal frequency with which children empty their bowels. Healthy snacks A piece of fruit. fibrerich snack for a child of any age. His or her bowel habit should return to normal within a few days. Gradually increase the amount of fibre-rich foods in your child’s diet. Has your child’s diet or day-to-day routine changed recently? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. others have one every 2 or 3 days. This may be a sign of anxiety about toilet training. children may become dehydrated. Avoiding constipation in children SELF-HELP Constipation in children aged over 6 months is often a result of a lack of sufficient fluids or fibre in the diet. A tear makes defecation painful. No treatment is necessary if your child is generally well. The fluid loss caused by a fever or vomiting may also disrupt bowel movements. dehydration (especially in hot weather). If the problem persists. Make sure your child drinks plenty of fluids throughout the day. Encourage your child to go to the toilet after meals and allow plenty of time so that he or she does not feel rushed. Minor changes to a child’s usual bowel habit are often caused by a change in diet or in the daily routine. You should also take steps to prevent constipation from recurring (see AVOIDING CONSTIPATION IN CHILDREN. who will probably prescribe stool-softeners for your child. or is he or she only recently trained? NO YES POSSIBLE CAUSE AND ACTION Your child may be stool-holding (resisting the urge to defecate). If your child remains constipated. If your child is aged less than 18 months. 124 . makes an enjoyable. Bowel habits should return to normal within a few weeks. Has your child just started toilet training. These will reduce the pain associated with opening the bowels. Constipation can be a problem when a child starts school if he or she is reluctant to use the toilets there or ask permission to go to the toilet. LAXATIVES Go to chart 39 ABDOMINAL PAIN (p. right). you should see your doctor within 24 hours. consult your doctor. which can lead to very hard or pellet-like faeces. or emotional stress. Is your child taking any medicines? NO YES POSSIBLE CAUSE AND ACTION Constipation can be a side effect of some drugs. Both of these extremes are normal so long as the child is otherwise well and that the faeces are not hard START HERE Does your child have severe abdominal pain? NO YES POSSIBLE CAUSES Constipation that occurs in combination with severe abdominal pain may be due to intestinal obstruction or another serious bowel disorder. is suitable for your child. below). Make sure he or she eats a healthy diet (see AVOIDING CONSTIPATION IN CHILDREN. WA R N I N G Laxatives are medicines that speed up the movement of faeces through the bowel. Never give your child a laxative unless it has been prescribed or suggested by your doctor. your doctor should decide on which. If your child has not passed faeces for 4 days. Consult your doctor. Does your child have either of the following? • Pain when defecating • Blood on the faeces NO YES POSSIBLE CAUSE AND ACTION An anal fissure (a tear or split inside the anus) is a possible cause. Try to give your child one or more of these foods at every meal. it may be preferable to postpone training until he or she is at least 2 years old. vegetables.CHILDREN: ALL AGES 41 Constipation or painful to pass. and wholegrain bread. such as a banana or an unpeeled apple. including overthe-counter cough remedies. It is also normal for babies and toddlers to strain and go bright red in the face when passing a normal. p. Consult this chart if your child is not having regular bowel movements or if he or she is passing very hard or pellet-like faeces. these include fruits. beans and pulses. although parents sometimes mistake this as a sign that their child is constipated. Some are not suitable for children. POSSIBLE CAUSE AND ACTION A change in diet can cause minor irregularities in bowel habits. There are several types that work in different ways.67). or has your child had a fever or been vomiting? NO YES POSSIBLE CAUSES In hot weather. which may lead to your child being afraid to open his or her bowels for fear of further pain. soft faeces. if any. an illness. Stop giving your child over-the-counter drugs. but do not stop giving him or her any prescribed drugs.

124). do not stop giving your child his or her prescribed drugs. green faeces may indicate gastroenteritis. a rare disorder affecting young children in which the intestine telescopes into itself. in bottle-fed babies. However. p. CALL YOUR DOCTOR NOW POSSIBLE CAUSES Blood in the faeces may be a sign of a serious infection of the digestive tract or inflammation of the lining of the intestines. 125 . which may correct the problem. Is your child taking any YES medicines? NO Has he or she just recovered from an episode of diarrhoea and vomiting? NO YES Are your child’s faeces very pale? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child’s pale faeces might be due to a failure to absorb fats as a result of an underlying disorder. ACTION Your doctor will probably advise you to give your child plenty of fluids and fibre-rich food (see AVOIDING CONSTIPATION IN CHILDREN. DIARRHOEA IN BABIES (p. Consult your doctor if the faeces have not returned to normal within a week.58). Call your doctor. It is normal for faeces to vary slightly in their colour. is possible.124). which will make passing faeces easier and allow the fissure to heal. POSSIBLE CAUSE Intussusception. there may be an underlying disorder causing the problem. CONSTIPATION (p. do not give your child anything to eat or drink. However. see chart 5. which is often associated with constipation. taking a sample of the faeces in a clean container for him or her to examine. Corticosteroid drugs may be prescribed if your child has an inflammatory disease. This is particularly likely if your child is under 2 years old and he or she is having bouts of inconsolable crying. especially if they are watery. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. an operation will be needed. if it does not. for a child over 1 year.222) to confirm the diagnosis. He or she may also arrange for your child to have colonoscopy (p.CHILDREN: ALL AGES 42 Abnormal-looking faeces differences are almost always caused by something your child has eaten. DIARRHOEA IN CHILDREN (p. or sooner if your child is unwell. For hard or pellet-like faeces. p. Other tests will be needed to determine the cause and appropriate treatment. your child will need tests and an enema. and is he or she unwell? NO POSSIBLE CAUSES AND ACTION Green faeces are normal in breast-fed babies and are not a cause for concern (see BABIES’ FAECES. If the faeces still look abnormal in 48 hours or if they are accompanied by other symptoms such as abdominal pain. or consistency. see chart 41.122). you should consult your doctor. Both of these disorders need urgent treatment. Sudden START HERE Has your child YES passed red. there is no cause for concern. ACTION While waiting for the ambulance. jelly-like matter. see chart 40. Is there blood on the faeces? NO YES POSSIBLE CAUSE Certain drugs can cause changes in the appearance of faeces. For runny faeces in a child under 1 year. ACTION Your doctor will examine your child. Consult your doctor. POSSIBLE CAUSE After an episode of diarrhoea and vomiting. ACTION Stop giving your child over-thecounter drugs and consult your doctor. and are his or her faeces green? NO YES Is the blood in small streaks on the faeces? NO YES POSSIBLE CAUSE A small amount of blood on the surface of the faeces may be due to an anal fissure (a split or tear in the lining of the anus). Meanwhile. He or she may also prescribe stool-softeners. t EMERGENCY! CALL AN AMBULANCE Is your child under 1 year old.59). treatment may include antibiotics. Analysis of a sample of faeces may be needed to confirm the diagnosis. In hospital. smell. Consult this chart only if there is a marked change in the appearance of your child’s faeces. ACTION If your child seems well. faeces may be abnormally pale for a few days. ACTION Your doctor will probably examine your child and send a sample of faeces for tests. If the cause of the bleeding is an infection. and the change should only last a few days.

Urinary tract infections can be more serious in children than they are in adults because they may be associated with reflux. or unpleasant smelling urine. If the diagnosis of diabetes is confirmed. in girls. he or she will be prescribed continuous. column 2 Urinary tract infections in childhood If you suspect that your child has a urinary tract infection. a vulval infection with thrush. are common in children. p. In some children. In older children. your child will be started on antibiotics. Does your child have any of the following. and take it to your doctor for him or her to test. low-dose antibiotics to reduce the risk of subsequent infection and kidney damage. ACTION Your doctor will take a blood sample to check your child’s blood sugar level. TOILETTRAINING PROBLEMS (p. If untreated. Urinary problems. Most children pass urine more frequently than adults. Occasionally. Urinary problems in a child should always be assessed promptly by your doctor. nappy rash is the commonest cause of inflamed skin. Symptoms of urinary problems in children include pain on passing START HERE Does your child find passing urine painful? NO YES Does your child’s penis or vulva look red and/or sore? NO YES POSSIBLE CAUSES Any condition that causes inflamed skin in the genital area can result in pain when passing urine. a urine sample will be sent to a laboratory for analysis to confirm the diagnosis.CHILDREN: ALL AGES 43 Urinary problems urine. The pain is due to urine coming into contact with the inflamed skin. consult your doctor. YES Is your child passing more urine than usual? NO ACTION If possible. opposite). Your child will also need to have drug treatment with insulin injections for the rest of his or her life.128). you will be given advice on your child’s diet and lifestyle (see DIABETES MELLITUS.65) if your child has not yet been toilet trained. it is important that you bring it to your doctor’s attention within 24 hours. which is needed by the body to get energy from sugar and carbohydrate foods. in which urine flows back towards the kidneys when the bladder is emptied. such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN. column 1 Continued on next page. Most young children who have had a urinary tract infection will need to have tests (see INVESTIGATING THE URINARY TRACT IN CHILDREN.149). in which urine flows back up the ureters towards the kidneys when the bladder is emptied. Continued on next page. If your child is diagnosed as having reflux. opposite) to establish whether reflux is occurring and to assess kidney function. may be needed to look for any associated problems. urinary tract infections are associated with reflux. needing to pass urine more frequently than usual. 126 . cloudy urine. such as urinary tract infections. a fungal skin infection or. This is because children have smaller bladders and have less well developed muscular control. If passing urine is still painful once the skin has healed or if your child is toilet trained. This treatment can often be discontinued by the time your child is 5 years old. In some cases. unexplained vomiting and fever may be due to a urinary tract infection. reflux of infected urine can cause permanent scarring of the kidneys and impaired kidney function in later life. It is caused by insufficient production of the hormone insulin. If the result indicates that an infection is likely. may be the cause. Meanwhile. ACTION Try self-help measures for relieving nappy rash (p. collect a sample of your child’s urine in a clean container. further tests. with or without a fever? • Frequent passing of small amounts of urine • Bedwetting or daytime accidents after being dry • Offensive-smelling or cloudy urine NO YES Does your child have one or more of the following? • Unexplained weight loss • Increased thirst • Excessive tiredness NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child may have a urinary tract infection (below). SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Diabetes mellitus is a possible cause of these symptoms. see chart 44. For problems with bladder control. In babies and children who are not yet toilet trained.

Rarely. and some drugs may change the colour of your child’s urine. This quick and painless procedure is performed to check that the kidneys and bladder are of normal size. taking a urine sample with you. detailed images of the kidneys can be taken with a gamma camera and viewed on a computer monitor. DMSA scanning Your child will be scanned approximately 2 hours after an injection of DMSA. In many cases. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Is your child reluctant or unable to pass urine? YES NO Investigating the urinary tract in children If your child has had a urinary tract infection (see URINARY TRACT INFECTIONS IN CHILDHOOD. Is your child’s urine discoloured? NO YES Go to chart 45 GENITAL PROBLEMS IN BOYS (p.CHILDREN: ALL AGES Continued from previous page. A child who feels a strong urge to pass urine but is unable to do so needs urgent medical help. column 2 Is your child a boy. POSSIBLE CAUSE Your child may have phimosis. anxious. including blood. and does his foreskin balloon when he passes urine? NO Is your child excited. opposite).41) is all that is needed. It will not harm your child. a very small amount of a radioactive substance called DMSA is given to the child by an intravenous injection. he or she will probably be referred for further tests to check kidney and bladder function and to exclude damage from urinary reflux. In some cases. your child may also need DMSA scanning. After the DMSA has passed into the urinary system. He or she may suggest painkillers and suggest you encourage your child to pass urine while he or she is in a warm bath. If you cannot identify a dietary cause for the change. If your child continues to pass urine frequently after his or her situation returns to normal. ultrasound scanning (p. ACTION Your doctor will examine your child to try to establish the cause of the problem. a urinary infection (opposite) may be causing pain on passing urine. The gamma camera picks up radioactivity released by the kidneys and produces a picture on a monitor. in which the opening in the foreskin is too small. It will establish whether he or she has urinary reflux. a procedure that provides extra information on kidney functioning. 127 .130) POSSIBLE CAUSES AND ACTION Some foods. or cold? NO YES YES POSSIBLE CAUSE AND ACTION It is normal to need to pass urine more frequently in times of excitement or anxiety or when exposed to cold temperatures. a change in urine colour is a sign of liver or kidney disease or is due to blood in the urine. If this fails. Does your child have problems with bladder control? NO YES Does your child regularly wet himself or YES herself during the day and/or at night? NO Go to chart 44 TOILET-TRAINING PROBLEMS (p. and your child may be reluctant to try to pass urine again. During the procedure.128) CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Your doctor will test the urine for the presence of abnormal substances. such as beetroot. In some cases. Technician Monitor Gamma camera CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. consult your doctor. your child may need hospital admission. however. column 1 Continued from previous page. CALL YOUR DOCTOR NOW POSSIBLE CAUSES Local soreness or severe constipation are possible causes. in which urine flows back towards the kidneys when the bladder is emptied. consult your doctor. The DMSA will be excreted in the urine and will be gone within 24 hours.

It is not known why some children learn later than others. He or she will probably also recommend adding extra fruit and vegetables to your child’s diet (see AVOIDING CONSTIPATION IN CHILDREN. START HERE Is your child under 2 years old? NO YES POSSIBLE CAUSE At this age. resulting in a partial blockage of the rectum. Continued on next page SELF-HELP Toilet-training tips • Encourage your child to use the potty. Children whose parents were late to learn may also be later in learning reliable control. Try using pull-up nappies. If the problem persists for more than a few weeks. Unless there is a physical problem. apart from the occasional “accident”. consult your doctor. nighttime bladder control. When you think your child is ready. such as the arrival of a new baby or parental separation. p. Once your child is using the potty reliably. Ideally. Take the potty with you if you go out for the day to maintain continuity. the age at which an individual child masters the different skills of toilet training such as night-time control varies widely. Consult your doctor. lastly. However. Rarely. Do not try to toilet train your child until he or she is ready. You may then find the toilet-training tips (below) useful. ACTION There is little that you can do to toilet train your child until he or she is ready. such as a new baby in the family or starting school. after the age of 5. Consult your doctor. Place your child on the potty after meals or at particular times of the day when you know success is likely. Talk to your child about his or her worries. Most children gain full control over their bladder and bowel functions between the ages of 2 and 5 years. progress to using a child seat on the toilet. Boys usually learn later than girls. a child’s nervous system is not mature enough for complete bladder or bowel control to have developed. he or she may refer your child to a specialist. Your child is probably rebelling against your efforts to enforce toilet training. Does your child pass very liquid faeces. ACTION Make sure that your child has every opportunity to use the toilet or potty. and provide plenty of love and reassurance. often soiling his or her underclothes? NO YES Are you worried about your child’s lack of bowel control? NO YES Has your child ever been able to control his or her bowel movements? NO POSSIBLE CAUSE A loss of previously normal bowel control usually has an emotional cause. Consult this chart if you are concerned about your child’s ability to control his or her bladder or bowels. and. • Put the potty in a convenient place so that • • • • your child can reach it quickly. and the process cannot be speeded up by pressure from parents. Few children have reliable control before the age of 2 years.124). who may refer you to a specialist.CHILDREN: ALL AGES 44 Toilet-training problems Changes in circumstances. toilet training occurs naturally. wait until your child is keen to cooperate before trying again. then daytime bladder control. usually at 18 months at the earliest. Such behaviour may be due to a recent change at home. 128 . try some of the following: • Familiarize your child with the potty by sitting him or her on it during nappy changes or while you are on the toilet. ACTION Your doctor may initially prescribe a laxative to clear the blockage. POSSIBLE CAUSES It does not usually take this long for a child to gain bladder or bowel control. and few have problems. Bowel control is usually achieved first. YES Have you been trying to train your child for more than a year? NO YES POSSIBLE CAUSE Your child may be constipated. your doctor may suggest that you have a break from toilet training. This causes soiling due to an overflow of liquid faeces past the blockage. there may be a physical cause for his or her lack of control. Learning to control bowel and bladder function is part of your child’s development. If your doctor suspects that your child’s constipation is caused by an underlying physical or behavioural problem. Wait until your child is older and shows signs of being able to exercise some control over his or her bladder and bowel functions. Your child may be anxious or upset and seeking attention. but it is seldom due to an unwillingness to learn. but avoid making it a big issue. may make a child anxious and delay toilet training. ACTION If there is no physical cause.

CHILDREN: ALL AGES

Continued from previous page

SELF-HELP

Overcoming bedwetting
Pad and buzzer
The moisture-detecting pad is placed on an undersheet, and the bed is then made up as usual. The buzzer is placed on the bed or nearby.

Are you worried about your child’s lack of bladder control?
NO

YES

CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND A CAUSE FOR YOUR CHILD ’ S PROBLEM FROM THIS CHART.

If your child regularly wets the bed, try to be patient. Reassure your child that you are not angry and that he or she will learn to stay dry through the night. Encourage him or her to use the toilet before going to bed, and perhaps also wake your child to use the toilet when you go to bed. A chart on which you award your child a star after each dry night may help, as may a pad-andbuzzer system. The pad, which can detect moisture, is laid under the bottom sheet. As soon as your child wets the bed, the buzzer sounds. The child will soon learn to wake before the buzzer goes off.
Pad is positioned where child’s hips will lie

Buzzer

Has your child been dry in the past and started wetting again?
NO

YES

SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSES Your child may have a urinary tract infection (see URINARY TRACT INFECTIONS IN CHILDHOOD, p.126). Alternatively, an emotional problem may be the cause. POSSIBLE CAUSE Reliable bladder control is seldom fully achieved before the age of 3, and many children will still be in nappies. There is unlikely to be any cause for concern. ACTION Your doctor will test a sample of your child’s urine. If the result indicates that an infection is likely, a urine sample will be sent to a laboratory for analysis to confirm the diagnosis. Meanwhile, your child will be started on antibiotics. Further tests, such as ultrasound scanning (see INVESTIGATING THE URINARY TRACT IN CHILDREN, p.127), may be needed to look for any associated problems. If no infection is found, your doctor will discuss the possibility of an emotional upset with you and your child.

Is your child under 3 years old?
NO

YES

ACTION Follow advice on toilet training (see TOILET-TRAINING TIPS, opposite), and make sure your child has plenty of opportunities to see other people, especially children, use the toilet. Most children learn quickest by imitation.

Does your child wet him- or herself during the day?
NO

YES

POSSIBLE CAUSES Lack of bladder control during the day is unlikely to have a medical cause in a child under 5, but in an older child, it may indicate a physical or emotional problem. Consult your doctor, whatever your child’s age.

Is your child over 5 years old?
NO

YES

ACTION Your doctor will examine your child and may arrange for tests, including urine tests, to find an underlying cause. If no physical cause is found, follow advice on toilet training (see TOILET-TRAINING TIPS, opposite). Children over 5 years may need to be referred to a specialist.

Does your child still wet the bed at night, even though he or she is dry in the daytime?
NO

YES

POSSIBLE CAUSE Lack of bladder control at night is common in children under 5 and is rarely due to an underlying disorder. ACTION If you are still putting your child in nappies, continue to do so until he or she is often dry in the morning. When accidents do occur, try not to get cross. Change the bedclothes with as little fuss as possible, and reassure your child. A mattress protector and bedclothes that are easy to wash and dry will make coping easier. Your child will eventually achieve night-time control.

POSSIBLE CAUSE Around 1 in 6 children wet their beds at age 5, and 1 in 20 still wet their beds at age 10. Regular bedwetting rarely has a physical cause, even in an older child, and is particularly common if one or both parents were late to acquire night-time bladder control. ACTION Follow measures for overcoming bedwetting (above). If these do not help, consult your doctor, who may prescribe a course of drug treatment or drugs that can be used for events such as an overnight school trip.

CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND A CAUSE FOR YOUR CHILD ’ S PROBLEM FROM THIS CHART.

129

CHILDREN: ALL AGES

45

Genital problems in boys
doctor promptly if your child develops a problem in the genital area. In some cases, a delay in treatment can have serious consequences – for example, it may lead to problems with your child’s fertility in the future.

Consult this chart if your child develops a painful or swollen penis or a problem with his scrotum (the supportive bag that encloses the testes). Although most genital problems in boys are due to minor infections, you should always consult your

START HERE

Does your child have a pain in the penis only when passing urine?
NO

YES

Go to chart 43 URINARY PROBLEMS (p.126)

WA R N I N G PAINFUL SWELLINGS Call an ambulance if your son develops a painful swelling in a testis or in the groin. Some conditions with these symptoms require emergency surgery.

POSSIBLE CAUSE Torsion of the testis, in which one of the testes is twisted within the scrotum, cutting off the blood supply, is a possibility (opposite). This condition can occur after an injury but often develops spontaneously during sleep.

t

EMERGENCY! CALL AN AMBULANCE

Does your child have a painful scrotum?
NO

YES

ACTION Urgent surgery to untwist the testis and restore its blood supply is essential. During surgery, both testes will be anchored within the scrotum to prevent the condition recurring.

Do one or both of the following apply to the swelling? • It is smaller or absent first thing in the morning • It increases in size when your child cries or coughs
NO

YES

Does your child have a painless swelling in the scrotum?
NO

YES

SEE YOUR DOCTOR WITHIN 24 HOURS

Does the skin of the scrotum look red and inflamed?
NO

YES

POSSIBLE CAUSES The skin of the scrotum may be inflamed as the result of an allergic reaction to a detergent used to wash your child’s nappies or underwear or because of a fungal infection. Consult your doctor. ACTION Your doctor will examine your son and prescribe a corticosteroid cream for an allergy or an antifungal cream for a fungal infection. If an allergy is diagnosed, use a non-biological detergent and rinse clothes thoroughly.

Continued on next page

POSSIBLE CAUSE AND ACTION Your child may have a harmless collection of fluid around the testis, known as a hydrocele. This condition is especially common in newborn babies and usually disappears by the time the child is 6 months old. Your doctor may arrange for your child to have an ultrasound scan (p.41) to exclude damage to the testis or an underlying disorder. Most hydroceles in children disappear without treatment.

Circumcision
Circumcision is a surgical operation to remove the foreskin, which is the fold of skin that covers the tip of the penis. In the UK, most circumcisions are carried out for religious reasons. However, in some cases, circumcision may also be recommended if a child’s foreskin is too tight or if a child has recurrent infections of the penis. In the past, circumcision was often performed routinely in childhood in the belief that it would improve hygiene, but this practice is no longer recommended. In newborn boys, circumcision is most often carried out under local anaesthetic, whereas, in older boys or in men, it is usually performed under general anaesthetic. During the operation, most of the foreskin is cut away. The remnant of the foreskin that remains is then stitched to the skin just behind the head of the penis, leaving the head uncovered. No dressing is needed while the wound heals. The stitches will either dissolve or fall out after a few days.

SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE Your child probably has a hernia, in which a loop of intestine bulges through a weak area in the abdominal wall. This condition is commonest in babies. ACTION Your doctor will examine your child. If the diagnosis is confirmed, the hernia should be repaired to prevent the possibility of a loop of intestine becoming trapped. The operation is carried out under general anaesthetic.

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CHILDREN: ALL AGES
Continued from previous page

Torsion of the testis
Twisting (torsion) of the testis within the scrotum reduces or stops the blood supply to the testis. It can affect males of any age but is most common at about age 10. The symptoms can start during sleep or following an injury and include pain in the scrotum, groin, and/or abdomen and redness and tenderness of the scrotum. There may also be associated nausea and/or vomiting. Torsion of the testis requires urgent surgery, which must be carried out within 6 hours, in order to prevent permanent damage to the testis. During surgery, the blood vessels are untwisted and then both of the testes are anchored to the scrotum to prevent recurrence of the condition.
Blood vessels compressed where twisted Penis Twisted testis Scrotum

Does one or both of the testes appear to be absent from your child’s scrotum?
NO

YES

A twisted testis
Twisting of the testis within the scrotum results in compression of the blood vessels, which can lead to permanent damage.

Is your child cold or feeling anxious?
NO

YES

POSSIBLE CAUSE AND ACTION Muscles attached to the testes draw them up into the groin for protection when it is cold and during times of stress. If your child relaxes in a warm bath, you should be able to feel the testes again. If you cannot feel both testes, consult your doctor.

Does your child have soreness, irritation, or redness at the tip of the penis?
NO

YES

POSSIBLE CAUSES Balanitis, in which the the foreskin is inflamed due to infection or chemical irritation, is likely. ACTION Make sure your son’s penis and foreskin are cleaned frequently using only water. If the symptoms are no better within 48 hours, consult your doctor. He or she may prescribe an antibiotic or antifungal cream. In future, avoid scented soaps and using biological detergents for clothes washing. If the condition recurs frequently, your doctor may recommend circumcision (opposite).

POSSIBLE CAUSE One or both of your child’s testes may have failed to descend fully into the scrotum. Consult your doctor. ACTION Your doctor will examine your child. If your child’s testes have not yet descended, your doctor will re-examine him regularly. In most cases, the testes descend on their own, usually within a year of birth. However, if they have not descended by 1–2 years of age, an operation will be needed to draw the testes into the scrotum to preserve fertility.

Has the foreskin been pulled back, and are YES you unable to replace it?
NO

Is your child over 4 years old, and/or does YES the foreskin balloon when he urinates? Are you concerned that your child’s foreskin may be too tight?
NO NO YES
POSSIBLE CAUSE AND ACTION The foreskin cannot normally be retracted in boys under a year old. As a boy grows older, the foreskin gradually becomes free of the head of the penis and it should then be possible to retract it. Trying to force the foreskin to retract may cause serious damage and may make the problem worse. Consult your doctor if you remain concerned or if your son’s foreskin still cannot be retracted by the time he is 4 years old. Your doctor may recommend circumcision (opposite).

POSSIBLE CAUSE A foreskin that cannot be replaced can damage the blood supply to the head of the penis if not treated urgently. ACTION While you are waiting for help, apply an ice pack to reduce the swelling. In hospital, the doctor will try to replace the foreskin, but it may be necessary to make a small cut in the foreskin under local anaesthetic. Prompt circumcision (opposite) is usually needed to prevent the problem from recurring.

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EMERGENCY! CALL AN AMBULANCE

POSSIBLE CAUSE Your child may have phimosis, in which the opening in the foreskin is too small. This can impede urine flow and makes recurrent infection of the head of the penis more likely. Consult your doctor. ACTION Do not use force in an to attempt to retract the foreskin because this may lead to further narrowing. Your doctor will examine your child to confirm the diagnosis and ensure there is no associated infection. He or she may recommend circumcision (opposite).

CONSULT

YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

CHILDREN: ALL AGES

46

Genital problems in girls
These symptoms may be caused by a minor infection or by irritation from toiletries or laundry products. Consult this chart if your daughter complains of any of these symptoms.

The most common genital problems in young girls are itching, inflammation of the external genital area, and, less commonly, an unusual discharge, possibly with pain on passing urine.

START HERE

Is your child’s YES genital area uncomfortable or itchy?
NO

Does your daughter have a thick, white, and lumpy vaginal discharge?
NO

YES

SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE Your daughter may have vaginal thrush, a fungal infection. This is especially likely if she has recently been taking antibiotics to treat another condition. ACTION Your doctor may want to take a vaginal swab to confirm the diagnosis. He or she will probably prescribe an antifungal cream or oral antifungal drugs. To avoid a recurrence, follow self-help measures for preventing genital problems in girls (below).

Does your daughter YES have a greyishyellow or greenish discharge?
NO

SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE AND ACTION A bacterial infection in your daughter’s vagina is possible. This sometimes occurs for no reason, but, in an older girl, a forgotten tampon may be the cause. Your doctor may take a swab to confirm the diagnosis and will probably prescribe antibiotics. If your doctor suspects a foreign body is present, he or she may arrange for your daughter to be examined by a specialist. POSSIBLE CAUSE Your daughter may have threadworms. These tiny, white worms, about 1 cm (1⁄ 2 in) long, infest the intestines and lay eggs around the anus at night, leading to intense irritation of the anus and genital area. Although harmless, they may be passed on from one person to another or picked up from contaminated food. Consult your doctor. ACTION Your doctor will examine your child. If threadworms are diagnosed, he or she will prescribe drugs that will kill the worms. All members of your family should be treated to prevent reinfection. Make sure your daughter takes extra care to wash her hands thoroughly after going to the toilet and before eating.

Does your daughter have intense itching around the genital and anal area that is much worse YES during the night?
NO

Does your daughter use bubble bath or YES wash her genital area with soap?
NO

POSSIBLE CAUSE AND ACTION Your daughter may be sensitive to the bath products or soap that she is using. Make sure your daughter washes her genital area using only water. Once the symptoms have disappeared, she can start using a mild, unperfumed soap (see PREVENTING GENITAL PROBLEMS IN GIRLS, right). However, if the irritation persists, consult your doctor.

Preventing genital problems in girls
SELF-HELP
The following self-help measures will reduce the likelihood of your child suffering from genital irritation or vaginal thrush. • Encourage your daughter to wash her genital area carefully once a day using an unperfumed, mild soap. • Ensure that your child knows to wipe from the front to the back after going to the toilet to prevent germs spreading from the bowel to the vagina and bladder. • Buy cotton pants, and ensure that they are changed daily. When washing, rinse the pants thoroughly. • Your child should not use talcum powder, which can cause vaginal irritation. • Discourage the use of vaginal deodorants or douches, which can upset the natural chemical balance of the vagina and increase the risk of infection.

Is your daughter over 9 years old, and does she have a thin, white or yellow vaginal discharge?
NO

SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE NOT ABLE TO DIAGNOSE YOUR DAUGHTER ’ S PROBLEM FROM THIS CHART.

YES

SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE NOT ABLE TO DIAGNOSE YOUR DAUGHTER ’ S PROBLEM FROM THIS CHART.

POSSIBLE CAUSE AND ACTION An increase in hormonal activity as a girl approaches puberty often produces this type of discharge. As long as there is no irritation, this is probably normal and no cause for concern. Reassure your daughter and make sure that she understands all the changes that are taking place in her body.

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47

Painful arm or leg
medical attention. Cramp is another common cause of limb pain, but it can be relieved by self-help: gently massage and stretch the affected muscle and apply a wrapped hot-water bottle if necessary. Any pain that has no obvious cause or that persists should be brought to your doctor’s attention.

Consult this chart if your child complains of pain in the arms and/or legs. Parents often attribute a recurrent ache in a child’s limb to growing pains (below). However, minor injuries are a more likely cause. Sprains and strains are not usually serious; however, a broken bone (fracture) needs immediate

START HERE

Did the pain follow an injury or a fall?
NO

YES

Is your child unable to move the limb?
NO

YES

POSSIBLE CAUSES Dislocation of a joint or a bone fracture is possible. ACTION Your child will probably need an X-ray (p.39) to determine the extent of the damage. The joint or bone may need to be repositioned under general anaesthetic and may be immobilized by bandages and/or a plaster cast for several weeks to allow the torn ligaments and/or broken bones to heal.

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EMERGENCY! CALL AN AMBULANCE

POSSIBLE CAUSES A minor sprain or strain of the ligaments or muscles in the limb is the most likely cause of your child’s pain.

Is the pain centred around a joint?
NO

YES

ACTION Follow the advice given for sprains and strains in children (p.135). If the pain is severe or is no better by the next day, see your doctor within 24 hours.

Go to chart 48 JOINT AND BACK PROBLEMS (p.134)

Does your child have a fever?
NO

YES

Are both arms and legs aching?
NO

YES
POSSIBLE CAUSE AND ACTION Generalized aching with a fever is most often due to a viral illness such as flu. Follow the self-help advice for bringing down a fever (p.77). If the pain is severe or is no better by the next day, see your doctor within 24 hours.

Is there a tender red or swollen area on one limb?
NO

YES

CALL YOUR DOCTOR NOW
POSSIBLE CAUSE An infection of the bone or the tissue around it is a possibility. ACTION Your doctor will examine your child and may send him or her to hospital for blood tests and X-rays (p.39). Bone infections need prolonged treatment with antibiotics, which will initially be given in hospital.

Growing pains
Many children complain of aching in the limbs, especially in the legs. These bouts of pain are often described as growing pains. However, growth does not cause the pain; the cause of growing pains is not known. Growing pains always occur in the late evening and at night. They always affect the legs, and the pain is often felt most in the thigh and calf muscles. In some cases, they may also affect the arms. Growing pains do not need medical attention. However, in some cases, pain in the limbs may be due to an unnoticed injury or a disorder affecting the bone or bone marrow. Consult your doctor if your child’s limb pain is associated with a limp, occurs in the morning, or affects your child’s ability to use the limb because pain with these features is unlikely to be growing pains. If a child complains of recurrent limb pains as well as stomach aches, there is a possibility that the pains are a physical symptom of an emotional problem, such as anxiety or fear.

SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

CALL YOUR DOCTOR NOW

Did pain in the arm YES begin after he or she was swung by the arms?
NO

POSSIBLE CAUSE AND ACTION The bone at the elbow may have slipped out of the ring of ligament that supports it. Your doctor may be able to return the bone to its normal position by gentle manipulation; if not, he or she may send your child to hospital for treatment.

Does your child have a limp?
NO

YES

Go to chart 50 LIMPING (p.138)

SEE

YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

133

CHILDREN: ALL AGES

48

Joint and back problems
children than in adults. However, in childhood the disease can also involve internal organs such as the heart and kidneys. Problems with the spine may be noticed for the first time in adolescence and need medical assessment. Severe back pain in a child of any age needs prompt medical attention.

Serious joint and back problems are uncommon in children. A painful or swollen joint is most often the result of a minor strain or sprain of the muscles and ligaments surrounding the joint. However, joint pain or swelling can be caused by arthritis (joint inflammation). Arthritis is less common in

START HERE

Does your child have pain that followed an injury or fall?
NO

YES

Is your child unable to YES move an injured joint, or is either of the danger signs (right) present?
NO

WA R N I N G DANGER
SIGNS Call an ambulance if your child sustains a back injury and has either of the following symptoms: • Difficulty with bladder or bowel control • Weakness or numbness in a limb

POSSIBLE CAUSE A minor sprain or strain of a ligament or muscle is the most likely cause of your child’s pain. ACTION Follow the advice on treating sprains and strains in a child (opposite). See your doctor within 24 hours if the pain is severe or is no better the next day.

POSSIBLE CAUSE Your child may have a serious injury such as a fracture affecting a joint or the spine. ACTION Your child will probably need an X-ray (p.39) to detect any damage. If a spinal injury is suspected, he or she may also need CT scanning (p.40). The treatment depends on the extent and the site of the injury.

t

EMERGENCY! CALL AN AMBULANCE

Does your child have a single painful joint?
NO

YES

Is the joint red, hot, or swollen, and/or does YES your child have a fever?
NO

CALL YOUR DOCTOR NOW
POSSIBLE CAUSE Septic arthritis, inflammation of a joint due to infection, is a possibility. ACTION Your doctor will probably arrange for your child to be seen in hospital. Fluid may be removed from the joint and analysed to confirm the diagnosis. If septic arthritis is confirmed, your child will need treatment in hospital with antibiotics.

Does your child have a pain in the hip, thigh, or groin?
NO

YES

Are several joints swollen or painful?
NO

YES
SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

POSSIBLE CAUSE Pain in any of these areas may indicate a hip-joint problem, which can often cause a child to limp.

Go to chart 50 LIMPING (p.138)

SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE Your child may have HenochSchönlein purpura, a condition in which small blood vessels become fragile and leak blood. Small amounts of blood can leak into the joints, skin, intestines, and kidneys, causing pain; however, the condition is not serious. ACTION Your doctor will examine your child and may arrange for blood and urine tests to confirm the diagnosis. If your child’s symptoms are mild, no treatment is required. If his or her pain is severe, corticosteroid drugs may be prescribed. The condition usually clears up in less than a month with no permanent damage.

Does your child have a purple rash over the buttocks and the backs of the legs?
NO

YES

Continued on next page, column 1

Continued on next page, column 2

134

treatment will include nonsteroidal anti-inflammatory drugs and. Your doctor will probably arrange for X-rays (p. If necessary. is possible. Are you concerned that your child may have a problem with his or her back? NO Does your child have a fever. Your child should avoid sports or any unnecessary exercise involving the affected part of the body until it is free from pain. write your child’s school a note explaining the problem. the eyes. in some cases. Reactive arthritis usually improves within weeks. treatment with exercises and sometimes a brace may be needed to correct the problem and prevent it from progressing. column 2 SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Your child may have systemic juvenile arthritis. If necessary. Nonsteroidal anti-inflammatory drugs and corticosteroids may be prescribed. Does your child’s spine appear to be curving sideways? NO YES POSSIBLE CAUSE A sideways curvature of the spine is called scoliosis. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. If the injury is no better within 24 hours. corticosteroid drugs. YES POSSIBLE CAUSE A minor sprain or strain of a ligament or muscle in the back is the most likely cause of your child’s pain. Did your child’s back pain start after strenuous exercise? NO Cold compress If your child has a sprain or strain. or does he or she have a stiff back on waking? NO YES POSSIBLE CAUSES AND ACTION Your child may have a serious problem such as a bone disorder or arthritis of the spine. Some children are born with it and are treated in their first few years. SEE YOUR DOCTOR WITHIN 24 HOURS Is your child woken in the night by back pain. p. column 1 Continued from previous page. Your doctor will probably refer your child to hospital for tests. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. such as a sore throat or a chest infection? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Juvenile chronic arthritis. inflammation of the joints in response to a recent infection. most often in adolescence. the internal organs. no treatment is needed. If the diagnosis is confirmed. in which the immune system attacks the joints and. consult your doctor. the appropriate treatment for the injury can be remembered as RICE – Rest. in which the immune system attacks the joints and. Compression. 135 .229). Ice. and Elevation (see TREATING SPRAINS AND STRAINS. ACTION Your child may be referred to hospital for blood tests and a full eye examination. give your child the recommended dose of a painkiller. is possible. a cold compress will help reduce the swelling. Treating sprains and strains in a child SELF-HELP SEE YOUR DOCTOR WITHIN 24 HOURS If your child has a sprain or strain or a deep bruise. some children develop the curvature later in childhood. See your doctor within 24 hours if the pain is severe or if it has not improved by the next day.39) of the back and blood tests to make a diagnosis and determine the appropriate treatment. Has your child recently had an infection. Your doctor may arrange for tests to confirm that the infection has cleared up and may prescribe nonsteroidal anti-inflammatory drugs. feel generally unwell. in some cases. In many cases. but if the curvature is severe. ACTION Your doctor will assess the curvature of the spine and will probably refer your child to a specialist. and/or have a blotchy rash? YES NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Reactive arthritis. ACTION Give your child the recommended dose of a painkiller. Your child should avoid sports until he or she is free of pain. However.CHILDREN: ALL AGES Continued from previous page. in some cases.

is the likeliest cause. consult your doctor. a fungal infection. When indoors. ACTION Most verrucas will disappear naturally in time. Once it is removed. peeling skin between the toes? NO YES POSSIBLE CAUSE Athlete’s foot. your child may need to wear a plaster cast or a firm bandage. warts that grow into the sole of the foot as a result of pressure from the weight of the body. Over-the-counter preparations can be used to treat verrucas effectively. t EMERGENCY! CALL AN AMBULANCE Does the pain only occur when your child is wearing shoes? NO YES POSSIBLE CAUSES AND ACTION Check your child’s shoes for stones or thorns. such as a splinter. If your child’s symptoms persist for longer than 2 weeks. even if they are relatively new. ACTION Your child will need an X-ray (p. POSSIBLE CAUSE A minor sprain or strain of the ligaments or muscles in the foot is likely. However. if your child’s foot is very painful or swollen or home treatment has been ineffective. Feet can also be damaged by wearing high heels or shoes with pointed toes for any length of time. and you should check your child’s shoes regularly. ACTION Regularly wash and dry your child’s feet carefully. and apply an over-the-counter antifungal cream. or scraping it off. and encourage your child to rest with the foot raised for a few hours. embedded in the skin. see your doctor within 24 hours. See your doctor within 24 hours if the pain is severe or is no better the next day. ACTION Follow the advice for treating sprains and strains in a child (p. it may result in foot problems later in life.39) to determine the type and extent of the damage. your child should wear open-toed sandals or go barefooted whenever possible. As children’s feet can grow very rapidly. START HERE Does your child have a painful or tender foot? NO YES Has your child injured his or her foot recently? YES NO Is your child able to walk on the foot? NO YES POSSIBLE CAUSES Your child may have a fracture or a serious injury to the muscles or ligaments of the foot. this may take months or even years. The bones in children’s feet are soft. you should see your doctor within 24 hours. particularly between the toes. column 1 Continued on next page. An operation may be needed to reposition the bones. however. If a verruca persists after treatment. Continued on next page.135). If the foreign body is too deep for you to remove or if the cause is not obvious and the sore is no better the next day. roughened skin on the sole of a foot? NO YES POSSIBLE CAUSE Your child may have one or more verrucas. unlike bones in other parts of the body.CHILDREN: ALL AGES 49 Foot problems Although wearing ill-fitting shoes may not cause symptoms at the time. They are caused by a viral infection of the skin. Depending on the nature of the injury. Does your child have a red. If redness and swelling develop in the foot. consult your doctor. tender area on the sole of the foot? NO YES Does your child have itchy. Children’s feet grow quickly. make sure your child’s shoes still fit comfortably. which could be the cause of the problem. and can be distorted by shoes that do not fit properly. remove it using a pair of tweezers. burning. POSSIBLE CAUSES Your child may have an infection from a cut or a foreign body. ACTION If you can see a splinter or other foreign body in your child’s skin. and can be treated at home. Most symptoms affecting children’s feet are caused by minor conditions. tender. column 2 136 . He or she may remove the verruca by freezing. such as veruccas. Does your child have one or more painful lumps of hard. Children should not wear second-hand shoes. the wound should heal quickly. Also check inside his or her socks. consult your doctor.

Consult your doctor so that the diagnosis can be confirmed. ACTION Your doctor may prescribe antibiotics and drain any pus under a local anaesthetic. your child’s shoes and/or socks may be too small. ACTION If the shape of the foot has resulted from its position in the uterus. there is probably no cause for concern. In this condition. and has it been YES like this since birth? Does one or both of your child’s feet turn inwards? NO POSSIBLE CAUSE AND ACTION Your child may have a condition called “intoeing” . while hip rotation usually corrects itself by the age of 8 years. Consult your doctor. This condition rarely needs treatment. tender swelling around the big toenail? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ligaments. however. Bow legs usually correct themselves by the age of 3 years. Special exercises and shoe inserts are almost always ineffective and unnecessary. It is usually noticed by a doctor when the child is born. treatment will consist of manipulation and the use of a splint. If this has not corrected the problem by 3 years of age. it should correct itself within a few weeks of birth. If they lead to pain or embarrassment. open-toed sandals. If the condition has developed recently. ingrowing toenail is a likely cause. 137 . Does the whole foot including the heel turn inwards. If the shape of the foot is due to a structural abnormality. Consult your doctor. Surgery is sometimes recommended to remove part or all of the toenail (see REMOVAL OF AN INGROWING TOENAIL. This may be the result of cutting the toenails incorrectly or wearing shoes that are too tight. and bones in their feet are not yet fully developed. ligaments in the foot are lax and only form an arch when the child stands on tiptoes. if practical. your child should always wear correctly fitting shoes or. both of which are normal in some children. This is usually noticed when a child begins to walk and is often caused by the inward rotation of the whole leg from the hip or by bow legs. an operation may be needed. The fat pad in the feet of young children also adds to this appearance. Make sure your child always wears well-fitting shoes and socks. Are you concerned about the appearance of your child’s feet? NO YES Does your child have a red. POSSIBLE CAUSES The shape of your child’s foot may be due to an abnormality in the structure of the bones in the foot or to the position of the baby’s foot when it was in the uterus. an operation is needed to correct the problem. column 1 Continued from previous page. Flat feet are rarely a cause for concern and do not prevent a child from doing well in sports or cause problems in the future. NO YES Are you concerned that your child may have YES flat feet? NO Is your child under 3 years old? NO POSSIBLE CAUSE AND ACTION Children under 3 years of age usually have flat feet because the muscles. p.CHILDREN: ALL AGES Continued from previous page. If your child’s feet are painful or if you are worried. There is no cause for concern at this age because a normal arch will probably develop as your child grows. column 2 POSSIBLE CAUSE An infected. To prevent ingrowing toenails. Keep the affected area clean and dry.236). POSSIBLE CAUSE AND ACTION Flat feet are often inherited. an operation to straighten the toes may be recommended when your child is older. In rare cases. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. consult your doctor. YES Are your child’s toes bent or curled under? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. and always cut the toenails straight across rather than in a curve. POSSIBLE CAUSES AND ACTION If your child was born with bent toes.

call your doctor at once.134) SEE YOUR DOCTOR WITHIN 24 HOURS Does your child have pain or discomfort in a hip or thigh without any obvious redness or swelling? NO YES Has your child had a recent infection. should be seen by a doctor within 24 hours. the growing end of the femur (thighbone) at the hip partially “slips” or separates from the adjacent bone. For limping due to a painful foot. YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your child’s symptoms may be due to a slipped femoral epiphysis. ACTION Your doctor will examine your child and may arrange for ultrasound scanning (p. in which the lining of the joint becomes inflamed as a result of a recent infection elsewhere in the body. FOOT (p. However. In this condition. ACTION Your doctor will examine your child and may arrange for an X-ray of the hip (p. treatment with surgery may also be needed.39) to make sure that the symptoms have no other cause. if necessary. Is your child between 10 and 16 years old? SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Swollen lymph nodes could be preventing your child from walking normally. If an injury has become infected. antibiotics may be needed. WA R N I N G CAUTION Never ignore a limp in a child. such as YES a sore throat? NO POSSIBLE CAUSE Your child may have irritable hip. A minor injury that causes a limp may get better on its own. is a possibility. If a limp is associated with a fever. Bed rest will be necessary initially. the only evidence of an injury may be a limp or reluctance to stand on the affected leg. NO SEE YOUR DOCTOR WITHIN 24 HOURS IF YOUR CHILD IS LIMPING AND YOU CANNOT MAKE A DIAGNOSIS FROM THIS CHART. in which the head of the femur becomes misshapen due to poor blood supply to the bone. Does your child have a lump or tender swelling YES in the groin? NO Is your child between 4 and 8 years old? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Perthes’ disease. ACTION Your doctor will examine your child and may arrange for an X-ray (p. Does your child have a swollen or painful knee or ankle? NO YES Go to chart 48 JOINT AND BACK PROBLEMS (p. In some cases. The swelling may be due to an infection such as glandular fever or it may be a reaction to an injury in the leg or the foot. any child with a limp. ACTION The doctor will examine your child and may also arrange for blood tests to check for infection. 138 . see chart 49. a rash.41) to confirm the diagnosis. 136). may refer him or her to hospital for tests and treatment. Your doctor will examine your child to determine the diagnosis and. or a swelling or if your child is feeling generally unwell. A limp or reluctance to walk may be the first sign of a problem in a child who is too young to explain that something is START HERE Could your child have had YES an injury? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION In a small child. There may be an underlying disorder that requires prompt treatment.39) to be taken. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOUR CHILD IS LIMPING AND YOU CANNOT MAKE A DIAGNOSIS FROM THIS CHART.CHILDREN: ALL AGES 50 PROBLEMS Limping wrong. He or she may also need surgery on the other leg to prevent the same problem from occurring. even a painless one. If the diagnosis is confirmed. your child will need surgery to secure the head of the femur in its correct position. Most cases of irritable hip clear up with just a few days of rest in bed.

Consult this chart if you are worried about your child’s weight or if your child is outside the normal range for his or her height (see GROWTH CHARTS. Has your child had a recent illness? NO YES Go to chart 13 EXCESSIVE WEIGHT GAIN (p. POSSIBLE CAUSES Your child may be suffering from anorexia and/or bulimia (see EATING DISORDERS. and conformist. high achievers. or diet pills • Avoids social occasions as a result of dieting NO POSSIBLE CAUSE AND ACTION It is quite common to lose weight during an illness. if your child seems unwell or if his or her weight continues to cause you concern. Anorexia nervosa This disorder affects approximately 1 per cent of adolescents. it is a time when eating disorders. Heart failure is a risk at very low weights. Eating disorders Adolescence is the most common time for eating disorders to develop. Adolescence is a time when young people are particularly START HERE Is your child overweight for YES his or her age (see GROWTH CHARTS. They are usually of normal weight but have episodes (called binges) when they eat excessive amounts. Repeated vomiting causes damage to the teeth. and as a result. often followed by deliberate vomiting or abuse of laxatives or diuretics. mainly affects females: 3 per cent of women develop it at some time in their lives. Most people with anorexia have an intense desire to be thin and see themselves as fat even when dangerously underweight. although the incidence in boys is rising. These disorders. including the heart. may cause permanent health problems. may admit your child to hospital for supervision and psychiatric treatment. Two of the most serious are anorexia nervosa (in which a person eats little or no food) and bulimia nervosa (in which a person avoids putting on weight by deliberately vomiting or abusing laxatives). Early diagnosis is important in successfully treating these potentially lifethreatening conditions.CHILDREN: ADOLESCENTS 51 Adolescent weight problems sensitive about their appearance. Bulimia nervosa Bulimia. if necessary. The rapid increase in height that occurs in adolescence and the development of adult body proportions sometimes leads a teenager to feel either too thin or too fat. This is usually no cause for concern.26).26)? NO POSSIBLE CAUSE Overweight adolescents are at risk of obesity persisting into later life. It usually occurs in people who are hard-workers. consult your doctor. However. mainly girls. you should consult your doctor. like anorexia. if you are worried that your child is continuing to lose weight or if you think your child has become too thin. An adolescent needs more calories than an adult with a manual job. People with bulimia often have low self-confidence and use food for comfort. YOUR CHILD’S WEIGHT IS WITHIN THE NORMAL RANGE . below). diuretics. p. They may also exercise compulsively.26). and the risk of suicide is also increased. such as anorexia nervosa. p. and is often triggered by weight loss after a diet. Severe weight loss affects the heart and circulation and. and your child’s weight is likely to catch up with his or her height over the next few months. Has your child had a recent growth spurt? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. POSSIBLE CAUSE AND ACTION A rapid increase in height during a growth spurt may not initially be matched with a similar gain in weight. in girls. which can occur together.74) Is your child YES underweight for his or her age (see GROWTH CHARTS. ACTION Your doctor will examine your child and may recommend psychiatric help or. However. They may disguise their weight loss by wearing loose clothes and tend to become isolated and/or change their behaviour. Consult your doctor. for example by refusing to eat with others. Vomiting and the abuse of laxatives can result in chemical imbalances that may affect the internal organs. 139 . or has he or she lost weight recently? NO Do any of the following apply to your child? • Has intense interest in weight loss and diets • Excessively critical of his or her body size • Menstrual periods have stopped YES Avoids meals and/or • hides food • Misuses laxatives. are most likely to occur. often causes periods to stop. The person loses weight until he or she is emaciated. p. BUT IF YOU STILL HAVE CONCERNS YOU SHOULD CONSULT YOUR DOCTOR .

He or she may recommend counselling or family therapy. The only exceptions are in situations where the information is needed by the police in relation to a serious crime or to safeguard other people. If your doctor is unavailable. offering your support and understanding without making a fuss will be all your child needs at this time. or style of clothing often cause START HERE Is your child’s behaviour YES at school causing problems. However. language. Worries about his or her changing body. treatment with antidepressants is recommended.96) Patient confidentiality An adolescent may avoid consulting a doctor for fear that information will be passed on to his or her family. however. Talk to him or her to see if there is an underlying problem. Your child may be given drug treatment to control the symptoms and counselling to deal with any underlying problems. who may be able to give advice or recommend relevant support services. a doctor will maintain confidentiality as long as he or she is convinced that the child has a mature outlook and is fully capable of making informed decisions on health matters. your child may need to be admitted to hospital to prevent self harm and to begin treatment for depression. 140 .CHILDREN: ADOLESCENTS 52 Adolescent behaviour problems awkwardness. Are you worried about your child’s weight and/or eating habits? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Your child may have a serious mental health problem that needs early treatment to prevent difficulties relating to social skills and education. Encourage your child to talk to you or to friends about his or her feelings. if you feel that your child is outside your control and may be endangering his or her health or risking conflict with the law. An adolescent is much more self-conscious than a child. and the need to fit in with the peer group becomes increasingly important. Arguments or misunderstandings at home about dress. or general conduct are common. If your child is no better in a week or so. The combined effects of the hormonal changes that begin at puberty and the psychological factors involved in developing independence often lead to behavioural difficulties. consult your doctor. However. Teenage suicide attempts are often impulsive and may follow family quarrels or the breakup of a relationship. and try to reduce or remove any sources of stress that may be worsening the problem. Even if a child is under age 16. Doctors cannot disclose personal information given to them by a patient over the age of 16 without the consent of the patient. your child should be aware that doctors are bound by rules of confidentiality. Try not to make a fuss about your child’s behaviour. call a local support line immediately (see USEFUL ADDRESSES. Consult your doctor if your child’s symptoms continue to be worrying. Suicide threats should always be taken seriously. there is no cause for concern. 311). performance in school. Your doctor may arrange for your child to be admitted to hospital for assessment. p. consult your doctor.139) Go to chart 26 SCHOOL DIFFICULTIES (p. including contraception. In some cases. In many cases. These attempts rarely indicate a determined wish to die. As long as a low mood does not last long or seem overly intense. Adolescence is the transition between childhood and adulthood. YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION Your child may be severely depressed and need urgent medical assessment. Continued on next page POSSIBLE CAUSE AND ACTION Your child may be depressed. even if they have been made repeatedly. Offer your support and encouragement. Do any of the following YES apply to your child? • Has seriously disturbed thoughts • Speech is rapid • Hears voices or sees things that are not there • Feels controlled by outside forces NO Have these symptoms lasted less than 2 weeks? YES NO Do two or more of the following apply? • Loss of enthusiasm • Constant tiredness • Difficulty sleeping • Loss of appetite • Poor concentration • Falling school performance NO YES Has your child talked about or threatened suicide? NO POSSIBLE CAUSE AND ACTION Adolescence is a period full of emotional highs and lows. or has he or she been playing truant? NO Go to chart 51 ADOLESCENT WEIGHT PROBLEMS (p.

You should bear in mind. consult your doctor. without an obvious cause. Regardless of your opinion about his or her actions. Offer your support and understanding. Explain the dangers of drug abuse. He or she may recommend counselling or family therapy. difficulties with friends.CHILDREN: ADOLESCENTS Continued from previous page Is your child worried about a problem. YES ACTION Talk to your child. p. Your child is entitled to confidential medical care from a doctor even if he or she is under 16 (see PATIENT CONFIDENTIALITY. and try to discover any underlying worries that he or she has.311). He or she may recommend counselling. to try to find out whether he or she is using drugs or solvents. If your child denies drug or solvent use or seems unable or unwilling to stop. or parental separation? NO YES YES POSSIBLE CAUSE Most adolescents experience periods of anxiety. but do not get aggressive or angry. If the symptoms persist for more than 2 weeks. such as diabetes mellitus or asthma.311). You should also consult your doctor. long-standing behaviour problems may be difficult to change. Counselling or family therapy will probably be recommended. Explain the dangers of not taking a prescribed medication as advised. Most adolescent drug users will use the drugs they buy immediately or will be careful to hide any evidence. Behavioural changes are often the only clues. He or she may recommend counselling or family therapy. Talk to your child. Consult your doctor. he or she may have a conduct disorder. and offer your support and understanding. irritability. ACTION Your doctor may refer your child to a specialist for assessment. POSSIBLE CAUSE AND ACTION Your child’s anxiety may be a symptom of depression. 141 .32). you should consult your doctor or a self-help group (see USEFUL ADDRESSES. If your child’s anxiety does not ease with time and extra support. who may be able to help by talking to your child. p. or aggressiveness • Lying and/or secretiveness about activities • Lethargy. Is your child’s behaviour aggressive or violent. however. or drowsiness • Falling school performance • Loss of interest in friends or usual activities • Altered sleep patterns • Inability to account for money spent • Disappearance of money or belongings If you suspect that your child is abusing drugs or solvents. ACTION Talk to your child. Talk to your child about his or her feelings. even if they have previously been responsible. consult your doctor or a self-help group (see USEFUL ADDRESSES. Are you concerned that your child may be sexually active? NO YES Has your child stopped following his or her treatment plan for a long-standing medical condition? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND AN EXPLANATION FOR YOUR CHILD ’ S BEHAVIOUR ON THIS CHART AND YOUR CHILD CONTINUES TO BEHAVE IN A WORRYING WAY. sleepiness. POSSIBLE CAUSE If your child is persistently antisocial or disruptive. This is usually due to a child’s resentment of being different from others or the need to feel in control of his or her life. p. opposite). choose a good time to discuss your concerns. try to talk to your child about your concerns. is common in adolescents. or is he or she breaking the law? NO YES Recognizing drug and solvent abuse POSSIBLE CAUSE AND ACTION If possible. Does your child seem particularly apprehensive or tense much of the time? NO Do any aspects of your child’s behaviour suggest drug or solvent abuse or the excess use of alcohol? NO POSSIBLE CAUSE Drug or solvent abuse (below) may be causing your child’s behaviour problems. such as exams. However. You are unlikely to discover any physical evidence that your child is taking drugs unless he or she wants you to do so. and try to provide your child with support. It may help to talk to your child’s teachers. POSSIBLE CAUSE AND ACTION A reluctance to follow the treatment plan for a long-standing disease. that most teenagers experience mood swings and other behavioural changes as a normal part of adolescence. This is a cause for concern only if it is severe enough to interfere with day-to-day functioning. such as unusual mood swings. consult your doctor. the most common signs of regular drug or solvent abuse are: • Behavioural changes. If your child is unwilling or unable to stop or denies drug usage. you should make sure that your child is aware of the risk of an unwanted pregnancy and of sexually transmitted infections (see SEX AND HEALTH. Although different drugs have different effects.

no cause for this can be found. puberty starts by 16 years of age without treatment. For this reason. your doctor may also refer your child to a specialist. He should continue to develop. a condition known as gynaecomastia. The earliest sign of puberty is usually enlargement of the penis and testes. and it usually disappears on its own within 18 months to 3 years. any changes in a breast should be checked by your doctor. ACTION Your doctor will examine your child and may arrange for blood tests to measure his hormone levels. hormonal drugs may be prescribed to delay its progress and to ensure that the slowing down in growth that comes at the end of puberty does not begin before your child reaches a normal adult height. but in some cases it may be due to a problem in the hormoneproducing control centres of the brain. in some cases. The time when a child goes through the physical changes involved in becoming an adult is known as puberty. If necessary. If necessary. liver disease. there are circumstances in which one or both breasts enlarge. The adolescent growth spurt usually starts in mid-to-late puberty. p. Often. the adolescent growth spurt does not tend to occur until puberty is well established. Does your child have a long-term illness such as cystic fibrosis or arthritis? NO YES POSSIBLE CAUSE AND ACTION Your child is showing signs that puberty has started. it is normal for the first signs of puberty to occur between the ages of 9 and 15. males have very little breast tissue. ACTION Your doctor will examine your son and may arrange for blood tests to measure his hormone levels. Other signs of puberty include the ability to START HERE Is your child YES showing any of the following signs of puberty? • Enlargement of the penis and testes • Pubic hair growth • A deepening voice • Frequent erections NO Is he under 9 years old? NO YES POSSIBLE CAUSE Puberty may have started abnormally early in your child. In boys. In most cases. Although he may be developing later than normal. Consult your doctor. puberty may be associated with a temporary enlargement of breast tissue (see BREAST DEVELOPMENT IN MALES. Sensible weight loss (see HOW TO LOSE WEIGHT SAFELY. your doctor may refer him to a specialist. Although there is often no obvious cause for this. Breast development in males Normally. It is quite common for adolescent boys to develop an enlargement of one or both breasts. below). Occasionally. and deepening of the voice. Is he 15 years old or over? NO YES Is he 15 years old or over? NO YES POSSIBLE CAUSE AND ACTION In boys. or has he had surgery involving the testes? NO YES POSSIBLE CAUSE AND ACTION Some long-term illnesses can temporarily delay the onset of puberty. POSSIBLE CAUSE The onset of puberty is delayed in your child. If your son is concerned that he is shorter than his peers. Consult your doctor. and puberty should be completed within the next 5 years. the growth of body and facial hair. The treatment of gynaecomastia depends on the underlying cause. Consult your doctor. however any age between 9 and 15 years is considered normal. Has your child been treated with chemotherapy or radiotherapy. If puberty has begun. 142 . it is usually due to a side effect of a prescribed drug or. there is probably no need to consult your doctor. however. this is no cause for concern. Discuss your concerns with your child’s regular doctor. but excess tissue may be removed surgically if necessary. POSSIBLE CAUSE Damage to the testes as a result of a previous illness or treatment may have reduced production of the male hormones necessary for puberty to proceed. This enlargement is usually caused by the changes in the body’s hormone levels that occur during puberty. If necessary. most boys start puberty at 12 years of age. reassure him that he should grow taller soon. which can be embarrassing but is no risk to health. An overweight male of any age may appear to have breasts because of a build-up of fatty tissue on the chest wall. although it is rare. When gynaecomastia occurs in older men. Breast cancer can occur in males.151) should reduce their size. As long as he remains well and continues to develop. he or she may refer your child to a specialist for hormone treatment. On average.CHILDREN: ADOLESCENTS 53 Problems with puberty in boys ejaculate seminal fluid. it tends to run in families and is more common in children who are short. ACTION Your doctor will examine your child and may arrange for blood tests to measure his hormone levels. CONSULT YOUR DOCTOR IF YOUR CONCERN IS NOT DEALT WITH IN THIS CHART.

Puberty usually lasts for about 5 years. he or she may then refer your child to a specialist. POSSIBLE CAUSES AND ACTION Being very underweight or overexercising may affect hormone production in the part of the brain that controls the onset of puberty and the menstrual cycle. 143 . Discuss your concerns with your child’s regular doctor. Your child may be referred to a specialist if necessary. and menstruation usually begins between the ages of 11 and 14. but in some cases it may be due to a problem in the hormone-producing control centres in the brain. Consult your doctor.CHILDREN: ADOLESCENTS 54 Problems with puberty in girls growth spurt in early puberty. The average age for a girl to start puberty is 111⁄ 2 years. Go to chart 130 ABSENT PERIODS (p.260) POSSIBLE CAUSE AND ACTION The onset of puberty is delayed in your child. The drugs will ensure that the slowing down in growth that comes at the end of puberty does not begin before she reaches a normal adult height. ACTION Your doctor may arrange for blood tests and may refer your child to a specialist. Although there is often no obvious cause for late puberty. she may be prescribed drugs to delay its progress. who will probably examine your child and may arrange for blood tests to measure her hormone levels. POSSIBLE CAUSE AND ACTION Some serious long-term illnesses can temporarily delay the onset of puberty. If your child is seriously underweight. Girls usually have a START HERE Is your child under 8. your child is showing signs that puberty has started. She should continue to develop normally. However. or is she involved in a vigorous exercise YES programme? NO POSSIBLE CAUSE AND ACTION Your child’s treatment may have affected the production of hormones. your doctor may then refer your daughter to a specialist. Is your child over 14 years old. it is not known what causes the early onset of puberty. unless you or your daughter are concerned.139) can be excluded. Puberty is the time when a child goes through the physical changes involved in becoming an adult. during which time all of the body features of an adult develop. although any age between 8 and 14 years is considered normal. If necessary. and puberty should be completed within the next 5 years.26). followed by armpit hair.149). this is no cause for concern. and YES is she showing any of the following signs of puberty? • Pubic hair • Breast enlargement • Periods NO Are any of the following signs of puberty present? • Pubic hair YES • Armpit hair • Breast enlargement NO POSSIBLE CAUSE Puberty may have begun abnormally early in your child. your doctor will advise her on how to gain weight safely (p. In many cases. Does your child have a long-term illness such as cystic fibrosis or arthritis? NO YES POSSIBLE CAUSE It is quite common for girls to have irregular periods for the first few years. Consult this chart if you are worried that your child has started puberty too early or that she seems abnormally late in reaching puberty. p. Although she is developing later than normal. who will examine your child and may arrange for blood tests to measure her hormone levels. Consult your doctor. It may take up to 40 menstrual cycles before the body establishes a regular pattern. Did your child start having periods that have now stopped? NO YES Is she substantially underweight (see GROWTH CHARTS. CONSULT YOUR DOCTOR IF YOUR CONCERN IS NOT DEALT WITH IN THIS CHART. Your doctor will advise you on your child’s ideal weight and discuss the negative effects of overexercise at this stage of life. Consult your doctor. The first signs of puberty are the enlargement of the breasts and the growth of pubic hair. If necessary. the possibility of pregnancy should always be considered. it tends to run in families and is more common in children who are short. Consult your doctor so that a serious underlying cause such as an eating disorder (p. If your child has started puberty. and has she not yet started having her periods? NO YES Has your child been treated at any stage with chemotherapy or radiotherapy? NO YES POSSIBLE CAUSE AND ACTION Despite the absence of periods. There is probably no need to consult your doctor.

Excessive washing can increase sebum production in the skin. who may prescribe other preparations or oral drugs for treating acne. but it may stop it getting worse. such as psoriasis. Washing will not prevent acne. However. because of the risk of side effects. Go to chart 78 SKIN PROBLEMS AFFECTING THE FACE (p. regular blood tests will be needed while you are taking them. the most noticeable skin changes during adolescence are caused by the rising levels of sex hormones. However. These drugs are usually very effective. or there is scarring.178) or go to chart 79 SKIN DISCOLORATION AND MOLES POSSIBLE CAUSE AND ACTION These are features of severe acne that should be treated by a doctor. There is no evidence that acne can be caused or made worse by having hair that hangs over the face. your general health will be improved by eating a healthy diet and exercising regularly. right). POSSIBLE CAUSE Greasy skin is normal at this age. below) may also help. Alternatively. however. 144 . ACTION Make sure your child knows what measures can be taken to improve acne (see COPING WITH ACNE. above). your acne is very severe. ACTION Regular washing with mild soap and water is normally all that is needed to keep greasy skin under control. below).CHILDREN: ADOLESCENTS 55 Adolescent skin problems adolescence. may also develop for the first time during START HERE Does your YES child have either of the following? • Inflamed red spots with white centres • Blackheads NO Do any of the YES following apply? • There are red spots or lumps under the skin • The spots are leaving scars on the skin • The spots occur over a wide area of the face. Use mild soap and water. Although it is not severe. Your doctor may prescribe long-term low-dose antibiotics. This drug unblocks pores and kills bacteria. These hormones encourage the sebaceous glands in the skin to produce increasing amounts of sebum – an oily substance that helps to lubricate the skin. Moderate to severe acne should receive medical treatment. your doctor may refer you to a specialist for treatment with oral retinoids. it is no cause for concern. The onset of adolescence often produces marked changes in the skin. causing an itchy. Nor are lack of exercise or eating sweets.182) Treatments for acne There is no instant cure for acne. Contact eczema may result from contact with certain metals or cosmetics. you should try over-the-counter lotions and creams containing benzoyl peroxide. Not only does the increased sebaceous activity give the skin an oily appearance. Women must not become pregnant during treatment with oral retinoids because these drugs can cause serious malformations in the fetus. Infantile eczema. These creams unblock pores by removing a fine surface layer of skin. However. or fatty foods known to be factors. benzoyl peroxide can make the skin sore. The following measures may be helpful in controlling acne: • Wash your face regularly. it may still be causing him or her distress. but it also encourages the development of acne. In terms of health. he or she may prescribe a skin preparation containing a retinoid drug. An over-the-counter acne lotion or cream (see TREATMENTS FOR ACNE. consult your doctor. may clear up altogether before or during adolescence. • Oily cosmetics and pomades for AfroCaribbean hair should be used sparingly. (p. Before consulting your doctor. Any make-up that is used should be oil-free and should be removed completely each night. which need to be taken for at least 6 months. Other skin problems. Understanding what causes acne and what does not will help you cope with the condition. but not more than twice a day. Your child should also follow self-help measures (see COPING WITH ACNE. • Remove any make-up at night. or back NO SELF-HELP Coping with acne Is your child worried by increasing oiliness of the skin? NO YES POSSIBLE CAUSE Your child probably has mild acne. which often affects younger children. If there is no improvement or if your child’s acne continues to cause him or her distress. If treatment with antibiotics and/or retinoid creams is ineffective. it may embarrass your child. who will examine your child and may prescribe acne treatment or may refer your child to a skin specialist for treatment (see TREATMENTS FOR ACNE. • Sunlight can help to improve mild acne – but be careful to avoid sunburn. although many treatments are available that will improve the appearance of the skin. another form of eczema – contact eczema – may occur for the first time during this period. red rash. chest. such as isotretinoin. Consult your doctor.180) or go to chart 77 GENERAL SKIN PROBLEMS (p. chocolates. which affects almost all adolescents to some extent. However. thereby reducing the number of spots. However.

....197 Coughing............................................ 224 109 Painful urination............................................... 150 Difficulty in sleeping........................................175 Hair and scalp problems......................................... 178 Skin problems affecting the face....................................... 236 117 Back pain.................................................................................................................... 238 118 Painful or stiff neck.....186 Disturbed or impaired vision..... 220 105 Constipation.................................... 154 Excessive sweating..196 Wheezing............................................................................................. 147 Loss of weight........ 223 108 General urinary problems...................................... 216 102 Swollen abdomen.. 152 Fever....................................................................................................................193 Runny or blocked nose........................................................184 Nail problems......................... 169 Depression.. 226 110 Painful joints..................... 160 Dizziness............ 170 Anxiety...... 172 Lumps and swellings........ 176 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 General skin problems....................... 235 116 Foot problems.................... 163 Forgetfulness and/or confusion. 148 Overweight.................................. 204 Teeth problems............................................ 212 100 Abdominal pain............................................................................................................................... 167 Difficulty in speaking............................................................................... 158 Feeling faint and passing out......................................188 Hearing problems............................................ 232 114 Painful knee....................... 230 112 Painful arm............................. 222 107 Anal problems.................... 164 Twitching and/or trembling.................166 Pain in the face................ 234 115 Swollen ankles.................................................. 231 113 Painful leg..........195 Hoarseness or loss of voice.................................................................................................................. 156 Headache..................... 219 104 Diarrhoea..............................190 Noises in the ear. 240 145 ........... 208 97 98 99 Difficulty in swallowing....A D U LT S : G E N E R A L GENERAL CHARTS FOR ADULTS 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 Feeling unwell......194 Sore throat........................................................................................................ 210 Recurrent vomiting........................................ 162 Numbness and/or tingling................... 174 Itching............................................................................................. 180 Skin discoloration and moles.............................................................. 182 Rash with fever... 228 111 Painful shoulder................ 221 106 Abnormal-looking faeces.. 202 Palpitations...198 Shortness of breath........ 218 103 Wind.192 Earache................................ 206 Mouth problems.................... 168 Disturbing thoughts and feelings..... 209 Vomiting................... 146 Tiredness........................ 200 Chest pain............185 Painful or irritated eye............................................................ 214 101 Recurrent abdominal pain.......

ACTION Cut down your alcohol consumption so that you stay within the recommended safe limits.154) Do you feel tired or are you lacking in energy most of the time? NO YES POSSIBLE CAUSE Tiredness is a common symptom of many disorders. but you should keep your consumption within safe limits to maintain good physical and emotional health. Experiencing severe hangovers or memory loss after drinking alcohol indicates that you are drinking to excess. Are you taking overthe-counter.A D U LT S : G E N E R A L 56 Feeling unwell you should always make an appointment to see your doctor if the feeling persists for more than a few days. Have you lost 4 kg (9 lb) or more in weight YES over the past 10 weeks without trying? NO Go to chart 58 LOSS OF WEIGHT (p. Do you have a temperature of 38ºC (100ºF) or above? NO POSSIBLE CAUSE A viral infection is the most common cause of a general feeling of ill health combined with a fever. prescribed. as do arguments or accidents precipitated by drinking. or an unhealthy lifestyle.30). p.148) Assessing your alcohol consumption SELF-HELP Some people use alcohol to cope with stressful situations or painful emotions. this habit can lead to alcohol dependence. there is a possibility that it may be a sign of a more serious underlying problem that requires medical treatment. stop taking any over-the-counter or recreational drugs. right). ask yourself the questions below. Consult your doctor. psychological pressures. your health may be at risk (see SAFE ALCOHOL LIMITS. POSSIBLE CAUSE AND ACTION Certain drugs can cause a feeling of ill heath as a side effect. This feeling is usually the result of a minor infection. your drinking may be becoming a problem. To assess your drinking habits. Go to chart 73 ANXIETY (p. YES Go to chart 61 FEVER (p.30)? NO YES POSSIBLE CAUSE Excessive consumption of alcohol can cause both physical and mental ill health (see ASSESSING YOUR ALCOHOL CONSUMPTION. • Have you ever thought that you ought to cut down on your drinking? • Have other people ever annoyed you by criticizing your drinking? • Have you ever felt guilty about drinking? • Have you ever had an ”eye-opener“ drink first thing in the morning? If you have answered yes to two or more of these questions. START HERE Do you feel continually on edge or worried for no particular reason? NO YES POSSIBLE CAUSE Feelings of anxiety resulting either from a specific problem or from an accumulation of different stresses and worries can make you feel unwell. some of which require medical treatment. 146 .147) Do you regularly drink more than the recommended safe alcohol limit (p. Sometimes you may have a vague feeling of being unwell without being able to identify a specific symptom such as pain. If you have more than two alcoholic drinks a day on most days. or recreational drugs? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. The answers may help you to judge whether drinking is affecting your life or becoming an uncontrollable habit. However. Social drinking Drinking alcohol can be an enjoyable part of your social life.172) POSSIBLE CAUSE Unexplained weight loss combined with a general feeling of being unwell may be a sign of an undiagnosed illness. Consult your doctor. but do not stop taking prescribed drugs. Meanwhile. Go to chart 57 TIREDNESS (p. consult your doctor. If unchecked. If you are having difficulty reducing your intake.

DIFFICULTY (p. brittle hair • Unexplained weight gain • Dry and/or rough skin NO Go to chart 58 LOSS OF WEIGHT (p.A D U LT S : G E N E R A L 57 IN SLEEPING Tiredness have cleared up after 2 or 3 weeks. In some cases. Have you lost 4 kg (9 lb) or more in weight over the past 10 weeks without trying? NO YES ACTION Your doctor will take a blood sample to check your blood sugar level. Anaemia can result from a variety of underlying causes. If the diagnosis is confirmed. you will be prescribed thyroid drugs. in which there is too little of the oxygen-carrying pigment haemoglobin in the blood.170) 147 . POSSIBLE CAUSE Weight loss and tiredness may be due to a disorder that needs treatment. such as beta blockers. further tests will be necessary to determine why anaemia has developed. Consult your doctor. ACTION Your doctor will take a blood sample to measure levels of thyroid hormones.149) is a possibility. see chart 60.148) Have you noticed any of the following? • Shortness of breath YES • Paler than normal skin • Feeling faint NO POSSIBLE CAUSE You may be suffering from hypothyroidism (underactive thyroid gland). For many. This condition is caused by insufficient production of the hormone insulin. such as flu or glandular fever. If the diagnosis is confirmed. this is sufficient. Go to chart 72 DEPRESSION (p. SEE YOUR DOCTOR WITHIN 24 HOURS Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE Certain drugs. you should consult your doctor because in some cases tiredness may indicate a serious health problem. For problems related to sleeping. do not stop taking your prescribed drugs. Treatment for anaemia usually needs to be combined with treatment of the underlying cause. however some people will need drug treatment with either tablets or insulin injections for life. you will need advice on diet and lifestyle. if it prevents you from carrying out daily activities. YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. It is common after some infectious illnesses. ACTION Your doctor will arrange for a blood test to confirm the diagnosis. which is needed by the body to obtain energy from sugar and carbohydrate foods. Do you have any of the YES following symptoms? • Feeling the cold more than you used to • Thinning. ACTION Consult your doctor. but should START HERE Have you noticed any of the following? • Increased thirst • Passing more urine than usual • Blurred vision NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Diabetes mellitus (p. However. can sometimes cause tiredness as a side effect. POSSIBLE CAUSE You may have anaemia.152). Meanwhile. Have you noticed any of the following? • Difficulty concentrating • Difficulty sleeping • Feeling in low spirits • Loss of interest in sex NO YES CONSULT POSSIBLE CAUSE Depression can lead to tiredness and feeling low. Tiredness is normal after physical exertion or long periods of hard work without a break. Occasional blood tests will be necessary to monitor the dosage. or if it is prolonged. if there is no obvious explanation for your tiredness. which need to be taken for life.

For many people with diabetes. unintentional weight loss. this is sufficient. see chart 51. ACTION You need to increase the number of calories you are taking in to balance the amount of energy you are using up (see HOW TO GAIN WEIGHT SAFELY. ACTION Your doctor will take a blood sample to check your blood sugar level. and nervous system disorders begin to occur. Using a condom is the only effective way of stopping the transmission of the virus during sexual intercourse. Symptoms of HIV infection and AIDS The initial infection with HIV may cause no symptoms or may result in a brief. If you are worried that you have lost a lot of weight and there is no obvious cause. and during breast-feeding. surgery to remove part of the gland is needed. As the immune system is weakened. 148 . For severe weight loss in adolescents. Continued on next page CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. you should consult your doctor. the virus can still be passed on during this time. Sometimes. Are you exercising more YES than you used to? NO POSSIBLE CAUSE Burning up more energy than you are taking in from food is the most likely cause of your weight loss. However. vaginal secretions. However. START HERE Has your weight decreased by only a small amount (less than 4 kg/9 lb in 10 weeks)? NO YES POSSIBLE CAUSE Minor fluctuations in weight are normal. the body becomes unable to protect itself against other infections or cancer. Consult your doctor. Once the immune system has been severely weakened. despite the absence of symptoms. this loss of immunity is known as acquired immunodeficiency syndrome (AIDS). How the virus is transmitted HIV is carried in body fluids such as blood. The virus can be passed on from an infected mother to her baby during pregnancy. Have you YES noticed one or more of the following? • Increased thirst • Passing more urine than usual • Blurred vision NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Diabetes mellitus (opposite) is a possibility. ACTION Your doctor will take a blood sample to measure levels of thyroid hormones. but people who use intravenous drugs or share dirty needles are also at increased risk. which are usually rapidly effective. If the diagnosis is confirmed. some people will need drug treatment either with tablets or with insulin injections for life. ACTION Increase the amount of food you eat. Is your appetite as good as usual? YES NO Have you noticed one or more of the following? • Feeling constantly YES on edge • Increased sweating • Bulging eyes • Trembling hands NO HIV infection and AIDS The human immunodeficiency virus (HIV) is an organism that progressively destroys cells in the immune system over several years. semen. severe. the drugs are not able to completely eradicate the virus from the body.A D U LT S : G E N E R A L 58 Loss of weight especially if it is combined with loss of appetite or other symptoms. This condition is caused by insufficient production of the hormone insulin.29). cancers. Minor fluctuations in weight due to temporary changes in your diet and/or in the amount of exercise you are taking are normal. Treatment and prevention Treatment for HIV infection includes multiple antiviral drugs that slow the rate at which the virus multiplies in the body and delay the progression to AIDS. As a result. you may be treated with thyroid drugs or radioactive iodine. you will need advice on diet and lifestyle.139). flu-like illness. however. and breast milk. which is needed by the body to obtain energy from sugar and carbohydrate foods. However. ADOLESCENT WEIGHT PROBLEMS (p. disorders such as fungal mouth infections and genital warts may develop. at delivery. serious infections. These conditions signify the onset of AIDS. p. may be an early warning sign of some cancers or infections that require urgent medical attention. Consult your doctor if you continue to lose weight or have fallen below the ideal weight for your height. Your weight loss is unlikely to be a cause for concern unless you are below your ideal weight (see ASSESSING YOUR WEIGHT. This is followed by a period of 5–10 years during which there are no symptoms. opposite). POSSIBLE CAUSE Hyperthyroidism (overactive thyroid gland) is a possible cause of your symptoms. If the diagnosis is confirmed. It is most commonly transmitted through unprotected sexual intercourse.

If there is insufficient insulin. make sure that your diet is high in complex carbohydrates. which results in problems with the eyes. Cells have to use fats as an energy source instead of glucose. which leads to a build-up of toxic byproducts. excessive passing of urine. In addition to these measures. diabetes is a life-long condition. Go to chart 72 DEPRESSION (p. and bread. or certain types of cancer are possibilities. it is important to gain weight sensibly so as to build up muscle and bone rather than excessive body fat. Cancer of the colon is also possible. left). It develops gradually and symptoms may go unrecognized for years. especially if you are over 40. 149 . Ideally. and weight loss.28). pasta. frequent sessions so that you avoid over-exerting yourself. and low in fats. Inflammation of the intestines or an ulcer are both possibilities. People with type 2 diabetes may be able to control their diabetes simply by keeping fit and following the right diet. heart. take exercise in small. Treatment aims to keep blood sugar levels as normal as possible to delay the onset of complications. such as sandwiches and bananas. Treating diabetes Anyone with diabetes needs to eat a diet high in complex carbohydrates. Try to have high-calorie. This type of diabetes is 10 times more common than type 1. Several small. such as bread. once it develops. and pulses. this form usually develops suddenly in childhood or adolescence and causes dramatic weight loss. nutritious snacks. Complications of diabetes High blood sugar over a prolonged period damages blood vessels throughout the body. such as pasta.A D U LT S : G E N E R A L Continued from previous page SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES A disorder of the digestive tract may be the cause of your weight loss. kidneys. you should aim to put on weight gradually by eating a healthy. If you tire easily. It mainly develops after the age of 40. nutritious meals each day provide a better supply of energy than one or two large meals. the pancreas continues to produce insulin. p. the pancreas produces too little insulin or none at all. If you are underweight (see ASSESSING YOUR WEIGHT. between meals. normally produced by the pancreas. A healthy diet If you have diabetes. glucose accumulates in the blood and the urine. ACTION Your doctor will take samples of blood and probably of sputum for analysis and will order a chest X-ray (p. and nervous system. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES A chronic infection. Have you noticed two or more of the following? • Profuse sweating during the night • Recurrent raised temperature • A general feeling of ill health • Blood in the sputum NO YES Have you noticed one or more of the following? • Inability to concentrate or make decisions YES • Difficulty in sleeping • Feeling in low spirits • Loss of interest in sex NO POSSIBLE CAUSE Depression can sometimes cause a marked loss of appetite. The injections are self-administered several times a day and the doses have to be carefully matched to food intake.222). and a colonoscopy (p.29). particularly in those who are overweight.170) CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. In type 2 diabetes. Have you noticed one or more of the following? • Recurrent bouts of diarrhoea and/or constipation • Recurrent pain in the abdomen • Blood in the faeces NO YES ACTION Your doctor will probably arrange for a variety of diagnostic tests. In type 1 diabetes. you may be referred to a specialist for treatment.38) and other tests. and low in fats (particularly animal fats). rice. Food supplements and milkbased drinks will also help. How to gain weight safely SELF-HELP Being underweight can be just as much of a health risk as being overweight. Diabetes mellitus affects about 3 in every 100 people. people with type 1 diabetes need lifelong treatment with insulin injections to replace the missing hormone. Keeping fit is also an important aspect of treatment. such as tuberculosis. Once the test results are known. There are two main forms of the disorder: type 1 and type 2. balanced diet (p. which may be sufficient to result in weight loss. Make sure that you continue to take regular exercise because this will help you to build up your muscles and increase your strength and may also improve your appetite. but these should be added to your normal diet rather than taken instead of meals. cereals. These chemical changes cause the symptoms of diabetes: thirst. Diabetes mellitus Diabetes mellitus is a condition in which body cells are not able to absorb enough of the sugar glucose (the body’s main energy source) from the blood. People with diabetes should visit their doctor every few months so that he or she can assess the control of blood sugar levels and detect and treat any complications of the disease at an early stage. Regular monitoring of blood sugar levels is necessary to ensure that the treatment is effective. These may include a blood test. stool tests. but body cells are resistant to it. This inability is due to a deficiency of the hormone insulin. but most need to take oral drugs and a few need insulin injections. an AIDS-related illness (see HIV INFECTION AND AIDS.

If necessary. Learning new eating habits is important if you are to be successful in maintaining weight loss. The decline is more marked in women. BMR tends to be lower in women. It may help to discuss the issue with your doctor. there may be a medical reason. p. much more than this is unhealthy. such as the hips or knees. reaching their heaviest at about age 50. consult your doctor. The fall in BMR with age is more marked in women than men. Normally. fat accounts for between 10 and 20 per cent of the weight of a man and about 25 per cent of a woman. He or she may recommend that you also have treatment for anxiety. ACTION Try to choose low-calorie snacks. This reduction in energy use even applies to the amount of energy needed to perform essential functions such as breathing and circulation (called the basal metabolic rate or BMR). tends to results in a gradual gain in weight with age. this tendency is a result of unhealthy eating habits learned as a child.A D U LT S : G E N E R A L 59 Overweight chart if you weigh more than the healthy weight for your height (see ASSESSING YOUR WEIGHT. opposite). Your weight gain may be due in part to changes in your body chemistry. or you have problems keeping excess weight off. To avoid gaining weight you may need to cut down on your food intake or increase your activity level. but it is more likely to be due to snacking more than you usually would.279) 250 200 150 100 Did you put on weight at a time when you were feeling under particular stress? NO YES POSSIBLE CAUSE Overeating in response to a stressful situation is a common problem. combined with the general reduction in the amount of exercise people often take as they get older. in some cases. ACTION Do not worry about putting on weight during the first weeks after giving up smoking. especially if you put on a lot of weight during the pregnancy. BMR falls. the rate at which the body consumes energy falls. Often. KEY 50 0 Male Female 10 20 30 40 50 60 70 AGE (years) Decline in basal metabolic rate Males and females have slightly different basal metabolic rates (BMR). however. Most people gradually gain a little weight as they grow older. you will need to take steps to resolve the problem that is causing your stress. Consult your doctor if you cannot lose weight. BMR (kilojoules/m2/hour) Go to chart 142 WEIGHT PROBLEMS AND PREGNANCY (p. However. ACTION You should aim to take in fewer calories (units of energy) each day than you burn up (see HOW TO LOSE WEIGHT SAFELY. much less of a health risk than smoking.29) or if you have excess abdominal fat – a waist measurement of over 89 cm (35 in) for women and over 102 cm (40 in) for men. Did you put on weight after giving up smoking? YES NO POSSIBLE CAUSE Withdrawal of tobacco often causes a temporary gain in weight. Excess fat around the abdomen is thought to be a greater risk for heart disease than fat elsewhere. ACTION Adopt a sensible approach to losing weight (see HOW TO LOSE WEIGHT SAFELY. As people age. The effect of this slowing down of metabolism. Consult this START HERE Have you been YES overweight for most of your life? NO Are one or both of your YES parents overweight? NO POSSIBLE CAUSES A tendency to be overweight can run in families. Weight gain is usually due to overeating. opposite). such as fresh fruit. Occasionally. there is an inherited predisposition to be overweight. increasing the risk of diseases such as diabetes and high blood pressure and of damage to weight-bearing joints. Wait until you have lost your intense craving for tobacco (after about 8 weeks) before adopting a weight-reducing diet (see HOW TO LOSE WEIGHT SAFELY. Have you been overweight since having a baby? NO YES POSSIBLE CAUSE Pregnancy is often associated with weight gain that is difficult to lose once the baby is born. Age and metabolic rate From adolescence onwards. POSSIBLE CAUSE Eating more than you need is likely to be the cause of your weight problem. opposite) until you reach your ideal weight. opposite). if you continue to have problems controlling your weight. adopt a gradual reducing diet (see HOW TO LOSE WEIGHT SAFELY. However. this weight gain is. and then maintain healthy eating habits. If this is unsuccessful. Continued on next page 150 .

• Cut down your alcohol consumption. This will maintain your general health and help to boost weight loss (see HOW TO LOSE WEIGHT SAFELY. You should try to reduce your daily calorie intake by 500–1. The following suggestions may help: • Cut down on fatty foods. • Avoid shopping for food when you are feeling hungry. potatoes. Calorie reduction The best type of weight-reducing diet is one that is low in calories but balanced so that you stay well nourished. can boost weight loss. you will lose weight. If after a month you have failed to lose weight. consult your doctor for advice. and pasta. The best way to lose weight is to combine a reduced calorie intake with regular exercise. such as corticosteroids. Rapid weight-loss plans and fasting should be avoided. you use up more calories. above). YES POSSIBLE CAUSE Certain prescribed drugs. if you have a caloriecontrolled diet. can cause weight gain as a side effect. Set yourself a realistic. Consult your doctor. Meanwhile. If the diagnosis is confirmed. POSSIBLE CAUSE Eating more than you need is the likely cause of your excess weight. above). Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE Alcohol is high in calories but has no nutritional value and is probably contributing to your weight gain. brittle hair NO POSSIBLE CAUSE You may be suffering from hypothyroidism (underactive thyroid gland). • Avoid excessive snacking. and it may take a little while for you to become accustomed to your new diet. ACTION Your doctor will take a blood sample to measure levels of thyroid hormones. you will be prescribed thyroid drugs. Did the weight gain follow a change from a physically active life to a more sedentary job or lifestyle? NO YES Have you noticed one or more of the following? • Excessive tiredness • Feeling the cold more than you used to • Increased dryness or roughness of the skin • Thinning. You should also try to incorporate physical exercise into your daily routine. How to lose weight safely SELF-HELP The most likely cause of being overweight is a combination of overeating and lack of exercise. about 2–4 kg (4–9 lb) a month is sensible. ACTION Reduce your food intake and/or increase your level of activity to restore the balance of energy intake and expenditure (see HOW TO LOSE WEIGHT SAFELY. 151 . but it also raises basal metabolic rate (BMR). If you have difficulty cutting down. Exercise Regular exercise benefits your general health as well as helping you to reduce weight. do not stop taking prescribed drugs. ACTION Follow a sensible reducing diet (see HOW TO LOSE WEIGHT SAFELY. Your weight gain is probably due to the fact you are taking less exercise at a time when your body needs less food to perform basic functions (see AGE AND METABOLIC RATE. opposite). Taking regular exercise Regular exercise.000 calories. Exercise does not have to be strenuous. the rate at which your body consumes energy when at rest to maintain basic processes such as breathing and digestion. right). • Oven bake or grill rather than fry food. but you should aim to do 30 minutes. good alternatives include wholemeal bread. which need to be taken for life. Not only are calories burned up during exercise. ACTION Cut down your alcohol consumption. five times a week. This will mean changing eating habits you have developed over many years.30)? NO YES Are you over 40 years old? NO YES POSSIBLE CAUSE Growing older is often accompanied by a gain in weight. Your doctor will arrange occasional blood tests to monitor the drug dosage. short-term target for weight loss. such as cycling. ACTION Adjusting your food intake to take account of your reduced energy requirements should help you to lose the weight you have put on. consult your doctor for advice. If your BMR rises. and. Consult your doctor. Set aside time each day for exercise.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE The energy requirements of the body vary according to the amount of exercise your daily routine involves. Do you regularly drink more than the recommended safe alcohol limit (p.

discuss the problem with your doctor.200) YES On nights when you have difficulty in sleeping. take steps to improve your sleep (see GETTING A GOOD NIGHT’S SLEEP. consult your doctor for advice. Lifestyle changes can sometimes help with sleeping problems (see GETTING A GOOD NIGHT’S SLEEP. getting back to sleep may be difficult. opposite). have you drunk excessive amounts of alcohol? NO YES POSSIBLE CAUSE Although excessive alcohol consumption may initially help to induce sleep. If you have difficulty doing so. Continued on next page ACTION Try to be patient while your sleeping patterns are returning to normal. If you are still having difficulty sleeping after a month.A D U LT S : G E N E R A L 60 Difficulty in sleeping get to sleep or if you frequently wake during the night. which is present in coffee. and it can take several weeks or months for the patterns to be re-established after you stop taking the drugs. have you drunk more tea. ACTION Try cutting down your alcohol consumption. and resist the temptation to ask your doctor to prescribe more drugs for your sleeping problem. Do you wake up in the YES night or early in the morning for no obvious reason and are unable to get back to sleep? NO Have you noticed any of the following? • Difficulty in concentrating • Frequent negative thoughts • Feeling low in spirits • Loss of interest in sex NO Go to chart 73 ANXIETY (p. making you feel more alert. or cola than usual? NO POSSIBLE CAUSE Sleeping drugs can disrupt your normal sleeping patterns.204). coffee. cut out caffeinated drinks altogether. It is quite common to have the odd night when you find it difficult to get to sleep or to stay asleep. ACTION Try to avoid these drinks in the late afternoon or evening. tea. Do you find that you are woken by attacks of breathlessness? NO YES POSSIBLE CAUSES Breathlessness that comes on suddenly during the night can be due to asthma or a serious heart or lung condition. If you still have trouble sleeping. and this need not cause concern. or if your sleeping difficulties persist. Consult this chart if you often find it hard to START HERE Does worrying YES about the day’s events stop you from falling asleep? NO POSSIBLE CAUSES Stresses or anxieties that arise during the day can make it difficult for you to relax sufficiently to fall asleep.172) YES POSSIBLE CAUSE Disturbed sleep that occurs together with any of these symptoms indicates that you may be depressed. stimulates the central nervous system. opposite). This may make it difficult for you to sleep. In the meantime.170) On nights when you have difficulty in sleeping. YES POSSIBLE CAUSE Caffeine (p. and certain other drinks. cola. Have you recently stopped taking sleeping drugs? NO Go to chart 92 SHORTNESS OF BREATH (p. 152 . Go to chart 72 DEPRESSION (p. it tends to make you wake during the night.

A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Eating to excess or late in the evening can often make it difficult to sleep. and do you take little physical exercise during the day? NO Are you over 60? NO YES POSSIBLE CAUSE AND ACTION Most people need less sleep as they grow older. these suggestions may help: • Exercise during the day to tire yourself physically and help you relax. ACTION Try eating lighter meals or eat your last meal of the day earlier in the evening. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Some drugs. • Have a warm drink such as heated up milk or camomile tea at bedtime. For this reason. Try to catch up on sleep by taking naps during the day. tea. you are more likely to wake up during the night and be unable to get back to sleep. This will make you more physically tired and may also help you to relax. • Try to establish regular times for going to sleep and waking up. or you find it difficult to fall asleep at the same time as when you were younger. will make you feel more tired and help you to sleep. • Avoid heavy meals in the evening. • Avoid high alcohol consumption: although alcohol may make you sleepy at first. If you still cannot sleep. Take advantage of your extra time. Meanwhile. Consult your doctor. However. • Make sure that your bed is comfortable and your bedroom is well ventilated. Regular exercise. get up. or do odd jobs. avoid daytime naps. such as walking. may cause sleep disturbance as a side effect. there are several measures Sleeping comfortably Try to sleep on your side with a pillow between your legs. Not only will regular exercise help you to sleep better. Follow the self-help measures for getting a good night’s sleep during pregnancy (below). and other drinks containing caffeine. p. You may also feel more comfortable if you place another pillow under your abdomen. Discuss any worries that you have about the birth with your doctor or health visitor. or read until you feel sleepy. Pillow between legs Getting a full night’s undisturbed sleep may be difficult during pregnancy. Before going to bed. even if you have had a mentally tiring day. have you eaten a late or particularly heavy meal? NO Are you pregnant? NO YES POSSIBLE CAUSE AND ACTION Your sleep problems may be related to your pregnancy. You may need to get up during the night to pass urine even early in pregnancy. Have a warm bath. 153 . such as beta blockers. Avoid drinks containing caffeine. Getting a good night’s sleep SELF-HELP Sleep is an important factor in maintaining good health. and try to avoid napping during the day. Anxiety about the birth may also cause sleep problems. • Cut out coffee. SELF-HELP Getting a good night’s sleep during pregnancy you can take to help make sleeping easier. Do you have a sedentary YES job. especially in the evening. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. especially in later pregnancy when the enlarging abdomen makes it more difficult to find a comfortable position. such as coffee and tea.29). do not stop taking your prescribed drugs. stop at least 1 hour before bedtime. On nights when you YES have trouble sleeping. particularly during the afternoon and evening. read. If you are having difficulty sleeping. ACTION Try to get some form of regular exercise during the day or evening. listen to the radio. Later in pregnancy. try to relax. but it will also improve your general health and feeling of wellbeing (see HOW EXERCISE BENEFITS HEALTH. your baby’s movements may disturb your sleep and your enlarged abdomen may make it difficult to get comfortable. cola. • If you need to work in the evening. many people over 60 need only 6 hours sleep a night. you may find that you wake earlier in the morning than you used to. Taking daily exercise POSSIBLE CAUSE A lack of physical exercise during the daytime may mean that you are not sufficiently tired to fall sleep easily.

below). add 0. Call your doctor immediately if your temperature rises to 40ºC (104ºF) or above. but you should consult your doctor if you are no better in a few days.6°C (1°F) to the reading to obtain the actual figure. but it usually indicates that your body is fighting an infection. ACTION While waiting for the doctor. Do you have one or more of the following? YES • Severe headache • Pain in the neck on bending the head forward • Dislike of bright lights • Drowsiness or confusion NO POSSIBLE CAUSE Meningitis. column 1 Continued on next page. If using a mercury thermometer.A D U LT S : G E N E R A L 61 Fever suspect that you have a fever if you feel shivery. Rest in a cool room. right).39). You will be given urgent treatment with antibiotics and may need intensive care. drink plenty of cool fluids. stop. When you are unwell. he or she will probably prescribe antibiotics and may arrange for you to have a chest X-ray (p. or ibuprofen to reduce the fever. ACTION If meningitis is suspected. When taking your temperature from the armpit. Continued on next page. A digital thermometer can also be placed under the tongue or in the armpit. To check if you do have a fever. column 3 154 . and/or have you been coughing up brownish sputum? YES NO YES Do you have a cough? NO SELF-HELP Managing a fever Have you been coughing up greyish yellow sputum? NO YES POSSIBLE CAUSE AND ACTION Acute bronchitis (inflammation of the airways in the lungs) due to a viral infection is the most likely cause. aspirin. you should measure your temperature every 4 hours.184) WARNING HIGH FEVER If you are not feeling well. place it under your tongue or armpit. and take paracetamol. If your doctor confirms that you have pneumonia. You may START HERE Do you have a rash? NO YES Go to chart 80 RASH WITH FEVER (p. Reducing a fever If you have a fever. Hospital admission may be necessary. is a strong possibility. Call your doctor if you become breathless or if you are no better in 48 hours. It can be a symptom of many diseases. Heat exposure and certain drugs can also raise your body temperature. carefully shake it until the mercury falls below 36ºC (97ºF). A fever is a body temperature higher than 38ºC (100ºF). Do you have one or more of the following? • Mild headache • Aching limbs • Runny nose NO YES POSSIBLE CAUSE A generalized viral infection. right). alternately hot and cold. If you become breathless at any time. This may be serious. and you are generally unwell. use a thermometer to measure your temperature accurately (see MANAGING A FEVER. Take steps to reduce your fever (see MANAGING A FEVER. below). You have a fever if your temperature is 38ºC (100ºF) or above. and take steps to reduce your temperature (see MANAGING A FEVER. take steps to reduce your fever (below). ACTION Take steps to reduce your fever (see MANAGING A FEVER. you will be admitted to hospital immediately. and leave it for 3 minutes. Medical treatment is not usually necessary. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible. Measuring your temperature Placing the thermometer under your tongue is usually the most convenient way of measuring your temperature. you should measure your temperature every 4 hours. especially for those already in poor health. Are you short of breath even when resting. call your doctor promptly. If you smoke. such as flu. reducing it will make you feel better. may be the cause of such symptoms. inflammation of the membranes surrounding the brain due to infection.

and do you have an abnormal vaginal discharge with or without lower abdominal pain? NO YES POSSIBLE CAUSE AND ACTION Exposure to heat may have caused your temperature to rise. Women who have repeated infections or men who have had one previous infection may need further tests. rest in a cool room and drink plenty of cold drinks. 155 .39). To bring it down. ACTION Your doctor will examine you and may arrange for tests to confirm the diagnosis. POSSIBLE CAUSE You may have a serious lung disorder. have you had a recurrent fever. such as tuberculosis or lung cancer.A D U LT S : G E N E R A L Continued from previous page. inflammation of the reproductive organs. such as malaria or typhoid. is a possibility. column 1 Continued from previous page. If your temperature has not started to fall within an hour. cancer of the lymph nodes. possibly YES with unintentional weight loss? NO SEE A DOCTOR WITHIN 24 HOURS IF YOU ARE STILL FEVERISH AFTER 2 DAYS AND ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. You may then be referred to a specialist for tests. Any treatment will depend on the test results.195) Do you have a sore throat? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Inflammation of the kidney (pyelonephritis) or inflammation of the bladder (cystitis) as a result of an infection may be the cause of your symptoms. call your doctor.148) is possible. to exclude an underlying cause. You will probably be prescribed antibiotics. If your doctor suspects a tropical disease after examining you.39) and other tests. such as ultrasound scanning (p. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Pelvic inflammatory disease. You will probably be given painkillers and prescribed antibiotics.199). such as antimalarial drugs. He or she may also order a chest X-ray (p. often due to a sexually transmitted infection. such as bronchoscopy (p. SEE A DOCTOR WITHIN 24 HOURS IF YOU ARE STILL FEVERISH AFTER 2 DAYS AND CANNOT MAKE A DIAGNOSIS FROM THIS CHART. You may need to be referred to a specialist for further investigations and for treatment. Have you spent several hours either in strong sunlight or in very hot conditions? NO YES Over the last few weeks.41). Are you coughing up blood? NO YES Do you have one or more of the following? YES • Pain in the back on one or both sides • Abnormally frequent urination • Pain when passing urine • Discoloured or cloudy urine NO ACTION Your doctor will examine you and test your urine for signs of infection. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A serious disorder such as tuberculosis. column 2 Go to chart 88 SORE THROAT (p. he or she may send you to hospital for tests including blood tests and tests on faeces. Have you recently returned from a trip abroad? NO YES ACTION Tell your doctor about your trip and about any medications that you have taken. ACTION Your doctor will examine you and will probably arrange blood and/or sputum tests. Are you female. ACTION Your doctor will probably arrange for initial blood and sputum tests and a chest X-ray (p. may be the cause. p. which will help determine what treatment is necessary. SEE YOUR DOCTOR WITHIN 24 HOURS SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A tropical disease that is rare in the UK. or an AIDS-related illness (see HIV INFECTION AND AIDS.

A D U LT S : G E N E R A L 62 Excessive sweating profusely. you may be treated with thyroid drugs or radioactive iodine. Consult your doctor.150) YES POSSIBLE CAUSE Your symptoms may be due to hyperthyroidism (overactive thyroid gland). or certain types of cancer are possibilities. Do you have drenching night sweats that are severe enough to wake you up? NO YES Do you have a persistent cough. Washing regularly and wearing comfortable. All of these forms of deodorant are equally effective. an AIDS-related illness (see HIV INFECTION AND AIDS. there is unlikely to be anything wrong.29)? NO YES Controlling excessive sweating Excessive sweating can be very embarrassing. and do you have episodes of feeling hot and sweating YES that last for a few minutes each time? NO Are you over 45 years old. Stronger treatments are available over the counter. Such deodorants may be bought in the form of a spray. ACTION After initial investigations. p. However. Continued on next page 156 . If you still sweat heavily. are one of the most common symptoms of the onset of the menopause (p. your doctor may suggest that you have an operation to destroy nerves near the back of the neck that supply the sweat glands under the arms and on the palms of the hands. so if you have always sweated START HERE Do you sweat profusely on most days? NO YES Do you weigh more than the healthy weight for your height (see ASSESSING YOUR WEIGHT. If the diagnosis is confirmed. particularly on your hands. p. consult your pharmacist or doctor.39) and blood tests. p. you may wish to consult your doctor to discuss treatments such as hormone replacement therapy (see A HEALTHY MENOPAUSE. and have your periods become YES infrequent or irregular? NO POSSIBLE CAUSE Sudden episodes of feeling hot and sweating.261). your doctor may refer you to a specialist for any further tests or appropriate treatment. which are usually rapidly effective. known as hot flushes. or a cream. knowing that they will stop after a year or so. ACTION Your doctor will take a blood sample to measure levels of thyroid hormones. loose clothing made from natural fibres that absorb sweat should help to prevent body odour. such as a chest X-ray (p. and/or have YES you lost weight? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES A chronic infection such as tuberculosis. Go to chart 59 OVERWEIGHT (p. In some cases. If these measures do not help to combat excessive sweating.148). Have you noticed one or more of the following symptoms? • Unexplained weight loss • Feeling constantly on edge • Bulging eyes • Trembling hands NO POSSIBLE CAUSE Being overweight can be associated with excessive sweating. An underarm deodorant containing an antiperspirant should help to reduce the amount of sweat produced from the armpits. Are you a woman.21). sweating that is not brought on by heat or exercise or that is more profuse than you are used to may be a sign of one of a number of medical conditions. Alternatively. surgery to remove part of the gland may be needed. However. Sweating is one of the natural mechanisms for regulating body temperature and is the normal response to hot conditions or strenuous exercise. ACTION Many women are prepared to put up with hot flushes. especially if it results in a noticeable body odour or causes the hands to be particularly wet and slippery. This operation dramatically reduces sweating in these areas. your doctor may prescribe a cream or gel containing aluminium chloride that is applied to the skin to reduce the activity of the sweat glands. Some people naturally sweat more than others. a rollon applicator.

You may also want to use an antiperspirant deodorant to reduce wetness and prevent body odour (see CONTROLLING EXCESSIVE SWEATING. YES POSSIBLE CAUSE AND ACTION Certain drugs. This is usually associated with an increase in sweating that is particularly noticeable under the arms. salty fluid containing various waste chemicals. consult your doctor. Are you taking any prescribed or over-thecounter drugs? NO YES Is the excessive sweating confined to your YES hands or feet? NO POSSIBLE CAUSE The hands and feet have a high concentration of sweat glands (left). and pore around the nipples. do not stop taking your prescribed drugs. This sweat evaporates on the surface of the skin to reduce body temperature as necessary. and soles of the feet. the apocrine sweat glands (see SWEAT GLANDS. Are you in your teens? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR EXCESSIVE SWEATING CONTINUES TO WORRY YOU . Eccrine glands These glands are found all over the body and are active from birth onwards. POSSIBLE CAUSE In adolescence. The sweat from them is a clear. Are you female. but consult your doctor if you are worried. Sweat glands Sweat glands are found in the layer of the skin called the dermis and release moisture (sweat) through pores in the surface of the skin. gland The scent from this type of Dermis gland is thought to play a role in attracting the opposite sex. If these measures do not help. and consult your doctor. It is perfectly normal.30)? NO POSSIBLE CAUSE Excessive alcohol consumption can be a cause of increased sweating. There are two types of sweat glands – eccrine glands and apocrine glands – and these produce different kinds of sweat. Go to chart 61 FEVER (p. opposite). in the groin. For severe cases of sweating of the hands. consult your doctor for advice. if it is allowed to Sweat gland remain on the skin for long. try doing some relaxation exercises (p. Consult your doctor if these exercises do not help. Eccrine glands are most concentrated on the forehead. apocrine surface glands become active. learn relaxation exercises (p.154) Do you regularly drink more than the recommended safe alcohol limit (p. Meanwhile.32) to use in stressful situations. this is not a cause for concern. ACTION If the sweating becomes worse when you are worried or feeling anxious. For this reason. such as some antidepressants and aspirin. and does the excessive sweating occur only during your periods? NO YES POSSIBLE CAUSE AND ACTION In some women. it may interact with bacteria to CROSS-SECTION OF SKIN produce body odour.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Sweating is the body’s response to fever and is part of the normal temperature control mechanism. The eccrine glands may also produce sweat in response to anxiety or fear. and profuse sweating is likely to become apparent first in these areas. Do you notice the sweating only when you are anxious or excited? NO YES POSSIBLE CAUSE AND ACTION Emotional stress can easily cause an increase in sweating. but if it happens regularly or causes embarrassment. Stop taking over-the-counter drugs.32). This is no cause for concern. left) become active. Apocrine glands Skin Hair During adolescence. can cause excessive sweating as a side effect. However. these parts of the body react most noticeably to a rise in temperature. changes in the levels of sex hormones can cause increased sweating during menstruation. surgery to destroy the nerves that control sweating in the palms may be considered. HOWEVER . UNLIKELY TO BE A SERIOUS CAUSE FOR THIS SYMPTOM . These glands produce a fluid that Sebaceous contains fats and proteins. They are mainly concentrated in Sweat the armpit. 157 . If you are having difficulty reducing your alcohol consumption. YES Do you have a temperature of 38°C (100°F) or above? NO ACTION Cut down your alcohol intake so that you stay within the recommended safe limit. palms. This in itself is not a cause for concern. ACTION Make sure you wash regularly. However. T HERE IS . Wash your hands and feet regularly.

p.41) of the head and will be admitted to hospital for observation. or an excessive consumption of alcohol. lasts for more than 24 hours. you will probably be admitted to hospital. in which there is bleeding within the skull due to a ruptured blood vessel. your doctor may prescribe specific drug treatment. Symptoms can often be eased by measures such as taking painkillers and antiemetics. surgery to stop the bleeding may be performed. where you will be given drugs to reduce the pressure. If these do not help or if your headache persists for more than 24 hours. Have you felt nauseous or been vomiting? NO YES Is your vision blurred? NO YES CALL YOUR DOCTOR NOW Is your vision disturbed in any other way.154) Have you injured your head within the last 48 hours? NO YES Are any of the danger signs listed in the box (right) present. and did it come on suddenly over a couple of minutes? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A subarachnoid haemorrhage. leaving no after-effects. POSSIBLE CAUSE The injury may have resulted in damage to the brain. If self-help advice does not help or attacks recur often.A D U LT S : G E N E R A L 63 Headache such as tension. quiet room.40) to confirm the diagnosis. or was it disturbed before the onset of pain? NO YES POSSIBLE CAUSE This may be a first attack of migraine. or have you vomited? NO YES POSSIBLE CAUSE A mild headache is common following a minor head injury. t EMERGENCY! CALL AN AMBULANCE Is the headache severe. and resting in a dark. ACTION You will probably have tests such as a skull X-ray (p. ACTION Try self-help measures for relieving a headache (opposite). You may need monitoring in intensive care and. is not improved by taking over-thecounter painkillers. you should see your doctor promptly. a serious disorder in which excess fluid causes increased pressure in the eye. especially if you are over 40. or recurs several times during one week. is a possibility. tiredness. ACTION Your doctor will probably send you to hospital for urgent tests such as CT scanning (p. Continued on next page 158 . Drugs are given as eye drops and possibly also by mouth or intravenously. WA R N I N G DANGER SIGNS Call an ambulance if a severe headache is accompanied by any of the following symptoms: • Flat. follow the advice on reducing the frequency of migraine (opposite).39) or MRI (p. From time to time nearly everyone suffers from mild to moderate headaches that develop gradually and clear up after a few hours. if you have a headache that is severe. ACTION Your doctor may examine you to exclude other causes. ACTION If your doctor confirms the diagnosis. call your doctor. in some cases. If you have repeated attacks. is a possibility.79) • Drowsiness or confusion • Weakness in a limb • Blurred vision • Loss of consciousness Go to chart 61 FEVER (p. an operation to improve fluid drainage from the eye will probably be carried out. Headaches like this are extremely unlikely to be a sign of a serious underlying disorder and are usually the result of factors START HERE Is your temperature 38°C (100°F) or above? NO YES POSSIBLE CAUSE Many illnesses that cause a fever also cause a headache. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Acute glaucoma. Once the pressure has been reduced. a severe headache that usually occurs on one side of the head. However. dark red spots that do not fade on pressure (see CHECKING A RED RASH. drinking plenty of fluids.

159 . If these measures do not help. can cause headaches as a side effect. darkened room and take the recommended dose of a standard painkiller. which should then be avoided if possible. do not stop taking any prescription drugs. a condition that may threaten your life and that of your baby. Is the pain felt mainly in the face. To ease the pain of a headache. cool. You need to identify the particular ones that affect you. Periodic rest from whatever you are doing will also help. • Eat regularly. Meanwhile. • Follow a regular sleep pattern if possible. either arrange for a vision test (p. Reducing the frequency of migraine SELF-HELP Many factors are known to trigger a migraine. as a result of poor posture or tension from concentration. rest in a quiet. However. Did the headache occur after you had been reading or doing close work? NO YES Are you sleeping poorly. you may need antibiotics. including oral contraceptives. if you develop a severe headache with swollen feet or ankles.283).285). try doing relaxation exercises (p. ACTION Try steam inhalation (see TREATING A COLD. you are not sitting in an awkward position. and/or are you feeling YES tense or under stress? POSSIBLE CAUSE AND ACTION Headaches can be caused by lack of sleep. and is the pain worse when you bend down? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Temporal arteritis (inflammation of the arteries in the scalp and elsewhere in the body) is a possibility. Keeping a migraine diary for a few weeks may help to pinpoint any triggering factors. because changing it may trigger an attack. POSSIBLE CAUSE Headaches are as common in pregnancy as at other times.189) with an optician or consult your doctor. It may be necessary for you to have regular blood tests to confirm that the dose you are taking is sufficient to control the inflammation. • If stress is a trigger. do not exceed the dose that is recommended on the packet. Try massaging your neck and shoulder muscles. Psychological stress often causes tension headaches. consult your doctor or midwife at once. make sure that when you read. and/or are these areas tender to touch? NO YES POSSIBLE CAUSE Muscle strain in your neck. who may offer you an alternative drug if your medication is a possible cause. ACTION Your doctor will measure your blood pressure and test your urine for evidence of pre-eclampsia. IF A HEADACHE PERSISTS OVERNIGHT OR IF YOU DEVELOP OTHER SYMPTOMS . Relieving a headache SELF-HELP Most headaches are not serious and are simply due to the pressures of everyday life.172) Are you taking any prescription drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. especially if you have recently had a cold or a runny or blocked nose. SEE YOUR DOCTOR WITHIN 24 HOURS .194). NO Go to chart 73 ANXIETY (p.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Sinusitis (inflammation of the membranes lining the air spaces in the skull) may be the cause of this problem. Headache relief Taking a painkiller is often an effective way to relieve a headache. blurred vision. Is the pain felt mainly in the temples. You may need to be admitted to hospital for fetal monitoring (p. Consult your doctor if your symptoms are no better in 48 hours. p. ACTION Try self-help measures for relieving a headache (below). Try self-help measures for relieving a headache (left).32). Are you pregnant? NO YES MOST HEADACHES ARE MINOR AND ARE DUE TO THE STRESSES AND STRAINS OF EVERYDAY LIFE . Painkillers may also help. Urgent treatment may be needed to prevent the condition from affecting the arteries supplying the eyes. Consult your doctor. or vomiting. is the most likely cause of your headache. The following self-help measures may also help in reducing the frequency of your migraine attacks: • Avoid foods such as cheese or chocolate. which are common triggering factors. You may have pre-eclampsia (p. If headaches do recur. take a break and get some fresh air. because missing a meal may trigger an attack. ACTION Your doctor will probably prescribe corticosteroid drugs to reduce the inflammation. In order to prevent the problem from recurring. However.

ACTION Avoid standing for long periods of time if possible. a temporary drop in blood pressure on rising from a sitting. Sit or lie in a cool room and drink plenty of cool fluids. lying. or passing urine may indicate a seizure. for example. If you think someone is having a seizure. If you have frequent episodes of faintness. lying. Feeling faint and passing out are usually caused by a sudden drop in blood pressure – as a result. People who feel faint usually experience a sensation of lightheadedness or dizziness and possibly nausea. If you have just had an episode of loss of consciousness and you think you may have had a seizure. lie down on your side. call an ambulance. but if you suffer repeated episodes. or bending down? NO POSSIBLE CAUSE Feeling faint or passing out during pregnancy is quite common. tongue-biting. call your doctor promptly. Loss of consciousness may sometimes be due to a serious underlying medical condition. You should not stop taking your prescribed drugs before you see your doctor. These symptoms are due to a reduction in the blood flow to the brain. and follow the advice for feeling faint (right). resulting in faintness as a side effect. 160 . of emotional START HERE Was the feeling YES of faintness accompanied by a spinning sensation? NO Go to chart 65 DIZZINESS (p. Head between the knees POSSIBLE CAUSE Low blood sugar is probably the cause of your faintness. but your dose may need adjusting.162) WA R N I N G RECOGNIZING A SEIZURE Loss of consciousness that is accompanied by jerky movements. If you do not feel better within 10 minutes. SELF-HELP Feeling faint YES Faintness may be accompanied by sweating and feeling nauseous. move your feet and legs around to encourage blood to return to the heart. Follow the instructions below to relieve the symptoms and avoid loss of consciousness. Isolated episodes of feeling faint are hardly ever a cause for concern. lowering blood pressure. call your doctor now. a lowering of your blood pressure is the desired effect. or has it been several hours since you last ate? NO POSSIBLE CAUSE AND ACTION Certain drugs can cause low blood pressure. Sit down and put your head between your knees.A D U LT S : G E N E R A L 64 Feeling faint and passing out shock – or they may be due to an abnormally low level of sugar in the blood. but you should consult your doctor if it happens frequently or if you are taking any drugs. This type of faintness is generally no cause for concern. Had you risen suddenly YES after sitting. sit down or. ACTION If you suffer from this type of faintness. Your vision may close in until you feel you are looking through a tunnel. may cause you to feel faint. Such feelings of faintness may sometimes progress to passing out – a brief loss of consciousness known as fainting. Had you spent several hours in hot and stuffy conditions before you felt faint? NO YES ACTION Eat something sweet. you should seek medical advice. If you must remain standing for any reason. POSSIBLE CAUSE Postural hypotension. If you are taking drugs to treat high blood pressure. or if you pass out for no obvious reason. lying. consult your doctor. Hormone changes cause blood vessels around the body to relax. or bending position. If you have frequent attacks of faintness or if you pass out. Relieving faintness Continued on next page POSSIBLE CAUSE AND ACTION Overheating can cause faintness. or lie down and raise your legs on a cushion or a chair. An observer may comment on your skin looking pale. make a habit of rising slowly from a sitting. if you are already sitting. If you begin to feel faint. or bending position. Are you pregnant? NO YES Are you taking any prescribed drugs? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES Are you having treatment for diabetes. consult your doctor.

This can cause compression of blood vessels in the neck when you turn your head. leading to faintness. your symptoms need urgent assessment. Do you have any form of heart disease. resulting in feelings of faintness. This is a normal response and does not need medical treatment. such as an irregular heartbeat and heart valve problems. In some cases. You will need tests such as ECG (p. further tests will be necessary to determine why anaemia has developed. there is too little of the oxygen-carrying pigment haemoglobin in the blood. or weakness in any part of the body • Confusion NO YES POSSIBLE CAUSES If you are over 40. ACTION Regardless of your age. in which a blood clot temporarily blocks a blood vessel supplying the brain. the most likely cause of your symptoms is a stroke. t EMERGENCY! CALL AN AMBULANCE Are you aged over 50. ACTION You will probably be admitted to hospital. resulting in faintness and passing out. for example from a peptic ulcer. ACTION Your doctor will arrange for a blood test to confirm the diagnosis. You may also have tests such as endoscopy (p. and/or did you notice your heart rate speed up or slow down before the onset of faintness? NO YES Did the faintness follow YES an emotional shock? NO POSSIBLE CAUSE AND ACTION A sudden emotional shock can cause a fall in blood pressure. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. 161 . Have you noticed one YES or more of the following symptoms? • Excessive tiredness • Shortness of breath • Paler than normal skin NO Have you vomited blood. may be the cause. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Your symptoms may be due to anaemia.41) to help to determine the cause and appropriate treatment.203) or a chest X-ray (p. the most likely cause of your symptoms is a transient ischaemic attack (TIA). your symptoms need urgent assessment in hospital. in which there is permanent damage to part of the brain due to a disruption in its blood supply. ACTION Your doctor may arrange for you to be admitted urgently to hospital. that reduce the output of blood from the heart. a disorder of the nervous system is a possibility. Anaemia can be the result of a variety of underlying causes. tingling. is a likely cause of these symptoms.213) to determine the cause of the bleeding. and does turning your head or looking upward bring on a feeling of faintness? NO YES POSSIBLE CAUSE Cervical spondylosis. You may need tests such as MRI (p. you may be given a supportive collar to restrict neck movement. ACTION If your doctor thinks your faintness is due to cervical spondylosis.41) to help to determine the cause and appropriate treatment. arthritis in the bones in the neck. ACTION Regardless of your age. You may need tests such as MRI (p. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSES There are a number of potentially serious conditions. or have your faeces become black or bloody? NO YES POSSIBLE CAUSE Bleeding in the digestive tract. If the bleeding was severe.39) to look for the cause of your faintness. In younger people. Consult your doctor. you may be given a blood transfusion.A D U LT S : G E N E R A L Continued from previous page Have these symptoms now disappeared? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES If you are over 40. In this condition. In younger people. Treatment for the anaemia will usually need to be combined with treatment of the underlying cause. Do you have one or more of the following symptoms? • Difficulty in speaking • Disturbed vision • Numbness. where your condition can be monitored. a disorder of the nervous system is a possibility.

in which a blood clot temporarily blocks a blood vessel supplying the brain. you may be given a supportive collar to restrict neck movements. your doctor may prescribe antiemetic drugs to relieve your symptoms. below) is inflamed. or weakness in any part of the body • Confusion NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES If you are over 40. Feeling unsteady on your feet for a moment is a common experience and need not be a matter for concern. along with other information from the body. When symptoms are severe.41) to help diagnose the cause and determine the appropriate treatment. leading to dizziness. in which the part of the inner ear concerned with balance (see HOW YOU KEEP YOUR BALANCE. You may have to undergo tests such as MRI (p.39). In younger people. who may arrange for a neck X-ray (p. This condition is due to viral infection. ACTION Your doctor will probably refer you to a specialist for hearing tests (p. causing hearing problems and dizziness. ACTION Regardless of your age. a disorder of the nervous system is a possibility. true dizziness (also known as vertigo). Have all your symptoms now disappeared? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS Have you been feeling nauseous and/or having bouts of vomiting? NO YES POSSIBLE CAUSE Labyrinthitis. t EMERGENCY! CALL AN AMBULANCE Have you noticed noises in the ear and/or loss of hearing? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Ménière’s disease may be the cause. However. This disease usually first develops in middle age. in which there is permanent damage to part of the brain due to a disruption in the blood supply to that area. Eardrum Ear canal Does turning your head or looking upwards bring on dizziness? NO YES Labyrinth Nerve CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. you should lie down and remain as still as possible. The condition should gradually improve but may last for 2–3 weeks. ACTION Whatever your age. ACTION There is no specific cure for labyrinthitis. your symptoms need urgent assessment. Any movement of the head causes the fluid to move and prompts hair cells within the canals to send signals to the brain. This structure consists of three fluid-filled tubes (known as semicircular canals) at right angles to each other. If the diagnosis is confirmed. may be the cause. If cervical spondylosis is diagnosed.A D U LT S : G E N E R A L 65 Dizziness unless you have drunk too much alcohol or have been spinning around yourself – for example on a fairground ride. These signals. your symptoms need urgent assessment in hospital. You may need tests such as MRI (p. However. a disorder of the nervous system is a possibility. are processed to maintain balance. In this rare disorder. Skull bone CROSS-SECTION OF THE EAR 162 . POSSIBLE CAUSE AND ACTION The cause may be cervical spondylosis (arthritis in the neck bones). the most likely cause of your symptoms is a stroke. Occasionally.190). right). How you keep your balance A structure in the inner ear called the labyrinth helps you to keep your balance. there is an increase in the amount of fluid in the labyrinth. the part of the ear concerned with balance (see HOW YOU KEEP YOUR BALANCE. in which there is a sensation that everything is spinning around. POSSIBLE CAUSES If you are over 40. tingling.41) to help diagnose the cause and determine the appropriate treatment. the most likely cause of your symptoms is a transient ischaemic attack (TIA). Dizziness may be a symptom of an underlying disorder and should be brought to your doctor’s attention. Consult your doctor. In younger people. is not normal START HERE Have you had one or more of the following symptoms? • Difficulty in speaking • Disturbed vision • Numbness. This can cause compression of the blood vessels in the neck when you turn your head. an operation is required. you may be given a drug to reduce the amount of fluid in the inner ear.

a disorder in which a nerve in the wrist is compressed. in which a blood clot temporarily blocks a blood vessel supplying the brain. The feeling disappears as soon as you move around. when swelling of the tissues around the nerve may develop. Numbness or tingling that occurs without apparent cause may be due to a disorder that needs medical treatment. in which there is permanent damage to part of the brain due to a disruption in its blood supply. An injection of a corticosteroid drug into the tissues around the nerve may reduce the swelling and relieve the symptoms. surgery may be needed. In some cases. You may need tests such as MRI (p. If the diagnosis is confirmed. In younger people. you may be given a supportive collar to wear to reduce the mobility of your neck and to relieve pressure on the nerves.41) to help to determine the cause and appropriate treatment. ACTION Your doctor may arrange for you to have a neck X-ray (p. Consult your doctor. may be the cause. If it persists. a disorder of the nervous system is a possibility. your symptoms need urgent assessment. Do not smoke. in which the blood vessels in fingers and toes become extra sensitive to the cold and constrict excessively. an operation may be necessary. the most likely cause of your symptoms is a stroke. Do your fingers or toes go numb and bluish in cold weather. ACTION Keep your hands and feet warm and dry. the most likely cause of your symptoms is a transient ischaemic attack (TIA). arthritis in the bones of the neck. Consult your doctor. In younger people. rarely. POSSIBLE CAUSES If you are over 40. is a possibility. You may need tests such as MRI (p.39). It is normal to experience numbness and/or tingling if you have been sitting in an awkward position. drug treatment or. In some cases. especially if you are over 50. POSSIBLE CAUSE Raynaud’s phenomenon. a disorder of the nervous system is a possibility. ACTION Regardless of your age. ACTION Regardless of your age. is the likely cause of these symptoms. Are the symptoms worse at night. t EMERGENCY! CALL AN AMBULANCE 163 . and/or do you have pains that shoot into the palm of your hand from the wrist? NO YES Does the numbness and/or tingling affect only one side of your body? NO YES Have you experienced one or more of the following symptoms? • Difficulty in speaking • Disturbed vision • Confusion • Faintness or dizziness NO YES POSSIBLE CAUSE Carpal tunnel syndrome. This disorder can cause irritation of nerves at the point where they leave the spine.A D U LT S : G E N E R A L 66 Numbness and/or tingling body. ACTION The condition may clear up of its own accord. The symptoms often improve within a few weeks. This is commonly called “pins and needles” and can occur in any part of the START HERE Is numbness YES and/or tingling confined to a hand or an arm? NO Have you noticed any stiffness in your neck? NO YES POSSIBLE CAUSE Cervical spondylosis. becoming red and painful as the feeling returns? NO YES Have all your symptoms YES now disappeared? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES If you are over 40. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. your doctor may refer you to hospital for tests to confirm the diagnosis. This condition is particularly common during pregnancy. your symptoms need urgent assessment in hospital.41) to help to determine the cause and appropriate treatment. Consult your doctor.

agitated. in which a blood clot temporarily blocks a blood vessel supplying the brain. the most likely cause of your symptoms is a transient ischaemic attack (TIA). t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSES If you are over 40. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSES If you are over 40. He or she requires medical attention immediately. Have you had one or more of the following symptoms? • Difficulty in speaking • Disturbed vision • Numbness. or disorientated. You may need tests such as MRI (p. column 1 Continued on next page. especially in later life when such “absent-mindedness” is a natural part of aging.40). or if he or she is seeing or hearing non-existent things. In younger people. Your doctor will examine you to diagnose the cause of your fever and determine the appropriate treatment. confusion after a head injury is short-lived. People often forget details when they have been preoccupied with other things. a disorder affecting the nervous system is a possibility. You may also need to remain in hospital to be monitored. In younger people. This chart deals with sudden or severe confusion or forgetfulness that you are aware of in yourself or in someone else who may not realize they have a problem. Continued on next page. especially a high fever over 39°C (102°F). tingling. ACTION You will be examined fully in hospital and may need X-rays (p. the most likely cause of your symptoms is a stroke. ACTION Regardless of your age.39) or CT scanning (p. or forgetfulness and confusion severe enough to disrupt everyday life. While waiting for the doctor. p. your symptoms need urgent assessment in hospital. or weakness in any part of the body • Faintness or dizziness NO YES Have all your symptoms YES now disappeared? NO POSSIBLE CAUSE In many cases. column 3 164 . take steps to reduce your temperature (see MANAGING A FEVER. particularly if it comes on START HERE Has the confusion or forgetfulness developed suddenly during the past few hours? NO YES Have you injured your head within the past 48 hours? NO YES WA R N I N G SUDDEN CONFUSION Call your doctor at once if a friend or relative suddenly becomes severely confused. ACTION Regardless of your age. confusion may be an indication of a serious brain injury or associated with bleeding between the skull and the brain. Do you have a temperature of 38°C (100°F) or above? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION A fever.154). a disorder of the nervous system is a possibility. and this is no cause for concern. confusion. can cause confusion.A D U LT S : G E N E R A L 67 Forgetfulness and/or confusion suddenly.40) to diagnose the cause and determine the appropriate treatment.41) or CT scanning (p. However.41) to help diagnose the cause and determine the appropriate treatment. may be due to an underlying medical problem. in which there is permanent damage to part of the brain due to a disruption in its blood supply. We all suffer from mild forgetfulness from time to time. You may need MRI (p. your symptoms need urgent assessment. However.

call your doctor immediately. Do you regularly drink more than the recommended safe alcohol limit (p. and social services may provide practical help.41) to exclude other underlying causes. Consult your doctor. p. POSSIBLE CAUSE AND ACTION Recreational drugs may cause confusion. column 2 CALL YOUR DOCTOR NOW POSSIBLE CAUSE A sudden worsening of disorders affecting the heart or lungs may reduce the supply of oxygen to the brain. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE Excessive alcohol consumption commonly causes memory loss and confusion. he or she may prescribe antidepressant drugs.30)? NO YES ACTION If you regularly drink enough alcohol to leave you confused. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Certain drugs may be the cause of forgetfulness or confusion as a side effect. If you have difficulty doing so. Continued from previous page. where you will be given oxygen and drugs to stabilize your condition. although in rare cases the condition can affect younger people. p. If you have trouble stopping. ACTION Your doctor will examine you and he or she may refer you to a specialist. You may need blood tests or MRI (p. consult your doctor for advice. Have you noticed that you YES have difficulty coping with everyday matters or in following complex instructions? NO Are you being treated for diabetes? NO POSSIBLE CAUSES Your blood sugar level may be too low. Consult your doctor. Do not stop taking your prescribed drugs unless your doctor tells you otherwise. you should cut down your consumption. 165 . column 1 POSSIBLE CAUSE Depression can cause forgetfulness and confusion. These drugs often improve mental functioning as well as treating depression. If you are no better within 10 minutes.311). but they may take a few weeks to take effect. these symptoms may be due to an abnormally high blood sugar level. leading to confusion. Less commonly. Stop using recreational drugs or inhaling solvents. Do you use recreational drugs or inhale solvents? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.A D U LT S : G E N E R A L Continued from previous page. Dementia is most likely to occur in people over the age of 65. and prolonged use can lead to irreversible brain damage. treatments cannot reverse dementia. who may be able to help or may put you in contact with a counsellor or a self-help group (see USEFUL ADDRESSES. Support groups (see USEFUL ADDRESSES. In most cases. POSSIBLE CAUSE Progressive loss of mental function (dementia) due to a disorder such as Alzheimer’s disease or recurrent small strokes is a possibility. consult your doctor. particularly in elderly people.311) can provide self-help information. Have you YES noticed any of the following symptoms? • Inability to concentrate or make decisions • Difficulty in sleeping • Feeling in low spirits • Loss of interest in sex NO Are you suffering YES from a serious heart or lung condition? NO ACTION You may need to be admitted to hospital. YES ACTION Eat or drink something very sweet. ACTION If your doctor confirms that you are depressed. This should correct a low blood sugar level and will do you no harm if your sugar level is too high. particularly if the symptoms started suddenly. but drug treatments may slow deterioration.

204) may cause twitching and trembling. coffee. he or she will probably want to see you every few months to monitor your condition. Consult your doctor. call an ambulance. reduce your caffeine intake. however. 166 . In mild cases. Consult your doctor. You may be advised to contact a selfhelp group (see USEFUL ADDRESSES. In the meantime. which are usually rapidly effective. or cola before you developed twitching or trembling? NO YES Are you taking any prescribed drugs. Occasionally. or they may be a result of stopping taking sleeping drugs or tranquillizers. This is a sign that you have become dependent on alcohol. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Sudden withdrawal of alcohol after long-term. do not stop taking any prescribed drugs. If you regularly suffer from such symptoms. legs. or cola for the next few hours and your symptoms should disappear. If the diagnosis is confirmed. WA R N I N G LOSS OF CONSCIOUSNESS If twitching and trembling are accompanied by loss of consciousness. Did you drink a large amount of tea. Brief episodes are often simply the result of tiredness or stress and are rarely a cause for START HERE Are your YES symptoms confined to brief flickering movements of one tiny area of the body – an eyelid. In some cases. Are you over 55. coffee. involuntary movements may be caused by problems that require medical treatment. ACTION Drink no more tea. you may be treated with thyroid drugs or with radioactive iodine. Consult your doctor. treatment may not be necessary. p. If you witness these symptoms in another person. for example? NO POSSIBLE CAUSE AND ACTION Tiredness or tension can often cause these minor twitches. and is the trembling worse when the affected part of the body is at rest? NO YES Have you recently cut out alcohol or reduced your intake after being a heavy drinker? NO YES POSSIBLE CAUSE Excessive amounts of caffeine (p. He or she will take a blood sample to measure your levels of thyroid hormones. Consult this chart if you experience any involuntary or uncontrolled movements. If they persist. but if symptoms become severe. ACTION If your doctor confirms the diagnosis. which should disappear. surgery to remove part of the gland may be needed. consult your doctor. heavy consumption can lead to uncontrolled shaking. If your symptoms persist. POSSIBLE CAUSE Parkinson’s disease (a disorder of the nerve centres in the brain that help control body movement) may be the cause.A D U LT S : G E N E R A L 68 Twitching and/or trembling concern. Jerking movements that happen while you are falling asleep are also common and harmless. or have you recently stopped taking sleeping drugs or tranquillizers? NO YES Is trembling associated with one or more of the following symptoms? • Unexplained loss of weight YES • Feeling constantly on edge • Increased sweating • Bulging eyes NO POSSIBLE CAUSE AND ACTION Your symptoms may be a side effect of certain prescribed drugs. consult your doctor. you may be prescribed drugs to help to relieve them. repeated trembling or shaking of the arms. ACTION Your doctor may arrange for blood tests to assess whether alcohol has damaged organs such as the liver. or if you are worried. or head. Such movements may range from slight twitching to prolonged.311). POSSIBLE CAUSE AND ACTION Hyperthyroidism (overactive thyroid gland) is a possibility. He or she will advise you on how to control your drinking in the future. they may be due to a seizure. such as excessive alcohol consumption or a neurological disorder. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

may be the cause of the pain. is a possibility. a viral infection affecting the nerves. anticonvulsant or antidepressant drugs may be able to relieve the pain. may be the problem. If you are no better within 48 hours. see chart 96. p. ACTION If you grind your teeth. TEETH PROBLEMS (p. If the rash is affecting an eye. see chart 63.194) and a painkiller may help to relieve your symptoms. Go to chart 82 PAINFUL OR IRRITATED EYE (p. For pain in or around the mouth. ACTION Steam inhalation (see TREATING A COLD. Regular blood tests are needed to confirm that the inflammation is controlled. It is often caused by infection or inflammation of the underlying tissues or irritation of a nerve. try applying a wrapped hot-water bottle to the face and massaging the muscles around the joint. Do you have an aching pain around the ear or jaw that is worse when you are chewing? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. which could affect vision. your dentist may suggest that you wear a mouth guard at night.186). Trigeminal neuralgia is usually treated with painkillers initially. throbbing ache or a sharp. a disorder in which the arteries in the scalp and other parts of the body become inflamed. For toothache. if this treatment is not effective. caused by the virus that is responsible for chickenpox.206). HEADACHE (p.158). and/or are these areas tender to touch? NO YES POSSIBLE CAUSE Trigeminal neuralgia. a red. MOUTH PROBLEMS (p. who may prescribe antibiotics. Your doctor will probably prescribe drug treatment with corticosteroid drugs for 6 months or more. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Temporal arteritis. Although pain in the face can be distressing and may require medical treatment. Do you have a severe. ACTION Your doctor will probably examine your ears and may suggest that you have a dental examination to rule out other causes.A D U LT S : G E N E R A L 69 Pain in the face pain may be a dull. For a headache. ACTION In some cases. Consult your dentist.208). YES stabbing pain in one side of the face. Do you have severe pain in or YES around an eye? NO POSSIBLE CAUSES Pain in or around an eye may be caused by a variety of eye disorders. 167 . and/or is the pain worse on bending down? NO POSSIBLE CAUSE Sinusitis (inflammation of the membranes lining the air spaces in the bones of the face). ACTION Your doctor will probably prescribe a painkiller and oral antiviral drugs. you will need dental treatment. stabbing sensation. Is the pain felt mainly in the temples. in addition. If your teeth are misaligned. Consult your doctor. Such problems may be due to misalignment of the teeth or may develop if you grind your teeth while you are asleep. pain caused by irritation of a nerve. a small segment of artery is removed to confirm the diagnosis. However. Urgent treatment may be needed to prevent damage to the blood vessels supplying the eyes. Take over-the-counter painkillers. which can follow a cold. especially if you are over 50. Is the pain felt mainly in YES the forehead and face. the joint between the jaw and the skull. or have you recently had. you may also be referred to a specialist for assessment and treatment. consult your doctor. blistery rash in the painful area? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have shingles. see chart 95. it is rarely a sign of a serious disorder. which is brought on by touching the skin in a particular area of the face? NO POSSIBLE CAUSE You may have a problem with the temporomandibular joint. Facial START HERE Do you have. Consult this chart if you develop pain or discomfort that is limited to the area of the face and/or the forehead.

difficulty in finding or using words or if your speech has become unclear. This condition is known as Bell’s palsy or facial palsy. In some cases. Occasionally. Voice exercises to improve articulation are often combined with play therapy. and antidepressants may make speech difficult by causing a dry mouth. Are you taking any prescribed drugs? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Unexplained difficulty in speaking may be an early sign of an underlying disorder of the brain or nervous system and needs prompt medical assessment. In children. using electronic devices to aid speech production. Consult this chart if you have. In adults. some loss of function is permanent. including imaging tests such as MRI (p. You may need to have tests. in which a blood clot temporarily blocks a blood vessel supplying the brain. although speech therapy (below) is often beneficial. t EMERGENCY! CALL AN AMBULANCE Are you unable to speak clearly because of pain or swelling in the mouth or tongue? NO POSSIBLE CAUSES A number of mouth conditions. ACTION Regardless of your age. he or she may arrange for tests. or weakness in any part of the body • Confusion • Faintness or dizziness NO YES Have all your symptoms disappeared? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES If you are over 40. a disorder of the nervous system is a possibility. learning difficulties. POSSIBLE CAUSES If you are over 40. such as MRI (p. ACTION Regardless of your age. which supplies the muscles of the face. the mouth. In younger people. is a possibility. and parents are taught the techniques needed to continue therapy at home and so support their child’s learning.41). Go to chart 96 MOUTH PROBLEMS (p. POSSIBLE CAUSE AND ACTION Certain drugs can cause difficulty in speaking as a side effect – for example. If it has come on gradually. including infections. Such speech difficulties may be related START HERE Have you had one or more of the following symptoms? • Disturbed vision • Numbness. In younger people. If the eye on the affected side does not close properly. problems with the development of normal speech and language may be due to other problems such as hearing loss. to help diagnose the cause and determine the appropriate treatment. the most likely cause of your symptoms is a stroke. voice exercises. in which there is permanent damage to part of the brain due to a disruption in its blood supply. Speech therapy Speech therapy is often recommended to help children and adults who have problems with speech and language. In many cases. or physical causes such as a cleft lip and palate. including imaging tests such as MRI (p. ACTION If the palsy has come on rapidly. help with communication – for example with the use of pictures or specialized computers – may be offered. to determine the cause and appropriate treatment. you should not stop taking your prescribed drugs unless you are advised to do so by your doctor. facial movements gradually return to normal over several weeks. speech therapy is mainly used to help restore speech or language that has been lost following surgery to the mouth or throat or as a result of disorders such as a stroke. or recently have had. Therapy in adults may involve relearning speech. or. your symptoms need urgent assessment. speech may be affected permanently. or the facial nerves. If speech cannot be restored. in order to help diagnose the cause and determine the appropriate treatment. in some cases. you may need to wear protective glasses and tape your eye closed when you go to sleep. can cause pain and swelling in the mouth that make it difficult to speak clearly. your symptoms need urgent assessment in hospital.208) YES CALL YOUR DOCTOR NOW Is speaking difficult because you are unable YES to move the muscles on one side of your face? NO POSSIBLE CAUSE Swelling or infection of the facial nerve. a disorder of the nervous system is a possibility. Your doctor may arrange for tests to diagnose the cause and determine the treatment. Speech therapy can help children with these problems learn to communicate effectively. the most likely cause of your symptoms is a transient ischaemic attack (TIA). sedatives or antianxiety drugs may cause slurred speech as a result of their action on the brain. You may need to have tests. your doctor may prescribe corticosteroid drugs. 168 . However.A D U LT S : G E N E R A L 70 Difficulty in speaking to disorders affecting the brain.41).41). tingling.

worthlessness. WA R N I N G SERIOUSLY DISTURBED BEHAVIOUR If someone you know develops seriously disturbed thoughts and behaviour. or do you hear or see things that others do not? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Feelings of this kind may be due to a mental health problem. YES vivid dreams about it? NO POSSIBLE CAUSE You may have post-traumatic stress disorder. POSSIBLE CAUSE AND ACTION Recreational drugs are meant to affect your mood but may have unwanted effects. causing you to relive the experience repeatedly. Despite your strong negative feelings. Consult your doctor. or call a support line. ACTION Your doctor may suggest psychological therapies (p. feelings of persecution and paranoia. If your thoughts and feelings START HERE Do you YES feel that you are being controlled by outside forces.311) for advice. including drugs that may help to relieve the symptoms. You will probably be given treatment. or hopelessness? NO YES Have you had or do you have suicidal thoughts? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION You are suffering from severe depression. Do you repeatedly think about an upsetting experience from your past or have frequent. contact that person’s doctor within 24 hours. p. beliefs that he or she has great accomplishments or power. He or she may be able to help you to put your feelings into context by discussing them with you. Your doctor may arrange for you to be assessed by a specialist and possibly admitted to hospital. talk to your doctor about them. or unrestrained behaviour.311).A D U LT S : G E N E R A L 71 Disturbing thoughts and feelings continue to worry you. p. You may be having upsetting or intrusive thoughts or you may be experiencing unfamiliar or uncontrolled emotions. Consult this chart if you begin to have thoughts and feelings that worry you or that seem to you or to other people to be abnormal or unhealthy. possibly combined with antidepressant drugs. unwelcome thoughts are often accompanied by irresistible urges to carry out simple acts again and again. or do you have unwarranted feelings of foreboding? NO Go to chart 72 DEPRESSION (p. Consult your doctor.172) Do you have repeated unwelcome thoughts or mental images? NO YES POSSIBLE CAUSE Obsessive–compulsive disorder is a possible cause.171). Seek medical help at once. this condition can be treated successfully. such as rapid speech. Have you taken recreational drugs recently? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Consult your doctor or a self-help group (see USEFUL ADDRESSES. In this condition. ACTION Your doctor may advise counselling to help you to recover from the experience and may also prescribe antidepressant drugs. Withdrawal from some drugs may also have unpleasant effects. Do you have feelings of guilt. he or she may suggest treatment or refer you to a specialized therapist. Such behaviour may indicate a serious mental health problem. 169 . triggers persistent intense emotions. in which a stressful event.170) YES Go to chart 73 ANXIETY (p. such as an accident. whatever your particular problem. such as the Samaritans (see USEFUL ADDRESSES. Do you feel restless or tense. If your concerns are justified.

take regular exercise. depression has no apparent cause. and take regular exercise to rebuild your strength. If you feel depressed for more than 2 weeks. START HERE Have you been feeling depressed for less than 2 weeks? NO YES POSSIBLE CAUSE You are unlikely to be suffering from serious depression unless your symptoms persist. or loss of a job. or consider contacting a self-help organization (see USEFUL ADDRESSES. Make sure you eat well. and sleep disturbances. Get plenty of rest. Have you recently recovered from a viral illness such as flu or glandular fever? NO YES POSSIBLE CAUSE It is common for a viral illness to be followed by a period of feeling low. Have you recently had a distressing event. consult your doctor. WA R N I N G THOUGHTS OF SUICIDE Anyone who contemplates suicide is in need of urgent help. POSSIBLE CAUSE Distressing events are often followed by a period of depression. p. True depression is associated with physical symptoms including excessive tiredness. Are you feeling low after a bereavement? NO YES POSSIBLE CAUSE Grief over the death of someone you have loved will probably make you feel low for a considerable time.311). Depression is a treatable disorder. such as divorce. such as early waking (see RECOGNIZING DEPRESSION. It may also be precipitated by hormonal changes at the menopause or after childbirth. Regular physical exercise and relaxation exercises (p. consult your doctor. then your sadness may have developed into a depressive illness. and make sure that you get enough sleep. Devote some time each day to leisure activities that you enjoy. Your low spirits may be the result of a temporary worry or disappointment. in many cases.173) may be the cause of your low mood. it follows a time a major life change. Some people react more severely than others.A D U LT S : G E N E R A L 72 Depression bereavement. If your depression seems to be getting worse. loss of weight. should seek medical help by contacting his or her doctor. consult your doctor.32). In some cases. who may prescribe antidepressant drugs and/or recommend psychological therapies (opposite). p. Recognizing depression The symptoms listed below may indicate that your low mood is due to a depressive illness. get plenty of sleep. as may relaxation exercises (p. such as retirement. Alternatively. ACTION Try to return to your normal routine gradually.32) may help. the Samaritans provide advice and support and can be called 24 hours a day (see USEFUL ADDRESSES. or if you feel you cannot cope. a depressive illness follows a traumatic event. However. Most people have minor ups and downs in mood. try to keep stress to a minimum. If you develop any of the symptoms of depression (below). such YES as a divorce or losing your job? NO ACTION You may find that you come to terms with what has happened without needing treatment. particularly if it occurs over a prolonged period. This is sometimes known as “reactive depression”.311). or who has considered suicide. Exercising regularly may also be beneficial. He or she may prescribe antidepressant drugs and/or recommend psychological therapies (opposite). ACTION Talking to friends or family about your problems may help you feel better. In other cases. it is very important to maintain social activities. A person who is so depressed that he or she feels that life is no longer worthwhile. left). Consult your doctor if you have noticed any of the following: • Weight loss • Loss of appetite • Waking early in the morning and being unable to get back to sleep • Difficulty getting to sleep • Thoughts of suicide • Inability to concentrate or make decisions • Loss of interest in sex • Inability to enjoy your favourite activities • Severe fatigue • Recurrent headaches Have you been under particular strain at work or at home? NO YES ACTION If possible. feeling good one day but low the next. These changes often have an identifiable cause and usually pass quickly. POSSIBLE CAUSE Stress (see RECOGNIZING STRESS. if you cannot cope with everyday life. which needs treatment. Discuss your feelings with friends or family. However. consult your doctor. and you should always see your doctor if you think you might be depressed. below). p. Continued on next page 170 . Discuss problems with close family or friends. and try to avoid stressful situations. If you continue to feel low or have symptoms that indicate you may have a depressive illness (see RECOGNISING DEPRESSION. ACTION However difficult it seems. Spend some time each day doing something that you enjoy. and you should consult your doctor. and some people have repeated episodes.

who may be able to help or may put you in contact with a counsellor or self-help group (see USEFUL ADDRESSES. Consult your doctor. CONSULT YOUR DOCTOR BECAUSE YOU MAY BE SUFFERING FROM A DEPRESSIVE ILLNESS . or a major accident may often be followed by depression. consult your doctor. Group therapy A therapist and group members sit together. or have you recently passed the menopause? NO YES IF YOU ARE UNABLE TO FIND AN EXPLANATION FOR YOUR FEELINGS FROM THIS CHART. POSSIBLE CAUSE AND ACTION Hormonal changes around the menopause may cause depression. Consult your doctor. Psychological therapies There are a variety of psychological therapies available. Some drugs can cause problems even years later. Are you menopausal. Such feelings may be exaggerated by concerns over the approach of old age and loss of fertility and by stressful events such as children leaving home. or you continue to feel depressed. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. consult your doctor. 171 . Consult your doctor.30)? NO YES POSSIBLE CAUSE Many recreational drugs can cause profound psychological disturbances. such as antihypertensives (drugs used to treat high blood pressure) and oral contraceptives. or have you ever used. such as a heart attack. who may suggest hormone replacement therapy (see A HEALTHY MENOPAUSE. a collection of symptoms that may include low spirits and is caused by hormone changes. POSSIBLE CAUSE Regularly drinking too much alcohol may lead to depression. CONSULT YOUR DOCTOR BECAUSE YOU MAY BE SUFFERING FROM A DEPRESSIVE ILLNESS . You should also be aware of why you drink. consult your doctor for advice. This may slow down your physical recovery. YES ACTION Your doctor will talk to you about your current health and will explain that this is a common reaction. do not stop taking your prescribed drugs. can cause depression as a side effect. is likely. recreational drugs? NO YES ACTION If you still take recreational drugs. while he or she provides help and advice. Meanwhile. If you find you cannot stop or are still having problems after you have stopped. some of which explore a person’s past. Do you regularly drink more than the recommended safe alcohol limit (p. Are you using. Drinking too much may be compounding the problem. You may be prescribed antidepressant drugs and/or your doctor may recommend psychological therapies (below).257). Follow selfhelp measures (see PREMENSTRUAL SYNDROME. Some people may use alcohol to help them cope with stress or unrecognized depression. p. If you find this difficult. All involve a therapist who usually encourages you to talk about your feelings and fears. If your symptoms do not improve.288) Do you often feel low just before your period is due? NO YES POSSIBLE CAUSE AND ACTION Premenstrual syndrome. Are you male? NO YES IF YOU ARE UNABLE TO FIND AN EXPLANATION FOR YOUR FEELINGS FROM THIS CHART. p.A D U LT S : G E N E R A L Continued from previous page Have you recently had a serious illness or accident? NO POSSIBLE CAUSES A serious physical illness. while others focus on current behaviour or thought processes. The members are encouraged to talk about their feelings and share their problems. In some cases.311). both during use and after withdrawal. p. ACTION Cut down the amount of alcohol you drink.261). Have you recently had a baby? NO YES Go to chart 150 DEPRESSION AFTER CHILDBIRTH (p. treatment with antidepressant drugs may be needed. stop now.

devote some time each day to leisure activities that you enjoy. Continued on next page 172 . Such anxiety may help you to deal with stressful events and can help to improve your performance in certain situations. or sleep well. POSSIBLE CAUSE Stress as a result of this event is probably the reason for your feelings of anxiety (see RECOGNIZING STRESS.171) or from contacting a self-help organization (see USEFUL ADDRESSES. ACTION Try to keep stress to a minimum. you will probably feel apprehensive and tense and be unable to concentrate. consult your doctor. p. you will probably be treated with thyroid drugs or radioactive iodine. ACTION Your doctor will take a blood sample to measure your levels of thyroid hormones. and a general feeling of tiredness. chest pains. you are worried about money or family matters or if you have exams coming up. Go to chart 72 DEPRESSION (p. recreational drugs? NO YES Have you recently had a major distressing event. Without medical testing. Have you become anxious since attempting YES to give up tobacco. including others going through the same process. and it is normal to feel anxious if.A D U LT S : G E N E R A L 73 Anxiety natural reaction to stress. and discuss any problems with close family or friends. Consult your doctor. it is important that you stop now. alcohol. abdominal cramps. trying to give them up may lead to feelings of anxiety developing. Consult your doctor if you feel that these measures are not working or if your anxiety seems to be becoming worse. opposite). for example. which are usually rapidly effective. or have you ever used. both during use and after withdrawal. anxiety caused by hyperthyroidism can be difficult to distinguish from anxiety due to other causes. If you are suffering from anxiety. surgery to remove part of the thyroid gland may be needed.311). ACTION Your doctor will give you advice on the best way to deal with your addiction and will monitor your progress. excessive sweating. or drugs such as tranquillizers or sleeping pills? NO Are you using.311). palpitations. To help you relax. If the diagnosis is confirmed. Such organizations should be able to put you in touch with people who can help. p. In some cases. However.32). If you have trouble stopping. think clearly. such as divorce or losing your job? NO YES POSSIBLE CAUSE Many recreational drugs can cause psychological disturbances. who may be able to help or may put you in contact with a counsellor or a self-help organization (see USEFUL ADDRESSES. Do you have one or more of the following? • Unexplained loss of weight • Increased sweating • Bulging eyes • Trembling hands NO YES POSSIBLE CAUSE Hyperthyroidism (overactive thyroid gland) is a possibility. Regular exercise may help. Some people may benefit from psychological therapies (p. ACTION If you still take recreational drugs. Such organizations should be able to put you in touch with people who can help.170) POSSIBLE CAUSE If you have become addicted to any of these substances. Consult your doctor. Anxiety is a START HERE Do you feel anxious most of the time? NO YES Have you noticed YES one or more of the following symptoms? • Inability to concentrate or make decisions • Feeling in low spirits • Early waking • Loss of interest in sex NO POSSIBLE CAUSE AND ACTION The presence of these symptoms suggests that your anxiety may be due to a depressive illness. as may relaxation exercises (p. You may have a sense of foreboding for no obvious reason or have repetitive worrying thoughts. including others going through the same process. Some people also have physical symptoms such as headaches. anxiety is not normal if it comes on without an apparent cause or if it is so severe that you can no longer cope with everyday life.

you should discuss your feelings with him or her. for example. or getting recurrent mouth ulcers is often a sign of stress as stress tends to depress the immune system. restoring your blood levels. Do you only feel anxious in certain social YES situations – for instance. Coping with a panic attack SELF-HELP Rapid breathing during a panic attack reduces carbon dioxide levels in the blood and may lead to frightening physical symptoms. or he or she may refer you to a counsellor for help. Most people can learn to manage their fears and anxiety so that they do not affect their lives on a day-to day basis. remove the bag and breathe normally for 15 seconds. Do you have episodes of intense anxiety coupled with sweating. If your anxiety is severe. nausea. tiredness. p. However.171). Place the bag over your mouth. ACTION Your doctor will ask you about your feelings. and/or dizziness? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may be having panic attacks. Stress can also result in flare-ups of existing disorders such as eczema. drug treatment with beta blockers or some types of antidepressant may be helpful. you rebreathe carbon dioxide. Do you feel anxious only when confronted with specific objects or if you are prevented from doing things in your usual way? NO YES POSSIBLE CAUSES Your anxiety may be caused by a phobia. A specific difficulty affecting you or your partner.251). it can. p. Otherwise. p. Then. In later life. If you are having panic attacks. Rebreathing from a bag Hold a paper bag tightly over the mouth. Talking about sex openly (see COMMUNICATING YOUR SEXUAL NEEDS. It is therefore important that you learn to recognize signs of stress and take action to deal with it (see STRESS. Having a series of infections. which increases heart rate and maximizes blood flow to the muscles in preparation for action. which increases the risk of heart attack. insomnia. in which feelings of intense anxiety are coupled with alarming physical symptoms. which is an irrational fear of a specific object or situation – for example. Repeat this process until your breathing rate is back to normal. anxiety may be related to decreasing sexual activity or worries about attractiveness (see SEX IN LATER LIFE. ACTION It is important to see your doctor as soon as possible so that he or she can confirm the diagnosis and rule out a physical cause for your symptoms. you may have obsessive–compulsive disorder.251) may also cause anxiety. such as palpitations and muscle spasms. If you are unable to communicate satisfactorily or if you do not have a regular partner with whom you can talk. a degree of anxiety is natural. and anxiety.273) is often the best way to deal with anxiety.270).171) or drug treatment for your anxiety. and breathe in and out slowly. headaches. you may feel the need to repeatedly wash your hands and become excessively anxious if you are unable to do so. When you do this. such as colds. He or she may be able to advise you or may suggest that you receive counselling (see SEX COUNSELLING. and breathe in and out 10 times. in which you feel an irresistible need to behave in a certain fashion. you will need treatment with psychological therapies (p. Panic attacks are unpredictable and usually have no obvious cause. particularly during early adult life. 173 . The normal stress response causes the release of epinephrine (adrenaline). consult your doctor. If your anxiety is so severe that you avoid certain types of social interaction. you may be afraid of spiders. including chest pain. Worries about sexual orientation (p. Do you have any worries related to sex? NO YES POSSIBLE CAUSE In some situations. Consult your doctor. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO FIND A CAUSE FOR YOUR ANXIETY FROM THIS CHART AND / OR UNEXPLAINED ANXIETY PERSISTS FOR MORE THAN A FEW DAYS . trembling. even though you may know that it is not necessary – for example. meeting people or going to parties? NO ACTION Your doctor may be able to teach you coping strategies for dealing with social situations.A D U LT S : G E N E R A L Continued from previous page Recognizing stress Stress is a normal part of life for many people and has a beneficial effect under certain circumstances. prolonged or excessive stress can result in a range of symptoms. POSSIBLE CAUSES Anxiety about sex is common. contribute to high blood pressure. can be a source of anxiety. stomach upsets. and the problem usually improves with experience. In the long term. readying the body for action. consult your doctor. p. stress may seriously damage health.32). ACTION If you have a regular partner. You can control the symptoms by breathing into and out of a paper bag. Follow self-help measures for coping with panic attacks (right). such as premature ejaculation or a fear of pregnancy or contracting a sexually transmitted disease. He or she may advise psychological therapies (p. These responses are beneficial if stress is released.

may be the problem. However. may be the cause.248). you may be referred to hospital for treatment.195) POSSIBLE CAUSE AND ACTION One of several viral infections. 174 . There is no specific treatment for glandular fever. For lumps and swellings in the scrotum. he or she may refer you to hospital for further tests. multiple swellings that last longer than about a month may be the result of an underlying disorder. he or she will refer you for an operation to repair the abdominal wall (see HERNIA REPAIR. BREAST PROBLEMS (p.215). START HERE Do you have a red. rubella can harm a developing fetus. If a hernia becomes tender to the touch. such as cancer of the lymphatic system (lymphoma) or an AIDS-related illness.A D U LT S : G E N E R A L 74 Lumps and swellings a swelling is due to enlargement of a lymph gland in response to an infection. Consult your doctor if you are no better in 2 days. p. Do you have a swelling or lump between your YES ear and the angle of the jaw? NO Have you recently developed a rash? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS Do you have any lumps or swellings in the neck? NO YES Do you also have lumps or swellings in your armpit and/or your groin? NO YES POSSIBLE CAUSES Glandular fever (infectious mononucleosis) or another viral infection is the most likely cause. If you are pregnant or have been in contact with a pregnant woman. Consult your doctor. Go to chart 88 SORE THROAT (p. If your doctor suspects another cause. Consult your doctor. He or she may prescribe antibiotics or drain the pus under a local anaesthetic. ACTION If you have a blocked salivary gland duct. including rubella. However. but it will clear up on its own. Do you have YES a soft lump in the groin that disappears when you press on it? NO POSSIBLE CAUSES This may be a salivary gland that has become enlarged due to a blocked duct. but it will clear up within 2 weeks. Your doctor may suggest painkillers to relieve discomfort. see your doctor. Always consult your doctor if you have one or more painless or persistent lumps or swellings. if a boil has not improved within 48 hours or if you are unwell. call your doctor at once. Consult this chart if you develop one or more swellings or lumps beneath the surface of the skin. in which part of the intestine protrudes through a weak area in the muscles of the abdominal wall. There is no treatment for mumps. or it could be the result of infection with the mumps virus. see chart 123. Do you have a sore throat? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. see your doctor within 24 hours to have the diagnosis confirmed. ACTION Most boils disappear on their own. particularly in young people.256). persistent lumps or swellings may be due to diseases affecting the immune system. POSSIBLE CAUSE A hernia. ACTION If your doctor confirms that you have a hernia. TESTES AND SCROTUM PROBLEMS (p. However. For breast lumps. In some cases. ACTION Your doctor will examine you and arrange for a blood test. see chart 128. painful swelling? NO YES POSSIBLE CAUSE You may have a boil caused by a bacterial infection.

such as aqueous cream. Have you started to use a different brand of an YES item such as soap or washing powder? NO Is your skin generally very dry? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.217) to determine the cause of the jaundice. In other cases. can be very itchy. For itching confined to the anus.A D U LT S : G E N E R A L 75 Itching reaction to a particular substance. It may be caused by an underlying disorder of the liver or gallbladder. Consult your doctor. ACTION Avoid using perfumed products and biological washing powders. ANAL PROBLEMS (p. regularly to moisturize your skin.178) Is itching confined to one or more patches of YES abnormal-looking skin? NO POSSIBLE CAUSE AND ACTION Certain drugs can cause itching as a side effect. POSSIBLE CAUSE AND ACTION Dry skin. POSSIBLE CAUSES A change in the appearance of skin that is not due to scratching may be the result of an insect bite or a skin disorder. HAIR AND SCALP PROBLEMS (p. consult your doctor. is often associated with itching. Itching (irritation of the skin that leads to an intense desire to scratch) may be caused by an infection or by an allergic START HERE Is the itching confined to the genital area? NO YES POSSIBLE CAUSES AND ACTION Itching in the genital area may be due to a fungal infection or to pubic lice. 175 . Go to chart 77 GENERAL SKIN PROBLEMS (p. If your symptoms persist. Meanwhile. If your symptoms persist. Treatment will depend on the underlying disorder. but do not stop taking any prescribed drugs. POSSIBLE CAUSE Skin irritation as a result of sensitivity to certain chemicals can cause widespread itching. who will prescribe an antifungal cream if you have a fungal infection or a treatment shampoo if you have pubic lice. Use an emollient. Loss of natural oils in the skin as a result of aging or from excessive washing may cause dryness and itching of the skin. and avoid bath products containing soap. itching can be a feature of a skin disorder or may even indicate an underlying disease or psychological stress. such as aqueous cream. see chart 76. consult your doctor. regularly to moisturize your skin. see chart 107. which may be inherited or due to overwashing or exposure to chemicals.223). Use an emollient. For itching confined to the scalp. yellow discoloration of the skin and the whites of the eyes. Consult your doctor.176). Does your skin and/or the whites of your eyes look yellow? NO YES ACTION Your doctor will probably arrange for you to have blood tests and possibly abdominal ultrasound scanning (p. stop taking any overthe-counter drugs. Are you taking any over-the-counter or prescribed drugs? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Jaundice.

column 1 Continued on next page. which will need to be taken for life. Fine hairs grow on most areas of the body. Your hair colour and type (straight. but the condition of START HERE Has your YES hair become generally thin? NO Has thinning occurred within 4 months of one YES of the following events? • A prolonged or serious illness • Childbirth • Stopping the oral contraceptive pill NO POSSIBLE CAUSE A long illness or hormonal changes can disrupt the normal hair growth cycle (see HAIR STRUCTURE AND FUNCTION. During the growth phase. Meanwhile. ACTION Your doctor will take a blood sample to measure your levels of thyroid hormones. POSSIBLE CAUSE AND ACTION Hairdressing methods such as these may damage your hair if used inexpertly or excessively. However. consult your doctor. cells in the follicle divide rapidly to form a new hair. column 2 176 . Your doctor will arrange for occasional blood tests to monitor the dosage. and the hair dies. Consult your doctor. A single hair grows between 6 mm (1⁄ 4 in) and 8 mm (1⁄ 3 in) a month. If the diagnosis is confirmed. can cause hair loss as a side effect. do not stop taking your prescribed drugs. wavy. You may need to have your hair cut short if it has been severely damaged. particularly those used to treat cancer. Do you use any of the following hairdressing techniques? • Bleaching • Dyeing • Perming • Tight braiding NO Hair structure and function YES Hair helps to provide the body with insulation and protection from the environment. This chart deals with some of the more common problems affecting the hair on the head and the condition of the scalp. Each hair grows in a hair follicle. Hairs are made of dead cells that grow from a living base. you will be prescribed thyroid drugs as tablets. The hair on the head is usually far thicker and problems affecting its growth are therefore very noticeable. Hair Sebaceous gland Erector muscle Hair follicle SKIN SECTION Continued on next page. During the rest phase. cell activity slows and then stops. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. resulting in a large number of hairs being lost at the same time. which has a rest phase followed by a growth phase. Consult your doctor. Every day some hairs grow while others are shed. and hair should return to normal within 6 months. below).A D U LT S : G E N E R A L 76 Hair and scalp problems your hair may be affected by your overall state of health and factors such as your diet and age. growing hair pushes the dead hair out of the follicle. The new. If you adopt a more natural hairstyle your hair will probably regain its thickness. or curly) are inherited. Hair often returns to normal at the end of treatment or if alternative drugs can be prescribed. Have you noticed one or more of the following symptoms? • Excessive tiredness • Unexplained weight gain • Feeling the cold more than you used to • Increased dryness or roughness of the skin NO YES POSSIBLE CAUSE You may be suffering from hypothyroidism (underactive thyroid gland). if you are concerned. ACTION The hair growth cycle should resume.

However. Consult your doctor. but this growth will be lost again when the treatment is discontinued. TRANSPLANTED HAIRS Continued from previous page. POSSIBLE CAUSE Male-pattern baldness (which can also affect women) typically causes this type of hair loss. Alopecia areata. will produce hair regrowth in some people. Does the whole of your scalp feel itchy? NO YES Is your scalp flaking? NO YES POSSIBLE CAUSE An infestation of head lice may be causing your symptoms. Recent treatments. Surgical transplantation of hairs is another option (see HAIR TRANSPLANT. often at the back of the scalp or behind the ears. avoiding the excessive use of chemicals (perms and dyes) or heat on your hair. the levels of these hormones in the body often rise after the menopause. above). However. and has the hair loss taken place slowly over many years? NO YES Do you have one or more bald patches surrounded by normal hair growth? NO YES POSSIBLE CAUSES Patchy hair loss may be the result of ringworm (especially if the scalp is inflamed and itchy). There are several preparations for treating head lice (p. flaking of the scalp may also be due to other skin conditions. ACTION Treat your hair gently. but new hair starts to grow from the transplanted follicles 3 weeks to 3 months later.A D U LT S : G E N E R A L Hair transplant Baldness can be treated surgically by several different methods of hair transplantation. The removed hairs and their attached follicles are then inserted in the bald area (the recipient site). consult your doctor. If your scalp does not improve within the next 4 weeks. and both sites are anaesthetized. ACTION Comb your hair with a finetoothed comb over a piece of white paper to see if any lice fall out. In women. Hair is then taken from a donor site elsewhere and inserted into the incisions. such as the drug minoxidil applied to the scalp or finasteride taken as tablets. in some cases. or if you are concerned. POSSIBLE CAUSES Dandruff is the most likely cause. If your hair loss is extensive. column 1 Continued from previous page. Are you over 55. skin and hair are taken from a donor site. Alopecia areata often clears up without treatment. consult your doctor. Your hair should then regrow. 177 . In this condition. column 2 POSSIBLE CAUSE Mild thinning of the hair as you grow older is common in both men and women. hair follicles are oversensitive to the male hormone testosterone. Is your hair receding from the forehead or thinning at the crown? NO YES ACTION Hair loss cannot be prevented. Magnifying glasses Scalpel Skin surface Incision Transplanted hair Hair follicle Recipient The procedure site The surgeon makes a number of tiny incisions in the bald area. is also a possibility. which often runs in families. ACTION Try an over-the-counter shampoo containing ketoconazole. a condition in which the body’s immune system attacks the hair follicles. ACTION Ringworm is usually treated with a course of antifungal drugs. A mild sedative is usually given. The transplanted hairs will fall out shortly after the transplant. In the method shown. in rare cases hair loss may be permanent.83). CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. with new hair growing in over the next 6–9 months. including an over-the-counter shampoo . such as psoriasis.

It is important.183) is a possibility. you should consult your doctor promptly. Short-term skin problems are often the result of a minor injury or a superficial infection and are easily treated. ACTION Your doctor will probably prescribe antibiotics. The patches often affect the scalp. covered with silvery white scales? NO YES Do you have a sore or ulcer that will not heal? YES NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have Lyme disease. oral drugs may help. however.175). are recognized and treated early. Do you have a rash that spreads out from a central red spot? NO YES Continued on next page 178 . that potentially fatal conditions. The condition sometimes runs in families. Exposure to sunlight is often beneficial. Your doctor will probably prescribe a painkiller and oral antiviral drugs. Many skin START HERE Have you recently developed a rash with a fever? NO YES POSSIBLE CAUSES The sudden appearance of a rash that is accompanied by a fever is often due to an infection. an infection transmitted by ticks and often picked up after walking in woodland areas.182) or go to chart 116 FOOT PROBLEMS (p. see chart 75. but most do not pose a serious risk to health.236) or go to chart 78 SKIN PROBLEMS AFFECTING THE FACE (p. red skin. rather than a problem originating in the skin itself. ITCHING (p. and knees but can occur anywhere. is a possibility. such as measles. ACTION Your doctor will probably refer you to hospital for a skin biopsy (p. make sure your arms and legs are covered whenever you are in an area where ticks are found. The initial tick bite may often go unnoticed. a disorder in which the skin cells grow unusually rapidly and form scaly patches. a viral infection affecting the nerves and caused by the same virus that is responsible for chickenpox. elbows. such as the hands or face. Do you have one or more patches of thickened. To reduce the risk of future bites. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A type of skin cancer (p.184) Do you have any of the following? • An area of paler or darker skin • A skin problem only affecting your feet • A skin problem only affecting your face NO YES Go to chart 79 SKIN DISCOLORATION AND MOLES (p. in which the abnormal area will be removed under local anaesthetic and examined in a laboratory to confirm the diagnosis. Exposed areas of skin. Do you have a painful rash of blisters confined YES to an area on one side of the body? NO POSSIBLE CAUSE Psoriasis. If the condition is widespread or severe. WA R N I N G CHANGES IN THE SKIN If you have any of the following symptoms. ACTION Your doctor may initially prescribe one of several different creams.183). removal of the abnormal area is the only treatment necessary. such as skin cancer. • An ulcer or sore that has failed to heal within 3 weeks • A slowly growing lump • A change in a long-standing mole or the development of a new mole Go to chart 80 RASH WITH FEVER (p. are most commonly affected. Consult your doctor. For itching in skin that appears normal.180) SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Shingles. is a possibility.A D U LT S : G E N E R A L 77 General skin problems conditions can be distressing if they persist or affect visible areas of skin. You may also be prescribed nonsteroidal anti-inflammatory drugs. They may be signs of skin cancer. For many skin cancers.

found in earrings and in the studs in jeans. In most cases. call your doctor before the next dose of any prescribed drugs is due. over-thecounter antihistamine creams or tablets should provide relief. moist areas. Everyone else in the household will need to be treated at the same time. POSSIBLE CAUSE You probably have irritant hand eczema (dermatitis). also known as hives. a parasitic infection. POSSIBLE CAUSE AND ACTION Some drugs commonly cause a rash. If eczema is the cause. Scabies mites burrow under the skin between the fingers and can cause a widespread rash. If urticaria recurs. consult your doctor. in many cases. and do you spend a lot of time with your hands in water or do you handle chemicals? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION If you can identify the cause and avoid it. treatment is with antifungal cream or tablets. where hands are frequently in water or exposed to chemicals. If these measures do not help. This is a common problem for people who work in occupations such as hairdressing and cleaning. Consult your doctor. wear cotton-lined rubber gloves. consult your doctor. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Scabies. in which inflammation of the skin occurs in response to contact with a particular substance. Use an emollient. and clothing and bedding also need to be washed. ACTION If the itching is severe. red lumps? NO YES Do you have one or more areas of itchy. This condition may occur as an allergic reaction to a particular type of food. such as shellfish. Alternatively. such as aqueous cream. Use a barrier cream or an emollient. ACTION Your doctor may want to take skin scrapings to see if fungi are present. who may refer you to hospital for tests to identify the cause. are most likely to be affected. who may prescribe a corticosteroid cream to relieve the itching and irritation. you will be prescribed corticosteroid cream. but the itching may continue for up to 2 weeks. such as flea or mosquito bites. Scabies is very contagious and often affects a whole family. but. ACTION Your doctor will probably prescribe a treatment lotion. the condition will probably clear up without any treatment. Insect bites. Otherwise. such as the groin or the armpit. The mites should die within 3 days of treatment. may only cause a rash in people who are allergic to them. you should consult your doctor. 179 . particularly if the affected areas are on the limbs. and others. is a common cause. with or without YES grey lines between your fingers and/or on your wrists? NO POSSIBLE CAUSE You may have atopic eczema. If this is not possible or if you are using chemicals. a type of eczema. which you will need to apply to the whole of your body from the neck down. This condition often appears first during childhood. Warm. such as aqueous cream. such as penicillin. and can flare up during adulthood. Are you taking any over-the-counter or prescribed drugs? NO YES Does the rash mainly affect your hands. is possible. Meanwhile. POSSIBLE CAUSE Allergic contact dermatitis. If the rash has developed suddenly. If these measures do not help. Do you have intense itching. urticaria clears up within hours and insect bites clear up within a few days. frequently throughout the day. ACTION An over-the-counter corticosteroid cream will probably relieve the irritation. ACTION Try to keep your hands out of water. make an appointment with your doctor. Nickel. YES and is it always in the same place? NO Do the abnormal areas of skin have clearly defined. although a wide variety of substances can cause allergic contact dermatitis. may be causing your symptoms. no cause can be found. YES abnormal-looking skin? NO POSSIBLE CAUSES You may have urticaria. and wash your hands with mild soap. If you are unsure why the condition is occurring. If they are. Does the area of itching clear up and then recur. to keep the skin from becoming dry. known as discoid eczema. are another possibility. Tests may be needed to look for an underlying cause. consult your doctor. scaly edges? NO YES POSSIBLE CAUSES You may have a fungal infection such as ringworm. stop taking any over-the-counter drugs. is a possibility.A D U LT S : G E N E R A L Continued from previous page Are these areas raised.

cold. In some people. This disorder commonly occurs in oily areas of the face and is often associated with dandruff. most people have had an infection with this virus. A moisturizing cream should soothe the rash. particularly around the eyes. do not kiss other people. is a possibility. these changes can be permanent. you will probably be referred to a specialist for assessment and treatment. or stress. column 1 Continued on next page. Consult this chart if you have a skin problem confined to the face. exposure to strong sunshine. Do you have a scaly.or yellow-topped spots? NO YES Are the spots mainly around the nose and mouth? NO YES Continued on next page. Consult your doctor. he or she may prescribe a corticosteroid cream. small children. For START HERE Are other areas of the skin also affected? NO YES Go to chart 77 GENERAL SKIN PROBLEMS (p. is a possible cause. cosmetics are a common cause of skin irritation and allergy. particularly babies. Do you have one or more painful blisters? NO YES Are the blisters mainly around your lips? NO YES ACTION Your doctor will probably prescribe painkillers and an oral antiviral drug. over-the-counter antiviral creams may speed up healing if used at the first sign of symptoms. Abnormal areas of skin on the face are more noticeable than on other parts of the body and may therefore be more distressing. Facial skin may also be at risk of damage from external factors that are not as likely to affect other areas of the body. Do you have white. and in women. which then lies dormant. If corticosteroids are needed. If they recur. a viral infection affecting the nerves and caused by the virus that is responsible for chickenpox. your doctor will prescribe a mild form. Facial skin. POSSIBLE CAUSE These are probably cold sores caused by herpes simplex virus. The herpes simplex virus can be passed on by direct skin contact such as kissing. the face is exposed to weather conditions such as sunlight. ACTION Cold sores will clear up of their own accord. YES ACTION Avoid using harsh soaps or detergents. in order to avoid giving the infection to them. mainly affecting the skin near the eyebrows and the hairline and the creases at the side of the nose? NO POSSIBLE CAUSE Seborrhoeic dermatitis is a possible cause. and wind.182) Do you have an area of discoloured skin? NO YES Do the blisters affect an area on one side of the face only? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Shingles. and people who have eczema. is thinner than skin on other parts of the body and is especially vulnerable to such damage. the virus is reactivated by a cold. The skin may improve if you use an over-the-counter dandruff shampoo containing ketoconazole on the scalp. who may prescribe antibiotics for several weeks or months. Consult your doctor if the rash does not improve. red rash. 180 . cold weather. One of the side effects of corticosteroid creams is to make the skin thinner and more fragile. By adulthood. The skin of the face can be affected by conditions that rarely appear on other parts of the body. column 2 POSSIBLE CAUSE AND ACTION Perioral dermatitis.A D U LT S : G E N E R A L 78 Skin problems affecting the face example.178) WA R N I N G CORTICOSTEROID CREAMS Never use a corticosteroid cream on the face unless your doctor has advised it. If your eye is affected. such as cold sores. which is related to acne and may occur after using corticosteroid creams. Go to chart 79 SKIN DISCOLORATION AND MOLES (p. If you have cold sores.

in which the abnormal area is removed under a local anaesthetic and examined in a laboratory to confirm the diagnosis. a condition similar to acne. You should avoid excessive exposure to the sun and cut down your alcohol intake. YES Does your face become easily flushed – for example when you have been drinking alcohol or when you enter a warm room? NO YES POSSIBLE CAUSE Basal cell carcinoma.183). and consult your doctor.144) and over-the-counter treatments for acne (p. is a possible cause. in which the abnormal area is removed under a local anaesthetic and examined in a laboratory to confirm the diagnosis. consult your doctor. a type of skin cancer (p. continue taking any prescribed drugs. Meanwhile.A D U LT S : G E N E R A L Continued from previous page. ACTION Your doctor will probably refer you to hospital for a skin biopsy (p. Consult your doctor.144).183). Try self-help measures (see COPING WITH ACNE. Because the abnormal area has been removed. column 1 Continued from previous page.183). a bacterial infection of the facial skin and the underlying tissues. POSSIBLE CAUSE Rosacea. Stop taking any over-the-counter drugs. the skin should return to normal in a few days. further surgery may be necessary. ACTION Your doctor may prescribe antibiotic tablets or cream to be used for several weeks or months. a type of skin cancer (p. If the infection is severe. If not treated. In some cases. with or without a central depression or ulcer? NO Do you also have blackheads and/or tender. resulting in a serious blood infection known as septicaemia. It usually develops between the ages of 40 and 60 and is often worst on the cheeks and nose. You can then reintroduce one item every few days so that the cause of the problem can be identified. Do you have an ulcer that will not heal? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. or you may have recently become allergic to a product you have been using for some time. Have you been taking any over-the-counter or prescribed drugs? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. which occurs when hair follicles are blocked by sebum (an oily substance secreted by skin glands). Consult your doctor. Is the affected skin red and swollen. POSSIBLE CAUSE Erysipelas. It usually starts during adolescence but often persists into adulthood. You may not need any further treatment if all of the abnormal area has been removed. POSSIBLE CAUSE AND ACTION Certain drugs increase the sensitivity of skin to sunlight and can cause a reaction confined to the face. this condition can spread. ACTION Your doctor will probably refer you to hospital for a skin biopsy (p. Consult your doctor. Stop using all the products that could be responsible. is a possible cause. p. because they may make the condition worse.183). you may need to be admitted to hospital so that you can be given treatment with intravenous antibiotics. red spots? NO YES POSSIBLE CAUSE AND ACTION Acne. If these steps do not help. is likely. column 2 Do you have a growth with a raised pearly edge. your doctor will probably prescribe oral antibiotics. ACTION If the diagnosis is confirmed. is possible. further treatment is not usually needed. YES CALL YOUR DOCTOR NOW Does the problem seem related to cosmetics or perfumed products? NO YES POSSIBLE CAUSE AND ACTION You may be allergic to a new product. 181 . is a possibility. and do you have a high temperature? NO POSSIBLE CAUSE Squamous cell carcinoma.

Do you have flat. Consult this chart if areas of your skin have become darker or paler than the surrounding skin or if you are worried about a new mole or changes in a mole. They range from 1–2 mm (1⁄ 32–1⁄ 16 in) in diameter on the cheeks (particularly in people with black skin) to 3 cm (1 in) in diameter on the trunk. Too much exposure to the sun can cause the skin to burn and increases the risk of developing skin cancer in later life. brown patches of skin on your cheeks? NO YES Are you taking the oral contraceptive pill. crusted lumps that appear to be stuck on to the surface of your skin? NO YES POSSIBLE CAUSE The most likely diagnosis is that you have one or more seborrhoeic warts. and damage to the eyes.64). If you are pregnant. The best way to reduce the risk of suninduced skin damage is to stay out of the sun between 11 am and 3 pm. water. Staying out of the sun may help.A D U LT S : G E N E R A L 79 Skin discoloration and moles in skin colour are most often due to exposure to the sun. These warts are very common and are not infectious. you may wish to have the wart removed if it catches on clothes or for cosmetic reasons. Removing the wart will leave a scar. ACTION Your doctor will examine you. However. they do not always disappear completely. If the diagnosis is confirmed. You should also wear sunglasses with the British Standard kitemark and that provide the maximum protection from UV light. take care even on cloudy days. which may be obvious. In hot climates. however. a form of skin cancer (opposite). Consult your doctor. and a wide-brimmed hat. ACTION There is no particular treatment. If cancer is confirmed. you may have a skin condition that needs medical attention. when the sun is strongest. premature aging. no treatment is necessary. They are caused by an increase in the levels of the pigment melanin in the skin. For birthmarks. see chart 8. but when changes occur there is a slight possibility of a malignant melanoma. Take extra care near snow. the greater the protection. he or she may still decide to have it removed and examined under a microscope (see SKIN BIOPSY. Sunscreens should be applied 15–30 minutes before you go outside and reapplied every 2 hours. darkbrown. an increased risk of skin cancer (opposite). particularly in people with brown skin. wear a longsleeved shirt. the higher the SPF. use a sunscreen on any exposed skin. Although changes START HERE Are you YES concerned about an area of darker skin? NO Do you have a mole YES with any of the following features? • Bleeding • Itching • An irregular edge • An uneven colour • Increasing size. and over-the-counter bleaching creams may make the patches less obvious. or ice or at high altitudes. or are you pregnant? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Do you have one or more raised. 182 . Finally. The degree of protection that you need depends on your skin type. opposite) for signs of cancerous cells. POSSIBLE CAUSE Chloasma is the term used to describe these patches. Continued on next page POSSIBLE CAUSE AND ACTION Patches of increased pigmentation sometimes occur for no known reason. or size larger than the round end of a pencil NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Moles do not normally change or appear for the first time after age 35. particularly on black skin. a wider area of skin may be removed to decrease the risk of cancerous cells remaining. long trousers or a long skirt. SKIN PROBLEMS IN BABIES (p. fair-skinned people need the most protection. Most moles are harmless. These changes often fade after childbirth or if you stop taking the contraceptive pill. you may also notice darkening of your nipples and a dark line extending downwards from your navel. If you do go out. Sunscreens partially absorb UV light and are rated by a sun protection factor (SPF). Protecting yourself from the sun SELF-HELP Exposure to the invisible ultraviolet (UV) rays in sunlight may cause sunburn. ACTION Even if your doctor thinks that the mole is harmless.

Malignant melanoma The uneven colour and irregular edges of this growth are characteristic of a malignant melanoma. The biopsy site is anaesthetized with local anaesthetic. an autoimmune disorder in which the body attacks its own tissue. in some cases. Malignant melanoma This rare but serious form of cancer can spread and may be fatal if not treated early. which occurs when pigment disappears from a mole. a minor fungal skin infection. Another form of the procedure is used if a skin condition is widespread. It is red or reddishbrown and may form a non-healing ulcer. consult your doctor. or bleeding mole may be malignant and needs urgent attention. It may form a shallow ulcer. In one form of the procedure (excision biopsy). Because these paler patches cannot tan and will burn. ACTION Your doctor may arrange for blood tests to look for other autoimmune conditions. painless lump of a pink to brownish-grey colour with a waxy or pearl-like border. painless. slowly enlarging lump with an irregular edge. POSSIBLE CAUSE This may be due to pityriasis versicolor. cosmetics may help to disguise the discoloured areas. if you are concerned about its appearance. the entire abnormal area is removed. itchy. It is usually caused by exposure to ultraviolet rays in sunlight. is removed. It is usually removed in an ellipse shape to ease stitching of the biopsy site. No treatment is necessary. The removed tissue is then examined under a microscope in a laboratory. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. and do they affect the YES same area on both sides of the body? NO POSSIBLE CAUSE Vitiligo. Do you have several small patches of paler skin affecting only your YES back and/or chest? NO POSSIBLE CAUSE AND ACTION This is probably a halo naevus. Your skin colour may take several weeks to return to normal after treatment. irregularly shaped. squamous cell carcinoma. such as cancers. 183 . and skin colour will return to normal. Otherwise. Consult your doctor. but consult your doctor if you are concerned. However. Fair-skinned people are particularly at risk. Normal skin Abnormal area of skin Epidermis Dermis Line of incision Do you have patches of paler skin? NO YES Excision biopsy After the biopsy site is anaesthetized. A new mole or a fast-growing. Do the patches have clearly defined edges. In this case. A typical lesion develops as a small. ACTION This condition is harmless and does not need treatment. All three can usually be cured by surgical removal if they are diagnosed at an early stage. Although there is no treatment for vitiligo. There are three main types of skin cancer: basal cell carcinoma. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Eventually the mole may disappear completely. a small representative area of skin. which includes both normal and abnormal skin. opposite). Basal cell carcinoma This is the most common type of skin cancer but the least dangerous because it very rarely spreads to other parts of the body. about 1–2 cm (3⁄ 8–3⁄ 4 in) in diameter. an incision is made to remove the abnormality and the whole thickness of skin. unevenly coloured. causing patches of skin to lose pigment. strong corticosteroid creams can help. taking the form of a hard. Squamous cell carcinoma Another common skin cancer is squamous cell carcinoma. It often affects the face. and malignant melanoma. is a likely cause. you should avoid exposing them to the sun (see PROTECTING YOURSELF FROM THE SUN.A D U LT S : G E N E R A L Continued from previous page Skin biopsy A skin biopsy is a procedure used to make or confirm a diagnosis of a variety of skin diseases. Skin cancer Do you have a pale area of skin surrounding a mole? NO YES Skin cancer is the most common form of cancer worldwide. who may advise you to use an overthe-counter antifungal shampoo on the body as a lotion.

p. If you do have scarlet fever. To find out if you have a fever. see your doctor within 24 hours (see RUBELLA AND PREGNANCY. followed by immunization if necessary. YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE NOT ABLE TO MAKE A DIAGNOSIS FROM THIS CHART. causing pneumonia. chickenpox can be serious and may infect the lungs. which is routine in childhood. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU HAVE A RASH WITH FEVER AND ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. right). an infectious disease which produces a bright red rash that is most marked in the skin folds. a viral infection affecting the nerves and caused by the same virus responsible for chickenpox.37). heart problems. inflammation of the membranes surrounding the brain due to infection. These diseases may be START HERE Do you have red or purple YES spots that do not fade when pressed (see CHECKING A RED RASH. you will be admitted to hospital immediately. is a possibility. measure your temperature with a thermometer (see MANAGING A FEVER. your doctor will prescribe antibiotics.154).154). Do you have a pale pink. p.79)? 1 NO Do you have one or YES more of the following symptoms? • Severe headache • Fever • Pain in the neck on bending the head forward • Dislike of bright light • Drowsiness or confusion NO POSSIBLE CAUSE Meningitis. POSSIBLE CAUSE AND ACTION Shingles. may be the cause. Your doctor may prescribe antiviral drugs. This may result in disorders such as blindness. is the likely cause of such symptoms. ACTION You may need a throat swab to confirm the diagnosis. immunization does not always give permanent protection. you should have a blood test to check your immunity. Your doctor will probably prescribe a painkiller and oral antiviral drugs. including rubella. You may be admitted to hospital for tests. You will be given urgent treatment with antibiotics and may need intensive care. Consult your doctor if your symptoms change. Consult this chart if you have widespread spots or discoloured areas of skin and a temperature of 38°C (100°F) or above. widespread rash? NO YES POSSIBLE CAUSES A number of different viruses. ACTION In adults. The risk of these disorders developing is lower if infection occurs in later pregnancy when development is complete. ACTION If meningitis is suspected. ACTION Use self-help measures to reduce your fever (see MANAGING A FEVER. Do you have a red rash and a sore throat? NO YES POSSIBLE CAUSE You may have scarlet fever. if you are pregnant or have been in contact with a pregnant woman.A D U LT S : G E N E R A L 80 Rash with fever more likely to cause complications in adults than children. may be the cause of these symptoms. an infectious disease caused by the herpes zoster virus. Many viral illnesses pose no risk. SEE YOUR DOCTOR WITHIN 24 HOURS Is the rash widespread and intensely itchy? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Chickenpox. a type of rash caused by bleeding under the skin due to a range of conditions. or are no better within 2 days. which will determine the treatment that is needed. p. worsen. SEE Rubella and pregnancy If you are pregnant and develop a rash. is a possibility. However. t EMERGENCY! CALL AN AMBULANCE Do you have a blistery rash? NO CALL YOUR DOCTOR NOW YES Is the rash confined to an area on one side of your body? NO YES POSSIBLE CAUSE AND ACTION Purpura. You may have an infectious disease. However. The disease can be prevented by immunization (p. and as an important safety precaution before trying to become pregnant. and deafness. the virus that causes rubella (German measles) may cross the placenta and harm the developing fetus. 184 . you should see your doctor as soon as possible so that the cause can be identified and the possible risk to the fetus assessed. However. Consult your doctor.

they are not due to a lack of calcium in the diet. in some people. ACTION Your doctor may prescribe antibiotics as either a topical cream or as tablets. most widespread skin conditions. especially if only one or two toenails are affected. Consult your doctor.39). Do you have one or more nails that are flaky. ACTION Your doctor may prescribe an antifungal cream to apply to the affected skin. ACTION There is no cure for psoriasis. although oral antifungal drugs may be used. POSSIBLE CAUSE Acute paronychia. POSSIBLE CAUSE AND ACTION White patches on the nails are very common and are usually due to a minor injury to the base of the nail. dead tissue called keratin. Consult your doctor. This may run in your family. However. but. but treatment of the skin. If pus has formed. silvery-white patches. However. In severe cases. can also affect the growth and appearance of the nails. Go to chart 116 FOOT PROBLEMS (p.A D U LT S : G E N E R A L 81 Nail problems infections. This is particularly likely if you spend a lot of time with your hands in water. particularly around the base of the nails. which protects the sensitive tips of the fingers and toes from damage. Avoid putting your hands in water too often. including psoriasis and eczema. may be the cause.236) Has the problem YES developed rapidly in only one nail? Have your nails become curved over. causing thick. Consult your doctor. Common problems affecting the nails include distortion of the nail and painful or inflamed skin around the nail. The most common causes of misshapen nails are injury and fungal START HERE Is the skin YES around one or more of your nails swollen or red and painful? NO Is only your big toe affected? NO YES POSSIBLE CAUSE An ingrowing toenail may be the cause of the problem. No particular action is required. the nails come loose from the nail bed. Have your nails become pitted or dimpled? NO YES POSSIBLE CAUSE Psoriasis may be the cause. the white patches will eventually grow out. NO YES POSSIBLE CAUSE Chronic paronychia. a fungal infection of the skin around the nails. it may indicate a serious underlying heart or lung disorder. may be the cause. only the nails are affected. and YES discoloured? NO POSSIBLE CAUSE A fungal infection of the nail is a possible cause of this abnormal appearance. if it has developed recently. such as a chest X-ray (p. thickened. until the affected nail grows out. so treatment for nail problems often needs to be continued for some time. Treatment may need to be continued for several months. a bacterial infection of the skin adjacent to a nail. and have your fingertips also become broader? NO POSSIBLE CAUSE An abnormality known as clubbing is a possibility. may result in an improvement in the appearance of the nails. ACTION Your doctor will probably arrange for tests. Consult your doctor. ACTION Your doctor will probably prescribe a topical antifungal cream or lotion. when you must do so. Contrary to popular belief. and. Nails are made of hard. to look for an underlying disorder and determine the appropriate treatment. it may need to be drained under a local anaesthetic. 185 . It takes between 6 months and 1 year for a nail to replace itself. wear cotton-lined rubber gloves if possible. This disease usually also affects the skin. Do you have white patches on your nails? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

or iritis. your doctor may prescribe oral antibiotics or may arrange for you to be admitted to hospital so that intravenous antibiotics can be administered. ACTION Carry out self-help measures for treating eye injuries (p. However. an eye problem that persists or impairs vision should always be seen by a doctor. there is a risk that the cornea may have been scratched. Consult your doctor.99). If these are unsuccessful or if the eye is still sore an hour after removing the foreign body. Is the skin around the eye red and swollen? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES A serious eye disorder such as glaucoma. you will need drugs to reduce the pressure. a type of migraine. a painful or irritated eye is due to a relatively minor problem and. Iritis needs immediate treatment with corticosteroid eye drops or tablets. keep a diary to see if you can identify a possible trigger factor (see REDUCING THE FREQUENCY OF MIGRAINE. The aching is usually due to fatigue of the muscles around the eye. if the problem occurs frequently. Could there be a foreign body. which is a bacterial infection of the skin and soft tissues around the eye. If you have glaucoma. See your optician promptly.189). a condition in which the eyes fail to produce enough tears.188). ACTION If dry eye is confirmed. In some cases. In hospital. For blurred vision. POSSIBLE CAUSE Dry eye. t EMERGENCY! CALL AN AMBULANCE WA R N I N G CONTACT LENS WEARERS If you wear contact lenses and experience any kind of eye pain or irritation. In most cases. inflammation of the coloured part of the eye. He or she may prescribe painkillers. is a possibility. Do you have severe pain in or around an eye? NO YES Is your vision blurred? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A cluster headache. redness. consult your doctor or see your optician for vision testing (p. ACTION Depending on the severity of the infection. An operation to improve fluid drainage from the eye may also be necessary.99) while waiting for medical help. seek urgent3 medical help. reading for long periods or doing close work in poor light does not strain the eyes themselves. unless you wear contact lenses. If the pain was caused by a piece of grit under the lens. is possible. the injury will be assessed. A red. surgery may be needed. and watering.159). Both conditions will be monitored carefully. CALL YOUR DOCTOR NOW POSSIBLE CAUSE You may have orbital cellulitis. in which excess fluid causes increased pressure in the eye. such as a piece of YES grit. your doctor will prescribe eye drops that act as artificial tears. in your eye? NO POSSIBLE CAUSE AND ACTION A foreign body in the eye may cause pain. see chart 83. DISTURBED OR IMPAIRED VISION (p. remove your contact lenses at once. Continued on next page 186 . You can use them as frequently as you need to in order to reduce discomfort. However. You should not use them again until the cause of the problem has been identified and treated. ACTION Your doctor will examine you and may send you to hospital for urgent assessment.A D U LT S : G E N E R A L 82 Painful or irritated eye need professional attention. may not START HERE Have you injured your eye? NO YES POSSIBLE CAUSE Damage to the eye always requires immediate medical treatment. If attacks recur. ACTION Your doctor will want to examine you to exclude other possible causes. Carry out self-help measures for treating eye injuries (p. painless area in the white of the eye is probably a burst blood vessel and should clear up on its own. are possible causes of your symptoms. p. The symptoms usually disappear on their own and do not require treatment. In contrast to widespread belief. Do your eyes feel dry and uncomfortable? NO YES Eyestrain Temporary discomfort or aching in or around the eyes is often described as eyestrain.

who may prescribe a corticosteroid eye ointment. Is your vision normal after cleaning away any discharge? NO YES Do you have a problem with one or more of YES your eyelids? NO POSSIBLE CAUSE AND ACTION Conjunctivitis. If the stye bursts. red lump on an eyelid? NO YES POSSIBLE CAUSE AND ACTION Blepharitis (inflammation and scaling of the lid margins) may be the cause. the eye itself becomes red and painful. Iritis needs immediate treatment with corticosteroid eye drops or tablets to prevent permanent damage to vision. This may be caused by a bacterial or viral infection. always consult your pharmacist before using any over-the-counter eye drops because some may be incompatible with contact lenses. exposing the inner surface of the lid. Consult your doctor if a stye fails to heal within a week. Are your eyelids red and itchy? NO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. carefully wipe away the pus using moistened cotton wool. a condition in which the eyelid turns inwards so that the lashes rub on the eye. If not treated promptly. use strict hygiene when cleaning non-disposable lenses. 187 . or irritation by chemicals. POSSIBLE CAUSE A stye (a boil-like infection at the base of an eyelash) is likely. ACTION Your doctor may refer you to an eye specialist. consult your doctor. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Iritis. If you do have dandruff. YES ACTION Your doctor may refer you to a specialist for a detailed eye examination and for other tests to look for disorders that sometimes occur with iritis. inflammation of the coloured part of the eye. and never moisten contact lenses with saliva. or ectropion. is possible. is a possibility. If the condition does not improve. This condition is often associated with dandruff. Do you have a tender. Consult your doctor. you may have an allergy to the cleaning or soaking solutions. If the condition is no better within 48 hours. Clear away any discharge from the eyes regularly using moist cotton wool. or if styes recur frequently. Although they are not serious. He or she may recommend a minor operation to realign the eyelid. such as arthritis. If your eyes are itchy.A D U LT S : G E N E R A L Continued from previous page SELF-HELP Avoiding contact lens problems Do you have bloodshot eyes with or without a sticky discharge? NO YES Most people who wear contact lenses do so to correct their vision and have few problems with them. If you wear contact lenses. in which the eyelid droops away from the eye. inflammation of the membrane covering the white of the eye and the inside of the eyelids. ACTION A stye will usually either burst and release pus or dry up within a week without treatment. both conditions can look unpleasant and increase the risk of damage to the cornea. consult your doctor. To prevent potentially serious eye infections. Is an eyelid turned inwards or outwards? NO YES POSSIBLE CAUSES You may have entropion. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Using an unperfumed moisturizing cream on your eyelids may also help. If your eyes become irritated while wearing or after wearing contact lenses. an infection may result in permanent damage to your vision. Contact lens Tear film Lens of eye Cornea Lens on the eye Contact lenses float on the film of tears that cleans and protects the front of the eye. try over-the-counter anti-allergy eyedrops. using an antifungal shampoo may help clear up both conditions. an allergy.

Symptoms can often be eased by self-help measures. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Some progressive nerve disorders.40) to look for the cause and determine the appropriate treatment. Have you had visual disturbances such as seeing flashing lights and floating spots? NO YES Were the visual disturbances followed by a severe headache? NO YES ACTION Your doctor may examine you to exclude other possible causes. Successful treatment of many of these disorders may depend on detecting the disease in its early stages. You may also need tests to assess the optic nerves supplying the eyes.40) or MRI (p. If self-help measures are not effective or if attacks recur often. seeing flashing lights or floating spots. If the tear is small. a small puff of air is aimed at the front of the eye to measure the pressure inside it. However. Both eyes will therefore be checked regularly. a disorder in which the light-sensitive membrane at the back of the eye is torn. can cause intermittent double vision. testing should start at an earlier age. raised fluid pressure in the eye can cause irreversible loss of vision. Any such change in vision should be brought to your doctor’s START HERE Have you YES injured your head in the past 48 hours? NO POSSIBLE CAUSE You may have damaged the part of the brain that is responsible for vision or the eye itself. your doctor may prescribe specific drug treatment.41) to investigate the brain. and resting in a dark. Treatment depends on the results. This chart deals with any change in your vision. ACTION You will probably be admitted to hospital for your vision to be monitored and you may have CT scanning (p. conventional surgery may be necessary. laser surgery may be used to repair the retina. a severe headache that usually occurs on one side of the head. both of which need urgent medical attention. ACTION Once in hospital. You should be tested for glaucoma every 2 years once you have reached the age of 40. t EMERGENCY! CALL AN AMBULANCE 188 . you will be examined and may have CT scanning (p. POSSIBLE CAUSES Sudden double vision may be due to bleeding in the brain or an enlarged blood vessel in the skull. Treatment depends on the results of these tests. t EMERGENCY! CALL AN AMBULANCE Continued on next page Screening for glaucoma In glaucoma.159). In the screening test. If you are very shortsighted or if glaucoma runs in your family. You may need imaging tests such as MRI (p. CALL YOUR DOCTOR NOW POSSIBLE CAUSE This may be a first attack of migraine. there may be a less serious cause.A D U LT S : G E N E R A L 83 Disturbed or impaired vision attention to rule out the possibility of a serious nervous system or eye disorder. ACTION The earlier treatment for this problem is started. Have you developed double vision? NO YES Did the double vision develop suddenly without any warning? NO YES POSSIBLE CAUSE Retinal detachment. Otherwise. ACTION Your doctor will examine you and you will probably be referred to a specialist. drinking plenty of fluids. double vision. including blurring. there is a considerable risk of developing it in the other eye. may cause such symptoms. t EMERGENCY! CALL AN AMBULANCE WA R N I N G DANGER SIGNS Sudden loss or blurring of your vision in one or both eyes may be a sign of a serious eye disorder. The procedure is painless and only takes a few seconds. the greater the chance of success. Call an ambulance or arrange to be taken to the emergency department of an eye hospital. follow the advice in the box on reducing the frequency of migraine (p. quiet room. such as multiple sclerosis.41). Screening for glaucoma is usually carried out as part of a routine eye examination. These disorders may be accompanied by other symptoms such as numbness in a limb. Following retinal detachment in one eye. If you have repeated attacks. such as taking painkillers and antiemetics. and loss of part or all of your field of vision. some of which could damage your sight.

do not stop taking your prescribed drugs. are possible causes of your symptoms. If you have glaucoma. I F A VISION PROBLEM HAS DEVELOPED RAPIDLY. Phoropter Has your vision become blurred? NO YES Having a vision test Different lenses are put into the phoropter and are changed until you are able to read letters near the bottom of the chart. inflammation of the coloured part of the eye. especially once you are over 40. You may also be tested for glaucoma (see SCREENING FOR GLAUCOMA. Later. it may be possible to use laser surgery to treat the condition and preserve your remaining vision. You should have regular eye tests. Do you have diabetes? NO YES Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. if so. may cause blurred vision as a side effect. ACTION Arrange for a vision test (above). you may need only to have glasses. which can cause changes in the back of the eye before general symptoms develop. may be the cause. you will need drugs to reduce the pressure in the eye. in which the tiny fragile blood vessels of the eye are progressively damaged. Consult your doctor. is a possibility. Meanwhile. which ones. or macular degeneration (deterioration of part of the retina) are both possible causes of blurred vision. or iritis. 189 . from the age of 40. opposite). including screening for glaucoma (opposite). an operation to replace the affected lens with an artificial one is often recommended. but in some cases vision is progressively lost. Do you have pain in one or both eyes? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES A serious eye disorder such as glaucoma. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. your optician will examine your eyes to look for disorders such as diabetes and high blood pressure. POSSIBLE CAUSE Diabetic retinopathy. you may still need glasses for reading. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. You may need glasses to correct your sight. such as antidepressants. Macular degeneration may be halted by laser surgery. Your ability to focus on near objects may also be measured by asking you to read very small print on a chart held at normal reading distance. These tests show whether you need corrective lenses. ACTION Your doctor may send you to hospital for urgent assessment. Are you over 50? NO YES POSSIBLE CAUSES A cataract. ACTION In the early stages of the development of a cataract. SEE YOUR DOCTOR WITHIN 24 HOURS . Consult your doctor. Do you experience YES blurred vision only when undertaking tasks such as reading or other close work? NO POSSIBLE CAUSE Presbyopia. ACTION If you are found to have diabetic retinopathy. In addition. Following this operation. in which the lens of the eye becomes cloudy.A D U LT S : G E N E R A L Continued from previous page Vision testing You should have your vision tested every 2 years. in which excess fluid causes increased pressure in the eye. progressive loss of the ability to see near objects with increasing age. and. The most common test gauges the sharpness of your distance vision by assessing how well you can read letters lined up in decreasing size on a Snellen chart. Iritis needs immediate treatment with corticosteroid eye drops or tablets. Consult your doctor.

ACTION Your doctor may prescribe antibiotic ear drops for an outer ear infection. In many cases. microphone.194). Hearing loss is also a common feature of aging. Sounds are played while the air pressure is varied and the pattern of the sound waves reflected by the eardrum is recorded. This is a relatively uncommon disorder in which there is an increase in the amount of fluid in the inner ear (see HOW YOU KEEP YOUR BALANCE. Follow the advice on preventing ear problems caused by flying (p. Consult your doctor if your symptoms do not improve. The pattern of sound reflected off the eardrum is recorded at different air pressures. Your doctor may also advise you to cut down your intake of salt and alcohol. Is there a greenishyellow discharge from the ear? NO YES POSSIBLE CAUSE An infection of the outer ear canal. A probe with a sound generator. particularly if you experience pain when pulling on the ear lobe. Very occasionally an operation is recommended.193) in future. The quietest sound you can hear at each frequency is recorded. which connects the middle ear to the throat. during which everything around you seems to spin. you may be given a drug to reduce the amount of fluid in the inner ear. may be the cause. if you suddenly develop severe hearing loss in one or both ears for no obvious reason. Hearing tests Preliminary hearing tests assess the type of hearing loss you might have. Tympanometry shows whether the eardrum moves normally when sounds hit it. which may help reduce the frequency of future attacks. However. Recorded results Have you had a runny or blocked nose. consult your doctor. always consult your doctor. Try steam inhalation (p. Audiometry measures the degree of hearing loss. ACTION This is usually no cause for concern and should clear up without treatment within a week. Headphones Audiometer Did the hearing loss start during or immediately after an aeroplane flight? NO YES ACTION Try blowing through your nose while pinching the nostrils closed. ACTION Your doctor will probably arrange for you to undergo tests in hospital to confirm the diagnosis. especially if you already had a blocked nose. Sounds of increasing volume and at different frequencies are transmitted to one ear at a time through headphones. Tympanometer Print-out of results Have you experienced YES attacks of dizziness. Probe Tympanometry A probe is placed in the ear canal. Continued on next page 190 . If you are found to have Ménière’s disease. Deterioration in the ability to hear some or all sounds may come on gradually over a period of several months or years or may occur suddenly over a matter of hours or days.162). The problem is most common in middle age. hearing loss is the result of an ear infection or START HERE Do you have an earache? NO YES Go to chart 86 EARACHE (p. If the infection is severe. damage to the eardrum resulting from a pressure difference between the middle and outer ear is possible. p. and do you also have noises in the ear? NO POSSIBLE CAUSE Ménière’s disease may be the problem. Your doctor may also clean the ear canal to remove debris. resulting in discharge blocking the canal. This may account for your hearing problem. Consult your doctor. and air pump is placed in the ear canal. or a sore throat in the past week? NO YES POSSIBLE CAUSE A cold or hay fever may result in blockage of the eustachian tube. If the hearing loss persists for more than 24 hours. Audiometry You will be asked to press a button every time you hear a sound.A D U LT S : G E N E R A L 84 Hearing problems a wax blockage and can be treated easily. you may be given oral antibiotics.193) POSSIBLE CAUSE Barotrauma.

into the ear because this may make the blockage worse and may damage the eardrum. amplifier. Hearing aids Hearing aids amplify sounds. your doctor may suggest trying over-the-counter ear drops or may arrange for your ears to be syringed. Do any of the following YES apply? • You regularly listen to loud music • You are exposed to loud noise at work • You have been exposed to loud noise very recently NO Modern hearing aid This type of hearing aid fits entirely within the ear canal. To prevent such problems. even if the noise does not cause discomfort. gradual loss of hearing as you get older. POSSIBLE CAUSE Otosclerosis. ACTION To remove ear wax yourself. which are all powered by a battery.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Brief exposure to loud noise can cause temporary hearing loss and ringing noises in the ears. can cause hearing problems as a side effect. especially through headphones. such as aspirin and some antibiotics. is a common cause of this symptom. To prevent your hearing deteriorating further. consult your doctor. This type of deafness can affect young adults and is more common in women. 191 . If wax blockage is the problem. ACTION If your doctor suspects otosclerosis. make sure that the volume is low enough for you to hear conversation above the music. Then try to wash the wax out while in a warm shower. He or she will probably arrange for hearing tests (opposite) to be performed. For example. your hearing should return to normal within hours. newer hearing aids are much smaller and can fit entirely within the ear canal. If you have been regularly exposed to loud noises and you are concerned about your hearing. you will probably be offered a hearing aid (above). If you cannot remove the wax. If you do listen to music through headphones. All types of hearing aids have a tiny microphone. who will probably arrange for your ear to be syringed. The range of sounds that is amplified by a hearing aid is usually tailored to an individual’s own pattern of hearing loss. the abnormal bone in the middle ear is removed and then replaced with a prosthesis. soften it with over-the-counter ear drops or olive oil for several days. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. follow the advice for preventing noise-induced hearing loss (below). Consult your doctor. can cause permanent loss of hearing. In older hearing aids. do not listen to very loud music. However. but continue taking prescribed medicines until you see your doctor. ACTION Your doctor will examine your ears and may refer you for hearing tests (opposite). repeated exposure to loud noise. always wear ear protectors or ear plugs. If you are exposed to loud noise at work. these parts are often housed in a small case that is worn behind the ear. It may get worse during pregnancy. If you have age-related hearing loss. but wax blockage may also be a possibility. In some cases. and speaker. Do not insert anything. an inherited disorder in which abnormal bone develops within the middle ear. In this procedure. he or she will probably arrange for you to undergo hearing tests (opposite). POSSIBLE CAUSE Wax blockage may be the cause of your hearing problem. These should be provided by your employer to protect you. such as cotton buds. an operation known as a stapedectomy is performed. Consult your doctor. ACTION If you have temporary hearing loss caused by a short exposure to excessive noise. However. Treatment is often initially with a hearing aid. Have other members of your family also suffered from gradual hearing loss? NO YES Preventing noiseinduced hearing loss SELF-HELP Excessive noise may damage the inner ear and cause hearing problems. Stop taking any over-the-counter drugs. All the components are fitted inside the small moulded case. YES Are you over 50 years of age? Has your hearing been getting worse over a period of several weeks or more? NO NO YES YES POSSIBLE CAUSES Presbycusis. improving hearing in people with most types of hearing loss. consult your doctor. avoid exposure to loud noise whenever possible. may be the problem. Are you taking any prescribed or over-thecounter drugs? NO POSSIBLE CAUSE Certain drugs.

or hissing. However. ACTION Your symptoms should disappear within hours. can cause noises in the ear as a side effect. consult your doctor.191). To prevent similar problems from occurring in the future. take steps to protect your hearing if you know you are going to be exposed to loud noise (see PREVENTING NOISE-INDUCED HEARING LOSS. follow the self-help advice on preventing ear problems caused by flying (opposite). In many cases. POSSIBLE CAUSE Recent exposure to loud noise may cause temporary ringing in the ears and hearing loss.190). Hearing noises inside your ear. ringing. p. Go to chart 84 HEARING PROBLEMS (p. is possible. If you are diagnosed with Ménière’s disease. including hearing tests (p. POSSIBLE CAUSE You may have Ménière’s disease.190) Go to chart 84 HEARING PROBLEMS (p. Meanwhile. this action restores hearing to normal. if you are no better after 24 hours. in which there is an increase in the amount of fluid formed in the inner ear (see HOW YOU KEEP YOUR BALANCE. Did this occur within the last 24 hours? NO YES Have you been exposed YES to excessive noise? NO Have you noticed any loss of hearing? NO POSSIBLE CAUSE Exposure to loud noise has probably caused some permanent loss of hearing. is known as tinnitus. an operation may be required. ACTION Try blowing through your nose while pinching your nostrils closed. continue to take any prescribed drugs. In a very few cases.190) Are you taking or have you recently taken any prescribed or over-thecounter drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. you will probably be given drug treatment to reduce the amount of fluid in the inner ear. Others have persistent tinnitus that is not only distressing but may also indicate an ear problem that should be investigated. YES POSSIBLE CAUSE In many cases. hearing loss is associated with noises in the ear. p. especially if you had a blocked nose when you travelled. Are you hearing whooshing sounds that occur in time with the beat of your pulse? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Stop taking any over-the-counter drugs.A D U LT S : G E N E R A L 85 Noises in the ear that clear up without needing medical treatment. which is often associated with noises in the ear. and consult your doctor. but occasionally it is associated with high blood pressure. and do you also have hearing loss? NO ACTION Your doctor may arrange for tests. such as buzzing. 192 . such as aspirin. POSSIBLE CAUSE AND ACTION The noise is probably blood flow in the ear. Have you experienced YES attacks of dizziness during which everything seems to spin around. consult your doctor. If the barotrauma persists for more than 24 hours. This noise is common and usually nothing to worry about. If it persists. consult your doctor.162). Some people have brief episodes of tinnitus that are not due to an ear disorder and START HERE Did the noises start during or immediately after a flight on an aircraft? NO YES POSSIBLE CAUSE Barotrauma. In future. Consult your doctor. damage to the eardrum due to a pressure difference between the middle and outer ear.

The infection may be a localized problem. Did the pain develop suddenly over a few hours and is it severe? NO YES POSSIBLE CAUSE Wax blockage may be the cause of your earache. or sucking sweets during take-off and landing to keep the eustachian tubes open. chewing gum. Over-thecounter painkillers should help relieve the pain. Alternatively. ACTION Your doctor may prescribe ear drops containing an antibiotic if you have an outer ear infection. It occurs because air pressure in an aircraft changes during take-off and landing. throbbing sensation to a sharp. or it may affect the whole of the outer ear. or you have a middle ear infection. treatment with antibiotics. Consult your doctor. Your doctor may examine you and prescribe antibiotics to clear up the infection. ACTION Try blowing through your nose while pinching the nostrils closed. the pain will require medical attention and. Is there a greenish-yellow discharge from your ear? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES An infection of the outerear canal may be the cause of your earache. Preventing ear problems caused by flying SELF-HELP A common problem in flying is barotrauma. If your earache gets worse. To avoid barotrauma. stabbing pain. take a painkiller such as paracetamol. if the eustachian tubes (which link the ears to the throat) are blocked. You should then be able to wash out the wax while in a warm shower. In many cases this action brings relief. A perforated eardrum usually heals rapidly by itself. the pressures in the ear cannot equalize. POSSIBLE CAUSE Barotrauma. 193 . in some cases. Do not insert cotton buds into the ear because this may make the blockage worse and may damage the eardrum. such as a boil. He or she may also prescribe ear drops containing an antifungal and/or corticosteroid drug. If severe. ACTION To remove ear wax yourself. is possible. You should avoid flying if you have a cold. soften it using over-the-counter ear drops or olive oil for several days. because you may have a middle ear infection. you may be given oral antibiotics. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.A D U LT S : G E N E R A L 86 Earache is often due to infection of the ear canal or of the middle ear behind the eardrum. due to a pressure difference between the middle and outer ear. you may have a middle ear infection and a perforated eardrum. who will probably arrange for your ear to be syringed. Do you have a cold? NO YES POSSIBLE CAUSE Colds that are accompanied by a severely blocked-up nose frequently cause mild earache. Earache may vary from a dull. severe. damage to the eardrum resulting from a pressure difference between the middle and outer ear. ACTION Your doctor will examine your ear and may clean it out with a cotton-wool covered probe. blow through your nose while holding the nostrils closed. The pain START HERE Does the pain worsen if you pull on your ear lobe? NO YES POSSIBLE CAUSE An infection of the ear canal is a possibility. If these measures do not work. damage to the eardrum. consult your doctor. If the pain persists for more than 24 hours. Although it is very common in childhood. If the infection is severe. causing earache and/or muffled hearing. ACTION If the pain is mild. it occurs much less frequently in adults. consult your doctor. follow the self-help advice on preventing ear problems caused by flying (below). To prevent similar problems from occurring in the future. especially if you already had a blocked nose. Do you have a blocked-up feeling in your ear that cannot be cleared by swallowing? NO YES Did the earache begin during or immediately after a flight on an aircraft? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION An acute viral or bacterial infection of the middle ear is possible. see your doctor within 24 hours. try swallowing frequently. If you cannot remove the wax.

or it can result from an allergic START HERE Have you YES had a runny or blocked nose for more than 1 month? NO Are your symptoms getting progressively worse? NO YES POSSIBLE CAUSES You may have a nasal polyp. watery discharge from your nose? NO POSSIBLE CAUSE You may have an allergy to a substance such as house dust or animal fur. such as a cold.A D U LT S : G E N E R A L 87 Runny or blocked nose reaction. This condition is caused by an allergy to pollen and usually occurs in the spring or summer. and it may be more difficult to stop the bleeding. Try to avoid sniffing and/or blowing your nose afterwards because you may dislodge the clot that has formed. Alternatively. in order to avoid an overdose. Most nosebleeds stop when pressure is applied to the nose. You could also try steam inhalation: fill a bowl one-third full with hot water. This irritation can be caused by a viral infection. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. this may cause another nosebleed. who may prescribe other drugs. go to a hospital casualty department because there is a risk of serious blood loss. ACTION Try to stay inside when the pollen count is high. aspirin. If your sinuses are affected. or nasal infections. Most people have a blocked or runny nose at least once a year. or ibuprofen. There is no cure for a common cold. POSSIBLE CAUSE AND ACTION Sinusitis. Taking painkillers will help to relieve symptoms.41). Are your eyes itchy? NO YES Nosebleeds Nosebleeds can be caused by blows to the nose. Press both sides of the soft part of the nose together for 15 minutes. who may prescribe antibiotics.39) or MRI (p. consult your doctor. • Try taking an over-the-counter painkiller such as paracetamol. If a nosebleed persists for half an hour or more. YES ACTION If you know what causes your allergy. but they may occur spontaneously. consult your doctor. forceful nose blowing. If these are not effective. This condition. The usual cause of these symptoms is irritation of the lining of the nose. Nosebleeds may be particularly serious in people over 50: the blood vessels are fragile. Many anti-allergy drugs are available over the counter. Treatment may involve surgery or drugs. ACTION Take self-help measures to relieve the symptoms (see TREATING A COLD. such as injury or forceful nose blowing. ACTION Your doctor may refer you to hospital for a thorough nose-and-throat examination. • Over-the-counter cold and flu remedies may help. such as hay fever (seasonal allergic rhinitis). and breathe in the steam for several minutes. However. make sure that the cold remedy does not already contain painkillers. may be the cause. below). If you are no better in 48 hours. • Fill a bowl one-third full with hot water and breathe in the steam for a few minutes to help clear congestion. inflammation of the membranes lining the air spaces in the bones of the face. if you plan to take painkillers as well. but occurs at any time of year. but if these do not help. but many of the symptoms can be relieved with the following self-help measures: • Drink plenty of fluids. POSSIBLE CAUSE AND ACTION A common cold or some other viral infection is probably making your nose run. consult your doctor. and breathe through your mouth. Nosebleeds (below) may have a specific cause. known as perennial allergic rhinitis. consult your doctor. Oral antihistamines or nasal corticosteroids may help and are available over the counter. 194 . is similar to hay fever. or they can occur for no obvious reason. They can be serious in people over the age of 50. Consult your doctor. try to avoid it. you may have a persistent sinus infection. which is a fleshy overgrowth of the tissue that lines the nose. you may need to have them imaged with an X-ray (p. who may prescribe other drugs. If your symptoms do not clear up within 2 weeks. and avoid areas of long grass. Do you have a green or yellow nasal discharge and/or pain in the face? NO Do you have aching limbs and a sore throat? YES NO YES SELF-HELP Treating a cold CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Do you have a clear. POSSIBLE CAUSE Hay fever (seasonal allergic rhinitis) is a possibility.

ACTION Take steps to reduce your fever (see MANAGING A FEVER. p. ACTION Try self-help measures (see SOOTHING A SORE THROAT. Consult your doctor. p. can scratch the throat. If your doctor suspects a drug side-effect. regularly. Consult your doctor if your symptoms are no better in a few days. he or she may arrange for a blood test to confirm the diagnosis.A D U LT S : G E N E R A L 88 Sore throat infection. or irritation from smoke. Soothing a sore throat SELF-HELP In most cases. and stay in bed if you feel particularly unwell. The cause of the soreness in this case is usually obvious. such as paracetamol or ibuprofen. • Place bowls of water or damp towels near radiators to keep air moist. Have you been smoking heavily or been in a very smoky atmosphere? NO POSSIBLE CAUSES Inflammation of the throat (pharyngitis) or tonsils (tonsillitis) due to a viral or bacterial infection is likely. Do you have a blocked or runny nose and/or have you been sneezing? NO YES Do you have two or more of the following symptoms? • Headache YES • Cough • Generalized aches and pains NO POSSIBLE CAUSE A viral infection. he or she will arrange for blood tests. below). p. ACTION If your doctor suspects that you have glandular fever. below) and self-help measures for treating a cold (p. If you are no better in a few days. • Gargle with warm. right) may relieve the discomfort. The following self-help measures may be useful: • Drink plenty of fluids. YES ACTION Try self-help measures for relieving a sore throat (see SOOTHING A SORE THROAT. POSSIBLE CAUSE A common cold is probably responsible for your sore throat. sore throats can be treated at home without medical advice. a sore throat is a common result. Swallowing something sharp. may be soothing. Call your doctor if you become breathless. Meanwhile. salt water (half a teaspoon of salt in a glass of water).154) and relieve cold symptoms (see TREATING A COLD.194). 195 . or raw feeling in the throat from time to time. consult your doctor. rough. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION A side-effect of certain drugs is to reduce the number of white blood cells (an important defence against infection).154) will help lessen your symptoms. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR SORE THROAT HAS NOT BEGUN TO IMPROVE AFTER A FEW DAYS . Most people suffer from a painful. • Take painkillers. There is no particular treatment. Consult your doctor if your throat is very sore or is no better in a few days. such as ice cream and ice lollies. such as flu or a bad cold. although self-help measures for relieving a fever (see MANAGING A FEVER. making it sore. is a likely cause. • Try over-the-counter throat lozenges containing a local anaesthetic. Self-help measures (see SOOTHING A SORE THROAT. do not stop taking your prescribed drugs. • Cold foods. POSSIBLE CAUSE Smoke is an irritant and has probably inflamed your throat.194). He or she may prescribe antibiotics. Are you taking any prescribed drugs? NO YES ACTION Try to stop smoking and avoid smoky atmospheres. such as a fish bone. A sore throat usually clears up within a few days and is most commonly due to a minor START HERE Is your temperature 38ºC (100ºF) or above? NO YES Have you noticed lumps or swellings in two or all of the following areas? • Neck • Armpit • Groin NO YES POSSIBLE CAUSES Glandular fever (infectious mononucleosis) or another viral infection is the likely cause. Consult your doctor if your symptoms are no better in 48 hours. such as a cold.

In most cases. • Do not smoke. and there is no need to consult your doctor. • Part fill a bowl with hot water. you should stop. consult your doctor. unexplained hoarseness or loss of voice. laryngitis If you have lost your voice or have become hoarse. and avoid exposure to a smoky atmosphere.30). treatment includes exercises from a speech therapist and advice on how to use your voice effectively. You should not rely on self-help measures for more than 2 weeks. If you smoke. or loss of voice is almost always due to laryngitis – inflammation and swelling of the vocal cords. the cause of the inflammation is a viral infection or overuse of the voice. especially if you are over 40 and smoke. ACTION Your doctor may refer you to a specialist. • If you have cold-like symptoms. Try self-help measures (see MANAGING LARYNGITIS. below). are you a teacher. the following measures may help: • Rest your voice as much as possible. You should also keep your alcohol intake within the recommended limits. and breathe in the steam for several minutes. who will examine your vocal cords to determine the cause and appropriate treatment. vocal cord nodules need surgical treatment. • Do not drink alcohol. Consult your doctor. below). There is a slight possibility of cancer of the larynx. Smoking also increases the risk of developing cancer of the larynx. who will examine your vocal cords to exclude other conditions. Do you smoke. symptoms can be relieved by using START HERE Has your voice changed YES within the past few days? NO Have you been using your voice excessively? NO YES WA R N I N G PERSISTENT CHANGE IN THE VOICE Consult your doctor promptly if you have hoarseness or loss or change of voice that is recurrent or lasts more than 2 weeks. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR HOARSENESS OR LOSS OF VOICE PERSISTS FOR MORE THAN 2 WEEKS OR RECURS FREQUENTLY. in these cases. • Drink plenty of fluids. Do you use your YES voice a great deal in your work – for example. ACTION Your doctor will probably refer you to a specialist. POSSIBLE CAUSES Chronic laryngitis (persistent inflammation of the vocal cords) due to smoking is the most likely cause. Hoarseness. you should always consult your doctor. actor. Consult your doctor. ACTION Your doctor will take a blood sample to measure your levels of thyroid hormones. The risk of developing either of these conditions is greater if you also regularly drink more than the recommended safe alcohol limits (p. which will need to be taken for life. or have you smoked in the past? YES NO SELF-HELP Managing Do you have two or YES more of the following symptoms? • Excessive tiredness • Increased dryness or roughness of the skin • Unexplained weight gain • Feeling the cold more than you used to • Thinner or brittle hair NO POSSIBLE CAUSE You may be suffering from hypothyroidism (underactive thyroid gland). If your symptoms have not completely disappeared within this time. or it can lead to chronic laryngitis (persistent inflammation of the vocal cords). Occasional blood tests will be necessary to monitor the dosage. Rarely. 196 . POSSIBLE CAUSE AND ACTION Overuse of the vocal cords – for example. due to shouting over loud music or cheering at a football match – can cause the vocal cords to become inflamed. and. If the diagnosis is confirmed. Try self-help measures (see MANAGING LARYNGITIS. POSSIBLE CAUSE AND ACTION Laryngitis (inflammation of the vocal cords) due to a viral infection is the most likely cause of sudden. you will be prescribed thyroid drugs.A D U LT S : G E N E R A L 89 Hoarseness or loss of voice self-help measures. huskiness. take painkillers such as paracetamol. Consult your doctor. persistent or recurrent hoarseness or loss or change of voice may have a serious cause. or singer? NO POSSIBLE CAUSES Excessive use of the voice over a long time can cause nodules (small areas of fibrous tissue) to grow on the vocal cords. However. In most cases.

ACTION While waiting for help to arrive. In addition. POSSIBLE CAUSE A severe attack of asthma is a possible cause of these symptoms. and breathe out as hard as you can. If you become short of breath. ACTION While waiting for the ambulance. Asthma is commonly diagnosed and monitored by measuring peak flow rate. You will probably be given oxygen and diuretic drugs. you should see your doctor. and are you a smoker or have you smoked in the past? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION You may have acute bronchitis. sit upright with your elbows supported on a table or the back of a chair. Try to keep calm. Because you are wheezing. in which the heart fails to pump effectively. Do you cough up grey or greenish-yellow sputum most days.203) and a chest X-ray (p. In hospital. Long-term drug treatment may be necessary to prevent a recurrence. known as pulmonary oedema. the airways become narrowed and produce excess mucus. inflammation of the airways due to a viral infection. t EMERGENCY! CALL AN AMBULANCE CALL YOUR DOCTOR NOW POSSIBLE CAUSE AND ACTION You may be having an asthma attack. call your doctor at once. Measuring peak flow rate Your peak flow rate is the maximum rate at which you can breathe out and is measured in litres per minute.A D U LT S : G E N E R A L 90 Wheezing smoking. asthma.194). your doctor may prescribe a bronchodilator drug to help relieve symptoms. If you suddenly start to wheeze or are short of breath. and the air sacs in the lungs are damaged. is a possibility. If the results show that you have asthma. Mouthpiece Peak flow rate meter POSSIBLE CAUSE Chronic obstructive pulmonary disease (COPD) is likely.154) and treating a cold (p. t EMERGENCY! CALL AN AMBULANCE YES CALL YOUR DOCTOR NOW IF YOU HAVE BEGUN WHEEZING AND YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. In this condition. Wheezing is a whistling or rasping sound made when you breathe out. If you have already been diagnosed with asthma and have your drugs with you. The most common cause of this condition is acute heart failure. which will help to clear the fluid from your lungs. It is usually due to narrowing of the airways as a result of inflammation caused by infection. ACTION Although the damage is irreversible. take two puffs of your relieving inhaler or follow the treatment plan given by your doctor. Consult your doctor. you will be given oxygen and additional bronchodilator and corticosteroid drugs. Your doctor may measure your peak flow rate in order to assess the severity of respiratory conditions in which the airways become narrowed. Using the meter Take a full breath. Your doctor is likely to measure your peak flow rate (below). 197 . sit upright in a chair. You may be given a peak flow rate meter to use at home so that you can check your condition regularly and adjust your treatment as necessary.39) will be needed. You must stop smoking to prevent the condition worsening. or START HERE Has the wheezing come on suddenly in the past few hours? NO YES Are you coughing up frothy pink or white sputum? NO YES WA R N I N G SIGNS Call an ambulance if you have or someone you are with has either of the following symptoms: • Sudden. get medical help at once. you will probably be prescribed a bronchodilator drug. Tests such as electrocardiography (p. The pointer on the meter shows the result. who will examine you and may prescribe a bronchodilator drug. you should follow the self-help advice for managing a fever (p. DANGER Is your temperature 38ºC (100ºF) or above? NO YES Are you short of breath? NO YES POSSIBLE CAUSE A build-up of fluid inside the lungs. wheezing is due to a small foreign body or a tumour partially blocking an airway. Rarely. severe shortness of breath • Blue-tinged lips or tongue An affected person should have any tight clothing loosened and should sit upright.

particularly when it is brought on by exercise or cold weather. The most common causes of coughing START HERE Is the cough dry (without sputum)? NO YES Is it possible that you have inhaled a small particle of food – for example. In hospital. the cough may either produce sputum or be “dry”. ACTION While waiting for medical help. If the fumes you have inhaled are known to be toxic. ACTION Once you have coughed up the foreign body. If you have already been diagnosed with asthma and have your drugs with you. however. there may be a more serious cause such as a tumour. such as a tumour. Try to keep calm. POSSIBLE CAUSE Coughing with a wheeze and shortness of breath may be due to an asthma attack and needs urgent medical treatment. your doctor will probably prescribe inhaled bronchodilator and corticosteroid drugs. ACTION Your doctor will examine you and may measure your peak flow rate (see MEASURING PEAK FLOW RATE. call your doctor immediately. t EMERGENCY! CALL AN AMBULANCE Do either of the following apply? • You have episodes of shortness of breath and wheezing • Your cough is brought on or made worse by exercise or cold weather NO YES Are you short of breath and wheezing now? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A cough may be a symptom of asthma. call your doctor at once.A D U LT S : G E N E R A L 91 Coughing are colds. If the cough continues for more than an hour. may cause a persistent dry cough as a side effect. A cough is the body’s natural response to irritation of an airway and causes the particle to be forcefully expelled from the lungs. column 3 198 .197). However. a peanut? NO YES WA R N I N G COUGHING UP BLOOD If you cough up sputum containing small streaks of blood on one occasion only. if you cough up blood on more than one occasion. the most likely cause is a small burst blood vessel in the lining of the windpipe. or is associated with shortness of breath. If the cough persists for more than 1 hour. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs. Sometimes. or inhaling a foreign body. Have you recently been exposed to irritant chemical fumes or smoke from a fire? NO YES POSSIBLE CAUSE Irritation of the airways and lungs by the fumes or particles in the smoke is the most likely cause. asthma. Meanwhile. Consult your doctor. take two puffs of your relieving inhaler or else follow your treatment plan. sit upright with your elbows supported on a table or the back of a chair. column 1 Continued on next page. this problem is unlikely to be serious. Coughing is the body’s response to irritation or inflammation in the lungs or the throat. p. Continued on next page. seek emergency medical advice. If asthma is diagnosed. smoking. POSSIBLE CAUSE A foreign body in the lungs has probably made you cough. a persistent cough may signal a more serious respiratory disorder. and you should see your doctor within 24 hours. do not stop taking prescription drugs. ACTION Your cough should settle once you are in a well ventilated area. treatment will probably include oxygen and corticosteroids. your cough should disappear. such as ACE inhibitors.

or have you smoked in the past? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have a serious lung disorder such as tuberculosis or lung cancer. YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. in which the acid stomach contents regurgitate back up the oesophagus. you should stop. Bronchoscopy Bronchoscopy can be used to diagnose lung disorders. he or she will probably prescribe antibiotics and may arrange for you to have a chest X-ray (p. and the bronchi are examined through the eyepiece. may be the cause of your cough. p. If the symptoms do not improve with these measures. 199 . your doctor may prescribe an ulcer-healing drug in order to reduce the production of stomach acid. Otherwise. and does it get worse when you bend over or lie down? NO YES Is your cough associated with any of the following? • Weight loss • Coughing up blood • Persistent hoarse voice YES • Night sweats NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air sacs in the lungs) is possible. p. Take painkillers and try steam inhalation (p. but your doctor may prescribe bronchodilators to help relieve your symptoms. If your doctor confirms that you have pneumonia. Depending on the results.39).39). Call your doctor if you become short of breath.A D U LT S : G E N E R A L Continued from previous page.154). a flexible bronchoscope is passed through the nose or mouth down into the lungs to view the bronchi (airways). CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION Your doctor will probably arrange for blood and sputum tests and a chest X-ray (p. If you smoke. You must stop smoking to prevent the condition becoming any worse. ACTION If you have a fever. POSSIBLE CAUSE Gastro-oesophageal reflux. Before the procedure. take steps to reduce it (see MANAGING A FEVER. In this condition the airways become narrowed and produce excess mucus and the air sacs in the lungs are damaged. Sometimes. column 2 Has the cough started within the past week? NO YES POSSIBLE CAUSE AND ACTION You may have acute bronchitis or another viral infection such as a common cold. In most cases. Flexible bronchoscope Bronchoscope Bronchus Lung POSSIBLE CAUSE Chronic obstructive pulmonary disease (COPD) is likely. you will be given a local anaesthetic spray to numb the back of your throat or nose and/or offered mild sedation. Hospital admission is sometimes necessary. Do you cough up thick. consult your doctor if you are no better in a few days. you may then be referred to a specialist for tests such as bronchoscopy (below). surgical instruments can also be passed down through the bronchoscope to remove tissue samples or carry out treatments during the procedure. and do you smoke. greyish sputum most days.194). as some regurgitated matter can enter the lungs. ACTION The damage is irreversible. Do you have pain in the centre of your chest. column 1 Are you short of breath? YES NO Continued from previous page. ACTION Your doctor will advise you on how to reduce the risk of gastro-oesophageal reflux (see COPING WITH GASTRO-OESOPHAGEAL REFLUX. Consult your doctor. Consult your doctor. ROUTE OF BRONCHOSCOPE Viewing the bronchi The bronchoscope is inserted through a nostril under local anaesthetic. such as lung cancer.209).

ACTION Take steps to reduce your fever (see MANAGING A FEVER. If your doctor confirms that you have pneumonia. is possible. p. ACTION While waiting for help to arrive.39) and electrocardiography (p. The most common cause of this condition is acute heart failure. sit upright in a chair. if you are breathing rapidly or you are “puffing” at rest or after very gentle exercise. severe shortness of breath • Blue-tinged lips or tongue While waiting for help to arrive. call your doctor at once. loosen any tight clothing on the affected person and help him or her to sit in an upright position. It is normal to become short of breath after strenuous exercise. This may be serious. t EMERGENCY! CALL AN AMBULANCE Did your shortness of breath come on during or immediately after a very stressful event? NO YES Continued on next page CALL YOUR DOCTOR NOW IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. he or she will probably prescribe antibiotics and may arrange for you to have a chest X-ray (p.203). in which a blood clot lodges in an artery in a lung. DANGER Go to chart 90 WHEEZING (p.202) WA R N I N G SIGNS Call an ambulance if you or someone you are with has either of the following symptoms: • Sudden. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE A sudden accumulation of fluid in the lungs. frothy sputum? NO YES Have you recently been immobile because of illness. known as pulmonary oedema. You will probably be given oxygen and diuretic drugs.294). Long-term drug treatment may be necessary to prevent a recurrence of the condition. p.197) Are you wheezing? NO YES Do you have a cough and/or a temperature of YES 38°C (100°F) or above? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible. follow self-help measures (see COPING WITH A PANIC ATTACK.154).39).173). A sudden shortness of breath and an inability to make any sound that comes on while eating is probably due to choking and needs urgent first-aid treatment (see CHOKING. which will help to clear the fluid from your lungs. you may be given anticoagulant drugs to dissolve the clot and to prevent further clots forming. 200 . and/or are you coughing up pink or white. is a possibility. You may also be admitted to hospital for tests such as electrocardiography (p. if this is the first time you have had these symptoms. you may have a problem affecting the heart or respiratory system. severe shortness of breath. p. The level of oxygen in your blood will probably be measured (see MEASURING BLOOD OXYGEN.203). Hospital admission is sometimes necessary. in which the heart fails to pump effectively. He or she will need to examine you to exclude other possible causes of your shortness of breath. or longdistance travel. injury. ACTION You will be admitted to hospital for tests such as a chest X-ray (p. If you have had such attacks before and have had them diagnosed as panic attacks. especially for those already in poor health. POSSIBLE CAUSE AND ACTION A panic attack brought on by stress can cause sudden. or have you had a baby within the last 2 weeks? NO YES POSSIBLE CAUSE Pulmonary embolism. However. However. If pulmonary embolism is diagnosed. Has the shortness of breath come on recently? NO YES Were you woken by an attack of breathlessness. Because such problems may be serious START HERE Is breathing painful? NO YES Go to chart 93 CHEST PAIN (p. blocking the blood flow. opposite).A D U LT S : G E N E R A L 92 Shortness of breath and threaten the oxygen supply to the tissues. Pregnant women and people who are overweight become short of breath most easily. it is very important to seek medical advice without delay if you become short of breath for no apparent reason.

You will need other tests. may be the cause. Pulse oximetry The pulse oximeter is clipped over a fingertip. in which the air sacs in the lungs become inflamed in response to certain inhaled substances. further tests will be necessary to determine why anaemia has developed. you should stop. your doctor may prescribe bronchodilator drugs to help relieve your symptoms. Do you cough up thick. ACTION Although the damage is irreversible. which indirectly measures the concentration of oxygen in blood in the tissues. an easier and painless method is pulse oximetry. in which there is too little of the oxygen-carrying pigment haemoglobin in the blood. This problem is most commonly due to heart failure (in which the heart fails to pump effectively).39) and skin tests to look for sensitivity to different substances. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Measuring blood oxygen Tests that measure the amount of oxygen in the blood show how efficiently the lungs are working and are used to help diagnose and monitor lung disorders such as pneumonia and pulmonary embolism. the airways become narrowed and produce excess mucus. to establish the underlying cause and appropriate treatment. Consult your doctor. Regardless of the underlying cause. greyish sputum on most days? NO YES POSSIBLE CAUSE Chronic obstructive pulmonary disease (COPD) is likely. If this is not possible. in which the lungs are progressively damaged by inhaled particles. Have you noticed any of the following symptoms with the shortness of breath? • Excessive tiredness • Feeling faint or passing out • Paler than YES normal skin NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have anaemia. ACTION Your doctor will ask you about your current and past occupations. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A gradual accumulation of fluid in the lungs and in other tissues is probably the cause of your symptoms. Anaemia can result from a variety of underlying causes. In this condition. and the air sacs in the lungs are damaged. especially in people over 60 years of age. 201 . The pulse oximeter is clipped over the fingertip and shines a light through the tissues. which will help clear excess fluid. If you smoke. In some cases. ACTION Your doctor will probably arrange for diagnostic tests. However. It shines light through the tissues of the finger and measures how much light is absorbed. The disorder can sometimes cause a fever. If the diagnosis is confirmed. It can also result from a kidney or liver disorder. you may have to consider a change of employment. Consult your doctor.A D U LT S : G E N E R A L Continued from previous page Do you work or have you worked in a dusty atmosphere – for example. ACTION Your doctor will arrange for a blood test to confirm the diagnosis. Are your ankles swollen? NO YES Does your work or hobby involve regular contact with grain or other crops and/or caged birds or animals? NO YES POSSIBLE CAUSE A lung disorder known as extrinsic allergic alveolitis. such as pneumoconiosis. He or she will also arrange for a chest X-ray (p. Changes in the amount of light absorbed by the tissues are detected and displayed on a monitor. including a chest X-ray (p. Tissues containing oxygen-rich blood absorb more light than those in which the blood is low in oxygen. which indicates the blood oxygen level. Blood oxygen levels can be measured by taking a blood sample from an artery. he or she may prescribe drugs. you will probably be advised to avoid further exposure to the substance causing the reaction. In severe cases. If you smoke. Consult your doctor. Consult your doctor. ACTION Your doctor will examine you. is a possibility. You may be given corticosteroid drugs to reduce the inflammation. in a mine or quarry? NO YES POSSIBLE CAUSE An occupational lung disease. usually in the wrist.203).39) and lung function tests to assess how well your lungs are working. Treatment for anaemia will usually need to be combined with treatment of the underlying cause. especially if you smoke or have smoked in the past. including diuretics. you must stop to prevent the condition from worsening. including blood tests and electrocardiography (p. you may have to consider changing your job or hobby.

POSSIBLE CAUSE A pneumothorax. Have you been coughing up green or yellow sputum? NO YES Do you have a cough with sputum.40). coronary angiography (p. especially for those already in poor health. consult your doctor if your symptoms are no better within a few days. Call your doctor at once if you become breathless. This may be serious. p. and drugs to stabilize your heart rhythm. Pain in the chest (anywhere between the neck and the bottom of the ribcage) may be alarming but usually does not have a serious cause. as well as painkillers.154). ACTION In hospital. ACTION Your doctor may arrange for you to have tests such as electrocardiography (opposite). Most chest pain is due to minor disorders such as muscle strain or indigestion.39). ACTION You will be admitted to hospital for tests such as a chest X-ray (p. he or she will probably prescribe antibiotics and may arrange for you to have a chest X-ray (p. in which a blood clot lodges in an artery in a lung. CHEW HALF AN ASPIRIN . or is this the first time you have had this type of pain? NO YES WAITING FOR THE AMBULANCE . or faintness. POSSIBLE CAUSE Pulmonary embolism. in which the blood supply to the heart muscle is temporarily inadequate. CALL YOUR DOCTOR NOW POSSIBLE CAUSE Acute bronchitis. shoulders. is the most likely explanation for chest pain of this kind. nausea. may be a sign of a serious disorder of the heart or lungs and may need emergency treatment. in some cases. injury. Continued on next page 202 . Hospital admission is sometimes necessary. If pulmonary embolism is diagnosed. Otherwise. or arms? NO YES Has the pain persisted despite several minutes rest. A small pneumothorax may need no treatment. If the pneumothorax is large. you should stop smoking.201). central chest pain. you may be given thrombolytic drugs to dissolve the blood clot. exercise ECG (p. and/or is your temperature 38°C (100°F) or above? NO YES ACTION Take steps to reduce your fever (see MANAGING A FEVER. you will have electrocardiography (opposite). in which air enters the two-layered membrane separating the lungs from the chest wall. oxygen.39) and electrocardiography (opposite). ACTION Your doctor may send you to hospital for a chest X-ray (p. If you are a smoker. causing a lung to collapse.39). or pain that is associated with breathlessness. UNLESS YOU ARE ALLERGIC TO IT. blocking blood flow. or longdistance travel. WHILE t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE A heart attack (myocardial infarction). CALL YOUR DOCTOR NOW POSSIBLE CAUSE Angina. p. If your doctor confirms that you have pneumonia. an irregular heartbeat. The level of oxygen in your blood may also be measured (see MEASURING BLOOD OXYGEN. t EMERGENCY! CALL AN AMBULANCE Are you short of breath? YES NO Have you recently been immobile because of illness. a viral infection of the airways. you may be given anticoagulant drugs to prevent further clots from forming.A D U LT S : G E N E R A L 93 Chest pain crushing. If a heart attack is confirmed. If angina is diagnosed. is possible.39). or have you had a baby within the last 2 weeks? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible. you will probably need treatment with antianginal drugs. START HERE Is the pain gripping or crushing. is probable. ACTION Take painkillers and try steam inhalation (p. and/or does it spread into your neck. may be the cause. Severe. a tube may be inserted between the ribs to remove the air. and. Surgery may be necessary in some cases. may be the cause. in which an artery supplying blood to the heart muscle is blocked by a blood clot.194). sweating.

Electrocardiography Electrocardiography (ECG) is used to record the electrical activity produced by the heart as it beats. is possible. Is the pain worse if you take a deep breath? NO YES Is your chest tender to touch? NO YES Is the pain in the centre of the YES chest. a viral infection affecting the nerves. is possible. ACTION Your doctor will examine you and may arrange tests such as a chest X-ray (p. One heartbeat During the procedure Small electrodes are attached to your chest. is safe. wrists.209). and does it come on after eating? NO YES POSSIBLE CAUSE Indigestion is the most likely explanation. you may be prescribed ulcerhealing drugs to reduce the production of stomach acid. wrists. and does it get worse when you bend over or lie down? NO Do you have a burning pain in your skin that is unaffected by YES breathing? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Pleurisy. may be the cause. SEE YOUR DOCTOR WITHIN 24 HOURS Is the pain on only one side of the chest? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE NOT ABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION Stay as active as feels comfortable. POSSIBLE CAUSE AND ACTION Shingles. Trace ECG machine Electrode ECG TRACING OF NORMAL HEART RHYTHM 203 . Signals picked up by each electrode produces a trace. This causes pain before a blistery rash develops. p. Have you had this type of pain before. If your symptoms do not improve. POSSIBLE CAUSES Inflammation or injury affecting a muscle. Each of the traces shows electrical activity in a different area of the heart. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE NOT ABLE TO MAKE A DIAGNOSIS FROM THIS CHART. and ankles and transmit the electrical activity of the heart to an ECG machine.39). To avoid further attacks try self-help measures for preventing indigestion (p. and causes no discomfort.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Gastrooesophageal reflux. Your doctor will probably prescribe a painkiller and oral antiviral drugs. For pain relief. inflammation of the twolayered membrane separating the lungs from the chest wall. Over-thecounter nonsteroidal antiinflammatory drugs will help to relieve the pain. Consult your doctor if you often have indigestion. a ligament. This records the transmitted information as a trace on a moving graph paper or a screen. This condition is often the result of a viral infection. Consult your doctor if the pain is no better after 48 hours. take an over-the-counter nonsteroidal anti-inflammatory drug. The test usually takes several minutes to complete. ACTION Your doctor will give you advice on how to cope with gastro-oesophageal reflux (see COPING WITH GASTRO-OESOPHAGEAL REFLUX. and ankles. ACTION Take an over-thecounter antacid to relieve the symptoms. Consult your doctor. The procedure is frequently used to investigate the cause of chest pain and to diagnose abnormal heart rhythms. Electrodes are attached to the skin of the chest. in which the acid stomach contents leak back up the oesophagus.217). or cartilage of the ribcage are the probable causes.

making you feel more energetic. Small amounts of caffeine do no harm. severe shortness of breath • Feeling faint or passing out NO Are you experiencing palpitations now? NO YES POSSIBLE CAUSE You may have a serious disorder of the heart or its blood vessels. cut down on the amount you smoke. or irregular beating of the heart. trembling. Do not stop taking your prescription drugs unless your doctor advises you to do so. ACTION Your doctor will examine you and may refer you to hospital for tests including ambulatory electrocardiography (opposite) to detect intermittent abnormalities of heart rate or rhythm. Treatment depends on the results but may include antiarrhythmic drugs. Have you drunk more tea. Have you smoked more than usual.39) to look for the underlying cause. The palpitations are preventing your heart from pumping effectively and need urgent treatment. or inhaled solvents? NO YES POSSIBLE CAUSE Nicotine. and certain other drinks. which has about twice the amount of caffeine that tea contains. ACTION Try to stop smoking or. strong. the addictive substance in tobacco. p. Treatment depends on the results but may include antiarrhythmic drugs. cola. It is normal for the heart rate to speed up during strenuous exercise. and sleeplessness. in a small proportion of people. If your symptoms persist or if you need help with stopping smoking or coming off drugs. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSE Caffeine (below). and some soft drinks. which is present in tea. chocolate. Palpitations are an awareness of unusually rapid. You need to see your doctor so that further episodes can be prevented. and you may feel your heart “thumping” for some minutes afterwards. at least.A D U LT S : G E N E R A L 94 Palpitations caffeine or nicotine or may simply be due to anxiety. However. including some used to treat heart disorders. Filter coffee contains about twice as much caffeine as instant coffee. or cola than usual? NO YES ACTION Reduce your intake of caffeinecontaining drinks gradually over several days. coffee. palpitations that occur at rest are caused by the effect of drugs such as START HERE Do you experience any of the following YES when you are having palpitations? • Pain in the chest or neck • Sudden. Do not take recreational drugs or inhale solvents. Caffeine stimulates the nervous system. but in large doses. Stop taking over-the-counter drugs. Some people are more likely to develop these symptoms than others. palpitations that occur at rest are a symptom of an underlying illness. It also increases the amount of urine produced. Inhaling solvents may result in potentially fatal palpitations. consult your doctor. In most cases. consult your doctor. may cause palpitations as a side effect.311). coffee. it may produce symptoms such as palpitations. coffee. used recreational drugs. Sudden withdrawal of caffeine may cause symptoms such as headaches. you should always seek medical advice. You may then have electrocardiography (p. Continued on next page 204 . notably cola. If you continue to have palpitations. Try to gradually cut down your caffeine intake to 2 cups of coffee a day or less. as can some recreational drugs. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A disorder of the heart or its blood vessels may have caused the palpitations. can cause palpitations. chocolate. ACTION In hospital you will have treatment to control the palpitations. If you have recurrent palpitations that have no obvious cause or that are associated with chest pain or shortness of breath. Caffeine Caffeine is present in varying amounts in tea. Are you taking any over-the-counter or prescribed drugs? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Certain drugs. This is usually no cause for concern. He or she may be able to advise you or refer you to a relevant self-help group (see USEFUL ADDRESSES. is a stimulant and may cause palpitations.203) and possibly a chest X-ray (p.

in which there is too little of the oxygen-carrying pigment haemoglobin in the blood. Consult your doctor. Do you have a preexisting heart condition? YES NO CALL YOUR DOCTOR NOW POSSIBLE CAUSE The palpitations may indicate that your condition has worsened.39). is a likely cause.203) and a chest X-ray (p. Do either of the following describe your palpitations? • Missed beats • Particularly strong or early beats NO YES POSSIBLE CAUSE AND ACTION Ectopic beats. Caffeine (opposite) and stress make ectopic beats more likely and should be avoided. Occasional ectopic beats are common and are very unlikely to be a sign of heart disease. You will need treatment for anaemia and for the underlying cause. surgery to remove part of the gland may be needed. as well as increase the heart rate itself. Whatever the cause.A D U LT S : G E N E R A L Continued from previous page Ambulatory electrocardiography In ambulatory electrocardiography (ECG). ACTION Your doctor will take a blood sample to measure levels of thyroid hormones. ACTION Your doctor will take a sample of blood to measure your haemoglobin levels. YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE You may have anaemia. Try to keep stress to a minimum and use relaxation techniques (p. been short of breath after mild exercise. ACTION Your doctor will arrange for you to have tests such as electrocardiography (p. If these measures do not help. If anaemia is confirmed. This trace (left) produced by the device shows an early abnormal beat (ectopic beat). you may be treated with thyroid drugs or radioactive iodine. Normal heartbeat Ectopic heartbeat Symptom Delayed marker heartbeat Shoulder strap Electrode Do you have any of the following symptoms? • Weight loss with increased appetite • Feeling constantly on edge • Bulging eyes • Increased sweating NO Symptom marker button Monitor YES Using a Holter monitor The device is worn under clothing. Whenever symptoms occur. which adds a mark to the recording. If the diagnosis is confirmed. AMBULATORY ECG TRACING Have you been feeling generally tired. in which a heartbeat is slightly delayed or early compared with the regular pattern. you will probably need further tests to determine why the condition has developed. Anaemia can result from a variety of underlying causes. a wearable device called a Holter monitor records the electrical activity of the heart by means of electrodes attached to the chest. but you may be prescribed antiarrhythmic drugs. which coincides with a symptom marker. consult your doctor.32). Ectopic beats are more common when resting quietly and disappear on exercise. 205 . Treatment will depend on the results. Are you tense and under stress? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. the palpitations will put additional strain on your heart and require investigation. In some cases. The recording is then analysed to see if there are any periods of arrhythmia and if they coincide with the marks denoting symptoms. you press a button. and do you have pale skin? NO POSSIBLE CAUSE Hyperthyroidism (overactive thyroid gland) is a possible cause of these symptoms. The device is usually worn for 24 hours or longer and detects intermittent arrhythmias (abnormal heart rates and rhythms). which are usually rapidly effective. POSSIBLE CAUSE AND ACTION Anxiety can increase your awareness of your heartbeat.

fleshy CROSS SECTION OF A TOOTH tissue called the gums. consult your dentist. or if you are no better in a few days. see chart 96. ACTION If you have tooth decay. Do you have pain for only a few seconds when your teeth are exposed to cold food or drinks or to cold air? NO POSSIBLE CAUSES Teeth can become sensitive to cold if their enamel (protective covering) becomes thin or damaged. Often. Consult your dentist. column 1 Continued on next page. The dentine and pulp form long. Have you recently had a filling in the painful tooth? NO YES Does the tooth hurt only when you bite on it? NO YES POSSIBLE CAUSES A cracked filling or else a crack or fracture in the tooth is the most likely cause of your toothache. The pulp contains nerves and blood vessels. If there is no improvement in your symptoms within 2 weeks or if the symptoms get worse. If untreated. Each tooth consists of a hard outer shell that surrounds a cavity of soft tissue. receding or infected gums. If you have a heart valve disorder. MOUTH PROBLEMS (p. pointed roots that extend into the jaw. but they all have a similar structure. decay can spread to the centre of the teeth. or tooth decay. antibiotics may be prescribed or the abscess may be drained before further treatment. beneath which is a substance similar to ivory. the tooth may have to be removed. opposite). a temporary crown is fitted while the permanent crown is made. Let your dentist know if you are pregnant so that any X-rays can be postponed. the exposed part of the shell. The crown. your dentist will probably fill the affected tooth. For pain affecting other parts of the mouth. Teeth are at constant risk of decay because bacteria act on sugars in our diet to create acids that erode the surface of the teeth. The crown is made of either white porcelain or a porcelain–metal alloy. The same conditions that cause decay can also cause gum START HERE Do you have constant toothache? NO YES CALL YOUR DENTIST NOW POSSIBLE CAUSES Tooth decay or a dental abscess. in which a collection of pus forms in or beneath a tooth as a result of an infection. ACTION Try using a toothpaste for sensitive teeth. The teeth are supported by a layer of firm. This tends to occurs naturally with increasing age but may also be due to excessive tooth brushing. Enamel Dentine Gum Pulp Jawbone Nerve Blood vessel YES Continued on next page. If the pain gets worse. called dentine. This involves your dentist reshaping the tooth into a peg and then cementing the crown over it. In rare cases. is coated with a tough layer of enamel. tell your dentist. may cause constant toothache. it may need fitting with an artificial biting surface. You should see your dentist every 6–12 months. who will check the filling and adjust it if necessary. known as a crown. especially if the filling is large. YES The structure of teeth Are your teeth discoloured? NO Teeth vary in shape and size. consult your dentist. column 3 206 . If you have a cracked tooth. ACTION Your dentist will replace a cracked filling. you will need to have antibiotics before dental treatment.208).A D U LT S : G E N E R A L 95 Teeth problems disorders and are often associated with poor dental hygiene (see CARING FOR YOUR TEETH AND GUMS. called the pulp. If you have a dental abscess. POSSIBLE CAUSE AND ACTION It is normal for a tooth to feel uncomfortable for a few days after it is filled.

ACTION Your dentist will probably scale and polish your teeth and advise you on oral hygiene (see CARING FOR YOUR TEETH AND GUMS. Consult your dentist. Brush for at least 2 minutes. ACTION Stop smoking and cut down your intake of tea and coffee. use dental floss or tape to clean between the teeth. it may need to be extracted. Gently scrape the side of the tooth. who may provide you with a mouth guard to protect your teeth while you sleep. POSSIBLE CAUSES Discoloration can occur if certain drugs are given to children while their teeth are developing. particularly if they are stressed or anxious.A D U LT S : G E N E R A L SELF-HELP Caring for your teeth and gums Daily care is vital to maintain dental health. 207 . painless bleeding from gums can be due to a blood disorder. Continued from previous page. CONSULT YOUR DENTIST IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. who will scale and polish your teeth. may also cause patchy discoloration. the gums become inflamed. Excessive fluoride intake. Continued from previous page. removing food particles that a brush cannot reach. Next. Consult your dentist. Make sure you clean each tooth. you may be prescribed antibiotics. using a small-headed toothbrush held at an angle to the teeth. guide it between the teeth. above). Prolonged grinding can damage the teeth. working away from the gum. above). consult your dentist or oral hygienist. column 1 POSSIBLE CAUSE You may have a problem with one of your wisdom teeth. In this condition. Brush and floss your teeth regularly (see CARING FOR YOUR TEETH AND GUMS. Are your gums tender and/or bleeding? NO YES Does your jaw ache when you wake up in the mornings. You need to limit your intake of foods and drinks containing sugar because these contribute to tooth decay. If these measures do not help. Rarely. possibly due to too high a dose of fluoride tablets or drops. Toothbrush held at angle to teeth Dental floss Floss curved around tooth Brushing your teeth Brush your teeth in small circular motions. column 2 Do you have pain or discomfort around one or more of your back teeth? NO Is the discoloration in discrete patches? NO YES YES POSSIBLE CAUSES You may have gingivitis. often as a result of poor oral hygiene. cleaning all the surfaces of your teeth. Brush your teeth at least twice a day. Poor oral hygiene can also cause discoloration. especially where they meet the gum. POSSIBLE CAUSE Teeth may be stained by smoking or drinking tea or coffee. after every meal. If your symptoms are severe. or do you grind your teeth at night? NO YES POSSIBLE CAUSE AND ACTION It is quite common for people to grind their teeth during sleep. Consult your dentist. if possible. You should also brush and floss your teeth regularly to prevent food particles from building up on your teeth and so reduce the risk of tooth decay and gum disease. If a tooth is causing pain. Consult your dentist. or. Use a soft electric or manual toothbrush with a small head and a fluoride toothpaste. You may need blood tests if gingivitis is not the cause. such as inflammation of the gum over an unerupted tooth. but most problems get better on their own. ACTION Your dentist may take an X-ray of your mouth to look at the position of your wisdom teeth within the jaw. Using dental floss Keeping the floss taut. the most common type of gum disease. causing cracks to develop or wearing away the surface. ACTION Your dentist may recommend a cosmetic coating that can be bonded to the front of the affected teeth.

POSSIBLE CAUSE AND ACTION Certain drugs. For problems with the skin around the mouth. a fungal infection. For example. are common. you should consult your doctor or dentist promptly. He or she may initially prescribe an antifungal cream and may arrange for a blood test to exclude iron deficiency. but they may be precipitated by stress. who will determine the cause and carry out any necessary dental treatment. Consult your doctor. Consult your doctor. it is more common in people whose immunity is lowered by certain diseases or drug treatments. ACTION Over-the-counter lozenges or ointments containing corticosteroid drugs should relieve the pain and help the ulcers to heal. If they do not heal within 10 days. can cause widespread soreness in the mouth as a side effect. p. do not stop taking prescription drugs. A sore mouth or tongue is most commonly due to a minor injury. SKIN PROBLEMS AFFECTING THE FACE (p. There is a slight possibility of oral cancer. ACTION Your doctor will prescribe oral antifungal drugs or lozenges. which is a generalized inflammation and soreness of the lining of the mouth. The cause is unknown. or spread all over your mouth. If a deficiency is found. particularly those used to treat cancer. you may need to undergo tests to look for an underlying cause. Consult your doctor.180). Are the corners of your mouth cracked or sore? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. In rare cases. It is important that you keep your mouth and gums healthy by maintaining good oral hygiene (see CARING FOR YOUR TEETH AND GUMS. Such injuries should heal within a week. consult your dentist. If the infection recurs. Minor infections are another relatively common cause of START HERE Is your whole mouth sore? NO YES Do you have YES creamy yellow or white patches in your mouth? NO WA R N I N G PERSISTENT LESIONS If you have a sore or another abnormal area in your mouth that is still there after 3 weeks.207) and having regular dental check-ups. is a possibility. you may be prescribed antibiotics. This condition is often associated with a minor fungal infection in the skin creases or poorly fitting dentures. see chart 78.A D U LT S : G E N E R A L 96 Mouth problems soreness in the mouth. Is an area on the side of your tongue or inside your cheek sore? YES NO POSSIBLE CAUSE These are known as aphthous ulcers. biting your tongue or cheek may cause a painful area. If dentures are causing the problem. POSSIBLE CAUSE AND ACTION Cracks at the corners of the mouth. may be the result of an iron or vitamin deficiency or of an infection. POSSIBLE CAUSES AND ACTION A jagged tooth or badly fitting dentures may cause enough friction to make your cheek or tongue sore. a widespread skin condition or an intestinal disorder such as Crohn’s disease may also affect the mouth. POSSIBLE CAUSE Stomatitis. known as angular stomatitis. ACTION Your doctor may arrange for blood tests to look for an iron or vitamin deficiency. consult your doctor. further tests may be needed to establish why this has occurred and what treatment is necessary. 208 . Do you have one or more shallow greyish ulcers with surrounding red areas? NO Are you taking any prescribed drugs? NO YES YES POSSIBLE CAUSE Oral thrush. it is due to an iron deficiency. Meanwhile. Consult your doctor. causing sore areas to develop. Occasionally. If an infection is the cause. Consult your dentist.

• To prevent heartburn at night. • Avoid spicy or acidic foods and high-fat foods. particularly if you are over 40. However. Difficulty in swallowing is most often due to a sore throat caused by an infection and usually clears up within a few days. p.29). frequent meals.213) or a barium swallow (see BARIUM CONTRAST X-RAYS. ACTION Your doctor will refer you to hospital for tests such as an upper digestive tract endoscopy (p. In this case. or lie down after a meal. • Do not exercise. ACTION Your doctor will examine your throat.A D U LT S : G E N E R A L 97 Difficulty in swallowing to a sore throat may be due to a disorder of the oesophagus. such as chocolate or cream. If your symptoms do not improve.195) Does food seem to stick high up in your chest? NO YES Do you often get a burning pain in the centre of your chest. your symptoms are still a problem. YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. prop up the head of your bed or use an extra one or two pillows. Go to chart 88 SORE THROAT (p. you should be reassessed by your doctor. where you may have a more thorough examination of your throat and an X-ray (p. However. Go to chart 73 ANXIETY (p. You may also need upper digestive tract endoscopy (p. over-the-counter antacids may help. If something is lodged there. If. • Do not wear tight belts or clothes with a tight waistband. difficulty in swallowing or pain that is not related START HERE Do you have a sore throat? NO YES Might you have swallowed something sharp. if you need to take antacids for more than 2 weeks.172) 209 . but you are still able to swallow? YES NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Your oesophagus may have become narrowed as a result of previous inflammation due to gastro-oesophageal reflux. may be the cause. The results of the tests will help your doctor determine what treatment is necessary. • Cut down your alcohol and coffee intake. Consult your doctor.213) or a barium swallow (see BARIUM CONTRAST X-RAYS.40). p.40) to confirm the diagnosis. ACTION Your doctor will advise you on coping with gastro-oesophageal reflux (below). you may be sent to the casualty department of a hospital. bend over. p. Alternatively. • Do not eat late at night. you should seek medical advice. However. or your throat may be scratched. • Stop smoking. there is a possibility of cancer of the oesophagus. you may be prescribed ulcer-healing drugs that reduce the production of stomach acid. • If you are overweight (see ASSESSING YOUR WEIGHT. Any obstruction found there may need to be removed under an anaesthetic. the following measures will help reduce the severity of the symptoms: • Eat small. Do you feel as if an object is stuck in your throat. in which the acid stomach contents leak back up the oesophagus. and/or have you lost weight without trying? NO YES Coping with gastro-oesophageal reflux SELF-HELP If you have been diagnosed as having gastrooesophageal reflux.39) to check for a foreign body. Is the difficulty in swallowing gradually getting worse. such as a fish bone? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES An object may be lodged in your throat. the tube that leads from the throat to the stomach. particularly when you bend or lie down? NO YES POSSIBLE CAUSE Gastro-oesophageal reflux. despite these measures. causing inflammation and a burning pain in the chest. try to lose weight. he or she may remove it. CONSULT POSSIBLE CAUSE Anxiety can sometimes cause this type of difficulty in swallowing.

If severe pain has been present for more than 4 hours.269) may be carried out in some cases to determine the cause of the pain. opposite). In particular. In the past few hours. severe abdominal pain that has not been relieved by vomiting? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES Appendicitis or another abdominal condition may be developing. is a possibility. or intravenously. you will need to use an additional form of contraception such as condoms for some time after the vomiting has stopped. call your doctor. YES Is the vomiting associated with a headache? NO YES Go to chart 63 HEADACHE (p. Laparoscopy (p. a disorder affecting the nerve signals from the brain or from the balance mechanism in the inner ear can START HERE Have you vomited repeatedly in the past days or weeks? NO YES POSSIBLE CAUSES Repeated attacks of vomiting may have a number of causes. ACTION Follow the self-help advice for preventing dehydration in adults (opposite). ACTION Do not eat or drink anything until you have seen your doctor. an operation to improve fluid drainage from the eye will probably be carried out. Make sure you drink plenty of fluids (see PREVENTING DEHYDRATION IN ADULTS. Drink only clear fluids and try an over-the-counter antacid to help to relieve any pain. You should consult your doctor if you are taking any other prescribed drugs and have been vomiting. Follow the instructions provided with the oral contraceptives or consult your doctor if you are not sure what to do. People who have recurrent migraine attacks recognize the familiar symptoms of headache with nausea and/or vomiting. can occur as a result of over-indulgence. WA R N I N G RED OR BLACK BLOOD IN VOMIT Call an ambulance if your vomit contains blood. If you use oral contraceptives. consult your doctor. and/or a temperature of 38ºC (100ºF) or above? NO YES POSSIBLE CAUSES Acute glaucoma. Occasionally. if you vomit repeatedly for more than 24 hours or if further symptoms develop. ACTION If your doctor confirms glaucoma. WA R N I N G VOMITING AND DRUGS Vomiting may prevent oral drugs from being absorbed and may thus reduce the effectiveness of the medication. but it may also follow a disturbance elsewhere in the digestive tract. which may appear as any of the following: • Bright red streaks • Black matter resembling coffee grounds • Blood clots Go to chart 99 RECURRENT VOMITING (p.41). Migraine is also a possible cause of vomiting. a serious disorder in which excess fluid causes increased pressure in the eye. alcohol can irritate the stomach lining. by mouth. your doctor will prescribe antiemetic drugs and possibly painkillers. especially if you are over the age of 40. If your vomiting is caused by migraine. inflammation of the stomach lining. You may be sent to hospital for tests such as ultrasound scanning (p. have you done any of the following? • Overeaten YES • Eaten large amounts of rich or spicy food • Drunk a large amount of alcohol NO POSSIBLE CAUSE Gastritis. but in other cases of vomiting accompanied by severe headache or when vomiting occurs with acute abdominal pain. Once the pressure has been reduced. Drugs are given as eye drops. Continued on next page POSSIBLE CAUSES AND ACTION Gastroenteritis (inflammation of the digestive tract often due to a viral infection) or food poisoning are the most likely causes. urgent medical attention is needed. you will probably be admitted to hospital and given drugs to reduce the pressure in the eye. 210 . however.A D U LT S : G E N E R A L 98 Vomiting produce vomiting. call an ambulance. or if you find it difficult to cut down on your alcohol intake.158) Do you have severe pain YES in or around one eye? NO CALL YOUR DOCTOR NOW Do you have diarrhoea. These conditions usually settle down within a few days. Vomiting is often the result of irritation of the stomach from infection or over-indulgence in rich food or alcohol. If you regularly vomit after over-eating or drinking alcohol.212) Do you have continuous.

A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSES Food poisoning from food contaminated by bacteria or by toxins. When symptoms are severe. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Certain prescribed drugs may cause nausea and vomiting as a side effect. ACTION There is no specific treatment for labyrinthitis. SELF-HELP Avoiding food poisoning • Put chilled food in the refrigerator as soon • • • as possible after purchase. while symptoms last. Preventing dehydration in adults SELF-HELP Vomiting and diarrhoea can cause dehydration as a result of the loss of large amounts of fluids and salts from the body. 211 . Store raw meat and fish away from other foods inside the refrigerator. • Wash your hands thoroughly before and after handling food. below). If you vomit repeatedly for more than 24 hours. and vegetables. did everything around you seem to spin? NO YES Fluid intake Make sure that you have frequent drinks. cooked meat.278) Are you pregnant? NO YES CALL YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND VOMITING CONTINUES FOR MORE THAN 24 HOURS . Once left-over food has cooled. Use a clean board Food poisoning is usually caused by eating food contaminated with bacteria or toxins and may be avoided by taking the following measures: • Regularly clean work surfaces with disinfectant and hot water. Wash salad thoroughly Safe food preparation Always wash fresh fruit and vegetables before preparing them. Are you taking any prescribed drugs? NO YES Go to chart 141 NAUSEA AND VOMITING IN PREGNANCY (p. Chopping boards should be washed in hot soapy water after use. or a food allergy. • Make sure the refrigerator is set at the recommended temperature. • Alternatively. • Use separate chopping boards for raw meat. drink oral rehydrating solution. inflammation of the part of the inner ear concerned with balance (see HOW YOU KEEP YOUR BALANCE. Have you eaten food that may have been contaminated or to which you may be allergic? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Labyrinthitis. call your doctor. • Always use food by the expiry date. may be responsible for your vomiting. and clean each board thoroughly after use. p. call your doctor. or if you develop further symptoms. However. and use good food hygiene to prevent recurrences of food poisoning (see AVOIDING FOOD POISONING. Do not stop taking your prescription drugs unless your doctor advises you to do so. and never refreeze thawed food. Choose fluids such as dilute orange juice or weak sweet tea. If you have vomiting and diarrhoea for more than 24 hours or if you develop further symptoms. The condition should gradually improve but may last for 2–3 weeks. cover or wrap it properly and store it in the refrigerator. as are babies and children. you should lie down and remain as still as possible. Defrost frozen food before cooking it. even if you are vomiting. may be the cause. which is available over the counter as a powder that you reconstitute. Before you vomited. Elderly people are particularly vulnerable to dehydration. ACTION Follow the advice on preventing dehydration in adults (right). The following selfhelp measures may be useful in reversing or preventing dehydration: • Drink plenty of fluids every 1–2 hours.162) due to a viral infection. your doctor may prescribe antiemetic drugs to relieve the vomiting.

Recurrent START HERE Could you be in the first 3 months of pregnancy? NO YES POSSIBLE CAUSE AND ACTION Morning sickness. If your symptoms do not improve with these measures. ACTION Your doctor may prescribe ulcerhealing drugs and will advise you to give up smoking and drinking alcohol. or inflammation of the gallbladder. and you should consult your doctor. you may be advised to have surgery to remove your gallbladder. see chart 141. Does your skin or the whites of your eyes look yellow? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE This condition is known as jaundice and may be due to a liver or gallbladder disorder. may be the cause of your symptoms. For vomiting during pregnancy. Such tests should help to establish the underlying cause of the jaundice so that appropriate treatment can be given. especially when you bend over or lie down? NO YES Is the pain mainly in the centre of your upper abdomen? NO POSSIBLE CAUSE Gastro-oesophageal reflux. you may be referred for tests such as upper digestive tract endoscopy (opposite) to confirm the diagnosis. Lifestyle factors such as irregular meals or excess alcohol can make the symptoms worse. Consult your doctor. causing inflammation and a burning pain. Consult your doctor. if your symptoms persist.41). you may be prescribed ulcer-healing drugs to reduce the production of stomach acid. and/or does it come on after eating fatty foods? NO YES POSSIBLE CAUSE An ulcer in the stomach or duodenum (the first part of the small intestine) is a possibility. ACTION Your doctor may arrange for you to have abdominal ultrasound scanning (p. Do a home pregnancy test (p.217). Infection with the Helicobacter pylori bacterium is now known to be the cause of many ulcers. Recurrent vomiting associated with weight loss or abdominal pain may have a serious cause. ACTION Your doctor will probably arrange for blood tests and possibly ultrasound scanning (p. Have you been suffering from recurrent episodes of abdominal pain related to eating? NO YES Does the pain spread from under your ribs on the right side of your abdomen. which may appear as any of the following: • Bright red streaks • Black matter resembling coffee grounds • Blood clots Do you sometimes get a burning pain in the centre of your chest. Adopting a low-fat diet may prevent further episodes of pain.260) and consult your doctor.210). YES ACTION Your doctor will advise you on coping with gastro-oesophageal reflux (p. NAUSEA AND VOMITING IN PREGNANCY (p. For isolated attacks of vomiting. Consult this chart if you have vomited or felt nauseated repeatedly over a number of days or weeks. WA R N I N G RED OR BLACK BLOOD IN VOMIT Call an ambulance if your vomit contains blood. in which the acid stomach contents leak back into the oesophagus. In some cases. the term used to describe nausea and/or vomiting in early pregnancy. followed by drugs to treat Helicobacter pylori infection.A D U LT S : G E N E R A L 99 Recurrent vomiting vomiting can be caused by inflammation of the stomach lining or by an ulcer.278). Continued on next page 212 . is the most likely cause of your symptoms. see chart 98.209). However. may be the cause of the symptoms. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Gallstones intermittently blocking the exit to the gallbladder. VOMITING (p.

However. your doctor may refer you for upper digestive tract endoscopy (above). POSSIBLE CAUSES An ulcer in the stomach or duodenum (the first part of the small intestine) is the most likely cause of your symptoms. 213 . Stomach cancer usually needs to be treated surgically. surgery may be needed to relieve the blockage. but there is a slight possibility of stomach cancer. If the vomiting is severe. may be the cause. Remember that vomiting can reduce the effectiveness of certain drugs (see VOMITING AND DRUGS. stop. if you smoke. Do not stop taking your prescribed drugs without your doctor’s advice. and recurrent attacks of vomiting associated with headaches are more likely to be due to migraine. regular meals and. Have you been suffering from recurrent headaches? NO YES ACTION If you have not previously been diagnosed as having migraine. ACTION Your doctor will examine you and may send you to hospital for tests such as X-rays (p.30)? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE A condition that causes increased pressure on the brain. follow the advice on relieving a headache (p. such conditions are rare. stomach. Samples for analysis can be taken during the procedure. your doctor will examine you to exclude other causes. If migraine is the cause of your symptoms. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Are you taking any prescribed drugs? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Certain drugs can cause recurrent vomiting as a side effect. POSSIBLE CAUSE Chronic gastritis (persistent inflammation of the stomach lining) is a possibility. and duodenum (first part of the small intestine) to look for disorders such as ulcers. you may be given fluids intravenously instead of by mouth.210). Eat small. Your throat may be sprayed with a local anaesthetic and/or you may be sedated. Endoscope Monitor Mouth guard to prevent damage from endoscope Do you have either of the following? • Reduced appetite • Unintentional weight loss of more than 4 kg (9 lb) NO YES Viewing the digestive tract The doctor can inspect the lining of the digestive tract. He or she may also refer you to hospital for MRI scanning (p. ACTION Your doctor will probably arrange for you to have upper digestive tract endoscopy (above). He or she may also prescribe antacids. Do you regularly drink more than the recommended safe alcohol limit (p.A D U LT S : G E N E R A L Continued from previous page Upper digestive tract endoscopy Endoscopy of the upper digestive tract involves passing a flexible viewing tube through the mouth to examine the inside of the oesophagus. Ulcers are usually treated with a course of antibiotics to kill the Helicobacter pylori bacteria that are responsible for the majority of these ulcers. SEE YOUR DOCTOR WITHIN 24 HOURS Have you recently developed severe constipation and/or swelling of the abdomen? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A blockage in the intestine could be the cause of your symptoms. p. such as a tumour. The procedure usually takes around 15 minutes. which is displayed on the monitor as the endoscope is moved around. Consult your doctor. In some cases.159) and reducing the frequency of migraine (p. ACTION Your doctor will advise you to cut down your alcohol intake to within the recommended limits. If your symptoms persist.39).41) of the brain. This disorder is aggravated by excessive alcohol intake.159).

Any abdominal pain that is severe or persistent should receive prompt medical attention. Do not eat or drink anything or take painkillers while waiting for medical help. urinary system. no treatment is needed. You may be admitted to hospital if you are very unwell. Do you have diarrhoea? NO YES POSSIBLE CAUSES Food poisoning or viral gastroenteritis may be the cause. POSSIBLE CAUSES AND ACTION A serious abdominal condition. but you may be advised to have your gallbladder removed. may be the cause. If the intestine becomes trapped. If you are very unwell. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES AND ACTION These symptoms may be due to gallstones (opposite) causing inflammation of the gallbladder or blocking the flow of bile to the intestine. DANGER Are any of the danger signs listed in the box (right) present? NO YES Have you had severe abdominal YES pain for more than 4 hours? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES Your pain may be due to a serious abdominal disorder such as appendicitis or a perforated ulcer. Further tests may be carried out to look for an underlying cause. Many cases of abdominal pain are short-lived and are due simply to eating or drinking too much or too quickly. You may need surgery to determine the cause of the symptoms and the treatment needed. When the symptoms have subsided.211) and see your doctor if the symptoms are no better in 48 hours. such as appendicitis or a perforated ulcer. its blood supply may be cut off.A D U LT S : G E N E R A L 100 Abdominal pain affecting the digestive system. you will probably need urgent admission to hospital for surgery to release the intestine and repair the hernia (see HERNIA REPAIR. may be the cause.217) to confirm the diagnosis. ACTION Usually. particularly if you have pain on passing urine. the reproductive system. drowsy. Follow the advice on preventing dehydration in adults (p. in women. or. causing severe pain. t EMERGENCY! CALL AN AMBULANCE Is the pain below the ribs on the right? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES Pyelonephritis (infection in the kidney) or kidney stones may be the cause. ACTION Your doctor will examine you and may refer you to hospital. opposite). If you have kidney stones. ACTION If your doctor confirms the diagnosis. Did the pain start in the back below the ribs and move to the groin? NO YES CALL YOUR DOCTOR NOW Do you have a tender swelling in the groin? NO YES POSSIBLE CAUSE A hernia. or confused • Black or bloodstained faeces • Blood in the urine Do not take painkillers or eat or drink while waiting for medical help because you may need emergency surgery. He or she may prescribe antibiotics and painkillers. in which part of the intestine pushes through a weak area in the abdominal wall. you may be admitted to hospital. you should drink plenty of fluids and take painkillers. you may have ultrasound scanning (p. pain in the abdomen may also be due to a disorder START HERE Have you had similar bouts of pain over the past week or more? NO YES Go to chart 101 RECURRENT ABDOMINAL PAIN (p. Your doctor will examine you. ACTION Your doctor will examine you and will prescribe antibiotics if a kidney infection is a likely cause.216) WA R N I N G SIGNS Call an ambulance if you have severe abdominal pain that lasts for longer than 4 hours and is associated with any of the following danger signs: • Vomiting • Fever • Swollen or tender abdomen • Swelling in the groin or scrotum • Feeling faint. You will probably be admitted to hospital and may need surgery to look for and treat the cause. However. Avoiding fatty foods reduces the risk of the pain recurring. Continued on next page 214 .

Inguinal hernia Femoral hernia INCISION SITES Are you male? NO YES Go to chart 136 LOWER ABDOMINAL PAIN IN WOMEN (p. IS Intestine is eased through the muscle Weakened muscle BEFORE POSSIBLE CAUSE AND ACTION You may have torsion of the testis (p. Follow the self-help measures for urinary tract infections (p. Both testes are then stitched to the inside of the scrotum to prevent a recurrence. The muscle and skin are then stitched. but they sometimes inflame the gallbladder or block its exit so that bile cannot be emptied into the intestine. although they are more common in people who are overweight and/or who eat a highfat diet.226). may be the cause. and the hernia is pushed back through the muscle. IF PAIN SEVERE . nausea. you may be prescribed ulcer-healing drugs to reduce the production of stomach acid. protrudes through a weakened muscle. both of which occur in the groin. cutting off the blood supply. are the most likely causes. and vomiting. more tests may be arranged to exclude an underlying problem. In both these cases. t Stitched skin EMERGENCY! CALL AN AMBULANCE Repaired muscle Repositioned intestine AFTER Repairing a hernia An incision is made in the skin.A D U LT S : G E N E R A L Continued from previous page Does the pain become worse when you bend over or lie down? NO YES POSSIBLE CAUSE Gastro-oesophageal reflux. Is the pain in the centre of the YES upper abdomen? NO Is it worse after eating a large meal or drinking excessive alcohol? NO YES Are you passing urine more often than normal and/or is urination painful? NO POSSIBLE CAUSE Pain in the centre of the upper abdomen may be due to a heart condition. Antacids may help to relieve the pain. POSSIBLE CAUSES Chronic gastritis (persistent inflammation of the lining of the stomach) or indigestion.Your doctor will arrange for urine tests to confirm the diagnosis. 215 . Most hernias can be repaired by a simple operation. inflammation of the bladder lining (usually due to bacterial infection). usually the intestine. Hernia CONSULT YOUR DOCTOR OR. often due to overeating. If your symptoms do not improve. If the condition recurs. The stones are formed in the gallbladder from bile (a liquid produced by the liver that aids in digestion).202) YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION You may have cystitis. and you will probably be prescribed antibiotics. During the procedure.131). ACTION Your doctor will advise you on coping with gastro-oesophageal reflux (p. This condition causes inflammation of the oesophagus and a burning pain in the chest. Torsion requires urgent surgery to untwist the testis and restore blood flow. Common types of hernia include inguinal and femoral hernias. or if attacks of pain occur frequently. Consult your doctor if antacids do not ease the pain. There is often no obvious cause for gallstone formation. Hernia repair When part of an organ. in which the acid stomach contents leak back up the oesophagus. but in some cases the gallbladder needs to be removed. p. Go to chart 93 CHEST PAIN (p. The frequency of these painful episodes may be reduced by eating a low-fat diet.209). ACTION Try to eat small. CALL YOUR DOCTOR NOW.30). regular meals and cut down on your alcohol intake (see SAFE ALCOHOL LIMITS. This can cause pain in the abdomen as well as in the scrotum. Chronic gastritis may be aggravated by drinking alcohol. Consult your doctor. the contents of the hernia are eased back into place and the weakened muscle is repaired. the result may be episodes of abdominal pain. In some cases a piece of synthetic mesh is sewn into the weakened muscle to strengthen it. Gallstones do not always result in symptoms. in which a testis is twisted in the scrotum. which is done under a local or general anaesthetic. it forms a hernia.269) Do you have a swollen or painful testis or scrotum? NO YES Cut in skin Gallstones About 1 in 10 people over the age of 40 has gallstones.

is the most likely explanation. which may be a contributing factor. cola. even if you think you know what is causing the pain.209). CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION Try self-help measures (see PREVENTING INDIGESTION. Try the following: • Keep a food diary and try to eliminate anything that seems to bring on an attack. ABDOMINAL PAIN (p. Most recurrent abdominal pain is START HERE Is the pain mainly above your waist? NO YES Is the pain worse when bending or YES lying down? NO POSSIBLE CAUSE Gastro-oesophageal reflux may be the cause. low-fat diet may help. • If constipation is a problem. For an isolated attack of abdominal pain. Adopting a healthy. gradually increase your intake of high-fibre foods and drink more water. These drugs reduce the production of stomach acid. opposite) and take over-thecounter antacids to relieve the symptoms. You may need to try several different approaches before finding one that helps you. try to stop. you may need surgery to remove your gallbladder. and/or does it come on after eating fatty foods? NO YES POSSIBLE CAUSES Inflammation of the gallbladder or gallstones that are intermittently blocking the exit to the gallbladder may be the cause of these symptoms. Have you noticed either YES of the following? • Reduced appetite • Unintentional weight loss of more than 4 kg (9 lb) NO Living with irritable bowel syndrome SELF-HELP Most people are able to control symptoms of irritable bowel syndrome by making dietary and lifestyle changes. but there is a slight possibility of stomach cancer. Is the pain confined to your lower abdomen? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. • If diarrhoea is your main symptom. you should consult your doctor. or fatty foods. An ulcer will usually be treated with antibiotics. ACTION Your doctor will advise you on coping with gastro-oesophageal reflux (p. in order to kill the Helicobacter pylori bacteria responsible for most ulcers. Consult your doctor if attacks of abdominal pain recur in spite of these measures. • Cut out or reduce your intake of tea. milk. spicy. and/or is YES it relieved by antacids? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES An ulcer in the stomach or duodenum is most likely. Consult your doctor. so that he or she can eliminate the slight possibility of a serious underlying problem. and beer. If your symptoms persist. Does the pain spread from under your ribs on the right side of your abdomen. Stomach cancer usually needs to be treated surgically. • Make sure you eat at regular times. In this disorder. you may be prescribed ulcer-healing drugs. see chart 100. causing inflammation and a burning pain. the acid contents of the stomach leak back into the oesophagus. chronic gastritis (persistent inflammation of the lining of the stomach) or a stomach ulcer are also possible. POSSIBLE CAUSES Simple indigestion.32) to relieve stress. ACTION You may have abdominal ultrasound scanning (opposite) to confirm the diagnosis. which may be due to overeating. coffee. • Try relaxation exercises (p. If your symptoms do not improve with these measures. Is the pain worse after a large meal or drinking excess alcohol.A D U LT S : G E N E R A L 101 Recurrent abdominal pain the result of minor digestive disorders and can be relieved by a change in eating habits. • If you smoke. If the pain persists. However. Consult this chart if you have had several episodes of pain in the abdomen (between the ribcage and the groin) over a number of days or weeks. try reducing your fibre intake. ACTION Your doctor will probably arrange for you to have upper digestive tract endoscopy (p. • Avoid eating large meals. Continued on next page 216 . Consult your doctor. fried.213).214).

and images from it are displayed on a monitor. If there is no infection.41) and intravenous urography (p.215). The radiographer moves the transducer over the area. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES A urinary tract infection is likely. and tea. you will probably be prescribed antibiotics. Most people are able to control the symptoms of irritable bowel syndrome using the self-help measures described (see LIVING WITH IRRITABLE BOWEL SYNDROME. However. Consult your doctor. Drink plenty of fluids and take painkillers to relieve the symptoms. and the kidneys. gel is placed on the skin over the area to be examined. fatty foods. you will probably need to have an operation to repair the hernia (p. a device called a transducer emits high-frequency sound waves and receives their echoes to produce images of internal organs. ACTION Your doctor will examine you and may arrange for tests such as colonoscopy (p. constipation.222) to establish the cause. Inflammation of the intestines may be treated with corticosteroid drugs. If cancer of the colon is the cause. opposite). 217 . and/or do you have blood in your faeces? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSES Ulcerative colitis and Crohn’s disease. However. there is a slight possibility of cancer of the colon. such as a bladder stone or a tumour. may be the cause of these symptoms. in which part of the intestine pushes through a weak area in the abdominal wall. the possibility of a more serious condition. Consult your doctor. ACTION If your doctor confirms the diagnosis. the gallbladder. Are you female? NO YES Go to chart 136 LOWER ABDOMINAL PAIN IN WOMEN (p. • Avoid eating rich. • Avoid eating large meals late at night. and/or diarrhoea. coffee. If you have an infection.227) to determine the correct treatment.222) to rule out cancer of the colon. Do you have any swelling or discomfort in the groin that is made worse by coughing or lifting heavy objects? NO Have you lost weight. are possible causes. it will be treated with surgery. However. disorders in which areas of the intestine become inflamed. • Avoid medicines that irritate the stomach. you will need ultrasound scanning (p. To produce good contact between the transducer and the abdomen. The images displayed on the monitor are continually updated. Ultrasound scanning of the abdomen is often used to investigate the liver. using gentle pressure. • Keep a food diary and avoid foods that trigger indigestion. ACTION Your doctor will arrange for urine tests to confirm the diagnosis. a disorder in which there is a combination of intermittent abdominal pain. • Cut down on alcohol. Preventing indigestion SELF-HELP The following measures may be helpful in preventing bouts of indigestion: • Eat at regular intervals without rushing.A D U LT S : G E N E R A L Continued from previous page Abdominal ultrasound scanning In ultrasound scanning (p.269) CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. there is a possibility of cancer of the colon. Do you also have any of the following symptoms? • Passing urine more often than normal • Pain on passing urine • Cloudy or bloodstained urine NO YES POSSIBLE CAUSE A hernia. such as aspirin.41). needs to be ruled out. Ultrasound gel Computer panel Monitor Radiographer Transducer Is the pain associated with diarrhoea and/or constipation? NO YES During the procedure The hand-held transducer is moved over the skin of the abdomen. ACTION You will probably be referred to hospital for tests such as colonoscopy (p. POSSIBLE CAUSE You probably have irritable bowel syndrome. The procedure is painless and safe.

214) Go to chart 103 WIND (p. You may have a serious condition needing urgent treatment. and/or are you having difficulty passing urine? NO POSSIBLE CAUSE Retention of urine in the bladder may be the cause of your swollen abdomen. or liver disorder can cause swelling in the abdomen and the ankles. Abdominal swelling that develops over a relatively short time is usually caused by START HERE Has the swelling developed in the last 24 hours? NO YES Do you also have abdominal pain? NO YES WA R N I N G PAINFUL SWELLING Call an ambulance if you develop sudden abdominal swelling with severe abdominal pain. Do a home pregnancy test (p. If these do not help. Are you constipated? NO YES POSSIBLE CAUSE Excessive amounts of faeces in the intestine may cause a swollen abdomen. ACTION You may find some of the self-help measures for coping with premenstrual syndrome (p.203). and consult your doctor. especially in women who have irregular periods. He or she may refer you to hospital for further tests.A D U LT S : G E N E R A L 102 Swollen abdomen excess wind in the intestines or by a disorder of the urinary system. Treatment may include diuretic drugs to remove excess fluid as well as treatment for the underlying cause.221) Are your ankles also swollen? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Fluid retention as a result of a heart. or if you develop additional symptoms. This is one of the features of premenstrual syndrome. abdominal swelling may also be due to a disorder of the reproductive organs or to pregnancy. to help to determine the cause. SEE YOUR DOCTOR WITHIN 24 HOURS Does the swelling reduce slightly when you pass urine. consult your doctor. kidney.258) CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND IF ABDOMINAL SWELLING PERSISTS WITH NO OBVIOUS CAUSE . An enlarged abdomen is most often due to excess weight that builds up over a period of years. In some cases. Go to chart 100 ABDOMINAL PAIN (p. In women. ACTION Your doctor will examine you and will probably arrange for blood and urine tests. 218 .260). YES Go to chart 119 BLADDER CONTROL PROBLEMS IN MEN (p. Go to chart 105 CONSTIPATION (p.242) or go to chart 129 BLADDER CONTROL PROBLEMS IN WOMEN (p.219) Might you be pregnant? NO YES Is your period due to start within the next few days? NO POSSIBLE CAUSE AND ACTION Swelling of the abdomen may be the first sign of pregnancy. POSSIBLE CAUSE Sudden abdominal swelling that is not accompanied by pain is most likely to be the result of wind (gas) in the intestines. YES POSSIBLE CAUSE Changes in hormone levels at this stage of the menstrual cycle can cause swelling due to fluid retention. such as electrocardiography (p. the underlying cause of the constipation needs prompt medical attention.257) useful.

209). in which the natural sugar in milk is not digested and ferments. or cabbage. Consult your doctor. If they persist. often produce excess gas in the intestines. may be causing your wind. Taking an antacid. ACTION Your doctor will examine you. such as dairy products. causing inflammation and a burning pain. In most cases tests will not be necessary. If the problem worries you. YES Is the wind brought on or made worse by eating or drinking dairy products? NO YES POSSIBLE CAUSE Malabsorption. The undigested food ferments and produces gas. producing gas. POSSIBLE CAUSE Lactose intolerance (p. can help relieve symptoms. is a possible cause. the food residues START HERE Is the wind relieved by belching? NO YES Do you get a burning pain in the centre of your chest. Do you have bouts of lower abdominal pain that are relieved by passing the wind or opening your bowels? NO POSSIBLE CAUSES You probably have irritable bowel syndrome. in which the acid stomach contents leak back into the oesophagus.A D U LT S : G E N E R A L 103 Wind then ferment. Wind is often caused by swallowing air while eating. wind. and particularly foul-smelling? NO YES ACTION If your doctor suspects malabsorption. onions. This is no cause for concern. In adults the condition is likely to be lifelong. although some people are affected by other types of food. Eat smaller meals and avoid fizzy drinks. Consult your doctor. consult your doctor. CONSULT YOUR DOCTOR IF YOU CANNOT MAKE A DIAGNOSIS FROM THIS CHART AND IF YOU ARE CONCERNED .122). bulky. If the diagnosis is confirmed. ACTION Your doctor may ask you to keep a food diary and/or he or she may test a sample of faeces to confirm the diagnosis. Consult your doctor. It may also occur when certain foods are not broken down properly in the intestines. particularly when you bend over or lie down? NO YES POSSIBLE CAUSE Gastro-oesophageal reflux. you may have further tests to find the underlying cause. is often associated with discomfort and belching. If your symptoms do not improve with these measures.216). consult your doctor. he or she may arrange for blood tests or tests on faeces. High-fibre foods such as cabbage are common causes of wind. Expelling the gas through either the mouth (belching) or the anus generally relieves these symptoms. is likely. ACTION Your doctor will advise you on coping with gastro-oesophageal reflux (p. p. Usually. This disorder often causes intermittent abdominal pain. you may be prescribed ulcer-healing drugs to reduce the production of stomach acid. or have you been drinking beer? NO YES POSSIBLE CAUSES AND ACTION High-fibre foods. POSSIBLE CAUSE AND ACTION Constantly swallowing air without realizing it. and/or diarrhoea. 219 . Excess wind (gas) in the digestive system can cause discomfort and a bloated feeling. which is often accompanied by wind. wind is nothing to worry about. Most people are able to control the symptoms of irritable bowel syndrome with self-help measures (see LIVING WITH IRRITABLE BOWEL SYNDROME. available over the counter. in which the digestive system is unable to absorb nutrients from food properly. producing gas. and drinks containing yeast. Do you often feel uncomfortably full YES after meals? NO POSSIBLE CAUSE AND ACTION Indigestion. Have you been eating foods such as beans. possibly as a nervous habit. constipation. Are your faeces pale. but you should consult your doctor if you suddenly develop problems with wind without having had a change in your diet. Avoiding all milk products will reduce the symptoms. Consult your doctor. is a possible cause.

from food contaminated by bacteria or toxins. Diarrhoea is rarely serious. If you use oral contraceptives. most attacks of diarrhoea result from viral infections and last for less than 48 hours. a disorder in which diarrhoea and constipation alternate. Follow the instructions provided with the oral contraceptives or consult your doctor if you are not sure what to do.222). Have you also had bouts of YES abdominal pain? Do any of the following apply? • You have a fever • You have been vomiting YES • You have eaten eaten that may food food that may have been have been contaminated contaminated NO NO Go to chart 101 RECURRENT ABDOMINAL PAIN (p. inflammation of the digestive tract usually due to a viral infection. do not stop taking prescribed drugs. or gastroenteritis. and usually no treatment is START HERE Have you noticed blood in your faeces? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSES Ulcerative colitis.A D U LT S : G E N E R A L 104 Diarrhoea needed other than ensuring that you drink plenty of fluids in order to avoid dehydration. ACTION Follow the advice on preventing dehydration in adults (p.222).216) POSSIBLE CAUSES You may have food poisoning.216). follow the steps for avoiding food poisoning (p. the treatment will include surgery. Diarrhoea is the frequent passing of unusually loose or watery faeces. 220 . Consult your doctor. Treatment may include corticosteroid drugs for ulcerative colitis or antibiotics for an infection. You may be referred to hospital for further tests such as colonoscopy (p. However. Most people are able to control the symptoms of irritable bowel syndrome using self-help measures (see LIVING WITH IRRITABLE BOWEL SYNDROME. WA R N I N G DIARRHOEA AND DRUGS Diarrhoea may prevent oral drugs from being absorbed and may thus reduce the effectiveness of the medication.222) to rule out colon cancer. Are you taking any prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs may cause diarrhoea as a side effect. If cancer of the colon is diagnosed. Also see your doctor if you have diarrhoea and your job involves handling food. there is a slight possibility of cancer of the colon. you will need to use an additional form of contraception such as condoms for some time after the diarrhoea has stopped. It is often accompanied by cramping pains in the lower abdomen. You should consult your doctor if you are taking any other prescribed drugs and have had diarrhoea. but see your doctor if you are no better in 48 hours. in which the colon becomes inflamed and ulcerated.211). p. Meanwhile. To reduce the risk of a recurrence. ACTION Your doctor will examine you and may arrange for tests such as colonoscopy (p.211). ACTION Your doctor will arrange for a sample of faeces to be tested to rule out an infection. Treatment depends on the results but may include surgery. He or she may refer you to hospital for tests such as colonoscopy (p.211) AND SEE YOUR DOCTOR IF YOU ARE NO BETTER IN 48 HOURS . In the UK. or an intestinal infection are possible causes. you should see your doctor if diarrhoea lasts more than 48 hours or if you have frequent episodes of diarrhoea. Consult your doctor. However. is a possible cause. IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Usually no treatment is needed. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Recurrent bouts of diarrhoea should always be investigated to rule out an underlying cause such as cancer of the colon. FOLLOW THE ADVICE ON PREVENTING DEHYDRATION (p. ACTION Your doctor will examine you and perform blood tests. Have you had several episodes of diarrhoea in recent weeks or months? NO YES Have you also had episodes of constipation? NO YES POSSIBLE CAUSES Irritable bowel syndrome.

Consult your doctor.A D U LT S : G E N E R A L 105 Constipation foods in the diet. there is a slight possibility of diverticular disease. Most people with irritable bowel syndrome are able to control their symptoms with self-help measures (see LIVING WITH IRRITABLE BOWEL SYNDROME. However. Overuse of some laxatives can also cause constipation because your bowels become resistant to their effects. • Try to achieve a regular routine in which you go to the toilet to open your bowels at the same time every day. causing constipation. Consult your doctor. If you are constipated for longer than 2 weeks. such as white bread.223) SELF-HELP Constipation POSSIBLE CAUSE You may be suffering from hypothyroidism (underactive thyroid gland). p. Do you find opening your bowels painful? NO YES POSSIBLE CAUSE AND ACTION Lack of fibre in the diet is the most common cause of persistent constipation. and/or diarrhoea. ACTION Your doctor will examine you and may arrange for tests such as colonoscopy (p. Do not stop taking prescribed drugs. You should not use stimulant laxatives such as senna persistently. If these measures fail to clear up your constipation within 2 weeks. you are constipated. Do you have two or more of the following symptoms? • Excessive tiredness • Unexplained weight YES gain • Feeling the cold more than you used to • Dry skin • Thinning or brittle hair NO Go to chart 107 ANAL PROBLEMS (p. The following simple steps can help to prevent or relieve constipation: • Increase your daily fibre intake. consult your doctor. consult your doctor so that cancer of the colon can be ruled out.222) to rule out diverticular disease and colon cancer. or of cancer of the colon. or if your faeces are small and hard. Some people open their bowels once or twice a day. Constipation is also common in pregnancy because hormone changes cause intestinal muscles to relax. in which bulges form in the wall of the colon. Do you have either of the following? • Abdominal pain that is relieved by passing YES wind or opening your bowels • Intermittent diarrhoea NO CONSULT YOUR DOCTOR IF YOU HAVE BEEN UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND YOUR CONSTIPATION LASTS FOR LONGER THAN 2 WEEKS . the bowel may become unable to work without them. The cause is often a lack of fluid or fibre-rich START HERE Have you suffered from constipation for several months or years? NO YES Do either of the following apply to you? • You regularly ignore the urge to open your bowels • You regularly use stimulant laxatives such as senna NO YES POSSIBLE CAUSES AND ACTION Putting off opening your bowels may lead to a loss of the normal pattern of intestinal activity. Stop taking over-thecounter drugs and consult your doctor. 221 . Follow the self-help measures for constipation (below) and if you use stimulant laxatives gradually wean yourself off them. POSSIBLE CAUSES You probably have irritable bowel syndrome. constipation. a disorder in which there is a combination of intermittent abdominal pain. others do so less frequently. If these do not help within 2 weeks. If you have difficulty doing this. you will be prescribed thyroid drugs. • Do not ignore the urge to open your bowels. Occasional blood tests will be necessary to monitor the dosage. • Reduce your intake of refined and highly processed foods. Try self-help measures for constipation (below). ACTION Your doctor will take a blood sample to measure levels of thyroid hormones. even if you are busy. You should also consult him or her if your constipation has not cleared up within 2 weeks. • Increase your daily fluid intake. Are you taking any over-the-counter or prescribed drugs? NO YES POSSIBLE CAUSE AND ACTION Certain drugs such as painkillers and some cough remedies can cause constipation.216). which need to be taken for life. If you have fewer bowel movements than usual. consult your doctor. If the diagnosis is confirmed. consult your doctor.

SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Haemorrhoids (piles). Consult your doctor if you are particularly concerned. your doctor will need to exclude more serious causes. Treatment may include antibiotics for an infection or corticosteroid drugs for ulcerative colitis. Most minor changes in the colour and consistency of your faeces are due to a recent change in diet or a temporary digestive upset. Are your faeces very dark or black. your doctor will explain the treatment options (see HAEMORRHOID TREATMENTS. or do they contain black material? NO YES ACTION If haemorrhoids are the cause of the bleeding. The symptoms may be due to a liver or gallbladder disorder in which the flow of bile to the intestine is blocked. If the diagnosis is confirmed. so you may be offered a sedative drug first. CALL YOUR DOCTOR NOW POSSIBLE CAUSES Ulcerative colitis. a blood transfusion may be needed. flexible tube called a colonoscope. if the faeces are significantly START HERE Have you noticed red blood in your faeces? NO YES Is the blood mixed in with the faeces and/or do you have abdominal pain. POSSIBLE CAUSE This condition is known as jaundice. Does your skin and/or the whites of your eyes look yellow? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Malabsorption. Colon Tip of colonoscope POSSIBLE CAUSE Bleeding in the digestive tract. Colonoscopy takes about 40 minutes. in which the colon becomes inflamed and ulcerated.213) and blood tests. failure of the digestive system to absorb nutrients from food properly. you should see your doctor within 24 hours even if you think that haemorrhoids (piles) are the cause. If he or she suspects cancer of the colon. It is uncomfortable. Treatment depends on the cause of the bleeding but may include ulcer-healing drugs. which are enlarged veins around the anus or inside the rectum. or a bowel infection. Colonoscopy The lining of the large intestine (colon) can be inspected using a long. Colonoscope Rectum During the procedure The colonoscope is passed via the anus through the rectum up into the colon. 222 . ACTION Your doctor will arrange for a sample of faeces to be tested to rule out an infection. opposite). Air is passed in to give a clearer view of the colon. Such tests should help to establish the underlying cause so that appropriate treatment can be given. You may need to be admitted to hospital for immediate tests including upper digestive tract endoscopy (p.A D U LT S : G E N E R A L 106 Abnormal-looking faeces darker or lighter in colour than usual. In some cases. is a possibility. you may have further tests to determine the cause of the malabsorption so that treatment can be given. you may be referred to hospital for tests such as colonoscopy (below). he or she may arrange for tests on blood and faeces. is a possibility. is used to look for disorders such as colon cancer. are likely. diarrhoea. ACTION Your doctor will probably arrange for blood tests and possibly for abdominal ultrasound scanning (p. such as cancer of the colon. This procedure. ACTION Your doctor will examine you. known as colonoscopy. However. ACTION If your doctor suspects malabsorption. Attachments on the colonoscope may be used to take tissue samples or perform treatments. Although haemorrhoids are most likely. YES NO YES POSSIBLE CAUSE AND ACTION Unabsorbed iron causes the faeces to appear black. cancer of the colon needs to be ruled out. are possible causes. However. Consult your doctor. or if they are streaked with blood. perhaps from a stomach ulcer. or a fever? NO YES WA R N I N G BLOOD IN THE FAECES If you notice bright red blood in your faces. You may be referred to hospital for further tests such as colonoscopy (below).217). this may indicate a potentially serious disorder of the digestive system that requires medical attention. Are you taking iron tablets? Are your faeces much paler than usual? NO CALL YOUR DOCTOR NOW CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.

Haemorrhoids may be injected with a chemical that causes them to shrink. Always wash your hands after going to the lavatory and before preparing food. If your symptoms are still troublesome or if you have bleeding from the anus. ACTION Treatment may consist of applying liquid chemicals to the wart. or minor surgery to remove them. Rarely. white worms about 1 cm (1⁄ 2 in long). which can aggravate the condition. avoid tight underwear. no medical treatment is needed for haemorrhoids. ACTION If threadworms are diagnosed. such lumps may be cancer of the anal canal. right). Although harmless. The anus contains a ring of powerful muscles that keep it closed except when passing START HERE Is opening YES your bowels painful and/or have you noticed any bleeding from the anus? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Haemorrhoids (enlarged veins in the rectum or around the anus). Consult your doctor who will examine you. and self-help measures solve the problem. your doctor may refer you to a specialist for treatment. Anal warts are often sexually transmitted and may be associated with genital warts or other sexually transmitted infections (p. they may be passed on from one person to another or picked up from contaminated food. You should eat plenty of high-fibre foods (see A HEALTHY DIET. WA R N I N G BLEEDING FROM THE ANUS You should always consult your doctor if you notice bright red blood in your faeces. Consult your doctor. in women. your doctor will prescribe drugs that kill the worms. then wash the area with warm water and dry it thoroughly. Do you have itching around the anus? NO YES Have you noticed YES white. Over-the-counter creams or suppositories may help to relieve discomfort. more serious causes. caused by a viral infection of the skin. but a more serious disorder is possible. infest the intestines and lay eggs around the anus at night.245 and p. If anal cancer is suspected. Bleeding should always be assessed by your doctor. there are various steps you can take to relieve it. p.221) and may prescribe a laxative to soften the stools. Surgery to remove enlarged veins is another treatment option. use soft toilet paper. This procedure is painless. or bleeding from the anus. Do you have one or more painless fleshy lumps around the anus? YES NO POSSIBLE CAUSES Itching around the anus can be associated with haemorrhoids but often develops without an obvious cause. The anus is the last part of the digestive tract and links the rectum to the outside of the body. Consult your doctor. Haemorrhoid treatments In many cases. your doctor will advise you on diet (see CONSTIPATION. If you have haemorrhoids. SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE This is probably an abscess. 223 . p. or an anal fissure (tear in the anus lining) are likely causes. thread-like particles in your faeces? NO POSSIBLE CAUSE You may have threadworms. If no cause is found for the itching. For an anal fissure. additional tests and treatments will be needed. These tiny. other. All members of your family should be treated to prevent reinfection. wash and dry the anus after opening the bowels.A D U LT S : G E N E R A L 107 Anal problems faeces.267). including self-help measures (see HAEMORRHOID TREATMENTS. The most common symptoms affecting the anus are itching and pain. wipe the anus with soft toilet tissue. An alternative procedure is “banding”. you can use over-the-counter treatments to kill the worms. should be excluded. your doctor will advise on treatment. such as cancer of the colon. your doctor will explain self-help measures and treatment options (see HAEMORRHOID TREATMENTS. A collection of ingrowing hairs is often the cause of abscesses in this area.28) to prevent constipation. below). If you have similar symptoms again. leading to intense irritation of the anus and. the genital area. ACTION If you have haemorrhoids. Avoid straining when opening the bowels. which are not usually signs of a serious disorder. Your doctor will probably arrange for you to go to hospital for a minor operation to drain the abscess. Try to resist the urge to scratch. in which a rubber band is placed tightly around the base of a haemorrhoid. and the haemorrhoid shrinks over a few days and falls off. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Do you have a tender lump in the crease above the anus? NO YES POSSIBLE CAUSES These are probably anal warts. Even though bleeding is most commonly due to haemorrhoids.

The bladder is filled with fluid to distend it. column 1 Continued on next page. Are you passing a larger volume of urine than usual? NO ACTION You will probably be referred to hospital for tests such as abdominal ultrasound scanning (p. tea. others will need drug treatment with either tablets or insulin injections for life. In some cases. such as glomerulonephritis. these variations may be due START HERE Is passing urine painful? NO YES Go to chart 109 PAINFUL URINATION (p. column 2 An illuminated and magnified view of the bladder lining is transmitted from the cystoscope to the monitor. a change may be caused by a bladder or kidney problem or a disorder of the nerves to the urinary tract. This condition is caused by insufficient production of the hormone insulin. Fluid to distend the bladder Surgeon Cystoscope Monitor Do you have one or more of the following symptoms? • Unexplained weight loss • Increased thirst • Blurred vision NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Diabetes mellitus is possible. You may be referred to hospital for further tests such as cystoscopy (right) to locate the source of the bleeding and determine appropriate treatment. opposite)? YES Have you injured your abdomen or the area below your ribs at the back in the last 48 hours? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Your injury may have resulted in damage to a kidney or the bladder. Is your urine bloodstained or smoky (see CHECKING THE APPEARANCE OF YOUR URINE. it may be caused by a more serious underlying disorder such as bladder cancer. This enables the lining of the bladder to be examined and minor procedures.226) WA R N I N G BLOOD IN THE URINE See your doctor within 24 hours if you notice blood in your urine. YES Cystoscopy During cystoscopy.217) to assess any damage. to be carried out through the cystoscope. For some people this is sufficient. bleeding will stop without specific treatment. Consult this chart for problems such as a change in the number of times you need to pass urine or the amount of urine produced. However. is inserted through the urethra and into the bladder. Although bleeding is usually due to an infection and can be easily treated. Viewing the bladder Continued on next page. Reduce your consumption of these fluids. bladder cancer.149). which is needed by the body to get energy from sugar and carbohydrate foods. YES Have you been drinking large amounts of coffee. less commonly. Consult your doctor if you continue to pass large amounts of urine. a thin viewing tube. cola.A D U LT S : G E N E R A L 108 General urinary problems simply to drinking large amounts of coffee or tea or to anxiety. known as a cystoscope. Bleeding may also be caused by bladder infection. However. ACTION Your doctor will take a blood sample to check your blood sugar level. If the diagnosis is confirmed. however. or alcohol? NO YES POSSIBLE CAUSE AND ACTION These drinks increase the amount of urine produced by the kidneys. 224 . surgery may be needed if the damage is substantial. p. NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Blood in the urine may be due to a disorder in which a kidney is inflamed. Cystoscopy may be carried out under a local or a general anaesthetic. In some cases. such as taking tissue samples. ACTION Your doctor will arrange for blood and urine tests. or. you will need advice on diet and lifestyle (see DIABETES MELLITUS.

243).41) of the kidneys. consult your doctor. Surgery may be necessary to remove bladder stones. A temporary colour change may be due to some drugs and foods. Meanwhile. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. urine is normally clear. a change in your urine may indicate a disorder. which will help to confirm the cause and determine the appropriate treatment. column 1 Continued from previous page. and consult your doctor. such as ultrasound scanning (p. Alternatively. If you are not sure whether you are pregnant. and red or cloudy urine may be due to bleeding or infection in the kidney or bladder. even when the bladder is not completely full. POSSIBLE CAUSE If you are not drinking excessive amounts of liquids.260) and consult your doctor. Very dark urine may be a sign of liver disease.A D U LT S : G E N E R A L Continued from previous page. Might you be or are you pregnant? NO YES POSSIBLE CAUSE AND ACTION Passing urine frequently is a common symptom in early pregnancy and is nothing to worry about.258). ACTION Your doctor will examine you and arrange for blood and urine tests. strawcoloured urine Normal urine Unless passed first thing in the morning. p. Consult your doctor. Do you feel YES particularly anxious. cystoscopy (opposite).258) Do you have difficulty in controlling your bladder? NO YES Checking the appearance of your urine The appearance of urine varies.172) Go to chart 119 BLADDER CONTROL PROBLEMS IN MEN (p. If you are not sure whether a change in the appearance of your urine is normal. 225 . column 2 Are you passing urine more frequently than usual? NO YES Are you currently taking any over-the-counter or YES prescribed drugs? NO POSSIBLE CAUSE AND ACTION Drugs such as diuretics are prescribed for conditions such as heart failure to increase the amount of urine passed. Clear. It is often darker in the morning than later in the day. You may be referred to hospital for further tests. and straw-coloured. such as beetroot. An enlarged prostate gland may be treated with either drugs or surgery (see PROSTATECTOMY. your doctor may advise you on self-help measures to control your symptoms. In men. Do you have a strong urge to pass urine with little urine passed? NO POSSIBLE CAUSES You may have a small or oversensitive bladder. an enlarged prostate gland may be the cause. do not stop taking any prescribed drugs. If you have an oversensitive or small bladder. the exit from the bladder may be partially blocked by a bladder stone. Consult your doctor.242) Are you male? NO YES Go to chart 129 BLADDER CONTROL PROBLEMS IN WOMEN (p. Stop taking any over-the-counter drugs. ACTION Your doctor will test your urine and may arrange for ultrasound scanning (p. do a home pregnancy test (p. or do your symptoms occur when you are under stress? NO Go to chart 73 ANXIETY (p. YES POSSIBLE CAUSE Anxiety commonly causes an urge to pass urine. a kidney or hormone disorder may be the cause. Other drugs can also cause you to pass more urine than usual as a side effect. or tests to study the pressures in your bladder (see URODYNAMIC STUDIES. p. However. pale.41). or prescribe drugs.

Painful urination may sometimes be accompanied by cloudy or blood-stained urine (see CHECKING THE APPEARANCE OF YOUR URINE. or you may have cystitis. To relieve symptoms and help to avoid a recurrence. may have been bruised during intercourse.244) Continued on next page. below). Are you female and have you recently had sexual intercourse? NO YES SELF-HELP Urinary tract infections Are you male? NO YES POSSIBLE CAUSES Your urethra. ACTION Your doctor will examine you and arrange for a urine test. You may be referred to hospital for tests such as intravenous urography (opposite). Pain or discomfort while passing urine is usually caused by inflammation of the lower urinary tract. • Change your contraceptive method if your symptoms occur after using either a diaphragm or a spermicide. To help prevent further attacks. Emptying your bladder frequently and completely is also important. but bruising will improve without treatment. you will be prescribed antibiotics. The following measures may also help to relieve the symptoms: • Drinking about 1⁄2 litre (1 pint) of fluid every hour for the first 4 hours. If symptoms are severe or still present in 24 hours. p. If you have a kidney infection. women who have recurrent urinary tract infections should take the following preventative measures: • Be careful about hygiene. Do you have a discharge from YES your penis? NO POSSIBLE CAUSE Your symptoms may be due to a sexually transmitted infection. wipe yourself from front to back to prevent bacteria around the anus from entering the urethra. usually due to an infection. you will not be able to tell if symptoms are due to bruising or cystitis. see your doctor.225). inflammation of the lining of the bladder. Urinary tract infections usually need treating with antibiotics. and do not use vaginal deodorants. the passage leading from the bladder to the outside. inflammation of the lining of the bladder. you should drink 2–3 litres (4–6 pints) of fluids per day. WA R N I N G BLOOD IN THE URINE See your doctor within 24 hours if you notice blood in your urine. • Taking painkillers. After a bowel movement. Go to chart 120 PROBLEMS WITH THE PENIS (p. • Pass urine shortly after sexual intercourse. column 2 226 . Try self-help for relieving the symptoms of urinary tract infections (right). it may be caused by a more serious underlying disorder such as bladder cancer. try self-help measures (see URINARY TRACT INFECTIONS. You may need to be admitted to hospital for treatment if you have a kidney stone. often due to infection. • Drinking cranberry juice.A D U LT S : G E N E R A L 109 Painful urination to inflammation in the genital area. SEE YOUR DOCTOR WITHIN 24 HOURS Are you passing urine more frequently than usual? NO YES Do you have lower abdominal pain. ACTION Your doctor will arrange for a urine test and will probably prescribe antibiotics. In addition. and/or is your urine bloodstained or cloudy? NO YES POSSIBLE CAUSE You probably have cystitis. Although bleeding is usually due to an infection and can be easily treated. column 1 Continued on next page. pain when passing urine may be due START HERE Do you have YES pain in the back just above the waist and/or a temperature of 38°C (100°F) or above? NO CALL YOUR DOCTOR NOW POSSIBLE CAUSES The most likely causes of your symptoms are pyelonephritis (a kidney infection) or a kidney stone. In women. • Use unperfumed toiletries when you wash. such as paracetamol. and even more in hot weather. ACTION Initially. usually due to a bacterial infection.

the infection may be sexually transmitted (see SEXUALLY TRANSMITTED INFECTIONS IN MEN. Over-the-counter painkillers may help to relieve the pain. p. X-ray table Adjustable arm CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. you may be prescribed antiviral drugs. he or she may refer you to a sexually transmitted infections clinic. where it is filtered from the blood into the urine. X-ray source Beam of X-rays Site of injection POSSIBLE CAUSE You may have genital herpes (see SEXUALLY TRANSMITTED INFECTIONS IN WOMEN. which is used to look for disorders of the urinary tract. Consult your doctor. Have you noticed soreness or itching in the genital area? NO YES Do you have blisters or shallow ulcers on the tip of your penis? NO YES POSSIBLE CAUSE You may have genital herpes (see SEXUALLY TRANSMITTED INFECTIONS IN MEN. Do you have blisters or shallow ulcers in the genital area? NO Go to chart 134 ABNORMAL VAGINAL DISCHARGE (p. The procedure is painless. Consult your doctor. may refer you to a sexually transmitted infections clinic. In some cases. X-rays of your kidneys and ureters are taken at intervals. Several X-rays are taken at intervals to show the contrast medium outlining these organs. such as kidney stones. he or she may refer you to a sexually transmitted infections clinic. During the procedure While you lie on the X-ray table. This condition can cause pain if urine comes into contact with the ulcers. YES ACTION Your doctor will examine you and. if a sexually transmitted infection is likely. ACTION Your doctor will examine you. Do you have an abnormal vaginal discharge? NO YES POSSIBLE CAUSE A vulval or vaginal infection can cause pain when urine is passed.267). Consult your doctor. inflammation of the prostate gland. It then passes from the kidneys to the ureters and the bladder. a contrast medium is injected into a vein in your arm. This condition can sometimes recur. but subsequent attacks are usually less severe. ACTION Your doctor will examine you. but subsequent attacks are usually less severe. p. usually as a result of a bacterial infection. is injected into a vein in your arm. you may be prescribed antiviral drugs. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.245). and it usually takes less than 1 hour in total. which shows up on X-rays. The contrast medium travels through the circulation to the kidneys. and. Over-the-counter painkillers may help to relieve the pain. Drawer containing X-ray film 227 . p. if genital herpes is a possibility. You will probably be prescribed antibiotics and advised to drink plenty of fluids.A D U LT S : G E N E R A L Continued from previous page. This condition can cause pain if urine comes into contact with the ulcers. and. If the diagnosis is confirmed. column 1 Continued from previous page.266) YES Intravenous urography Intravenous urography (IVU) is an X-ray imaging procedure (p. This condition can sometimes recur. is a likely cause. if genital herpes is a possibility. column 2 Do you have pain between your legs? NO POSSIBLE CAUSE Prostatitis. If the diagnosis is confirmed. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.245).39). An iodine-based contrast medium.

234) Have you recently injured the joint – for example in a fall? NO YES Are you unable to move the joint without severe pain. SWOLLEN ANKLES (p. Consult your doctor if the pain is severe or if there has been no improvement within 48 hours. Sometimes an operation is needed to reposition bones. an X-ray (p. For swelling of the ankles with no associated pain. Your doctor will arrange for a blood test. in some cases. inflammation of a tendon or the sheath that covers it. Most joints are designed to allow some movement. Consult your doctor. and. see chart 115. undergo constant wear and tear and are particularly prone to disorders such as osteoarthritis.230) or go to chart 114 PAINFUL KNEE (p. and/or does YES it appear misshapen? NO POSSIBLE CAUSES A fracture. The major weight-bearing joints. POSSIBLE CAUSE Osteoarthritis. Consult your doctor. A joint is the junction of two or more bones. and a sample of fluid from the joint may be examined. This condition often affects a single weight-bearing joint. bleeding into the joint. joint replacement (opposite) may be recommended.39) to confirm the diagnosis. Aches and pains in joints are common and are most often the result of overuse or of a minor injury.39) of the joint will probably be taken to discover the extent of the damage. If you have gout. in which uric acid crystals form in a joint. but the range and type of movement depend on the structure of the joint. ACTION Follow the self-help advice for treating sprains and strains (opposite). ACTION Your doctor may prescribe nonsteroidal anti-inflammatory drugs. 228 . Are only some movements of the joint painful? NO YES POSSIBLE CAUSE You may have tendinitis. Osteoarthritis is particularly likely if you are over 50. a progressive condition in which cartilage covering the ends of the bones within a joint is gradually destroyed. long-term drug treatment to prevent a recurrence. Consult this chart if you have one or more painful joints. or if you are overweight. However. it will help to lose weight. A local injection of a corticosteroid drug or physiotherapy may also help. Is the painful joint swollen and hot? NO YES POSSIBLE CAUSES Damage to the muscles. Do you have pain and stiffness in the affected joint that has come on gradually over months or years? Continued on next page YES NO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. ACTION At the hospital. such as the hips and the knees.A D U LT S : G E N E R A L 110 Painful joints are usually short-lived and do not need medical treatment. if the joint has been damaged previously. or ligaments in and around the joint are possible causes. if you are overweight. or tendons in and around the joint may be the cause of the pain. persistent pain in a joint implies a potentially serious underlying disorder and should be investigated. you will be prescribed nonsteroidal anti-inflammatory drugs and. ACTION Your doctor may arrange for an X-ray (p. Depending on the type and nature of the injury. or a serious injury to the muscles. This may be due to overuse or a sports injury. Overthe-counter painkillers should help to relieve the symptoms. such as a hip or a knee.235). tendons. ligaments. t EMERGENCY! CALL AN AMBULANCE SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES AND ACTION You may have gout. An infection in the joint is also possible. is a probable cause. In severe cases. or dislocation. A joint infection needs antibiotic treatment. Your doctor may refer you for physiotherapy. Such symptoms START HERE Is only one joint affected? NO YES Is your shoulder or knee the affected joint? NO YES Go to chart 111 PAINFUL SHOULDER (p. you may need to wear a plaster cast or a firm bandage.

Your doctor may prescribe nonsteroidal antiinflammatory drugs to relieve joint pain.A D U LT S : G E N E R A L Continued from previous page Have you recently had an infection such as a genital tract infection or gastroenteritis? YES NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSE Reactive arthritis. ACTION Your doctor may arrange for a blood test and X-rays (p. even tiny finger joints. but most joints in the body can now be replaced. or plastic. and shoulders. other joints are also involved. Both the pelvic socket and the head of the thighbone. an autoimmune disorder. and Elevation. Then wrap a bandage firmly over a thick layer of cotton wool to provide compression. Are several of your joints hot and swollen? NO Do you have pain and stiffness in your joints that has come on gradually over several months or years? NO YES Do you have psoriasis or an inflammatory bowel disease. Consult your doctor. 229 . The procedure usually relieves pain and increases the range of movement possible in the affected joint. and keep the limb raised. Joint replacement is most commonly performed for hips. is a probable cause. Your doctor may refer you for physiotherapy. in which the body attacks its own tissues. the ends of the damaged bones are removed. In most cases. may be the cause. Apply a cold compress or wrapped ice pack for several minutes. particularly if the small joints at the ends of the fingers are affected. you will be referred to hospital for further treatment with drugs that suppress the immune system and for physiotherapy. Ice pack Hip replacement During the procedure. Do you have any of the following? • Pain and swelling affecting the small joints of both hands • Generalized stiffness lasting at least an hour in the morning • Tiredness and feeling generally unwell NO Joint replacement Joints that have been severely damaged by a disorder such as arthritis or by an injury may be surgically replaced with artificial joints made of metal. Reactive arthritis often clears up promptly but in rare cases may persist for months or even years. a progressive condition in which cartilage covering the ends of the bones within a joint is gradually destroyed. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. Area of pelvis hollowed out Head of thighbone removed Skin incision Treating sprains Apply an ice pack to the affected area. the pelvis is shaped to accept the artificial component. Pelvis LOCATION SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Rheumatoid arthritis. POSSIBLE CAUSE Osteoarthritis. He or she will probably prescribe nonsteroidal anti-inflammatory drugs to relieve the pain. SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. which is inflammation of the joints in response to an infection elsewhere.39) to exclude other types of arthritis. ceramic. ACTION Your doctor may arrange for tests to confirm that the infection has cleared up. He or she will probably prescribe nonsteroidal anti-inflammatory drugs. is the most likely cause of your symptoms. During the operation. such as Crohn’s disease or ulcerative colitis? NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE These conditions may be associated with a type of arthritis affecting the lower spine and pelvis. This condition may run in families. which fits into the socket. YES Treating sprains and strains SELF-HELP Treat sprains and strains by following the RICE procedure – Rest. Over-the-counter painkillers should help to relieve the symptoms.39) to confirm the diagnosis. consult your doctor. Compression. are replaced. and the artificial components are fixed in place. If it is no better in 48 hours. In many cases. knees. ACTION Your doctor may arrange for blood tests or an X-ray (p. Try to rest with the injury elevated for at least 24 hours. Ice. ACTION Further treatment of your underlying condition may improve your joint symptoms.

Consult your doctor. such as tennis. ACTION Your doctor will examine you and will probably recommend painkillers or nonsteroidal anti-inflammatory drugs. consult your doctor. or ligaments in and around the shoulder may be the cause. You may be referred for physiotherapy. You may need to take a long-term low dose of corticosteroids and have regular blood tests. and/or is your neck painful? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. in which a tendon or the sheath that covers it is inflamed. tendons. He or she may arrange for tests such as an X-ray (p. your shoulder may be manipulated back into position under anaesthetic or you may need treatment for a fracture. ACTION Your doctor will examine you and will probably recommend nonsteroidal antiinflammatory drugs. If the pain is severe or no better in 48 hours. POSSIBLE CAUSE AND ACTION A nerve in the neck may be compressed or irritated. You will have to wear a sling for several weeks to immobilize the shoulder joint. in which the capsule of the joint is inflamed. If you play sports that involve strenuous arm movements. and does the pain disturb your sleep? YES Do you also have any of the following? • Tender shoulder or upper arm muscles • Difficulty turning over in bed • Feeling depressed • Mild fever • Unintentional weight loss NO NO YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Polymyalgia rheumatica. t EMERGENCY! CALL AN AMBULANCE POSSIBLE CAUSES Damage to the muscles. 230 . POSSIBLE CAUSE A frozen shoulder.229). Depending on the injury. Consult your doctor. There is often no obvious cause for the inflammation. a corticosteroid injection into the joint may help relieve pain. Are all movements painful. or ligaments of the shoulder is also possible. If the diagnosis is confirmed. trying to exercise the arm will make the symptoms worse. tendons. fall. He or she may also inject the tendon sheath with a corticosteroid drug and/or refer you for physiotherapy. may be the cause. or START HERE Did the pain immediately follow an injury. Initially. especially if you are over 60. Is it painful to move your arm? NO YES Are some movements or positions much more YES painful than others? NO POSSIBLE CAUSE You may have tendinitis. physiotherapy may help. Shoulder pain and/or stiffness without any obvious cause occurs most commonly in elderly people. Painkillers will help to relieve pain. or violent movement? NO YES Is your shoulder too painful to move. Occasionally. an autoimmune disorder in which the body attacks its own tissues. Is the pain brought on or made worse by moving your neck. The shoulder is one of the most complex joints in the body and has a very wide range of movements. A serious injury to the muscles. and/or YES is it misshapen or swollen? NO POSSIBLE CAUSES You may have dislocated your shoulder or fractured your collarbone. is likely.39). However. as the symptoms improve. This may be caused by overuse or a sports injury or there may be no obvious cause. which should relieve the symptoms within 48 hours. ACTION Follow self-help measures for treating sprains and strains (p. Consult your doctor. he or she will prescribe corticosteroid drugs.A D U LT S : G E N E R A L 111 Painful shoulder regularly lift heavy weights. The condition may persist for up to a year despite treatment. shoulder injuries are a risk. ACTION You will probably need an X-ray (p.39) and may suggest that you wear a soft supportive collar around your neck. ACTION Your doctor will arrange for blood tests.

or ligaments of the arm is the most likely cause. your doctor may recommend surgery. p. in which there is inflammation at the site where a tendon attaches to bone at the elbow. Arm pain that develops gradually may originate from problems in the neck. you should make a complete recovery. strenuous physical activity.229). even if you do not have chest pain. Carpal tunnel syndrome that develops during pregnancy often improves after delivery. These symptoms could be due to a heart attack. Such injuries are particularly likely to occur after any unaccustomed. or ligaments that hold the various bones and joints in place. tendons. or ligaments of the arm is possible. Depending on the nature of the injury. POSSIBLE CAUSES A fracture or dislocation or a serious injury to the muscles. tendons.39) and will probably suggest that you wear a soft supportive collar around your neck. t EMERGENCY! CALL AN AMBULANCE Do you also have numbness and tingling in your hand. Tendinitis may be treated with a corticosteroid injection around the tendon. In some cases. make sure that you are sitting correctly if you use a keyboard (p. ACTION Your doctor may arrange for tests to confirm the diagnosis.34) and take regular breaks from repetitive tasks. if symptoms persist. unless you are allergic to it. However.39) to discover the type and extent of the damage. otherwise. sweating. A corticosteroid injection into the tissues in the wrist and wearing a wrist splint. Do you have pain that is brought on or made worse by repetitive movements? NO YES POSSIBLE CAUSES You may have repetitive strain injury (RSI) or tendinitis. Go to chart 110 PAINFUL JOINTS (p. and/or is the pain severe even when resting? NO YES WA R N I N G DANGER SIGNS Call an ambulance if you develop pain in the arm that is accompanied by shortness of breath. 231 . Sometimes an operation is needed to reposition bones. Do you also have a tender area near your elbow that is made worse by some movements? NO YES POSSIBLE CAUSES You may have tennis or golfer’s elbow. you may need to wear a plaster cast or a firm bandage. Consult your doctor if the pain is severe or if it is no better within 48 hours. consult your doctor. POSSIBLE CAUSES Damage to the muscles. ACTION You will probably need an X-ray (p. fall. in which a nerve is compressed at the wrist. This condition is very common in pregnancy. which is inflammation of a tendon or the sheath surrounding it. POSSIBLE CAUSE Carpal tunnel syndrome. may help. who may inject the tender area with a corticosteroid drug. tendons. or violent movement? NO YES Are you unable to move your arm. especially at night. chew half an aspirin. If your symptoms do not improve within 6 weeks. is a possible cause.228) Is the pain in a joint? NO YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. While you are waiting for help to arrive. especially YES during the night? NO POSSIBLE CAUSE AND ACTION A nerve that runs down the arm may be compressed or irritated at its origin in the neck. Consult your doctor. Tennis elbow affects the outer side of the elbow.A D U LT S : G E N E R A L 112 Painful arm such as playing a sport for the first time in many years. Consult your doctor. or feeling faint. ACTION If your doctor diagnoses RSI. If action is taken early. Consult your doctor. START HERE Did the pain immediately follow an injury. nausea. Does pain shoot down the length of your arm? NO YES ACTION Carry out self-help measures (see TREATING SPRAINS AND STRAINS. golfer’s elbow affects the inner side. You may be referred for physiotherapy. He or she may arrange for tests such as an X-ray (p. ACTION Rest your arm as much as possible and take over-the-counter nonsteroidal antiinflammatory drugs to relieve the pain. pain may be related to repetitive movements such as typing or playing a musical instrument. Pain in the arm may result from injury or straining of the muscles. the condition may become permanent.

pain in the leg may also have a more serious cause such as a disorder affecting the blood vessels that supply the leg.234) POSSIBLE CAUSE Damage to muscles.40) used to detect narrowed or blocked arteries in the legs. If it is not treated. to examine the veins in the leg. your doctor may recommend nonsteroidal antiinflammatory drugs. anticoagulant drugs will be prescribed. you will be referred to hospital at once for tests. Depending on the nature of the injury. If you have cellulitis. and may be needed for several weeks. t EMERGENCY! CALL AN AMBULANCE Is the pain confined to the knee? NO YES Go to chart 114 PAINFUL KNEE (p. or violent movement? NO YES Are you unable to move the leg. Pain in the leg is often the result of minor damage to muscles. a condition in which a blood clot blocks a vein in the leg. A dye is injected into the catheter and flows from the femoral artery to other vessels in the legs. Such injuries are likely to be the cause of pain that comes on after unaccustomed strenuous exercise START HERE Did the pain immediately follow an injury.228) Does the pain affect one or more joints in your leg? NO ACTION Carry out self-help measures (see TREATING SPRAINS AND STRAINS. blocking the blood flow. Consult your doctor if the pain is severe or if it is no better within 48 hours. consult your doctor. A dye that shows up on X-ray images is then injected through the catheter.A D U LT S : G E N E R A L 113 Painful leg or playing a sport for the first time in years. see chart 116. In most cases. The procedure takes about 30 minutes and is done under a local anaesthetic. Sometimes an operation is needed to reposition bones. Femoral angiography Femoral angiography is a contrast X-ray procedure (p.235). may be the cause. your doctor will prescribe antibiotics and will probably recommend that initially you rest with the affected leg elevated. there is a risk that a piece of the blood clot may break off and be carried in the circulation to lodge in a blood vessel in the lungs. you may need to wear a plaster cast or a firm bandage. or ligaments of the leg or to the cartilage within the knee joint may be the cause. Several X-rays of the blood vessels are taken to identify sites of blockage. tendons. tendons. This condition is more likely after long periods of immobility due to illness or long-distance travel. YES SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Inflammation of a superficial vein (thrombophlebitis) or a bacterial infection of the skin and underlying tissues (cellulitis) may be the cause. p. such as Doppler ultrasound scanning (p. or ligaments. initially by injection. tendons. ACTION You will probably need to have an X-ray (p. ACTION If your doctor suspects deep vein thrombosis. Entry site of catheter Tip of catheter Femoral artery Has a small area of skin on one leg become red and tender? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Deep vein thrombosis (DVT). If you are in any doubt about the cause of a painful leg. FOOT PROBLEMS (p.39) in order to discover the type and extent of the damage. ACTION If you have thrombophlebitis. A catheter is inserted into an artery in the arm and is threaded towards the heart and then to the femoral artery. For pain in the foot. or ligaments of the leg or to the cartilage within the knee joint. Go to chart 110 PAINFUL JOINTS (p. The condition usually clears up in about 2 weeks. fall. Continued on next page 232 .229). However. Is one calf painful and/or swollen? NO YES During the procedure A catheter is inserted into an artery in an arm and guided to the femoral artery in the leg. and/or is the pain severe even when resting? NO YES POSSIBLE CAUSES You may have a fracture or dislocation or a serious injury to the muscles.236).

If your symptoms are severe or you are at risk of developing a leg ulcer. Do you have episodes of pain in the muscles of one or both calves? NO YES POSSIBLE CAUSE These are probably muscle cramps – uncontrollable. If varicose veins are severe. Symptoms can usually be controlled by following self-help advice on coping with varicose veins (above). Consult your doctor. the entire varicose vein may be surgically removed. may be treated by injection therapy or by surgery. • Avoid tight clothing that may restrict the blood flow in the legs either at the knee or in the groin. may be the cause. ACTION Carry out self-help measures (see TREATING SPRAINS AND STRAINS. p. Injection therapy is mainly used to treat varicose veins below the knee. ACTION Your doctor will examine you and may refer you to hospital for tests such as Doppler ultrasound scanning (p. • When sitting. they increase the risk of a leg ulcer developing in the future. You may also need other tests to see if blood vessels elsewhere are affected. which causes the walls to stick together. ACTION Your doctor may suggest physiotherapy or manipulation of the spine. If you have frequent attacks of cramp. the sciatic nerve. your doctor may recommend treatment such as surgery (see TREATMENTS FOR VARICOSE VEINS. ACTION Your doctor will examine you to confirm the diagnosis.235) or femoral angiography (opposite) to assess the blood vessels in your legs. Varicose vein Point of injection Syringe Perforating vein Injection therapy A chemical is injected into the vein.41) to establish the cause and determine the appropriate treatment. Did the pain come on a few hours after unaccustomed or unusually strenuous exercise? NO YES Does the pain always develop after the same amount of exercise. Surgical treatment may involve tying off small veins called perforating veins. is compressed or irritated where it leaves the spine. Coping with varicose veins SELF-HELP If you have aching legs caused by varicose veins. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. consult your doctor. When you do start exercising again. POSSIBLE CAUSE Varicose veins. you should stop. 233 . always include warm-up and cool-down exercises (see EXERCISING SAFELY. which prevents blood pooling in the affected vein. ACTION Stretch and rub the affected muscle to relieve the pain. The compression or irritation may be due to a slipped disc. Do one or both legs ache and feel heavy. especially after prolonged standing? NO YES POSSIBLE CAUSE Sciatica is likely. • If you are overweight. or ligament is the likely cause of your pain. surgery will be required to widen or bypass the affected arteries. keep your legs elevated on a stool or footrest. If the pain is severe. • If you must stand. Alternatively. You will be advised to cut down the amount of fat in your diet and take regular exercise. If you smoke. Cramp often has no obvious cause but may develop during exercise or while lying in bed. distorted veins in the leg. such as walking a given distance. p. Does the pain shoot down the back of the leg from the buttock? NO YES Treatments for varicose veins If they are severe. Consult your doctor. try to lose weight. painful contractions of a muscle that occur without warning. below). The leg is then bandaged for 2 weeks to compress the vein. and does it disappear with rest? NO YES POSSIBLE CAUSE Impaired blood flow to the legs as a result of narrowing of the arteries can cause this type of pain and may result in serious complications. which are swollen. tendon. which runs down the entire length of the leg.A D U LT S : G E N E R A L Continued from previous page POSSIBLE CAUSE Damage to a muscle. In this condition. causing the walls to stick together. move your feet and legs at regular intervals to keep the blood flowing. the following measures may help: • Avoid prolonged standing. In this procedure. you may have MRI (p. Consult your doctor.29). a chemical is injected into the vein. varicose veins. swollen and distorted veins in the legs. Consult your doctor if the pain is severe or no better within 48 hours. preventing blood from entering the vein. Do not exercise until the pain has gone completely. In some cases.229).

A D U LT S : G E N E R A L 114 Painful knee Doing work that involves a lot of bending or kneeling. Depending on the nature of the injury. or playing certain sports. Very small instruments can then be passed down through the arthroscope or inserted into the joint through other small incisions. you may need long-term drug treatment to reduce the amount of uric acid in the body. swollen. ACTION You doctor may refer you to hospital for tests such as arthroscopy (right). ACTION You will probably need to have an X-ray (p. The probe can be used to manipulate the cartilage and improve the view. Consult your doctor if the pain is severe or no better within 48 hours. p. is the most likely cause of your symptoms. An infection within the joint is also a possibility. in hospital initially. Has your knee become progressively more painful over several months or years? NO YES POSSIBLE CAUSE Osteoarthritis.229). Guided by the view on the monitor. Fluid passed down a tube is then used to wash away the debris from within the operating area. The knee is one of the principal weight-bearing joints in the body and is subject to much wear and tear. your doctor may refer you for physiotherapy to strengthen the muscles around the joint.229) may be needed. you will be prescribed nonsteroidal anti-inflammatory drugs. allowing the surgeon to inspect the joint. Consult your doctor. and/or are you unable to move your knee or put weight on it? NO POSSIBLE CAUSES A fracture or dislocation causing bleeding into the knee joint. Any damage may be repaired during the arthroscopy. Such injuries are commonly caused by twisting the joint while it is supporting your weight. t EMERGENCY! CALL AN AMBULANCE Is your knee red. If you are also overweight. During the procedure An arthroscope and a probe are inserted into the joint. If the joint is infected. In some cases. Sometimes an operation is needed to reposition bones. you will need treatment with antibiotics. or cartilage of the knee is possible. if the joint has been damaged previously. Consult your doctor. a progressive condition in which cartilage covering the ends of the bones within a joint is slowly destroyed. the inside of a joint. View of knee joint Monitor Does your knee ever seem to lock or give way? NO SEE YOUR DOCTOR WITHIN 24 HOURS YES POSSIBLE CAUSES Gout. Its stability largely depends on the muscles and ligaments around it. is inspected using a viewing instrument called an arthroscope. If the symptoms recur. and the view from the arthroscope is displayed on a screen. ACTION Your doctor will examine you.39) to confirm the diagnosis. ligaments. the surgeon is able to carry out procedures such as repairing torn ligaments or removing damaged cartilage. The procedure is usually performed under a general anaesthetic. Consult this chart if one or both knees are painful. 234 . such as the knee. If you have gout. The arthroscope is inserted into the joint through a small incision in the skin. ACTION Carry out self-help measures (see TREATING SPRAINS AND STRAINS. causing inflammation. In severe cases. CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART AND THE PAIN IS SEVERE OR PERSISTENT. START HERE Have you recently injured your knee? NO YES Is your knee YES extremely painful and/or misshapen. ligaments. or if you are overweight. and very painful to touch? NO YES POSSIBLE CAUSES Injury to the muscles. a joint replacement (p. ACTION Your doctor will examine you and may arrange for you to have blood tests and an X-ray (p. increases the risk of damaging your knees. This condition is particularly likely if you are over 50. Arthroscopy In arthroscopy. and may arrange for a blood test and for a sample of fluid to be taken from the joint and examined. or you may require surgery at a later date. Over-the-counter painkillers should help to relieve your symptoms. or a serious injury to the muscles. you may need to wear a plaster cast or a firm bandage. Surgeon Arthroscope Probe POSSIBLE CAUSES A torn cartilage or damage to a ligament within the knee joint may be the cause. hot.39) to discover the type and extent of the damage. in which the waste product uric acid forms crystals in a joint. it will help to lose weight. is a possibility. or cartilage of the knee may be the cause of the pain.

ACTION Sitting with your feet raised should help the swelling go down. kidney. high-frequency sound waves are used to assess the speed and direction of the flow in a blood vessel. see chart 146. YES and/or do you have a swollen abdomen? NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE Fluid retention as a result of a heart. If not treated. a piece of clot may break off and then lodge in a blood vessel in a lung. Follow the self-help advice on coping with varicose veins (p. who may suggest treatment (see TREATING VARICOSE VEINS. YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE Deep vein thrombosis (DVT). SWOLLEN ANKLES IN PREGNANCY (p. If you frequently have swollen ankles. or liver disorder is possible. Meanwhile. see chart 110. especially after a period of immobility. Initial treatment will often include diuretic drugs. ACTION If your doctor suspects a DVT. PAINFUL JOINTS (p.228). liver. Doppler ultrasound scanning In Doppler ultrasound scanning. Walking or moving your feet regularly to exercise the calf muscles can help prevent fluid accumulating. POSSIBLE CAUSE Gravity causes accumulation of fluid in the tissues in these circumstances. Scans are usually performed to detect narrowing or blockages in an artery or vein. such as calcium channel blockers. you will be referred to hospital for tests such as Doppler ultrasound scanning (below) to examine the veins in the leg. Anticoagulant drugs will be prescribed. It is also common in pregnancy due to increased pressure on blood vessels in the abdomen. may cause swollen ankles as a side effect. Transducer is moved over skin above vessels 235 . ACTION Your doctor will probably arrange for tests. If your symptoms are severe. in which a blood clot blocks a vein in the leg. and may be needed for several weeks.203) and a chest X-ray (p. such as on an aeroplane YES flight. For painful swelling of one or both ankles. do not stop taking any of your prescribed drugs.233). Have you been sitting still for a long time. consult your doctor. or standing for a long time? NO Do you have prominent veins in the leg or legs affected by the swelling? NO YES POSSIBLE CAUSE AND ACTION Varicose veins (swollen and distorted veins) are likely to have caused the swelling. consult your doctor. is likely. then relays the data to a computer.39). blocking the blood flow.A D U LT S : G E N E R A L 115 Swollen ankles standing still. If you are pregnant. p. initially by injection. Consult your doctor. occasionally. Painless swelling of the ankles is most often caused by fluid accumulating in the tissues after long periods of sitting or START HERE Are both of the ankles affected? NO YES Are you short of breath.233). CONSULT A transducer emits sound waves and detects the echoes from the blood vessels to be examined. but you will also need treatment for the underlying cause. which creates an image of the blood flow. Monitor During the procedure YOUR DOCTOR IF YOU ARE UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART.283). or kidney disorder. such as electrocardiography (p. However. swelling of the ankles may be due to a potentially serious heart. A transducer emits sound waves into the blood vessels and picks up the echoes. Are you taking any prescribed drugs? NO YES Do you have a swollen and/or tender calf above the affected ankle? NO POSSIBLE CAUSE AND ACTION Certain drugs.

keep the affected area clean and dry.232) to determine the site and cause of the blockage.149) increases the risk of skin infections and ulcers on the feet. POSSIBLE CAUSE A minor fracture of one of the small bones in your foot (a march fracture) is a possibility. See your doctor promptly if you develop an ulcer or sore on your foot. SWOLLEN ANKLES (p. This may be the result of cutting your toenails incorrectly or wearing shoes that are too tight. If you have diabetes. you may need minor surgery. possibly by a blood clot. your foot will be firmly bandaged and you will be advised to rest it for a week or two. Never attempt self-treatment for corns or calluses. If the condition recurs. t EMERGENCY! CALL AN AMBULANCE Has one or both of your feet suddenly become painful and very pale or blue? NO YES CALL YOUR DOCTOR NOW POSSIBLE CAUSE A blood vessel in the leg may have become blocked. you may need to wear a plaster cast or a firm bandage. POSSIBLE CAUSES A fractured bone or serious damage to the muscles. or itching in your feet or if your feet become misshapen in any way. including those who have diabetes mellitus. your doctor may recommend surgery (see REMOVAL OF AN INGROWING TOENAIL. Nail bed under skin Area to be removed Ingrown edge Do you have redness and swelling around the YES edge of a big toenail? NO POSSIBLE CAUSE An infected. or ligaments of the foot is the most likely cause. Consult your doctor. Depending on the injury. ACTION You will probably need an X-ray (p. and. ACTION Clean the toe. during which part or all of the nail is removed under local anaesthetic. and/or is it misshapen or swollen? NO WA R N I N G DIABETES AND FOOT CARE Diabetes mellitus (p. but you will be able to walk within 1–2 days. p. Consult your doctor if the pain is severe or if it is no better within 48 hours. if possible. or ligaments of the foot is possible. wear open-toed sandals to expose the toe to air.39) to discover the extent of the damage. cutting off the supply of blood and oxygen to the foot. and always cut the nail straight across. see chart 115. ACTION Your doctor will examine you and may arrange for an X-ray (p. clean. The operation The ingrown part of the toenail is removed and the nail bed treated. POSSIBLE CAUSES Damage to the muscles. Most foot problems are the result of an injury or infections of the skin or nails and are usually minor. consult your doctor. fall. ingrowing toenail is a likely cause. Sometimes. irritation. For ankles that are swollen but not painful. right). except in people START HERE Are you YES suffering from pain that immediately followed an injury. tendons. ACTION Carry out self-help measures (see TREATING SPRAINS AND STRAINS. an operation is needed to reposition bones. and inspect your feet every day. who may prescribe antibiotics or drain any pus under local anaesthetic. Consult this chart if you have any pain.A D U LT S : G E N E R A L 116 Foot problems whose feet are affected by poor circulation. Treatment may include thrombolytic drugs to dissolve the clot or surgery to remove or bypass the blockage. wear correctly fitting shoes or open-toed sandals if practical. ACTION Your doctor will arrange for you to be admitted to hospital for tests such as femoral angiography (p. If the infection gets worse. If you have a march fracture.229). dry. tendons. To prevent a recurrence. Continued on next page 236 . A substance is applied to the nail bed (the area from which the nail grows) to prevent the nail regrowing.39) to confirm the diagnosis.235). The toe will take about 2 weeks to heal. Do you have pain that started after a run or a long walk? NO YES Removal of an ingrowing toenail If you have repeated problems with an ingrowing toenail. or violent movement? NO Are you unable to move YES your foot.

Is the skin between your toes peeling. you may need long-term drug treatment. and tender? YES NO SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSES Gout. is the likeliest cause. POSSIBLE CAUSE A verruca. ACTION Your doctor may arrange for blood tests or X-rays (p. POSSIBLE CAUSE These are probably areas of abnormally thickened skin that are known as calluses (or corns if they are on a toe). and itchy? NO YES ACTION Wash and dry your feet carefully. 237 . consult your doctor before removing any thickened skin. thickened tissue develops over a misaligned joint. He or she may recommend you wear inserts in your shoes to cushion your feet. who may suggest surgery to correct the underlying misalignment. consult your doctor. consult your doctor. CONS