Professional Documents
Culture Documents
Medical Association
FAMILY
NEW
DOCTOR
HOME ADVISER
The British
Medical Association
FAMILY
NEW
DOCTOR
HOME ADVISER
Medical Editors
DR TONY SMITH & DR SUE DAVIDSON
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.
At the same time, we are now more self-reliant. Most of us realize that
the majority of common, minor illnesses such as a cold or an attack
of diarrhoea do not need expert medical assessment or complex drug
treatments. These disorders are self-limiting – we can expect to get
better, 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.
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. 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. No book can teach you how to make a medical
diagnosis, and this is not a guide to being your own doctor. What it does
do, however, 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. If you do need to see a doctor, the charts tell you whether
you need emergency help, an urgent appointment, an appointment within
24 hours, or just a routine one. This book will give you the information
you need to make the best use of your doctor.
The charts in this book have been developed by doctors and reviewed
by medical experts. We hope that this book will make an important
contribution to giving people more control over their own health.
CONTENTS
HOW TO USE THIS BOOK......................... 8 30 Hearing problems.......................... 104
SYMPTOM CHARTS 31 Runny or blocked nose............... 106
43–288 32 Sore throat......................................... 107
YOUR BODY AND HEALTH 33 Coughing........................................... 108
HOW TO USE THE CHARTS.................. 44
9–42 34 Breathing problems....................... 110
System-by-system chartfinder.................. 46
35 Mouth problems............................. 112
Symptom-by-symptom chartfinder....... 48
YOUR BODY................................................... 10 36 Teeth problems................................ 114
Skeleton.............................................................. 10 37 Eating problems.............................. 116
Muscles............................................................... 11 CHARTS FOR CHILDREN 38 Vomiting in children..................... 118
Cardiovascular system................................ 12 49–144
39 Abdominal pain.............................. 120
Respiratory system....................................... 13 Contents............................................................. 49 40 Diarrhoea in children................... 122
Nervous system.............................................. 14 41 Constipation..................................... 124
CHILDREN: BABIES
The senses......................................................... 15 UNDER ONE ........................................... 50–65 42 Abnormal-looking faeces........... 125
Digestive system............................................. 16 1 Sleeping problems in babies........ 50 43 Urinary problems........................... 126
Endocrine system.......................................... 17 2 Excessive crying................................ 52 44 Toilet-training problems............. 128
Lymphatic system.......................................... 17 3 Fever in babies................................... 54 45 Genital problems in boys........... 130
Urinary system................................................ 18 4 Vomiting in babies........................... 56 46 Genital problems in girls............ 132
Male reproductive system......................... 19 5 Diarrhoea in babies......................... 58 47 Painful arm or leg.......................... 133
Female reproductive system..................... 20 6 Feeding problems.............................. 60 48 Joint and back problems............ 134
Conception and pregnancy....................... 21 7 Slow weight gain............................... 62 49 Foot problems................................. 136
The newborn baby....................................... 23 8 Skin problems in babies................. 64 50 Limping.............................................. 138
The growing child......................................... 24
CHILDREN: ALL AGES.................... 66–138 CHILDREN: ADOLESCENTS....... 139–144
Growth charts................................................. 26
9 Feeling generally unwell................ 66 51 Adolescent weight problems..... 139
10 Tiredness............................................... 68 52 Adolescent behaviour
HEALTHY LIVING........................................ 28
problems............................................. 140
A healthy diet.................................................. 28 11 Sleeping problems in children.... 70
53 Problems with puberty
Exercise.............................................................. 29 12 Growth problems............................. 72
in boys................................................. 142
Alcohol............................................................... 30 13 Excessive weight gain..................... 74
54 Problems with puberty
Tobacco.............................................................. 31 14 Fever in children............................... 76 in girls.................................................. 143
Drugs................................................................... 31 15 Rash with fever................................. 78 55 Adolescent skin problems.......... 144
Sex and health................................................ 32 16 Skin problems in children............ 80
Stress................................................................... 32 17 Hair, scalp, and nail problems... 82
GENERAL CHARTS FOR ADULTS
Safety and health........................................... 33 18 Itching.................................................... 84
145–240
19 Lumps and swellings....................... 85
PROFESSIONAL HEALTHCARE.............. 35 20 Dizziness, fainting, and Contents.......................................................... 145
Healthcare throughout life....................... 35 seizures.................................................. 86 56 Feeling unwell.................................. 146
Visiting your doctor..................................... 35 21 Headache.............................................. 88 57 Tiredness............................................ 147
Health checks and screening................... 36 22 Confusion and/or drowsiness..... 90 58 Loss of weight................................. 148
Immunization.................................................. 37 23 Clumsiness........................................... 92 59 Overweight........................................ 150
24 Speech difficulties............................. 93 60 Difficulty in sleeping.................... 152
MEDICAL TESTS.......................................... 38 25 Behaviour problems........................ 94 61 Fever..................................................... 154
Testing samples.............................................. 38 26 School difficulties............................. 96 62 Excessive sweating......................... 156
Physiological tests......................................... 39 27 Eye problems...................................... 98 63 Headache........................................... 158
Imaging tests.................................................... 39 28 Disturbed or impaired vision... 100 64 Feeling faint and passing out... 160
Endoscopy......................................................... 42 29 Painful or irritated ear................. 102 65 Dizziness............................................ 162
6
CONTENTS
66 Numbness and/or tingling......... 163 110 Painful joints.................................... 228 142 Weight problems and
67 Forgetfulness and/or 111 Painful shoulder............................. 230 pregnancy.......................................... 279
confusion............................................ 164 112 Painful arm....................................... 231 143 Vaginal bleeding in
68 Twitching and/or trembling...... 166 pregnancy.......................................... 280
113 Painful leg.......................................... 232
69 Pain in the face................................ 167 144 Abdominal pain in
114 Painful knee...................................... 234
pregnancy.......................................... 281
70 Difficulty in speaking................... 168 115 Swollen ankles................................. 235
145 Skin changes in pregnancy........ 282
71 Disturbing thoughts and 116 Foot problems................................. 236
feelings................................................. 169 146 Swollen ankles in pregnancy.... 283
117 Back pain........................................... 238
72 Depression......................................... 170 147 Back pain in pregnancy.............. 284
118 Painful or stiff neck...................... 240
73 Anxiety................................................ 172 148 Recognizing the onset of
labour.................................................. 285
74 Lumps and swellings.................... 174
149 Breast problems and
75 Itching................................................. 175 CHARTS FOR MEN
pregnancy.......................................... 286
76 Hair and scalp problems............ 176 241–254
150 Depression after childbirth....... 288
77 General skin problems................ 178 Contents.......................................................... 241
78 Skin problems affecting 119 Bladder control problems
the face................................................ 180 in men.................................................. 242 FIRST AID
79 Skin discoloration and 120 Problems with the penis............. 244 289–302
moles.................................................... 182 121 Erection difficulties....................... 246
80 Rash with fever............................... 184 122 Ejaculation problems................... 247 FIRST AID...................................................... 290
81 Nail problems.................................. 185 123 Testes and scrotum ABC of resuscitation................................. 290
82 Painful or irritated eye................ 186 problems............................................ 248 Action in an emergency........................... 291
83 Disturbed or impaired 124 Painful intercourse in men........ 249 Recovery position....................................... 292
vision................................................... 188 125 Low sex drive in men.................. 250 Artificial respiration.................................. 293
84 Hearing problems.......................... 190 126 Fertility problems in men.......... 252 Choking.......................................................... 294
85 Noises in the ear............................ 192 127 Contraception choices Cardiopulmonary resuscitation
86 Earache............................................... 193 for men................................................ 254 (CPR)............................................................ 296
87 Runny or blocked nose............... 194 Shock................................................................ 298
88 Sore throat........................................ 195 Anaphylactic shock................................... 298
89 Hoarseness or loss of voice....... 196 CHARTS FOR WOMEN Severe bleeding............................................ 299
255–288 Severe burns.................................................. 299
90 Wheezing............................................ 197
91 Coughing............................................ 198 Contents.......................................................... 255 Unconsciousness.......................................... 300
92 Shortness of breath....................... 200 128 Breast problems.............................. 256 Major seizures.............................................. 300
93 Chest pain......................................... 202 129 Bladder control problems Spinal injury.................................................. 301
94 Palpitations....................................... 204 in women........................................... 258 Fractures......................................................... 301
130 Absent periods................................ 260 Swallowed poisons.................................... 302
95 Teeth problems............................... 206
131 Heavy periods.................................. 262 Bites and stings............................................ 302
96 Mouth problems............................ 208
132 Painful periods................................ 263
97 Difficulty in swallowing............. 209
133 Irregular vaginal bleeding.......... 264
98 Vomiting............................................ 210 DRUGS GUIDE AND
134 Abnormal vaginal discharge..... 266
99 Recurrent vomiting....................... 212 USEFUL ADDRESSES
100 Abdominal pain.............................. 214 135 Genital irritation............................ 268
303–313
101 Recurrent abdominal pain........ 216 136 Lower abdominal pain
in women........................................... 269
102 Swollen abdomen.......................... 218 DRUGS GUIDE............................................. 304
137 Painful intercourse in
103 Wind.................................................... 219 How drugs affect you............................... 304
women................................................. 270
104 Diarrhoea.......................................... 220 Using drugs safely....................................... 304
138 Low sex drive in women............ 272
105 Constipation.................................... 221 A–Z of drugs................................................. 305
139 Fertility problems in women.... 274
106 Abnormal-looking faeces........... 222
140 Contraception choices USEFUL ADDRESSES................................. 311
107 Anal problems................................. 223 for women......................................... 276
108 General urinary problems......... 224 141 Nausea and vomiting
109 Painful urination............................ 226 in pregnancy..................................... 278 INDEX & ACKNOWLEDGMENTS..... 314
7
HOW TO USE THIS BOOK
HEALTHY
A healthy diet
LIVING
Diet has a major influence on health. It can affect your risk of
Meat, fish, and nuts are rich in protein,
essential for building and repairing cells,
and provide B vitamins and minerals such
as iron. They can also be high in fat, so
Fruit and vegetables are high
in fibre (which aids digestion),
natural sugar, and water. Aim
to eat at least five portions a
Assessing your weight
To avoid diseases associated with being overweight or underweight,
you need to maintain your weight within the range considered normal
for your height. To find out if you are within this range, you can use
a height and weight chart such as the one shown below. You can also
assess your weight by calculating your body mass index (BMI). To do
this, divide your weight in kilograms by the square of your height in
metres. A BMI figure under 20 indicates that you are underweight,
Planning an exercise routine
Y O U R B O D Y A N D H E A LT H
MEDICAL
Testing samples
TESTS
Tests that are carried out on samples of body fluids, such as
Tests on body fluids
Tests may be performed on body fluids from wounds or abnormal
areas of skin, from mucous membranes such as those of the nose and
Physiological tests
Certain investigations that do not involve testing samples
(opposite) or imaging internal structures (see IMAGING TESTS,
right) can be performed to assess the function of organs or
systems. These physiological tests are commonly used to assess
vision and hearing, the nervous system, and the heart and lungs.
Imaging tests
Y O U R B O D Y A N D H E A LT H
WEIGHT
170 by the individual; others by a X-rays are a form of radiation that can pass through body tissues
of salt, alcohol, and caffeine. In Aerobics HHHH HHH HH on the function of certain organs, such as the liver or kidneys, measure how well sounds of varying
150 70 doctor. The samples are to leave an image on photographic film. The ability of the rays to
addition, water is vital for life, HEALTHY WEIGHT Basketball or reveal the presence of abnormal substances or abnormal pitch and volume can be heard or,
HHHH HHH HH then usually sent to a penetrate tissues depends on the density of those tissues. Solid, dense
and you should aim to drink at 130 60 in children, show the ability to
Cycling (fast) HHHH HH HHH levels of normal substances, such as hormones, in the body. laboratory for analysis.
hear speech (see HEARING
tissues such as bone let few rays through and appear white on the
least 8 glasses (2 litres) a day. 110 50 UNDERWEIGHT Climbing stairs HHH H HHH In addition, some tests can reveal the presence of disease- image. Muscular organs, such as the heart, appear grey. Tissues
TESTS, p.190, and HEARING
Dancing (aerobic) causing microorganisms. Most tests on body samples are Having a swab taken containing air, such as the lungs, and fluid-filled areas, such as the
90 40 HHH HHHH H TESTS IN CHILDHOOD, p.105).
144 150 156 162 168 174 180 186 192 cm carried out in a laboratory, but some may be performed in Fluids from wounds or bladder, let most of the X-rays through and appear black on the
Golf H HH H
from body cavities, Response button film. X-ray images are often used to assess bone injuries such as
BODY
long-term disease, increase your life expectancy, and improve blood test, which can reveal
head tiny amounts of blood invisible to the
main food groups and the
proportion of your diet that
each group should form.
Foods in the larger segments
Bread, potatoes,
and pasta are high
Muscleswhich
Fatty foods,
are are
in energy,
maintain
fibrous
its and
your quality of life in later years.
high bundles of tissue that move the body,
The When
part of your daily routine, youmoves
sugary and work internal
posture, organs such as
you of
three types make
the skeleton;
will probably
heart; and smooth
exercise
muscle
cardiac
find
muscle,
a
are skeletal
KEY
muscle,
muscle, which forms
that you
found
which coversGood
H Small HH
and
effect the walls effect
of the
H H H Very good
effect
H H H H Excellent
effect the long term, serious problems such asand
the numbers of red and white blood
Overexposure to the sun may lead to sunburn,
help blood
skin
heatstroke,
cancer.
blood
and, incarries if
to clot). Blood
You aretests
chemistry
many
at can measure
cells these
resolve
affectthe
and ofproblems,
substances
necessary,
your levels
platelets or
before apart
(cells
theyfrom
that
seek
of these substances.
health.
help
startcells,
to
shields
naked eye. This from
test may
debrisbe carried out if the doctor suspects that
there may be bleeding in the digestive tract. The test may also be
used to screen for colorectal cancer. Tests on samples of faeces are
HEALTHCARE
Some tests are used to establish whether nerves are able to conduct
impulses normally. Abnormalities may be the result of something
compressing a nerve or a disease such as diabetes mellitus. Another
contrast X-ray include barium contrast X-rays (p.40), used to image
the digestive tract; angiography (p.40), which shows blood vessels;
and intravenous urography (p.227), which shows the urinary tract.
in fibre, starches, and foods, which can have a lot more energy for ordinary daily activities such as in the walls of the digestive tract, especially high risk if you have red or blond
These hair
testsand
are green
used toordetect
blue kidney,Manyliver, types
and muscle
of manualdamage,
work are Ear test, known as EEG, records the electrical activity produced in the
of the chart should form a the heart, intestines, and bladder. These functions are the blood vessels, and the genital and urinary tracts. Each type of usually carried out in a laboratory.
Skeleton greater part of your diet than
those in the smaller slices.
some vitamins and minerals,
Types of joint
so can form a large proportion
of Joints
your diet limited
cause tooth decay, shopping, housework, child care,
performed by three different types of muscle (right), of
amounts
should be eaten in
and gardening. Exercising safely
muscle has a different function and consists of fibres of a particular
eyes because your skin contains a low level
that absorbs ultraviolet light. To minimize
of bone
certain melanin,
the riskthe
to measure of sun
a pigment
disorders, and inflammation.
leveldamage,
dangerous.
of cholesterolorinheavy
One
the blood.
type is with
Working
objectsIn may
carried
addition,
out
machinery
blood
put you at risk
Cell and tissue
protectors
cut out
tests
Healthcare throughout life Visiting your doctor
brain and is useful for the diagnosis of disorders such as epilepsy.
X-ray
are formed where two or more bones meet. Different types shape. Skeletal muscle, which moves theTo limbs and body, is formed loud noise
Heart and lung testsBefore your first appointment with a new doctor, you may
10 11 34 35
Symptom charts A D U LT S : G E N E R A L
Relieving
X-ray
A D U LT S : W O M E N
Plastic cover
t
other physical activities, such as swimming. 24 HOURS
bruised or strained your back. Follow self-help EMERGENCY!
Once your back pain has cleared up, you Do you have a tender, Lumps are usually more obvious before aging may also cause a nipple to become
should take steps to prevent a recurrence by red area in one breast? YES a period. If you are particularly worried, indrawn. Consult your doctor.
measures for relieving back pain (opposite). If CALL AN AMBULANCE POSSIBLE CAUSE AND ACTION Mastitis,
your pain is severe or if it has not improved following the self-help advice for taking care which is inflammation in the breast, is consult your doctor, who will examine
Did the pain NO POSSIBLE CAUSE AND ACTION Breast tenderness ACTION Your doctor will examine your
within 48 hours, consult your doctor. POSSIBLE CAUSE You may have damaged your of your back (opposite). likely. This condition is usually due to may be the first sign of pregnancy. If there your breasts to make sure that there
come on breasts and will probably arrange for tests
spinal cord. Try to keep completely still while infection and is rare in women who are is a chance you might be pregnant, carry are no individual lumps that require
Do you have suddenly after SEE YOUR DOCTOR WITHIN 24 HOURS Do both your such as mammography (above) to exclude
waiting for an ambulance. not breast-feeding. Non-breast-feeding out a home pregnancy test (p.260). If you investigation. Naturally lumpy breasts
breasts feel lumpy? YES a problem deeper in the breast.
pain in one side ACTION In hospital, you will be examined and an extended women who are affected are usually are not pregnant, a serious cause is unlikely, do not require treatment and do not
YES POSSIBLE CAUSE You may have a crush fracture Do you have a single increase the risk of breast cancer.
Improving your posture and taking care to try to remain active and take weight-bearing may refer you for physiotherapy to help you notice changes. Look at your breasts in a
Does the pain prevent lift heavy objects safely can help you avoid Are you female exercise, such as walking. strengthen the muscles that support the spine. Aspiration involves removing cells or liquid mirror, checking for changes in the size or
YES from a breast lump using a needle and Do you have a discharge
you from moving, back problems. Stand up straight, and avoid and pregnant? shape of your breasts, changes to your YES POSSIBLE CAUSES Nipple discharge is usually
YES syringe. If the lump is solid, cells will be POSSIBLE CAUSES A noncancerous growth from a nipple? due to hormone changes and is no cause
and/or does it shoot Premenstrual
t
lifting a heavy POSSIBLE CAUSE AND ACTION You have probably information is displayed on a monitor. The procedure is painful, but it usually takes or ultrasound scanning (p.41) and breast tissue. Treatment is often not necessary, women experience in the days leading up to
Upper body you lose any displayed as an image. The computer in the breast, consult your doctor.
aspiration (see ASPIRATION OF A BREAST but occasionally affected milk ducts may need
WA R N I N G
You can find the information that you need
for dealing with major emergencies, ranging
If you suspect a spinal injury (p.301), do not
move the victim
Infants
8
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. This section starts by
explaining the structure and function of the
major body systems. It then looks at how you
can modify your lifestyle to prevent health
problems from developing. 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.
9
Y O U R B O D Y A N D H E A LT H
YOUR BODY
Skeleton Types of joint
Joints are formed where two or more bones meet. Different types
The skeleton provides form, support, and protection for the of joint allow for differing degrees of movement. A few joints, such
body. It consists of 206 bones, with further support from as those in the skull, are fixed. Semimovable joints, such as those
cartilage (a tough, fibrous material). The axial skeleton – the in the spine, provide stability and some flexibility. The majority of
skull, spine, and ribcage – consists of 80 bones and protects joints, known as synovial joints, move freely. The main types of
the brain, spinal cord, heart, and lungs. The appendicular synovial joint, and their planes of movement, are illustrated below.
skeleton has 126 bones and consists of the limb bones,
collarbones, shoulder blades, and bones of the pelvis. All
bones are living tissue with cells that are constantly replacing
old bone with new material. Bones
Skull
contain a soft, fatty material
PIVOT JOINT
called bone marrow; this is BALL-AND-
Jawbone
surrounded by spongy bone, (mandible) SOCKET JOINT
which is in turn surrounded by
denser compact bone. The Collarbone
marrow in the bones of the (clavicle)
spine, skull, ribs, and pelvis
manufactures blood cells.
Shoulder blade ELLIPSOIDAL JOINT
SADDLE JOINT
(scapula)
Breastbone (sternum)
Humerus
Rib
PLANE JOINT HINGE JOINT
Kneecap
(patella)
Femur Soft Fibrous
core covering
Lumbar
Compact Spongy Bone Fibula SECTION OF INTERVERTEBRAL DISC
vertebrae
bone bone marrow (5 bones)
Tibia Intervertebral disc
Vertebra
Ankle bones
(tarsals)
Areas
where ribs
Foot bones are attached
(metatarsals) Sacrum
(5 fused
bones) Ligaments
Toe bones Coccyx THORACIC
STRUCTURE OF BONE (phalanges) (4 fused bones) VERTEBRAE
10
Y O U R B O D Y A N D H E A LT H
Orbicular of mouth
Splenius How muscles work
Orbicular of eye of head Semispinalis of head
Smaller pectoral Movement occurs when signals
Greater pectoral Erector Trapezius from the nervous system cause
Internal of spine
intercostal muscles to contract. Conscious
Deltoid Deltoid movements of the body are
External produced by the interaction of
intercostal Latissimus
dorsi skeletal muscles, bones, and
joints. Most muscles connect one
Biceps
of arm bone to another and cross a joint.
Deep When a muscle contracts, it pulls
Triceps
flexor of of arm on the bones to move them.
fingers Many muscles are found in pairs,
Extensor one on each side of a joint, and
of fingers produce opposing movements.
Gluteus For example, in the upper arm the
minimus
triceps contracts to pull
Ulnar the arm straight and
Quadrate
extensor
of thigh the biceps contracts
of wrist
to bend the arm.
Triceps contracts
Internal
oblique of Biceps relaxes
abdomen
Abductor
of finger Gluteus
Long maximus
adductor
of thigh Sartorius
Biceps STRAIGHTENING THE ARM
Popliteal of thigh
Gracilis Rectus
of thigh Triceps relaxes
Gastrocnemius
Gastrocnemius
Anterior Soleus
tibial Posterior
Long extensor tibial Achilles
of toes tendon
Long
Short extensor Short
flexor of
of big toe extensor
big toe
of toes Biceps contracts
Abductor
of big toe BENDING THE ARM
FRONT VIEW BACK VIEW
11
Y O U R B O D Y A N D H E A LT H
Mitral
Radial artery Pulmonary valve
valve
Inferior vena cava
Tricuspid Left
Femoral valve ventricle
Common iliac artery
vein
Inferior
Femoral artery Great saphenous vena cava Heart muscle
vein (myocardium)
Descending aorta Right ventricle
Popliteal artery Popliteal vein
Anterior
Blood circulation
Anterior tibial artery
tibial vein The heart pumps blood into two linked circuits: the pulmonary and
the systemic. The pulmonary circuit takes deoxygenated blood to the
Peroneal artery Posterior lungs, where it absorbs oxygen and releases carbon dioxide (a waste
tibial vein
gas) through a network of capillaries; the oxygenated blood is then
Posterior tibial artery
returned to the heart. The systemic circuit takes oxygenated blood to
Small saphenous
vein body tissues, where it releases oxygen and nutrients through capillary
Dorsal artery walls; carbon dioxide and other wastes pass from the tissues into
of the foot the blood, and the deoxygenated blood is returned to the heart.
Dorsal vein
of the foot
Deoxygenated blood Oxygenated blood going
coming from the to the upper body
Arteries and veins upper body Oxygenated
blood coming Capillary
Arteries have thick, muscular, elastic walls to withstand the high Deoxygenated blood from the network
pressure of blood pumped out of the heart. Veins return blood to the going to the lungs lungs in lungs
heart. They have thinner walls that stretch easily, allowing them to
expand and hold large volumes of blood when the body is at rest.
The linings of many large veins have folds that act as one-way valves
to stop blood from flowing the wrong way.
Deoxygenated
blood coming Oxygenated
from the blood going to
ARTERY VEIN lower body Heart the lower body
12
Y O U R B O D Y A N D H E A LT H
Lung
Air flow
Mouth Heart
Domed
Trachea Lung diaphragm
Each lung
Bronchus decreases in
volume as
the ribcage X-RAY OF CHEST
becomes DURING EXHALATION
smaller
13
Y O U R B O D Y A N D H E A LT H
The brain is the most complex organ in the body. It has more than
100 billion nerve cells and billions of pathways. The largest part of
the brain is the cerebrum. It is divided into two halves (hemispheres),
Organization of the nervous system
which are connected by a bundle of nerve fibres called the corpus The central nervous system, comprising the brain and spinal cord,
callosum. The outer layer (cerebral cortex) consists of tissue called grey processes and coordinates nerve signals. The spinal cord forms the
matter, which generates and processes nerve signals. The inner layer link between the brain and the rest of the body. Motor pathways,
consists of white matter, which transmits the signals. The cerebrum which carry messages from the brain,
controls conscious thought and movement and interprets sensory descend through the spinal cord, while Brain
information; different parts govern specific activities such as speech sensory pathways from the skin and
and vision. A structure at the base of the brain called the cerebellum other sensory organs ascend through
controls balance, coordination, and posture. The brain is connected to the spinal cord carrying messages
Cervical
the spinal cord by the brainstem, which controls vital functions such to the brain. A network of Spinal nerves
as respiration. Just above the brainstem is the hypothalamus, which peripheral nerves reaches all cord
links the nervous system and the endocrine system and helps to parts of the body. Each nerve
regulate body temperature, sleep, and sexual behaviour. The brain is formed from hundreds of
is protected by the skull and by membranes called meninges. Clear nerve fibres, which project
cerebrospinal fluid cushions the brain and spinal cord from injury. from nerve cells, grouped in
bundles. Thirty-one pairs of
Voluntary movement is Sensory information is nerves branch off the spinal
controlled in these areas processed in these areas
cord. These divide into smaller
Visual
information and smaller nerves throughout
Speech is is processed the torso and the limbs.
controlled in these areas
in these
areas
Thoracic nerves
Lumbar nerves
Sacral nerves
14
Y O U R B O D Y A N D H E A LT H
15
Y O U R B O D Y A N D H E A LT H
16
Y O U R B O D Y A N D H E A LT H
Endocrine system the development of certain male sexual characteristics. The medulla
secretes epinephrine (adrenaline) and norepinephrine (noradrenaline),
The endocrine system produces hormones – chemicals that are which increase the heart rate and blood flow to the muscles in
response to stress (a reaction called the “fight or flight response”).
carried in the bloodstream and control processes in other parts
of the body. Such processes include metabolism (the chemical
reactions constantly occurring in the body), responses to stress, Pancreas
growth, and sexual development. The pancreas lies behind the stomach. It produces digestive juices
Hypothalamus that help to break down food. It also releases the hormones insulin
The system comprises glands
and glucagon, which play an important part in regulating the level
and other hormone-producing Pineal gland
of glucose, a sugar that forms the body’s main energy source.
cells. Glands, such as the
pituitary, adrenal, and thyroid Pituitary gland
called releasing factors that control the function of the pituitary, and Lymph vessels carry a fluid Thymus
also acts as a link between the nervous and endocrine systems. gland
called lymph around the body.
Lymph helps to maintain the Spleen
Pineal gland body’s fluid balance by collecting
The pineal gland is situated deep inside the brain. Its precise function excess fluid from the tissues and Peyer’s
has yet to be clarified. However, the gland is known to produce a returning it to the bloodstream. patch in
hormone called melatonin, which is thought to be associated with It also carries white blood cells, intestine
the daily cycle of sleep and waking. which fight infection. Lymph nodes,
situated at junctions between lymph
vessels, filter infectious organisms Deep
Thyroid and parathyroid glands from the lymph. They are packed with inguinal
(groin)
The thyroid gland, in the neck, produces hormones that control lymphocytes, a type of white blood lymph
metabolism. Some thyroid cells also secrete the hormone calcitonin, cell. Clusters of nodes are found in nodes
which lowers the blood level of calcium. The four parathyroid glands, many parts of the body, including the
behind the thyroid, produce a hormone that controls blood levels of neck, armpits, and groin.
calcium and phosphate. Calcium is vital for healthy bones and, with Popliteal
phosphate, plays an important part in nerve and muscle function. Spleen and thymus lymph
nodes
The spleen and the thymus gland produce
Adrenal glands certain types of lymphocytes (white blood
The adrenal glands lie on top of the kidneys. Each gland has a cortex cells). These cells produce antibodies,
(outer layer) and a medulla (core). The cortex produces corticosteroid which help to destroy infective
hormones, whose roles include helping to regulate blood levels of salt organisms. The spleen also breaks
and glucose, and tiny amounts of male sex hormones, which promote down worn-out red blood cells.
17
Y O U R B O D Y A N D H E A LT H
Adrenal Cortex of
gland the kidney
GLOMERULUS
Medulla of
the kidney Nephron
Kidney
Peritoneum
(membrane Medulla
lining the Renal artery
Renal abdomen)
artery
Ureter
Renal vein
Renal Bladder
vein Renal pelvis
Ureter
Bladder
Ureter
Prostate
gland Urethra
FEMALE
Major calyx
Urethra Protective
Minor calyx capsule
18
Y O U R B O D Y A N D H E A LT H
Epididymis
Urethra
Erectile
Vas tissue
deferens Penis
Urethra
Scrotum Testis Seminiferous
FRONT VIEW SECTION THROUGH THE PENIS
tubule
Sperm production
Once puberty has been reached, sperm
are manufactured continuously in the
testes at a rate of about 125 million
each day. The sperm develop around the
walls of the seminiferous tubules; their
tails, which enable them to swim, point
towards the centre of the tubules.
Mature sperm are stored in a coiled tube
called the epididymis, situated behind
Erectile each testis. The sperm are eventually
tissue
ejaculated during sexual activity or are
Penis reabsorbed into the body.
Developing
sperm
Sperm
tails
Tubule
wall
Rectum Centre of
tubule
SPERM INSIDE A
Foreskin Urethra SEMINIFEROUS TUBULE
Anus Muscle Scrotum Epididymis Testis
19
Y O U R B O D Y A N D H E A LT H
Fallopian Uterus
Fimbriae tube
Fallopian
tube
Ovary
Ovary
Cervix
Uterus
Bladder
Vagina
FRONT VIEW
Immature
Cervix Pubic egg
cartilage Blood
follicle
vessel
Empty
Vagina Clitoris
follicle
Labia Mature
Rectum egg follicle
egg egg
THE OVARY
about 28 days but this can vary from month Blood vessels glands enlarge
to month and from woman to woman. Shed lengthen
blood
and cells
A complete menstrual cycle
The chart shows changes that occur in the
endometrium (uterus lining) and the ovary
during a menstrual cycle. The egg can be 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28
fertilized by a sperm at ovulation, the DAYS
time when it is released from its follicle.
20
Y O U R B O D Y A N D H E A LT H
Beginning of pregnancy
Milk duct
The cell produced by the fusion of the egg and sperm is called a
zygote. Within 2 days of fertilization, the zygote starts its journey
Lobule along the fallopian tube towards the uterus, propelled by the
muscular action of the tube’s walls. At the same time, the zygote
divides itself repeatedly to form a cluster of cells, which is called
Breast structure a morula. After 5–7 days, the cell cluster reaches the uterus. It
The breasts consist mainly of embeds itself securely in the endometrium (the lining of the uterus)
lobules and milk ducts, together and continues to grow. From this moment onwards, the pregnancy
with fat and connective tissue. Fatty
tissue is properly established. One part of the cell cluster grows into the
Milk is released through the endometrium and becomes the placenta, which
nipple. The dark area surrounding will nourish the developing baby. The rest of
the nipple is called the areola. Lung
the cells, from which the baby will grow,
become an embryo.
The menopause
The menopause is the time when menstrual cycles cease. It usually The zygote The cluster of An embryo
begins to dividing cells, starts to form
occurs between the ages of 45 and 55. The ovaries stop responding
divide soon called a morula, once the cluster
to follicle-stimulating hormone and produce less of the female sex LOCATION
after it has grows as it of cells has
hormones oestrogen and progesterone. As a result ovulation and A single cell been formed travels along embedded itself
menstruation end, and once a woman has reached the menopause she called a zygote is the fallopian in the lining of
is no longer fertile. In the years just before and after the menopause, formed if an egg tube the uterus wall
fuses with a
hormone changes produce symptoms such as mood swings, hot sperm
flushes, vaginal dryness, and night sweats. The menopause may also
result in long-term physical changes, such as osteoporosis.
21
Y O U R B O D Y A N D H E A LT H
22
Y O U R B O D Y A N D H E A LT H
Reflex actions and movements The heart before and after birth
Babies are born with certain automatic patterns of behaviour. Some In the fetus, the task of adding oxygen to the blood and filtering out
of these activities are involuntary actions, such as breathing and waste gases is done by the placenta, but at birth the baby has to start
passing urine and faeces, and others are reflex actions, instinctive breathing, obtaining oxygen from the lungs. Before birth, the fetus’s
movements designed to protect and to aid survival. Some reflex heart pumps blood around the body and to the umbilical cord, but
actions, such as sucking and “rooting” (searching for the mother’s most of the blood bypasses the pulmonary arteries (the vessels leading
breast), obviously aid survival. Others may be relics from a more to the lungs) by flowing through two special openings in the heart.
primitive stage of human evolution; for example, the grasp reflex is With a baby’s first breath the lungs expand and take in air; this
thought to have originated with our ape ancestors, whose babies had triggers changes in the heart and circulation, causing the two openings
to cling to their mothers as they were carried. The reflex actions, and in the heart to close so that all blood from the rest of the body then
involuntary actions such as passing urine, are eventually replaced flows through the pulmonary arteries to the lungs to be oxygenated.
by voluntary, controlled actions as the baby’s nervous system and
muscles mature. Two typical reflex responses are shown below. Deoxygenated Oxygenated blood Closed ductus Oxygenated
blood from to upper body arteriosus blood to upper
Walking reflex upper body
Open ductus Deoxygenated
body
If a newborn baby is held arteriosus blood to
upright with the feet on a Pulmonary lungs
firm surface, he or she artery
will make movements Closed
that resemble stepping Blood foramen
or walking. from lungs ovale
Minimal
blood to
lungs Oxygenated
blood from
Open lungs
Arms and foramen
hands are ovale
Deoxygenated
stretched
Oxygenated Oxygenated blood from Oxygenated
open
blood from blood to lower body blood to
Startle (Moro) reflex placenta lower body lower body
If a baby is startled, a Circulation in the fetal heart Circulation in the heart at birth
protective movement An opening called the foramen The foramen ovale and ductus
Legs make occurs in which the baby ovale and a channel called the arteriosus close, so that all blood
“stepping” flings the arms wide and ductus arteriosus divert most blood from the heart passes to the lungs
motion stretches the legs out. away from the pulmonary arteries. to be oxygenated.
23
Y O U R B O D Y A N D H E A LT H
Ossified Cranium
Secondary epiphysis
ossification
centre Ossified Suture
Growth plate growth
plate NEURAL
Diaphysis (shaft)
Adult brain NETWORK
Blood vessel and skull
Blood vessel The brain and
Marrow skull have reached
Marrow cavity cavity full size. The neural
Long bone in a child Long bone in an adult network is mature,
Growth and ossification (bone All of the cartilage inside the bone although it may go on
formation) take place in the ends has ossified. A layer of cartilage developing as a person
of the long bone. protects the ends of the bone. continues to learn.
24
Y O U R B O D Y A N D H E A LT H
Developmental milestones
AGE (YEARS)
0 1 2 3 4 5
Physical skills
Can lift head to 45° Can walk without help Can catch a bounced ball
The most important skills
are control of posture, Can roll over Can stand without help
balance, and movement.
Can crawl Can throw a ball Can balance on one foot for a second
Babies first learn how to
lift and turn their heads, Can stand by hoisting
then to sit up. They later up own weight Can kick a ball
learn how to crawl,
Can sit unsupported Can walk up stairs without help
stand, walk, and run. Can bear Can hop on
weight on legs Can walk holding on to furniture Can pedal a tricycle one leg
Manual dexterity Holds hands together Likes to scribble Can copy a circle
and vision
Children have to learn Can build a tower of four bricks
Plays with feet
how to coordinate their
hand movements and Passes rattle from hand to hand Can draw a straight line Can copy a square
vision so that they can
perform tasks such as Reaches out
for a rattle Can pick up a small object
picking up objects or
drawing shapes. Can draw rudimentary
Can grasp object between finger and thumb likeness of a person
Social behaviour Smiles spontaneously Can eat with a spoon and fork Can eat with a knife and fork
and play
The first social skill that Mimics housework Separates easily from parent
babies master is smiling at
people. They later learn to Plays peekaboo Can undress without help Can dress without help
play with other children
and tolerate separation
Eats with fingers Stays dry in the day
from their parents.
Children also acquire
Looks at own hands Can drink from a cup Stays dry at night
practical skills such as
feeding and dressing
themselves. AGE (MONTHS)
0 2 4 6 8 10 12 14 16 18 20 22 24 30 36 42 48 54 60
0 1 2 3 4 5
AGE (YEARS)
25
Y O U R B O D Y A N D H E A LT H
WEIGHT
11
measurements from the clinic. circumference, or
24
22 10
20 9
(as here) weight, 18 8
in metric and 16 50th percentile
Measuring your child’s height 14
7
imperial units 6
To measure your child, ask him or her to take 12
5
10
4
2nd percentile
off his or her shoes and stand against a wall. Rest 8
The horizontal 6
3
a flat object, such as a book, vertically on your axis shows the 2
0 2 4 6 8 10 12 14 16 18 20 22 24
child’s head. Mark where the base meets the wall. age – in this case, AGE (MONTHS)
Measure the distance from the mark to the floor. in months
HEAD CIRCUMFERENCE
19 48 19 48
18 46 18 46
44 44
17 17
42 42
16 50th percentile 16 50th percentile
40 40
15 38 15 38
2nd percentile 2nd percentile
14 36 36
14
34 34
13 13
32 32
12 30 12 30
0 2 4 6 8 10 12 14 16 18 20 22 24 0 2 4 6 8 10 12 14 16 18 20 22 24
AGE (MONTHS) AGE (MONTHS)
22 10 22 10
20 9 20 9
18 8 18 8
16 7
50th percentile 16 50th percentile
7
14 6 14 6
12 12
5 5
10
4
2nd percentile 10 2nd percentile
4
8 8
3 3
6 6
2 2
0 2 4 6 8 10 12 14 16 18 20 22 24 0 2 4 6 8 10 12 14 16 18 20 22 24
AGE (MONTHS) AGE (MONTHS)
26
Y O U R B O D Y A N D H E A LT H
LENGTH
LENGTH
28 70 28 70
26 65
50th percentile 26 50th percentile
65
24 60 24 60
22 55 22 55
20 50
2nd percentile 20 2nd percentile
50
18 45 18 45
16 40 16 40
14 35 14 35
0 2 4 6 8 10 12 14 16 18 20 22 24 0 2 4 6 8 10 12 14 16 18 20 22 24
AGE (MONTHS) AGE (MONTHS)
200 90 200 90
180 80 180 80
160 70 160 70
140 98th percentile 140 98th percentile
WEIGHT
WEIGHT
60 60
120 120
50 50
100 100
40 40
80 80
30 30
60 60
50th percentile 50th percentile
40 20 40 20
2nd percentile 2nd percentile
20 10 20 10
0 0 0 0
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
AGE (YEARS) AGE (YEARS)
55 140 55 140
130 130
50 50
120 120
45 50th percentile 45 50th percentile
110 110
40 100 40 100
2nd percentile 2nd percentile
35 90 35 90
80 80
30 30
70 70
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
AGE (YEARS) AGE (YEARS)
27
Y O U R B O D Y A N D H E A LT H
HEALTHY LIVING
A healthy diet Meat, fish, and nuts are rich in protein,
essential for building and repairing cells,
and provide B vitamins and minerals such
Fruit and vegetables are high
in fibre (which aids digestion),
natural sugar, and water. Aim
Diet has a major influence on health. It can affect your risk of as iron. They can also be high in fat, so to eat at least five portions a
developing many diseases; for example, a high-fat diet increases eat them only in moderation day; examples of one portion
your risk of heart disease. It is also crucial in weight control. include one medium-sized
fruit, such as an apple, or
For a balanced diet you need the correct amounts of one dessert bowl of salad
carbohydrates, fats, proteins, vitamins, and
minerals. Eat plenty of high-fibre foods,
limit foods with a high fat or sugar
content, and avoid large amounts
of salt, alcohol, and caffeine. In
addition, water is vital for life,
and you should aim to drink at
least 8 glasses (2 litres) a day.
Food groups
This pie chart shows the five
main food groups and the
proportion of your diet that Fatty foods,
each group should form. Bread, potatoes, which are high
and pasta are high in energy, and sugary
Foods in the larger segments in fibre, starches, and foods, which can
of the chart should form a some vitamins and minerals, cause tooth decay,
greater part of your diet than so can form a large proportion should be eaten in
those in the smaller slices. of your diet limited amounts
28
Y O U R B O D Y A N D H E A LT H
lb kg Height/weight graph for men and women Fitness benefits of different activities
100
210
OVERWEIGHT Activity Fitness benefits
90
190
80 Stamina Flexibility Strength
WEIGHT
170
Aerobics ★★★★ ★★★ ★★
150 70
HEALTHY WEIGHT Basketball ★★★★ ★★★ ★★
130 60
Cycling (fast) ★★★★ ★★ ★★★
110 50 UNDERWEIGHT Climbing stairs ★★★ ★ ★★★
Exercise Tennis ★★
★★
★★★ ★★
Walking (briskly) ★ ★
Most people know that exercise is an important part of
Yoga ★ ★★★★ ★
a healthy lifestyle. Regular exercise protects physical and
mental health. It can also reduce your risk of developing
long-term disease, increase your life expectancy, and improve KEY
your quality of life in later years. When you make exercise a ★ Small ★★ Good ★★★ Very good ★★★★ Excellent
part of your daily routine, you will probably find that you effect effect effect effect
have a lot more energy for ordinary daily activities such as
shopping, housework, child care, and gardening. Exercising safely
How exercise benefits health To avoid overexertion or injury, start by setting realistic goals.
If you are not fit, begin exercising slowly and build up gradually.
Regular exercise benefits most of Take care not to overexert yourself so that you are in pain or feel
the body’s systems, especially the The supply of blood to ill. Make sure that you use the correct protective equipment, clothing,
cardiovascular, musculoskeletal, the brain is increased,
thus promoting mental and footwear for your sport. Every time you exercise, start with
and respiratory systems. It can a warming-up routine and finish with a cooling-down routine to
alertness, and chemical
also benefit mental health by changes occur that prevent muscle cramps and stiffness and minimize the risk of injury.
providing pleasure, reducing improve mood These types of routine involve gentle
stress, and producing aerobic exercise, such as slow jogging,
physical changes that followed by a series of movements to
improve mood. stretch your muscles. Two typical
The heart stretches are shown here. Keep your
Blood pressure is reduced, back straight
becomes
and this decrease helps Rest your hands while you
stronger and
to lower the risk of on your knee to move your
can pump
cardiovascular disease steady yourself hips
more blood
with every
heartbeat Hip and thigh stretch
Kneel, then put one foot on the
The lungs can take in floor in front of you. Push your
more oxygen from each hips down and forwards to
breath and supply more
stretch the back thigh.
oxygen to the body
Repeat for the other thigh.
29
Y O U R B O D Y A N D H E A LT H
the liver at an average rate of about 1 unit per hour (see VOLUME OF
Exercising at different ages DRINK EQUAL TO 1 UNIT OF ALCOHOL, below). Your body cannot alter
Most people, whatever their age, can derive physical and mental this rate, so that the more you drink, the longer it takes for your
benefits from exercise. Apart from the overall improvements to your body to break down the alcohol. If you drink heavily at night, you
flexibility, strength, and stamina, exercise has different benefits for may still be intoxicated the next morning. This situation can be
people at different stages of life. In children, it helps to build strong dangerous if you plan to drive a vehicle or operate machinery.
bones and muscles, improves coordination, and can also be fun. In the short term, excessive drinking can cause intoxication and
In adults, exercise helps to minimize hangovers. In the longer term, alcohol damages most body systems.
the risk of heart disease. In older Regular, excessive drinking can also lead to alcohol dependence and
people, it helps to slow processes social problems including domestic violence and vagrancy.
associated with aging, such as
loss of bone density, and enables The brain’s control of inhibitions Drinking alcohol
people to stay mobile for longer. and coordination is impaired by makes the blood
alcohol. Long-term drinking vessels in the skin
Regular exercise can also enable damages brain cells that control widen, causing the
pregnant women to cope better learning and memory body to lose heat.
with the demands of pregnancy Long-term drinking
and childbirth. The heart may be protected raises the risk of
against disease by one or two high blood pressure
Activities for children drinks a day, but drinking
Games such as football can improve more than this amount
physical aspects such as strength, balance, will increase the risk of
cardiovascular disease
and coordination. Such games can also be
fun and enable children to make new
The liver may become
friends with the other players. inflamed (hepatitis) by
excessive consumption
of alcohol. Long-term
drinking can seriously
damage the liver and
cause diseases such as
cirrhosis and cancer
Sexual performance
may be impaired by
alcohol. In the long term,
fertility may be reduced
Alcohol the percentage of alcohol by volume (abv). The higher the abv, the
smaller the volume equivalent to 1 unit. The box below shows a
Alcohol is a drug that alters your mental and physical state, selection of alcoholic drinks, each equal to 1 unit. Measures served
at home or in bars may be larger than those shown here.
reducing tension and facilitating social interaction. For this
reason, it has been used socially for centuries. However, in
excess, alcohol may cause loss of control over behaviour and Volume of drink equal to 1 unit of alcohol
in the long term, physical, psychological, and social problems.
30
Y O U R B O D Y A N D H E A LT H
31
Y O U R B O D Y A N D H E A LT H
Sexual relationships
Sexual fulfilment depends on a blend of
physical and psychological factors, and
Sources of stress
what is right for one person or couple may Stress may result from external events or circumstances, your
not suit another. You and your partner personal reactions to pressure, or a combination of these factors.
should be happy with the frequency of Major external sources of stress include long-term problems, such
sexual activity, and should be able to as an unhappy relationship, debilitating illness, or unemployment;
discuss which activities you enjoy major changes, even desirable ones, such as marriage or moving
or find unappealing. Anyone in a house; and a build-up of everyday stresses, such as being late for
sexual relationship should be work or getting caught in a traffic jam. Behaviour patterns that
aware of transmitted infections cause or aggravate stress include impatience and aggression, lack
(STIs) and understand how to of confidence, and suppressing feelings of tension or anxiety.
minimize the risk of exposure
to such conditions by practising Recognizing signs of stress
safe sex (below). In addition, to If signs of stress are recognized early, action can be taken to prevent
avoid an unwanted pregnancy, health problems. These signs may include having less energy than
you should be familiar with the usual, a reduced appetite, or eating more than you do normally. You
options for contraception (see Physical and emotional benefits may have headaches, mouth ulcers, or be unusually susceptible to
CONTRACEPTION CHOICES FOR Good sexual relationships fulfil
minor infections, such as colds. If you feel very stressed, you may be
both partners’ needs for comfort
MEN, p.254, and CONTRACEPTION anxious, tearful, irritable, or low in spirits. Sleep may be disrupted,
and closeness as well as satisfying
CHOICES FOR WOMEN, p.276). and relationships may suffer. To distract yourself, you may rely on
their physical desires.
It is common to experience a alcohol, tobacco, or drugs. If stress is causing any of these problems,
temporary lack of sexual desire or inability to perform sexually (see seek help from your family, friends, or doctor.
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, Making lifestyle changes
or to the use of alcohol, recreational drugs, or certain medications.
If your lifestyle is stressful, try to minimize the harmful effects that
Disorders such as diabetes mellitus can cause longer-term sexual
stress may cause. Find time to keep up with your family and friends,
problems. It is important to discuss concerns with your partner. Talk
and take up leisure activities. Exercising regularly can help to relieve
to your doctor if the problem is persistent.
physical tension, as may learning to relax your body consciously (see
RELAXATION EXERCISES, below). Break stressful tasks down into small,
Practising safe sex easy parts. Concentrate on important tasks and limit the number of
Sexually transmitted infections (STIs) are usually spread by contact less urgent ones to conserve your time and energy. If people make
with infected skin or body fluids such as semen, blood, and vaginal heavy demands on you, try to set limits on these demands.
secretions. Many STIs are uncomfortable but fairly minor problems,
but some, such as HIV infection, are life-threatening. You can take Relaxation exercises
simple steps to protect yourself. If you have sex with someone whom If you are under stress, your muscles tighten,
you do not know to be free of infection, use a condom, which gives the heart beats more rapidly, and breathing
protection against most STIs (apart from genital warts and pubic becomes fast and shallow. Relax both
lice, which can affect body areas that are not covered by a condom). your mind and body by learning simple
If you develop an STI, you should avoid sexual activity until you relaxation routines that slow down your
have been treated and are free of infection. body’s stress responses. The breathing
technique shown here may help to
Stress reduce stress. For more information,
ask your doctor if he or she can
Stress is a physical or mental demand that provokes certain recommend any relaxation classes.
responses in us, allowing us to meet challenges or escape
from danger. A moderate amount of stress can improve your Breathing to relax
Breathe slowly and deeply, using your
performance in situations such as sports and work, but
diaphragm and abdominal muscles.
excessive stress can harm your health. You can minimize Rest one hand on your chest and one on
harmful stress by identifying situations that you find stressful your abdomen: the lower hand should
and developing ways to cope with them. move more than the upper one.
32
Y O U R B O D Y A N D H E A LT H
33
Y O U R B O D Y A N D H E A LT H
34
Y O U R B O D Y A N D H E A LT H
PROFESSIONAL HEALTHCARE
Healthcare throughout life Visiting your doctor
Looking after your health involves not only following a healthy Before your first appointment with a new doctor, you may be
lifestyle but also making effective use of the healthcare system. asked to fill in a questionnaire about your health and lifestyle.
Doctors and other professional healthcare workers provide On your first visit, your doctor will ask further questions and
treatment when you are ill and are also involved in some check if you are up to date with immunizations and screening.
important elements of preventive healthcare. These include During later visits, the doctor will add notes to your medical
health education, checkups during childhood and later in life, records, which are transferred if you change to another GP.
screening tests to identify risk factors and early signs of disease, You have the right to see your own or your child’s records.
and immunizations to help prevent certain infectious diseases. During a visit, do not hesitate to ask questions about your
To get the most from what professional healthcare has to health and treatments. Most appointments last 7–10 minutes.
offer, you need to be aware of the options for you and your
Consulting your doctor
family and to learn how to make the best use of the services
Provide your GP with
that doctors and other healthcare professionals can provide. accurate information
about symptoms, and
Healthcare providers feel confident about
Most disorders can be diagnosed and treated by general practitioners asking questions.
(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 Your medical history
heavy bleeding, you should go straight to an accident and emergency When you first visit a doctor, you will be questioned about your
department in a hospital for treatment. If your injury or symptoms present and past health; treatments that you are having or have had;
are not severe, you should consider waiting to see your GP or disorders that could run in your family; and aspects of your lifestyle,
contact NHS Direct. Hospital clinics for the treatment of sexually such as diet and exercise. The information gathered from these
transmitted infections, called STI clinics or genito-urinary medicine questions is known as a medical history. If you then visit your doctor
clinics, are also run on the basis of self-referral. with a disorder or unexplained symptoms, your medical history can
help him or her to reach a diagnosis. In addition, if there is evidence
Choosing a doctor that you are at risk of developing certain disorders, your doctor will
If you are looking for a new GP, you can obtain a list of doctors in suggest preventive measures or screening to detect early signs.
your area from your Community Health Council or local library;
you could also ask friends and neighbours if they can recommend Having a physical examination
anyone. When you find a likely practice, ask about their opening
When you see your doctor, you may have a physical examination to
hours and how long, on average, you will have to wait for an
assess your state of health, look for abnormalities, or confirm or rule
appointment that is not urgent. In addition, ask whether the practice
out a diagnosis. The examination usually begins with a check of
offers home visits, advice over the telephone, services provided by
external areas, such as the eyes, ears, skin, and nails, and a test of
other healthcare professionals such as nurses, and special services,
nervous reflexes. In some cases, the doctor can gather information
such as family planning clinics. You may also wish to ask if you
about other areas apart from the one being examined; for example,
can choose a female doctor rather than a male doctor (or vice versa),
a pale-coloured tongue may be a sign of anaemia. He or she may also
if you have a strong preference in this matter.
check for abnormalities by listening to organs with a stethoscope
Using the internet (auscultation), by feeling
If you are new to an (palpation), or by
area and need to register tapping areas and
with a GP, you may be listening to the sounds
able to find out about produced (percussion).
local practices by
looking on Listening to the chest
the internet. 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 levels, which also affect your risk of heart disease and stroke, and
eye pressure measurement, to check for glaucoma, a disorder that
and screening may cause blindness if left untreated. People with long-term
disorders are usually offered regular screening to detect early signs
Health checks provide an opportunity to discuss with your of complications. For example, people with diabetes mellitus have
regular screening for kidney disease, cardiovascular disorders, nerve
doctor or health visitor your or your child’s general health. damage, and problems in the blood vessels of the eye, which left
In the UK, children are offered routine checks that focus on untreated may lead to blindness.
healthy growth and development. In adults, health checks Inflatable cuff wrapped
usually are given after registering with a new doctor, for Sphygmomanometer, around upper arm and
a device that measures connected to the
insurance purposes, or when starting a new job. In addition, blood pressure sphygmomanometer
pregnant women and those with a long-term illness, such as Stethoscope
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.
36
Y O U R B O D Y A N D H E A LT H
37
Y O U R B O D Y A N D H E A LT H
MEDICAL TESTS
Testing samples Tests on body fluids
Tests may be performed on body fluids from wounds or abnormal
Tests that are carried out on samples of body fluids, such as areas of skin, from mucous membranes such as those of the nose and
blood or urine, are often the first investigations requested by throat, or from internal areas such as the inside of a joint or around
a doctor before making or confirming a diagnosis. Samples of the brain and spinal cord. The tests may involve looking for infectious
urine and faeces can usually be collected easily by the patient, microorganisms, abnormal cells such as cancerous cells, or abnormal
and blood samples by the doctor in his or her surgery. Some levels of certain chemicals. Other tests involve assessing cells or other
substances that are normally found in the fluid, such as sperm in a
samples, such as cell and tissue samples and certain body
sample of semen. Some samples,
fluids, may need to be collected during a hospital procedure. such as saliva, can be collected Tongue depressor
The results of tests on body samples can provide information Swab
by the individual; others by a
on the function of certain organs, such as the liver or kidneys, doctor. The samples are
or reveal the presence of abnormal substances or abnormal then usually sent to a
levels of normal substances, such as hormones, in the body. laboratory for analysis.
In addition, some tests can reveal the presence of disease-
causing microorganisms. Most tests on body samples are Having a swab taken
carried out in a laboratory, but some may be performed in Fluids from wounds or
a doctor’s surgery or even at home. from body cavities,
such as the mouth, are
usually collected with a
Blood tests swab – a sterile cotton
Blood tests can be used to find information about the blood itself and bud on a plastic stick.
to assess the function of other parts of the body, such as the liver.
The samples are usually taken from a vein, but may also be taken Tests on faeces
from capillaries (tiny blood vessels) by a finger prick or occasionally
Samples of faeces may be tested for infectious microorganisms or for
from an artery. The most common blood tests performed are blood
evidence of digestive disorders. One common test is the faecal occult
cell tests and blood chemistry tests. Blood cell tests include measuring
blood test, which can reveal tiny amounts of blood invisible to the
the numbers of red and white blood cells and of platelets (cells that
naked eye. This test may be carried out if the doctor suspects that
help blood to clot). Blood carries many substances apart from cells,
there may be bleeding in the digestive tract. The test may also be
and blood chemistry tests can measure the levels of these substances.
used to screen for colorectal cancer. Tests on samples of faeces are
These tests are used to detect kidney, liver, and muscle damage,
usually carried out in a laboratory.
certain bone disorders, and inflammation. One type is carried out
to measure the level of cholesterol in the blood. In addition, blood
chemistry tests are performed to see if a gland, such as the thyroid
Cell and tissue tests
gland in the neck, is producing abnormal amounts of a hormone. Microscopic studies of individual cells, or of a larger sample of tissue
containing a variety of cells, can give a definitive diagnosis for many
Urine tests disorders. Tests on cells are often used to diagnose cancer or screen
for genetic disorders. Cells may be obtained from body fluids such
Urine is most commonly tested for evidence of urinary tract infections
as sputum (fluid coughed up from the lungs) or scraped from tissue
or diabetes, and can also be used to assess kidney function. Most urine
surfaces such as the cervix (see CERVICAL SMEAR TEST, p.264). Cells
tests are dipstick tests, which involve dipping a chemically treated
may also be withdrawn from the body using a needle and syringe.
stick into a sample of urine to show the presence or concentration
This process, called aspiration, is often used to take cells from the
of specific substances, such as glucose, or the presence of infectious
lungs, thyroid gland, or breasts (see ASPIRATION OF A BREAST LUMP,
organisms. Dipstick tests are usually performed in a doctor’s office.
p.256). Tissue tests are used to detect areas of abnormal tissue such
If the test suggests an infection, the sample may be sent to a laboratory
as cirrhosis of the liver or tumours. Samples are taken by biopsy, in
to grow and identify the microorganism. A specific test for a hormone
which a small piece of tissue is removed from parts of the body such
produced in pregnancy is the basis of the urine pregnancy test, which
as the skin (see SKIN BIOPSY, p.183) or the liver (below).
can be performed at home (see HOME PREGNANCY TEST, p.260).
The intensity of each colour Having a liver biopsy
shows the concentration of Under local anaesthesia, a hollow needle
a certain substance The chart is inserted into the liver through a small
Testing with a dipstick
shows possible incision between the right lower ribs, and
When a dipstick is put into
test results a core of liver is removed. You will then
a urine sample, chemicals in need to stay in bed for up to 6 hours.
the squares along the stick
react and cause a colour
change. Each square on the Biopsy needle
stick tests for a different
chemical. After a specified
amount of time, the colours
of the squares, which
indicate the concentration
of substances in the urine,
are compared to a chart.
38
Y O U R B O D Y A N D H E A LT H
Treadmill
Mobile table
Having an X-ray
You are positioned on or against a Control
special table or surface that allows panel
X-rays to pass through it to a cassette Drawer
of film. You have to keep still during the containing
procedure so that the image will be clear. film cassette
39
Y O U R B O D Y A N D H E A LT H
Aorta
Coronary
CONTRAST X-RAY OF artery
OESOPHAGUS
Catheter
entry
site Aorta
POSITION OF TIP
Femoral OF CATHETER
artery
ROUTE OF CATHETER Normal
coronary artery
Lead
Narrowed area of
apron Radiologist coronary artery
CT scanning
Computerized tomography (CT) scanning Scanner X-ray source Loop of
is an X-ray-based technique that produces Liver Kidney intestine
detailed cross-sectional images of the body. X-rays
Spine
The images show a wide range of tissues of
varying densities that do not show clearly on
plain X-rays. CT scans reveal the anatomy
of organs and other body structures, as well Manual
as abnormalities such as tumours or scar control
tissue inside organs. The scanner moves panel
around the body; one section emits X-rays,
which pass through the body to a detector
on the other side of the machine. This X-ray CT SCAN OF ABDOMEN
detector transmits data to a computer, which
Having a CT scan
creates an image that is shown on a monitor
A motorized bed moves
or reproduced on X-ray film. Hollow or you through the scanner.
fluid-filled areas usually appear black on The machine rotates
the images but can be shown with a contrast around you; one section
medium, which blocks the passage of X-rays. emits X-rays, which pass
In some cases, data from the scans can be through you to a detector.
used to create three-dimensional images. CT X-ray A radiographer, in another
scans are most commonly used to investigate detector room, uses a computer
the brain or the solid abdominal organs but to control the procedure.
may also be carried out to view the lungs. Motorized bed CT scanning is painless.
40
Y O U R B O D Y A N D H E A LT H
MRI End of
femur
Magnetic resonance imaging (MRI) uses magnetic force and radio Skin (thigh
waves to create images of internal structures and tissues. MRI can bone)
Radiofrequency Patella
reveal fine details and abnormalities more clearly than other forms source, which (kneecap)
of imaging. The scanner contains two powerful magnets and a emits radio
radiofrequency source. One magnet creates a powerful magnetic waves Cartilage
field, which causes hydrogen atoms within
joint
throughout the body to line up. The Fat
radiofrequency source emits radio waves
that briefly knock the atoms out of End of tibia
alignment. As the atoms realign, they (shinbone)
emit signals (resonance) that are picked MRI SCAN OF KNEE JOINT
up by the other magnet placed around
Scanner
the area being scanned. Information
Companion
about the signals is transmitted to a for patient
computer, which produces an image Manual
control
on a monitor. MRI is often used to panel Motorized
examine the brain and spinal cord. bed
It is also used to investigate sports
injuries such as torn tendons.
Receiving magnet
Counterbalance
for gamma
camera
Having an
ultrasound scan
A gel is applied to the Gamma
skin to improve contact camera
with the transducer. The
device is then moved across this
area. The images of the internal
structures appear on a monitor. Motorized bed
41
Y O U R B O D Y A N D H E A LT H
42
SYMPTOM CHARTS
SYMPTOM
C HARTS
The charts help you identify the possible
causes of a symptom, tell you when to seek
medical help, and, if appropriate, suggest how
you can treat the symptom or its cause
yourself. The section consists of charts for
children of different ages, charts for all adults,
and charts specifically for men and for
women. 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
SYMPTOM CHARTS
Warning box
This box highlights danger signs that need urgent A D U LT S : G E N E R A L
medical attention or provides key information.
Read the box first before working through the chart
117 Back pain
Starting point Most people have at least one episode of back pain during cartilage in the spine, in many cases as a result of tasks such
The starting point for each chart is always their lives, and they usually recover without needing medical as lifting excessively heavy weights. Severe back pain may
located in the top left corner of the page help. Back pain is often due to poor posture. However, it be due to pressure on a nerve or, rarely, it may be due to a
may be a sign of damage to the joints, ligaments, or discs of problem with an internal organ such as a kidney.
Question boxes
These boxes ask for further information about
START Did the pain Are any of the danger WA R N I N G
your symptoms and can be answered YES or NO. follow an YES
signs in the warning YES
HERE DANGER
Make sure that you read the questions carefully injury, fall, box (right) present? SIGNS Call an ambulance if you
or violent have back pain or have recently injured your
NO back and you develop problems with either
movement? bladder or bowel control. Rarely, damage to
Yes and No options NO the spinal cord may be the cause.
You can leave each question box by answering either
YES or NO. YES is always to the right of a box, and
NO is always at the bottom of a box POSSIBLE CAUSE AND ACTION You have probably
t
bruised or strained your back. Follow self-help EMERGENCY!
measures for relieving back pain (opposite). If CALL AN AMBULANCE
Pathway your pain is severe or if it has not improved
within 48 hours, consult your doctor. POSSIBLE CAUSE You may have damaged your
The arrowed pathways lead you from one question spinal cord. Try to keep completely still while
Do you have waiting for an ambulance.
to the next and eventually to a possible diagnosis pain in one side ACTION In hospital, you will be examined and
of the small of YES CALL YOUR DOCTOR NOW will probably have tests such as CT scanning
your back just POSSIBLE CAUSE Pyelonephritis, a bacterial infection of
(p.40) to look for the site and extent of any
above the waist, a kidney, may be the cause of these symptoms.
damage. In some cases, surgery to stabilize the
and do you spine may be required.
How the charts are organized feel generally ACTION Your doctor will examine you and arrange for
a urine test. If an infection is confirmed, you will be
unwell with a prescribed antibiotics. You may also need to have an
temperature of abdominal ultrasound scan (p.217) or a contrast
The charts are divided into four groups, each 38°C (100°F) X-ray of the kidneys (see INTRAVENOUS UROGRAPHY,
or above? p.227) to look for an underlying cause. SELF-HELP Taking care of
group indicated by a different colour bar down NO
your back
the edge of the page. The groups are: Improving your posture and taking care to
• Charts for children: problems affecting children Does the pain prevent
you from moving,
lift heavy objects safely can help you avoid
back problems. Stand up straight, and avoid
of all ages, as well as charts specifically for and/or does it shoot YES wearing high-heeled shoes. Be aware of your
babies under one and adolescents. down one leg? posture when sitting at a desk (see SAFETY AT
WORK, p.34), in a car, or at home. You should
NO
• General charts for adults: problems that can have a supportive mattress on your bed.
Regular gentle exercise may strengthen your
affect both men and women Did the pain abdominal and back
YES
come on after muscles and help
• Charts for men: specific problems affecting men lifting a heavy POSSIBLE CAUSE AND ACTION You have probably
strained some of the muscles and/or ligaments in
Upper body you lose any
object or after straight
• Charts for women: specific problems affecting undertaking your back. Follow self-help measures for relieving
back pain (opposite). If pain is severe or no better
excess weight.
women, including symptoms during pregnancy. an unusually within 48 hours, consult your doctor. Lifting safely
strenuous Bend your knees
exercise? when you pick
Women’s A D U LT S : W O M E N
up an object,
NO
charts
For breast problems during pregnancy or after giving birth, breast cancer can often be successfully treated. It is therefore Mammography uses X-rays (p. 39) to detect X-ray Compressed breast Plastic cover
abnormal areas of breast tissue. It is used as a machine
see chart 149, BREAST PROBLEMS AND PREGNANCY (p.286). important to familiarize yourself with the look and feel of
START
HERE
Are both
breasts tender
or painful?
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.
In some cases, it is associated with other
symptoms of premenstrual syndrome, such
Two X-rays are usually taken of each breast.
The procedure is uncomfortable but lasts only
a few seconds. If an abnormality is detected,
you will need further tests such as aspiration
(see ASPIRATION OF A BREAST LUMP, opposite) to
X-ray plate
Men’s
syndrome (opposite) may reduce breast
tenderness. Otherwise, consult your doctor. Continued from
A D U LT S : M E N SEE YOUR DOCTOR WITHIN previous page POSSIBLE CAUSE AND ACTION Some A D U LT S :POSSIBLE
M E N CAUSES A change in a nipple may
24 HOURS women have lumpier breasts than others. be a sign of breast cancer. However, normal
Do you have a tender, Lumps are usually more obvious before aging may also cause a nipple to become
red area in one breast? YES
Fertility problems in men POSSIBLE CAUSE AND ACTION Mastitis, a period. If you are particularly worried, indrawn. Consult your doctor.
126 NO
which is inflammation in the breast, is
likely. This condition is usually due to
Continued from
POSSIBLE CAUSE AND ACTION Breast tenderness
previous page
may be the first sign of pregnancy. If there (see SEXUALLY TRANSMITTED INFECTIONSyour
consult your doctor,
POSSIBLE CAUSE Sexually transmitted infections
breasts
IN MEN ,
Semen whoanalysis
will examine
to make sure that there
ACTION Your doctor will examine your
breasts and will probably arrange for tests
are no individual lumps that require
charts
breast-feeding. Non-breast-feeding a home pregnancy test (p.260). If you YES investigation.
from Naturally breasts
breasts feel lumpy? a problem deeper in the breast.
Fertility problems affect 1 in 10 couples who want children, The two mainwomen whoofare
causes affected are
infertility usually
in men are insufficientare
sperm
not pregnant, a serious cause is unlikely, the testes do not requireanalysis
to the penis. Consult your doctor. treatment and do
is usually one notof the first tests that
Do you have a single smokers, and they tend to have repeated increase the risk of breast
is carried out.cancer.
The man is asked to ejaculate
and in many cases, a cause is not found. Failure to conceive YES
production episodes.
and a blockage of the vas deferens, the tubesbut you should consult your doctor.
that NO Your doctor will examine you, and he
ACTION
lump in a breast? Your doctor will probably
or she may refer you to a specialist for tests to into a clean container (semen collected from
may be the result of a problem affecting either one or both transport the spermantibiotics
prescribe to the penis during
to treat ejaculation.
infection. a condom is not suitable). The sample must
establish whether the tubes leading from your
Object
conceive; 1 in 5 normally fertile couples take infection in the past? difficult. Wearing a nipple shell inside your
to conceive NO 1 year to conceive. If your partner If you examine your breasts regularly, you semen normally contains at least 50 million
POSSIBLE CAUSES AND ACTION Many types at least has bra during pregnancy may help to draw the
for less than Aspiration of a drugs,
of anticancer breast
andlump
radiotherapy not conceived within 1 year, consult yourwill become familiar with their normal NO POSSIBLE CAUSE AND ACTION Infrequent sperm, the majority of which are healthy. nipple
A out in preparation for breast-feeding.
doctor, who may want to arrange for initial appearance and feel and find it easier to
6 months? involving the testes, can permanently intercourse is a common cause of failure to low sperm count is defined as fewer than 20
tests, which will include a sperm count (seenotice changes. Look at your breasts in a
Aspirationdamage
involves sperm
removing production. Consult your
cells or liquid SEMEN ANALYSIS, opposite).
conceive. If you have sex less than three times million sperm per millilitre. If the test shows
directly in
doctor, who may arrange for semen mirror, checking for changes in the size or Do you ahave
week,a the
discharge
chance of sperm being present to any abnormality, it will be repeated.
from a breast lump using a needle and POSSIBLE CAUSES Nipple discharge is usually
analysis (opposite). If a sperm sample shape of your breasts, changes to your fertilize an egg when itYES
from a nipple? is released is reduced.
syringe. If was
the lump is solid, cells
thewill be POSSIBLE CAUSES A noncancerous growth due to hormone changes and is no cause
A D U LT S : G E N E R A L collected init the
stored before treatment started,
or cyst are the most likely causes of
nipples, or dimpled skin. Then, while lying If possible, try to have intercourse
A D Uwith Syour
LT for
: concern.
G E N E RInArare
L cases, a cancerous or SELF-HELP Premenstrual
canneedle.
be usedThese cells are then(artificial)
for intrauterine or standing, put one arm behind your head, NO more often (see MAXIMIZING THE
partner
sent to a laboratory
insemination. to beOtherwise,
examined under inseminationbreast lumps. However, breast cancer is CHANCE OF CONCEPTION, opposite). If your
noncancerous growth affecting a milk duct syndrome
and feel the breast on that side with firm,
by donor
a microscope. may be an
This technique canoption a possibilityPthat
identify(see ASSISTED needs
OSSIBLE to be Rarely,
CAUSES ruled out.
surgery to the groin partner has still not conceived within aisfurther
the cause. Consult your doctor.
Back pain
manipulation of the spine. If the pain is severe, you may front of you
small circular movements. Feel around the
117 whether orCONCEPTION
not the lump , p.275).
is cancerous. If fluid
is withdrawn into the needle instead of cells,
Consult your maydoctor.
damage the vas deferens,
transport sperm from the testes
ACTION Your doctor may arrange for you
the tubesfrom
Continued that
to thepage
previous Are and
whole breast, including the nipple
penis.
Prostate surgery often results in semen flowing Do you
you over 50? YES
have sex less
3–6 months, consult your doctor.
S E L F - H E L P Relieving ACTION The doctor will examine your breasts
and may arrange for mammography (above)
Premenstrual syndrome is a group of
symptoms, often including bloating, mood
to have either mammography (opposite)
armpit. Repeat the process with
often
the other
NO YES back pain to exclude an abnormality in the underlying swings, and breast tenderness, that some
Have you ever been the lump can be diagnosed as a breast cyst. backwards into the bladder during ejaculation,
breast. If you discover a lump or anythan three times
changes
Most people have at least one episode of back pain during cartilage in the spine,
YES The procedure in many
is painful, cases takes
but it usually as a resultorofultrasound
tasks such scanning (p.41) and a week on average?
reducing fertility. Consult your doctor. in the breast, consult your doctor.
breast tissue. Treatment is often not necessary, women experience in the days leading up to
treated with anticancer Have you had surgery aspiration (see ASPIRATION OF A BREAST but occasionally
sprains affected milk ducts may need
their lives, and they usually recover without
drugs orneeding medical
radiotherapy? as lifting excessively
less than a minute to heavy weights. Severe back
carry out. pain may Most back pain is the result of minor a period. The following measures may help
to the groin, such as a LUMP, left) to rule out
ACTION breast
Your cancer.
doctor will examine you and or strains and can usually be to be removed surgically.
Continued on
cases, removal of thefor
to check lump is advised.
a blockage. more than YESdaily activities. Sperm count
prostate gland? confirmed, surgery may successfully treatflat, thefeel around the the vertebrae, resulting in the spinal column nipple look abnormal? your normal YES Sperm are viewed under a microscope with an exercise such as yoga.
Needle whole breast and armpit gradually becoming hard and inflexible). This recommended safe
NO condition. If you have had Has yoursurgery,
prostate •limit
Rest in bed if the pain is severe, but do a grid to help count the number of sperm• Eat little and often, including plenty of
from area YES circles.
the in small is especially likely if you are between 20 and 40. alcohol NO (p.30)?
next page
follow an signs in the warning well as painful with the pads AREA TO
ACTION YourBE doctor will examine you and
inflammatory drugs. condition, such as eczema. However, Paget’s • Do not eat fried foods or excessive
HERE DANGER SIGNS Call an ambulance EXAMINED
injury, fall, box (right) present? POSSIBLE ifCAUSE
you The lump is probably a
over a period of
of your fingers arrange for you to have a blood test and X-rays
Raise armof your back and pelvic areas. If you • Place a heating pad or wrapped disease, a rare form of breast cancer, is a
hot-water amounts of chocolate.
or violent have back pain or have recently injured your which is a noncancerous
fibroadenoma, (p.39) possibility. Consult your doctor.
NO months or years? bottle against the painful area. • Avoid drinks containing large amounts
Did you have mumps back and you develop problems with either
growth. Consult your doctor. are found to have ankylosing spondylitis,
movement? bladder or bowel control. Rarely, damage toS E L F - H E L P Maximizing the • If heat does not provide relief, ACTION Your doctor will examine your
try using of caffeine, such as coffee, tea, and cola.
YES POSSIBLE CAUSE In adolescents and adults, you will probably be given nonsteroidal anti- Heavy alcohol
after the age of 12? During the theprocedure
mumps the virusspinal
can cord
causemay be the cause.
inflammation of Your doctor will examine you and NO
ACTION inflammatory drugs. You will also be referred to an ice pack (or a wrapped breasts.
POSSIBLE
If you
pack of frozen have aCAUSE
skin condition, you consumption • Try taking the recommended daily
NO chance
will probably arrange forof conception
tests such as Are you outside the mayarea can impair
be prescribed sperm production.
corticosteroid creams. IfIf excessive allowance of a vitamin B supplement.
the istestes,
A fine needle andto
attached this may permanently
a syringe and affect a physiotherapist, who will teachYES you exercises POSSIBLE CAUSEpeas); AND place it over the painful
Being for
NO
fertility. Consult your doctor. ultrasound scanning (p.41). Small lumps healthy
to help keepweight range
your back mobile. These mobility substantially underweight
ACTION
15 minutes every 2–3 hours.
your doctoralcohol
suspectsconsumption
Paget’s disease,continues
you willover a long 6
inserted into the breast lump. Cells or fluid
may not need Iftreatment; larger lumps may C ONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
or overweight probably be period of for
referred time, it can
tests such permanently
as damage• Try
thetaking evening primrose oil, particularly
are then carefully you are planning to have a baby, you and for yourareheight
exercises (see part of the treatment may reduce Ifyour
an essential yourfertility.
backache Consult
is severeyour
or is no better testes.
ACTION withdrawn.
Your doctor will examine yoube and surgically removed. A DIAGNOSIS FROM THIS CHART. mammography Consult your doctor.
(above). in the days before your period.
CHILDREN: ALL AGES your partner should both see your doctor to ASSESSING
for this disorder
YOUR andWEIGHT , C HMAKE
can be supplemented
I L D Rby
E N :doctor,
A L L who may
E S arrange
A Gwithin for semen
2 days, consult your doctor.
POSSIBLE CAUSE AND ACTION You have probably will probably arrange for semen analysis ACTION Your doctor will arrange for semen
t
discuss the planning of a healthy pregnancy other
p.29), physical
or hasactivities, such as swimming.
there been analysis (above).
Once Makeyour sure
back you
paineat
has cleared up, you
bruised or strained your back. Follow self-help (opposite) to assess sperm production. analysis (above) to confirm the diagnosis.
EMERGENCY! a healthy diet. If you are overweight,
measures for relieving back pain (opposite). If CALL AN AMBULANCE
(p.275). There are also several straightforward a sudden change in should take steps to prevent a recurrence by
Meanwhile, reduce your alcohol intake; if
try to lose weight (see HOW TO LOSE
14 Fever in children Do you have
your pain is severe or if it has not improved
within 48 hours, consult your doctor.
Do you have a
YES
256
POSSIBLE CAUSE You may have damaged
Continuedself-help
previous
from
page
steps that you can take to maximize
your chance of conception.
your
spinal cord. Try to keep completely still whileA healthy diet with plenty
POSSIBLE waiting Some illnesses, especially liver
Did the pain
come
SELF-HELP
on vitamin-
of fresh,
your weight?
Bringing down a fever
NO underweight,
following the self-help advice for taking care
WEIGHT SAFELY, p.151). If you are
of follow
your back the(opposite).
gaining weight safely (p.149).
advice on
you have difficulty cutting down, your doctor
may be able to advise you or refer you to a
self-help group. It may take a few months for
257
For children under 1, see chart 3, FEVER IN BABIES (p.54). and be long-standing
hot and sweaty.illness?
If your child does not feel well, and
CAUSES for an ambulance.
yousome hormone disorders, may rich foods, plenty of rest, suddenly
and keeping after
alcohol SEE YOUR
Lowering a temperature will help your child feel more DOCTOR WITHIN 24 HOURS
Wet face Drink
sperm production to return to normal after
pain in one side diseases anmay
extended you have changed your drinking habits.
consumption to a minimum all help to
comfortable and
A fever is an abnormally high body temperature ACTIONS In hospital, you will
yourbedoctor.
examined and YESlessens the likelihood
POSSIBLEof aCAUSE
febrile You
convulsion
may have cloth
a crush fracture
of the small of of 38˚CYES should CALLtake his or
YOUR her temperature
NO
DOCTOR NOW (see TAKING YOUR reduce CHILD
sperm ’production. Consult
will probably have tests such as CT scanning stay in bed
increase your chance of conception. or (p.55). Remove your child’s
Regular
occurring Do
of a clothes
you smoke
vertebra and
as give himuse
or
a result of osteoporosis, in which OSSIBLE CAUSE Osteoarthritis of the spine
PFan
(100˚F) or above. It is usually a signyour
that the
backbody
justis fighting TEMPERATURE , below). If it is raised, take steps toACTION reduceYour it doctor
(p.40) to lookwillforarrange
the sitefor
and semen
extent of anysexual intercourse – ideally confinement or her to
at least three YESthin and POSSIBLE is CAUSES Smoking and/or usingsymptoms. In
POSSIBLE CAUSE Pyelonephritis, a bacterial infection of can bones
plenty of cold drinks. If your childthroughout the body become
is over 2 months
recreational drugs? probably the cause of your
an infection. Heat exposure can alsoabove
lead tothea raised
waist, (see B RINGING DOWN A FEVER , opposite). A high fever
analysis (opposite) to check whether there
damage. In some cases, surgery to stabilize times the a week – will also help; a wheelchair,
if intercourse orhim or her the recommendedweak.doseOsteoporosis is symptomless unless a recreational drugs can impair sperm
this condition, joints between the vertebrae in
238
a kidney, may be the cause of these symptoms. old, give of
temperature. A child with a fever will feeldogenerally unwell cause seizures (febrile convulsions) in young children. is a problem with
spine maythe bequantity
required.or quality of NOThe disorder is most common function or thereduce the progressively
production ofdamaged. This is
and you is less frequent, a coupleare may you over
miss the 60? If the fever doesn’t fracture
paracetamol. fall and occurs. spine are
ACTION Your doctor will examine you and arrangeyour for sperm. In some cases, a change in the in women who have passed the menopause. sperm in particularly
the testes. Consult
likely ifyour
you doctor.
are over 50 and you
feel generally a urine test. If an infection is confirmed, you will betreatment for the underlying condition may woman’s fertile days, which are usually yourmid-child is over 6 months old, give him
unwell with a Does your child wayhave
between periods. ConceptionNO isormost
her the recommended dose of
However, a prolonged period of immobility will ACTION Your are overweight.
doctor mayConsultarrangeyourfor doctor.
prescribed antibiotics. You may also need to have an improve sperm production.
Are you taking any any of the following? also lead to the development of osteoporosis. semen analysis (above). Try to stop
ACTION Your doctor may arrange for blood
temperature of abdominal ultrasound scan (p.217)YES or a contrast likely if intercourse occurs at this time. After as well. The doses of both
ibuprofen
Does your prescribed drugs? • Severe headache sexual intercourse, the woman should ACTION Initial treatment for the pain is with
lie can be repeated every 4 hours.
smoking tests
and/or andusing recreational
an X-ray (p.39) todrugs.
confirm the POSSIBLE CAUSE Tight-fitting underwear or
START 38°C (100°F) X-ray of the kidneys (seeWA R N I N G UROGRAPHY,
INTRAVENOUS drugs
Do you wear
YES Go to chart 15 RASH WITHp.227) FEVER to(p.78)
look for S E L F - H E L P Taking care of todown painkillers. Yourunderpants
doctor may also request bone diagnosis. Over-the-counter painkillers should trousers, saunas, and steam baths can increase
child have or above? NOan underlying cause. • Reluctance bendfor 10–15 minutes; this allows the
that are tight-fitting, or treatment for
HERE D maximum number of sperm to enter
Cooling
the
your child densitometry (below). Specific help to relieve your symptoms. If you arethe temperature within the scrotum. Raised
a rash?
NO
ANGER SIGNS Call an ambulance if your back
your the head forward Undress your child, lie him or her doin you usedepends
osteoporosis saunasonorthe underlying cause. overweight, it will help to lose weight (seetemperature HOW can reduce sperm production.
POSSIBLE
child has a fever that is associated with any of AND ACTION Some types of
CAUSE uterus. In addition, men should avoid YES that you
NO the following symptoms: prescribed drug, such as certain hormone • Dislike of bright lights YES
wearing tight-fitting underwear or trousers
a cool room, and sponge his or her However,
steam baths in all frequently?
cases, it is important TO LOSE WEIGHT SAFELY, p.151). Your doctor
ACTION Your chance of conception may be
Improving your posture andDrowsiness head and body with tepid water.try to remain active and take weight-bearing may refer you for physiotherapy to help you
• A seizure lasting more than 5treatments
minutes and immunosuppressants, • taking
may care to or because these garments may cause an exercise, suchNO as walking. strengthen the muscles that support the spine.
improved if you wear loose-fitting underwear
Does the •pain Flat, prevent reduce
dark red spots that do not on liftproduction.
fadesperm heavy objectsConsult
safely can
yourhelp you avoid
confusion Are you female made of natural fibres such as cotton, which
SEE YOUR DOCTOR WITHIN you fromonmoving,
pressure (see CHECKING A RED doctor.
RASH, p.79)In the
backmeantime,
problems.do not up
Stand stop takingand avoid
straight,
increase in the temperature within the
and pregnant? YES CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO allow air to circulate more freely. Discontinue
Continued
24 HOURS and/or • Abnormal
does
next page it shootdrowsiness YES your prescribedwearingdrugs.
high-heeled shoes. • Flat,
Be awaredark red
of your spotsand reduce sperm production.
scrotum MAKE A DIAGNOSIS FROM THIS CHART. use of any saunas or steam baths for a while.
t
down one• leg? A severe headache posture when sitting at a desk that (seedo notATfade on
SAFETY
NO
EMERGENCY!
Is your child
POSSIBLE CAUSE A viral or bacterial
infection of the middle ear is a possible
While waiting for medical help, follow the WORK, p.34), in a car, or at home. pressure (p.79)
You should Bone densitometry CALL AN AMBULANCE
advice
NO for bringing down a fever (p.77). have a supportive mattress on your bed.
complaining of earache, YES cause of your child’s symptoms.252 NO CAUSE Meningitis, 253
Regular gentle exercise may strengthen your This technique usesPOSSIBLE
low-intensity X-rays (p.39) inflammation
to measure During the procedure
and/or is he or she Did the pain Your doctor will examine your of the membranes surrounding
ACTION
abdominal and back the density of bone. X-rays are passed through thethe brain
body, The X-ray generator and detector move
tugging at either ear? YES is confirmed, he or
Continuation box
come on after muscles and help POSSIBLE CAUSE Gastroenteritis, inflammation and their absorption is interpreted by a computer and along the length of the spine, and
NO lifting she may prescribe painkillers and/or
a heavy POSSIBLE CAUSE AND CALL
antibiotics. You can also try self-help
ACTIONYOUR DOCTOR
You have NOW
probably Upper body you lose any of the digestive tract, usually due todisplayed
such symptoms.
a viral as an image. The computer information is displayed on a monitor.
or afterfor relieving earache strained
object measures (p.103).
some of the muscles and/or ligaments in
POSSIBLE CAUSE A condition such as croup,straight Does your
excess child
weight. infection, is the most likely cause of diarrhoea ACTION If meningitis is suspected, your child
calculates the average bone density and X-ray detector
undertaking your back. Follow self-help measures for relieving
in which the throat becomes swollen and have diarrhoea? YES CONSULT YOUR
with DOCTOR IF YOU
a fever. Your compares it withwill
child may also vomit. the be admitted to hospital immediately. He
back pain (opposite). If pain is severe or no better ARE UNABLE TO MAKE A DIAGNOSIS or she will be given urgent treatment with
an unusually narrowed due to a viral infection, is possible.
General
within 48 hours, consult your doctor. FROM THIS A CTIONAND
CHART Follow
YOURthe self-help measures
BACK normal
for range forantibiotics
the
Lifting safely and may need intensive care.
strenuous ACTION Your doctor may give your child an NO preventing
PAIN IS SEVERE dehydration
OR IF THE NATURE in children person’s
(p.123) age and sex.
Bend your knees Monitor
exercise? inhaled corticosteroid drug to ease his or her and treating
OF LONG - STANDING BACKgastroenteritis
PAIN in children
The(p.118).
procedure takes
Does your child have Does your child have when you pick
breathing. You should also try self-help If your child
SUDDENLY CHANGES . has diarrhoea for moreabout
than 20 minutes
YES
a cough and/or a noisy breathing and/or YES
NO measures for relieving a cough (p.108). If your
up an object,
and keep your
24 hours, call your doctor. and is painless.
runny nose? a barking cough? child’s symptoms are severe, he or she may
medical help
backyour
straight
adults’
NO spine flat
disc (a ruptured disc of cartilage between the vertebrae)
that is irritating a nerve where it leaves the spinal cord. Object
SEE YOUR DOCTOR WITHIN 24 HOURS
Your doctor may recommendSELF-H either Taking your
E L Pphysiotherapy or directly in X-ray beam
POSSIBLE CAUSES Pharyngitis or tonsillitis, an
manipulation of the spine. If the temperature
pain is severe, you may front of you
child’s Go to chart 147 BACK PAIN IN X-ray generator infection of the throat or the tonsils, are the
Continued on have MRI (p.41) to confirm the diagnosis. In some most likely causes. The infection may be due
next page cases, surgery may be needed. Does your child have PREGNANCY (p.284)
to a bacteria or a virus.
CALL YOUR DOCTOR NOW A convenient method of taking your child’s any of the following?
charts
which is placed in the ear. You can also use POSSIBLE CAUSE Your child may have a urinary
238 pneumonia (infection of the air spaces in the a standard thermometer placed in the • Frequent passing of tract infection (p.126).
the diagnosis. He or she may prescribe 239
lungs) is possible. armpit or in the mouth. Do not put a glass urine antibiotics for the infection. You can also try
Is your child’s ACTION If your doctor confirms the diagnosis,
YES ACTION Your doctor will test a sample of your self-help measures for soothing your child’s
breathing faster YES thermometer in the mouth of a child aged • Bedwetting or child’s urine. If the diagnosis is confirmed, a sore throat (p.107).
he or she will probably prescribe antibiotics under 7. For the correct result, add 0.6 C o
daytime wetting after urine sample will be sent for analysis, and
than normal? See and may arrange for a chest X-ray (p.39). o
(1 F) to a reading from the armpit.
CHECKING YOUR Take steps to reduce your child’s temperature being dry your child will be prescribed antibiotics. In
some cases, further tests, such as ultrasound
CHILD’S BREATHING (see BRINGING DOWN A FEVER, opposite), and Thermometer • Offensive-smelling or scanning (see INVESTIGATING THE URINARY
make sure he or she drinks plenty of fluids. cloudy urine
Children’s
POSSIBLE CAUSE Overheating, leading to a rise
POSSIBLE CAUSES Many viral infections, such Has your child been in body temperature, is the most likely cause.
as a cold, can cause a cough and runny nose. exposed to hot sunshine
YES ACTION Take steps to reduce your child’s
ACTION Take steps to reduce your child’s or high temperatures? temperature by removing any excess clothing
charts
next page there is no improvement within 48 hours. THIS CHART. down a fever (above) and call your doctor.
76 77
matching colour to tell you where say whether to call an ambulance or how
to pick up the pathway quickly to get in touch with your doctor
44
SYMPTOM CHARTS
Continued from
previous page Are you over 50?
NO
YES SELF-HELP
back pain
Relieving
Knees raised
to keep the
spine flat
Drug treatments
If a type of drug, such a painkiller or sleeping drug,
X-ray beam
is in italic typeface, additional information can be
Go to chart 147 BACK PAIN IN X-ray generator found in the A–Z of drugs (pp.305–310)
PREGNANCY (p.284)
239
45
SYMPTOM CHARTS
CHARTFINDERS
To help you find the chart you need, the charts have been identify your symptom, you should use the symptom-by-
listed here in two ways. The system-by-system chartfinder symptom chartfinder (p.48). This alphabetical list covers
(below) groups the symptom charts under the affected all the symptoms in the book and can direct you to the
body part or process, such as ear and hearing symptoms page of the right chart. In addition, the contents (pp.6–7)
or pregnancy and childbirth symptoms. You should use has a complete list of the symptom charts, and, at the
this chartfinder if you know the affected body system but start of each group of charts, such as charts for children,
cannot clearly define your symptom. However, if you can there is a list of the charts in that group.
System-by-system chartfinder
GENERAL (WHOLE-BODY) BONE, JOINT, AND MUSCLE NOSE AND THROAT SYMPTOMS
SYMPTOMS SYMPTOMS
31 Runny or blocked nose
2 Excessive crying (babies)............... 52 47 Painful arm or leg (children).... 133 (children)............................................ 106
3 Fever in babies. ................................... 54 48 Joint and back problems 32 Sore throat (children)................... 107
6 Feeding problems (children)............................................ 134 33 Coughing (children)...................... 108
(babies).................................................. 60 49 Foot problems (children)............ 136 87 Runny or blocked nose............... 194
9 Feeling generally unwell 50 Limping (children)......................... 138 88 Sore throat........................................ 195
(children).............................................. 66 110 Painful joints.................................... 228 89 Hoarseness or loss of voice....... 196
10 Tiredness (children)......................... 68 111 Painful shoulder............................. 230 91 Coughing........................................... 198
14 Fever in children............................... 76 112 Painful arm....................................... 231
15 Rash with fever 113 Painful leg......................................... 232
(children).............................................. 78 HEART AND LUNG SYMPTOMS
114 Painful knee...................................... 234
19 Lumps and swellings
115 Swollen ankles................................ 235
(children).............................................. 85 34 Breathing problems
116 Foot problems................................. 236 (children)............................................ 110
37 Eating problems
(children)............................................ 116 117 Back pain........................................... 238 90 Wheezing............................................ 197
56 Feeling unwell.................................. 146 118 Painful or stiff neck...................... 240 92 Shortness of breath....................... 200
57 Tiredness............................................ 147 93 Chest pain......................................... 202
61 Fever.................................................... 154 94 Palpitations....................................... 204
SKIN, HAIR, AND NAIL SYMPTOMS
62 Excessive sweating........................ 156
74 Lumps and swellings.................... 174 8 Skin problems in babies................ 64
80 Rash with fever............................... 184 15 Rash with fever (children)........... 78 BRAINAND NERVOUS SYSTEM
16 Skin problems in children............ 80 SYMPTOMS
46
SYMPTOM CHARTS
68 Twitching and/or trembling...... 166 36 Teeth problems (children).......... 114 123 Testes and scrotum
69 Pain in the face................................ 167 38 Vomiting in children..................... 118 problems............................................ 248
70 Difficulty in speaking................... 168 39 Abdominal pain (children)........ 120 124 Painful intercourse in men........ 249
47
SYMPTOM CHARTS
Symptom-by-symptom chartfinder
Page No. Excessive sweating......................... 156 Nausea and vomiting in Shoulder, painful............................ 230
A Excessive weight gain, in children... 74 pregnancy................................... 278 Skin
Abdomen, swollen......................... 218 Eye Neck, painful or stiff...................... 240 changes in pregnancy................. 282
Abdominal pain............................. 214 painful or irritated..................... 186 Nose, runny or blocked................. 194 discoloration and moles............. 182
in children.................................. 120 problems, in children................... 98 in children.................................. 106 general problems........................ 178
lower, in women........................ 269 Numbness and/or tingling.............. 163 itching......................................... 175
in pregnancy............................... 281 Overweight..................................... 150 itching, in children....................... 84
recurrent..................................... 216 F problems, in adolescents............ 144
Anal problems................................ 223 Face problems affecting the face........ 180
Ankles, swollen.............................. 235 pain in........................................ 167 P problems, in babies...................... 64
in pregnancy............................... 283 skin problems affecting.............. 180 Pain problems, in children................... 80
Anxiety........................................... 172 Faeces, abnormal-looking.............. 222 abdominal.................................. 214 rash with fever........................... 184
Appetite, loss of, in children.......... 116 in children.................................. 125 abdominal, in children............... 120 rash with fever, in children.......... 78
Arm, painful................................... 231 Fainting.......................................... 160 abdominal, in pregnancy........... 281 Sleeping problems
in children.................................. 133 in children.................................... 86 abdominal, recurrent................. 216 in babies....................................... 50
Feeding problems, in babies............ 60 arm............................................. 231 in children.................................... 70
Feeling unwell................................. 146 arm, in children.......................... 133 difficulty in sleeping................... 152
B in children.................................... 66 back............................................ 238 Sore throat...................................... 195
Back pain....................................... 238 Fertility problems back, in children........................ 134 in children.................................. 107
in children.................................. 134 in men........................................ 252 back, in pregnancy..................... 284 Speaking, difficulty in.................... 168
in pregnancy.............................. 284 in women................................... 274 chest........................................... 202 Speech difficulties, children............. 93
Back problems, in children............ 134 Fever............................................... 154 ear............................................... 193 Spots, in children............................. 80
Behaviour problems in babies....................................... 54 ear, in children............................ 102 Swallowing, difficulty in................ 209
in adolescents............................. 140 in children.................................... 76 eye.............................................. 186 Sweating, excessive......................... 156
in children.................................... 94 rash with.................................... 184 face............................................. 167 Swellings......................................... 174
Bladder control problems rash with, in children................... 78 headache..................................... 158 in children.................................... 85
in men........................................ 242 Foot problems................................ 236 headache, in children................... 88 Swollen abdomen........................... 218
in women................................... 258 in children.................................. 136 during intercourse, in men......... 249 Swollen ankles................................ 235
Bleeding Forgetfulness.................................. 164 during intercourse, in women.... 270 in pregnancy............................... 283
from anus................................... 223 joint............................................ 228
from nose................................... 194 joint, in children.........................134
vaginal, irregular........................ 264 G–I knee............................................ 234 T
vaginal, in pregnancy................. 280 Genital irritation, women.............. 268 leg............................................... 232 Teeth problems............................... 206
Blocked nose.................................. 194 Genital problems leg, in children............................133 in children.................................. 114
in children.................................. 106 in boys........................................ 130 lower abdominal, in women...... 269 Testes problems.............................. 248
Breast problems.............................. 256 in girls........................................ 132 neck............................................ 240 Throat, sore.................................... 195
and pregnancy............................ 286 Growth problems, in children......... 72 period......................................... 263 in children.................................. 107
Breath, shortness of....................... 200 Hair problems................................ 176 shoulder...................................... 230 Tingling........................................... 163
Breathing problems, in children..... 110 in children.................................... 82 during urination......................... 226 Tiredness......................................... 147
Headache........................................ 158 Palpitations..................................... 204 in children.................................... 68
in children.................................... 88 Penis problems............................... 244 Toilet-training problems................ 128
C Hearing problems........................... 190 in boys........................................ 130 Tongue, sore................................... 208
Chest pain...................................... 202 in children.................................. 104 Periods Twitching and/or trembling............ 166
Clumsiness, in children.................... 92 Hoarseness..................................... 196 absent......................................... 260
Confusion....................................... 164 Impaired vision.............................. 188 heavy.......................................... 262
in children.................................... 90 in children.................................. 100 painful........................................ 263 U–W
Constipation................................... 221 Intercourse, painful Pregnancy Urinary problems........................... 224
in children.................................. 124 in men........................................ 249 abdominal pain in..................... 281 bladder control problems in
Contraception choices in women................................... 270 back pain in............................... 284 men........................................ 242
for men....................................... 254 Irregular vaginal bleeding.............. 264 breast problems and.................. 286 bladder control problems
for women.................................. 276 Irritated ear, in children................. 102 nausea and vomiting in.............. 278 in women............................... 258
Coughing....................................... 198 Irritated eye.................................... 186 onset of labour........................... 285 in children.................................. 126
in children.................................. 108 Itching............................................. 175 skin changes in........................... 282 painful urination........................ 226
Crying, excessive, in babies............. 52 in children.................................... 84 swollen ankles in........................ 283 Vaginal bleeding
vaginal bleeding in..................... 280 irregular...................................... 264
weight problems and................. 279 in pregnancy............................... 280
D–E J–L Puberty, problems with Vaginal discharge, abnormal......... 266
Depression...................................... 170 Joint problems, in children............ 134 in boys........................................ 142 Vaginal irritation............................ 268
after childbirth........................... 288 Joints, painful................................ 228 in girls......................................... 143 Vaginal problems in girls............... 132
Diarrhoea....................................... 220 Knee, painful.................................. 234 Vision, disturbed or impaired........ 188
in babies....................................... 58 Labour, recognizing onset of......... 285 in children.................................. 100
in children.................................. 122 Leg, painful.................................... 232 R–S Voice, loss of.................................. 196
Disturbed vision............................. 188 in children.................................. 133 Rash with fever.............................. 184 Vomiting......................................... 210
in children.................................. 100 Limping, in children....................... 138 in children.................................... 78 in babies....................................... 56
Disturbing thoughts and feelings... 169 Loss of voice................................... 196 Rashes, in children........................... 80 in children.................................. 118
Dizziness......................................... 162 Loss of weight................................ 148 Runny nose..................................... 194 in pregnancy............................... 278
in children.................................... 86 Lumps............................................. 174 in children.................................. 106 recurrent..................................... 212
Drowsiness, in children.................... 90 in children.................................... 85 Scalp problems............................... 176 Weight
Ear in children.................................... 82 excessive gain, in children........... 74
noises in...................................... 192 School difficulties............................. 96 loss of......................................... 148
painful or irritated, in children.. 102 M–O Scrotum problems.......................... 248 overweight.................................. 150
Earache........................................... 193 Moles.............................................. 182 Seizures, in children......................... 86 problems, in adolescents............ 139
Eating problems, in children.......... 116 Mouth problems............................ 208 Sex drive, low problems and pregnancy............ 279
Ejaculation problems..................... 247 in children.................................. 112 in men........................................ 250 slow gain, in babies..................... 62
Erection difficulties........................ 246 Nail problems................................. 185 in women................................... 272 Wheezing........................................ 197
Excessive crying, in babies............... 52 in children.................................... 82 Shortness of breath........................ 200 Wind............................................... 219
48
CHILDREN
CHARTS FOR
CHILDREN
49
CHILDREN: BABIES UNDER ONE
50
CHILDREN: BABIES UNDER ONE
Continued from
previous page POSSIBLE CAUSES You may find that sharing SELF-HELP Helping older
a room with your baby results in disturbed
nights for both you and your baby. The babies to sleep
problem may be that you make sounds that
disturb your baby. However, it is more likely Babies older than about 4 months are past
that you will be overaware of your baby’s the stage of needing frequent night feeds
movements during sleep and may think that and benefit from a bedtime routine. It is best
the little noises that babies often make in their
to be consistent and firm, but this should not
sleep are signs of wakefulness. Many babies
are restless sleepers and, if left undisturbed, prevent bedtimes from being fun. Your baby
Does your baby sleep in needs reassurance that separation from you
the same room as you? YES will continue to sleep.
at bedtime is not a punishment. Here are
ACTION If possible, move your baby into
NO some tips for problem-free nights:
a different room. It is unlikely that you would
fail to hear a true cry, but you are not so likely • Avoid too much excitement in the hour
to be disturbed by less urgent sounds. or so before bed.
• Provide a night-light if your baby seems
frightened of the dark.
• Do not be too ready to go to your baby
if you hear whimpering in the night. He
or she may be making noises while asleep.
Is your baby waking Does your baby seem • If your baby cries at night, settle him
YES or her as quickly and quietly as possible.
repeatedly at night after YES unwell in any way?
previously sleeping well?
NO
NO
POSSIBLE CAUSES AND ACTION If your baby has
specific symptoms, such as fever, diarrhoea,
or vomiting, consult the relevant chart in this
book. If there are no specific symptoms but
your baby continues to seem unwell, you
should contact your doctor.
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART.
Could your baby be
waking because he or
YES POSSIBLE CAUSE AND ACTION As your baby
she is hungry? grows, he or she will need more food.
SELF-HELP Reducing the Increasing feeds in the evening may stop your
NO
risk of SIDS baby waking at night. Alternatively, you may
need to start weaning your baby (p.63) if you
There are things you can do to reduce the have not already done so. Consult your doctor
risk of sudden infant death syndrome (SIDS), or health visitor for advice.
also known as cot death. They are:
• Always put your baby to sleep on his or Could your baby be
her back near the foot of the cot. This
too cold or hot during
position is the safest, since he or she YES POSSIBLE CAUSE Being too hot or cold may
the night? be causing your baby to wake in the night.
cannot wriggle under the bedclothes.
• Use a firm mattress with no pillow. NO ACTION Try to keep the temperature in your
• Do not overwrap your baby in bedclothes. baby’s room at about 18°C (65°F). Your baby
• Do not place your baby’s cot close to a should need no more covers than you would
radiator or other type of heater. in similar circumstances. Letting your baby get
too hot may increase the risk of sudden infant
• Do not smoke in the presence of your baby. death syndrome, or SIDS (left). If your baby
kicks off the bedclothes and gets cold, try
Place baby on
his or her back Has there been any dressing him or her in a sleep suit at night.
recent domestic
Firm YES
mattress upheaval or possible
cause of anxiety?
POSSIBLE CAUSE Babies sense anxiety or stress
NO in their parents and can be disturbed by it.
ACTION It may take some time to reassure your
baby. If you can, try to keep your baby’s routine
as stable as possible, even if your own life is
unsettled. When your baby wakes at night,
POSSIBLE CAUSE AND ACTION A need for the offer a drink and a cuddle, but make sure that
reassurance of your presence is the most your baby understands that he or she will be
Sleeping safely
common explanation for waking at night put back in the cot; otherwise, there is a danger
Lay your baby down on his or her back at
when a baby is past the stage of needing that the baby will get into the habit of waking
the foot of the cot, so that bedding cannot during the night and expecting to play (see
night feeds. Try to stick to a bedtime routine
cover the face. Do not overwrap the baby. (see HELPING OLDER BABIES TO SLEEP, above). HELPING OLDER BABIES TO SLEEP, above).
51
CHILDREN: BABIES UNDER ONE
2 Excessive crying
Crying is a young baby’s only means of communicating causes of their baby’s crying and are usually able to deal
physical discomfort or emotional distress. All babies with them according to need. You should consult this chart
sometimes cry when they are hungry, wet, upset, or in pain, if your baby cries more often than you think is normal or if
and some babies occasionally cry for no obvious reason. your baby suddenly starts to cry in an unusual way. In some
Most parents soon learn to recognize the most common cases, you may be advised to seek medical help.
Continued on
next page
52
CHILDREN: BABIES UNDER ONE
Continued from
previous page Does your baby seem POSSIBLE CAUSE Colic is the term often used
content for most of to describe this common type of crying. It
the day but cry a great YES usually starts when a baby is about 6 weeks
old and ceases by the age of 4 months. The
deal during the late precise cause of colic is not known.
afternoon and evening?
ACTION There is no effective cure for colic.
NO However, some self-help measures may give
you and your baby temporary relief (see
DEALING WITH COLIC, opposite). The main
Is your baby under priority for parents is to find a way of coping
4 months old? YES
with a constantly crying baby (see COPING
WITH CRYING, opposite).
NO
53
CHILDREN: BABIES UNDER ONE
3 Fever in babies
For children over 1, see chart 14, FEVER IN CHILDREN (p.76). (see TAKING YOUR BABY’S TEMPERATURE, below). A high fever
A fever is an abnormally high body temperature of 38ºC may cause a baby to have a seizure, which is a medical
(100ºF) or above. A baby that has a fever will have a hot emergency (see FEBRILE CONVULSIONS IN BABIES AND CHILDREN,
forehead and is likely to seem unhappy and fretful. If you opposite). If your baby has a fever, take steps to reduce it
think your baby may be unwell, take his or her temperature (see BRINGING DOWN A FEVER, p.77), and consult this chart.
54
CHILDREN: BABIES UNDER ONE
t
Continued from EMERGENCY!
previous page
CALL AN AMBULANCE
Fever after immunizations
POSSIBLE CAUSE Meningitis, inflammation of Some babies and young children develop a
the membranes surrounding the brain due to mild fever after an immunization. Routine
infection, may be the cause of these symptoms. immunizations (p.37) are usually given at
Does your baby have ACTION If meningitis is suspected, your baby the ages of 2, 3, 4, and 12–15 months.
YES will be admitted to hospital immediately. He If your child develops a fever after an
any of the following?
or she will be given urgent treatment with immunization, you should follow the self-
• Abnormal drowsiness antibiotics and may need intensive care. help advice for reducing his or her fever (see
• Restlessness BRINGING DOWN A FEVER, p.77). Call your doctor
• A high-pitched or immediately if your child’s temperature rises
abnormal cry above 39ºC (102ºF) or if he or she has other
symptoms, such as an unusual or high-
• Flat, dark red spots
pitched cry. You should also call your doctor
that do not fade on CALL YOUR DOCTOR NOW
if self-help measures are not successful in
pressure (p.79)
POSSIBLE CAUSE Gastroenteritis, an infection reducing your child’s temperature.
NO of the digestive system, is the most likely If your child has been unwell after having an
cause of these symptoms, especially if your immunization, mention it to your doctor or
baby is also vomiting. health visitor before the next immunization is
ACTION Your doctor will check whether due. He or she can advise you on how to deal
your baby is dehydrated. He or she may also with any symptoms that may develop.
give you advice on preventing dehydration in If your child has a fever at the time when
Does your baby have babies (p.59) and self-help measures for
diarrhoea? YES an immunization is due, it should be
treating gastroenteritis in babies (p.57).
postponed until he or she is better.
NO
POSSIBLE CAUSE Some babies may feel POSSIBLE CAUSE Overheating, caused by too
Has your baby been uncomfortable or have a mild fever in the
YES much clothing or by being in excessively warm
immunized recently? week after a routine immunization (p.37). surroundings, can result in a fever.
NO ACTION Follow the advice for dealing ACTION A baby does not need to wear much
with fever after immunization (right). more clothing than an adult would in similar
conditions and will be comfortable in a room
temperature of 15–20ºC (60–68ºF). A baby’s
cot should never be placed next to a radiator.
Remove any excess clothing and move the
Is your baby very baby to a slightly cooler (though not cold)
YES
warmly dressed, and/or place. If your baby’s temperature is not down
is he or she in warm to normal within an hour, follow the advice
surroundings? for reducing a fever (p.77) and call your doctor.
SEE YOUR DOCTOR WITHIN 24 HOURS IF YOU
NO ARE UNABLE TO MAKE A DIAGNOSIS FROM
THIS CHART.
A febrile convulsion is a type of seizure that within 6 months. Most affected children stop
affects some children aged 6 months to 5 having convulsions at about 5 years of age.
years. It is triggered by an abrupt rise in body Febrile convulsions are rarely an indication of
temperature, often at the onset of a feverish epilepsy in later life.
illness. During a convulsion, the child may: Convulsions may be avoided by keeping your
• Lose consciousness child’s temperature down (see BRINGING DOWN A
• Shake or jerk violently FEVER, p.77). If he or she does have a febrile
• Stop breathing temporarily or breathe convulsion, remove excess clothes, try to reduce
shallowly, which may result in a bluish tinge his or her temperature by sponging with tepid
to the skin water, and surround him or her with soft objects, Cooling
• Pass urine and/or faeces such as pillows, to prevent injury. your child
• Roll back his or her eyes After the seizure has finished, place your child If your child has
Febrile convulsions usually last for less than in the recovery position (p.292). He or she may a febrile convulsion,
5 minutes and, although frightening, are not fall asleep shortly afterwards. Call your doctor if remove clothing and
often serious. About a third of children who your child has a convulsion. If it lasts more than bedcovers to cool
have had a febrile convulsion have another one 5 minutes, call an ambulance. him or her down.
55
CHILDREN: BABIES UNDER ONE
4 Vomiting in babies
For children over 1 year, see chart 38, VOMITING IN the effortless bringing up of small amounts of milk. Almost
CHILDREN (p.118). any minor upset can cause a baby to vomit once, and this
In young babies, it is easy for parents to confuse vomiting, is unlikely to be a cause for concern. However, persistent
which may indicate an illness, with regurgitation (posseting), vomiting in babies can be a sign of an underlying problem.
56
CHILDREN: BABIES UNDER ONE
Continued from
previous page SELF-HELP Treating gastroenteritis in babies
Gastroenteritis does not need treatment with
drugs such as antibiotics; giving rehydrating
solutions will prevent dehydration (p.59) and
aid recovery. If your baby is breast-fed, you
should gradually reduce the amount of
rehydrating solution given as he or she gets
better. If your baby is bottle-fed, give only
rehydrating solutions at first, then on the
Does your baby second day give feeds that are half rehydrating
YES
have a cough? solution half milk. Gradually return to normal
feeding over the next 24 hours. If, at any stage, Giving rehydrating solutions
NO diarrhoea recurs, temporary lactose intolerance Rehydrating solutions should be prepared with
(p.122) may be the cause. Go back to giving cooled, boiled water and can be flavoured to
rehydrating solutions, and call your doctor. encourage the baby to drink.
Is your baby’s
vomit yellowish- YES
green? t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Intussusception, in which the
NO intestine telescopes in on itself, causing an
Does the vomiting only obstruction, is a possibility.
occur during or after YES ACTION Your baby will probably be admitted
travel in a vehicle? to hospital, where he or she can be fully
examined and an exact diagnosis made.
NO Treatment for intussusception usually involves
an enema to force the displaced intestinal
tissue back into the right position. If the enema
Pyloric stenosis is not successful, surgery will be necessary.
57
CHILDREN: BABIES UNDER ONE
5 Diarrhoea in babies
For children over 1 year, see chart 40, DIARRHOEA IN faeces up to 6 times a day, and this situation should not be
CHILDREN (p.122). mistaken for diarrhoea. If your baby does have diarrhoea,
Diarrhoea is the frequent passing of abnormally loose or give him or her plenty of fluids to prevent dehydration (see
watery faeces. It is normal for a breast-fed baby to pass soft PREVENTING DEHYDRATION IN BABIES, opposite).
58
CHILDREN: BABIES UNDER ONE
Continued from
previous page Babies’ faeces
The first faeces that a baby passes are known orange-yellow, like mustard, and there may
as meconium, which is a sticky greenish-black be visible mucus. They may smell of sour milk.
substance consisting mainly of mucus and bile. Bottle-fed babies pass bulkier and more
Within a day or two, the faeces change to a substantial faeces than breast-fed babies.
greenish-brown colour, then settle to a regular The faeces are usually light brown and smell
Has your baby recently colour. Most babies pass faeces several times strongly, rather like the faeces of an adult.
started on solid foods, a day, although some can go for a few days Green faeces are a sign that food has passed
or have you introduced without passing any. As long as your baby through the intestines very rapidly. For a breast-
new foods into his or seems well, there is probably nothing wrong. fed baby, green faeces may be normal, but in a
her diet? YES
Breast-fed babies can pass faeces very bottle-fed baby, such faeces may result from a
NO frequently. The faeces are very soft and usually gastrointestinal infection.
59
CHILDREN: BABIES UNDER ONE
6 Feeding problems
For children over 1, see chart 37, EATING PROBLEMS (p.116). hungry crying, and swallowing too much air, leading
Feeding problems are a common source of irritability and to regurgitation. There may also be special problems for
crying in young babies as well as concern in their parents. mothers who are breast-feeding. This chart deals with most
Such problems may include a reluctance to feed, constant of the common problems that may arise.
START Is your baby Does your baby POSSIBLE CAUSES Reluctance to feed is most
YES YES
reluctant to normally feed well? often due to a minor illness, such as a cold.
HERE
take feeds? NO However, if it persists, it may also be caused
by a more serious illness. Young babies who
NO refuse to feed may become dehydrated. Call
your doctor immediately if your baby is under
3 months old and has refused feeds for more
than 3 hours, or is over 3 months old and has
refused feeds for more than 6 hours.
ACTION Your doctor will examine your baby
Is your baby to exclude an underlying illness. If a cold is
YES POSSIBLE CAUSE AND ACTION Some babies, like the problem, your doctor may advise you to
gaining weight at some adults, eat less than others. Providing clean your baby’s nostrils, which may help
the expected rate that your baby is happy, alert, and gaining him or her to breathe while feeding.
(see GROWTH weight at the expected rate, there is no cause
CHARTS, p.26)? for you to be concerned.
NO
NO
60
CHILDREN: BABIES UNDER ONE
Have you given your POSSIBLE CAUSE Babies are often not keen
to move on to solid food, and this is not
baby a new food a cause for concern. SEE YOUR DOCTOR WITHIN 24 HOURS
recently? YES
ACTION Initially, try giving your baby POSSIBLE CAUSE Gastro-oesophageal reflux, in
NO small amounts of solid food once a day. which the stomach contents leak back into the
Make sure the food is smooth and not too oesophagus, may be the cause. However, if the
thick. Gradually provide a wider variety of symptoms only occur occasionally, they may
tastes (see WEANING YOUR BABY, p.63). be due to wind (see DEALING WITH WIND, p.53).
POSSIBLE CAUSE It is not uncommon for
ACTION Your doctor will examine your baby
older babies to suddenly take a dislike to
to exclude other causes. You may be advised
a food they previously ate happily. This
POSSIBLE CAUSES Your baby may dislike the to put your baby to sleep on his or her side
is normal and not a cause for concern.
new texture or taste of the food. He or she with the head higher than the feet. If your baby
ACTION Try to vary your baby’s diet, and may also be less willing to eat something new is old enough, spending more time sitting in a
gradually introduce a wider variety of if he or she is tired. baby chair may help, as will thickening his or
tastes and textures. If your baby refuses her feeds with cornflour or carob-seed
to eat one particular food, stop offering ACTION Stop giving your baby the new powder. Your doctor may also suggest a drug
it to him or her, and reintroduce it at a food for a while. Try it again at a later date, that increases the muscular activity of the
later date. However, if you are concerned, preferably at breakfast time when your baby oesophagus. Most babies grow out of this
consult your doctor or health visitor. is less likely to be tired. condition by the age of 1.
61
CHILDREN: BABIES UNDER ONE
62
CHILDREN: BABIES UNDER ONE
63
CHILDREN: BABIES UNDER ONE
START
HERE
Does your
baby have a
rash of dark
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Meningitis, inflammation of
red spots that the membranes surrounding the brain due to
do not fade infection, may be the cause of this type of rash
on pressure Are all areas of the in a baby who is unwell.
YES
(p.79)? body affected? ACTION If meningitis is suspected, your baby
will be admitted to hospital immediately. He
NO NO
or she will be given urgent treatment with
antibiotics and may need intensive care.
64
CHILDREN: BABIES UNDER ONE
Continued from
previous page POSSIBLE CAUSE Your baby may have cradle Newborn skin
cap, a form of seborrhoeic dermatitis. It is a
common, harmless condition.
A newborn baby’s skin is very delicate and
ACTION You can soften the crusts by rubbing easily irritated. Do not use soap or wipes to
your baby’s scalp with baby or olive oil at clean your baby until he or she is at least
night and then washing off the crusts the next
morning. Alternatively, special shampoos to 6 weeks old because these can dry the skin.
treat the condition are available over the Water is usually sufficient for cleansing the
counter. However, the condition usually clears nappy area, and a few drops of baby oil in
Does your baby have up by itself within a few weeks. If it does not the bath water will help avoid dry skin.
YES or if you are concerned, consult your doctor.
yellowish-brown There are several harmless skin problems
crusts on the scalp? that commonly affect babies. These include:
NO
• Blotchy skin partly due to blood vessels
being visible because there is little fat below
the skin and partly because circulation is
not mature, resulting in uneven blood flow.
POSSIBLE CAUSE Your child may have atopic • Milia – white spots on the nose and cheeks
eczema, an allergic condition. This diagnosis is caused by blocked sebaceous glands in the
most likely if any other family members also skin. The spots clear up without treatment
suffer from eczema or other allergic conditions. within the first couple of weeks.
Does your baby have a Consult your doctor.
YES • Peeling or flaking skin on the hands and
red, itchy rash on the ACTION If the diagnosis is confirmed, your feet. Gently rub emollient lotion into
face, inside the elbows, doctor will advise you on dealing with atopic the affected areas.
or behind the knees? eczema (p.80). He or she may also prescribe a
corticosteroid cream. If the rash is widespread • Urticaria – a rash of spots with a white
or weepy, your child should see the doctor centre and red halo, which clears up
NO
within 24 hours. Many children with atopic quickly without treatment.
eczema grow out of it by the age of 8. • Heat rash – small red spots, often on the
face and chest. Make sure that your baby
is not too warm. No treatment is needed.
NO
SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE A skin infection with the
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
fungus that causes thrush is a possibility. It
MAKE A DIAGNOSIS FROM THIS CHART.
may accompany nappy rash and oral thrush.
ACTION Your doctor will probably prescribe
an antifungal cream and will possibly also
prescribe a corticosteroid cream.
SELF-HELP Nappy rash
Nappy rash affects most babies at some • Change your baby’s nappy often.
time. It is particularly common after diarrhoea • Make sure that you dry the creases in
but can also develop if the skin becomes your baby’s skin thoroughly.
irritated from wearing a wet or soiled nappy • Apply a water-repellent cream such as POSSIBLE CAUSE Your baby probably has nappy
for a long time. You can help clear up your zinc and castor oil or petroleum jelly. rash, which affects most babies at some time,
particularly when they have diarrhoea. Some
baby’s nappy rash by following these steps: • If you use cloth nappies, make sure they babies seem more susceptible than others.
• Leave your baby to play without wearing are thoroughly rinsed, and avoid using
a nappy as often as possible – preferably biological detergents. ACTION Follow the advice on treating nappy
at least once a day. Consult your doctor if the rash becomes rash (left). If the rash does not clear up within
a few days or if it becomes worse, consult your
• Wash the baby’s nappy area with water, blistery, weepy, or ulcerated or if it does not
doctor, who may prescribe a corticosteroid
dry it carefully, and avoid scented wipes. clear up within a few days.
cream to reduce the inflammation.
65
CHILDREN: ALL AGES
or chart 14 FEVER IN CHILDREN (p.76) POSSIBLE CAUSE Your child may have an
infectious disease, such as measles.
Go to chart 15 RASH WITH FEVER (p.78)
Has your child been
vomiting and/or had
diarrhoea? YES
NO
POSSIBLE CAUSES Abdominal pain may occur
in a child for a variety of reasons.
Go to chart 39 ABDOMINAL PAIN (p.120) POSSIBLE CAUSE A digestive upset is the most
likely cause of these symptoms. It may be the
result of an infection such as gastroenteritis.
Does your child
YES
complain of stomach Go to chart 4 VOMITING IN BABIES (p.56)
ache or cry and draw Does your child have
up his or her legs? two or more of the or chart 5 DIARRHOEA IN BABIES (p.58)
following symptoms?
NO or chart 38 VOMITING IN CHILDREN (p.118)
• Unexplained weight
loss YES or chart 40 DIARRHOEA IN CHILDREN
• Increased thirst (p.122)
• Passing more urine
than usual
• Excessive tiredness
NO
Does your child have
any of the following?
SEE YOUR DOCTOR WITHIN 24 HOURS
• Pain on passing urine
• Frequent passing of POSSIBLE CAUSE These symptoms may be due
YES SEE YOUR DOCTOR WITHIN 24 HOURS to diabetes mellitus. This condition is caused
urine by insufficient production of the hormone
• Bedwetting or daytime POSSIBLE CAUSE Your child may have a insulin, which is needed by the body to get
wetting after being dry urinary tract infection (p.126). energy from sugar and carbohydrate foods.
• Offensive-smelling or ACTION Your doctor will test a sample of your ACTION Your doctor will take blood and urine
cloudy urine child’s urine. If the diagnosis is confirmed, a samples to check your child’s blood sugar level.
urine sample will be sent for analysis, and your If the diagnosis is confirmed, your child will
NO child will be prescribed antibiotics. In some probably need insulin injections for life. He
cases, further tests, such as ultrasound scanning or she will be taught how to inject the insulin
(see INVESTIGATING THE URINARY TRACT IN and monitor his or her blood sugar level. Your
Continued on CHILDREN, p.127), may be needed to look for doctor will also advise you on your child’s diet
next page any associated problems. and lifestyle (see DIABETES MELLITUS, p.149).
66
CHILDREN: ALL AGES
Continued from
previous page SELF-HELP Encouraging your child to drink
If your child is unwell, it is better to concentrate Eating ice lollies
on encouraging him or her to drink rather than If your child is
worrying about a poor appetite. The following reluctant to drink,
measures may encourage your child to drink: offer him or her
an alternative
• Offer him or her interesting drinks, such as
Is your child refusing fruit-flavoured squashes, rather than plain water. such as a
all food, including flavoured ice
• Offer him or her ice lollies or ice cubes to suck. lolly instead.
treats such as sweets • Offer small drinks frequently. Encourage your
that would normally child to drink before an activity, such as a story.
be appealing? YES
• Use straws, bright or unusual cups, or ”grown-
up” cups to add interest.
NO
• Let your child help prepare drinks or ice lollies.
Has there been a recent POSSIBLE CAUSE Your child may be anxious
domestic upset, such about something at school, such as exams.
as a house move, or is Many children express anxiety by behaving
in different ways than they normally do.
another child in the YES POSSIBLE CAUSE Some children are easily
house ill? unsettled by changes around them. They ACTION Talk to your child to find out what
may express this by changes in behaviour the problem is. You should also talk to his or
NO or feeling unwell. An illness in another her teachers to see if there is a problem you
child in the family may cause conflicting are not aware of, such as bullying. If your
feelings; your child may be anxious child continues to complain of feeling unwell,
about the other child but also jealous of consult your doctor.
the extra attention given to him or her.
ACTION Talk to your child to find out
what the problem is. Extra reassurance
Has your child been may help. If your child still feels unwell, POSSIBLE CAUSE AND ACTION Your child may be
feeling unwell for consult your doctor. unhappy or worried rather than physically ill.
YES Some children find it hard to express feelings
several weeks or more? and may seem unwell instead. Take time to talk
NO to your child, and, if necessary, consult your
doctor, who may refer him or her to a specialist.
Are your child’s height
YES
and weight within the
normal range for his or
her age (see GROWTH POSSIBLE CAUSE AND ACTION Your child may
CHARTS, p.26)? have an underlying disorder, such as a urinary
tract infection. Consult your doctor, who may
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO NO arrange for tests to look for an underlying
MAKE A DIAGNOSIS FROM THIS CHART AND YOUR cause and determine the appropriate treatment.
CHILD IS NO BETTER IN 48 HOURS . Your child may be referred to a specialist.
67
CHILDREN: ALL AGES
10 Tiredness
For unusual drowsiness, see chart 22, CONFUSION AND/OR seems tired most of time or tiredness is preventing him or
DROWSINESS (p.90). her from taking part in social activities or keeping up at
It is normal for a child to be tired if he or she has slept badly school, there may be an underlying medical problem. In
the night before or had a particularly long or energetic day. many cases, such tiredness is short-lived and may be the
It is also common for children to need more sleep than result of a recent infection. However, you should consult
normal during growth spurts and at puberty. If your child your doctor to rule out a more serious problem.
68
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE AND ACTION Certain POSSIBLE CAUSES Children often snore if they
drugs, such as antihistamines and have a cold, and this is nothing to worry
anticonvulsants, can cause tiredness as about. However, if your child snores all the
a side effect. Consult your doctor. time, he or she may have enlarged tonsils or
Meanwhile, make sure your child does not adenoids (p.107), which may be blocking the
stop taking his or her prescribed drugs. airway during sleep. Consult your doctor.
Is your child taking any ACTION Your doctor will examine your
YES
prescribed drugs? child’s throat. In some cases, your doctor
may refer your child to a specialist. Surgical
NO removal of the tonsils and adenoids may
Does your child snore? YES improve the situation.
NO
69
CHILDREN: ALL AGES
70
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE Symptoms of conditions POSSIBLE CAUSES Waking more than once or
such as asthma or eczema that do not twice during the night to pass urine may be a
bother a child during the day can disturb sign of an underlying disorder – for example,
his or her sleep. Consult your doctor. a urinary tract infection. However, the most
common cause is drinking too many fluids.
ACTION Your doctor will examine
your child and prescribe appropriate Go to chart 43 URINARY PROBLEMS (p.126)
Is your child’s sleep treatment. If your child is already
YES
disturbed by symptoms receiving treatment for a condition such
such as a cough or as asthma or eczema, it may need to be
itchy skin? adjusted. Once the symptoms have been
treated, your child should sleep better. Sleep requirements in
NO
childhood
Children vary in the amount of sleep that they
need, and it is normal for some children to
Does your child wake sleep more than others of a similar age. In
YES
several times a night general, children sleep less as they grow up.
to pass urine? The proportion of sleep spent dreaming also
goes down, from about half in a newborn to
NO
about a fifth in a teenager. You should only
worry about your child’s sleeping if he or she
seems unwell or if excessive sleepiness
POSSIBLE CAUSE AND ACTION Certain drugs,
such as some used to treat asthma, can cause interferes with his or her activities.
disturbed sleep as a side effect. Consult your Age Average total
doctor. Meanwhile, do not stop giving your sleep per 24 hours
your child his or her prescribed drugs.
Up to 3 months 16 hours
NO
POSSIBLE CAUSE Your child may be being
POSSIBLE CAUSE AND ACTION Children are
disturbed by others in the room.
often ready to start their day earlier than their
ACTION If possible, place your child in a parents and may go through a phase of early
separate room to sleep so that he or she waking. If you want your child to go back to
is able to sleep through the night without sleep, follow the self-help advice for getting
CONSULT YOUR DOCTOR OR HEALTH VISITOR IF being disturbed. After a few weeks, he or your child to sleep (opposite). If your child is
YOU ARE UNABLE TO IDENTIFY A CAUSE FOR YOUR she may be able to share a room again old enough, you may wish to leave him or her
CHILD ’ S SLEEPING PROBLEM FROM THIS CHART. without waking up at night. to play quietly instead.
71
CHILDREN: ALL AGES
12 Growth problems
For children under 1, see chart 7, SLOW WEIGHT GAIN are rare. The best way to avoid unnecessary anxiety is to
(p.62). For weight problems in adolescents, see chart 51, keep a regular record of your child’s height and weight so
ADOLESCENT WEIGHT PROBLEMS (p.139). that you can check that his or her growth rate is within the
Many parents worry that their child is too short or too thin; normal range (see GROWTH CHARTS, p.26). Consult this chart
others worry that their child or is too tall or has put on too if your child is losing weight or is gaining weight at a much
much weight. However, some children are naturally smaller slower rate than you would expect, or if your child fails to
or bigger than average, and serious disorders affecting growth grow in height as much as expected.
START Are you Is your child’s weight Go to chart 13 EXCESSIVE WEIGHT GAIN
YES YES
mainly above the normal
HERE (p.74)
concerned range for his or her
about your age (see GROWTH
child’s weight? CHARTS, p.26)?
NO NO
72
CHILDREN: ALL AGES
Continued from
previous page Cystic fibrosis
Cystic fibrosis is a genetic disorder in which Technician
secretions from the glands are abnormally Electrical source
thick. This results in a range of problems; in
particular, thick mucus in the lungs causes a
Electrode
persistent cough and recurrent chest infections. attached
Are you mainly Abnormal secretions from the pancreas to arm
concerned about your YES interfere with the child’s ability to digest food
child’s height? and cause him or her to pass pale, bulky,
strong-smelling faeces. Children with cystic
NO fibrosis frequently fail to grow normally and
are often underweight. The condition is present
from birth but is sometimes undetected for
months or years, during which time the lungs
may have become damaged. Regular chest Sweat testing
CONSULT YOUR DOCTOR IF YOU ARE UNABLE
physiotherapy performed by a parent,
TO MAKE A DIAGNOSIS FROM THIS CHART. Cystic fibrosis results in higher than normal
antibiotics, and drugs to aid digestion now levels of salt in sweat. A small, painless electric
enable most affected children to survive current is applied to the skin to induce sweating.
well into adulthood. The sweat is then collected and analysed.
NO
73
CHILDREN: ALL AGES
NO
Is your child taking
any prescribed drugs? YES
NO
POSSIBLE CAUSE AND ACTION Certain drugs,
such as corticosteroids, can cause weight
gain as a side effect. Consult your doctor.
Does your child have Meanwhile, your child should not stop taking
any of the following? his or her prescribed drugs.
• Swollen ankles
Has your child gained
weight rapidly over the YES • Puffy face, especially
last 2 months? in the morning
YES SEE YOUR DOCTOR WITHIN 24 HOURS
• Swollen abdomen
NO
NO POSSIBLE CAUSES Fluid retention due to a
potentially serious kidney disorder may be
the cause. A heart or liver disorder, causing
a build-up of fluid, is a less likely possibility.
POSSIBLE CAUSE AND ACTION Your child’s weight ACTION Your doctor will examine your child
gain is probably due to eating more than he or and will probably arrange for blood and urine
she needs. Try the self-help measures for helping tests. He or she may also refer your child to
your child reach a healthy weight (opposite), hospital for further tests to determine the
Continued on and consult your doctor if these measures do underlying cause. Drugs are usually prescribed
next page not help or if your child is severely overweight. to treat both the symptoms and the cause.
74
CHILDREN: ALL AGES
Continued from
previous page Are other members of
YES POSSIBLE CAUSE Overeating within the whole
the family overweight? family is the most likely cause, although
NO genetic factors may also play a part.
ACTION Look at the way the whole family
eats. By changing your own eating patterns,
you can encourage your child to lose weight.
Follow the advice for helping your child
achieve a healthy weight (below), and consult
your doctor if these measures do not help or if
Has your child been your child is severely overweight.
YES
overweight since
early childhood?
Is your child always
NO
made to finish all the
food on his or her plate? YES
NO
Has your child been ACTION Never force your child to eat. Allow
POSSIBLE CAUSE AND ACTION Your child’s weight him or her to stop eating, even if there is some
overweight for less gain is probably due to eating more than he or food left, and serve smaller portions to avoid
than 6 months? YES
she needs. Try the self-help measures for helping waste. Follow the advice for helping your child
your child reach a healthy weight (below), and reach a healthy weight (below), and consult
NO
consult your doctor if these measures do not your doctor if these measures do not help or
help or if your child is severely overweight. if your child is severely overweight.
75
CHILDREN: ALL AGES
14 Fever in children
For children under 1, see chart 3, FEVER IN BABIES (p.54). and be hot and sweaty. If your child does not feel well, you
A fever is an abnormally high body temperature of 38˚C should take his or her temperature (see TAKING YOUR CHILD’S
(100˚F) or above. It is usually a sign that the body is fighting TEMPERATURE, below). If it is raised, take steps to reduce it
an infection. Heat exposure can also lead to a raised (see BRINGING DOWN A FEVER, opposite). A high fever can
temperature. A child with a fever will feel generally unwell cause seizures (febrile convulsions) in young children.
76
CHILDREN: ALL AGES
Continued from
previous page SELF-HELP Bringing down a fever
Lowering a temperature will help your child feel more Wet face Drink
comfortable and lessens the likelihood of a febrile convulsion cloth
occurring (p.55). Remove your child’s clothes and give him
Fan
or her plenty of cold drinks. If your child is over 2 months
old, give him or her the recommended dose of
paracetamol. If the fever doesn’t fall and
your child is over 6 months old, give him
Does your child have or her the recommended dose of
any of the following? ibuprofen as well. The doses of both
• Severe headache drugs can be repeated every 4 hours.
• Reluctance to bend Cooling your child
the head forward Undress your child, lie him or her in
• Dislike of bright lights YES a cool room, and sponge his or her
head and body with tepid water.
• Drowsiness or
confusion
• Flat, dark red spots
t
that do not fade on
EMERGENCY!
pressure (p.79) CALL AN AMBULANCE
NO POSSIBLE CAUSE Meningitis, inflammation
of the membranes surrounding the brain
due to an infection, may be the cause of
POSSIBLE CAUSE Gastroenteritis, inflammation such symptoms.
of the digestive tract, usually due to a viral
infection, is the most likely cause of diarrhoea ACTION If meningitis is suspected, your child
Does your child will be admitted to hospital immediately. He
YES with a fever. Your child may also vomit.
have diarrhoea? or she will be given urgent treatment with
ACTION Follow the self-help measures for antibiotics and may need intensive care.
NO preventing dehydration in children (p.123)
and treating gastroenteritis in children (p.118).
If your child has diarrhoea for more than
24 hours, call your doctor.
77
CHILDREN: ALL AGES
START
HERE
Does your
child have any
of the danger
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Meningitis, inflammation of
WA R N I N G
DANGER SIGNS Call an ambulance if your
child has a rash and a fever with any of the
signs listed in the membranes surrounding the brain due to following symptoms:
the box on infection, may be the cause of these symptoms.
the right? • A seizure lasting more than 5 minutes
ACTION If meningitis is suspected, your child • Abnormal drowsiness
NO will be admitted to hospital immediately. He • A severe headache
or she will be given urgent treatment with • The rash consists of or is accompanied by
antibiotics and may need intensive care. flat, dark red spots that do not fade on
pressure (see CHECKING A RED RASH, p.79)
While waiting for medical help, follow the
advice for bringing down a fever (p.77).
Are the blisters confined
to the hands, feet, and YES
the inside of the mouth?
NO
POSSIBLE CAUSE AND ACTION Your child may
have hand, foot, and mouth disease, a mild
viral infection. Consult your doctor, who will
POSSIBLE CAUSE Chickenpox, an confirm the diagnosis. There is no specific
Does your child have a infectious disease caused by the herpes treatment for this condition, but if your child
YES
rash of small blisters? zoster virus, is the likely cause of these has a sore mouth, take steps to relieve the pain
symptoms. In children, this is usually (see RELIEVING A SORE MOUTH, p.113). Make
NO
a mild disease, and most children feel sure that your child drinks plenty of fluids
unwell for only the first few days. Consult (see ENCOURAGING YOUR CHILD TO DRINK,
your doctor if the symptoms are severe. p.67) to prevent dehydration.
ACTION Keep your child’s fingernails
short to discourage scratching, which can
lead to scarring. Itching may be relieved
by adding baking soda to your child’s
bath water and by applying calamine SEE YOUR DOCTOR WITHIN 24 HOURS
lotion to the spots. Follow the advice for
bringing down a fever (p.77). POSSIBLE CAUSE Scarlet fever, a bacterial throat
infection, is a likely cause of these symptoms,
especially if your child is also vomiting and
has a rash that is particularly prominent in the
Does your child have a folds of the skin, such as the armpits.
YES
severe sore throat? ACTION Your doctor will examine your child
to confirm the diagnosis. He or she may
NO prescribe antibiotics. Follow the advice for
reducing a fever (p.77) and also for relieving
a sore throat (p.107).
Does your child have
red eyes, a runny nose, YES
and/or a dry cough?
NO
Does your child have a
red or pink mottled or YES SEE YOUR DOCTOR WITHIN 24 HOURS
blotchy rash? POSSIBLE CAUSE Measles is the most likely
NO cause of these symptoms, even if your child
POSSIBLE CAUSE AND ACTION Rubella, also
has been immunized against the disease.
known as German measles, is a possibility,
especially if your child has swollen glands. ACTION Your doctor will examine your child
You do not need to consult a doctor unless to confirm the diagnosis. He or she may
your child has been in contact with a pregnant prescribe antibiotics. Make sure your child
woman, in which case, the diagnosis should be drinks plenty of fluids (see ENCOURAGING
Continued on confirmed. Take steps to reduce your child’s YOUR CHILD TO DRINK, p.67), and follow the
next page fever (see BRINGING DOWN A FEVER, p.77). advice for bringing down a fever (p.77).
78
CHILDREN: ALL AGES
Continued from
previous page Viral infections that cause a rash
Many viral infections cause a fever and a rash. also affect adults, whose symptoms can be
The more serious ones, such as measles, have more severe than children’s. The incubation
become much less common as a result of routine period is the time between acquiring an
immunizations. Many of these infections can infection and first developing symptoms.
Erythema infectiosum Bright red cheeks; lacy rash, mainly Until 1 week after the rash develops
Does your child have a (4–20 days) on trunk
bright red rash on the
cheeks with or without Hand, foot, and mouth disease Mild fever; rash of small blisters For duration of blisters
(4 days) on hands, feet, and inside of mouth
a lacy rash on the trunk? YES
Measles (7–14 days) Cough; runny nose; red eyes; Until 5 days after the rash develops
NO mottled or blotchy red rash, first
on the face, then trunk and arms
Roseola infantum (variable) High fever followed by flat, light- Until 5 days after the onset of the
red rash on the trunk; swollen symptoms
glands in the neck
Rubella (14–19 days) Mild fever; swollen glands in the From 1 week before the rash
neck; flat pink mottled or blotchy develops until 5 days after the rash
rash, mainly on face and trunk develops or until the rash disappears
Scarlet fever (2–5 days) High fever; severe sore throat; Until the prescribed course of
vomiting; red rash on body, most antibiotics is completed
obvious in skin folds
79
CHILDREN: ALL AGES
80
CHILDREN: ALL AGES
ACTION Avoid using soaps or other bath ACTION If your doctor confirms the diagnosis,
products on the affected areas. Instead, you will probably be advised to wash the
Does your child have use an emollient, such as aqueous cream, crusts away gently with warm water. Your
YES
patches of red, inflamed to clean and moisturize the skin. The doctor may also prescribe an antibiotic
skin that is also flaking? condition often improves if the scalp cream or, if the condition is widespread, oral
is treated with an over-the-counter antibiotics. Until the infection clears up, you
NO dandruff shampoo or a shampoo should make sure that your child keeps a
containing ketocanazole. If the rash does separate towel and other wash things to avoid
not improve within a week or if you are infecting others. Keep your child away from
concerned, consult your doctor, who may other children while he or she is infected.
prescribe a corticosteroid cream.
Does your child have
one or more small
lumps of rough skin? YES POSSIBLE CAUSE These may be warts, which
are caused by a viral infection of the skin. A
NO wart that grows into the sole of the foot is
known as a verruca and may be painful.
ACTION Most warts disappear naturally in
time, but this may take months or years.
POSSIBLE CAUSE AND ACTION Molluscum
Over-the-counter wart treatments may speed
contagiosum, a harmless but contagious
Does your child have up the process. However, if a wart persists
viral skin infection, is likely. The pimples
after you have treated it or if it is painful,
several raised, pearly clear up without treatment, but this
consult your doctor. He or she may suggest
pimples up to 5 mm YES may take up to 2 years. Meanwhile, they
other treatments, such as freezing.
may catch on clothing and look unsightly.
(1⁄ 4 in) in diameter, each Individual pimples can be treated by your
with a central dimple? doctor, but because the treatment may be
painful and may leave a scar, it is usually
NO
best not to treat the condition. POSSIBLE CAUSE Your child may have acne,
which is very common during adolescence.
Go to chart 55 ADOLESCENT SKIN
PROBLEMS (p.144)
Is your child over
YES
10 years old, and does
he or she have any of
the following? POSSIBLE CAUSE AND ACTION Certain drugs
• Blackheads Is your child taking any can cause skin problems as a side effect. Stop
giving your child any over-the-counter drugs
• Inflamed spots with prescribed or over-the- YES and consult your doctor. Meanwhile, do not
white tops counter drugs? stop giving your child any prescribed drugs.
• Painful red lumps NO
under the skin
NO
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART.
81
CHILDREN: ALL AGES
82
CHILDREN: ALL AGES
Continued from
previous page SELF-HELP Treating head lice
Contrary to popular belief, head lice prefer Removing lice and eggs
clean, not dirty, hair. Head lice can be treated Carefully combing
with an over-the-counter lotion or shampoo. through your child’s
Follow the directions on the packet, and then hair with a fine-
remove the dead lice and their eggs, known as toothed nit comb
nits, by combing through the hair with a fine- will remove eggs
toothed nit comb. Alternatively, try coating and dead lice.
the hair in conditioner and combing it through
with a nit comb daily, or try using a battery- Fine-toothed
operated comb that electrocutes the lice. nit comb
Whichever method you use, treat everyone in
the household and wash all combs and towels
Does your child have in hot water to prevent reinfestations.
YES
an itchy scalp?
NO
Is the scalp flaking? YES POSSIBLE CAUSES Your child probably has
dandruff, which is a form of seborrhoeic
NO dermatitis often associated with a fungal scalp
infection. However, a flaking scalp may also
be due to other conditions, such as psoriasis.
ACTION An over-the-counter dandruff shampoo
POSSIBLE CAUSE An infestation of head or a shampoo containing ketocanazole should
lice is possible. Lice are transmitted by clear up the condition. If your child’s scalp is
close contact. Comb your child’s hair over no better within 4 weeks, consult your doctor.
a sheet of white paper using a fine-toothed
comb to confirm that lice are present.
These tiny black insects are less than 2 mm
(1⁄16 in) long. Their white eggs (nits) can
Does your child have a sometimes be seen attached to hair shafts.
red, painful area around POSSIBLE CAUSE An ingrowing toenail is the
YES ACTION Head lice can be treated with
one or more nails? preparations available from your most likely cause of these symptoms.
NO pharmacist (above).
Go to chart 49 FOOT PROBLEMS (p.136)
83
CHILDREN: ALL AGES
18 Itching
Itching is a common and distressing symptom for a child with any disorder that produces itching, because if it persists,
and can have a variety of causes, including external irritants scratching can lead to an infection or changes in the skin,
or infestation by parasites. It is important to deal promptly which can, in turn, lead to further itching.
84
CHILDREN: ALL AGES
85
CHILDREN: ALL AGES
t
Is your child being EMERGENCY!
YES
given treatment CALL AN AMBULANCE
for diabetes?
POSSIBLE CAUSE Severe hypoglycaemia, Is your child under
NO which is an extremely low blood sugar 5 years old, and did he
level, may have caused your child to lose or she have a high fever YES
consciousness. Your child’s blood sugar
will not return to normal without
before the episode?
Did your child immediate treatment. NO
hold his or her ACTION If you have been given glucagon
breath and turn for injection, administer it to your child
blue before losing while you wait for the ambulance to
YES arrive. Do not try to give an unconscious CALL YOUR DOCTOR NOW
consciousness? child anything to eat or drink.
NO POSSIBLE CAUSE Your child has had a
seizure, which may be due to epilepsy.
ACTION If the child has not had a seizure
before, your doctor will examine him or
Did any of the her and may arrange for an EEG test to
following apply? record the electrical activity in the brain.
POSSIBLE CAUSE AND ACTION Your child may Epilepsy will not be diagnosed until the
• Hot or airless have had a breath-holding attack (opposite). child has had two or more seizures. If
conditions Such attacks usually result from pain, anger, your child does have epilepsy, he or she
or frustration in a child under 3 years of age. may be prescribed drug treatment with
• Prolonged The best way to deal with an attack is to
standing anticonvulsants to prevent further attacks.
ignore it as much as possible. However, if you
• Lack of food in are concerned about your child’s behaviour,
recent hours consult your doctor or health visitor.
YES
• Stress or anxiety
NO CALL YOUR DOCTOR NOW
POSSIBLE CAUSE Your child may have had a
febrile convulsion (see FEBRILE CONVULSIONS IN
BABIES AND CHILDREN, p.55). These seizures are
SEE YOUR DOCTOR WITHIN 24 HOURS POSSIBLE CAUSE AND ACTION Your child
often brought on by an infection that causes a
IF YOU ARE UNABLE TO MAKE A probably fainted due to a temporary reduction
raised temperature. Although frightening, the
DIAGNOSIS FROM THIS CHART. in the amount of blood reaching the brain.
seizures are not usually serious.
Fainting occurs most often in early puberty
but can occur at any age; it is rarely a cause ACTION While waiting for medical help, take
for concern. If your child feels faint again, try steps to reduce your child’s temperature (see
self-help measures for dealing with faintness BRINGING DOWN A FEVER, p.77). Your doctor
(opposite). A child who has frequent fainting will examine your child and try to find a cause
Continued on attacks should be seen by a doctor, who may for the fever. In some cases, your child may
next page do tests to find out if he or she has anaemia. need to be admitted to hospital.
86
CHILDREN: ALL AGES
Continued from
previous page SELF-HELP Dealing with faintness
If your child suddenly turns pale, complains that her feet raised to improve the blood flow to the
his or her vision is closing in, and/or appears brain. Make sure plenty of fresh air is available,
confused, he or she may be feeling faint. This and loosen the child’s clothes, if necessary. If
condition is more likely if the atmosphere is hot you are sure that your child is fully conscious,
or stuffy, if your child has not eaten, if he or she offer him or her a sweet drink in order to raise
Does your child have
has been standing for a long time, or if the the blood sugar level. If your child loses
episodes in which he or child is particularly stressed or anxious. consciousness and does not regain it within
she seems unaware of Your child should lie 3 minutes, call an ambulance and administer
the surroundings for down with his or first aid (see UNCONSCIOUSNESS, p.300).
a few moments? YES
Relieving faintness
NO Lying down with the legs raised
increases the flow of blood to the
brain and usually quickly relieves
feelings of faintness.
87
CHILDREN: ALL AGES
21 Headache
Headaches are a very common complaint. By the age of 7, infection that causes a fever. They can also be a symptom of
40 per cent of children have had a headache, and this figure a number of relatively minor disorders. Consult this chart if
rises to 75 per cent by the age of 15. Parents may worry that your child complains of a headache with or without other
the pain is due to a serious condition, such as meningitis or a symptoms. Always consult your doctor if a headache is
brain tumour. However, these conditions are extremely rare. severe, persistent, or recurs frequently, or if this is the first
Headaches often occur on their own but may accompany any time that your child has had a particular type of headache.
t
Has your child had a pressure (p.79) EMERGENCY!
head injury within the CALL AN AMBULANCE
last 24 hours? YES NO
POSSIBLE CAUSE Meningitis, inflammation of
NO the membranes surrounding the brain due to
infection, may be the cause of these symptoms.
POSSIBLE CAUSE Feverish illnesses are often ACTION If meningitis is suspected, your child
accompanied by headaches. will be admitted to hospital immediately. He
or she will be given urgent treatment with
Go to chart 14 FEVER IN CHILDREN (p.76) antibiotics and may need intensive care.
88
CHILDREN: ALL AGES
Continued from
previous page Is your child completely
YES POSSIBLE CAUSE A severe headache associated
well between attacks? with these symptoms may be a migraine,
NO particularly if other members of the family also
suffer from migraines. Consult your doctor.
ACTION Your doctor will probably examine
your child to exclude other possible causes.
Does your child have Symptoms can often be eased by self-help
YES measures, such as taking a painkiller and an
recurrent headaches CALL YOUR DOCTOR NOW
antiemetic (drug that relieves nausea), drinking
with or preceded by POSSIBLE CAUSE If your child is not well plenty of fluids, and resting in a darkened
any of the following? between headaches or his or her performance room. You should also try to discover whether
• Nausea or vomiting at school has worsened recently, it may be an there are any specific triggers, such as a food
indication of a serious brain disorder that needs or an activity (see REDUCING THE FREQUENCY
• Abdominal pain urgent investigation. OF MIGRAINE, p.159).
• Seeing flashing lights ACTION Your doctor will examine your child
• Pale appearance and may arrange for him or her to be seen
urgently in hospital for tests such as MRI
NO (p.41) or CT scanning (p.40) in order to
establish the cause.
89
CHILDREN: ALL AGES
t
START Has your child EMERGENCY! WA R N I N G
HERE injured his or YES CALL AN AMBULANCE
her head in the DANGER SIGNS Call an ambulance if your
POSSIBLE CAUSES In many cases, confusion child is drowsy or confused and also has any
past few days? following a head injury is short-lived. of the following symptoms:
NO However, it may be an indication of a serious • Slow or irregular breathing
brain injury or be associated with bleeding • Flat, dark red spots that do not fade on
between the skull and the brain. pressure (see CHECKING A RED RASH, p.79)
ACTION Do not give your child anything to • Severe headache
eat or drink while waiting for the ambulance. • Vomiting
Your child will be fully examined in hospital Also call an ambulance if your child becomes
and may need tests such as a skull X-ray unconscious or is difficult to wake.
Does your child have a (p.39) or CT scanning (p.40). He or she may
temperature of 38˚C need to stay in hospital for monitoring.
(100˚F) or above? YES
NO
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES Meningitis, inflammation of
the membranes surrounding the brain due to an
infection, may be the cause of these symptoms.
Does your child have Encephalitis, inflammation of brain tissue as a
any of the following? result of a virus infection, is also a possibility.
Might your child have • Severe headache ACTION If meningitis is suspected, your child
will be admitted to hospital immediately.
swallowed any of the • Reluctance to bend He or she will be given urgent treatment
following? the head forward YES with antibiotics and may need intensive care.
• Drugs prescribed for • Dislike of bright lights Encephalitis often gets better by itself but may
an adult need treatment with an antiviral drug.
• Flat, dark red spots
• Poisonous plants that do not fade
or fungi on pressure (p.79)
YES CALL YOUR DOCTOR NOW
• Cleaning products NO
NO POSSIBLE CAUSES Your child’s confusion may
be the result of a severe infection, such as
pneumonia or a urinary tract infection.
ACTION Take steps to reduce the fever (see
BRINGING DOWN A FEVER, p.77), and make
sure your child drinks plenty of fluids. Your
doctor will examine your child, and if there
is an obvious site of infection, he or she may
Does your child have prescribe antibiotics. Otherwise, your child
one or more of the may need to be admitted to hospital for tests
t
following? to determine the cause and treatment needed.
EMERGENCY!
• Unexplained weight CALL AN AMBULANCE
loss
POSSIBLE CAUSE AND ACTION Your child’s
• Increased thirst symptoms may be due to poisoning.
CALL YOUR DOCTOR NOW
• Passing more urine While you are waiting for medical help POSSIBLE CAUSE Diabetes mellitus (p.149)
than usual YES to arrive, follow the first-aid procedure is a possibility. This condition is caused by
for swallowed poisons (p.302). Try to insufficient production of the hormone
NO find the container or a sample of the insulin, which is needed by the body to get
substance that your child has swallowed energy from sugar and carbohydrate foods.
to take with you to the hospital.
ACTION Your doctor will take a blood sample
to test your child’s blood sugar level. If the
diagnosis is confirmed, your child may need to
be admitted to hospital for insulin injections
and intravenous fluids until the condition is
Continued on
next page controlled. Insulin will be needed for life.
90
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSES Confusion or drowsiness
in children with diabetes may indicate a low
blood sugar level, particularly if the symptoms
have come on suddenly. Less commonly, these
symptoms may be the result of a high blood
Is your child being sugar level and may have developed gradually.
YES
treated for diabetes?
ACTION If your child is sufficiently alert, give
NO POSSIBLE CAUSE AND ACTION If your child has him or her something very sweet to eat or drink.
had an epileptic seizure, it may have left him This should correct a low blood sugar level and
or her drowsy or confused. If your child has will do no harm if the sugar level is too high.
been diagnosed as having epilepsy, consult If your child cannot cooperate or is no better
Is there evidence that your doctor because your child’s treatment within 10 minutes, call your doctor at once.
YES may need adjusting. However, you should call However, you should call an ambulance if
your child has had a
your doctor immediately if your child has not your child becomes unconscious.
seizure, for example
previously been diagnosed as having epilepsy:
has your child done he or she needs to be assessed promptly.
either of the following?
• Bitten his or her
tongue
• Wet him- or herself
NO Has your child had
diarrhoea, with or
without vomiting, in YES CALL YOUR DOCTOR NOW
the past 24 hours? POSSIBLE CAUSE Your child’s symptoms may
be due to dehydration.
NO
ACTION Your doctor will examine your child
to assess how severely dehydrated he or she
is. In most cases, giving your child fluids at
home will treat the dehydration and prevent
it worsening (see PREVENTING DEHYDRATION
t
IN CHILDREN, p.123). However, if your child is
Has your child been EMERGENCY! very unwell or unable to drink sufficient fluids
YES
exposed to hot CALL AN AMBULANCE to treat the dehydration, he or she may need
sunshine or high to be admitted to hospital.
POSSIBLE CAUSE Your child’s symptoms
temperatures recently? may be due to heatstroke, in which a
NO high temperature and dehydration can
cause confusion and drowsiness.
ACTION While waiting for help, lay your
child in a cool place and remove all his
or her outer clothing. Sponge him or her
with tepid water. If your child is able to CALL YOUR DOCTOR NOW
cooperate, offer him or her cool drinks.
POSSIBLE CAUSE AND ACTION Drowsiness or
confusion may be a side effect of some drugs,
including antihistamines and anticonvulsants.
Is your child taking any If your child is taking a prescribed drug, ask
prescription drugs or YES your doctor’s advice before the next dose is
over-the-counter drugs? due. Your child should stop taking any over-
the-counter drugs.
NO
91
CHILDREN: ALL AGES
23 Clumsiness
Children vary greatly in their levels of manual dexterity, unlikely to be a sign of an underlying disease, although poor
physical coordination, and agility. Some children naturally vision can be an unrecognized cause. Severe clumsiness that
acquire these skills later than others. They have difficulty in has come on suddenly or that follows a head injury may
carrying out delicate tasks, such as tying shoelaces, and may result from a serious problem with the nervous system and
often accidentally knock things over. Such clumsiness is needs urgent medical attention.
START Is your
YES POSSIBLE CAUSE Most children under 3 years
HERE child under old are still developing physical coordination
3 years old? skills. Some children are slower to develop
these skills than others.
NO
ACTION Provide your child with plenty of
enjoyable opportunities to improve his or her
Does the clumsiness physical skills (see IMPROVING COORDINATION,
significantly interfere below). Avoid letting anyone be openly critical
with his or her school of your child’s clumsiness.
YES
performance or
day-to-day activities?
NO POSSIBLE CAUSES Severe clumsiness may be
Has your child always due to dyspraxia, a condition also known as
been clumsy? YES
developmental coordination disorder, or to
an underlying disorder of the muscular or
NO nervous system. Consult your doctor.
ACTION Your doctor may refer your child to
POSSIBLE CAUSE A natural tendency to mild an occupational therapist or other specialist to
clumsiness is a characteristic that some be assessed. You and your child may be taught
children are born with and is likely to be special exercises to do together to improve
more noticeable when they are anxious. This your child’s coordination and dexterity. These
is hardly ever a cause for concern. often result in a marked improvement.
ACTION Do not scold your child for his or
her clumsiness because this is likely to make
Is your child taking any things worse. You can help your child by
prescribed drugs, or encouraging him or her to take up sports and SELF-HELP Improving
do you think your hobbies that improve physical skills (see coordination
child could be taking IMPROVING COORDINATION, right).
recreational drugs or Some children learn physical skills easily and
inhaling solvents? YES
are naturally better coordinated than others.
However, you can help your child develop
NO
coordination and manual dexterity to the
best of his or her abilities by providing
POSSIBLE CAUSES AND ACTION Certain drugs,
especially some prescribed for epilepsy, may opportunities for varied physical activities.
cause clumsiness. Consult your doctor. Athletic skills
Meanwhile, do not stop any prescribed drugs. Running, hopping, and jumping help young
Clumsiness may also result from drug or solvent children to improve their coordination.
abuse. If you suspect this (see RECOGNIZING Swimming and ball games are good exercises
DRUG AND SOLVENT ABUSE, p.141), talk to your for children of any age.
child to try to find out if he or she is abusing
Has your child had drugs. Explain the dangers and give support.
Moving to music
unexplained headaches If your child is unwilling or unable to stop or
Dancing is a fun way to help a child learn to
or vomiting since the denies drug usage, consult your doctor or a coordinate body movements. Disciplined
onset of the clumsiness? YES self-help group (see USEFUL ADDRESSES, p.311). forms of dancing, such as ballet, also
improve balance, physical grace, and agility.
NO Games and hobbies
Placing cut-out shapes in a frame helps young
children develop the hand–eye coordination
needed to learn manual tasks, such as sewing
CALL YOUR DOCTOR NOW or woodwork, later on. Similarly, scribbling
on scrap paper is an important stage in the
POSSIBLE CAUSE AND ACTION A potentially development of writing and drawing skills.
serious nervous system disorder is a possibility. Other toys that are good for improving
Your doctor may arrange for your child to be
hand–eye coordination include building
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO seen in hospital for tests to determine the
MAKE A DIAGNOSIS FROM THIS CHART. diagnosis and appropriate treatment. blocks, jigsaws, and some computer games.
92
CHILDREN: ALL AGES
24 Speech difficulties
Consult this chart if your child has any problem with his or the advice of your doctor or health visitor. If not addressed
her speech, such as a delay in starting to talk, lack of clarity, early, speech difficulties may cause behaviour and school
defects in pronunciation, or stammering. Such difficulties problems. A speech therapist will usually be able to improve
often improve with time, but, in most cases, it is wise to seek your child’s ability to communicate effectively.
93
CHILDREN: ALL AGES
25 Behaviour problems
Perception of what constitutes a behaviour problem varies BEHAVIOUR, opposite). However, most of these problems are
widely between parents. At some stage, most children will outgrown. This chart covers some of the more common or
behave in a way that causes their parents concern, even if it serious behaviour problems that parents have to cope with.
is by doing something as minor as nail-biting (see HABITUAL It will help you to decide if help from your doctor is advisable.
94
CHILDREN: ALL AGES
Continued from
previous page Habitual behaviour
Childhood habits, such as nail-biting, are Twirling the hair
common and rarely do any serious harm. They Children of all ages
may provide comfort from stress or be a means may play with their
of expressing emotion, such as anger. Rarely, hair, often unaware
habits such as breath-holding attacks (p.87) that they are doing
may be used to manipulate parents. so. In some cases,
this can lead
About a third of children bite their nails, a
Has your child become habit that may persist into adulthood. Thumb-
to hair loss.
unusually withdrawn sucking is common in children under 3. Some
and lost interest in YES may continue up to the age of 6 or 7, when
activities that he or she they should be persuaded to stop to prevent
previously enjoyed? the adult teeth being pushed out of position.
NO Children are often unaware of habitual
behaviour. To stop a habit, draw your child’s
attention to it when it occurs, but do not get
angry. If you are worried, consult your doctor.
POSSIBLE CAUSES Both depression and POSSIBLE CAUSE It is normal for small children
anxiety can cause these symptoms. to test the rules and disobey their parents.
Is your child unruly, Many young children also go through a
YES ACTION Talk to your child to see if there
noisy, and disobedient? is a reason for his or her behaviour.
period of particularly difficult behaviour
known as the “terrible twos”.
NO Offer support and encouragement, and
try to remove or reduce any sources of ACTION All children grow out of this
stress that may be contributing. If your behaviour. Meanwhile, follow the advice for
child’s symptoms persist for more than coping with the “terrible twos” (opposite). If,
2 weeks or worsen, consult your doctor. at any stage, you feel that you cannot cope,
consult your doctor or health visitor.
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
Is your child under
YES
WORRIES YOU . 4 years old?
NO
95
CHILDREN: ALL AGES
26 School difficulties
School difficulties fall into two main groups: those related difficulties, which may be the result of emotional problems,
mainly to learning, whether of a specific subject or of physical disorders, or social factors, or which may arise
schoolwork in general; and those concerned with behaviour, from a general developmental problem. Discussion with
including classroom behaviour and reluctance to go to school staff usually helps the situation. Your family doctor
school. Consult this chart if your child has any such and the school medical services may also be able to help.
Continued on
next page
POSSIBLE CAUSE A child whose general
development is normal for his or her age
but who has problems in one area is said
Bullying to have a specific learning difficulty. For
example, difficulty in reading and writing
is known as dyslexia (opposite). Discuss the
Bullying can take many forms. As well as important that you reassure him or her that problem with your child’s teachers initially,
physical violence, it includes teasing, name- the bullying is not his or her fault. Build up your and consult your doctor.
calling, spreading unpleasant stories, and child’s self-esteem, and talk to his or her school. ACTION Your doctor will probably examine
excluding children from groups. Bullying is Schools should have a policy on bullying. your child to make sure that a physical
especially common in primary school. The bully needs help, too. In many cases, problem, such as poor eyesight or an
A child who is being bullied is singled out bullying is an expression of an underlying unrecognized illness, is not contributing to
for attention by the bully and may become very problem such as a need for attention. If your your child’s difficulties. Your doctor may liaise
unhappy and insecure. He or she may not want child is a bully, it is important that you make with the school medical services. Work with
to go to school, and his or her schoolwork may it clear that this behaviour is harmful and your child’s school to encourage your child as
much as possible. In some cases, extra support
suffer. If your child is being bullied, it is vitally unacceptable while trying to find the cause.
in school may be necessary.
96
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE Truancy combined with other
antisocial behaviours, such as stealing, is more
common in adolescents. In some cases, it is due
to bullying (opposite) or the influence of friends.
Do any of the following Talk to your child’s teachers and your doctor.
apply to your child? ACTION If problems persist despite intervention
Has your child • He or she often comes at school, it may be necessary to refer your
YES
been playing home with unexplained child to a child guidance clinic. Long-standing
truant? bruises or cuts. YES behaviour problems may be difficult to change.
NO • Money or belongings are
frequently “lost” at school.
• He or she comes home POSSIBLE CAUSE This type of problem may be due
with broken belongings. to bullying, even if your child is initially reluctant
to admit it (see BULLYING, opposite).
NO
ACTION Talk to your child about the situation,
Has your and speak to his or her teachers. Bullying or other
YES
child become violence at school should be taken very seriously.
reluctant to go Your child’s school should have a policy for dealing
Does your child resist all with bullying, and you can help by building up
to school? attempts to get him or her YES your child’s confidence.
NO into school?
NO
POSSIBLE CAUSES School refusal may be a sign that
something is seriously wrong. There may be a
problem at school, such as bullying (opposite), or
POSSIBLE CAUSES Dislike of school may be a failure of the school to meet the child’s needs.
Have teachers caused by a variety of factors. For example, Occasionally, refusal to go to school is caused by
complained children starting a new school may be anxious. anxiety at home or, in a young child, by anxiety
Your child may be having difficulties with work over separation from his or her parents.
about your at school or be afraid of certain teachers or
child’s behaviour pupils. If not tackled, a dislike of school may ACTION Try to discover the underlying cause of
at school? YES your child’s refusal to go to school so that it can
progress into a refusal to attend school.
be dealt with, and make every effort to ensure
NO ACTION Try to find out the cause of the problem, that your child attends school. In the meantime,
and discuss your child’s feelings with his or her discuss the problem with your child’s teachers.
teachers so that they can watch out for signs of If the situation does not improve, consult your
bullying (opposite). Do not keep your child at doctor. He or she may recommend you seek help
home. Depending on the cause of the problem, it for your child through a child guidance clinic.
SCHOOL DIFFICULTIES THAT HAVE may be necessary for your child to receive extra
NOT BEEN DESCRIBED ON THIS CHART
teaching or help through a child guidance clinic.
SHOULD BE DISCUSSED WITH YOUR
CHILD ’ S TEACHERS . Y OUR DOCTOR ’ S
ADVICE MAY ALSO BE HELPFUL IN
POSSIBLE CAUSE Although this type of behaviour
SOME CASES .
is normal in small children, school-age children
Is your child easily who are constantly active and disruptive may
YES
bored, unable to have attention deficit hyperactivity disorder
concentrate, restless, (p.95). Consult your doctor.
Dyslexia impulsive, and/or ACTION Your doctor will probably refer your child
disruptive? to a specialist to confirm the diagnosis. Children
with this condition need extra support at home
Dyslexia means difficulty with words. Early NO and in school, and some need drug treatment.
signs include difficulty in learning to read,
write, and spell. Dyslexia is not linked to low
intelligence. If you think your child may be
dyslexic, talk to your doctor and your child’s
teachers. They should be able to arrange for POSSIBLE CAUSES Bad behaviour that is confined
a formal assessment to school can be due to a number of problems.
of your child and
Is your child’s Schoolwork may be too easy, leading to boredom,
subsequent support
behaviour at home YES or it may be too difficult, possibly because of an
(see also USEFUL
acceptable? unrecognized learning difficulty, resulting in loss of
interest. Bad behaviour may also be the result of
ADDRESSES, p.311). NO rejecting authority. In some cases, poor behaviour
at school may be due to bullying (opposite).
Reading
Children with ACTION Talk to your child to try to uncover the
dyslexia need
cause of the problem. It is also wise to discuss the
problem with your child’s teachers. Adjustments
extra support
may need to be made to your child’s schoolwork
and patience
so that it meets his or her needs more closely. In
when learning Go to chart 25 BEHAVIOUR PROBLEMS some cases, help through a child guidance clinic
to read. (p.94) may be arranged by your doctor.
97
CHILDREN: ALL AGES
27 Eye problems
For blurred vision in children, see chart 28, DISTURBED OR cases, it is reasonable to treat these problems at home
IMPAIRED VISION (p.100). initially. Always seek immediate medical advice about injury
This chart deals with pain, itching, redness, and/or discharge to the eye or for any foreign body in the eye that cannot be
from one or both eyes. In children, such symptoms are most removed by simple self-help measures. You should also seek
commonly the result of infection or local irritation. In most medical help if home treatment is not effective.
START
HERE
Has your
child had an
injury causing
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE AND ACTION An eye injury
obvious always requires immediate medical attention
damage to because there is a risk of permanent damage.
the eye? POSSIBLE CAUSE AND ACTION A foreign
While waiting for the ambulance, carry out
self-help measures (see TREATING EYE INJURIES,
NO body, such as a piece of grit, in the eye,
opposite). Once in hospital, the injury will be
may cause pain, redness, and watering. Try
assessed. In some cases, surgery will be needed.
to stop your child rubbing the eye, and
carry out self-help measures for treating
eye injuries (opposite). If these measures
are not possible, are unsuccessful, or if
the eye remains sore for more than an
hour after removing the foreign body,
Is there a foreign body, you should seek medical help immediately. SEE YOUR DOCTOR WITHIN 24 HOURS
YES
such as a piece of grit
POSSIBLE CAUSE Bacterial conjunctivitis is
or sand, in the eye? likely. This is inflammation of the membrane
NO covering the white of the eye and the inside of
the eyelids due to infection by bacteria.
Is there a sticky, pus-like ACTION Your doctor will probably prescribe
YES antibiotic eye drops or ointment. He or she
discharge from the eye?
may also advise you on self-help measures
NO for coping with conjunctivitis (opposite). To
prevent your child spreading conjunctivitis,
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.
Does the white of the
eye look bloodshot? YES
NO
Is vision in the affected
YES POSSIBLE CAUSE Nonbacterial conjunctivitis is
eye as good as normal? likely. This is inflammation of the membrane
NO covering the white of the eye and the inside of
the eyelids due to allergy, chemical irritation,
or a viral infection.
Continued on ACTION The inflammation will usually clear
next page up on its own. However, if you are not sure
that conjunctivitis is the cause or if your
symptoms persist for more than 48 hours,
you should consult your doctor.
Blocked tear duct
Tears are produced continuously to clean time a child is 1 year old. Massage may help
and moisturize the front of the eye. Excess unblock a tear duct. Wash your hands
tears drain away through the tear ducts. thoroughly, and use a forefinger to massage CALL YOUR DOCTOR NOW
These are narrow passages that lead from the skin just below the inner corner of the
the inner corner of the lower eyelid to the eye in a gentle circular motion. Repeat the POSSIBLE CAUSE Iritis, inflammation of the
inside of the nose. If a tear duct becomes massage three or four times a day for 1 or coloured part of the eye, is a possibility.
blocked, tears cannot drain away normally 2 weeks. This technique may help the tear ACTION Your doctor will refer your child
and the eye waters. duct to open. If a blocked tear duct has not to a specialist for a detailed eye examination
Blocked tear ducts are common in babies. opened by the age of 1 year, the doctor may and for other tests to look for disorders that
One or both tear ducts may be blocked at refer your child to a specialist for treatment. sometimes occur with iritis, such as arthritis.
Iritis needs immediate treatment with
birth. This is not a cause for concern, as in The duct may have to be opened with a thin
corticosteroid eye drops or tablets to prevent
most cases the ducts open naturally by the probe under a general anaesthetic. permanent damage to vision.
98
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE Blepharitis, inflammation of SELF-HELP Coping with
the lid margins, is the most likely cause of
itchy, scaly eyelids. This condition is often conjunctivitis
associated with dandruff. Consult your doctor.
ACTION Your doctor will probably prescribe A common cause of conjunctivitis in children
an ointment to apply to the eyelids. Treating is a bacterial infection, which is easily spread.
the scalp with an over-the-counter anti- If your child has conjunctivitis, you should
dandruff shampoo may also result in an try to stop him or her from touching the
improvement in the eyelids. affected eye. Remove the discharge from
Are the eyelids your child’s eye with warm water and cotton
YES
red and itchy? wool as often as necessary. Keep your child
NO away from other children until his or her
symptoms have cleared up. You can help
prevent other family members from catching
conjunctivitis by having a separate towel and
POSSIBLE CAUSE A stye, a boil-like infection at face cloth for your child.
the root of an eyelash, is likely.
ACTION A stye will usually clear up within a Clean, damp
week without special treatment. It will either cotton wool
burst, releasing pus, or gradually disappear.
Is there a tender If pus is released, use a clean piece of cotton
YES wool moistened with warm water to clear
red lump on one
away the discharge, wiping towards the outer
eyelid? side of the eye. To prevent infection spreading,
NO try to discourage your child from touching the
affected eye. Consult your doctor if a stye fails
to heal within a week or if styes recur often.
99
CHILDREN: ALL AGES
START
HERE
Has your child
had a recent
head injury
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE A head injury can affect
WA R N I N G
SUDDEN LOSS OF VISION Call an
ambulance if your child complains of a
or an injury the part of the brain that is responsible for sudden loss of sight in one or both eyes.
to the eye? vision. A head injury resulting in a vision This is a serious symptom, which needs
problem or an eye injury always requires urgent medical assessment.
NO immediate medical attention.
ACTION In hospital, the injury will be
assessed and tests, such as skull X-rays
t
(p.39) and MRI scanning (p.41), may EMERGENCY!
be carried out in order to determine the CALL AN AMBULANCE
appropriate treatment.
POSSIBLE CAUSE AND ACTION Sudden loss of
vision is always a serious symptom, even if it
only lasts a few minutes or affects only one eye.
Has your child Your child’s eyes will need to be examined by
suddenly lost all or part YES a specialist. Your child may also be admitted
of his or her vision? to hospital for tests.
NO POSSIBLE CAUSE A squint can cause
double vision. This is because the images
relayed to the brain from the eyes are not Is there a sticky, pus-like
the same. If a squint is not corrected, the
brain will suppress the image from one discharge, and is normal
YES
eye and vision will then fail to develop vision restored when the
Has your child normally. Consult your doctor. eye is cleaned?
YES
been suffering from
ACTION Your doctor will examine your NO
double vision? child’s eyes and will probably refer him
NO or her to an eye specialist, who will
explain the different treatment options
used to correct a squint (opposite). CALL YOUR DOCTOR NOW
POSSIBLE CAUSE Iritis, inflammation of
the coloured part of the eye, is possible.
Is your child’s vision Are one or both eyes ACTION Your doctor may refer your child
blurred at all distances? YES red and painful? YES
to a specialist for an eye test and to look
for associated disorders such as arthritis.
NO NO If iritis is diagnosed, your child will need
urgent treatment with corticosteroid eye
drops or tablets to prevent permanent
damage to his or her sight.
100
CHILDREN: ALL AGES
101
CHILDREN: ALL AGES
Preventing
barotrauma
POSSIBLE CAUSE AND ACTION Barotrauma, damage Tell your child
to the eardrum resulting from a pressure difference to blow through
between the middle and outer ear, is possible. The
the nose while
pain usually improves within 24 hours. If the pain
holding the
Continued on persists for longer than this, consult your doctor
who will examine your child’s ear. nostrils closed.
next page
102
CHILDREN: ALL AGES
Continued from
previous page Structure of the ear in children
From the outside, children’s ears look the much Inner ear Middle ear
the same as those of adults. However, the
eustachian tube, which connects the middle ear
to the back of the throat, is shorter and more Outer ear
horizontal than in adults, allowing infections to
reach the middle ear more easily. In addition,
Is there a the adenoids (see TONSILS AND ADENOIDS, p.107),
discharge from lymphatic tissue that lie close to the back of the
Ear canal
YES
the affected ear? throat, tend to be larger in children; they can Eardrum
NO readily block the eustachian tubes, preventing Eustachian
CROSS SECTION OF
drainage and increasing the risk of infection. THE EAR tube
103
CHILDREN: ALL AGES
30 Hearing problems
Hearing problems are often not noticed in a child. If your at routine developmental checks by your health visitor or
child always needs to have the television or radio on louder doctor, but you may be the first to notice that your baby is
than you think necessary or there is a sudden deterioration not responding to sounds or learning to speak as quickly as
in your child’s school performance, a hearing problem may you think he or she should. This should always be brought
be the cause. Hearing problems in babies are often detected to your doctor’s attention.
104
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSES Your child may have glue ear Treating glue ear
(chronic secretory otitis media), in which fluid
builds up in the middle ear, causing hearing
problems. This condition may be due to an In the disorder glue ear (chronic secretory
allergy or to persistently enlarged adenoids otitis media), fluid builds up in the middle ear,
blocking the eustachian tube, which connects resulting in reduced hearing. The condition
the middle ear and the back of the throat (see may be treated surgically by inserting a tiny
STRUCTURE OF THE EAR IN CHILDREN, p.103). plastic tube, called a grommet, through the
ACTION Your doctor will probably arrange eardrum. The grommet allows air into the
for hearing tests, including tympanometry middle ear and fluid to drain away. The
(see HEARING TESTS IN CHILDHOOD, below), to grommet is left in place and usually falls out
Do any of the following confirm the diagnosis. He or she may suggest after 6–12 months. The eardrum then heals.
YES
apply to your child? anti-allergy drugs such as antihistamines. If Although grommets relieve hearing problems
the fluid persists, your doctor may recommend
• Suffers from recurrent surgical removal of the adenoids and/or the
caused by fluid build-up, they do not prevent
ear infections insertion of a tiny tube through the eardrum future ear infections. The operation to insert
• Has a persistently to drain the fluid (see TREATING GLUE EAR, a grommet is usually performed under
runny or blocked nose right). In most cases, normal hearing is restored. general anaesthesia as day surgery and rarely
needs to be repeated.
• Snores
NO
105
CHILDREN: ALL AGES
NO
POSSIBLE CAUSE A foreign body, such as a
bead or a peanut, may be lodged in your
child’s nose and may have caused an infection.
Consult your doctor.
ACTION Never try to remove a foreign body
POSSIBLE CAUSE A common cold or other viral
from your child’s nose yourself, because you
infection is probably the cause.
may only force it further into the nose. Your
ACTION Follow the self-help measures for doctor may be able to remove the obstruction.
treating a child with a cold (right). If your However, if the foreign body is difficult to
child has a fever, take steps to reduce it (see reach, your child may need to be admitted to
Relieving congestion
BRINGING DOWN A FEVER, p.77). Your child’s hospital for a minor operation under general
Inhaling steam from a bowl of hot, but not
symptoms should begin to improve after a few anaesthetic to remove it. The infection should
days. If they do not or if your child develops then clear up by itself, but in some cases boiling, water can help clear a blocked nose.
other symptoms, consult your doctor. antibiotics are needed to treat it. Children should always be supervised.
106
CHILDREN: ALL AGES
32 Sore throat
Sore throats are common in childhood. An older child will by swallowing. Most sore throats are the result of minor
usually tell you if his or her throat hurts. In a baby or a viral infections that clear up within 2–3 days without the
young child, the first sign you may have that something is need for medical treatment. In a few cases, however,
wrong may be a reluctance to eat because of the pain caused antibiotics may be needed to treat a bacterial infection.
Nasal cavity
Has your child been
YES
sneezing, and/or does Eustachian
tube opening
he or she have a
SELF-HELP Soothing your runny nose?
Tongue
child’s sore throat NO
Tonsils
If your child has a sore throat, the following
measures may help to reduce discomfort: LOCATION OF TONSILS AND ADENOIDS
• Give your child as many cold, non-acidic
drinks, such as milk, as he or she wants.
Using a straw may make drinking easier.
POSSIBLE CAUSE Inflammation of the
• Offer ice cream and ice lollies to eat. throat as a result of a minor viral
• Give liquid paracetamol. infection or irritation is the likely cause POSSIBLE CAUSE A cold or other viral infection
• Offer your child throat lozenges if he or she of your child’s sore throat. may be causing your child’s sore throat.
is old enough to suck them safely without
choking or swallowing them whole. ACTION Follow the self-help measures ACTION Follow the self-help measures for
for soothing your child’s sore throat treating a child with a cold (p.106). If your
• If your child is old enough, teach him or (left). Consult your doctor if your child child’s symptoms have not improved within
her to gargle with warm, salty water. is no better within a few days. a few days, consult your doctor.
107
CHILDREN: ALL AGES
33 Coughing
Coughing is a normal protective reaction to irritation airways, such as colds. A runny nose can cause a cough,
of the throat or lungs. In babies under 6 months, coughs particularly at night as fluid drips down the back of the
are unusual and can be a sign of a serious lung infection if throat and causes irritation. A cough at night, even if it is
the child is also unwell. In older children, the vast majority not accompanied by wheezing, can be a symptom of asthma,
of coughs are due to minor infections of the throat or upper and you should consult your doctor if you are concerned.
t
The object may have lodged in an airway, EMERGENCY!
causing severe irritation. CALL AN AMBULANCE
Is your child less than ACTION Your doctor will examine your
child and may arrange for a chest X-ray POSSIBLE CAUSE Your child may be choking on
1 year old, and does he an inhaled foreign body.
(p.39). If a foreign body is lodged in an
or she seem very unwell? YES airway, your child may need to go into ACTION While waiting for help to arrive, follow
NO hospital for the object to be removed, the first-aid measures for choking (p.294). Once
possibly under general anaesthesia. in hospital, your child will be examined and
any foreign body will be removed. This may
involve your child having a general anaesthetic.
108
CHILDREN: ALL AGES
Continued from
previous page
Has your child been POSSIBLE CAUSE Even though your child has
immunized against YES been immunized, a mild attack of whooping
whooping cough? cough (pertussis), an infectious disease that
causes bouts of coughing, may be the cause.
NO The infection is much less serious in children
who have been immunized than in those who
have not. Consult your doctor.
ACTION Your doctor will probably prescribe
antibiotics for your child to reduce the chance
of him or her passing the infection on to
SEE YOUR DOCTOR WITHIN others. Coughing may persist for several weeks,
24 HOURS but symptoms are rarely severe enough for the
Does your child have child to need hospital admission.
YES
bouts of uncontrollable POSSIBLE CAUSE Your child may
coughing followed by a have whooping cough (pertussis), an
infectious disease that causes bouts of
noisy intake of breath, severe, uncontrollable coughing.
and/or is coughing
often accompanied ACTION Your doctor will probably
prescribe antibiotics to reduce the chance
by vomiting? of your child passing the infection on to
NO others. If the condition is severe, your
doctor may send your child to hospital
for treatment. Episodes of coughing may
persist for several months. Severe cases of POSSIBLE CAUSES Your child may have
whooping cough, which are more likely enlarged tonsils or adenoids (p.107), which
in children aged under 1 year, may result can block the airway. Consult your doctor.
in permanent damage to the lungs.
ACTION Your doctor will examine your child
and may arrange for hearing tests (p.105) or
refer your child to a specialist. In some cases,
removal of the tonsils and/or adenoids is
advised, although symptoms often improve
Does your child always Does your child have as the child grows up. Adenoids rarely cause
have a runny nose? YES YES a problem in children over 8 years.
any of the following?
NO • Frequent ear
infections
• Nasal speech
• Snoring
• Poor hearing
NO
109
CHILDREN: ALL AGES
34 Breathing problems
Breathing problems in children include excessively noisy or that make him or her breathless. Any child who starts to
fast breathing and shortness of breath. Although rapid or wheeze needs to be seen by a doctor, and a child with severe
noisy breathing is usually obvious, shortness of breath may be difficulty in breathing needs urgent attention. Breathing
less noticeable because a child may simply avoid activities problems that occur suddenly also need immediate attention.
START
HERE
Have your
child’s
breathing
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Your child may be
WA R N I N G
DANGER SIGNS Call an ambulance if your
child’s breathing problem is accompanied by
problems choking on an inhaled foreign body, any of the following symptoms:
started within such as a piece of food or a small object,
• Blue-tinged lips or tongue
the last few particularly if the problem started while
• Abnormal drowsiness
minutes? he or she was eating.
• Inability to speak or make sounds
ACTION While waiting for help to arrive,
NO follow the first-aid measures for choking
(p.294). In hospital, your child will be
t
examined and any foreign body removed. EMERGENCY!
CALL AN AMBULANCE
Are any of the danger POSSIBLE CAUSE Your child’s breathing problems
YES
signs in the warning may be due to a serious condition that needs
box (right) present? urgent medical attention.
NO CALL YOUR DOCTOR NOW ACTION Your child will be examined in hospital
and may have tests such as a chest X-ray (p.39)
POSSIBLE CAUSE AND ACTION Bronchiolitis, a
and tests for measuring blood oxygen (p.201).
viral lung infection, is a possible cause. Your
The underlying cause will be treated, and
child may be admitted to hospital for tests
oxygen may be given to ease breathing.
including a chest X-ray (p.39). Treatment for
the condition may include giving oxygen and
bronchodilator drugs.
NO 2–12 months 50
t
1–5 years 40
EMERGENCY!
CALL AN AMBULANCE 5 years and over 30
110
CHILDREN: ALL AGES
ambulance. While waiting for help to arrive, you should: Sit your child POSSIBLE CAUSE A severe attack
upright with his or of asthma is a possibility.
• Help your child to sit upright, leaning forwards slightly,
with his or her forearms supported on a table or the her arms supported. ACTION While waiting for help,
back of a chair. Do not leave your give your child the number of
child alone. puffs of his or her relieving
• Make sure any prescribed reliever drugs for asthma inhaler or nebulizer according
have been taken according to the treatment plan.
to his or her treatment plan and
• Try to stay calm and keep your child calm. Do not carry out the self-help measures
leave him or her alone. Try to keep other people from for easing breathing in an asthma
crowding around your child to prevent him or her from attack (left). In hospital, your
becoming more anxious. child will be examined and his or
her blood oxygen levels measured
(see MEASURING BLOOD OXYGEN,
p.201). He or she may be given
oxygen and bronchodilator drugs
Continued from as well as oral corticosteroids to
previous page Is your child Has your child
YES YES ease his or her breathing.
also wheezing? been diagnosed
as having
NO
asthma in
the past?
NO
Is your child’s
breathing
abnormally
YES
t EMERGENCY!
CALL AN
AMBULANCE
111
CHILDREN: ALL AGES
35 Mouth problems
For problems specifically relating to the teeth, see chart 36, and delicate, these areas are susceptible to minor injuries
TEETH PROBLEMS (p.114). and infections. Younger children often pick up infections
Consult this chart if your child complains of a painful mouth affecting the mouth and lips because they tend to put objects
or has sores in the mouth or on the tongue or lips. Because into their mouths. Allergies can cause swelling of the mouth
the lining of the mouth and the skin of the lips are thin or tongue, which can be serious (see WARNING, below).
112
CHILDREN: ALL AGES
CONSULT YOUR DOCTOR IF YOU ARE UNABLE SELF-HELP Relieving a sore mouth
TO MAKE A DIAGNOSIS FROM THIS CHART.
113
CHILDREN: ALL AGES
36 Teeth problems
Your child’s teeth are constantly at risk of decay. Regular checkups, make an appointment with your dentist. In young
brushing can help prevent decay (see CARING FOR YOUR CHILD’S children, pain associated with the teeth may be due to teething
TEETH AND GUMS, below), which, if untreated, can spread to (opposite), which is usually no cause for concern. If your
central parts of the tooth, causing serious damage. Your child child has toothache or an accident needing urgent dental
should have regular dental checkups from about 3 years of treatment and your dentist is unavailable, call the casualty
age. If symptoms of decay, such as toothache, develop between department of a local hospital for details of an on-call dentist.
Cleaning a young
child’s teeth
Use only a pea-sized
amount of toothpaste
on a soft toothbrush.
CALL YOUR DENTIST NOW
The head of the brush POSSIBLE CAUSE Your child may have a dental
should be as small abscess, in which pus forms in or beneath a
as possible. tooth as a result of an infection.
ACTION If your child has a dental abscess, your
Brush your dentist may prescribe antibiotics to treat the
child’s infection. Once the infection has cleared up,
teeth from your child may need further dental work to
behind Continued on treat the underlying cause. In rare cases, the
next page tooth may need to be removed.
114
CHILDREN: ALL AGES
Continued from
previous page Does the pain last only Teething
YES
a few seconds?
NO The eruption of a tooth, particularly a molar,
can be uncomfortable and may make your
Does your child feel child irritable and restless. You may be able
YES
pain in his or her teeth to feel the emerging tooth if you run your
when they are exposed finger over the gum. A baby may have
to hot or cold foods? flushed cheeks, be less willing to feed, and
may sleep poorly when teething. However,
NO
SEE YOUR DENTIST WITHIN you should not attribute other symptoms,
24 HOURS such as a fever or diarrhoea, to teething.
Babies who are teething often seem to
POSSIBLE CAUSE Your child may have
Does your child feel decay deep within a tooth or in a crack like chewing on a cold, hard object, such as
pain when he or she in a tooth. This is especially likely if your a chilled teething ring or a raw carrot. Over-
bites on a tooth that YES child also has bouts of throbbing tooth the-counter local anaesthetic gels can be
has been filled recently? pain not brought on by food or drink. soothing if gently applied to the affected
ACTION Your dentist will examine your gums. The recommended dose of a painkiller
NO child’s teeth and may need to remove and can also be given if necessary.
fill any decayed areas.
115
CHILDREN: ALL AGES
37 Eating problems
For children under 1 year, see chart 6, FEEDING PROBLEMS (p.60). smaller appetites. Such variations in appetite are normal and
The appetites of children are more closely governed by their are not a problem as long as your child seems well and is
body’s energy requirements than are the appetites of adults. growing normally. Some children may refuse to eat to gain
Most children alternate between active periods, during their parents’ attention or control. This is relatively common
which they have large appetites, and inactive periods, when in young children; however, they usually grow out of it. In
they eat much less. In addition, when children are growing older children and adolescents, a refusal to eat may be a
rapidly, their appetites will be larger than usual. Some symptom of the potentially life-threatening disorder
children naturally burn up less energy than others and have anorexia nervosa (see EATING DISORDERS, p.139).
116
CHILDREN: ALL AGES
Continued from
previous page Are your child’s POSSIBLE CAUSE Your child’s appetite may be
height and weight reduced if he or she is in a phase of slow growth
within the normal or is taking less exercise then previously.
range for his or her YES ACTION As long as your child seems well and
age (see GROWTH happy and is not losing weight, there is no
CHARTS, p.26)? cause for concern. However, if your child
begins to lose weight or fails to grow normally,
NO you should consult your doctor.
Has your child been
YES
eating less than you
think is appropriate for
longer than 3 months? Is your child over
YES POSSIBLE CAUSES Your child may have an
NO 12 years old? underlying illness such as an intestinal disorder
NO that is causing a loss of appetite and poor
growth. However, dieting or the eating disorder
anorexia nervosa (see EATING DISORDERS, p.139)
need to be considered. Consult your doctor.
ACTION Your doctor will examine your
Does your child refuse child and may arrange for tests to exclude an
to eat when at home YES POSSIBLE CAUSES AND ACTION When away underlying disorder. If it is appropriate, an
from home, it is quite common for peer assessment by a psychiatrist may be suggested.
but eat well at school pressure to lead a child to eat foods he or
or other people’s homes? she would not normally eat. Alternatively,
a child may refuse to eat at home as a
NO means of gaining your attention. Try not
to make food an issue, and show as little
concern as possible when your child POSSIBLE CAUSES Your child may have an
refuses food. Follow self-help measures underlying illness such as an intestinal disorder
for coping with food fads (opposite). that is causing a loss of appetite and poor
growth. The eating disorder anorexia nervosa
(see EATING DISORDERS, p.139) may develop in
children under 12 years of age but is not
common. Consult your doctor.
Is your child taking
YES POSSIBLE CAUSE AND ACTION Certain drugs ACTION Your doctor will examine your
any prescribed drugs? can interfere with appetite, in some cases by child and may arrange for tests to look for
NO causing mild nausea as a side effect. Consult an underlying illness and determine the
your doctor. Meanwhile, do not stop your appropriate treatment. If it is appropriate, an
child’s prescribed drugs. assessment by a psychiatrist may be suggested.
117
CHILDREN: ALL AGES
38 Vomiting in children
For children under 1 year, see chart 4, VOMITING IN the body, such as in the urinary tract, can also cause vomiting
BABIES (p.56). in children, but there will usually be other symptoms as well.
When a child vomits only once, this is usually caused by Rarely, vomiting can be a symptom of a serious condition
overeating or an emotional upset and is rarely due to a needing urgent treatment. If your child is vomiting, make
serious disorder. Repeated vomiting is most likely to be due sure he or she drinks plenty of fluids to avoid dehydration
to an infection of the digestive tract. Infections elsewhere in (see PREVENTING DEHYDRATION IN CHILDREN, p.123).
t
START Has your EMERGENCY! WA R N I N G
YES
HERE child had CALL AN AMBULANCE
continuous DANGER SIGNS Call an ambulance if
POSSIBLE CAUSE A serious abdominal your child’s vomit is greenish or yellow or
abdominal condition, such as appendicitis, is possible. if vomiting is accompanied by any of the
pain for more following symptoms:
ACTION Do not give your child painkillers
than 4 hours or anything to eat or drink while waiting for • Flat, dark red spots that do not fade on
that has not help. Your child will probably be admitted pressure (see CHECKING A RED RASH, p.79)
been relieved to hospital, where his or her condition can be • Abnormal drowsiness
by vomiting? closely observed and tests carried out. He or • Sunken eyes and/or dry tongue
she may need surgery to look for and treat the • Black or bloodstained faeces
NO cause of the symptoms. • Severe abdominal pain that has lasted for
more than 4 hours
t
Is your child’s vomit EMERGENCY!
greenish or yellow? YES
CALL AN AMBULANCE
NO POSSIBLE CAUSE Your child may have an
intestinal obstruction. In a child aged under
2 years, this may be due to intussusception,
in which the intestine telescopes in on itself.
Does your child seem Has he or she had a A strangulated hernia, in which part of the
YES YES intestine pushes through a weak area in the
unusually drowsy? head injury within the abdominal wall and becomes trapped, is a
past few days? possibility at any age.
NO
NO ACTION Do not give your child painkillers
or anything to eat or drink while waiting for
help. Your child will probably be admitted
to hospital for tests and may need surgery.
SELF-HELP Treating
gastroenteritis in children t EMERGENCY!
CALL AN AMBULANCE
t
POSSIBLE CAUSE Vomiting and abnormal EMERGENCY!
If your child has gastroenteritis, it is drowsiness are serious symptoms that may CALL AN AMBULANCE
vital to replace fluids that are lost be caused by meningitis (inflammation
through vomiting and diarrhoea. In of the membranes surrounding the brain POSSIBLE CAUSE AND ACTION A serious head
due to infection). This is particularly injury, resulting in bleeding in or around
many cases, your child will recover if
likely if your child also has a fever. the brain, may be the cause. Your child will
you follow the measures listed below.
probably be admitted to hospital for tests such
However, if your child is not getting ACTION If meningitis is suspected,
as CT scanning (p.40) and for observation.
better after 24 hours, call your doctor. your child will be admitted to hospital
An operation is sometimes necessary.
immediately. He or she will be given
• Give your child frequent small drinks urgent treatment with antibiotics and
(see PREVENTING DEHYDRATION IN CHILDREN, may need intensive care.
p.123). A drink given soon after
vomiting has more chance of being SEE YOUR DOCTOR WITHIN 24 HOURS
absorbed before the child next vomits.
• Do not give your child any milk to POSSIBLE CAUSE Whooping cough (pertussis),
drink for the first 2 days of illness. an infectious disease that causes bouts of
Does vomiting follow severe coughing, often followed by vomiting,
• Do not give any solid food on the bouts of coughing? YES
may be the cause, even if your child has been
first day of illness.
immunized against it.
• Gradually reintroduce food, starting NO
with toast or plain biscuits. ACTION Your doctor will probably prescribe
antibiotics. These do not relieve the symptoms
• Your child should then have a light but reduce the chance of the infection being
diet for 2 or 3 days and gradually
Continued on passed on. If the condition is severe, your
return to a normal diet. child may need treatment in hospital.
next page
118
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE Gastroenteritis, inflammation SELF-HELP Coping with
of the digestive tract, usually due to a viral
infection, is the most likely cause and may be
travel sickness
associated with abdominal pain.
If your child suffers from travel sickness,
Does your child have ACTION Follow the self-help measures for
some of the following suggestions may help:
diarrhoea? YES preventing dehydration in children (p.123)
and treating gastroenteritis in children • Give only light meals or snacks before and
NO (opposite). If your child has not started to during your journey.
recover after 24 hours or if he or she develops • Try to travel at night to encourage your
further symptoms, call your doctor. child to sleep through the journey.
• Keep a car window open.
Does your child have • Discourage your child from reading during
two or more of the your journey.
following symptoms? CALL YOUR DOCTOR NOW • Provide plenty of distractions, such as
tapes of stories and songs.
• Unexplained loss of POSSIBLE CAUSE These symptoms may be due
weight to diabetes mellitus. This condition is caused • Try giving your child an over-the-counter
YES travel sickness remedy before the journey.
by insufficient production of the hormone
• Increased thirst insulin, which is needed by the body to get Your pharmacist can advise you.
• Passing more urine energy from sugar and carbohydrate foods. • Be prepared. For example, bring a change
than usual ACTION Your doctor will take a blood sample
of clothes for your child.
• Excessive tiredness to check your child’s blood sugar level. If Looking out
the diagnosis is confirmed and your child is of the window
NO vomiting, he or she will probably need to be If your child suffers
admitted to hospital. Your child will probably from travel sickness,
need insulin injections for life and will be
games that encourage
taught how to inject the insulin and monitor
Does your child have him or her to look
his or her blood sugar level. Your doctor will
out the window
two or more of the also advise you on your child’s diet and
may help.
following symptoms? lifestyle (see DIABETES MELLITUS, p.149).
• Fever
• Pain on passing urine
YES
• Bedwetting or
daytime wetting after
being dry
• Offensive-smelling Is your child passing
or cloudy urine pale faeces and
unusually dark urine,
NO SEE YOUR DOCTOR WITHIN 24 HOURS
and/or are your child’s
skin and whites of the POSSIBLE CAUSE Your child’s symptoms may
eyes yellow? YES be due to a urinary tract infection (p.126).
119
CHILDREN: ALL AGES
39 Abdominal pain
In, most cases, abdominal pain is short-lived and disappears whether abdominal pain in a child, particularly a young child,
on its own without treatment. However, in some cases, there needs medical attention or whether to wait and see. If your
may be a serious physical cause, such as appendicitis, that child has stomach ache or if his or her behaviour causes you
needs urgent medical attention. It can be difficult to decide to suspect abdominal pain, consult this chart for advice.
START
HERE
Has your
child been in
severe pain
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE A serious abdominal
WA R N I N G
DANGER SIGNS Call an ambulance if your
child has severe abdominal pain lasting for
continuously condition, such as appendicitis, is possible. more than 4 hours or if pain is associated
for more than with any of the following symptoms:
ACTION Your child will probably be admitted
4 hours? to hospital, where his or her condition can be • Swelling in the groin
NO closely observed and tests carried out. Do not • Swelling in the scrotum
give him or her painkillers or anything to eat • Greenish-yellow vomit
or drink while you are waiting for help. Your • Black or bloodstained faeces
child may need surgery to identify and treat Do not give your child painkillers or
the cause of the pain. anything to eat or drink while waiting.
t
swelling in either the EMERGENCY!
groin or the scrotum? YES
CALL AN AMBULANCE
NO 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,
POSSIBLE CAUSE This type of pain may be the or strangulated. Swelling in the scrotum may
first sign that your child has appendicitis or be due to torsion of the testis (p.131), in
another condition in which the lining of the which a testis twists inside the scrotum.
Does the pain get worse abdominal cavity becomes inflamed.
YES ACTION In both cases, emergency surgery is
when you gently press ACTION Give your child sips of water but needed. A child with a strangulated hernia
the child’s abdomen? nothing else to drink or eat. Follow the advice must have the hernia repaired. This procedure
for relieving abdominal pain (opposite). involves replacing the intestine and repairing
NO Watch your child carefully, and if the pain the weakness in the muscle wall (see HERNIA
is still there after 4 hours, call your doctor. REPAIR, p.215). In the operation to treat torsion
of the testis, the testis is untwisted, and both
testes are then anchored to the wall of the
scrotum to prevent the problem from recurring.
t
Is your child vomiting, EMERGENCY!
YES
and is the vomit CALL AN AMBULANCE
greenish yellow?
120
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSES These symptoms are often Intussusception
associated with abdominal pain in childhood,
which may be due to swollen lymph nodes.
In intussusception, part of the intestine
ACTION Unless your child shows any of the telescopes into itself, causing an obstruction.
Does your child also signs mentioned in the warning box (opposite), The cause is unknown, but it may occur
YES give the child painkillers and encourage him
have a sore throat, a during viral infections. If your doctor
or her to drink (p.67). If the pain worsens or
cough, or a runny nose? is no better within 24 hours, see your doctor. suspects that your child has intussusception,
your child will be admitted to hospital and
NO
may be given intravenous fluids. An enema
will probably be given to confirm the
diagnosis. This may also correct the problem
Does your child have SEE YOUR DOCTOR WITHIN 24 HOURS by forcing the intestine back into position. If
any of the following? POSSIBLE CAUSE Your child may have a
the enema does not help, emergency surgery
may be needed to relieve the obstruction
• Pain on passing urine urinary tract infection (p.126).
and remove any damaged intestine.
• Frequent passing of ACTION Your doctor will test a sample of your
urine child’s urine. If the diagnosis is confirmed, a Small intestine
urine sample will be sent for analysis, and
• Bedwetting or YES your child will be prescribed antibiotics. In
daytime wetting after some cases, further tests, such as ultrasound
being dry scanning (see INVESTIGATING THE URINARY
TRACT IN CHILDREN, p.127), may be needed
• Offensive-smelling or to look for any associated problems. LOCATION
cloudy urine Trapped small
• Fever intestine
NO Large intestine
NO
121
CHILDREN: ALL AGES
40 Diarrhoea in children
For children under 1 year, see chart 5, DIARRHOEA IN The most common cause of diarrhoea in children is a viral
BABIES (p.58). infection of the digestive tract. In most cases, drug treatment is
Diarrhoea is the frequent passing of abnormally loose or inappropriate; avoiding food, so that the intestines are rested,
watery faeces. While diarrhoea can be serious in babies, in and drinking plenty of fluids (see PREVENTING DEHYDRATION
older children, it is unlikely to be a cause for concern. IN CHILDREN, opposite) is the best course of action.
122
CHILDREN: ALL AGES
Continued from
previous page POSSIBLE CAUSE Lactose intolerance (opposite), SELF-HELP Preventing
in which the body cannot digest lactose, the
natural sugar found in milk, may be the
dehydration in children
cause. This condition is usually temporary.
Consult your doctor. If your child has diarrhoea, vomiting, and/or a
ACTION If your doctor suspects lactose fever, it is important to give him or her plenty
intolerance, he or she will probably arrange of fluids to prevent or treat dehydration, a
for a sample of your child’s faeces to be tested potentially life-threatening condition.
Does the diarrhoea to detect undigested sugars. If your child is The most suitable fluid to give your child is
YES
always occur after your lactose intolerant, you will need advice from oral rehydrating solution. It can be made up
child has milk or other a dietitian on a lactose-free diet. from powders bought over the counter or
dairy products? by dissolving 2 level teaspoons of sugar in
200 ml (7 fl.oz) of cooled, boiled water. You
NO can also give your child diluted, unsweetened
fruit juice as an alternative to the sugar
POSSIBLE CAUSE AND ACTION Certain drugs, solution, but avoid giving him or her milk.
such as antibiotics, can cause diarrhoea. Call While the symptoms last, offer your child
your doctor before the next dose of the drug is drinks at frequent intervals. He or she should
Is your child taking due to ask if it could be the cause and if you drink 1–11⁄ 2 litres (35–53 fl.oz) of fluid per
YES
any prescription drugs? should stop giving it to your child. day. If your child vomits, give him or her a
drink soon afterwards to replace the lost fluid.
NO
If your child still has diarrhoea after
24 hours, call your doctor.
Replacing fluids
Encourage your child to sip rehydrating
solution or diluted fruit juice at least once
an hour while symptoms last. He or she
should also drink soon after vomiting.
Are your child’s height Is your child under
and weight within the 3 years, and does the
normal range for his YES diarrhoea contain any YES
or her age (see GROWTH recognizable pieces
CHARTS, p.26)? of food?
NO NO
POSSIBLE CAUSE AND ACTION Toddler diarrhoea,
a common condition in which a young child
fails to digest food properly, is likely. This
may be due partly to your child not being able
to chew his or her food enough. It is not a
danger to health; however, you should consult
Is your child passing your doctor so that he or she can make sure
YES POSSIBLE CAUSE An inability to absorb
pale, bulky faeces? nutrients from food due to a disorder
an infection is not the cause.
NO such as cystic fibrosis (p.73) or coeliac
disease, in which the intestine is damaged
by a gluten allergy, may be the cause.
ACTION Your doctor will examine your
child and will probably arrange for
initial tests. Treatment depends on the
cause but may include drugs to aid POSSIBLE CAUSE AND ACTION Some children
digestion or a special diet with vitamin routinely produce soft faeces that can be
and mineral supplements. If cystic mistaken for diarrhoea. If you are not sure
GIVEYOUR CHILD PLENTY OF FLUIDS , AND SEE fibrosis is suspected, your child may whether or not your child’s faeces are normal,
YOUR DOCTOR WITHIN 24 HOURS . be referred to hospital for further tests. consult your doctor or health visitor for advice.
123
CHILDREN: ALL AGES
41 Constipation
Consult this chart if your child is not having regular bowel or painful to pass. It is also normal for babies and toddlers
movements or if he or she is passing very hard or pellet-like to strain and go bright red in the face when passing a
faeces. There is a wide variation in the normal frequency normal, soft faeces, although parents sometimes mistake this
with which children empty their bowels. Some children have as a sign that their child is constipated. Minor changes to a
a bowel movement several times a day, others have one child’s usual bowel habit are often caused by a change in diet
every 2 or 3 days. Both of these extremes are normal so long or in the daily routine, an illness, dehydration (especially in
as the child is otherwise well and that the faeces are not hard hot weather), or emotional stress.
124
CHILDREN: ALL AGES
42 Abnormal-looking faeces
For hard or pellet-like faeces, see chart 41, CONSTIPATION differences are almost always caused by something your
(p.124). For runny faeces in a child under 1 year, see chart child has eaten, and the change should only last a few days.
5, DIARRHOEA IN BABIES (p.58); for a child over 1 year, see However, there may be an underlying disorder causing the
chart 40, DIARRHOEA IN CHILDREN (p.122). problem. If the faeces still look abnormal in 48 hours or if
It is normal for faeces to vary slightly in their colour, smell, they are accompanied by other symptoms such as abdominal
or consistency. Consult this chart only if there is a marked pain, you should consult your doctor, taking a sample of the
change in the appearance of your child’s faeces. Sudden faeces in a clean container for him or her to examine.
START
HERE
Has your child
passed red,
jelly-like
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Intussusception, a rare
matter, and disorder affecting young children in which
is he or she POSSIBLE CAUSES AND ACTION Green faeces the intestine telescopes into itself, is possible.
unwell? are normal in breast-fed babies and are not This is particularly likely if your child is under
a cause for concern (see BABIES’ FAECES, p.59). 2 years old and he or she is having bouts of
NO However, in bottle-fed babies, green faeces inconsolable crying.
may indicate gastroenteritis, especially if they
are watery. Call your doctor. ACTION While waiting for the ambulance, do
not give your child anything to eat or drink.
In hospital, your child will need tests and an
enema, which may correct the problem; if it
Is your child under does not, an operation will be needed.
YES
1 year old, and are his
or her faeces green?
NO Is the blood in small
streaks on the faeces? YES POSSIBLE CAUSE A small amount of blood
on the surface of the faeces may be due to
NO an anal fissure (a split or tear in the lining
of the anus), which is often associated with
constipation. Consult your doctor.
ACTION Your doctor will probably advise
Is there blood on you to give your child plenty of fluids and
the faeces? YES
fibre-rich food (see AVOIDING CONSTIPATION IN
CHILDREN, p.124). He or she may also prescribe
NO stool-softeners, which will make passing faeces
POSSIBLE CAUSE Certain drugs can cause easier and allow the fissure to heal.
changes in the appearance of faeces.
ACTION Stop giving your child over-the-
counter drugs and consult your doctor.
Meanwhile, do not stop giving your child
his or her prescribed drugs. CALL YOUR DOCTOR NOW
Is your child taking any POSSIBLE CAUSES Blood in the faeces may be a
medicines? YES sign of a serious infection of the digestive tract
or inflammation of the lining of the intestines.
NO Has he or she just Both of these disorders need urgent treatment.
recovered from an ACTION Your doctor will probably examine
episode of diarrhoea YES your child and send a sample of faeces for
and vomiting? tests. He or she may also arrange for your
child to have colonoscopy (p.222) to confirm
NO the diagnosis. If the cause of the bleeding is an
infection, treatment may include antibiotics.
Are your child’s faeces Corticosteroid drugs may be prescribed if your
YES child has an inflammatory disease.
very pale? SEE YOUR DOCTOR WITHIN
NO 24 HOURS
POSSIBLE CAUSE Your child’s pale faeces
might be due to a failure to absorb fats POSSIBLE CAUSE After an episode of diarrhoea
as a result of an underlying disorder. and vomiting, faeces may be abnormally pale
for a few days.
ACTION Your doctor will examine your
child. Analysis of a sample of faeces ACTION If your child seems well, there is no
may be needed to confirm the diagnosis. cause for concern. Consult your doctor if the
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO Other tests will be needed to determine faeces have not returned to normal within a
MAKE A DIAGNOSIS FROM THIS CHART. the cause and appropriate treatment. week, or sooner if your child is unwell.
125
CHILDREN: ALL AGES
43 Urinary problems
For problems with bladder control, see chart 44, TOILET- urine, needing to pass urine more frequently than usual,
TRAINING PROBLEMS (p.128). cloudy urine, or unpleasant smelling urine. Occasionally,
Most children pass urine more frequently than adults. This unexplained vomiting and fever may be due to a urinary
is because children have smaller bladders and have less well tract infection. In some children, urinary tract infections are
developed muscular control. Urinary problems, such as associated with reflux, in which urine flows back towards the
urinary tract infections, are common in children. Symptoms kidneys when the bladder is emptied. Urinary problems in a
of urinary problems in children include pain on passing child should always be assessed promptly by your doctor.
Continued on Continued on
next page, column 1 next page, column 2
126
CHILDREN: ALL AGES
127
CHILDREN: ALL AGES
44 Toilet-training problems
Most children gain full control over their bladder and bowel Changes in circumstances, such as a new baby in the family
functions between the ages of 2 and 5 years. Few children or starting school, may make a child anxious and delay
have reliable control before the age of 2 years, and few have toilet training. Children whose parents were late to learn
problems, apart from the occasional “accident”, after the age may also be later in learning reliable control. Unless there is
of 5. However, the age at which an individual child masters a physical problem, toilet training occurs naturally, and the
the different skills of toilet training such as night-time control process cannot be speeded up by pressure from parents.
varies widely. It is not known why some children learn later Consult this chart if you are concerned about your child’s
than others, but it is seldom due to an unwillingness to learn. ability to control his or her bladder or bowels.
128
CHILDREN: ALL AGES
Continued from
previous page SELF-HELP Overcoming bedwetting
If your child regularly wets the bed, try to be patient. Pad and buzzer
Reassure your child that you are not angry and that he The moisture-detecting pad is
or she will learn to stay dry through the night. Encourage placed on an undersheet, and
him or her to use the toilet before going to bed, and the bed is then made up as
Are you worried about usual. The buzzer is placed
perhaps also wake your child to use the toilet
your child’s lack of on the bed or nearby.
bladder control? YES when you go to bed. A chart on which you
award your child a star after each dry
NO night may help, as may a pad-and-
buzzer system. The pad, which can
detect moisture, is laid under the
bottom sheet. As soon as your Buzzer
child wets the bed, the buzzer
CONSULT YOUR DOCTOR IF YOU ARE UNABLE sounds. The child will soon
TO FIND A CAUSE FOR YOUR CHILD ’ S learn to wake before
PROBLEM FROM THIS CHART. the buzzer goes off.
129
CHILDREN: ALL AGES
t
when passing these symptoms require emergency surgery.
EMERGENCY!
urine? CALL AN AMBULANCE
NO
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
Do one or both of the
can occur after an injury but often following apply to the
develops spontaneously during sleep. swelling?
ACTION Urgent surgery to untwist the • It is smaller or absent
Does your child have testis and restore its blood supply is first thing in the YES
YES
a painful scrotum? essential. During surgery, both testes morning
will be anchored within the scrotum to
NO prevent the condition recurring. • It increases in size
when your child cries
or coughs
NO
Does your child have
a painless swelling in YES
the scrotum?
NO
Circumcision
130
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 Blood vessels
can affect males of any age but is most common compressed
at about age 10. The symptoms can start during where twisted
sleep or following an injury and include pain in
the scrotum, groin, and/or abdomen and redness Penis
and tenderness of the scrotum. There may also
be associated nausea and/or vomiting. Torsion Twisted testis
Does one or both of of the testis requires urgent surgery, which
the testes appear to must be carried out within 6 hours, in order Scrotum
be absent from your YES
to prevent permanent damage to the testis. A twisted testis
child’s scrotum? During surgery, the blood vessels are untwisted Twisting of the testis within the scrotum
NO and then both of the testes are anchored to the results in compression of the blood vessels,
scrotum to prevent recurrence of the condition. which can lead to permanent damage.
t
Has the foreskin been
pulled back, and are EMERGENCY!
YES
CALL AN AMBULANCE
you unable to replace it?
POSSIBLE CAUSE A foreskin that cannot be
NO replaced can damage the blood supply to the
head of the penis if not treated urgently.
Is your child over
4 years old, and/or does ACTION While you are waiting for help, apply
YES an ice pack to reduce the swelling. In hospital,
the foreskin balloon
the doctor will try to replace the foreskin, but
when he urinates? it may be necessary to make a small cut in
NO the foreskin under local anaesthetic. Prompt
Are you concerned that circumcision (opposite) is usually needed to
your child’s foreskin prevent the problem from recurring.
YES
may be too tight?
POSSIBLE CAUSE AND ACTION The foreskin
NO cannot normally be retracted in boys
POSSIBLE CAUSE Your child may have phimosis,
under a year old. As a boy grows older,
in which the opening in the foreskin is too
the foreskin gradually becomes free of
small. This can impede urine flow and makes
the head of the penis and it should then
recurrent infection of the head of the penis
be possible to retract it. Trying to force
more likely. Consult your doctor.
the foreskin to retract may cause serious
damage and may make the problem ACTION Do not use force in an to attempt to
worse. Consult your doctor if you retract the foreskin because this may lead to
remain concerned or if your son’s further narrowing. Your doctor will examine
foreskin still cannot be retracted by the your child to confirm the diagnosis and ensure
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO time he is 4 years old. Your doctor may there is no associated infection. He or she may
MAKE A DIAGNOSIS FROM THIS CHART. recommend circumcision (opposite). recommend circumcision (opposite).
CHILDREN: ALL AGES
132
CHILDREN: ALL AGES
START
HERE
Did the pain
follow an
injury or
YES Is your child unable to
move the limb?
NO
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES Dislocation of a joint or a
a fall? bone fracture is possible.
NO ACTION Your child will probably need an
X-ray (p.39) to determine the extent of the
POSSIBLE CAUSES A minor sprain or strain of damage. The joint or bone may need to be
the ligaments or muscles in the limb is the repositioned under general anaesthetic and
most likely cause of your child’s pain. may be immobilized by bandages and/or a
ACTION Follow the advice given for sprains plaster cast for several weeks to allow the
Is the pain centred and strains in children (p.135). If the pain is torn ligaments and/or broken bones to heal.
YES severe or is no better by the next day, see your
around a joint?
doctor within 24 hours.
NO
133
CHILDREN: ALL AGES
NO
POSSIBLE CAUSE Pain in any of these areas may
indicate a hip-joint problem, which can often
Are several joints cause a child to limp.
YES
swollen or painful? SEE YOUR DOCTOR WITHIN 24 HOURS IF Go to chart 50 LIMPING (p.138)
NO YOU ARE UNABLE TO MAKE A DIAGNOSIS
FROM THIS CHART.
134
CHILDREN: ALL AGES
NO
135
CHILDREN: ALL AGES
49 Foot problems
The bones in children’s feet are soft, unlike bones in other Although wearing ill-fitting shoes may not cause symptoms
parts of the body, and can be distorted by shoes that do not at the time, it may result in foot problems later in life. Most
fit properly. Children’s feet grow quickly, and you should symptoms affecting children’s feet are caused by minor
check your child’s shoes regularly. Children should not wear conditions, such as veruccas, and can be treated at home.
second-hand shoes. Feet can also be damaged by wearing However, if your child’s foot is very painful or swollen or
high heels or shoes with pointed toes for any length of time. home treatment has been ineffective, consult your doctor.
START Does your Has your child injured Is your child able to
YES
HERE child have a his or her foot recently? YES walk on the foot? YES
painful or NO NO
tender foot?
NO
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES Your child may have a
fracture or a serious injury to the muscles
or ligaments of the foot.
Does the pain only ACTION Your child will need an X-ray
YES POSSIBLE CAUSES AND ACTION Check your (p.39) to determine the type and extent of
occur when your child child’s shoes for stones or thorns, which could the damage. An operation may be needed
is wearing shoes? be the cause of the problem. Also check inside to reposition the bones. Depending on the
his or her socks. As children’s feet can grow nature of the injury, your child may need
NO very rapidly, make sure your child’s shoes still to wear a plaster cast or a firm bandage.
fit comfortably, even if they are relatively new.
136
CHILDREN: ALL AGES
CONSULT YOUR DOCTOR IF YOU ARE UNABLE CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
TO MAKE A DIAGNOSIS FROM THIS CHART. MAKE A DIAGNOSIS FROM THIS CHART.
137
CHILDREN: ALL AGES
50 Limping
For limping due to a painful foot, see chart 49, FOOT wrong. A minor injury that causes a limp may get better
PROBLEMS (p. 136). on its own. However, any child with a limp, even a painless
A limp or reluctance to walk may be the first sign of a problem one, should be seen by a doctor within 24 hours. There may
in a child who is too young to explain that something is be an underlying disorder that requires prompt treatment.
NO
138
CHILDREN: ADOLESCENTS
139
CHILDREN: ADOLESCENTS
140
CHILDREN: ADOLESCENTS
Continued from
previous page Is your child worried POSSIBLE CAUSE Most adolescents experience
about a problem, such periods of anxiety. This is a cause for concern
as exams, difficulties YES only if it is severe enough to interfere with
day-to-day functioning.
with friends, or
parental separation? ACTION Talk to your child, and try to discover
any underlying worries that he or she has.
NO Offer your support and understanding. It may
Does your child help to talk to your child’s teachers. If your
YES child’s anxiety does not ease with time and
seem particularly extra support, consult your doctor. He or she
apprehensive or tense may recommend counselling or family therapy.
much of the time?
NO
POSSIBLE CAUSE AND ACTION Your child’s
anxiety may be a symptom of depression.
Talk to your child about his or her feelings,
and offer your support and understanding.
POSSIBLE CAUSE Drug or solvent abuse If the symptoms persist for more than
(below) may be causing your child’s 2 weeks, without an obvious cause, consult
Do any aspects of your your doctor. He or she may recommend
child’s behaviour behaviour problems.
counselling or family therapy.
suggest drug or solvent YES ACTION Talk to your child, to try to
abuse or the excess use find out whether he or she is using drugs
of alcohol? or solvents. Explain the dangers of drug
abuse, and try to provide your child with
POSSIBLE CAUSE If your child is persistently
NO support. If your child is unwilling or
antisocial or disruptive, he or she may have
unable to stop or denies drug usage, you
a conduct disorder. Consult your doctor.
should consult your doctor or a self-help
group (see USEFUL ADDRESSES, p.311). ACTION Your doctor may refer your child
to a specialist for assessment. Counselling or
family therapy will probably be recommended.
However, long-standing behaviour problems
may be difficult to change.
Is your child’s
behaviour aggressive or
violent, or is he or she YES
breaking the law? Recognizing drug and
NO solvent abuse
You are unlikely to discover any physical
POSSIBLE CAUSE AND ACTION If possible, try evidence that your child is taking drugs
to talk to your child about your concerns. unless he or she wants you to do so. Most
Regardless of your opinion about his or her adolescent drug users will use the drugs they
actions, you should make sure that your child buy immediately or will be careful to hide
Are you concerned is aware of the risk of an unwanted pregnancy
YES any evidence. Behavioural changes are often
that your child may be and of sexually transmitted infections (see SEX
sexually active? AND HEALTH, p.32). Your child is entitled to
the only clues. You should bear in mind,
confidential medical care from a doctor even however, that most teenagers experience
NO if he or she is under 16 (see PATIENT mood swings and other behavioural changes
CONFIDENTIALITY, opposite). as a normal part of adolescence.
Although different drugs have different
effects, the most common signs of regular
drug or solvent abuse are:
• Behavioural changes, such as unusual
mood swings, irritability, or aggressiveness
Has your child stopped
following his or her • Lying and/or secretiveness about activities
• Lethargy, sleepiness, or drowsiness
treatment plan for a YES POSSIBLE CAUSE AND ACTION A reluctance to • Falling school performance
long-standing medical follow the treatment plan for a long-standing
• Loss of interest in friends or usual activities
condition? disease, such as diabetes mellitus or asthma,
is common in adolescents, even if they have • Altered sleep patterns
NO previously been responsible. This is usually • Inability to account for money spent
due to a child’s resentment of being different • Disappearance of money or belongings
from others or the need to feel in control of If you suspect that your child is abusing
his or her life. Talk to your child, but do not drugs or solvents, choose a good time to
get aggressive or angry. Explain the dangers of discuss your concerns. If your child denies
CONSULT YOUR DOCTOR IF YOU ARE UNABLE not taking a prescribed medication as advised. drug or solvent use or seems unable or
TO FIND AN EXPLANATION FOR YOUR CHILD ’ S You should also consult your doctor, who may
unwilling to stop, consult your doctor or a
BEHAVIOUR ON THIS CHART AND YOUR CHILD be able to help by talking to your child. He or
CONTINUES TO BEHAVE IN A WORRYING WAY. she may recommend counselling. self-help group (see USEFUL ADDRESSES, p.311).
141
CHILDREN: ADOLESCENTS
142
CHILDREN: ADOLESCENTS
Does your child have a POSSIBLE CAUSES AND ACTION Being very
long-term illness such underweight or overexercising may affect
as cystic fibrosis or hormone production in the part of the brain
CONSULT YES that controls the onset of puberty and the
YOUR DOCTOR IF YOUR CONCERN arthritis? menstrual cycle. Consult your doctor so that
IS NOT DEALT WITH IN THIS CHART.
NO a serious underlying cause such as an eating
disorder (p.139) can be excluded. Your doctor
will advise you on your child’s ideal weight
and discuss the negative effects of overexercise
at this stage of life. If your child is seriously
POSSIBLE CAUSE AND ACTION The onset of underweight, your doctor will advise her on
puberty is delayed in your child. Although how to gain weight safely (p.149). Your child
there is often no obvious cause for late may be referred to a specialist if necessary.
POSSIBLE CAUSE It is quite common for girls
to have irregular periods for the first few puberty, it tends to run in families and is
years. It may take up to 40 menstrual cycles more common in children who are short.
before the body establishes a regular pattern. Consult your doctor, who will examine
However, the possibility of pregnancy should your child and may arrange for blood POSSIBLE CAUSE AND ACTION Some serious
always be considered. tests to measure her hormone levels. If long-term illnesses can temporarily delay the
necessary, he or she may then refer your onset of puberty. Discuss your concerns with
Go to chart 130 ABSENT PERIODS (p.260) child to a specialist. your child’s regular doctor.
143
CHILDREN: ADOLESCENTS
or go to chart 79 SKIN
(p.182)
DISCOLORATION AND MOLES
Treatments for acne
There is no instant cure for acne, although containing a retinoid drug. These creams unblock
many treatments are available that will improve pores by removing a fine surface layer of skin.
the appearance of the skin. Before consulting If treatment with antibiotics and/or retinoid
your doctor, you should try over-the-counter creams is ineffective, your acne is very severe,
lotions and creams containing benzoyl peroxide. or there is scarring, your doctor may refer you
POSSIBLE CAUSE Greasy skin is normal at This drug unblocks pores and kills bacteria, to a specialist for treatment with oral retinoids,
this age. In terms of health, it is no cause for thereby reducing the number of spots. However, such as isotretinoin. These drugs are usually
concern; however, it may embarrass your child.
benzoyl peroxide can make the skin sore. very effective. However, because of the risk of
ACTION Regular washing with mild soap and Moderate to severe acne should receive side effects, regular blood tests will be needed
water is normally all that is needed to keep medical treatment. Your doctor may prescribe while you are taking them. Women must not
greasy skin under control. Excessive washing
long-term low-dose antibiotics, which need to become pregnant during treatment with oral
can increase sebum production in the skin.
Any make-up that is used should be oil-free be taken for at least 6 months. Alternatively, retinoids because these drugs can cause serious
and should be removed completely each night. he or she may prescribe a skin preparation malformations in the fetus.
144
A D U LT S : G E N E R A L
GENERAL
CHARTS FOR
ADULTS
56 Feeling unwell.................................. 146 77 General skin problems................. 178 97 Difficulty in swallowing............. 209
57 Tiredness............................................. 147 78 Skin problems affecting 98 Vomiting............................................. 210
58 Loss of weight.................................. 148 the face................................................ 180 99 Recurrent vomiting....................... 212
59 Overweight........................................ 150 79 Skin discoloration and 100 Abdominal pain.............................. 214
moles..................................................... 182
60 Difficulty in sleeping..................... 152 101 Recurrent abdominal pain......... 216
61 Fever...................................................... 154
80 Rash with fever................................184
102 Swollen abdomen........................... 218
62 Excessive sweating......................... 156 81 Nail problems...................................185
103 Wind..................................................... 219
63 Headache............................................ 158 82 Painful or irritated eye..................186
104 Diarrhoea........................................... 220
64 Feeling faint and passing out.... 160 83 Disturbed or impaired
105 Constipation..................................... 221
vision.....................................................188
65 Dizziness.............................................. 162 106 Abnormal-looking faeces........... 222
84 Hearing problems...........................190
66 Numbness and/or tingling.......... 163 107 Anal problems.................................. 223
85 Noises in the ear..............................192
67 Forgetfulness and/or 108 General urinary problems.......... 224
confusion............................................. 164 86 Earache.................................................193
87 Runny or blocked nose................194 109 Painful urination............................. 226
68 Twitching and/or trembling.......166
88 Sore throat..........................................195 110 Painful joints..................................... 228
69 Pain in the face................................. 167
89 Hoarseness or loss of voice........196 111 Painful shoulder.............................. 230
70 Difficulty in speaking................... 168
90 Wheezing.............................................197 112 Painful arm........................................ 231
71 Disturbing thoughts and
feelings................................................. 169 91 Coughing.............................................198 113 Painful leg........................................... 232
72 Depression.......................................... 170 92 Shortness of breath........................ 200 114 Painful knee....................................... 234
73 Anxiety................................................. 172 93 Chest pain.......................................... 202 115 Swollen ankles................................. 235
74 Lumps and swellings..................... 174 94 Palpitations....................................... 204 116 Foot problems.................................. 236
75 Itching...................................................175 95 Teeth problems................................ 206 117 Back pain............................................ 238
76 Hair and scalp problems............. 176 96 Mouth problems............................. 208 118 Painful or stiff neck....................... 240
145
A D U LT S : G E N E R A L
56 Feeling unwell
Sometimes you may have a vague feeling of being unwell you should always make an appointment to see your doctor
without being able to identify a specific symptom such as if the feeling persists for more than a few days; there is a
pain. This feeling is usually the result of a minor infection, possibility that it may be a sign of a more serious underlying
psychological pressures, or an unhealthy lifestyle. However, problem that requires medical treatment.
NO
Social drinking
POSSIBLE CAUSE AND ACTION Certain drugs Drinking alcohol can be an enjoyable part
can cause a feeling of ill heath as a side effect.
of your social life, but you should keep your
Consult your doctor. Meanwhile, stop taking
consumption within safe limits to maintain
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO any over-the-counter or recreational drugs,
MAKE A DIAGNOSIS FROM THIS CHART. but do not stop taking prescribed drugs. good physical and emotional health.
146
A D U LT S : G E N E R A L
57 Tiredness
For problems related to sleeping, see chart 60, DIFFICULTY have cleared up after 2 or 3 weeks. However, if there is no
IN SLEEPING (p.152). obvious explanation for your tiredness, if it prevents you
Tiredness is normal after physical exertion or long periods from carrying out daily activities, or if it is prolonged, you
of hard work without a break. It is common after some should consult your doctor because in some cases tiredness
infectious illnesses, such as flu or glandular fever, but should may indicate a serious health problem.
147
A D U LT S : G E N E R A L
58 Loss of weight
For severe weight loss in adolescents, see chart 51, especially if it is combined with loss of appetite or other
ADOLESCENT WEIGHT PROBLEMS (p.139). symptoms, may be an early warning sign of some cancers or
Minor fluctuations in weight due to temporary changes in infections that require urgent medical attention. If you are
your diet and/or in the amount of exercise you are taking worried that you have lost a lot of weight and there is no
are normal. However, severe, unintentional weight loss, obvious cause, you should consult your doctor.
148
A D U LT S : G E N E R A L
Diabetes mellitus
Diabetes mellitus is a condition in which body more common than type 1. It mainly develops sugar levels is necessary to ensure that the
cells are not able to absorb enough of the sugar after the age of 40, particularly in those who are treatment is effective. People with type 2
glucose (the body’s main energy source) from overweight. It develops gradually and symptoms diabetes may be able to control their diabetes
the blood. This inability is due to a deficiency of may go unrecognized for years. simply by keeping fit and following the right
the hormone insulin, normally produced by the Complications of diabetes diet, but most need to take oral drugs and a
pancreas. If there is insufficient insulin, glucose High blood sugar over a prolonged period few need insulin injections.
accumulates in the blood and the urine. Cells damages blood vessels throughout the body, People with diabetes should visit their doctor
have to use fats as an energy source instead of which results in problems with the eyes, kidneys, every few months so that he or she can assess
glucose, which leads to a build-up of toxic by- heart, and nervous system. Treatment aims to the control of blood sugar levels and detect
products. These chemical changes cause the keep blood sugar levels as normal as possible to and treat any complications of the disease
symptoms of diabetes: thirst, excessive passing delay the onset of complications. at an early stage.
of urine, and weight loss. Diabetes mellitus Treating diabetes
affects about 3 in every 100 people; once it Anyone with diabetes needs to eat a diet high
develops, diabetes is a life-long condition. in complex carbohydrates, such as bread, pasta, A healthy diet
If you have
There are two main forms of the disorder: and pulses, and low in fats (particularly animal
diabetes, make
type 1 and type 2. In type 1 diabetes, the fats). Keeping fit is also an important aspect of
sure that your
pancreas produces too little insulin or none treatment. In addition to these measures, people diet is high
at all; this form usually develops suddenly in with type 1 diabetes need lifelong treatment with in complex
childhood or adolescence and causes dramatic insulin injections to replace the missing hormone. carbohydrates,
weight loss. In type 2 diabetes, the pancreas The injections are self-administered several times such as pasta, rice,
continues to produce insulin, but body cells are a day and the doses have to be carefully matched cereals, and bread,
resistant to it. This type of diabetes is 10 times to food intake. Regular monitoring of blood and low in fats.
149
A D U LT S : G E N E R A L
59 Overweight
Normally, fat accounts for between 10 and 20 per cent of chart if you weigh more than the healthy weight for your
the weight of a man and about 25 per cent of a woman; height (see ASSESSING YOUR WEIGHT, p.29) or if you have
much more than this is unhealthy, increasing the risk of excess abdominal fat – a waist measurement of over 89 cm
diseases such as diabetes and high blood pressure and of (35 in) for women and over 102 cm (40 in) for men. Excess
damage to weight-bearing joints, such as the hips or knees. fat around the abdomen is thought to be a greater risk for
Most people gradually gain a little weight as they grow heart disease than fat elsewhere. Weight gain is usually due
older, reaching their heaviest at about age 50. Consult this to overeating. Occasionally, there may be a medical reason.
150
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE The energy requirements of SELF-HELP How to lose
the body vary according to the amount of
exercise your daily routine involves. weight safely
ACTION Adjusting your food intake to take
The most likely cause of being overweight
account of your reduced energy requirements
should help you to lose the weight you have is a combination of overeating and lack of
put on. This will mean changing eating habits exercise. The best way to lose weight is to
you have developed over many years, and it combine a reduced calorie intake with regular
Did the weight gain may take a little while for you to become exercise. Set yourself a realistic, short-term
YES
follow a change from accustomed to your new diet. You should also target for weight loss; about 2–4 kg (4–9 lb)
a physically active life try to incorporate physical exercise into your a month is sensible. Rapid weight-loss plans
daily routine. This will maintain your general
to a more sedentary health and help to boost weight loss (see HOW
and fasting should be avoided.
job or lifestyle? TO LOSE WEIGHT SAFELY, right). Calorie reduction
The best type of weight-reducing diet is
NO one that is low in calories but balanced so
that you stay well nourished. You should
try to reduce your daily calorie intake by
500–1,000 calories. The following
suggestions may help:
POSSIBLE CAUSE You may be suffering from • Cut down on fatty foods; good
hypothyroidism (underactive thyroid gland). alternatives include wholemeal bread,
Have you noticed Consult your doctor. potatoes, and pasta.
one or more of the ACTION Your doctor will take a blood sample • Oven bake or grill rather than fry food.
following? to measure levels of thyroid hormones. If the • Avoid excessive snacking.
• Excessive tiredness diagnosis is confirmed, you will be prescribed • Cut down your alcohol consumption.
• Feeling the cold more YES
thyroid drugs, which need to be taken for life. • Avoid shopping for food when you are
Your doctor will arrange occasional blood feeling hungry.
than you used to tests to monitor the drug dosage. Exercise
• Increased dryness or Regular exercise benefits your general health
roughness of the skin as well as helping you to reduce weight.
• Thinning, brittle hair Exercise does not have to be strenuous, but
you should aim to do 30 minutes, five times
NO
a week. Not only are calories burned up
during exercise, but it also raises basal
POSSIBLE CAUSE Certain prescribed drugs, such metabolic rate (BMR), the rate at which
as corticosteroids, can cause weight gain as a your body consumes energy when at rest to
side effect. Consult your doctor. Meanwhile,
maintain basic processes such as breathing
do not stop taking prescribed drugs.
and digestion. If your BMR rises, you use up
more calories, and, if you have a calorie-
controlled diet, you will lose weight.
Are you taking any Taking regular
YES
prescribed drugs? exercise
Regular exercise,
NO such as cycling, can
POSSIBLE CAUSE Alcohol is high in calories but
has no nutritional value and is probably boost weight loss.
contributing to your weight gain. Set aside time
each day for
ACTION Cut down your alcohol consumption.
If you have difficulty cutting down, consult exercise.
your doctor for advice.
Do you regularly
YES
drink more than the
recommended safe Are you over
YES
alcohol limit (p.30)? 40 years old?
NO NO
POSSIBLE CAUSE Growing older is often
accompanied by a gain in weight. Your weight
gain is probably due to the fact you are taking
less exercise at a time when your body needs
POSSIBLE CAUSE Eating more than you need is less food to perform basic functions (see AGE
the likely cause of your excess weight. AND METABOLIC RATE, opposite).
ACTION Follow a sensible reducing diet (see ACTION Reduce your food intake and/or
HOW TO LOSE WEIGHT SAFELY, above). If after increase your level of activity to restore the
a month you have failed to lose weight, balance of energy intake and expenditure
consult your doctor for advice. (see HOW TO LOSE WEIGHT SAFELY, above).
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A D U LT S : G E N E R A L
60 Difficulty in sleeping
It is quite common to have the odd night when you find it get to sleep or if you frequently wake during the night.
difficult to get to sleep or to stay asleep, and this need not Lifestyle changes can sometimes help with sleeping problems
cause concern. Consult this chart if you often find it hard to (see GETTING A GOOD NIGHT’S SLEEP, opposite).
152
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 SELF-HELP Getting a good
evening can often make it difficult to sleep.
night’s sleep
ACTION Try eating lighter meals or eat your
last meal of the day earlier in the evening. Sleep is an important factor in maintaining
good health. If you are having difficulty
sleeping, these suggestions may help:
On nights when you • Exercise during the day to tire yourself
YES
have trouble sleeping, physically and help you relax.
have you eaten a late or • Cut out coffee, tea, cola, and other drinks
particularly heavy meal? POSSIBLE CAUSE AND ACTION Your sleep containing caffeine, particularly during the
problems may be related to your pregnancy. afternoon and evening.
NO You may need to get up during the night to
pass urine even early in pregnancy. Later
• Avoid high alcohol consumption: although
alcohol may make you sleepy at first, you
in pregnancy, your baby’s movements may
are more likely to wake up during the
disturb your sleep and your enlarged abdomen
may make it difficult to get comfortable. night and be unable to get back to sleep.
Anxiety about the birth may also cause sleep • Try to establish regular times for going to
Are you pregnant? problems. Follow the self-help measures for sleep and waking up; avoid daytime naps.
YES
getting a good night’s sleep during pregnancy • Avoid heavy meals in the evening.
NO (below). If you still cannot sleep, get up, read, • Have a warm drink such as
or do odd jobs. Try to catch up on sleep by heated up milk or camomile tea
taking naps during the day. Discuss any
at bedtime.
worries that you have about the birth with
your doctor or health visitor. • If you need to work in
the evening, stop at
least 1 hour before
bedtime.
Are you taking any • Make sure that
YES POSSIBLE CAUSE AND ACTION Some drugs, such your bed is
prescribed drugs? as beta blockers, may cause sleep disturbance as comfortable and
NO a side effect. Consult your doctor. Meanwhile, your bedroom is
do not stop taking your prescribed drugs. well ventilated.
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A D U LT S : G E N E R A L
61 Fever
A fever is a body temperature higher than 38ºC (100ºF). It suspect that you have a fever if you feel shivery, alternately
can be a symptom of many diseases, but it usually indicates hot and cold, and you are generally unwell. To check if
that your body is fighting an infection. Heat exposure and you do have a fever, use a thermometer to measure your
certain drugs can also raise your body temperature. You may temperature accurately (see MANAGING A FEVER, below).
t
4 hours. Call your doctor immediately if your
EMERGENCY! temperature rises to 40ºC (104ºF) or above,
CALL AN AMBULANCE and take steps to reduce your temperature
(see MANAGING A FEVER, below).
POSSIBLE CAUSE Meningitis, inflammation
Do you have one or of the membranes surrounding the brain
more of the following? YES due to infection, may be the cause of
such symptoms.
• Severe headache
ACTION If meningitis is suspected, you CALL YOUR DOCTOR NOW
• Pain in the neck on will be admitted to hospital immediately.
bending the head You will be given urgent treatment with POSSIBLE CAUSE A chest infection such as
forward antibiotics and may need intensive care. pneumonia (infection of the air spaces in
• Dislike of bright lights the lungs) is possible. This may be serious,
especially for those already in poor health.
• Drowsiness or
confusion ACTION While waiting for the doctor, take
steps to reduce your fever (below). If your
NO Are you short of breath doctor confirms that you have pneumonia, he
even when resting, or she will probably prescribe antibiotics and
and/or have you may arrange for you to have a chest X-ray
YES (p.39). Hospital admission may be necessary.
been coughing up
brownish sputum?
Do you have a cough? YES NO
NO SELF-HELP Managing a fever
When you are unwell, you should measure
your temperature every 4 hours. If using a
mercury thermometer, carefully shake it until
the mercury falls below 36ºC (97ºF), place it
Have you been under your tongue or armpit, and leave it for
YES POSSIBLE CAUSE AND ACTION Acute bronchitis
coughing up greyish (inflammation of the airways in the lungs) due 3 minutes. A digital thermometer can also be
yellow sputum? to a viral infection is the most likely cause. placed under the tongue or in the armpit.
NO Take steps to reduce your fever (see MANAGING When taking your temperature from the
A FEVER, right). If you smoke, stop. Medical armpit, add 0.6°C (1°F) to the reading to
treatment is not usually necessary, but you obtain the actual figure. You have a fever if
should consult your doctor if you are no your temperature is 38ºC (100ºF) or above.
better in a few days. If you become breathless
at any time, call your doctor promptly. Reducing a fever
If you have a fever, reducing it will make you
feel better. Rest in a cool room, drink plenty
of cool fluids, and take
Do you have one or paracetamol, aspirin, or
YES POSSIBLE CAUSE A generalized viral infection,
more of the following? such as flu, is a strong possibility. ibuprofen to reduce
• Mild headache ACTION Take steps to reduce your fever (see
the fever.
• Aching limbs MANAGING A FEVER, right). Call your doctor
Measuring your
• Runny nose if you become breathless or if you are no
better in 48 hours. temperature
NO Placing the
thermometer under
your tongue is
usually the most
convenient way
of measuring your
Continued on Continued on
next page, column 1 next page, column 3
temperature.
154
A D U LT S : G E N E R A L
Have you spent several ACTION Your doctor will examine you and
YES
hours either in strong will probably arrange blood and/or sputum
sunlight or in very tests. He or she may also order a chest
Over the last few X-ray (p.39) and other tests. You may need
hot conditions? weeks, have you had a to be referred to a specialist for further
NO recurrent fever, possibly YES investigations and for treatment.
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.
155
A D U LT S : G E N E R A L
62 Excessive sweating
Sweating is one of the natural mechanisms for regulating profusely, there is unlikely to be anything wrong. However,
body temperature and is the normal response to hot sweating that is not brought on by heat or exercise or that
conditions or strenuous exercise. Some people naturally is more profuse than you are used to may be a sign of one
sweat more than others, so if you have always sweated of a number of medical conditions.
156
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE Sweating Do you POSSIBLE CAUSE Excessive alcohol
is the body’s response regularly drink consumption can be a cause of
to fever and is part of more than the increased sweating.
the normal temperature YES
control mechanism.
recommended ACTION Cut down your alcohol
safe alcohol intake so that you stay within the
Go to chart 61 FEVER limit (p.30)? recommended safe limit. If you
are having difficulty reducing
(p.154) your alcohol consumption,
NO
consult your doctor for advice.
Do you have a
temperature of
38°C (100°F) YES
or above?
POSSIBLE CAUSE AND ACTION
NO Certain drugs, such as some
antidepressants and aspirin, can
Are you taking cause excessive sweating as a side
effect. Stop taking over-the-counter
POSSIBLE CAUSE AND any prescribed drugs, and consult your doctor.
ACTION In some women, or over-the- YES
Meanwhile, do not stop taking
changes in the levels of counter drugs? your prescribed drugs.
sex hormones can cause
increased sweating during NO
Are you female, menstruation. This is no
cause for concern, but
and does the consult your doctor if you
excessive POSSIBLE CAUSE The hands and
YES are worried. feet have a high concentration
sweating occur of sweat glands (left). For this
only during reason, these parts of the body
your periods? react most noticeably to a rise in
temperature. However, this is not
NO Is the excessive a cause for concern.
sweating ACTION If the sweating becomes
confined to your YES worse when you are worried or
hands or feet? feeling anxious, learn relaxation
exercises (p.32) to use in stressful
NO situations. Wash your hands and
feet regularly. If these measures
do not help, consult your doctor.
For severe cases of sweating of
Sweat glands the hands, surgery to destroy the
nerves that control sweating in
the palms may be considered.
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. There
are two types of sweat glands – eccrine glands and apocrine glands – Do you notice
and these produce different kinds of sweat. the sweating
Eccrine glands only when you YES POSSIBLE CAUSE AND ACTION
These glands are found all over the body and are active from birth are anxious Emotional stress can easily cause
onwards. The sweat from them is a clear, salty fluid containing various or excited? an increase in sweating. This in
itself is not a cause for concern,
waste chemicals. This sweat evaporates on the surface of the skin to but if it happens regularly or
NO
reduce body temperature as necessary. The eccrine glands may also causes embarrassment, try doing
produce sweat in response to anxiety or fear. Eccrine glands are most some relaxation exercises (p.32).
concentrated on the forehead, palms, and soles of the feet, and profuse Consult your doctor if these
sweating is likely to become apparent first in these areas. exercises do not help.
Apocrine glands
During adolescence, apocrine Hair Skin
glands become active. They surface
are mainly concentrated in Are you in
YES POSSIBLE CAUSE In adolescence,
the armpit, in the groin, and Sweat your teens? the apocrine sweat glands (see
around the nipples. These pore SWEAT GLANDS, left) become active.
NO
glands produce a fluid that This is usually associated with
Sebaceous an increase in sweating that is
contains fats and proteins. gland
The scent from this type of particularly noticeable under the
Dermis arms. It is perfectly normal.
gland is thought to play a role CONSULT YOUR DOCTOR IF YOU
in attracting the opposite sex. ARE UNABLE TO MAKE A DIAGNOSIS ACTION Make sure you wash
However, if it is allowed to Sweat FROM THIS CHART AND YOUR regularly. You may also want to
remain on the skin for long, it gland EXCESSIVE SWEATING CONTINUES TO use an antiperspirant deodorant
WORRY YOU . T HERE IS , HOWEVER , to reduce wetness and prevent
may interact with bacteria to
UNLIKELY TO BE A SERIOUS CAUSE body odour (see CONTROLLING
produce body odour. CROSS-SECTION OF SKIN FOR THIS SYMPTOM . EXCESSIVE SWEATING, opposite).
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63 Headache
From time to time nearly everyone suffers from mild to such as tension, tiredness, or an excessive consumption of
moderate headaches that develop gradually and clear up alcohol. However, if you have a headache that is severe, lasts
after a few hours, leaving no after-effects. Headaches like for more than 24 hours, is not improved by taking over-the-
this are extremely unlikely to be a sign of a serious counter painkillers, or recurs several times during one week,
underlying disorder and are usually the result of factors you should see your doctor promptly.
START Is your WA R N I N G
YES POSSIBLE CAUSE Many illnesses that cause a
HERE temperature fever also cause a headache.
38°C (100°F) DANGER SIGNS Call an ambulance if
or above? Go to chart 61 FEVER (p.154) a severe headache is accompanied by any
of the following symptoms:
NO • Flat, dark red spots that do not fade
on pressure (see CHECKING A RED RASH, p.79)
Are any of the danger • Drowsiness or confusion
signs listed in the box • Weakness in a limb
YES • Blurred vision
(right) present, or have • Loss of consciousness
Have you you vomited?
YES
injured your
NO
head within the
last 48 hours?
NO
POSSIBLE CAUSE A mild headache is
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE The injury may have resulted
common following a minor head injury. in damage to the brain.
ACTION Try self-help measures for ACTION You will probably have tests such as
relieving a headache (opposite). If these a skull X-ray (p.39) or MRI (p.41) of the head
do not help or if your headache persists and will be admitted to hospital for observation.
for more than 24 hours, call your doctor.
Is the headache
YES CALL YOUR DOCTOR NOW
severe, and CALL YOUR DOCTOR NOW
did it come POSSIBLE CAUSE A subarachnoid
on suddenly haemorrhage, in which there is bleeding POSSIBLE CAUSE Acute glaucoma, a serious
within the skull due to a ruptured blood disorder in which excess fluid causes increased
over a couple pressure in the eye, is a possibility, especially
vessel, is a possibility.
of minutes? if you are over 40.
ACTION Your doctor will probably send
NO you to hospital for urgent tests such as ACTION If your doctor confirms the diagnosis,
CT scanning (p.40) to confirm the you will probably be admitted to hospital,
diagnosis. You may need monitoring in where you will be given drugs to reduce the
intensive care and, in some cases, surgery pressure. Drugs are given as eye drops and
to stop the bleeding may be performed. possibly also by mouth or intravenously. Once
the pressure has been reduced, an operation
to improve fluid drainage from the eye will
probably be carried out.
Have you felt
nauseous or YES Is your vision blurred? YES
been vomiting? NO
NO CALL YOUR DOCTOR NOW
POSSIBLE CAUSE This may be a first attack
Is your vision disturbed of migraine, a severe headache that usually
in any other way, or occurs on one side of the head.
was it disturbed before YES
ACTION Your doctor may examine you to
the onset of pain? exclude other causes. Symptoms can often be
eased by measures such as taking painkillers
NO and antiemetics, drinking plenty of fluids, and
resting in a dark, quiet room. If you have
repeated attacks, follow the advice on reducing
the frequency of migraine (opposite). If self-help
Continued on advice does not help or attacks recur often, your
next page doctor may prescribe specific drug treatment.
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A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE Sinusitis (inflammation of the SELF-HELP Reducing the
membranes lining the air spaces in the skull)
may be the cause of this problem, especially frequency of migraine
if you have recently had a cold or a runny
or blocked nose. Many factors are known to trigger a migraine.
ACTION Try steam inhalation (see TREATING You need to identify the particular ones that
A COLD, p.194). Painkillers may also help. affect you. Keeping a migraine diary for a
Consult your doctor if your symptoms are no few weeks may help to pinpoint any
better in 48 hours; you may need antibiotics. triggering factors, which should then be
Is the pain felt mainly
YES avoided if possible. The following self-help
in the face, and is the
measures may also help in reducing the
pain worse when you
frequency of your migraine attacks:
bend down?
• Avoid foods such as cheese or chocolate,
NO which are common triggering factors.
• Eat regularly, because missing a meal may
CALL YOUR DOCTOR NOW trigger an attack.
• Follow a regular sleep pattern if possible,
POSSIBLE CAUSE Temporal arteritis because changing it may trigger an attack.
(inflammation of the arteries in the scalp
and elsewhere in the body) is a possibility. • If stress is a trigger, try doing relaxation
exercises (p.32).
Is the pain felt mainly Urgent treatment may be needed to
YES prevent the condition from affecting the
in the temples, and/or arteries supplying the eyes.
are these areas tender
to touch? ACTION Your doctor will probably
prescribe corticosteroid drugs to reduce POSSIBLE CAUSE Muscle strain in your neck,
NO the inflammation. It may be necessary for as a result of poor posture or tension from
you to have regular blood tests to confirm concentration, is the most likely cause of
that the dose you are taking is sufficient your headache.
to control the inflammation.
ACTION Try self-help measures for relieving
a headache (below). In order to prevent the
problem from recurring, make sure that when
you read, you are not sitting in an awkward
Did the headache position. Periodic rest from whatever you are
occur after you doing will also help. If headaches do recur,
YES either arrange for a vision test (p.189) with
had been reading
an optician or consult your doctor.
or doing close work?
NO
Are you sleeping poorly, POSSIBLE CAUSE AND ACTION Headaches can be
caused by lack of sleep. Psychological stress
and/or are you feeling YES often causes tension headaches. Try self-help
tense or under stress? measures for relieving a headache (left).
NO Go to chart 73 ANXIETY (p.172)
SELF-HELP Relieving
a headache
Most headaches are not serious and are Are you taking any
simply due to the pressures of everyday YES POSSIBLE CAUSE AND ACTION Certain drugs,
prescription drugs? including oral contraceptives, can cause
life. To ease the pain of a headache, take a
NO headaches as a side effect. Consult your doctor,
break and get some fresh air. Try massaging
who may offer you an alternative drug if your
your neck and shoulder muscles. If these medication is a possible cause. Meanwhile, do
measures do not help, rest in a quiet, cool, not stop taking any prescription drugs.
darkened room and take the
recommended dose of a
standard painkiller.
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A D U LT S : G E N E R A L
160
A D U LT S : G E N E R A L
Continued from
previous page Have these symptoms
YES CALL YOUR DOCTOR NOW
now disappeared?
POSSIBLE CAUSES If you are over 40, the most
NO
likely cause of your symptoms is a transient
ischaemic attack (TIA), in which a blood clot
temporarily blocks a blood vessel supplying
Do you have one or the brain. In younger people, a disorder of the
YES
more of the following nervous system is a possibility.
t
symptoms? EMERGENCY! ACTION Regardless of your age, your symptoms
• Difficulty in speaking CALL AN AMBULANCE need urgent assessment. You may need tests
such as MRI (p.41) to help to determine the
• Disturbed vision POSSIBLE CAUSES If you are over 40, the cause and appropriate treatment.
• Numbness, tingling, most likely cause of your symptoms is
or weakness in any a stroke, in which there is permanent
damage to part of the brain due to a
part of the body disruption in its blood supply. In younger
• Confusion people, a disorder of the nervous system CALL YOUR DOCTOR NOW
is a possibility.
NO POSSIBLE CAUSES There are a number of
ACTION Regardless of your age, your
symptoms need urgent assessment in potentially serious conditions, such as an
hospital. You may need tests such as irregular heartbeat and heart valve problems,
MRI (p.41) to help to determine the that reduce the output of blood from the
cause and appropriate treatment. heart, resulting in faintness and passing out.
Do you have any form
ACTION Your doctor may arrange for you to
of heart disease, and/or be admitted urgently to hospital, where your
did you notice your condition can be monitored. You will need
heart rate speed up or tests such as ECG (p.203) or a chest X-ray
slow down before the (p.39) to look for the cause of your faintness.
onset of faintness? YES
NO
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65 Dizziness
Feeling unsteady on your feet for a moment is a common unless you have drunk too much alcohol or have been
experience and need not be a matter for concern. However, spinning around yourself – for example on a fairground ride.
true dizziness (also known as vertigo), in which there is a Dizziness may be a symptom of an underlying disorder and
sensation that everything is spinning around, is not normal should be brought to your doctor’s attention.
t
SEE YOUR DOCTOR WITHIN
EMERGENCY!
24 HOURS
CALL AN AMBULANCE
POSSIBLE CAUSE Labyrinthitis, in which POSSIBLE CAUSES If you are over 40, the most
Have you been the part of the inner ear concerned with likely cause of your symptoms is a stroke, in
feeling nauseous balance (see HOW YOU KEEP YOUR BALANCE, which there is permanent damage to part of
and/or having below) is inflamed, may be the cause. the brain due to a disruption in the blood
YES This condition is due to viral infection.
bouts of supply to that area. In younger people, a
vomiting? ACTION There is no specific cure for disorder of the nervous system is a possibility.
labyrinthitis. However, your doctor may ACTION Whatever your age, your symptoms
NO prescribe antiemetic drugs to relieve your need urgent assessment in hospital. You may
symptoms. When symptoms are severe, have to undergo tests such as MRI (p.41) to
you should lie down and remain as still as help diagnose the cause and determine the
possible. The condition should gradually appropriate treatment.
improve but may last for 2–3 weeks.
Have you
noticed noises How you keep your balance
YES SEE YOUR DOCTOR WITHIN 24 HOURS
in the ear and/or
loss of hearing? POSSIBLE CAUSE Ménière’s disease may be the
A structure in the inner ear called the labyrinth
cause. In this rare disorder, there is an increase
NO in the amount of fluid in the labyrinth, the part helps you to keep your balance. This structure
of the ear concerned with balance (see HOW consists of three fluid-filled tubes (known as
YOU KEEP YOUR BALANCE, right), causing semicircular canals) at right angles to each
hearing problems and dizziness. This disease other. Any movement of the head causes the
usually first develops in middle age. fluid to move and prompts hair cells within
ACTION Your doctor will probably refer you the canals to send signals to the brain. These
to a specialist for hearing tests (p.190). If the signals, along with other information from
Does turning diagnosis is confirmed, you may be given a the body, are processed to maintain balance.
your head drug to reduce the amount of fluid in the inner
ear. Occasionally, an operation is required. Eardrum Ear canal
or looking YES
upwards bring
on dizziness? Labyrinth
Nerve
NO
POSSIBLE CAUSE AND ACTION The cause may be
cervical spondylosis (arthritis in the neck bones). Skull bone
This can cause compression of the blood vessels
in the neck when you turn your head, leading
to dizziness. Consult your doctor, who may
arrange for a neck X-ray (p.39). If cervical
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO spondylosis is diagnosed, you may be given a
MAKE A DIAGNOSIS FROM THIS CHART. supportive collar to restrict neck movements. CROSS-SECTION OF THE EAR
162
A D U LT S : G E N E R A L
t
nervous system is a possibility.
EMERGENCY!
CALL AN AMBULANCE ACTION Regardless of your age, your symptoms
need urgent assessment. You may need tests
POSSIBLE CAUSES If you are over 40, the most such as MRI (p.41) to help to determine the
likely cause of your symptoms is a stroke, cause and appropriate treatment.
POSSIBLE CAUSE Raynaud’s phenomenon, in which there is permanent damage to part
in which the blood vessels in fingers and of the brain due to a disruption in its blood
toes become extra sensitive to the cold and supply. In younger people, a disorder of the
constrict excessively, is the likely cause of nervous system is a possibility.
these symptoms. Consult your doctor.
ACTION Regardless of your age, your symptoms
ACTION Keep your hands and feet warm need urgent assessment in hospital. You may
and dry. Do not smoke. In some cases, drug need tests such as MRI (p.41) to help to
treatment or, rarely, surgery may be needed. determine the cause and appropriate treatment.
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A D U LT S : G E N E R A L
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE In many cases, confusion
after a head injury is short-lived. However,
confusion may be an indication of a serious
brain injury or associated with bleeding
Have you had one or Have all your symptoms between the skull and the brain.
YES YES
more of the following now disappeared? ACTION You will be examined fully in hospital
symptoms? NO and may need X-rays (p.39) or CT scanning
• Difficulty in speaking (p.40). You may also need to remain in
hospital to be monitored.
• Disturbed vision
• Numbness, tingling,
or weakness in any
part of the body
• Faintness or dizziness
NO
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES If you are over 40, the CALL YOUR DOCTOR NOW
most likely cause of your symptoms is
a stroke, in which there is permanent POSSIBLE CAUSES If you are over 40, the most
damage to part of the brain due to a likely cause of your symptoms is a transient
disruption in its blood supply. In younger ischaemic attack (TIA), in which a blood clot
people, a disorder affecting the nervous temporarily blocks a blood vessel supplying
system is a possibility. the brain. In younger people, a disorder of the
nervous system is a possibility.
ACTION Regardless of your age, your
symptoms need urgent assessment in ACTION Regardless of your age, your symptoms
hospital. You may need MRI (p.41) or need urgent assessment. You may need tests
CT scanning (p.40) to diagnose the cause such as MRI (p.41) to help diagnose the cause
and determine the appropriate treatment. and determine the appropriate treatment.
Do you have a
temperature of 38°C
YES CALL YOUR DOCTOR NOW
(100°F) or above?
POSSIBLE CAUSE AND ACTION A fever, especially
NO
a high fever over 39°C (102°F), can cause
confusion. While waiting for the doctor,
take steps to reduce your temperature (see
MANAGING A FEVER, p.154). Your doctor will
Continued on next Continued on next examine you to diagnose the cause of your
page, column 1 page, column 3 fever and determine the appropriate treatment.
164
A D U LT S : G E N E R A L
165
A D U LT S : G E N E R A L
166
A D U LT S : G E N E R A L
167
A D U LT S : G E N E R A L
70 Difficulty in speaking
Consult this chart if you have, or recently have had, to disorders affecting the brain, the mouth, or the facial
difficulty in finding or using words or if your speech has nerves. In some cases, speech may be affected permanently,
become unclear. Such speech difficulties may be related although speech therapy (below) is often beneficial.
t
weakness in any EMERGENCY! ACTION Regardless of your age, your symptoms
part of the body CALL AN AMBULANCE need urgent assessment. You may need to have
• Confusion tests, including imaging tests such as MRI
POSSIBLE CAUSES If you are over 40, the (p.41), in order to help diagnose the cause and
• Faintness or most likely cause of your symptoms is determine the appropriate treatment.
dizziness a stroke, in which there is permanent
damage to part of the brain due to a
NO disruption in its blood supply. In younger
people, a disorder of the nervous system
is a possibility.
ACTION Regardless of your age, your
symptoms need urgent assessment in POSSIBLE CAUSES A number of mouth
hospital. You may need to have tests, conditions, including infections, can cause
Are you unable including imaging tests such as MRI pain and swelling in the mouth that make it
to speak clearly (p.41), to help diagnose the cause and difficult to speak clearly.
because of pain determine the appropriate treatment.
Go to chart 96 MOUTH PROBLEMS (p.208)
or swelling in
the mouth or
tongue? YES
NO
CALL YOUR DOCTOR NOW
POSSIBLE CAUSE Swelling or infection of the
Speech therapy
Is speaking facial nerve, which supplies the muscles of the
face, is a possibility. This condition is known Speech therapy is often recommended to
difficult because as Bell’s palsy or facial palsy. help children and adults who have problems
you are unable with speech and language.
YES ACTION If the palsy has come on rapidly, your
to move the doctor may prescribe corticosteroid drugs. If it In children, problems with the development
muscles on one has come on gradually, he or she may arrange of normal speech and language may be due
side of your face? for tests, such as MRI (p.41), to determine the to other problems such as hearing loss,
cause and appropriate treatment. If the eye on learning difficulties, or physical causes such
NO the affected side does not close properly, you as a cleft lip and palate. Speech therapy can
may need to wear protective glasses and tape help children with these problems learn to
your eye closed when you go to sleep. In many
communicate effectively. Voice exercises to
cases, facial movements gradually return to
normal over several weeks. Occasionally, improve articulation are often combined with
Are you taking some loss of function is permanent. play therapy, and parents are taught the
any prescribed YES techniques needed to continue therapy at
drugs? home and so support their child’s learning.
NO In adults, speech therapy is mainly used
to help restore speech or language that has
SEE YOUR DOCTOR WITHIN 24 HOURS been lost following surgery to the mouth or
POSSIBLE CAUSE AND ACTION Certain drugs can throat or as a result of disorders such as
SEE YOUR DOCTOR WITHIN 24 HOURS cause difficulty in speaking as a side effect – a stroke. Therapy in adults may involve
for example, sedatives or antianxiety drugs relearning speech, voice exercises,
POSSIBLE CAUSE AND ACTION Unexplained may cause slurred speech as a result of their or, in some cases, using electronic devices
difficulty in speaking may be an early sign of action on the brain, and antidepressants may to aid speech production. If speech cannot
an underlying disorder of the brain or nervous make speech difficult by causing a dry mouth.
be restored, help with communication –
system and needs prompt medical assessment. However, you should not stop taking your
Your doctor may arrange for tests to diagnose prescribed drugs unless you are advised to for example with the use of pictures or
the cause and determine the treatment. do so by your doctor. specialized computers – may be offered.
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A D U LT S : G E N E R A L
START Do you WA R N I N G
YES SEE YOUR DOCTOR WITHIN 24 HOURS
feel that you
HERE SERIOUSLY
are being POSSIBLE CAUSE AND ACTION Feelings of this DISTURBED BEHAVIOUR
controlled by kind may be due to a mental health problem. If someone you know develops seriously
Your doctor may arrange for you to be disturbed thoughts and behaviour, such
outside forces, as rapid speech, beliefs that he or she has
assessed by a specialist and possibly admitted
or do you to hospital. You will probably be given great accomplishments or power, feelings
hear or see treatment, including drugs that may help of persecution and paranoia, or unrestrained
things that to relieve the symptoms. behaviour, contact that person’s doctor
others do not? within 24 hours. Such behaviour may
indicate a serious mental health problem.
NO
NO
NO
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A D U LT S : G E N E R A L
72 Depression
Most people have minor ups and downs in mood, feeling bereavement, or loss of a job. In other cases, it follows a
good one day but low the next. These changes often have an time a major life change, such as retirement. It may also be
identifiable cause and usually pass quickly. True depression precipitated by hormonal changes at the menopause or after
is associated with physical symptoms including excessive childbirth. However, in many cases, depression has no
tiredness, loss of weight, and sleep disturbances, such as early apparent cause, and some people have repeated episodes.
waking (see RECOGNIZING DEPRESSION, below). In some cases, Depression is a treatable disorder, and you should always
a depressive illness follows a traumatic event, such as divorce, see your doctor if you think you might be depressed.
ACTION You may find that you come to terms doing something that you enjoy, take regular
Have you recently had with what has happened without needing exercise, and make sure that you get enough
a distressing event, such YES treatment. However, if you cannot cope sleep. If you develop any of the symptoms of
as a divorce or losing with everyday life, consult your doctor, who depression (below), then your sadness may
have developed into a depressive illness, and
your job? may prescribe antidepressant drugs and/or
you should consult your doctor.
recommend psychological therapies (opposite).
NO
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A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSES A serious physical POSSIBLE CAUSE Regularly drinking too much
illness, such as a heart attack, or a alcohol may lead to depression. You should
major accident may often be followed also be aware of why you drink. Some people
by depression. This may slow down your may use alcohol to help them cope with stress
physical recovery. Consult your doctor. or unrecognized depression. Drinking too
Have you much may be compounding the problem.
YES ACTION Your doctor will talk to you
recently had a
about your current health and will ACTION Cut down the amount of alcohol
serious illness explain that this is a common reaction. you drink. If you find this difficult, or you
or accident? You may be prescribed antidepressant continue to feel depressed, consult your
NO drugs and/or your doctor may recommend doctor for advice.
psychological therapies (below).
Do you
YES
regularly drink
more than the
POSSIBLE CAUSE Many recreational drugs can
recommended cause profound psychological disturbances,
safe alcohol both during use and after withdrawal. Some
limit (p.30)? Are you using, or drugs can cause problems even years later.
NO have you ever used, YES ACTION If you still take recreational drugs, stop
recreational drugs? now. If you find you cannot stop or are still
having problems after you have stopped,
NO consult your doctor, who may be able to help
or may put you in contact with a counsellor or
self-help group (see USEFUL ADDRESSES, p.311).
Do you often
feel low just POSSIBLE CAUSE AND ACTION Premenstrual
YES Group therapy
before your syndrome, a collection of symptoms that A therapist and group members sit together.
period is due? may include low spirits and is caused by The members are encouraged to talk about
hormone changes, is likely. Follow self- their feelings and share their problems.
NO help measures (see PREMENSTRUAL
SYNDROME, p.257). If your symptoms
do not improve, consult your doctor.
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A D U LT S : G E N E R A L
73 Anxiety
If you are suffering from anxiety, you will probably feel natural reaction to stress, and it is normal to feel anxious if,
apprehensive and tense and be unable to concentrate, think for example, you are worried about money or family matters
clearly, or sleep well. You may have a sense of foreboding or if you have exams coming up. Such anxiety may help
for no obvious reason or have repetitive worrying thoughts. you to deal with stressful events and can help to improve
Some people also have physical symptoms such as headaches, your performance in certain situations. However, anxiety is
excessive sweating, chest pains, palpitations, abdominal not normal if it comes on without an apparent cause or if it
cramps, and a general feeling of tiredness. Anxiety is a is so severe that you can no longer cope with everyday life.
• Unexplained loss
of weight YES POSSIBLE CAUSE Hyperthyroidism
• Increased sweating (overactive thyroid gland) is a possibility.
Without medical testing, anxiety caused
• Bulging eyes by hyperthyroidism can be difficult to POSSIBLE CAUSE Stress as a result of this event
• Trembling hands distinguish from anxiety due to other is probably the reason for your feelings of
causes. Consult your doctor. anxiety (see RECOGNIZING STRESS, opposite).
NO
ACTION Your doctor will take a blood ACTION Try to keep stress to a minimum,
sample to measure your levels of thyroid and discuss any problems with close family or
hormones. If the diagnosis is confirmed, friends. To help you relax, devote some time
you will probably be treated with thyroid each day to leisure activities that you enjoy.
drugs or radioactive iodine, which are Regular exercise may help, as may relaxation
usually rapidly effective. In some cases, exercises (p.32). Consult your doctor if you
Continued on surgery to remove part of the thyroid feel that these measures are not working or if
next page gland may be needed. your anxiety seems to be becoming worse.
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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 insomnia, and anxiety. Having a series of
and has a beneficial effect under certain infections, such as colds, or getting recurrent
circumstances, readying the body for action. mouth ulcers is often a sign of stress as stress
The normal stress response causes the release tends to depress the immune system. Stress can
of epinephrine (adrenaline), which increases also result in flare-ups of existing disorders such
heart rate and maximizes blood flow to the as eczema. In the long term, stress may seriously
muscles in preparation for action. These damage health; it can, for example, contribute
responses are beneficial if stress is released. to high blood pressure, which increases the risk
However, prolonged or excessive stress can of heart attack. It is therefore important that
result in a range of symptoms, including chest you learn to recognize signs of stress and take
pain, stomach upsets, headaches, tiredness, action to deal with it (see STRESS, p.32).
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A D U LT S : G E N E R A L
NO
POSSIBLE CAUSE AND ACTION One of several
viral infections, including rubella, may be the
cause. Consult your doctor if you are no better
in 2 days. If you are pregnant or have been
in contact with a pregnant woman, see your
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO doctor within 24 hours to have the diagnosis
MAKE A DIAGNOSIS FROM THIS CHART. Go to chart 88 SORE THROAT (p.195) confirmed; rubella can harm a developing fetus.
174
A D U LT S : G E N E R A L
75 Itching
For itching confined to the scalp, see chart 76, HAIR AND reaction to a particular substance. In other cases, itching
SCALP PROBLEMS (p.176). For itching confined to the anus, can be a feature of a skin disorder or may even indicate an
see chart 107, ANAL PROBLEMS (p.223). underlying disease or psychological stress. Loss of natural
Itching (irritation of the skin that leads to an intense desire oils in the skin as a result of aging or from excessive washing
to scratch) may be caused by an infection or by an allergic may cause dryness and itching of the skin.
175
A D U LT S : G E N E R A L
176
A D U LT S : G E N E R A L
Hair transplant
Baldness can be treated surgically by several Magnifying Transplanted hair
glasses Skin surface
different methods of hair transplantation. In
Hair follicle
the method shown, skin and hair are taken Scalpel Incision
from a donor site, often at the back of the Recipient The procedure
scalp or behind the ears. The removed hairs site
The surgeon makes
and their attached follicles are then inserted
a number of tiny
in the bald area (the recipient site). A mild incisions in the bald
sedative is usually given, and both sites are area. Hair is then
anaesthetized. The transplanted hairs will fall taken from a donor
out shortly after the transplant, but new hair site elsewhere and
starts to grow from the transplanted follicles inserted into the
3 weeks to 3 months later. incisions. TRANSPLANTED HAIRS
NO NO
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A D U LT S : G E N E R A L
178
A D U LT S : G E N E R A L
Continued from
previous page Are these areas raised,
red lumps? YES POSSIBLE CAUSES You may have urticaria, also
known as hives. This condition may occur as an
NO allergic reaction to a particular type of food,
such as shellfish, but, in many cases, no cause
Do you have one or can be found. Insect bites, such as flea or
mosquito bites, are another possibility.
more areas of itchy, YES
abnormal-looking skin? ACTION If the itching is severe, over-the-
counter antihistamine creams or tablets should
NO provide relief. In most cases, urticaria clears
up within hours and insect bites clear up
within a few days. If urticaria recurs, you
Does the rash mainly should consult your doctor. Tests may be
Are you taking any affect your hands, and needed to look for an underlying cause.
over-the-counter or YES do you spend a lot of
prescribed drugs? time with your hands YES
NO in water or do you
handle chemicals?
NO POSSIBLE CAUSE You probably have irritant
hand eczema (dermatitis). This is a common
CONSULT YOUR DOCTOR IF YOU ARE UNABLE
problem for people who work in occupations
TO MAKE A DIAGNOSIS FROM THIS CHART.
such as hairdressing and cleaning, where hands
are frequently in water or exposed to chemicals.
ACTION Try to keep your hands out of water.
If this is not possible or if you are using
chemicals, wear cotton-lined rubber gloves.
Use a barrier cream or an emollient, such as
POSSIBLE CAUSE AND ACTION Some drugs Does the area of itching aqueous cream, frequently throughout the
commonly cause a rash, and others, such as clear up and then recur, day, and wash your hands with mild soap.
penicillin, may only cause a rash in people who and is it always in the YES If these measures do not help, consult your
are allergic to them. If the rash has developed doctor, who may prescribe a corticosteroid
suddenly, call your doctor before the next dose
same place? cream to relieve the itching and irritation.
of any prescribed drugs is due. Otherwise, make NO
an appointment with your doctor. Meanwhile,
stop taking any over-the-counter drugs.
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A D U LT S : G E N E R A L
POSSIBLE CAUSE Seborrhoeic dermatitis is POSSIBLE CAUSE These are probably cold sores
a possible cause. This disorder commonly caused by herpes simplex virus. By adulthood,
Do you have a scaly, occurs in oily areas of the face and is most people have had an infection with this
red rash, mainly often associated with dandruff. virus, which then lies dormant. In some people,
affecting the skin near ACTION Avoid using harsh soaps or
the virus is reactivated by a cold, exposure to
YES strong sunshine, cold weather, or stress.
the eyebrows and the detergents. A moisturizing cream should
hairline and the creases soothe the rash. The skin may improve ACTION Cold sores will clear up of their
at the side of the nose? if you use an over-the-counter dandruff own accord. If they recur, over-the-counter
shampoo containing ketoconazole on antiviral creams may speed up healing if used
NO the scalp. Consult your doctor if the at the first sign of symptoms. The herpes
rash does not improve; he or she may simplex virus can be passed on by direct skin
prescribe a corticosteroid cream. contact such as kissing. If you have cold sores,
do not kiss other people, particularly babies,
small children, and people who have eczema,
in order to avoid giving the infection to them.
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A D U LT S : G E N E R A L
POSSIBLE CAUSE Squamous cell carcinoma, a POSSIBLE CAUSE Rosacea, a condition similar to
type of skin cancer (p.183), is a possibility. acne, is possible. It usually develops between
Is the affected skin Consult your doctor. the ages of 40 and 60 and is often worst on
red and swollen, and the cheeks and nose. Consult your doctor.
ACTION Your doctor will probably refer you
do you have a high to hospital for a skin biopsy (p.183), in which ACTION Your doctor may prescribe antibiotic
temperature? YES the abnormal area is removed under a local tablets or cream to be used for several weeks or
anaesthetic and examined in a laboratory to months. You should avoid excessive exposure
NO confirm the diagnosis. You may not need any to the sun and cut down your alcohol intake,
further treatment if all of the abnormal area because they may make the condition worse.
has been removed. In some cases, further
surgery may be necessary.
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A D U LT S : G E N E R A L
182
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 Normal skin
or confirm a diagnosis of a variety of skin
diseases, such as cancers. The biopsy site is Abnormal
anaesthetized with local anaesthetic. In one area of skin
form of the procedure (excision biopsy), the
Epidermis
entire abnormal area is removed. Another form
of the procedure is used if a skin condition is
Do you have patches widespread. In this case, a small representative Dermis
YES
of paler skin? area of skin, about 1–2 cm (3⁄ 8–3⁄ 4 in) in
diameter, which includes both normal and Line of incision
NO
abnormal skin, is removed. It is usually Excision biopsy
removed in an ellipse shape to ease stitching After the biopsy site is anaesthetized, an
of the biopsy site. The removed tissue is then incision is made to remove the abnormality
examined under a microscope in a laboratory. and the whole thickness of skin.
Skin cancer
Skin cancer is the most common form of cancer form of a hard, painless, slowly enlarging lump
Do you have a worldwide. It is usually caused by exposure to with an irregular edge. It is red or reddish-
YES
pale area of skin ultraviolet rays in sunlight. Fair-skinned people brown and may form a non-healing ulcer.
surrounding a mole? are particularly at risk. There are three main types Malignant melanoma
of skin cancer: basal cell carcinoma, squamous This rare but serious form of cancer can spread
NO
cell carcinoma, and malignant melanoma. All and may be fatal if not treated early. A new
three can usually be cured by surgical removal mole or a fast-growing, irregularly shaped,
if they are diagnosed at an early stage. unevenly coloured, itchy, or bleeding mole may
Basal cell carcinoma be malignant and needs urgent attention.
This is the most common type of skin cancer
but the least dangerous because it very rarely
Malignant
spreads to other parts of the body. A typical
melanoma
lesion develops as a small, painless lump of a The uneven colour
pink to brownish-grey colour with a waxy or and irregular edges
pearl-like border. It may form a shallow ulcer. of this growth are
Squamous cell carcinoma characteristic of
Another common skin cancer is squamous cell a malignant
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
carcinoma. It often affects the face, taking the melanoma.
MAKE A DIAGNOSIS FROM THIS CHART.
183
A D U LT S : G E N E R A L
t
START Do you have Do you have one or EMERGENCY!
HERE red or purple YES1
more of the following YES
CALL AN AMBULANCE
spots that do symptoms?
POSSIBLE CAUSE Meningitis, inflammation of
not fade when • Severe headache the membranes surrounding the brain due to
pressed (see • Fever infection, may be the cause of these symptoms.
CHECKING A
RED RASH,
• Pain in the neck on ACTION If meningitis is suspected, you will
bending the head be admitted to hospital immediately. You
p.79)? will be given urgent treatment with antibiotics
forward and may need intensive care.
NO • Dislike of bright light
• Drowsiness or confusion
NO
184
A D U LT S : G E N E R A L
81 Nail problems
Nails are made of hard, dead tissue called keratin, which infections. However, most widespread skin conditions,
protects the sensitive tips of the fingers and toes from damage. including psoriasis and eczema, can also affect the growth
Common problems affecting the nails include distortion of the and appearance of the nails. It takes between 6 months and
nail and painful or inflamed skin around the nail. The most 1 year for a nail to replace itself, so treatment for nail
common causes of misshapen nails are injury and fungal problems often needs to be continued for some time.
NO
POSSIBLE CAUSE A fungal infection of the
nail is a possible cause of this abnormal
appearance, especially if only one or two
toenails are affected. Consult your doctor.
POSSIBLE CAUSE Psoriasis may be the cause.
Have your nails ACTION Your doctor will probably prescribe
This disease usually also affects the skin, causing
a topical antifungal cream or lotion, although
become pitted YES thick, silvery-white patches, but, in some
oral antifungal drugs may be used. Treatment
or dimpled? people, only the nails are affected. In severe
may need to be continued for several months,
cases, the nails come loose from the nail bed.
until the affected nail grows out.
NO
ACTION There is no cure for psoriasis, but
treatment of the skin, particularly around
the base of the nails, may result in an
improvement in the appearance of the nails.
Do you have
white patches YES POSSIBLE CAUSE AND ACTION White patches
on your nails? on the nails are very common and are usually
due to a minor injury to the base of the nail.
NO Contrary to popular belief, they are not due
to a lack of calcium in the diet. No particular
action is required; the white patches will
eventually grow out.
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART.
185
A D U LT S : G E N E R A L
t
START Have you EMERGENCY! WA R N I N G
YES
injured CALL AN AMBULANCE
HERE CONTACT
your eye? POSSIBLE CAUSE Damage to the eye always
LENS WEARERS If you wear
contact lenses and experience any kind of
NO requires immediate medical treatment. eye pain or irritation, remove your contact
ACTION Carry out self-help measures for lenses at once. You should not use them
treating eye injuries (p.99) while waiting for again until the cause of the problem has
medical help. In hospital, the injury will be been identified and treated. If the pain was
assessed. In some cases, surgery may be needed. caused by a piece of grit under the lens,
there is a risk that the cornea may have
been scratched. See your optician promptly.
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A D U LT S : G E N E R A L
Continued from
previous page SELF-HELP Avoiding contact lens problems
Most people who wear contact lenses do so
to correct their vision and have few problems
with them. If your eyes become irritated while Contact lens
wearing or after wearing contact lenses, you
Tear film
may have an allergy to the cleaning or soaking
solutions. To prevent potentially serious eye Lens of eye
infections, use strict hygiene when cleaning
non-disposable lenses, and never moisten Cornea
contact lenses with saliva. If not treated Lens on the eye
Do you have bloodshot promptly, an infection may result in permanent
eyes with or without a Contact lenses float
YES damage to your vision. If you wear contact on the film of tears
sticky discharge? lenses, always consult your pharmacist before that cleans and
NO using any over-the-counter eye drops because protects the front
some may be incompatible with contact lenses. of the eye.
187
A D U LT S : G E N E R A L
START
HERE
Have you
injured your
head in the
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE You may have damaged
WA R N I N G
DANGER SIGNS Sudden loss or blurring
of your vision in one or both eyes may be
past 48 hours? the part of the brain that is responsible for a sign of a serious eye disorder. Call an
vision or the eye itself. ambulance or arrange to be taken to the
NO
ACTION You will probably be admitted to emergency department of an eye hospital.
hospital for your vision to be monitored
and you may have CT scanning (p.40) or
MRI (p.41). Treatment depends on the
results of these tests.
CALL YOUR DOCTOR NOW
POSSIBLE CAUSE This may be a first attack
of migraine, a severe headache that usually
occurs on one side of the head.
Have you had visual Were the visual ACTION Your doctor may examine you to
disturbances such as YES disturbances followed YES exclude other possible causes. Symptoms can
seeing flashing lights by a severe headache? often be eased by self-help measures, such as
and floating spots? NO
taking painkillers and antiemetics, drinking
plenty of fluids, and resting in a dark, quiet
NO room. If you have repeated attacks, follow the
advice in the box on reducing the frequency of
migraine (p.159). If self-help measures are not
effective or if attacks recur often, your doctor
may prescribe specific drug treatment.
t
Screening for glaucoma is usually carried out disorders, such as multiple sclerosis, can EMERGENCY!
as part of a routine eye examination. In the cause intermittent double vision. These CALL AN AMBULANCE
screening test, a small puff of air is aimed at disorders may be accompanied by other
the front of the eye to measure the pressure symptoms such as numbness in a limb. POSSIBLE CAUSES Sudden double vision may
be due to bleeding in the brain or an enlarged
inside it. The procedure is painless and only ACTION Your doctor will examine you
blood vessel in the skull, both of which need
takes a few seconds. You should be tested and you will probably be referred to a
urgent medical attention. However, there may
for glaucoma every 2 years once you have specialist. You may need imaging tests
be a less serious cause.
reached the age of 40. If you are very short- such as MRI (p.41) to investigate the
brain. You may also need tests to assess ACTION Once in hospital, you will be examined
sighted or if glaucoma runs in your family,
the optic nerves supplying the eyes. and may have CT scanning (p.40) to look for the
testing should start at an earlier age. Treatment depends on the results. cause and determine the appropriate treatment.
188
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 Phoropter
2 years, especially once you are over 40. 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. 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
Has your vision reading distance. These tests show whether you
YES
become blurred? need corrective lenses, and, if so, which ones.
In addition, your optician will examine your
NO eyes to look for disorders such as diabetes and
high blood pressure, which can cause changes Having a vision test
in the back of the eye before general symptoms Different lenses are put into the phoropter and
develop. You may also be tested for glaucoma are changed until you are able to read letters
(see SCREENING FOR GLAUCOMA, opposite). near the bottom of the chart.
189
A D U LT S : G E N E R A L
84 Hearing problems
Deterioration in the ability to hear some or all sounds may a wax blockage and can be treated easily. Hearing loss is
come on gradually over a period of several months or years also a common feature of aging. However, if you suddenly
or may occur suddenly over a matter of hours or days. In develop severe hearing loss in one or both ears for no
many cases, hearing loss is the result of an ear infection or obvious reason, always consult your doctor.
190
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE Brief exposure to loud noise Hearing aids
can cause temporary hearing loss and ringing
noises in the ears. However, repeated exposure
to loud noise, even if the noise does not cause Hearing aids amplify sounds, improving
discomfort, can cause permanent loss of hearing. hearing in people with most types of hearing
loss. All types of hearing aids have a tiny
ACTION If you have temporary hearing loss
caused by a short exposure to excessive noise, microphone, amplifier, and speaker, which
your hearing should return to normal within are all powered by a battery. In older hearing
Do any of the following hours. If you have been regularly exposed to aids, these parts are often housed in a small
YES
apply? loud noises and you are concerned about your case that is worn behind the ear. However,
• You regularly listen hearing, consult your doctor. He or she will newer hearing aids are much smaller and
to loud music probably arrange for hearing tests (opposite) can fit entirely within the ear canal. The
to be performed. To prevent your hearing range of sounds that is amplified by a
• You are exposed to deteriorating further, follow the advice for
loud noise at work hearing aid is usually tailored to an
preventing noise-induced hearing loss (below).
individual’s own pattern of hearing loss.
• You have been
exposed to loud noise Modern
very recently hearing aid
NO This type of hearing
aid fits entirely
within the ear canal.
All the components
POSSIBLE CAUSE Certain drugs, such as aspirin
and some antibiotics, can cause hearing are fitted inside the
problems as a side effect. Stop taking any small moulded case.
over-the-counter drugs, but continue taking
Are you taking any prescribed medicines until you see your doctor.
prescribed or over-the- YES
counter drugs?
NO
191
A D U LT S : G E N E R A L
192
A D U LT S : G E N E R A L
86 Earache
Earache may vary from a dull, throbbing sensation to a is often due to infection of the ear canal or of the middle ear
sharp, severe, stabbing pain. Although it is very common in behind the eardrum. If severe, the pain will require medical
childhood, it occurs much less frequently in adults. The pain attention and, in some cases, treatment with antibiotics.
193
A D U LT S : G E N E R A L
194
A D U LT S : G E N E R A L
88 Sore throat
Most people suffer from a painful, rough, or raw feeling in infection, such as a cold, or irritation from smoke. Swallowing
the throat from time to time. A sore throat usually clears up something sharp, such as a fish bone, can scratch the throat.
within a few days and is most commonly due to a minor The cause of the soreness in this case is usually obvious.
195
A D U LT S : G E N E R A L
SELF-HELP Managing
laryngitis
Do you have two or
YES POSSIBLE CAUSE You may be suffering from
If you have lost your voice or have become more of the following hypothyroidism (underactive thyroid gland).
hoarse, the following measures may help: symptoms? Consult your doctor.
• Rest your voice as much as possible. • Excessive tiredness ACTION Your doctor will take a blood sample
• Do not smoke, and avoid exposure to • Increased dryness or to measure your levels of thyroid hormones.
a smoky atmosphere. If the diagnosis is confirmed, you will be
roughness of the skin
• Do not drink alcohol. prescribed thyroid drugs, which will need to
• Drink plenty of fluids. • Unexplained weight be taken for life. Occasional blood tests will
• If you have cold-like symptoms, take gain be necessary to monitor the dosage.
painkillers such as paracetamol. • Feeling the cold more
• Part fill a bowl with hot water, and than you used to
breathe in the steam for several minutes.
You should not rely on self-help measures
• Thinner or brittle hair
for more than 2 weeks. If your symptoms NO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART AND YOUR
have not completely disappeared within this
HOARSENESS OR LOSS OF VOICE PERSISTS FOR
time, consult your doctor. MORE THAN 2 WEEKS OR RECURS FREQUENTLY.
196
A D U LT S : G E N E R A L
90 Wheezing
Wheezing is a whistling or rasping sound made when you smoking. Rarely, wheezing is due to a small foreign body or
breathe out. It is usually due to narrowing of the airways as a tumour partially blocking an airway. If you suddenly start
a result of inflammation caused by infection, asthma, or to wheeze or are short of breath, get medical help at once.
Is your
temperature Are you short
of breath? YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE A build-up of fluid inside
38ºC (100ºF) the lungs, known as pulmonary oedema, is a
or above? YES
NO possibility. The most common cause of this
NO condition is acute heart failure, in which the
heart fails to pump effectively.
ACTION While waiting for help to arrive, sit
CALL YOUR DOCTOR NOW upright in a chair. You will probably be given
oxygen and diuretic drugs, which will help to
POSSIBLE CAUSE AND ACTION You may clear the fluid from your lungs. Tests such as
be having an asthma attack. Your doctor electrocardiography (p.203) and a chest X-ray
is likely to measure your peak flow rate (p.39) will be needed. Long-term drug treatment
(below). If the results show that you may be necessary to prevent a recurrence.
have asthma, you will probably be
Do you cough prescribed a bronchodilator drug.
up grey or
greenish-yellow
sputum most
days, and are
SEE YOUR DOCTOR WITHIN
24 HOURS
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE A severe attack of asthma
you a smoker is a possible cause of these symptoms.
POSSIBLE CAUSE AND ACTION You may
or have you have acute bronchitis, inflammation of the ACTION While waiting for the ambulance, sit
smoked in airways due to a viral infection. Because upright with your elbows supported on a table
the past? YES
you are wheezing, you should see your or the back of a chair. Try to keep calm. If you
doctor, who will examine you and may have already been diagnosed with asthma and
NO prescribe a bronchodilator drug. In have your drugs with you, take two puffs of
addition, you should follow the self-help your relieving inhaler or follow the treatment
advice for managing a fever (p.154) and plan given by your doctor. In hospital, you
treating a cold (p.194). If you become will be given oxygen and additional
short of breath, call your doctor at once. bronchodilator and corticosteroid drugs.
CALL YOUR DOCTOR NOW IF YOU HAVE
BEGUN WHEEZING AND YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART.
Measuring peak flow rate
Your peak flow rate is the maximum rate at Mouthpiece
which you can breathe out and is measured
Peak flow
in litres per minute. Your doctor may measure
rate meter
POSSIBLE CAUSE Chronic obstructive your peak flow rate in order to assess the
pulmonary disease (COPD) is likely. In this severity of respiratory conditions in which
condition, the airways become narrowed and Using the meter
the airways become narrowed. Asthma is Take a full breath,
produce excess mucus, and the air sacs in the
lungs are damaged. Consult your doctor. commonly diagnosed and monitored by and breathe out
measuring peak flow rate. You may be given as hard as you
ACTION Although the damage is irreversible, a peak flow rate meter to use at home so that can. The pointer
your doctor may prescribe a bronchodilator
you can check your condition regularly and on the meter
drug to help relieve symptoms. You must stop
smoking to prevent the condition worsening. adjust your treatment as necessary. shows the result.
197
A D U LT S : G E N E R A L
91 Coughing
Coughing is the body’s response to irritation or inflammation are colds, smoking, asthma, or inhaling a foreign body.
in the lungs or the throat; the cough may either produce Sometimes, however, a persistent cough may signal a more
sputum or be “dry”. The most common causes of coughing serious respiratory disorder, such as a tumour.
Have you
YES POSSIBLE CAUSE Irritation of the airways
recently been and lungs by the fumes or particles in the POSSIBLE CAUSE A foreign body in the lungs
exposed to smoke is the most likely cause. has probably made you cough. A cough is the
irritant chemical ACTION Your cough should settle once body’s natural response to irritation of an
fumes or smoke you are in a well ventilated area. If the airway and causes the particle to be forcefully
from a fire? fumes you have inhaled are known to be expelled from the lungs.
toxic, seek emergency medical advice. If ACTION Once you have coughed up the foreign
NO the cough persists for more than 1 hour, body, your cough should disappear. If the cough
or is associated with shortness of breath, continues for more than an hour, call your
call your doctor at once. doctor immediately.
t
NO POSSIBLE CAUSE AND ACTION Certain EMERGENCY!
drugs, such as ACE inhibitors, may CALL AN AMBULANCE
cause a persistent dry cough as a side
effect. Consult your doctor. Meanwhile, POSSIBLE CAUSE Coughing with a wheeze and
do not stop taking prescription drugs. shortness of breath may be due to an asthma
attack and needs urgent medical treatment.
ACTION While waiting for medical help, sit
upright with your elbows supported on a table
Do either of the or the back of a chair. Try to keep calm. If you
following apply? have already been diagnosed with asthma and
• You have episodes of have your drugs with you, take two puffs of
shortness of breath your relieving inhaler or else follow your
Are you short of breath treatment plan. In hospital, treatment will
and wheezing YES YES
and wheezing now? probably include oxygen and corticosteroids.
• Your cough is
brought on or made NO
worse by exercise
or cold weather
NO
SEE YOUR DOCTOR WITHIN 24 HOURS
POSSIBLE CAUSE A cough may be a symptom of
asthma, particularly when it is brought on by
exercise or cold weather.
ACTION Your doctor will examine you and may
measure your peak flow rate (see MEASURING
PEAK FLOW RATE, p.197). If asthma is diagnosed,
Continued on Continued on your doctor will probably prescribe inhaled
next page, column 1 next page, column 3 bronchodilator and corticosteroid drugs.
198
A D U LT S : G E N E R A L
Has the cough started POSSIBLE CAUSE AND ACTION You may
within the past week? YES have acute bronchitis or another viral
infection such as a common cold. Take Do you have pain
NO painkillers and try steam inhalation in the centre of your
(p.194). If you smoke, you should stop. chest, and does it get
Call your doctor if you become short of YES
breath. Otherwise, consult your doctor if worse when you bend
you are no better in a few days. over or lie down?
NO
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A D U LT S : G E N E R A L
92 Shortness of breath
It is normal to become short of breath after strenuous and threaten the oxygen supply to the tissues, it is very
exercise. Pregnant women and people who are overweight important to seek medical advice without delay if you
become short of breath most easily. However, if you are become short of breath for no apparent reason. A sudden
breathing rapidly or you are “puffing” at rest or after very shortness of breath and an inability to make any sound
gentle exercise, you may have a problem affecting the heart that comes on while eating is probably due to choking and
or respiratory system. Because such problems may be serious needs urgent first-aid treatment (see CHOKING, p.294).
START Is breathing WA R N I N G
YES Go to chart 93 CHEST PAIN (p.202)
HERE painful?
DANGER SIGNS Call an ambulance if you
NO or someone you are with has either of the
following symptoms:
Go to chart 90 WHEEZING (p.197) • Sudden, severe shortness of breath
• Blue-tinged lips or tongue
While waiting for help to arrive, loosen any
tight clothing on the affected person and
Are you wheezing? YES help him or her to sit in an upright position.
Do you have a cough
NO
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
Has the shortness the lungs) is possible. This may be serious,
of breath come YES Were you woken by an especially for those already in poor health.
on recently? attack of breathlessness,
and/or are you ACTION Take steps to reduce your fever (see
NO MANAGING A FEVER, p.154). If your doctor
coughing up pink or confirms that you have pneumonia, he or she
white, frothy sputum? YES
will probably prescribe antibiotics and may
NO arrange for you to have a chest X-ray (p.39).
Hospital admission is sometimes necessary.
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A D U LT S : G E N E R A L
Continued from
previous page Do you work or have POSSIBLE CAUSE An occupational lung disease,
you worked in a dusty such as pneumoconiosis, in which the lungs
atmosphere – for YES are progressively damaged by inhaled particles,
may be the cause. Consult your doctor.
example, in a mine
or quarry? ACTION Your doctor will ask you about your
current and past occupations. He or she will
NO also arrange for a chest X-ray (p.39) and lung
function tests to assess how well your lungs
Do you cough are working. If you smoke, you should stop.
YES In severe cases, you may have to consider a
up thick, greyish
POSSIBLE CAUSE Chronic obstructive change of employment.
sputum on most
days? pulmonary disease (COPD) is likely,
especially if you smoke or have smoked
NO in the past. In this condition, the airways
become narrowed and produce excess
mucus, and the air sacs in the lungs are
damaged. Consult your doctor. SEE YOUR DOCTOR WITHIN 24 HOURS
ACTION Although the damage is
irreversible, your doctor may prescribe POSSIBLE CAUSE A gradual accumulation
bronchodilator drugs to help relieve your of fluid in the lungs and in other tissues is
symptoms. If you smoke, you must stop probably the cause of your symptoms. This
to prevent the condition from worsening. problem is most commonly due to heart failure
(in which the heart fails to pump effectively),
especially in people over 60 years of age. It
can also result from a kidney or liver disorder.
Are your ankles
swollen? YES ACTION Your doctor will examine you.
Regardless of the underlying cause, he or
NO she may prescribe drugs, including diuretics,
which will help clear excess fluid. You will
need other tests, including blood tests and
electrocardiography (p.203), to establish the
underlying cause and appropriate treatment.
Does your work
YES POSSIBLE CAUSE A lung disorder known as
or hobby involve extrinsic allergic alveolitis, in which the air
regular contact sacs in the lungs become inflamed in response
with grain or other to certain inhaled substances, is a possibility.
crops and/or caged The disorder can sometimes cause a fever. Measuring blood oxygen
birds or animals? Consult your doctor.
ACTION Your doctor will probably arrange Tests that measure the amount of oxygen in
NO for diagnostic tests, including a chest X-ray the blood show how efficiently the lungs are
(p.39) and skin tests to look for sensitivity
working and are used to help diagnose and
to different substances. If the diagnosis is
confirmed, you will probably be advised monitor lung disorders such as pneumonia
to avoid further exposure to the substance and pulmonary embolism. Blood oxygen
causing the reaction. If this is not possible, levels can be measured by taking a blood
you may have to consider changing your job sample from an artery, usually in the wrist.
or hobby. You may be given corticosteroid However, an easier and painless method is
Have you noticed drugs to reduce the inflammation. pulse oximetry, which indirectly measures the
any of the following concentration of oxygen in blood in the
symptoms with the tissues. The pulse oximeter is clipped over
shortness of breath? the fingertip and shines a light through the
• Excessive tissues. Changes in the amount of light
tiredness absorbed by the tissues are detected and
• Feeling faint displayed on a monitor. Tissues containing
or passing out oxygen-rich blood absorb more light than
those in which the blood is low in oxygen.
• Paler than SEE YOUR DOCTOR WITHIN 24 HOURS
normal skin YES
201
A D U LT S : G E N E R A L
93 Chest pain
Pain in the chest (anywhere between the neck and the crushing, central chest pain, or pain that is associated with
bottom of the ribcage) may be alarming but usually does breathlessness, an irregular heartbeat, nausea, sweating, or
not have a serious cause. Most chest pain is due to minor faintness, may be a sign of a serious disorder of the heart
disorders such as muscle strain or indigestion. Severe, or lungs and may need emergency treatment.
START
HERE
Is the pain
gripping
or crushing,
YES
Has the pain persisted
despite several minutes
rest, or is this the first
YES
t
WHILE
EMERGENCY!
CALL AN AMBULANCE
WAITING FOR THE AMBULANCE , CHEW
and/or does time you have had HALF AN ASPIRIN , UNLESS YOU ARE ALLERGIC TO IT.
it spread into this type of pain?
POSSIBLE CAUSE A heart attack (myocardial
your neck, infarction), in which an artery supplying
NO
shoulders, blood to the heart muscle is blocked by
or arms? a blood clot, may be the cause.
NO ACTION In hospital, you will have electro-
cardiography (opposite). If a heart attack is
CALL YOUR DOCTOR NOW confirmed, you may be given thrombolytic
drugs to dissolve the blood clot, as well as
POSSIBLE CAUSE Angina, in which the painkillers, oxygen, and drugs to stabilize
blood supply to the heart muscle is your heart rhythm.
temporarily inadequate, is the most likely
explanation for chest pain of this kind.
t
ACTION Your doctor may arrange for you
to have tests such as electrocardiography EMERGENCY!
(opposite), exercise ECG (p.39), and, in CALL AN AMBULANCE
some cases, coronary angiography (p.40). POSSIBLE CAUSE Pulmonary embolism, in
If angina is diagnosed, you will probably which a blood clot lodges in an artery in a
need treatment with antianginal drugs. lung, blocking blood flow, is possible.
Surgery may be necessary in some cases.
Are you short of breath? YES ACTION You will be admitted to hospital
for tests such as a chest X-ray (p.39) and
NO electrocardiography (opposite). The level of
oxygen in your blood may also be measured
Have you recently been (see MEASURING BLOOD OXYGEN, p.201). If
pulmonary embolism is diagnosed, you may
immobile because of be given anticoagulant drugs to prevent
illness, injury, or long- further clots from forming.
distance travel, or have YES
you had a baby within
the last 2 weeks?
CALL YOUR DOCTOR NOW
NO
POSSIBLE CAUSE A chest infection such as
pneumonia (infection of the air spaces in
the lungs) is possible. This may be serious,
especially for those already in poor health.
Have you been Do you have a cough ACTION Take steps to reduce your fever (see
coughing up green or YES MANAGING A FEVER, p.154). If your doctor
YES with sputum, and/or is
yellow sputum? your temperature 38°C confirms that you have pneumonia, he or she
will probably prescribe antibiotics and may
NO (100°F) or above? arrange for you to have a chest X-ray (p.39).
NO Hospital admission is sometimes necessary.
202
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE Gastro- Is the pain worse Is your chest
YES YES
oesophageal reflux, in which if you take a tender to touch?
the acid stomach contents deep breath?
leak back up the oesophagus, NO
may be the cause. Consult NO
your doctor.
ACTION Your doctor will
Is the pain in give you advice on how to SEE YOUR DOCTOR
the centre of the YES cope with gastro-oesophageal
Do you have WITHIN 24 HOURS
reflux (see COPING WITH
chest, and does GASTRO-OESOPHAGEAL a burning pain
it get worse POSSIBLE CAUSE Pleurisy,
REFLUX, p.209). If your in your skin that inflammation of the two-
when you bend symptoms do not improve, is unaffected by layered membrane separating
over or lie you may be prescribed ulcer- breathing? YES the lungs from the chest
down? healing drugs to reduce the wall, is possible. This
production of stomach acid. NO condition is often the result
NO of a viral infection.
ACTION Your doctor will
examine you and may
arrange tests such as a chest
X-ray (p.39). Over-the-
Have you counter nonsteroidal anti-
YES POSSIBLE CAUSE Indigestion is inflammatory drugs will
had this type of the most likely explanation. SEE YOUR DOCTOR WITHIN
pain before, and 24 HOURS IF YOU ARE NOT help to relieve the pain.
does it come on ACTION Take an over-the- ABLE TO MAKE A DIAGNOSIS
counter antacid to relieve the FROM THIS CHART.
after eating? symptoms. To avoid further
NO attacks try self-help measures
for preventing indigestion
(p.217). Consult your doctor
if you often have indigestion.
Electrocardiography
Electrocardiography (ECG) is used to record the electrical activity During the procedure
produced by the heart as it beats. The procedure is frequently Small electrodes are attached to your chest, Electrode
used to investigate the cause of chest pain and to diagnose wrists, and ankles. Signals picked up by
abnormal heart rhythms. Electrodes are attached to the skin of each electrode produces a trace.
the chest, wrists, and ankles and transmit the electrical activity
of the heart to an ECG machine. This records the transmitted Trace
information as a trace on a moving graph paper or a screen. ECG
Each of the traces shows electrical activity in a different area of machine
the heart. The test usually takes several minutes to complete,
is safe, and causes no discomfort.
One heartbeat
203
A D U LT S : G E N E R A L
94 Palpitations
Palpitations are an awareness of unusually rapid, strong, or caffeine or nicotine or may simply be due to anxiety.
irregular beating of the heart. It is normal for the heart rate However, in a small proportion of people, palpitations that
to speed up during strenuous exercise, and you may feel occur at rest are a symptom of an underlying illness. If you
your heart “thumping” for some minutes afterwards. This have recurrent palpitations that have no obvious cause or
is usually no cause for concern. In most cases, palpitations that are associated with chest pain or shortness of breath,
that occur at rest are caused by the effect of drugs such as you should always seek medical advice.
START
HERE
Do you experience
any of the following YES
when you are
Are you
experiencing
palpitations
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE You may have a serious
having palpitations? now? disorder of the heart or its blood vessels. The
• Pain in the chest NO palpitations are preventing your heart from
or neck pumping effectively and need urgent treatment.
• Sudden, severe ACTION In hospital you will have treatment to
shortness of control the palpitations. You may then have
electrocardiography (p.203) and possibly a
breath chest X-ray (p.39) to look for the underlying
• Feeling faint or cause. Treatment depends on the results but
passing out may include antiarrhythmic drugs.
NO
204
A D U LT S : G E N E R A L
Continued from
previous page Ambulatory electrocardiography
In ambulatory electrocardiography (ECG), a
wearable device called a Holter monitor records
the electrical activity of the heart by means of Shoulder strap
electrodes attached to the chest. The device is
usually worn for 24 hours or longer and detects Electrode
intermittent arrhythmias (abnormal heart rates
and rhythms). Whenever symptoms occur, you
Do you have any of the press a button, which adds a mark to the Symptom
following symptoms? recording. The recording is then analysed to see
marker
button
• Weight loss with if there are any periods of arrhythmia and if they
increased appetite coincide with the marks denoting symptoms.
• Feeling constantly Normal Ectopic Symptom Delayed Monitor
on edge heartbeat heartbeat marker heartbeat
• Bulging eyes
• Increased sweating YES
Using a Holter monitor
NO The device is worn under clothing. This trace
(left) produced by the device shows an early
abnormal beat (ectopic beat), which coincides
AMBULATORY ECG TRACING with a symptom marker.
205
A D U LT S : G E N E R A L
95 Teeth problems
For pain affecting other parts of the mouth, see chart 96, disorders and are often associated with poor dental hygiene
MOUTH PROBLEMS (p.208). (see CARING FOR YOUR TEETH AND GUMS, opposite). You
Teeth are at constant risk of decay because bacteria act on should see your dentist every 6–12 months. If you have a
sugars in our diet to create acids that erode the surface of the heart valve disorder, tell your dentist; you will need to have
teeth. If untreated, decay can spread to the centre of the teeth. antibiotics before dental treatment. Let your dentist know if
The same conditions that cause decay can also cause gum you are pregnant so that any X-rays can be postponed.
START Do you
YES CALL YOUR DENTIST NOW
HERE have constant
toothache? POSSIBLE CAUSES Tooth decay or a dental
abscess, in which a collection of pus forms in
NO or beneath a tooth as a result of an infection,
Have you recently may cause constant toothache.
had a filling in the YES
ACTION If you have tooth decay, your
painful tooth? dentist will probably fill the affected tooth.
NO If you have a dental abscess, antibiotics may
be prescribed or the abscess may be drained
before further treatment. In rare cases, the
tooth may have to be removed.
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A D U LT S : G E N E R A L
207
A D U LT S : G E N E R A L
96 Mouth problems
For problems with the skin around the mouth, see chart 78, soreness in the mouth. Occasionally, a widespread skin
SKIN PROBLEMS AFFECTING THE FACE (p.180). condition or an intestinal disorder such as Crohn’s disease
A sore mouth or tongue is most commonly due to a minor may also affect the mouth, causing sore areas to develop. It
injury. For example, biting your tongue or cheek may cause is important that you keep your mouth and gums healthy by
a painful area. Such injuries should heal within a week. maintaining good oral hygiene (see CARING FOR YOUR TEETH
Minor infections are another relatively common cause of AND GUMS, p.207) and having regular dental check-ups.
208
A D U LT S : G E N E R A L
97 Difficulty in swallowing
Difficulty in swallowing is most often due to a sore throat to a sore throat may be due to a disorder of the oesophagus,
caused by an infection and usually clears up within a few days. the tube that leads from the throat to the stomach. In this
However, difficulty in swallowing or pain that is not related case, you should seek medical advice.
NO ACTION Your doctor will refer you to hospital • Do not exercise, bend over, or lie down
for tests such as an upper digestive tract after a meal.
endoscopy (p.213) or a barium swallow (see • Do not wear tight belts or clothes with
BARIUM CONTRAST X-RAYS, p.40). The results a tight waistband.
of the tests will help your doctor determine • To prevent heartburn at night, prop up
what treatment is necessary. the head of your bed or use an extra one
or two pillows.
If, despite these measures, your symptoms
are still a problem, over-the-counter antacids
POSSIBLE CAUSE Anxiety can sometimes cause may help. However, if you need to take
this type of difficulty in swallowing. antacids for more than 2 weeks, you should
CONSULT YOUR DOCTOR IF YOU ARE UNABLE
TO MAKE A DIAGNOSIS FROM THIS CHART. Go to chart 73 ANXIETY (p.172) be reassessed by your doctor.
209
A D U LT S : G E N E R A L
98 Vomiting
Vomiting is often the result of irritation of the stomach from produce vomiting. People who have recurrent migraine attacks
infection or over-indulgence in rich food or alcohol, but it recognize the familiar symptoms of headache with nausea
may also follow a disturbance elsewhere in the digestive tract. and/or vomiting, but in other cases of vomiting accompanied
Occasionally, a disorder affecting the nerve signals from the by severe headache or when vomiting occurs with acute
brain or from the balance mechanism in the inner ear can abdominal pain, urgent medical attention is needed.
• Overeaten
YES POSSIBLE CAUSE Gastritis, inflammation
• Eaten large amounts of the stomach lining, can occur as a
of rich or spicy food result of over-indulgence. In particular,
• Drunk a large amount alcohol can irritate the stomach lining. POSSIBLE CAUSES AND ACTION Gastroenteritis
of alcohol ACTION Follow the self-help advice for (inflammation of the digestive tract often due
preventing dehydration in adults to a viral infection) or food poisoning are the
NO (opposite). Drink only clear fluids and most likely causes. Make sure you drink
try an over-the-counter antacid to help to plenty of fluids (see PREVENTING DEHYDRATION
relieve any pain. If you regularly vomit IN ADULTS, opposite). These conditions usually
after over-eating or drinking alcohol, or if settle down within a few days; however, if you
Continued on you find it difficult to cut down on your vomit repeatedly for more than 24 hours or if
next page alcohol intake, consult your doctor. further symptoms develop, call your doctor.
210
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSES Food poisoning from food SELF-HELP Preventing
contaminated by bacteria or by toxins, or a food dehydration in adults
allergy, may be responsible for your vomiting.
ACTION Follow the advice on preventing Vomiting and diarrhoea can cause dehydration
dehydration in adults (right), and use good food as a result of the loss of large amounts of
hygiene to prevent recurrences of food
poisoning (see AVOIDING FOOD POISONING, fluids and salts from the body. Elderly people
below). If you vomit repeatedly for more than are particularly vulnerable to dehydration, as
Have you eaten food 24 hours, or if you develop further symptoms, are babies and children. The following self-
YES
that may have been call your doctor. help measures may be useful in reversing or
contaminated or to preventing dehydration:
which you may be • Drink plenty of fluids every 1–2 hours,
allergic? while symptoms last. Choose fluids such
as dilute orange juice or weak sweet tea.
NO
• Alternatively, drink oral rehydrating
SEE YOUR DOCTOR WITHIN 24 HOURS solution, which is available over the
counter as a powder that you reconstitute.
POSSIBLE CAUSE Labyrinthitis, inflammation of If you have vomiting and
the part of the inner ear concerned with balance
diarrhoea for more than
(see HOW YOU KEEP YOUR BALANCE, p.162) due
to a viral infection, may be the cause. 24 hours or if you
develop further
ACTION There is no specific treatment for symptoms, call
labyrinthitis. However, your doctor may
your doctor.
prescribe antiemetic drugs to relieve the
vomiting. When symptoms are severe, you
Before you vomited, should lie down and remain as still as
YES Fluid intake
did everything around possible. The condition should gradually
you seem to spin? improve but may last for 2–3 weeks. Make sure
that you
NO have frequent
drinks, even if you
are vomiting.
NO
211
A D U LT S : G E N E R A L
99 Recurrent vomiting
For isolated attacks of vomiting, see chart 98, VOMITING vomiting can be caused by inflammation of the stomach
(p.210). For vomiting during pregnancy, see chart 141, lining or by an ulcer. Lifestyle factors such as irregular meals
NAUSEA AND VOMITING IN PREGNANCY (p.278). or excess alcohol can make the symptoms worse. Recurrent
Consult this chart if you have vomited or felt nauseated vomiting associated with weight loss or abdominal pain may
repeatedly over a number of days or weeks. Recurrent have a serious cause, and you should consult your doctor.
Do you
YES POSSIBLE CAUSE Gastro-oesophageal reflux,
sometimes get in which the acid stomach contents leak back
a burning pain into the oesophagus, causing inflammation
in the centre and a burning pain, may be the cause of your
of your chest, Is the pain mainly symptoms. Consult your doctor.
especially when in the centre of your YES ACTION Your doctor will advise you on coping
you bend over upper abdomen? with gastro-oesophageal reflux (p.209). If your
or lie down? symptoms do not improve with these measures,
NO you may be prescribed ulcer-healing drugs to
NO reduce the production of stomach acid.
212
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 Endoscope Monitor
involves passing a flexible viewing tube
through the mouth to examine the inside of Mouth guard
the oesophagus, stomach, and duodenum to prevent
damage from
(first part of the small intestine) to look for
endoscope
disorders such as ulcers. Your throat may be
Do you have either of sprayed with a local anaesthetic and/or you
the following? may be sedated. The procedure usually takes
• Reduced appetite around 15 minutes. Samples for analysis can
• Unintentional weight be taken during the procedure.
loss of more than
4 kg (9 lb) YES Viewing the digestive tract
The doctor can inspect the lining of the
NO digestive tract, which is displayed on the
monitor as the endoscope is moved around.
Do you regularly
YES
drink more than the
recommended safe
alcohol limit (p.30)?
POSSIBLE CAUSE Chronic gastritis (persistent
NO SEE YOUR DOCTOR WITHIN inflammation of the stomach lining) is a
24 HOURS possibility. This disorder is aggravated by
excessive alcohol intake. Consult your doctor.
POSSIBLE CAUSE A condition that causes
increased pressure on the brain, such as a ACTION Your doctor will advise you to cut
tumour, may be the cause. However, such down your alcohol intake to within the
conditions are rare, and recurrent attacks recommended limits. He or she may also
of vomiting associated with headaches prescribe antacids. Eat small, regular meals
are more likely to be due to migraine. and, if you smoke, stop. If your symptoms
Have you been persist, your doctor may refer you for upper
YES ACTION If you have not previously been
suffering from diagnosed as having migraine, your
digestive tract endoscopy (above).
recurrent headaches? doctor will examine you to exclude other
NO causes. He or she may also refer you to
hospital for MRI scanning (p.41) of the
brain. If migraine is the cause of your
symptoms, follow the advice on relieving
a headache (p.159) and reducing the
frequency of migraine (p.159).
213
A D U LT S : G E N E R A L
t
and may refer you to hospital. You may
need surgery to determine the cause of EMERGENCY!
the symptoms and the treatment needed. CALL AN AMBULANCE
POSSIBLE CAUSES AND ACTION A serious
abdominal condition, such as appendicitis or a
Do you have perforated ulcer, may be the cause. Do not eat
YES POSSIBLE CAUSES Food poisoning or viral
diarrhoea? gastroenteritis may be the cause.
or drink anything or take painkillers while
waiting for medical help. You will probably be
NO ACTION Usually, no treatment is needed. admitted to hospital and may need surgery to
Follow the advice on preventing dehydration look for and treat the cause.
in adults (p.211) and see your doctor if the
symptoms are no better in 48 hours.
Is the pain
YES SEE YOUR DOCTOR WITHIN 24 HOURS
below the ribs
on the right? POSSIBLE CAUSES AND ACTION These symptoms
CALL YOUR DOCTOR NOW may be due to gallstones (opposite) causing
NO inflammation of the gallbladder or blocking
POSSIBLE CAUSES Pyelonephritis (infection in the flow of bile to the intestine. Your doctor
the kidney) or kidney stones may be the cause, will examine you. He or she may prescribe
particularly if you have pain on passing urine. antibiotics and painkillers. If you are very
unwell, you may be admitted to hospital.
ACTION Your doctor will examine you and When the symptoms have subsided, you may
will prescribe antibiotics if a kidney infection have ultrasound scanning (p.217) to confirm
is a likely cause. If you have kidney stones, the diagnosis. Avoiding fatty foods reduces
Did the pain you should drink plenty of fluids and take the risk of the pain recurring, but you may
YES painkillers. You may be admitted to hospital
start in the back be advised to have your gallbladder removed.
if you are very unwell. Further tests may be
below the ribs carried out to look for an underlying cause.
and move to
the groin?
CALL YOUR DOCTOR NOW
NO
POSSIBLE CAUSE A hernia, in which part of
Do you have a tender the intestine pushes through a weak area in
swelling in the groin? YES
the abdominal wall, may be the cause. If the
intestine becomes trapped, its blood supply
NO may be cut off, causing severe pain.
ACTION If your doctor confirms the diagnosis,
you will probably need urgent admission to
Continued on hospital for surgery to release the intestine and
next page repair the hernia (see HERNIA REPAIR, opposite).
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A D U LT S : G E N E R A L
Continued from
previous page
Does the pain POSSIBLE CAUSE Gastro-oesophageal reflux,
become worse when in which the acid stomach contents leak
you bend over or YES back up the oesophagus, may be the cause.
lie down? This condition causes inflammation of the
oesophagus and a burning pain in the chest.
NO Consult your doctor.
ACTION Your doctor will advise you on coping
with gastro-oesophageal reflux (p.209). If
your symptoms do not improve, you may be
Is the pain in prescribed ulcer-healing drugs to reduce the
the centre of the YES Is it worse after eating a production of stomach acid.
upper abdomen? large meal or drinking YES
excessive alcohol?
NO
NO
POSSIBLE CAUSES Chronic gastritis (persistent
inflammation of the lining of the stomach) or
indigestion, often due to overeating, are the
most likely causes. Chronic gastritis may be
POSSIBLE CAUSE Pain in the centre of the upper aggravated by drinking alcohol.
abdomen may be due to a heart condition. ACTION Try to eat small, regular meals and
Are you passing cut down on your alcohol intake (see SAFE
urine more Go to chart 93 CHEST PAIN (p.202) ALCOHOL LIMITS, p.30). Antacids may help
often than to relieve the pain. Consult your doctor if
normal and/or YES antacids do not ease the pain, or if attacks
is urination of pain occur frequently.
painful?
NO SEE YOUR DOCTOR WITHIN 24 HOURS
Hernia repair
POSSIBLE CAUSE AND ACTION You may have
cystitis, inflammation of the bladder lining When part of an organ, usually the intestine,
(usually due to bacterial infection).Your protrudes through a weakened muscle, it
doctor will arrange for urine tests to confirm forms a hernia. Common types of hernia
the diagnosis, and you will probably be
include inguinal and femoral hernias, both
prescribed antibiotics. Follow the self-help
Are you male? YES measures for urinary tract infections (p.226). of which occur in the groin. Most hernias
If the condition recurs, more tests may be can be repaired by a simple operation, which
NO arranged to exclude an underlying problem. is done under a local or general anaesthetic.
During the procedure, the contents of the
hernia are eased back into place and the
weakened muscle is repaired. In some cases
a piece of synthetic mesh is sewn into the
weakened muscle to strengthen it.
Do you have a
swollen or painful YES Inguinal hernia
Go to chart 136 LOWER ABDOMINAL testis or scrotum?
PAIN IN WOMEN (p.269) Femoral
NO hernia
Cut in skin
INCISION SITES
Gallstones Hernia
CONSULT YOUR DOCTOR OR, IF PAIN IS Intestine is
About 1 in 10 people over the age of 40 SEVERE , CALL YOUR DOCTOR NOW. eased through
has gallstones. The stones are formed in the the muscle
gallbladder from bile (a liquid produced by
Weakened
the liver that aids in digestion). There is often muscle
no obvious cause for gallstone formation, BEFORE
although they are more common in people
Stitched skin
t
who are overweight and/or who eat a high-
fat diet. Gallstones do not always result in EMERGENCY! Repaired
CALL AN AMBULANCE muscle
symptoms, but they sometimes inflame
the gallbladder or block its exit so that bile POSSIBLE CAUSE AND ACTION You may have Repositioned
cannot be emptied into the intestine. In both torsion of the testis (p.131), in which a testis intestine
these cases, the result may be episodes of is twisted in the scrotum, cutting off the blood AFTER
abdominal pain, nausea, and vomiting. The supply. This can cause pain in the abdomen as
Repairing a hernia
frequency of these painful episodes may be well as in the scrotum. Torsion requires urgent
An incision is made in the skin, and the
surgery to untwist the testis and restore blood
reduced by eating a low-fat diet, but in some hernia is pushed back through the muscle.
flow. Both testes are then stitched to the inside
cases the gallbladder needs to be removed. of the scrotum to prevent a recurrence. The muscle and skin are then stitched.
215
A D U LT S : G E N E R A L
216
A D U LT S : G E N E R A L
Continued from
previous page Abdominal ultrasound scanning
In ultrasound scanning (p.41), a device called a Ultrasound gel
transducer emits high-frequency sound waves Computer panel Monitor
and receives their echoes to produce images of
internal organs. Ultrasound scanning of the Radiographer
abdomen is often used to investigate the liver,
the gallbladder, and the kidneys. To produce
Is the pain Transducer
good contact between the transducer and the
associated abdomen, gel is placed on the skin over the
with diarrhoea area to be examined. The radiographer moves
and/or the transducer over the area, using gentle
constipation? YES
pressure, and images from it are displayed on
a monitor. The procedure is painless and safe.
NO
During the procedure
The hand-held transducer is moved over the
skin of the abdomen. The images displayed on
the monitor are continually updated.
Do you have
Have you lost weight, SEE YOUR DOCTOR WITHIN 24 HOURS
any swelling
or discomfort and/or do you have YES POSSIBLE CAUSES Ulcerative colitis and
in the groin that blood in your faeces? Crohn’s disease, disorders in which areas of
is made worse the intestine become inflamed, are possible
NO
causes. However, there is a possibility of
by coughing cancer of the colon.
or lifting
heavy objects? YES ACTION You will probably be referred to
hospital for tests such as colonoscopy (p.222)
NO POSSIBLE CAUSE You probably have irritable to establish the cause. Inflammation of the
bowel syndrome, a disorder in which there intestines may be treated with corticosteroid
is a combination of intermittent abdominal drugs. If cancer of the colon is the cause, it
pain, constipation, and/or diarrhoea. However, will be treated with surgery.
there is a slight possibility of cancer of the
colon. Consult your doctor.
ACTION Your doctor will examine you and SEE YOUR DOCTOR WITHIN 24 HOURS
may arrange for tests such as colonoscopy
Do you also (p.222) to rule out cancer of the colon. Most POSSIBLE CAUSES A urinary tract infection
have any of people are able to control the symptoms of is likely. However, the possibility of a more
the following irritable bowel syndrome using the self-help serious condition, such as a bladder stone or
symptoms? measures described (see LIVING WITH IRRITABLE a tumour, needs to be ruled out.
BOWEL SYNDROME, opposite).
• Passing urine ACTION Your doctor will arrange for urine
more often tests to confirm the diagnosis. If you have an
than normal infection, you will probably be prescribed
antibiotics. Drink plenty of fluids and take
• Pain on painkillers to relieve the symptoms. If there
passing urine POSSIBLE CAUSE A hernia, in which part of
is no infection, you will need ultrasound
scanning (p.41) and intravenous urography
• Cloudy or the intestine pushes through a weak area in
(p.227) to determine the correct treatment.
bloodstained the abdominal wall, may be the cause of these
urine YES symptoms. Consult your doctor.
ACTION If your doctor confirms the diagnosis,
NO you will probably need to have an operation to
repair the hernia (p.215).
SELF-HELP Preventing
indigestion
The following measures may be helpful in
preventing bouts of indigestion:
• Eat at regular intervals without rushing.
Are you female? YES Go to chart 136 LOWER ABDOMINAL PAIN • Avoid eating large meals late at night.
NO IN WOMEN (p.269) • Cut down on alcohol, coffee, and tea.
• Avoid eating rich, fatty foods.
• Keep a food diary and avoid foods that
trigger indigestion.
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
• Avoid medicines that irritate the stomach,
MAKE A DIAGNOSIS FROM THIS CHART.
such as aspirin.
217
A D U LT S : G E N E R A L
218
A D U LT S : G E N E R A L
103 Wind
Excess wind (gas) in the digestive system can cause then ferment, producing gas. High-fibre foods such as
discomfort and a bloated feeling. Expelling the gas through cabbage are common causes of wind, although some people
either the mouth (belching) or the anus generally relieves are affected by other types of food, such as dairy products.
these symptoms. Wind is often caused by swallowing air Usually, wind is nothing to worry about, but you should
while eating. It may also occur when certain foods are not consult your doctor if you suddenly develop problems with
broken down properly in the intestines; the food residues wind without having had a change in your diet.
219
A D U LT S : G E N E R A L
104 Diarrhoea
Diarrhoea is the frequent passing of unusually loose or needed other than ensuring that you drink plenty of fluids
watery faeces. It is often accompanied by cramping pains in order to avoid dehydration. However, you should see
in the lower abdomen. In the UK, most attacks of diarrhoea your doctor if diarrhoea lasts more than 48 hours or if you
result from viral infections and last for less than 48 hours. have frequent episodes of diarrhoea. Also see your doctor if
Diarrhoea is rarely serious, and usually no treatment is you have diarrhoea and your job involves handling food.
220
A D U LT S : G E N E R A L
105 Constipation
Some people open their bowels once or twice a day; others foods in the diet. Constipation is also common in pregnancy
do so less frequently. If you have fewer bowel movements because hormone changes cause intestinal muscles to relax. If
than usual, or if your faeces are small and hard, you are you are constipated for longer than 2 weeks, consult your
constipated. The cause is often a lack of fluid or fibre-rich doctor so that cancer of the colon can be ruled out.
221
A D U LT S : G E N E R A L
NO Colonoscopy
The lining of the large intestine (colon) can
CALL YOUR DOCTOR NOW
be inspected using a long, flexible tube
CONSULT YOUR DOCTOR IF YOU ARE UNABLE POSSIBLE CAUSE Bleeding in the digestive tract, called a colonoscope. This procedure, known
TO MAKE A DIAGNOSIS FROM THIS CHART. perhaps from a stomach ulcer, is a possibility. as colonoscopy, is used to look for disorders
ACTION Your doctor will examine you. such as colon cancer. Attachments on the
You may need to be admitted to hospital for colonoscope may be used to take tissue
immediate tests including upper digestive tract samples or perform treatments. Colonoscopy
endoscopy (p.213) and blood tests. Treatment takes about 40 minutes. It is uncomfortable,
depends on the cause of the bleeding but may so you may be offered a sedative drug first.
Does your skin and/or include ulcer-healing drugs. In some cases, a
blood transfusion may be needed.
the whites of your eyes Colon
look yellow? YES
Tip of
NO colonoscope
SEE YOUR DOCTOR WITHIN 24 HOURS
Colonoscope
POSSIBLE CAUSE This condition is known as
POSSIBLE CAUSE Malabsorption, failure of the jaundice. The symptoms may be due to a liver Rectum
digestive system to absorb nutrients from food or gallbladder disorder in which the flow of
properly, is a possibility. Consult your doctor. bile to the intestine is blocked.
ACTION If your doctor suspects malabsorption, ACTION Your doctor will probably arrange During the procedure
he or she may arrange for tests on blood and for blood tests and possibly for abdominal
The colonoscope is passed via the anus
faeces. If the diagnosis is confirmed, you may ultrasound scanning (p.217). Such tests should
through the rectum up into the colon. Air is
have further tests to determine the cause of the help to establish the underlying cause so that
malabsorption so that treatment can be given. appropriate treatment can be given. passed in to give a clearer view of the colon.
222
A D U LT S : G E N E R A L
START Is opening WA R N I N G
YES SEE YOUR DOCTOR WITHIN
your bowels
HERE 24 HOURS
BLEEDING
painful and/or FROM THE ANUS You should
have you POSSIBLE CAUSES Haemorrhoids (enlarged always consult your doctor if you notice
veins in the rectum or around the anus), bright red blood in your faeces, or bleeding
noticed any from the anus. Even though bleeding
or an anal fissure (tear in the anus lining)
bleeding from are likely causes, but a more serious is most commonly due to haemorrhoids,
the anus? disorder is possible. other, more serious causes, such as cancer
of the colon, should be excluded.
NO ACTION If you have haemorrhoids, your
doctor will explain self-help measures and
treatment options (see HAEMORRHOID
TREATMENTS, below). For an anal fissure,
your doctor will advise you on diet (see
CONSTIPATION, p.221) and may prescribe
a laxative to soften the stools. POSSIBLE CAUSE You 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
Do you have itching Have you noticed of the anus and, in women, the genital area.
around the anus? YES YES Although harmless, they may be passed on
white, thread-like from one person to another or picked up from
NO
particles in your faeces? contaminated food. Consult your doctor.
NO ACTION If threadworms are diagnosed, your
doctor will prescribe drugs that kill the
worms. All members of your family should be
treated to prevent reinfection. Always wash
POSSIBLE CAUSES Itching around the anus can your hands after going to the lavatory and
be associated with haemorrhoids but often before preparing food. If you have similar
develops without an obvious cause. Consult symptoms again, you can use over-the-counter
your doctor who will examine you. If you treatments to kill the worms.
have haemorrhoids, your doctor will advise
Do you have one or on treatment, including self-help measures
more painless fleshy (see HAEMORRHOID TREATMENTS, right).
If no cause is found for the itching, there are
lumps around the anus? YES various steps you can take to relieve it. Try to
NO resist the urge to scratch; use soft toilet paper; Haemorrhoid treatments
wash and dry the anus after opening the
bowels; avoid tight underwear.
In many cases, no medical treatment is
needed for haemorrhoids, and self-help
measures solve the problem. You should eat
POSSIBLE CAUSES These are probably anal plenty of high-fibre foods (see A HEALTHY DIET,
warts, caused by a viral infection of the skin. p.28) to prevent constipation, which can
Anal warts are often sexually transmitted and aggravate the condition. Avoid straining
may be associated with genital warts or other when opening the bowels; wipe the anus
sexually transmitted infections (p.245 and with soft toilet tissue; then wash the area
Do you have a tender p.267). Rarely, such lumps may be cancer of with warm water and dry it thoroughly.
lump in the crease the anal canal. Consult your doctor.
YES Over-the-counter creams or suppositories
above the anus? ACTION Treatment may consist of applying may help to relieve discomfort.
NO liquid chemicals to the wart, or minor surgery If your symptoms are still troublesome or
to remove them. If anal cancer is suspected, if you have bleeding from the anus, your
additional tests and treatments will be needed. doctor may refer you to a specialist for
treatment. Haemorrhoids may be injected
with a chemical that causes them to shrink.
SEE YOUR DOCTOR WITHIN 24 HOURS An alternative procedure is “banding”, in
which a rubber band is placed tightly around
POSSIBLE CAUSE This is probably an abscess. A the base of a haemorrhoid. This procedure is
collection of ingrowing hairs is often the cause painless, and the haemorrhoid shrinks over
of abscesses in this area. Your doctor will
a few days and falls off. Surgery to remove
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO probably arrange for you to go to hospital for
MAKE A DIAGNOSIS FROM THIS CHART. a minor operation to drain the abscess. enlarged veins is another treatment option.
223
A D U LT S : G E N E R A L
START Is passing WA R N I N G
YES Go to chart 109 PAINFUL URINATION
urine painful?
HERE (p.226) BLOOD IN THE URINE See your doctor
NO within 24 hours if you notice blood in your
urine. Although bleeding is usually due to
an infection and can be easily treated, it
Have you injured your may be caused by a more serious underlying
disorder such as bladder cancer.
abdomen or the area
Is your urine blood- below your ribs at YES
stained or smoky the back in the last
(see CHECKING THE YES 48 hours?
APPEARANCE OF YOUR
URINE, opposite)? NO CALL YOUR DOCTOR NOW
224
A D U LT S : G E N E R A L
Do you have
difficulty
in controlling YES Checking the appearance of your urine
your bladder?
The appearance of urine varies. It is often
NO darker in the morning than later in the day. A
temporary colour change may be due to some Clear, straw-
drugs and foods, such as beetroot. However, a coloured urine
change in your urine may indicate a disorder.
Very dark urine may be a sign of liver disease,
and red or cloudy urine may be due to bleeding Normal urine
or infection in the kidney or bladder. If you are Unless passed first thing in
not sure whether a change in the appearance the morning, urine is normally
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART. of your urine is normal, consult your doctor. clear, pale, and straw-coloured.
225
A D U LT S : G E N E R A L
Are you passing Do you have lower POSSIBLE CAUSE You probably have cystitis,
inflammation of the lining of the bladder,
urine more abdominal pain, and/or usually due to a bacterial infection.
YES is your urine blood- YES
frequently
ACTION Your doctor will arrange for a urine
than usual? stained or cloudy? test and will probably prescribe antibiotics.
NO NO To relieve symptoms and help to avoid a
recurrence, try self-help measures (see
URINARY TRACT INFECTIONS, below).
226
A D U LT S : G E N E R A L
227
A D U LT S : G E N E R A L
228
A D U LT S : G E N E R A L
Continued from
previous page
Have you recently had SEE YOUR DOCTOR WITHIN 24 HOURS
an infection such as a POSSIBLE CAUSE Reactive arthritis, which is
genital tract infection YES
inflammation of the joints in response to an
or gastroenteritis? infection elsewhere, may be the cause.
Are several of your NO ACTION Your doctor may arrange for tests
joints hot and swollen? YES to confirm that the infection has cleared up.
He or she will probably prescribe nonsteroidal
NO anti-inflammatory drugs. Reactive arthritis
often clears up promptly but in rare cases may
persist for months or even years.
229
A D U LT S : G E N E R A L
t
START Did the pain Is your shoulder too EMERGENCY!
YES
HERE immediately painful to move, and/or YES CALL AN AMBULANCE
follow an is it misshapen or POSSIBLE CAUSES You may have dislocated
injury, fall, swollen? your shoulder or fractured your collarbone.
or violent A serious injury to the muscles, tendons, or
NO
movement? ligaments of the shoulder is also possible.
NO ACTION You will probably need an X-ray
(p.39). Depending on the injury, your shoulder
may be manipulated back into position under
POSSIBLE CAUSES Damage to the muscles, anaesthetic or you may need treatment for a
tendons, or ligaments in and around the fracture. You will have to wear a sling for
shoulder may be the cause. several weeks to immobilize the shoulder
joint. Painkillers will help to relieve pain.
ACTION Follow self-help measures for treating
sprains and strains (p.229). If the pain is severe
or no better in 48 hours, consult your doctor.
230
A D U LT S : G E N E R A L
Go to chart 110 PAINFUL JOINTS (p.228) ACTION If your doctor diagnoses RSI, make
sure that you are sitting correctly if you use a
keyboard (p.34) and take regular breaks from
Is the pain in a joint? YES repetitive tasks. If action is taken early, you
NO should make a complete recovery; otherwise,
the condition may become permanent.
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO Tendinitis may be treated with a corticosteroid
MAKE A DIAGNOSIS FROM THIS CHART. injection around the tendon.
231
A D U LT S : G E N E R A L
START
HERE
Did the pain
immediately
follow an
YES
Are you unable to
move the leg, and/or is
the pain severe even
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES You may have a fracture or
injury, fall, when resting? dislocation or a serious injury to the muscles,
or violent tendons, or ligaments of the leg or to the
NO
movement? cartilage within the knee joint.
232
A D U LT S : G E N E R A L
Continued from
previous page POSSIBLE CAUSE Damage to a muscle, tendon, or SELF-HELP Coping with
ligament is the likely cause of your pain.
varicose veins
ACTION Carry out self-help measures (see
TREATING SPRAINS AND STRAINS, p.229). Do not
exercise until the pain has gone completely. When If you have aching legs caused by varicose
you do start exercising again, always include veins, the following measures may help:
warm-up and cool-down exercises (see EXERCISING • Avoid prolonged standing.
SAFELY, p.29). Consult your doctor if the pain is • If you must stand, move your feet and legs at
severe or no better within 48 hours. regular intervals to keep the blood flowing.
• When sitting, keep your legs elevated on
Did the pain come a stool or footrest.
YES
on a few hours after • Avoid tight clothing that may restrict the
unaccustomed or blood flow in the legs either at the knee
unusually strenuous Does the pain always or in the groin.
exercise? develop after the same • If you are overweight, try to lose weight.
NO
amount of exercise,
such as walking a given YES
distance, and does it
disappear with rest?
POSSIBLE CAUSE Impaired blood flow to the
NO legs as a result of narrowing of the arteries
can cause this type of pain and may result in
serious complications. Consult your doctor.
ACTION Your doctor will examine you and
Do you have episodes may refer you to hospital for tests such as
YES
of pain in the muscles Doppler ultrasound scanning (p.235) or
of one or both calves? femoral angiography (opposite) to assess the
blood vessels in your legs. You may also need
POSSIBLE CAUSE These are probably muscle
NO other tests to see if blood vessels elsewhere are
cramps – uncontrollable, painful contractions
affected. If you smoke, you should stop. You
of a muscle that occur without warning. Cramp
will be advised to cut down the amount of fat
often has no obvious cause but may develop
in your diet and take regular exercise. In some
during exercise or while lying in bed.
cases, surgery will be required to widen or
ACTION Stretch and rub the affected muscle to bypass the affected arteries.
relieve the pain. If you have frequent attacks of
cramp, consult your doctor.
233
A D U LT S : G E N E R A L
START
HERE
Have you
recently
injured your
YES
Is your knee
extremely
painful and/or
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSES A fracture or dislocation
knee? misshapen, causing bleeding into the knee joint, or a
NO
and/or are you serious injury to the muscles, ligaments, or
unable to move cartilage of the knee is possible.
your knee or put ACTION You will probably need to have an
weight on it? X-ray (p.39) to discover the type and extent of
the damage. Sometimes an operation is needed
NO to reposition bones. Depending on the nature
of the injury, you may need to wear a plaster
Is your knee red, cast or a firm bandage.
hot, swollen, and
YES POSSIBLE CAUSES Injury to the muscles,
very painful to touch? ligaments, or cartilage of the knee may be
NO the cause of the pain.
ACTION Carry out self-help measures
(see TREATING SPRAINS AND STRAINS, p.229).
Consult your doctor if the pain is severe or
no better within 48 hours. Arthroscopy
In arthroscopy, the inside of a joint, such
as the knee, is inspected using a viewing
Does your knee ever SEE YOUR DOCTOR WITHIN instrument called an arthroscope. The
seem to lock or 24 HOURS procedure is usually performed under
give way? YES a general anaesthetic. The arthroscope
POSSIBLE CAUSES Gout, in which the waste
product uric acid forms crystals in a joint, is inserted into the joint through a small
NO causing inflammation, is the most likely incision in the skin, and the view from
cause of your symptoms. An infection the arthroscope is displayed on a screen.
within the joint is also a possibility. Very small instruments can then be passed
ACTION Your doctor will examine you, down through the arthroscope or inserted
and may arrange for a blood test and for into the joint through other small incisions.
CONSULT YOUR DOCTOR IF YOU ARE UNABLE a sample of fluid to be taken from the joint Guided by the view on the monitor, the
TO MAKE A DIAGNOSIS FROM THIS CHART AND and examined. If you have gout, you will be surgeon is able to carry out procedures such
THE PAIN IS SEVERE OR PERSISTENT. prescribed nonsteroidal anti-inflammatory as repairing torn ligaments or removing
drugs. If the symptoms recur, you may damaged cartilage. Fluid passed down a
need long-term drug treatment to reduce
tube is then used to wash away the debris
the amount of uric acid in the body. If the
joint is infected, you will need treatment from within the operating area.
with antibiotics, in hospital initially. View of Monitor
knee joint
Has your knee become
progressively more Surgeon
YES POSSIBLE CAUSE Osteoarthritis, a progressive
painful over several condition in which cartilage covering the
months or years? ends of the bones within a joint is slowly Arthroscope
destroyed, is a possibility. This condition is
NO
particularly likely if you are over 50, if the Probe
joint has been damaged previously, or if
you are overweight. Consult your doctor.
ACTION Your doctor will examine you and
POSSIBLE CAUSES A torn cartilage or damage
may arrange for you to have blood tests and
to a ligament within the knee joint may be the
an X-ray (p.39) to confirm the diagnosis.
cause. Such injuries are commonly caused by
Over-the-counter painkillers should help
twisting the joint while it is supporting your
to relieve your symptoms. If you are also During the procedure
weight. Consult your doctor.
overweight, it will help to lose weight. In An arthroscope and a probe are inserted into
ACTION You doctor may refer you to hospital some cases, your doctor may refer you for
the joint, allowing the surgeon to inspect the
for tests such as arthroscopy (right). Any damage physiotherapy to strengthen the muscles
joint. The probe can be used to manipulate
may be repaired during the arthroscopy, or you around the joint. In severe cases, a joint
may require surgery at a later date. replacement (p.229) may be needed. the cartilage and improve the view.
234
A D U LT S : G E N E R A L
NO
POSSIBLE CAUSE AND ACTION Certain drugs,
Do you have a such as calcium channel blockers, may cause
swollen and/or swollen ankles as a side effect. Consult your
tender calf doctor. Meanwhile, do not stop taking any
above the of your prescribed drugs.
affected ankle? YES CALL YOUR DOCTOR NOW
235
A D U LT S : G E N E R A L
236
A D U LT S : G E N E R A L
Continued from
previous page Is the skin of the heel
YES POSSIBLE CAUSE Thickened skin on the heels
thickened, and are tends to crack over time, causing pain.
there painful cracks?
ACTION Avoid thickened skin building up by
NO soaking your feet and then using a pumice
stone or foot file on the skin. Use moisturizing
cream regularly. If these measures do not help,
consult your doctor or a chiropodist. If you
have diabetes mellitus (p.149), consult your
doctor before removing thickened skin.
POSSIBLE CAUSE You may have plantar
Do you have fasciitis, in which fibrous tissues in the
YES heel are inflamed. This condition may be
pain in a heel
associated with certain types of arthritis
when you put or an overgrowth of bone under the heel.
weight on it? Consult your doctor.
NO ACTION Your doctor may arrange for blood
tests or X-rays (p.39) to look for associated
POSSIBLE CAUSE These are probably areas of
conditions. He or she may recommend you
abnormally thickened skin that are known as
wear inserts in your shoes to cushion your
calluses (or corns if they are on a toe). Calluses
feet. You may be given an injection of a
and corns form to protect the foot in areas
corticosteroid drug into the heel.
where there is excessive pressure, such as that
caused by badly fitting shoes.
ACTION Soak your feet to soften the skin, and
rub the lumps with a pumice stone. Adhesive
Do you have one
Are the lumps on the sponge padding, available over the counter,
or more lumps can be stuck over tender areas to protect them
toes or the sides of
of hard skin on YES YES
from pressure. If this does not help, consult
the feet?
your feet? your doctor or a chiropodist. If you have
NO diabetes, consult your doctor before removing
NO any thickened skin. To prevent a recurrence,
always wear correctly fitting shoes.
237
A D U LT S : G E N E R A L
t
bruised or strained your back. Follow self-help EMERGENCY!
measures for relieving back pain (opposite). If CALL AN AMBULANCE
your pain is severe or if it has not improved
within 48 hours, consult your doctor. POSSIBLE CAUSE You may have damaged your
spinal cord. Try to keep completely still while
Do you have waiting for an ambulance.
pain in one side ACTION In hospital, you will be examined and
of the small of YES CALL YOUR DOCTOR NOW will probably have tests such as CT scanning
your back just POSSIBLE CAUSE Pyelonephritis, a bacterial infection of
(p.40) to look for the site and extent of any
above the waist, a kidney, may be the cause of these symptoms.
damage. In some cases, surgery to stabilize the
and do you spine may be required.
ACTION Your doctor will examine you and arrange for
feel generally a urine test. If an infection is confirmed, you will be
unwell with a prescribed antibiotics. You may also need to have an
temperature of abdominal ultrasound scan (p.217) or a contrast
38°C (100°F) X-ray of the kidneys (see INTRAVENOUS UROGRAPHY,
or above? p.227) to look for an underlying cause. SELF-HELP Taking care of
NO
your back
Improving your posture and taking care to
Does the pain prevent lift heavy objects safely can help you avoid
you from moving, back problems. Stand up straight, and avoid
and/or does it shoot YES wearing high-heeled shoes. Be aware of your
down one leg? posture when sitting at a desk (see SAFETY AT
WORK, p.34), in a car, or at home. You should
NO have a supportive mattress on your bed.
Regular gentle exercise may strengthen your
Did the pain abdominal and back
YES
come on after muscles and help
lifting a heavy POSSIBLE CAUSE AND ACTION You have probably Upper body you lose any
object or after strained some of the muscles and/or ligaments in straight
your back. Follow self-help measures for relieving excess weight.
undertaking back pain (opposite). If pain is severe or no better
an unusually within 48 hours, consult your doctor. Lifting safely
strenuous Bend your knees
exercise? when you pick
NO up an object,
and keep your
back straight
SEE YOUR DOCTOR WITHIN 24 HOURS while lifting it.
238
A D U LT S : G E N E R A L
Continued from
previous page Are you over 50? YES SELF-HELP Relieving
NO back pain
Most back pain is the result of minor sprains
or strains and can usually be helped by
POSSIBLE CAUSE You may have ankylosing simple measures. Try the following:
spondylitis (inflammation of the joints between • If possible, keep moving and carry out
the vertebrae, resulting in the spinal column your normal daily activities.
Has your gradually becoming hard and inflexible). This
YES is especially likely if you are between 20 and 40.
• Rest in bed if the pain is severe, but do
back gradually Consult your doctor.
not stay in bed for more than 2 days.
become stiff as • Take over-the-counter nonsteroidal anti-
well as painful ACTION Your doctor will examine you and inflammatory drugs.
arrange for you to have a blood test and X-rays
over a period of (p.39) of your back and pelvic areas. If you
• Place a heating pad or wrapped hot-water
months or years? bottle against the painful area.
are found to have ankylosing spondylitis,
you will probably be given nonsteroidal anti- • If heat does not provide relief, try using
NO inflammatory drugs. You will also be referred to an ice pack (or a wrapped pack of frozen
a physiotherapist, who will teach you exercises peas); place it over the painful area for
to help keep your back mobile. These mobility 15 minutes every 2–3 hours.
exercises are an essential part of the treatment If your backache is severe or is no better
for this disorder and can be supplemented by within 2 days, consult your doctor.
other physical activities, such as swimming. Once your back pain has cleared up, you
should take steps to prevent a recurrence by
following the self-help advice for taking care
Did the pain of your back (opposite).
come on
suddenly after SEE YOUR DOCTOR WITHIN 24 HOURS
an extended POSSIBLE CAUSE You may have a crush fracture
YES
stay in bed or of a vertebra as a result of osteoporosis, in which POSSIBLE CAUSE Osteoarthritis of the spine
confinement to bones throughout the body become thin and is probably the cause of your symptoms. In
a wheelchair, or weak. Osteoporosis is symptomless unless a this condition, joints between the vertebrae in
are you over 60? fracture occurs. The disorder is most common the spine are progressively damaged. This is
in women who have passed the menopause. particularly likely if you are over 50 and you
NO However, a prolonged period of immobility will are overweight. Consult your doctor.
also lead to the development of osteoporosis.
ACTION Your doctor may arrange for blood
ACTION Initial treatment for the pain is with tests and an X-ray (p.39) to confirm the
painkillers. Your doctor may also request bone diagnosis. Over-the-counter painkillers should
densitometry (below). Specific treatment for help to relieve your symptoms. If you are
osteoporosis depends on the underlying cause. overweight, it will help to lose weight (see HOW
However, in all cases, it is important that you TO LOSE WEIGHT SAFELY, p.151). Your doctor
try to remain active and take weight-bearing may refer you for physiotherapy to help you
Are you female exercise, such as walking. strengthen the muscles that support the spine.
and pregnant? YES
NO
Bone densitometry
This technique uses low-intensity X-rays (p.39) to measure During the procedure
the density of bone. X-rays are passed through the body, The X-ray generator and detector move
and their absorption is interpreted by a computer and along the length of the spine, and
displayed as an image. The computer information is displayed on a monitor.
calculates the average bone density and X-ray detector
CONSULT YOUR DOCTOR IF YOU
ARE UNABLE TO MAKE A DIAGNOSIS compares it with the
FROM THIS CHART AND YOUR BACK normal range for the
PAIN IS SEVERE OR IF THE NATURE person’s age and sex. Monitor
OF LONG - STANDING BACK PAIN The procedure takes
SUDDENLY CHANGES . about 20 minutes
and is painless.
Knees raised
to keep the
spine flat
X-ray beam
239
A D U LT S : G E N E R A L
t
that do not fade when to repair a fracture may be required.
EMERGENCY!
pressed (p.79) YES
CALL AN AMBULANCE
NO POSSIBLE CAUSE Meningitis, inflammation
of the membranes surrounding the brain,
due to infection, may be the cause of POSSIBLE CAUSE You may have torticollis (wry
these symptoms. neck), in which the muscles on one side of
the neck contract, causing pain and stiffness.
ACTION If meningitis is suspected, you Although painful, this condition is not serious.
will be admitted to hospital immediately.
Did you wake with a You will receive urgent treatment with ACTION Take over-the-counter painkillers and
YES antibiotics and may need intensive care. rest your neck by lying down so that your neck
stiff, painful neck? muscles are not supporting the weight of your
NO head. Torticollis usually improves in 24–48
hours without medical treatment. If you are
no better in 48 hours, consult your doctor,
who may prescribe a soft, supportive neck
collar to wear until the symptoms have gone.
Do you have one or
more tender swellings at YES Go to chart 74 LUMPS AND SWELLINGS
the sides of your neck? (p.174)
NO POSSIBLE CAUSE A nerve that runs down the
arm may be compressed or irritated at its
origin in the neck. Consult your doctor.
ACTION Your doctor will examine you and
Do you have pain that Has this pain may arrange for tests such as an X-ray (p.39).
YES YES
shoots down an arm? developed suddenly? He or she will probably suggest that you wear
a soft supportive collar around your neck.
NO NO You may be referred for physiotherapy.
240
A D U LT S : M E N
CHARTS FOR
MEN
241
A D U LT S : M E N
START
HERE
Are you
unable to pass YES
any urine?
Have you recently
injured your back
or neck?
YES
t EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE AND ACTION You may have
NO NO damaged the nerves controlling your bladder.
Once in hospital, your bladder will be emptied
by means of a catheter, and tests such as MRI
(p.41) will be arranged to help diagnose the
cause and determine the appropriate treatment.
242
A D U LT S : M E N
Continued from
previous page
Do any of the following POSSIBLE CAUSE In some cases, damage to the
apply to you? brain, spinal cord, or nerves controlling the
bladder can cause continence problems.
• You have had a stroke Consult your doctor.
• You have diabetes YES ACTION Your doctor will examine you and may
• You have multiple request a urine test to exclude an additional
Do you have problems sclerosis or another problem such as a urine infection. In some
with incontinence YES long-standing nervous cases, drug treatment may help. Alternatively,
during the daytime? system disorder you may be referred to a continence adviser,
who will help you manage the problem.
NO NO
Is the incontinence
associated with swelling
of the abdomen, and/or Prostatectomy
do you pass only small YES Are you constipated? YES
volumes of urine when NO Prostatectomy is a surgical procedure in
you try to empty which part or all of the prostate gland is
your bladder? removed. Partial prostatectomy is usually
NO performed to relieve urinary symptoms, such
as leakage of urine, caused by an enlarged
prostate gland. The most common procedure
POSSIBLE CAUSE You may have an enlarged is transurethral prostatectomy (TURP), in
prostate gland that is blocking the flow of which the excess tissue is removed through
urine out of the bladder. This results in the the urethra. Total prostatectomy may be
bladder becoming overfilled and possibly performed to treat prostate cancer. It
leaking urine. Consult your doctor. involves removing the entire gland through
ACTION Your doctor will examine you and an incision in the abdomen and requires a
may arrange for tests, including ultrasound longer stay in hospital than TURP. Both types
Are you taking any scanning (p.41), to establish the cause. If
YES of prostatectomy can cause fertility problems
prescribed drugs? the blockage is due to an enlarged prostate, because sperm may pass into the bladder on
treatment will be with either drugs or a
NO prostatectomy (right).
ejaculation. Other complications such as
incontinence or impotence are rare with TURP
but can occur after total prostatectomy.
Enlarged Diathermy
prostate gland wire
POSSIBLE CAUSE AND ACTION Drugs such as
diuretics, which result in a sudden increase Urethra Penis Bladder
in the amount of urine produced, may cause
episodes of incontinence. Consult your doctor
about the problem. He or she may be able to
Are you over 65, adjust your drug treatment or give you advice
and have you become YES on coping with the effects of the drugs.
increasingly forgetful?
NO
243
A D U LT S : M E N
244
A D U LT S : M E N
Continued from
previous page POSSIBLE CAUSES Syphilis (see SEXUALLY POSSIBLE CAUSE You may have genital warts,
TRANSMITTED INFECTIONS IN MEN, below) a sexually transmitted infection (see SEXUALLY
or cancer of the penis may be the cause. TRANSMITTED INFECTIONS IN MEN, below) caused
Consult your doctor or go to a sexually by a virus. Consult your doctor or go to a
transmitted infections (STI) clinic. sexually transmitted infections (STI) clinic.
Do you have one or
more painless sores YES ACTION The doctor may take a swab ACTION The doctor will examine you. If
on your penis? from the sore. You may also need a the diagnosis of genital warts is confirmed,
biopsy, in which a tissue sample is taken treatment may involve surgical removal of
NO from the sore. Syphilis is treated with the warts under local anaesthetic or the
antibiotics. Cancer of the penis can be application of drugs to them. In some cases,
treated with radiotherapy or surgery. genital warts may recur.
Genital warts 1–20 months Pink, fleshy lumps on the penis and, in some cases, Treatment may be by surgical removal under local
around the anus. A rectal infection may cause pain on anaesthetic or by applying topical drugs to the warts. In
passing faeces. some cases, the warts may recur after treatment.
Gonorrhoea 2–10 days There may be pain on passing urine and, in some cases, a The doctor will take a swab from the rectum or the urethra
discharge from the penis. (the tube that carries urine out of the body) to identify the
infectious organism. Treatment is with antibiotics.
HIV infection 6–8 weeks There may be no initial symptoms, but some people may Diagnosis is made by a blood test taken 3 or more months
have a brief flu-like illness, sometimes with a rash and after the initial infection. People with HIV infection are
swollen lymph nodes. After years without symptoms, AIDS usually referred to special centres for treatment.
may develop (see HIV INFECTION AND AIDS, p.148). HIV can Combinations of antiviral drugs are given that may be
be passed on whether or not you have symptoms. effective in delaying the progression of HIV to AIDS.
Non-gonococcal 1–6 weeks Pain on passing urine, especially first thing in the The doctor will take a swab from the urethra (the tube that
urethritis morning. There may also be a discharge from the penis. carries urine out of the body) to find the cause – often a
chlamydial infection. Treatment is usually with antibiotics.
Pubic lice 0–17 days Usually there is intense itching in the pubic region, Treatment is with a lotion that kills the lice and their eggs.
particularly at night. Lice are 1–2 mm long and Such lotions can be bought over the counter.
may be visible.
Syphilis 1–12 weeks A highly infectious, painless sore develops in the genital The disease is diagnosed by blood tests and tests on swabs
area, usually on the penis or in the rectum. If untreated, taken from any sores. The usual treatment is a course of
the condition can progress to involve internal organs, antibiotic injections, followed by blood tests to check for a
and rash, fever, and swollen lymph nodes will develop. recurrence of the condition.
*Time between contact with the disease and the appearance of symptoms
245
A D U LT S : M E N
246
A D U LT S : M E N
START Is ejaculation WA R N I N G
YES POSSIBLE CAUSES A sexually transmitted
painful?
HERE infection or prostatitis (inflammation of the
BLOOD IN THE SEMEN Blood-streaked
NO prostate gland) are possible causes.
semen is usually due to leakage from small
Go to chart 124 PAINFUL INTERCOURSE blood vessels in a testis or epididymis (where
sperm from the testis is stored). A single
IN MEN (p.249).
episode is no cause for concern, but consult
your doctor if it recurs because it may be
due to a prostate gland infection.
Do you ejaculate
immediately after
penetration, or with YES
minimal stimulation? Are you sexually
inexperienced, or have
NO YES POSSIBLE CAUSES AND ACTION Excitement
you just started a new and/or anxiety about sexual intercourse with a
sexual relationship? new partner may cause premature ejaculation.
NO As the relationship develops, this is likely
to become less of a problem. Some men find
Is ejaculation delayed, that putting on a condom (p.254) can dull
or does ejaculation fail sensation sufficiently to delay ejaculation.
YES The squeeze technique (below) may also help.
to occur at all?
NO POSSIBLE CAUSES AND ACTION Most problems
with ejaculation are related to poor technique
on the part of one or both partners or to a lack
of communication. If the problem persists, talk
to your doctor, who may arrange for you and SELF-HELP The squeeze
CONSULT YOUR DOCTOR IF YOU ARE UNABLE
your partner to see a counsellor together (see technique
TO MAKE A DIAGNOSIS FROM THIS CHART.
SEX COUNSELLING, p.251).
This technique, used to prevent premature
ejaculation, can be done by the man himself
or by his partner. Just before ejaculation, the
shaft of the penis, just below the head, is
POSSIBLE CAUSE AND ACTION Performance squeezed firmly between the thumb and
anxiety during sexual intercourse may be forefinger. This causes the erection to be
Can you ejaculate making you so tense that you are unable to partially lost, temporarily preventing
easily when you YES ejaculate. Discuss your worries with your ejaculation. By practising this technique
masturbate? partner. If the problem persists, talk to your regularly, a man can gain greater control
doctor, who may arrange for you and your over ejaculation. Eventually, using the
NO partner to have either relationship or sex
counselling (p.251). squeeze technique will become unnecessary.
247
A D U LT S : M E N
START
HERE
Do you have
pain in one or
both testes?
YES
t EMERGENCY!
CALL AN
AMBULANCE
WA R N I N G
PAINLESS LUMPS AND
SWELLINGS Consult your
NO POSSIBLE CAUSES AND ACTION The
injury may have damaged a testis doctor if you develop a lump
or caused it to twist within the or swelling in the scrotum, even
scrotum (see TORSION OF THE if it causes no pain. Cancer of
Have you had TESTIS, p.131). Your injury will be
the testis is always a possibility,
YES
an injury in assessed, and ultrasound scanning especially in men aged 20–40.
your genital (p.41) may be needed. Treatment This condition is easily treated if
it is detected at an early stage
area within the will depend on the diagnosis.
but can be fatal if ignored.
past 48 hours?
NO
Has the
pain come on
suddenly over YES
a few hours?
Do you have
one or more
NO
t EMERGENCY!
CALL AN
AMBULANCE
POSSIBLE CAUSE Torsion of the
painless testis, in which a testis is twisted
YES POSSIBLE CAUSES If there are SEE YOUR DOCTOR WITHIN
swellings several swellings, you may have in the scrotum, cutting off the
24 HOURS
in or near epididymal cysts, which are cysts blood supply (see TORSION OF
the testes? filled with sperm. However, if POSSIBLE CAUSES You may have THE TESTIS, p.131) is possible.
there is only one swelling, cancer inflammation of the testes. ACTION If torsion of the testis is
NO of the testis is a possible cause. In This may be due to a sexually diagnosed, you will need urgent
either case, consult your doctor. transmitted infection (p.245) surgery to untwist the testis and
or to mumps. In some cases, restore its blood supply. Both
ACTION Your doctor will examine
inflammation may be associated testes are then anchored within
you and may refer you to a
with a urinary tract infection or, the scrotum to prevent the
specialist or request tests such
particularly in older men, an condition recurring.
as ultrasound scanning (p.41).
infection of the prostate.
Epididymal cysts do not need
treatment unless they are causing ACTION Your doctor will examine
discomfort. If so, they can be you. In most cases, treatment
Do you have removed surgically. Cancer of the with antibiotics will be needed,
a painless testis is treated with surgery and although mumps will clear up
generalized drugs and can often be cured. without treatment.
swelling of
the scrotum? YES
248
A D U LT S : M E N
249
A D U LT S : M E N
250
A D U LT S : M E N
Continued from
previous page Sex counselling
Counselling with a sex therapist or counsellor is
often helpful when there is a psychological basis
for a sexual problem. The sessions usually last
about 1 hour and a course of treatment may
last for several weeks or months. Both partners
Have you recently need to attend the therapy sessions so that the
therapist can help them to understand their
recovered from a major
illness or operation? YES sexual needs and communicate them honestly.
A therapist may also suggest exercises to do at
NO home. One such exercise is a technique called
sensate focus. In this exercise, a couple touch Talking therapy
and stimulate each other’s bodies but agree not A sex therapist may be able to help you and
to have full sexual intercourse for several weeks. your partner develop better communication
Sensate focus can be helpful for problems that and work through sexual problems in a safe,
stem from anxiety about sexual performance. supportive environment.
POSSIBLE CAUSES AND ACTION These POSSIBLE CAUSE AND ACTION Serious illness or
symptoms may be caused by low levels surgery can sometimes alter your perception of
Do you often drink of the male sex hormone testosterone your body and of yourself in general (see SEX
as a result of a disorder that affects AFTER ILLNESS, opposite), resulting in a reduced
more than the the testes or an organ such as the liver,
recommended safe sex drive. Consult your doctor, who may advise
which processes hormones. Consult your counselling (see USEFUL ADDRESSES, p.311).
alcohol limit (p.30)? YES doctor, who may arrange for blood tests
to check your hormone levels and to
NO detect any underlying cause. Treatment
may be of the underlying cause or may
include hormone treatment. POSSIBLE CAUSE AND ACTION Alcohol can
reduce your sex drive and can cause erection
difficulties as well as more serious health
problems. Try to drink less alcohol. You
should also consult your doctor so that any
other causes can be excluded.
Are you generally
anxious, and/or do you
have specific anxieties YES POSSIBLE CAUSES AND ACTION General anxiety
can reduce your sex drive. Specific concerns
about sex? about sex, such as worry about contracting a Sexual orientation
NO sexually transmitted infection (see SEXUALLY
TRANSMITTED INFECTIONS IN MEN, p.245) or Although heterosexuality is considered the
making your partner pregnant, can also norm by some people, it is common for
suppress sex drive. Concern about sexual adolescents to go through a phase of having
orientation (right) is another possible cause.
homosexual feelings before they become
Talk to your partner, and, if you are still
concerned, consult your doctor. attracted to people of the opposite sex.
Some people, however, remain homosexual
Are you over 50? YES or bisexual throughout their lives. While
homosexuality and bisexuality are becoming
NO POSSIBLE CAUSE Sex drive may decline slightly more openly accepted, some people still
as you get older (see SEX IN LATER LIFE, p.270). have feelings of guilt associated with their
This need not be a problem if your needs and
sexuality or are victims of prejudice. Whatever
your partner’s are compatible. If your loss of
sex drive has occurred suddenly or if you are your sexual orientation, if you have multiple
concerned, consult your doctor. partners, you are at an increased risk of
sexually transmitted infections, including
ACTION Your doctor may arrange for blood
HIV infection and AIDS (p.148), and need to
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO tests to check your hormone levels. Any cause
MAKE A DIAGNOSIS FROM THIS CHART. will be treated, if possible, whatever your age. practise safe sex (see SEX AND HEALTH, p.32).
251
A D U LT S : M E N
252
A D U LT S : M E N
Continued from
previous page POSSIBLE CAUSE Sexually transmitted infections Semen analysis
(see SEXUALLY TRANSMITTED INFECTIONS IN MEN,
p.245) can result in a blockage of the vas
deferens, the tubes that transport sperm from If a couple has fertility problems, semen
the testes to the penis. Consult your doctor. analysis is usually one of the first tests that
is carried out. The man is asked to ejaculate
ACTION Your doctor will examine you, and he
or she may refer you to a specialist for tests to into a clean container (semen collected from
establish whether the tubes leading from your a condom is not suitable). The sample must
testes are blocked. In some cases, surgery to then be kept at body temperature and
relieve the blockage may be possible. analysed within 2 hours. The volume of
semen is measured, and a sample is then
Have you had a viewed under a microscope to assess the
YES
sexually transmitted shape and activity levels of the sperm and to
infection in the past? count the number of sperm. Each millilitre of
semen normally contains at least 50 million
NO sperm, the majority of which are healthy. A
POSSIBLE CAUSE AND ACTION Infrequent
intercourse is a common cause of failure to low sperm count is defined as fewer than 20
conceive. If you have sex less than three times million sperm per millilitre. If the test shows
a week, the chance of sperm being present to any abnormality, it will be repeated.
fertilize an egg when it is released is reduced.
If possible, try to have intercourse with your
partner more often (see MAXIMIZING THE
CHANCE OF CONCEPTION, opposite). If your
partner has still not conceived within a further
3–6 months, consult your doctor.
Do you have sex less
YES
often than three times
a week on average?
NO
NORMAL SPERM LOW SPERM
Do you regularly COUNT COUNT
drink more than the Sperm count
YES
recommended safe Sperm are viewed under a microscope with
alcohol limit (p.30)? a grid to help count the number of sperm
and the proportion of abnormal sperm.
NO
253
A D U LT S : M E N
SITES OF
INCISIONS
SELF-HELP Putting on Is it possible that you
would change your Penis
a condom mind about having
children if you were in Secured ends
A condom must be put on before intimate YES of vas deferens
a new relationship?
sexual contact because sperm may be
released before ejaculation. First, air must be NO
Testis
squeezed out of the end. The condom is then
unrolled over the erect penis. After sex, the
The operation
During a vasectomy, a small section of the
condom must be held in place while the man
vas deferens that leads from each testis is
withdraws his penis to prevent semen leaking
removed and the cut ends are secured.
out. Never use a condom
more than once.
254
A D U LT S : W O M E N
CHARTS FOR
WOMEN
255
A D U LT S : W O M E N
Continued on
SELF-HELP Breast
next page self-awareness
Are you aged under 20? YES
NO If you examine your breasts regularly, you
will become familiar with their normal
Aspiration of a breast lump appearance and feel and find it easier to
notice changes. Look at your breasts in a
Aspiration involves removing cells or liquid mirror, checking for changes in the size or
from a breast lump using a needle and shape of your breasts, changes to your
syringe. If the lump is solid, cells will be POSSIBLE CAUSES A noncancerous growth nipples, or dimpled skin. Then, while lying
collected in the needle. These cells are then or cyst are the most likely causes of
or standing, put one arm behind your head,
sent to a laboratory to be examined under breast lumps. However, breast cancer is
a possibility that needs to be ruled out. and feel the breast on that side with firm,
a microscope. This technique can identify small circular movements. Feel around the
whether or not the lump is cancerous. If fluid
Consult your doctor.
whole breast, including the nipple and
is withdrawn into the needle instead of cells, ACTION Your doctor may arrange for you
armpit. Repeat the process with the other
the lump can be diagnosed as a breast cyst. to have either mammography (opposite)
or ultrasound scanning (p.41) and breast. If you discover a lump or any changes
The procedure is painful, but it usually takes in the breast, consult your doctor.
aspiration (see ASPIRATION OF A BREAST
less than a minute to carry out.
LUMP, left) to rule out breast cancer.
Examining your
Treatment of noncancerous lumps is
Breast lump often unnecessary. However, in some breasts
cases, removal of the lump is advised. Keeping your fingers
flat, feel around the
Needle whole breast and armpit
area in small circles.
Press gently
with the pads AREA TO BE
EXAMINED
POSSIBLE CAUSE The lump is probably a of your fingers
fibroadenoma, which is a noncancerous Raise arm
growth. Consult your doctor.
During the procedure ACTION Your doctor will examine you and
will probably arrange for tests such as
A fine needle is attached to a syringe and
ultrasound scanning (p.41). Small lumps
inserted into the breast lump. Cells or fluid
may not need treatment; larger lumps may
are then carefully withdrawn. be surgically removed.
256
A D U LT S : W O M E N
Mammography
Mammography uses X-rays (p. 39) to detect X-ray Compressed breast Plastic cover
abnormal areas of breast tissue. It is used as a machine
screening test to detect signs of breast cancer
X-rays X-ray
and is also carried out to investigate breast machine
lumps. Mammography is offered every 3 years
from age 50 to 65. The breast is positioned in
the X-ray machine and compressed so that the Technician
breast tissue can be easily seen on the X-ray.
Two X-rays are usually taken of each breast. X-ray plate
The procedure is uncomfortable but lasts only POSITION OF BREAST
a few seconds. If an abnormality is detected, During the procedure
you will need further tests such as aspiration Your breast is compressed between the plastic
(see ASPIRATION OF A BREAST LUMP, opposite) to cover and X-ray plate. X-rays pass through
determine the cause of the abnormality. the breast tissue onto the plate.
Continued from
previous page POSSIBLE CAUSE AND ACTION Some POSSIBLE CAUSES A change in a nipple may
women have lumpier breasts than others. be a sign of breast cancer. However, normal
Lumps are usually more obvious before aging may also cause a nipple to become
a period. If you are particularly worried, indrawn. Consult your doctor.
consult your doctor, who will examine
ACTION Your doctor will examine your
your breasts to make sure that there
breasts and will probably arrange for tests
are no individual lumps that require
Do both your such as mammography (above) to exclude
YES investigation. Naturally lumpy breasts
breasts feel lumpy? a problem deeper in the breast.
do not require treatment and do not
increase the risk of breast cancer.
NO
NO
• Eat little and often, including plenty of
carbohydrates and fibre.
POSSIBLE CAUSES You may have a skin • Reduce your salt intake.
condition, such as eczema. However, Paget’s • Do not eat fried foods or excessive
disease, a rare form of breast cancer, is a amounts of chocolate.
possibility. Consult your doctor.
• Avoid drinks containing large amounts
ACTION Your doctor will examine your of caffeine, such as coffee, tea, and cola.
breasts. If you have a skin condition, you • Try taking the recommended daily
may be prescribed corticosteroid creams. If allowance of a vitamin B6 supplement.
your doctor suspects Paget’s disease, you will
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO probably be referred for tests such as • Try taking evening primrose oil, particularly
MAKE A DIAGNOSIS FROM THIS CHART. mammography (above). in the days before your period.
257
A D U LT S : W O M E N
t
START Are you unable to Have you recently EMERGENCY!
YES YES
pass any urine? injured your back CALL AN AMBULANCE
HERE or neck?
NO POSSIBLE CAUSE AND ACTION You may have
NO damaged the nerves controlling your bladder.
Once in hospital, your bladder will be emptied
by means of a catheter, and tests such as MRI
(p.41) will be arranged to determine the cause
of your symptoms and appropriate treatment.
258
A D U LT S : W O M E N
Continued from
previous page Have you recently SELF-HELP Pelvic-floor
had a baby? YES
strengthening exercises
NO
Exercises can help strengthen the pelvic-floor
muscles, which support the bladder, uterus,
Do you leak urine
YES and rectum. If done regularly, they can help
when you sneeze, POSSIBLE CAUSE You probably have stress
incontinence as a result of weak muscles prevent and treat urinary incontinence.
cough, or run? You can perform pelvic-floor exercises
supporting the neck of the bladder. This is
NO a common problem. Consult your doctor. lyind down, sitting, or standing. In order to
ACTION Your doctor will examine you to identify the pelvic-floor muscles, imagine
exclude a prolapse of the uterus, which is that you are passing urine and have to stop
sometimes associated with this condition. suddenly midstream. The muscles that you
He or she may arrange for urodynamic feel tighten around the vagina, urethra, and
studies (opposite). You may be advised to rectum are the pelvic-floor muscles.
Do you often have do pelvic-floor exercises (right). In severe To strengthen the pelvic-floor muscles,
a sudden urge to cases, surgery may be needed. contract them and hold them contracted for
pass urine that is 10 seconds. Then relax the muscles slowly.
YES
difficult to control? Repeat this contraction and relaxation cycle
10 times. Practice your pelvic-floor exercises
NO
at least every hour during the day.
If you have been doing the exercises to
POSSIBLE CAUSE AND ACTION Childbirth has
treat bladder control problems, you should
probably weakened the muscles that support
the neck of the bladder. This is very common. see an improvement within 2 weeks, but you
Do any of the following Regular pelvic-floor exercises (right) should will need to continue doing the exercises
apply to you? restore control. Consult your doctor if bladder regularly to maintain the improvement.
control does not return within 2 months.
• You have had a stroke
recently
• You have diabetes POSSIBLE CAUSE You may have an irritable
• You have a long-term bladder, in which there is a strong urge to
nervous-system pass urine even when the bladder contains
disorder such as little urine. Consult your doctor.
YES POSSIBLE CAUSE In some cases, damage to the
multiple sclerosis brain, spinal cord, or nerves controlling the ACTION Your doctor will examine you and
bladder can cause continence problems. test your urine to rule out an infection, which
NO can cause similar symptoms. He or she may
Consult your doctor.
also arrange for bladder function tests (see
ACTION Your doctor will examine you and may URODYNAMIC STUDIES, opposite). In most
request a urine test to exclude an additional cases, drug treatment to reduce the sensitivity
problem such as a urine infection. In some of the bladder combined with exercises to
Is incontinence cases, drug treatment may help. Alternatively, increase the amount of urine that the bladder
associated with swelling you may be referred to a continence adviser, can hold without triggering the urge to pass
of the abdomen, and who will help you manage the problem. urine will help to improve the symptoms.
do you pass only small
volumes of urine when
you try to empty your
YES POSSIBLE CAUSE AND ACTION You may have
bladder? an obstruction to the outflow of the bladder,
NO which is preventing the bladder from emptying
normally. This causes the bladder to become
overfull and results in urine leaking from the
bladder. Constipation is a possible cause of the
POSSIBLE CAUSE AND ACTION Drugs such as obstruction. Consult your doctor, who will
diuretics, which result in a sudden increase in probably arrange for tests to determine the
Are you taking any the amount of urine produced, may precipitate underlying cause. He or she may refer you to
prescribed drugs? YES
incontinence. Talk to your doctor about the hospital so that your bladder can be drained
problem. He or she may be able to alter your and for treatment of the blockage.
NO drugs or give advice on coping with their effects.
259
A D U LT S : W O M E N
260
A D U LT S : W O M E N
Continued from
previous page POSSIBLE CAUSES Being underweight and/or A healthy menopause
following a rigorous exercise programme can
cause periods to stop temporarily.
The menopause is the stage in a woman’s
ACTION Eat a healthy diet (p.28), and cut life when periods stop, the ovaries no longer
down on the amount of exercise you do. produce eggs, and the amount of the sex
If your periods do not start again within
3 months, consult your doctor. hormone oestrogen declines. It normally
occurs between the ages of 45 and 55.
Are you underweight Around 8 in 10 women have mild symptoms
YES
(see ASSESSING YOUR at menopause, but some may develop more
WEIGHT, p.29), and/or severe problems, including hot flushes, mood
do you have a rigorous swings, and night sweats. The decline in
exercise programme? oestrogen levels also increases the risk of
NO POSSIBLE CAUSE AND ACTION Oral contraceptive osteoporosis and heart disease in later life.
pills alter your normal hormone levels and may Lifestyle changes
affect your periods. Some pills intentionally An adequate intake of calcium and regular
stop periods occurring. If your periods do not weight-bearing exercise will help to reduce
return after stopping the pill, carry out a home the risk of osteoporosis. Exercise also helps
pregnancy test (opposite). If the result is
negative and your periods have not restarted to protect against heart disease, as does
Have you recently within 3 months, consult your doctor. stopping smoking and eating a healthy diet
YES (p.28). It may be worth adding soya products
started or stopped
to your diet – these have a natural
taking the oral
oestrogen-boosting effect. If you
contraceptive pill? suffer from mood swings, talk
NO to your partner or to friends
POSSIBLE CAUSE AND ACTION Progestogen going through menopause.
intrauterine contraceptive devices can reduce
You may also find relaxation
the amount of bleeding during periods or stop
periods altogether. Many women consider this techniques helpful.
an advantage, but if you are worried, consult Drug treatment
your doctor. He or she may suggest an Talk to your doctor about
Have you recently alternative method of contraception (see hormone replacement
YES METHODS OF CONTRACEPTION, p.277).
been fitted with a therapy (HRT), which
progestogen intrauterine replaces diminishing
contraceptive device? oestrogen and helps to
prevent heart disease and
NO osteoporosis but slightly
increases the risk of breast
cancer. It is suitable for many,
POSSIBLE CAUSES Both chemotherapy and but not all, women.
radiotherapy may damage the ovaries,
causing premature menopause and absent Keeping active
Have you had periods. Consult your doctor. Weight-bearing exercise, such
YES as jogging, can help to prevent
chemotherapy and/or ACTION Your doctor may arrange for a blood
test to confirm that you are menopausal. He osteoporosis after menopause.
radiotherapy to the Exercise is also good for the heart
lower abdomen? or she may want to discuss with you the
possibility of hormone replacement therapy and has a positive effect on mood.
NO (see A HEALTHY MENOPAUSE, right).
Are you over 45? YES POSSIBLE CAUSE You may be approaching POSSIBLE CAUSES You may have polycystic
the menopause. Consult your doctor. ovary syndrome, a condition in which there
NO are multiple fluid-filled cysts on both of the
ACTION Your doctor may arrange for
ovaries and ovulation does not occur normally.
a blood test to confirm that you are
Alternatively, a hormonal disorder is a
menopausal. He or she may discuss
possibility. Consult your doctor.
hormone replacement therapy with
you (see A HEALTHY MENOPAUSE, right). ACTION Your doctor will probably arrange for
tests, such as blood tests to measure hormone
Have you noticed levels and ultrasound scanning (p.41) of your
an increase in facial pelvis to detect ovarian cysts. Treatment
YES depends on the cause but will probably
or body hair and/or include drug treatment.
deepening of the voice?
NO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
MAKE A DIAGNOSIS FROM THIS CHART.
261
A D U LT S : W O M E N
Are you over 45? YES POSSIBLE CAUSES AND ACTION Heavy periods
may be a sign that you are approaching the Speculum
NO menopause. In rare cases, excessive bleeding
may be due to cancer of the uterus. Consult Sampling tube Vagina
your doctor, who will examine you and During the procedure
may arrange for tests, such as endometrial
A speculum is inserted into the vagina to
sampling (right). If no abnormality is found,
hold it open. A sample of the tissue lining the
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO drug treatment may be suggested. Endometrial
MAKE A DIAGNOSIS FROM THIS CHART. cancer will need surgical treatment. uterus is then drawn into the sampling tube.
262
A D U LT S : W O M E N
263
A D U LT S : W O M E N
NO
Continued on
next page Are you over 45
years old? YES
NO
Cervical smear test
Abnormal cells in the cervix that are or may
become cancerous can be detected by a
cervical smear test, which may be performed Bladder
POSSIBLE CAUSE AND ACTION In general,
for screening (see COMMON SCREENING TESTS, occasional irregular periods are no cause
p.36). The procedure is painless and quick. Cells Uterus for concern if they are normal in other
are collected from the cervix using a spatula ways. Consult your doctor if your periods
and placed on a slide for examination under a have not returned to normal within
Cervix
microscope. If abnormal cells are detected, a 2 months or if the blood loss and/or
colposcopy (opposite) may be needed. pain seem excessive.
Spatula
Speculum
CROSS SECTION
Leg support
During the
procedure
An instrument
called a speculum POSSIBLE CAUSE AND ACTION Irregular periods
is used to hold the
may be a sign that you are approaching the
menopause. This is no cause for concern, but
vagina open while
you should consult your doctor. If the diagnosis
cells are collected
is confirmed, he or she may discuss with you
from the cervix the pros and cons of hormone replacement
with a spatula. therapy (see A HEALTHY MENOPAUSE, p.261).
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A D U LT S : W O M E N
Continued from
previous page Colposcopy
A colposcope is a microscope that gives a magnified view of the
cervix from outside the body. It is used if a cervical smear test Monitor
(opposite) has detected abnormal cells. During the procedure,
the doctor may apply a substance to the cervix that distinguishes
between normal and abnormal tissue. Samples can then be
taken from abnormal areas for examination in a laboratory.
Various treatments can also be carried out during colposcopy.
For example, abnormal tissue can be destroyed using a laser or
Does the unexpected by freezing tissue with a probe. Colposcope
bleeding occur only in The whole procedure usually Leg
YES takes less than 40 minutes. support
the first few hours after
sexual intercourse? During the procedure
The vagina is held
NO
open by a speculum,
and the doctor inspects
the cervix through the
colposcope. A monitor
may display the image.
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A D U LT S : W O M E N
NO
SEE YOUR DOCTOR WITHIN
24 HOURS
POSSIBLE CAUSE Pelvic inflammatory
disease (inflammation of the reproductive
organs), which may be due to a sexually
POSSIBLE CAUSE AND ACTION A foreign body
transmitted infection (STI), is a possible
left in the vagina can act as a focus for
cause. It is important to see your doctor
infection. Remove the item, and consult
or go to an STI clinic within 24 hours
Is the discharge your doctor if the discharge is still present in
because, if the infection is not treated,
YES 24 hours’ time. If you cannot remove the item,
associated with it may lead to infertility.
see your doctor within 24 hours so that he or
abdominal pain, fever, ACTION You will be examined and tests she can remove it. In some cases, treatment
or abdominal pain done to confirm the diagnosis. You will with antibiotics will be needed to prevent any
during intercourse? probably be prescribed antibiotics and infection spreading to the reproductive organs.
advised to take painkillers.
NO
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A D U LT S : W O M E N
Continued from
previous page
Are you taking the
contraceptive pill, or YES
are you pregnant?
NO
Genital herpes 4–7 days There is usually soreness or itching in the genital area The diagnosis is usually made according to the
or on the thighs, followed by the appearance of a crop appearance of the skin. Oral antiviral drugs taken early
of small, painful blisters. The blisters burst to produce shorten episodes but do not eradicate the virus. Genital
shallow ulcers, which are painful when urinating. The herpes is most infectious while the ulcers are present, but
ulcers heal after 10–21 days. The condition may recur. in some cases can remain infectious after the ulcers heal.
Genital warts 1–20 months Pink, fleshy lumps on the vulva, and in some cases, Warts may be removed by surgery or by applying drugs to
inside the vagina, on the cervix, and around the anus. them. In some cases, they recur after treatment. Regular
Warts may go unnoticed if they occur internally. cervical smear tests (p.264) are needed because some types
of genital wart may be associated with cervical cancer.
Gonorrhoea 7–21 days May be symptomless in women. It may cause The doctor will take a swab from the vagina or the
abnormal vaginal discharge, lower abdominal pain, rectum to identify the infectious organism. Treatment is
and fever. If there is rectal infection, there may be pain with antibiotics.
when passing faeces.
HIV infection 6–8 weeks May be no initial symptoms, but some people may have Diagnosis is made by a blood test taken 3 or more
a brief flu-like illness, sometimes with a rash and swollen months after the initial infection. People with HIV
lymph nodes. After years without symptoms, AIDS may infection are usually referred to special centres for
develop (see HIV INFECTION AND AIDS, p.148). HIV can be treatment. Combinations of antiviral drugs are often
passed on whether or not you have symptoms. effective in delaying the progression of HIV to AIDS.
Pubic lice 0–17 days Usually there is intense itching in the pubic region, Treatment is with a lotion that kills the lice and their eggs.
particularly at night. The lice are 1–2 mm long and Such lotions can be bought over the counter.
may be visible.
Syphilis 1–12 weeks In the first stage, a highly infectious, painless sore The disease is diagnosed by blood tests and tests on
called a chancre develops in the genital area or inside swabs taken from any sores. The usual treatment is a
the vagina. In some cases, the sores go unnoticed. course of antibiotic injections. You will need to have
If the condition is left untreated, it can progress to regular blood tests for 2 years after the treatment to
involve internal organs, causing a rash, fever, and check that the disease has not recurred.
swollen lymph nodes.
Trichomonal infection Variable An unpleasant-smelling, greenish-yellow vaginal The diagnosis is confirmed by examination of a sample of
discharge, associated with irritation and soreness discharge taken from the vagina. The usual treatment is
around the vagina. Pain on intercourse. with oral antibiotics.
*Time between contact with the disease and the appearance of symptoms
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A D U LT S : W O M E N
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A D U LT S : W O M E N
NO Ovary
Manipulating
probe Uterus
POSSIBLE CAUSE AND ACTION Ovulation may Laparoscopy to view the ovaries
cause mild abdominal pain, lasting only a few
The laparoscope is inserted through a small
hours, that occurs at about the same time each
incision to give an illuminated view of the
month. This is no cause for concern, but if the
CONSULT YOUR DOCTOR OR , IF ABDOMINAL PAIN pain is different from usual, or severe, you ovaries. Probes are used to move organs or
IS SEVERE , CALL YOUR DOCTOR NOW. should call your doctor. manipulate the ovaries for better viewing.
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A D U LT S : W O M E N
Do you feel
pain only
when having YES POSSIBLE CAUSES The pain may
intercourse in be caused by pressure on an
ovary during intercourse.
certain positions? However, an ovarian cyst is also a
NO possibility. Consult your doctor. Have you had
YES POSSIBLE CAUSE AND ACTION
ACTION Your doctor will examine prolonged, Soreness of the genital area may
you and may arrange for you to particularly occur after very frequent sex and
have ultrasound scanning (p.41) vigorous, or is sometimes associated with
CONSULT YOUR DOCTOR IF YOU or a laparoscopy (p.269), which very frequent urinary symptoms. This is usually
ARE UNABLE TO MAKE A DIAGNOSIS will determine what treatment, if intercourse? no cause for concern. If soreness
FROM THIS CHART. any, you will need. is severe, abstaining from sex for
NO a few days should help.
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A D U LT S : W O M E N
NO
272
A D U LT S : W O M E N
Continued from
previous page Is your relationship POSSIBLE CAUSE AND ACTION If you or your
with your partner partner have a specific sexual problem,
YES concern about it may have reduced your
satisfactory in
sex drive. Try to talk frankly with your
other respects? partner (see COMMUNICATING YOUR SEXUAL
NO NEEDS, below). If the problem is not resolved,
consult your doctor, who may recommend
sex counselling (p.251).
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A D U LT S : W O M E N
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A D U LT S : W O M E N
Continued from
previous page POSSIBLE CAUSES Infection of the reproductive Planning for a healthy
tract or a previous ectopic pregnancy may
have damaged or blocked the fallopian tubes. pregnancy
Consult your doctor.
Whether or not you are having problems
ACTION Your doctor will probably arrange for
you to have a laparoscopy (p.269) to inspect conceiving, it is worth taking steps to ensure
the ovaries and establish whether the fallopian that if or when you do conceive, you have
Have you ever had tubes are healthy. Surgery may be done to the best chance of a healthy pregnancy.
YES
an infection of the open damaged fallopian tubes. If surgery is Ideally, you and your partner should see your
reproductive tract or not successful, you may be referred for IVF doctor at least 3 months before you start
(see ASSISTED CONCEPTION, below).
a pregnancy outside trying to conceive so that any problems can
the uterus (ectopic be dealt with in advance. Your doctor will
pregnancy)? probably do the following:
• Ensure that any pre-existing disease, such
NO as diabetes, is well controlled.
• Review prescription drugs to avoid
potential harm to the fetus.
POSSIBLE CAUSE AND ACTION Infrequent • Ask about inherited conditions in your
intercourse is a common cause of failure to and your partner’s families so that genetic
conceive. If you have sex less than three times counselling can be arranged if needed.
a week, the chance of sperm being present to • Check that you are immune to rubella
Do you have sexual fertilize an egg when it is released are reduced. (German measles), which if contracted in
YES
intercourse less often If possible, try to have sexual intercourse with
early pregnancy can cause birth defects.
than three times a your partner more often. If, despite this, you
week on average? have still not conceived within a further 3–6 • Advise you to take a daily supplement of
months, consult your doctor. 400 micrograms of folic acid, starting at
NO least 3 months before trying to conceive,
to reduce the risk of neural tube defects
such as spina bifida.
• Give you and your partner general health
advice about factors that could affect
fertility such as diet, smoking, and alcohol
consumption (see MAXIMIZING THE CHANCE
Do you exercise POSSIBLE CAUSE AND ACTION Vigorous training
OF CONCEPTION, p.252).
YES
frequently and/or may alter your hormone levels, affecting
train in a sport to a ovulation. Reducing the amount of exercise
competitive level? you take may improve your fertility. If you
have not conceived 3–6 months after lowering
NO your activity level, consult your doctor.
Are you underweight
(see ASSESSING YOUR
WEIGHT, p.29), or have YES
you recently lost a lot
of weight?
Assisted conception NO
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A D U LT S : W O M E N
START Have you Did the unprotected CALL YOUR DOCTOR NOW
YES YES
recently had sex take place within
HERE
sex without the past 72 hours? ACTION Emergency hormonal contraception
contraception, (EHC) may be an option. Your doctor can
NO prescribe two doses of EHC to be taken 12
or do you
hours apart. Alternatively, EHC is available
think that your from pharmacies. The sooner EHC is taken
contraception after unprotected sex, the more effective it
may have Did the unprotected will be. If you are concerned you may have
failed? sex take place within YES contracted an STI (p.267), tell your doctor.
the past 5 days?
NO
NO
CALL YOUR DOCTOR NOW
ACTION Your doctor may recommend that
ACTION No contraceptive method is effective you have an intrauterine device (IUD) fitted
at this stage. If your period is late, use a home (see METHODS OF CONTRACEPTION, opposite).
pregnancy test kit (p.260) to find out if you are The IUD prevents a fertilized egg implanting
pregnant. Consult your doctor if the result is in the uterus and is very effective in preventing
positive. If you are concerned that you may pregnancy. However, it may not be suitable
have an STI (p.267), consult your doctor. if you may have contracted an STI (p.267).
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A D U LT S : W O M E N
Methods of contraception
A wide choice of contraceptive methods is available, although Uterus Diaphragm The diaphragm
the majority are for use by the woman. Pregnancy can be Before sex, the
prevented in different ways, including using a barrier to sperm diaphragm is coated
or altering the woman’s hormone balance. Choose a method with spermicidal gel
that is safe and effective for you and also suits your lifestyle or cream and then
and preferences. If you have decided you definitely do not inserted into the
want children in the future, male sterilization (see VASECTOMY, vagina so that it covers
p.254) or female sterilization (opposite) may be suitable. DIAPHRAGM the cervix. During sex,
it should not be felt by
Barrier methods
These methods prevent sperm entering the uterus. They Bladder either partner. It must
be left in place for at
include the cervical cap, the diaphragm (right), and male and
Vagina least 6 hours after sex
female condoms. Barrier methods are more effective when
and then removed
used with a spermicide, already present in many condoms. DIAPHRAGM IN POSITION and washed.
Hormonal methods
The combined oral contraceptive pill (COCP) contains the Combined oral contraceptive pills
hormones oestrogen and progestogen and prevents the These pills contain the hormones
release of eggs. COCPs are effective and safe in women who oestrogen and progestogen. They are
do not have risk factors such as smoking, obesity, or a history usually taken, one a day, for 21 days,
of blood clots. The progestogen-only pill (POP) works mainly followed by 7 pill-free days, during
by thickening the mucus at the entrance to the cervix, which you will have your period. On
preventing penetration by sperm, and is suitable for most the 29th day, you begin another pack.
women. However, to be effective, POPs must be taken at
exactly the same time each day. Progestogens can also be Uterus IUD Ovary The intrauterine
Copper device (IUD)
given as 3-monthly injections or as an implant lasting 3 years. wire Once fitted, many
Mechanical methods Threads IUDs can be left in
The intrauterine device, or IUD, (right) is placed in the uterus by extend place for up to 5 years.
a doctor to prevent fertilized eggs implanting. The intrauterine through Some IUDs contain
system (IUS), a progestogen-releasing IUD, also reduces blood cervix
copper, which kills
loss during periods and helps prevent pelvic infection. INTRAUTERINE sperm, but the main
Natural method DEVICE effect of all IUDs is to
The most commonly used natural method involves monitoring Cervix prevent fertilized eggs
body temperature and mucus from the cervix in order to from implanting
Vagina in the uterus.
predict ovulation. Sex is then avoided around this time. IUD IN POSITION
Continued from
previous page
Could you remember to ACTION The progestogen-only pill (see
take a pill reliably at the YES METHODS OF CONTRACEPTION, above) may suit
same time each day? you. It alters your hormone balance, preventing
conception, and is suitable for women who
NO have medical conditions that prevent them
using the combined oral contraceptive pill;
Do you have high however, if a pill is taken more than 3 hours
blood pressure, or have YES late, protection is substantially reduced.
you ever had a blood
clot in a leg vein (deep Have you ever had any
vein thrombosis)? of the following?
NO • An infection of the
reproductive tract
YES ACTION A barrier method, such as a diaphragm
• A pregnancy outside or condoms, may be the best choice for you;
the uterus (an ectopic alternatively, an intrauterine system (IUS) may
Do two or more of the pregnancy) be an appropriate method (see METHODS OF
YES CONTRACEPTION, above).
following apply? • Heavy periods
• You smoke NO
• You are overweight
• You are over
35 years old
NO
ACTION You can choose from the whole range ACTION A barrier method or an IUD may suit
of contraceptive methods (see METHODS OF you; alternatively, progestogen injections or
CONTRACEPTION, above). There is unlikely to a progestogen implant are possible options
be a medical restriction on your choice. (see METHODS OF CONTRACEPTION, above).
277
A D U LT S : W O M E N
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A D U LT S : W O M E N
279
A D U LT S : W O M E N
t
ACTION Your doctor will probably send
EMERGENCY!
you to hospital for ultrasound scanning NO CALL AN AMBULANCE
(below). This will establish the site of
the placenta and exclude other possible POSSIBLE CAUSE You may have a placental
causes. In most cases, admission to abruption, in which the placenta partially
hospital for observation and bed rest separates from the wall of the uterus. This
is necessary until the bleeding stops. condition may be life-threatening for both
you and your baby.
ACTION In hospital, you will have ultrasound
scanning (see ULTRASOUND SCANNING IN
Ultrasound scanning in pregnancy PREGNANCY, left) to confirm the diagnosis.
Treatment depends on the severity of the
Ultrasound scanning is a safe and painless Monitor condition. If bleeding is heavy, your baby may
procedure. A device called a transducer is moved Image need to be delivered urgently by a caesarean
of fetus section. In other cases, rest and observation
over the skin, sending out ultrasound waves
Ultrasound in hospital may be sufficient.
(high-frequency, inaudible sound waves). The
transducer
sound waves are reflected off internal tissues
and organs and are then picked up and passed
to a computer, which creates an image on a
monitor. During pregnancy, ultrasound scanning
CALL YOUR DOCTOR NOW
is used to produce detailed images of the fetus. POSSIBLE CAUSE Bleeding from a placenta
Most women have at least one scan during praevia, in which the placenta partly or
pregnancy. A routine scan will detect multiple completely covers the opening of the cervix,
pregnancies, the site of the placenta, and the may be the cause.
amount of amniotic fluid, which is the fluid that ACTION Your doctor will arrange for you to
surrounds the baby in the uterus. Detailed scans be admitted to hospital immediately. Once in
after 20 weeks may detect abnormalities such hospital, you will have ultrasound scanning
as heart defects or a cleft palate. Ultrasound (see ULTRASOUND SCANNING IN PREGNANCY,
Having a scan
scanning is also used to investigate problems left) to determine the position of the placenta.
An ultrasound transducer is moved gently
If the bleeding is light, you may be closely
such as bleeding during pregnancy. The
280 over the abdomen. An image of the fetus observed in hospital. If it is heavy, you may
procedure takes between 5 and 20 minutes. is displayed on a monitor. need an emergency caesarean section.
280
A D U LT S : W O M E N
t
NO EMERGENCY!
CALL AN AMBULANCE
POSSIBLE CAUSE Constipation due to POSSIBLE CAUSE You may have a placental
hormone changes affecting the activity abruption, in which the placenta partially
of the intestines is common in pregnancy separates from the wall of the uterus and, in
Are you constipated? YES and may cause some discomfort. some cases, causes bleeding. This condition
may be life-threatening for your baby.
NO ACTION Try self-help measures for
constipation (p.221), but do not take ACTION In hospital, you will have ultrasound
stimulant laxatives, such as senna, which scanning (see ULTRASOUND SCANNING IN
can cause premature labour. If these PREGNANCY, opposite) in order to confirm the
measures do not help or pain persists, diagnosis. Treatment depends on the severity
consult your doctor. of the condition. If bleeding is severe, your
baby may need to be delivered urgently by
Are you more than a caesarean section. In other cases, rest and
28 weeks pregnant? YES
observation in hospital may be sufficient.
NO Is the abdominal pain
YES
severe and constant?
NO POSSIBLE CAUSE Intermittent pain at this stage
of pregnancy may indicate the onset of labour.
SEEYOUR DOCTOR WITHIN 24 HOURS IF YOU ARE Go to chart 148 RECOGNIZING THE ONSET
UNABLE TO MAKE A DIAGNOSIS FROM THIS CHART. OF LABOUR? (p.285)
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A D U LT S : W O M E N
Do you have
YES POSSIBLE CAUSE Acne, which occurs when
blackheads and/or hair follicles become blocked by sebum (an
tender red spots oily substance secreted by sebaceous glands in
affecting your face, the skin), is likely. This condition may develop
back, and/or chest? POSSIBLE CAUSE AND ACTION Stretch marks or worsen during pregnancy due to hormone
on the abdomen, thighs, and sometimes the changes causing increased sebum production.
NO breasts are very common in pregnancy. They
are related to changes in the elastic tissue ACTION Try self-help treatments for acne
content of the skin, rather than to how much (p.144). If these fail, you should consult your
the skin stretches, and there is little you can doctor. However, many prescribed treatments
do to prevent or minimize them. Although cannot be used in pregnancy.
stretch marks are pink during pregnancy, they
gradually fade to a silvery white colour after
the birth and are less noticeable.
Have you developed
YES
stretch marks?
NO POSSIBLE CAUSE Itchy abdominal skin during
Does the itchy skin pregnancy is usually caused by stretching as
look normal? YES the baby grows and is not a cause for concern.
If you have persistent widespread itching,
NO consult your doctor.
ACTION Apply an emollient cream such as
aqueous cream and avoid soap and perfumed
bath products. Wear underwear made of
Do you have itching, Are you more than natural fibres such as cotton.
YES
mainly affecting the 28 weeks pregnant,
abdomen? and do you have itchy YES
NO blisters or weals on
your lower abdomen?
POSSIBLE CAUSE You may have a harmless
NO condition known as polymorphic eruption
of pregnancy, which occurs in the last
3 months of pregnancy. Consult your doctor.
ACTION Your doctor may prescribe a
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO corticosteroid cream. The condition usually
MAKE A DIAGNOSIS FROM THIS CHART. MAKE A DIAGNOSIS FROM THIS CHART. only lasts for around 6 weeks.
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A D U LT S : W O M E N
283
A D U LT S : W O M E N
Do you have a
YES
temperature of 38˚C
(100˚F) or above and/or Are you more than POSSIBLE CAUSE This type of backache may
28 weeks pregnant, be an indication of the onset of labour. You
any of the following? should check to see whether you have other
is the pain different
• Pain on passing urine from previous back YES
signs that labour has started.
• Cloudy urine pain, and does the pain Go to chart 148 RECOGNIZING THE ONSET
• A frequent urge to stay the same when you OF LABOUR (p.285)
pass urine change position?
NO NO
Do you have a shooting
YES
pain and/or pins and
needles down the back
SELF-HELP Looking after your back in pregnancy of one leg?
NO
Your back is especially vulnerable during pregnancy because
ligaments around the spine soften and because the enlarging Shoulders
abdomen may lead to poor posture. The following measures held back
will protect your back and help to prevent back pain: POSSIBLE CAUSE Even in early pregnancy,
• Adopt a good posture when you are standing: your back Straight hormone changes can soften the ligaments
should be kept straight and your buttocks tucked in. spine supporting the spine, leading to backache.
• Wear flat shoes rather than high heels. ACTION Follow the advice on looking
• Use a chair with good back support. after your back in pregnancy (left).
• Sleep on a firm mattress. Consult your doctor if the pain becomes
severe enough to restrict your activities.
• Try gentle stretching
exercises for the Buttocks
lower back. tucked in
• Make sure you lift
small children and Knees
heavy objects safely. relaxed POSSIBLE CAUSE Sciatica, in which the sciatic
nerve is compressed at the point where it leaves
the spine, may be the cause. In pregnancy, this
Lifting safely CORRECT INCORRECT condition is due to hormone changes softening
To lift a small child, the ligaments supporting the spine.
bend your knees and lift Standing correctly
ACTION Follow the self-help advice for looking
with your back straight. Stand with your back straight and your
after your back in pregnancy (left). Consult
Keep the child as close to shoulders back. Tuck in your buttocks, your doctor if the pain becomes severe enough
your body as possible. and relax your knees. to restrict your daily activities.
284
A D U LT S : W O M E N
285
A D U LT S : W O M E N
NO
POSSIBLE CAUSES Generalized lumpiness
of the breasts is common during pregnancy. Feeding your baby
However, a single breast lump should always
be investigated because of the slight risk of
CONSULT YOUR DOCTOR IF YOU ARE UNABLE
breast cancer. Consult your doctor. Breast-feeding has a number of advantages
TO MAKE A DIAGNOSIS FROM THIS CHART. over bottle-feeding. However, as long as
ACTION Your doctor will examine your
formula milk is prepared according to the
breasts and may refer you for ultrasound
scanning (p.41). Most breast lumps are instructions, it is a satisfactory alternative to
harmless and do not need treatment. breast milk for your baby. Whichever method
you choose, feeding is a good time to enjoy
being with your baby and to establish a
Are your breasts strong and loving bond with him or her.
swollen, hard, Breast-feeding
and tender, and POSSIBLE CAUSE Breast engorgement, in which Breast milk contains all the nutrients that a
have you had a the breasts become overfull and painful, occurs baby needs and is easily digested. It requires
baby within the YES when more milk than necessary is produced. no preparation, is at the correct temperature,
last week or have This is common when milk first comes in or and is sterile. In addition, antibodies present
if breast-feeding is stopped abruptly. in breast milk help protect the baby against
you stopped
ACTION Wear a firm, supportive bra and take infection, making gastroenteritis less likely
breast-feeding
painkillers if necessary. Your milk supply will and reducing the risk of allergies developing.
abruptly? adapt to your baby’s demands within a week Breast-feeding may help you return to your
NO or so. If you have stopped breast-feeding, your pre-pregnancy weight more quickly because
milk will dry up within 2–3 weeks. Avoid it uses up calories. It may also reduce your
expressing milk as this stimulates production. long-term risk of breast cancer.
Bottle-feeding
Are you breast- Formula milks are the nutritional equivalent
feeding? YES of breast milk and are equally digestible, but
they lack the protective antibodies of breast
NO millk. However, if you are ill or you are taking
prescribed drugs that may affect your baby,
bottle-feeding may be suggested. Bottle-
feeding can be shared with your partner or
CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO
Continued on
MAKE A DIAGNOSIS FROM THIS CHART.
other carers, allowing you to take a break.
next page
286
A D U LT S : W O M E N
Continued from
previous page SELF-HELP Avoiding cracked nipples
Cracked nipples are common at the start of Nipple
breast-feeding. They are usually caused by Palate Areola
damage to the nipple as a result of the baby
not latching on properly. Make sure that your
baby takes the entire nipple and most of the
areola (the darker area around the nipple) into
his or her mouth. Dry your nipples thoroughly
after each feed, and use absorbent breast pads
SUCKING
and change them frequently. Your midwife may POSITION
be able to advise you on over-the-counter nipple
creams and sprays, which may help to prevent Positioning a baby at the breast
or soothe cracked nipples. If you do develop The entire nipple and most of the surrounding
Are one or both cracked nipples, they should heal by the time dark area (areola) should be in the baby’s
nipples painful? YES your breast-feeding routine is fully established. mouth to avoid cracked nipples developing.
NO
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A D U LT S : W O M E N
START Is it less than YES POSSIBLE CAUSE Many women feel tearful WA R N I N G
a week since and low for several days after childbirth.
HERE POSTNATAL
your baby This is commonly known as “baby blues”. PSYCHOSIS If someone you
was born? These feelings are probably caused by the know has recently had a baby and is now
dramatic changes in hormone levels that behaving erratically, seeing or hearing things
NO follow childbirth. In addition, the reality of a that are not there, or having strange or
new baby, with sleepless nights and constant bizarre ideas, you should call her doctor
demands for your attention, may be more at once. This may be a serious psychiatric
stressful than you expected. condition known as postnatal psychosis,
which requires immediate treatment.
ACTION Follow the advice on looking after
Is your mood so low yourself after childbirth (below). Consult your
that you feel that you doctor if the feelings last more than a few days.
YES
might harm yourself
or your baby?
CALL YOUR DOCTOR NOW
NO
POSSIBLE CAUSE You probably have severe
postnatal depression and need to have urgent
POSSIBLE CAUSES You probably have postnatal medical treatment.
Is your baby more depression. This occurs in around 1 in 10
than 6 months old, women after childbirth. You are more likely ACTION After talking to you about how you
to become depressed if you have previously feel, your doctor may prescribe antidepressant
and do any of the drugs. If your depression is particularly severe,
following apply? had depression or have had a difficult or very
long labour. Consult your doctor. the doctor may recommend that you are
• You are not enjoying admitted to hospital for treatment, preferably
your baby YES ACTION Your doctor will probably recommend a hospital with a mother-and-baby unit, which
counselling and prescribe antidepressant drugs. allows your baby to stay with you. You may
• You are unable to In addition, follow the advice on looking after be given antidepressant drugs and offered
laugh about things yourself after childbirth (below). You should psychological therapy (p.171).
notice an improvement in your mood within
• You are worried or 2 weeks of starting treatment.
anxious for no reason
NO
Are you tired all the
time, disorganized, and
unable to think about YES
anything but your baby?
SELF-HELP Looking after yourself after childbirth NO
288
FIRST AID
F IRST
AID
In some cases, immediate action can save a
life. This section contains illustrated step-by-
step instructions for the most common
emergency situations you are likely to come
across. In addition to emergency first-aid
treatments for adults, it includes techniques
specifically for babies and children. As well as
familiarizing yourself with the articles here,
you should ideally obtain practical training
from a recognized first-aid organization so
that you will be prepared for any emergency.
289
FIRST AID
FIRST AID
First aid is the immediate care given to a sick or injured
person before health-care professionals arrive. Its aims
are to preserve life, prevent a condition from worsening, GAUZE ROLLER ADHESIVE
and promote as fast a recovery as possible. Your top BANDAGES HYPOALLERGENIC TAPE
ADHESIVE DRESSINGS
priority in emergency situations, before starting first aid,
is to call 999 for medical assistance. If possible, ask a
bystander to make the call. The next priority is to check
the scene for possible dangers to you, the victim, or
bystanders, such as fire or dangerous fumes. You will
not be able to help the person if you become a victim
TRIANGULAR BANDAGES ANTISEPTIC
yourself, so you should always put your own safety first. CREAM
DISPOSABLE GLOVES
If you cannot approach the victim safely, phone for help
immediately. If it is safe to approach, you should then
aim to assess the victim’s condition and give first aid.
The instructions in this section are designed to help
you handle common emergency situations. There is no SCISSORS SAFETY PINS
substitute for professional training, however, and the best COLD PACK
form of training is a practical course in first aid. The CALAMINE
British Red Cross, St John Ambulance, and St Andrew’s TWEEZERS LOTION
Ambulance Association all run courses. On successful Contents of a basic first-aid kit
completion of a first-aid course, you receive a certificate Recommended items to include in your
first-aid kit are shown here. Keep such a
that is valid for 3 years. Training in some skills, such as kit at home and in your car, and check
ANTISEPTIC GAUZE
artificial respiration, is valid for only 1 year. WIPES DRESSINGS and replenish the contents regularly.
ABC of resuscitation
Oxygen is vital for life. Normally, it is taken in by breathing ABC sequence before giving any other treatment. You need to
and circulates around the body in the bloodstream. If either open the airway; establish if the victim is breathing; and assess
breathing or circulation fail, a procedure called resuscitation whether the blood is circulating by checking for a pulse and
must be performed to supply the body with oxygen. The other signs, such as normal skin colour. If the victim is not
procedure is based on three checks known as the ABC of breathing, you must give artificial respiration to breathe oxygen
resuscitation: “ABC” stands for Airway, Breathing, and into the body. If there is no pulse or other signs of circulation,
Circulation. If a person is unconscious, always follow the you must start cardiopulmonary resuscitation (CPR).
A: Airway
To open the airway,
place one hand on the
Site of
victim’s forehead, and brachial
place two fingers of pulse
your other hand
under the chin. Gently
tilt the head back by
pressing down on the
forehead while you C: Circulation
lift the chin. For an To assess circulation, feel
infant, use only one the pulse, using two fingers,
finger to lift the chin. INFANT
for up to 10 seconds. For an
infant, feel the brachial pulse, Site of
on the inside of the arm. For carotid
pulse
an adult or child, feel the
carotid pulse, in the neck, by
B: Breathing pressing the hollow between
To check breathing, watch the the trachea (windpipe) and
chest for movement, listen for the large neck muscle. Look
breath, and feel for breath on for other signs of circulation,
your cheek for up to 10 seconds. such as normal skin colour. If
If there is no breathing, begin there is no sign of circulation,
artificial respiration (p.293). start CPR (pp.296–297). ADULT OR CHILD
290
FIRST AID
Action in an emergency
When faced with an emergency, you should always work to you will not be able to help anyone else if you become a
a clear plan, staying calm and controlled so that you can act victim yourself. Very simple measures, such as turning off an
effectively. Take several deep, slow breaths to help you calm electrical switch, may be enough to eliminate danger. After
down, if necessary. If possible, you should send someone for you have made sure that the scene is safe, the next step is to
an ambulance while you deal with the situation. Before check the victim’s condition and carry out the appropriate
trying to help the victim you must be certain that you are first-aid treatment. Treat multiple injuires in order of
not putting yourself in any possible danger. Remember that priority, dealing with life-threatening conditions first.
HERE If you have someone there to help you, send • Check the victim for serious injuries and
him or her to call an ambulance. treat as appropriate.
• Call an ambulance unless someone else has
already done so.
EMERGENCY ACTION!
Call an ambulance unless someone else has
already done so. EMERGENCY ACTION!
NO
EMERGENCY ACTION!
291
FIRST AID
Recovery position
The recovery position is a secure position in which to place a and heartbeat may stop. The recovery position keeps the
person who is unconscious but breathing. If an unconscious head, neck, and back aligned, keeps the airway open, and
victim is left lying on his or her back, the tongue may block allows fluid to drain out of the mouth if the victim vomits.
the throat and prevent air from reaching the airways to the You may not need to follow all of the steps shown below if
lungs. This situation is life-threatening because the breathing the person is found lying on his or her front or side.
Hand
Leg stays held
straight against
cheek
Leg pulled
into bent
position
Head is
tilted back
Victim’s
hand Infants
3 Continue to pull the
upper leg so that the
victim rolls on to his or her
supports
head
side. If necessary, support
Knee comes
the body with your knees so to rest on Body tilted
that the victim does not roll floor downwards
too far. Leave the victim’s
hand supporting his or her Victim’s head
head, and tilt the head so remains tilted Recovery position
that the airway stays open. for an infant
Hold the infant
securely in your
arms so that the
head is lower than the body.
The head should be tilted
back to keep the airway
open and allow any vomit
Leg supports to drain from the mouth.
292
FIRST AID
Artificial respiration
Artificial respiration is a way to force your exhaled air into until help arrives. If the pulse is absent, indicating that the
the lungs of a person who is not breathing. If breathing has heart has stopped, you need to carry out cardiopulmonary
stopped, the victim will be unconscious, the chest will not rise resuscitation (pp.296–297) – artificial respiration combined
or fall, and you will not be able to feel or hear breath. The with chest compressions. When giving artificial respiration to
face may be greyish blue. In this situation, you must give an infant, be careful not to blow too hard or air will go into
artificial respiration immediately – your exhaled air still the stomach. Use a face shield or mask, if available. However,
contains enough oxygen to sustain the victim’s vital organs even if you do not have one, do not hesitate to help a victim.
Nose is
pinched Rescuer watches
closed
Fingers keep
victim’s chest
6 Check the pulse (see
ABC of resuscitation,
chin lifted
5 Look at the victim’s
chest again. If there
p.290). If it is absent,
start CPR (pp.296–297).
Infants
Site of
brachial
pulse
293
FIRST AID
Choking
Choking is due to obstruction of the
airway. In adults, a common cause of
Conscious adults
choking is food stuck in the throat.
Infants and children often put small
objects in their mouths and can easily
Hand is
kept flat 2 If the victim continues to
cough without clearing
the object, you will need to
Hand is
clasped
over fist
choke. An adult or older child who is give abdominal thrusts. Stand
choking may cough and gasp and point behind the victim and reach
to or grasp at the throat. A young child around the body. Make
who is choking will have difficulty in a fist with one hand.
Position the thumb side
speaking and breathing and the face of your fist in the middle
and neck will become flushed. A of the abdomen, just
choking infant may squeak, turn blue, below the breastbone.
and seem to cry silently. If coughing
does not clear the blockage, you need
to give first aid to avoid suffocation.
3 Place your other hand
over your fist, and pull
sharply inwards and
The techniques on these pages show upwards. Give 5 of these
how to treat conscious victims who are thrusts. If the object is
choking as well as those who have lost not dislodged, repeat this
consciousness while being treated for cycle of 5 slaps and 5
choking or were found unconscious
and known to have choked. You must
1 Encourage the victim to cough.
If this does not dislodge the
object, bend the person forwards
thrusts. If the victim
continues to choke or
loses consciousness (see
reopen a blocked airway before giving and give the back 5 sharp slaps Unconscious adults,
any other first-aid treatment. between the shoulder blades. below), call an ambulance.
Hands positioned on
chest, against lower
WA R N I N G
2 If the victim is not breathing, attempt up
to 5 slow breaths of artificial respiration
(p.293). If the chest does not move (a sign
part of breastbone
Lay your other hand on top with the the recovery position
fingers raised. Thrust quickly inwards Hands positioned
(p.292) and monitor against central
and upwards up to 5 times. Check the the breathing and upper abdomen
mouth again. If the victim is not pulse regularly (see
breathing, give another 5 breaths of ABC of resuscitation,
artificial respiration. If unsuccessful,
continue the cycle of back slaps
p.290) until medical
help arrives.
4 If chest thrusts do
not dislodge the
object, give up to 5
and artificial respiration until abdominal thrusts,
medical help arrives. with your fist against
the child’s upper
abdomen. If the child
is still choking, call
an ambulance and
repeat Steps 2–4 until
help arrives.
294
FIRST AID
Unconscious children
Give up to
5 back slaps
7 If the breaths still do not reach
the lungs, repeat Steps 2–6
295
FIRST AID
Adults
296
FIRST AID
Children
Middle finger
on end of the
breastbone
Infants
297
FIRST AID
Shock
Shock can occur as a result of any severe injury
or illness that dramatically reduces the flow of
blood around the body, such as a heart attack
WA R N I N G 1 If you have a helper, send him or
her to call an ambulance. Treat any
obvious cause of shock, such as severe
or severe bleeding. It can also be due to loss of • Do not leave the victim alone, except to bleeding (opposite page).
call an ambulance. If possible, ask a helper
body fluids from burns or severe diarrhoea and to summon medical help.
vomiting. If shock is not treated rapidly, vital
organs such as the brain and heart may fail.
• Do not let the victim eat or drink unless he
or she has diabetes and is hypoglycaemic. 2 If the person is breathing
normally, lay him or her
down. If you suspect a
Signs of shock may include a rapid pulse; grey- fracture (p.301), keep the
blue skin, especially on the lips; sweating; and person flat. Otherwise, raise
cold, clammy skin. Later, excessive thirst and Raise legs the legs above the level of the
nausea and vomiting may occur. The victim above level heart. If the person is having
of heart difficulty in breathing, help
may feel weak or dizzy and develop rapid,
him or her to sit in a
shallow breathing and a faint pulse. He
comfortable position.
or she may be restless, gasp for air, and
eventually lose consciousness. It is
essential to call for medical help at the
first signs of shock, and to keep the
victim warm and comfortable.
3 Loosen any
restrictions
around the neck,
4 Stop the victim becoming cold by
covering him or her with a blanket.
Check the victim’s level of consciousness
chest, and waist, by asking simple, direct questions. Check pulse at
and remove the Monitor breathing and pulse and be regular intervals
victim’s shoes. Call prepared to resuscitate if necessary
an ambulance if a (see ABC of resuscitation, p.290).
helper has not Cover the victim
already done so. with a coat or
blanket
Anaphylactic shock
Anaphylactic shock is a life-threatening allergic reaction to
a specific food, drug, or insect sting. It can develop within 1 Call an ambulance or send a helper to
do so immediately. If possible, provide
the emergency services with details of the
seconds or a few minutes. The victim may be anxious and cause of the allergic reaction.
may have puffy eyes, a swollen face, lips, and tongue, and
an itchy, red skin rash. He or she may develop wheezing
and severe breathing difficulties and may lose consciousness.
An injection of epinephrine (adrenaline) and oxygen must
2 If the victim is conscious, help him
or her to sit up in the position that
makes breathing easiest.
be given as quickly as possible. If the person is aware of
having an allergy and carries a supply of epinephrine, you
can help him or her to use this supply. Otherwise, first aid is 3 Check if the victim is carrying a
syringe of epinephrine (adrenaline).
Help him or her to use it, or administer
limited to keeping the person comfortable and, if necessary,
it yourself if you have been trained.
helping him or her to breathe until medical help arrives.
298
FIRST AID
Severe bleeding
Severe bleeding is dramatic and distressing and can be life-
threatening. Although you must try to stop the bleeding as 1 Place a sterile dressing, pad, or clean cloth
over the wound and press firmly in place
for at least 10 minutes, or longer if necessary,
quickly as possible, you must also be alert to the general
condition of the victim. A person who is bleeding heavily may until the bleeding stops. If no clean dressing is
available, ask the victim to apply pressure with
lose consciousness (see Unconsciousness, p.300) and is also the palm or fingers of his or her own hand.
likely to develop shock (opposite page). Severe bleeding from
an injury to the face or neck can cause choking (pp.294–295).
Any of these conditions may require immediate
treatment. Before and after treating bleeding,
2 If the bleeding does
not stop, raise the
injured part above the
wash your hands well. Wear disposable level of the heart, if
gloves if they are available and follow possible, and continue to
apply pressure. However,
the procedure below to stop the bleeding.
if you suspect a fracture
Limb raised (p.301), do not move
above level the injured part.
WA R N I N G of heart
Severe burns
A severe burn may involve all layers of the skin. If it is very damage and may help to prevent loss of body fluids and
severe, it may also destroy the tissues underlying the skin. the onset of shock (p.298). It is also essential to protect the
The affected area may appear red and may have blisters that wound from infection. The larger and deeper the burn, the
weep clear fluid. In some cases, the area may be brown or greater the risk of shock or infection. A victim who has been
charred. If the burn extends to very deep tissues, the skin may burned in a fire will probably have suffered damage to the
be white. If the nerve endings are damaged, there may be loss airway as a result of inhaling smoke or hot air. You should
of feeling in the injured area. The immediate response for a monitor his or her breathing regularly. If consciousness is lost,
serious burn is to cool the area rapidly, which minimizes be prepared to resuscitate (see ABC of resuscitation, p.290).
299
FIRST AID
Unconsciousness
Unconsciousness results from an interruption to the normal
activity of the brain. It is a potentially life-threatening 1 If you have a helper, send him or her to
call an ambulance. If you need to leave
the victim alone to call for help, place the
condition that needs immediate medical help. A victim is
person in the recovery position (p.292).
likely to be unconscious if he or she does not respond to loud However, if you suspect spinal injury,
noises or gentle tapping or shaking. The person will make no do not move the person unless the
sound or movement and his or her eyes will remain closed. If ariway is blocked.
an unconscious victim is lying on his or her back, the tongue
may fall back and block the airway.
First-aid priorities are to maintain
an open airway and to check for
and treat obvious injuries.
WA R N I N G
Major seizures
A major seizure (convulsion) is a result of an electrical
disturbance in the brain and consists of muscular spasms 1 Attempt to support the victim if you see him
or her falling. If bystanders are present, ask
them to move away and remove any objects
and loss of body control. Seizures that are recurrent usually from around the victim.
indicate the brain disorder epilepsy. During a major seizure,
a person falls unconscious, often letting out a cry. The body
becomes rigid, the back arches, the jaw is clenched, the eyes 2 Lay the victim down. Loosen clothing
around his or her neck, and try to protect
the head with something soft, such as a piece
roll upwards, and the tongue may be bitten. The breathing
of folded clothing.
becomes noisy and, in some cases, temporarily ceases.
Convulsive shaking movements of the body may then Protect
victim’s
follow, and may last for 1–3 minutes. The victim head
recovers consciousness within a few minutes
but is left dazed and sleepy. Anyone
who is giving first aid should protect
the victim from injuring him- or
herself during a major seizure and
should remain present until
recovery is complete.
One leg kept
straight
WA R N I N G
300
FIRST AID
Spinal injury
The main risk when dealing with someone who has spinal injury is that any
movement may damage the spinal cord. The most dangerous injuries are those to WA R N I N G
the neck, but any spinal injury is potentially serious. When calling the emergency
Do not move the victim from the position in
services, try to tell them how the injury to the spine occurred. If you suspect an which he or she was found unless he or she
injury to the spinal cord, it is vital to keep the victim still until a doctor arrives. is in danger or loses conciousness and needs
Signs of possible damage to the spinal cord include a burning sensation or tingling to be resuscitated.
in a limb or loss of feeling in a limb. The victim may
also have breathing difficulties.
Fractures
You should suspect a fracture if the person cannot move the injured part or it is
misshapen or very painful. There is likely to be swelling and bruising and possibly WA R N I N G
bleeding and a visible wound. A person with an upper limb fracture is usually able
to walk and can be taken to hospital, keeping the injured part as still as possible. • Do not give anything to eat or drink, in
case the victim needs general anaesthesia.
Fracture of a lower limb bone is a serious injury, requiring immediate hospital • Do not move a victim with a lower limb
treatment. Fractures of the thighbone often involve severe internal bleeding and injury unless he or she is in danger.
there is a danger of shock (p.298). No weight must be placed on an injured leg.
Injured arm
1 Help the victim to lie down, and
treat any bleeding (see Severe
bleeding, p.299).
4 Try to minimize the risk
of shock (p.298) developing
by keeping the person warm
supported Broad-fold
across chest bandage and comfortable. Regularly
301
FIRST AID
Swallowed poisons
Poisoning can be caused by swallowing toxic
chemicals or poisonous plants or by overdosage 1 If the victim is conscious, ask questions
to obtain as much information as
possible about the poisoning. If the victim
of recreational or medicinal drugs. Common is unconscious, go to step 3.
symptoms include pain in the abdomen or
chest, nausea, vomiting, diarrhoea, and breathing
difficulties. There may be signs of burning around 2 Call your doctor or local poison centre
for further instructions and give them
as much information as possible. Stay with
the mouth and lips. The victim may appear
the victim and monitor his or her condition.
sluggish and confused and may lose consciousness. If he or she develops signs of shock or
Rarely, certain poisons can result in anaphylactic breathing difficulties, call an ambulance.
shock (p.298), a life-threatening allergic reaction.
Signs of this condition include swelling of the face,
lips, and tongue, breathing difficulties, and a rash. 3 If the victim is unconscious or loses
consciousness, check his or her
breathing and pulse and be prepared
If you suspect poisoning, seek medical help at
to resuscitate if necessary (see ABC of
once, giving as much information as possible. resuscitation, p.290).
WA R N I N G
4 Place the victim in the recovery
position (p.292) unless you suspect
that he or she has a spinal injury. Call an
Do not try to induce the victim to vomit
unless you are advised to do so by a ambulance and then return to the victim.
medical professional. If alcohol poisoning is a possibility, keep
the victim warm with a blanket.
Insect stings
sting, apply a cold pack and wait
for medical help. If you suspect 4 Keep the victim calm while
waiting for the ambulance.
Regularly monitor the victim’s
that the bite is from a venomous
snake, proceed to Step 3. breathing and pulse and be ready
to resuscitate if necessary (see ABC
of resuscitation, p.290.
WA R N I N G
Get medical help immediately
3 Minimize the victim’s
movement to stop the venom
from spreading farther around the
if the victim is allergic to body. Immobilize the injured leg
insect stings. by binding it to the uninjured leg
and immobilize an injured arm
with a sling.
302
USEFUL ADDRESSES
DRUGS GUIDE
& USEFUL
ADDRESSES
The Drugs Guide will help you understand
prescribed and over-the-counter drugs and
how to use them safely. It explains the general
principles of drug treatment and contains
information on specific drug groups. Useful
Addresses provides sources for additional
health information and tells you how to
contact self-help and support groups.
303
DRUGS GUIDE
DRUGS GUIDE
A vast range of drugs is available for treating disorders.
Drugs are used not only to cure many conditions but, in
some cases, to control symptoms in disorders such as INJECTABLE SOLUTIONS SUPPOSITORIES
304
DRUGS GUIDE
305
DRUGS GUIDE
also used to treat cancers of the breast, In most cases, diarrhoea clears up in about
prostate, and endometrium. Many anticancer Anticonvulsants 48 hours and drug treatment is not required.
drugs are potentially harmful to a developing Drugs used in the treatment of epilepsy and Drinking plenty of fluids is usually all that
fetus. Therefore, you should always consult other types of seizure. Anticonvulsant drugs is needed. In some cases, oral rehydration
your doctor about your contraception needs are taken regularly to reduce the frequency solutions may be needed. Do not give anti-
before starting treatment. and severity of seizures and as an emergency diarrhoeal drugs to children.
P OSSIBLE SIDE EFFECTS treatment to stop a prolonged seizure. The main types of antidiarrhoeal drug are
In the early stages of treatment, nausea, Anticonvulsant drugs are also administered opioids, bulk-forming agents, and adsorbents.
vomiting, and diarrhoea may occur, which to prevent seizures following a serious head Some are available over the counter. Opioids
in some cases may be sufficiently serious to injury or some types of brain surgery; they are the most effective antidiarrhoeal. They are
make hospitalization necessary. Anticancer may be given to a child with a high fever who used when the diarrhoea is severe and debili-
drugs may also cause hair loss, anaemia, has a history of febrile convulsions (seizures tating. Opioids also help to relieve abdominal
increased susceptibility to infection, and/or brought on by a high temperature). pain associated with diarrhoea. Bulk-forming
abnormal bleeding. To minimize adverse ef- The choice of drug is largely determined by agents and adsorbents have a milder effect
fects, anticancer drugs are usually given in the type of seizure to be treated. Long-term and are often used to regulate bowel action
short courses, with time between each course. treatment may require the use of more than over a prolonged period, for example in peo-
one type of anticonvulsant drug. You should ple with irritable bowel syndrome. Do not
always consult your doctor before planning a take a bulk-forming agent when taking opi-
Anticoagulant and pregnancy because some anticonvulsants oids; the combination could cause faeces to
affect the development of the fetus. compact and block the intestine.
antiplatelet drugs P OSSIBLE SIDE EFFECTS P OSSIBLE SIDE EFFECTS
Drugs used to prevent unwanted blood clots Anticonvulsant drugs can produce various All types of antidiarrhoeal can cause consti-
from forming in the blood vessels. They are adverse effects, including reduced concentra- pation and therefore need to be taken with
also used to stabilize clots that have already tion, impaired memory, poor coordination, plenty of water. There is a risk of dependence
formed, preventing an embolism, in which a and fatigue. Your doctor will try to establish with prolonged use of opioids.
piece of existing clot breaks off, is carried a dose that prevents seizures while minimiz-
away, and blocks a blood vessel supplying a ing adverse effects. Regular monitoring of
vital organ. Anticoagulant drugs cannot dis- blood levels of the drug may be necessary in Antiemetics
solve blood clots, however, and thrombolytic order to achieve this. A group of drugs used to treat nausea and
drugs are used for this purpose. vomiting caused by motion sickness, vertigo,
In general, antiplatelet drugs are used to inner ear disorders such as Ménière’s disease,
prevent unwanted clots from forming in Antidepressants certain drugs (especially anticancer drugs),
arteries; anticoagulants are prescribed to pre- Drugs that help to relieve many of the symp- and, occasionally, severe vomiting during
vent clots from developing or enlarging in toms of depression, such as loss of interest in pregnancy. Some antiemetic drugs are avail-
veins. The drugs are usually taken orally, but everyday activities, poor appetite, lethargy, able over the counter. If you need to take
anticoagulants may be given by injection or insomnia, despair, and thoughts of suicide. an antiemetic for any reason other than to
infusion if clotting must be controlled There are three main types of antidepres- prevent or relieve motion sickness, you
quickly, for example during or after surgery. sant: selective serotonin re-uptake inhibitors should consult your doctor so that he or she
Warfarin, the most frequently used oral (SSRIs), tricyclics, and monoamine oxidase can determine the cause of the vomiting and
anticoagulant, is used long term to prevent inhibitors (MAOIs). The antidepressant effect the correct treatment. Do not take anti-
deep vein thrombosis, in which an unwanted of these drugs begins after 10–14 days, but emetics during pregnancy except on medical
clot forms in a vein, or pulmonary embolism, the full effect may not be felt for up to advice. Antiemetics are normally taken orally,
in which a clot lodges in the lungs. The drug 8 weeks. People with moderate to severe but they may be given by injection or as a
is also prescribed to people at risk of a stroke. depression are most commonly prescribed suppository if vomiting is severe.
Because oral anticoagulants interact with SSRIs or tricyclics because there are fewer P OSSIBLE SIDE EFFECTS
many other drugs, patients are given a warn- side effects than with MAOIs. MAOIs react Many antiemetics can cause drowsiness.
ing card that lists prohibited drugs. adversely with certain foods, such as cheese, Therefore, you should not drive or operate
If you have angina or you have had a heart and with many other drugs. Therefore, they machinery until you know how the drugs
attack or a stroke you may be advised to take are usually prescribed only when other types affect you. Some may result in a dry mouth,
an antiplatelet drug for life. Aspirin is the of antidepressant have not been effective. difficulty in passing urine, and dizziness.
most commonly used antiplatelet drug. It People taking MAOIs are given a card that
should not be taken with any other anticoag- lists foods and drugs they must avoid.
ulant except on the direction of a doctor. P OSSIBLE SIDE EFFECTS Antifungal drugs
Oral anticoagulants can be harmful to a SSRIs can cause headaches, diarrhoea, nausea, A group of drugs prescribed to treat infec-
fetus. You should tell your doctor if you are and reduced sex drive. Restlessness and tions caused by fungi. Antifungal drugs are
planning to become pregnant or are pregnant. anxiety may also occur. A dry mouth, diffi- commonly used to treat athlete’s foot and
P OSSIBLE SIDE EFFECTS culty in passing urine, constipation, and ringworm. They are also used to treat oral
Easy bruising is a side effect of warfarin and, blurred vision are common with tricyclics, or vaginal thrush and rare fungal infections
more rarely, rashes, hair loss, and diarrhoea but these effects tend to diminish as treatment that affect internal organs.
may occur. People taking oral anticoagulants continues. Side effects of MAOIs include a Antifungal preparations are available as
are given regular blood tests because too high dry mouth, drowsiness, lightheadedness, and tablets, lozenges, liquids, creams, injections,
a dose can cause abnormal bleeding. digestive disturbances. and vaginal suppositories. Some of these can
be bought over the counter.
WA R N I N G P OSSIBLE SIDE EFFECTS
Antidiarrhoeal drugs Preparations applied to the skin, scalp,
Contact your doctor immediately if you are Drugs used to relieve diarrhoea, either as a mouth, or vagina may occasionally increase
taking an oral anticoagulant and you have short-term measure to control an acute attack irritation. Antifungal drugs given by mouth
nosebleeds or notice blood in your urine. of diarrhoea, or in the long term for intestinal or injection can cause more serious side-
disorders such as irritable bowel syndrome. effects, including liver or kidney damage.
306
DRUGS GUIDE
307
DRUGS GUIDE
P OSSIBLE SIDE EFFECTS Corticosteroid drugs are also used to suppress the treatment of high blood pressure. Loop
The most common side effects of calcium the immune system in order to prevent the diuretics are more powerful than thiazides
channel blockers are headaches, facial flush- rejection of a transplanted organ and in the and are used to treat accumulation of fluid
ing, and dizziness (usually on standing up). treatment of certain types of cancer, such as due to heart failure and some kidney and
However, these effects generally disappear those of the lymphatic system (lymphomas) liver disorders. They may also be given by
with continued treatment. Nausea, fatigue, and of the blood (leukaemias). injection for the emergency treatment of
and palpitations are less common side effects. P OSSIBLE SIDE EFFECTS heart failure. Both thiazide and loop diuretics
Short-term use of corticosteroids rarely pro- can cause excessive loss of potassium from
WA R N I N G duces side effects. Prolonged use of strong the body, which can result in confusion and
topical corticosteroids can cause local dam- weakness. If your potassium levels become
Do not suddenly stop taking a calcium age to the skin. Long-term treatment with low you may be given a potassium-sparing
channel blocker drug without consulting oral corticosteroids may cause easy bruising, diuretic, either alone or in combination with
your doctor. Abrupt withdrawal can cause acne, a moon-shaped face, and weight gain. a thiazide or loop diuretic.
worsening of angina. It can also cause raised blood pressure, P OSSIBLE SIDE EFFECTS
osteoporosis, slow growth in children, and All diuretics increase the frequency with
increased risk of infection. which you need to pass urine, an effect that is
Abrupt withdrawal from long-term, high- most noticeable at the start of treatment.
Cold and flu remedies dose corticosteroids can lead to a rapid fall in Some diuretics may raise the level of uric
Preparations for the relief of symptoms of blood pressure and, in some cases, shock, acid in the blood, and thereby increase
the common cold and flu. Many different which can be fatal. If your doctor prescribes the risk of gout. They can also raise blood
preparations are available over the counter. corticosteroid drugs for you for more than sugar levels, which can cause or aggravate
The main ingredient is usually a mild pain- 3 weeks, you will be given a medical alert diabetes mellitus. Potassium-sparing diuretics
killer, such as paracetamol or aspirin, which card that gives details of your medication to can cause a dry mouth, digestive distur-
helps to relieve aches and pains. Other com- inform any health professional treating you. bances, and a rash.
mon ingredients include antihistamines and
decongestants, which help to reduce nasal
congestion, and caffeine, which acts as a mild Cough remedies Immunosuppressants
stimulant. Those remedies containing anti- Preparations containing various drugs used to Drugs that reduce the activity of the immune
histamines can cause drowsiness. Vitamin C treat coughing. Coughing is a natural reflex system (the body’s natural defences). They
is frequently included in cold relief products, action that helps to clear the lungs of sputum. are prescribed following transplant surgery to
but there is no evidence that it speeds recov- The effectiveness of cough medicines is prevent foreign tissues from being rejected.
ery. Zinc tablets are claimed to shorten the doubtful, which is why doctors rarely pre- Immunosuppressants are also given to halt
duration of colds, but indigestion is one scribe them for minor respiratory disorders. the progress of autoimmune disorders (in
of their side effects. However, a wide variety of cough remedies which the body’s immune system attacks its
is available over the counter. Most consist of own tissues) such as rheumatoid arthritis.
a syrupy base to which various drugs and Recently, immunosuppressant drugs have
Corticosteroids flavourings have been added. been given in the early stages of these dis-
Drugs that are similar to the natural cortico- The main groups of drugs used to treat orders with the aim of preventing tissue
steroid hormones produced by the adrenal coughs are expectorants, mucolytics, and damage. They are unable, however, to restore
glands. The production of corticosteroids by suppressants. Expectorants are supposed to tissue that has already been damaged.
the adrenal glands is regulated by a pituitary encourage productive coughs (that produce There are two main types of immuno-
hormone. Corticosteroid drugs have a wide sputum). The benefit of these is not proven, suppressant: corticosteroids and cytotoxic
variety of uses. They are available as topical however. Mucolytics make sputum less immunosuppressants. The drugs cyclosporin
creams, ointments, and lotions and as nasal sticky and easier to cough up, but they are and tacrolimus are also used. Corticosteroids
sprays. They can also be taken orally or given of little benefit to most people. Cough are usually used initially for autoimmune dis-
by inhaler or injection. Corticosteroids are pre- suppressants, which often contain drugs orders. If they are not effective, cytotoxic
scribed to people with Addison’s disease, in such as codeine or pholcodine, are usually drugs may used in addition; cyclosporin is
which levels of the natural hormones hydro- effective in relieving a troublesome cough. also an option. To prevent rejection of trans-
cortisone and aldosterone are inadequate due Cough suppressants may have a sedative plants, the most commonly used drugs are
to destruction of the adrenal glands by dis- effect and can cause drowsiness. cyclosporin, tacrolimus, and azathioprine.
ease. Corticosteroids are also prescribed Some immunosuppressants can harm a
following surgical removal of the adrenal fetus. You should tell your doctor if you are
glands or when the pituitary gland has been Diuretics planning a pregnancy or are pregnant.
destroyed by disease, surgery, or irradiation. A group of drugs that help to remove excess P OSSIBLE SIDE EFFECTS
Corticosteroids are used in the treatment water from the body by increasing the All immunosuppressants have potentially
of inflammatory intestinal disorders, such as amount that is lost as urine. Diuretic drugs serious adverse effects. By reducing the activ-
ulcerative colitis and Crohn’s disease. Urgent are commonly used in the treatment of high ity of the immune system, they increase the
corticosteroid treatment is required to reduce blood pressure and heart failure (a reduction risk of infection. These drugs also increase
inflammation in temporal arteritis, a condi- in the heart’s pumping efficiency). Diuretics the risk of certain cancers and can make the
tion in which inflammation of the artery are also used to treat other conditions in body’s blood clotting mechanism less effective.
supplying the retina can lead to blindness. which excess fluid accumulates in the body,
Corticosteroids are also used in the treat- such as liver or kidney disorders and glau-
WA R N I N G
ment of autoimmune diseases (in which the coma. Some diuretics may be used to prevent
body attacks its own tissues), such as rheum- altitude sickness and to treat the inner ear dis- When taking immunosuppressant drugs,
atoid arthritis, and in asthma, eczema, iritis order Ménière’s disease. it is important that you report any signs of
(inflammation of the iris), and hay fever. The The most frequently prescribed diuretic infection, such as a sore throat or fever, or
injection of corticosteroids around an drugs are thiazides, potassium-sparing diur- any unusual bruising or bleeding, to your
inflamed tendon or joint may relieve pain in etics, and loop diuretics. Thiazide drugs are doctor immediately.
disorders such as tennis elbow and arthritis. the most commonly prescribed diuretic for
308
DRUGS GUIDE
309
DRUGS GUIDE
310
USEFUL ADDRESSES
USEFUL ADDRESSES
Throughout the UK, hundreds of organizations, from or emotional conditions, and many have support groups
government agencies such as the Department of Health or can provide information about groups in your area.
to nonprofit organizations such as the Red Cross, are No responsibility for information provided by the
dedicated to helping people deal with most conditions. organizations or online sites listed here can be accepted
This list is a limited sample of such organizations, but by the British Medical Association (BMA). The inclusion
further information is available from local libraries, of an organization or online site in this list does not
hospitals, and GP or health clinics. Most organizations indicate endorsement by the BMA, and you are advised
provide information about resources for specific medical always to consult your doctor on personal health matters.
Acne Support Group Anthony Nolan Bone British Allergy Foundation British Dental Health
PO Box 230 Marrow Trust 30 Bellegrove Road Foundation
Hayes, Middlesex UB4 0UT The Royal Free Hospital Welling Eastlands Court
Tel: (020) 8561 6868 Hampstead Kent DA16 3PY St. Peter’s Road
Online: www.m2w3.com/acne London NW3 2QG Helpline: (020) 8303 8525 Rugby
Tel: (020) 7284 1234 E-mail: info@allergyfoundation.com Warwickshire CV21 3QP
Action for ME Online: www.anthonynolan.org.uk Online: www.allergyfoundation.com Tel: (01788) 546365
Campaign to improve the E-mail: feedback@dentalhealth.
lives of people with myalgic Arthritis Care British Association for org.uk
encephalomyelitis 18 Stephenson Way
Counselling Online: www.dentalhealth.org.uk
PO Box 1302 London NW1 2HD 1 Regent Place
Wells, Somerset BA5 1YE Rugby British Dyslexia
Tel: (020) 7380 6500
Online: www.arthritiscare.org.uk
Warwickshire CV21 2PJ Association
Tel: (01749) 670799
Tel: (01788) 550899 98 London Road
E-mail: wells@afme.org.uk
Online: www.afme.org.uk Arthritis Research Campaign E-mail: bac@bac.co.uk Reading RG1 5AU
Copeman House, St. Mary’s Court Online: www.counselling.co.uk Helpline: (0118) 966 8271
Action on Smoking and Health St. Mary’s Gate, Chesterfield Tel: (0118) 966 2677
British Association E-mail: admin@bda-
102 Clifton Street Derbyshire S41 7TD
for Sexual and dyslexia.demon.co.uk
London EC2A 4HW Tel: (01246) 558033 Relationship Therapy Online: www.bda-dyslexia.org.uk
Tel: (020) 7739 5902 E-mail: info@arc.org.uk
PO Box 13686
E-mail: action.smoking.health Online: www.arc.org.uk British Epilepsy Association
London SW20 9ZH
@dial.pipex.com New Anstey House
Online: www.ash.org.uk BackCare Tel: (020) 8543 2707
E-mail: info@basmt.org.uk Gate Way Drive
16 Elmtree Road, Teddington, Yeadon
Addiction Recovery Foundation Middlesex TW11 8ST Online: www.basmt.org.uk
Leeds LS19 7XY
122A Wilton Road Tel: (020) 8977 5474 British Brain and Spine
London SW1V 1JZ Helpline: 0808 800 5050
Online: www.backpain.org Foundation Tel: (0113) 210 8800
Tel: (020) 7233 5333 7 Winchester House E-mail: epilepsy@bea.org.uk
E-mail: acw@easynet.co.uk BBC Online Health and
Kennington Park Online: www.epilepsy.org.uk
Online: easyweb.easynet.co.uk/acw Fitness Cranmer Road
Online: www.bbc.co.uk/health London SW9 6EJ British Heart Foundation
Age Concern 14 Fitzhardinge Street
Helpline: 0808 808 1000
1268 London Road Breast Cancer Campaign London W1H 4DH
Tel: (020) 7793 5900
London SW16 4ER 29–33 Scrutton Street Online: www.bbsf.org.uk Heartline: 0990 200656
Tel: (020) 8765 7200 London EC2A 4HU Tel: (020) 7935 0185
E-mail: infodep@ace.org.uk Tel: (020) 7749 3700 British Chiropractic Online: www.bhf.org.uk
Online: www.ace.org.uk Online: www.bcc-uk.org Association
Blagrave House British Kidney Patient
Alcoholics Anonymous Breast Cancer Care 17 Blagrave Street Association (BKPA)
PO Box 1, Stonebow House 210 New Kings Road Reading Oakhanger Place
Stonebow, York YO1 7NJ London SW6 4NZ Berkshire RG1 1QB Bordon
Helpline: 0845 769 7555 Helpline: 0808 800 6000 Tel: (0118) 950 5950 Hampshire GU35 9JZ
Tel: (01904) 644026 Tel: (020) 7384 2984 E-mail: britchiro@aol.com Tel: (01420) 472021/2
Online: www.alcoholics- E-mail: bcc@breastcancercare.org.uk Online: www.chiropractic-uk.co.uk
anonymous.org.uk Online: www.breastcancercare. British Liver Trust
org.uk British Colostomy Ransomes Europark
Alzheimer’s Disease Society Association Ipswich
10 Greencoat Place Breastfeeding Network 15 Station Road Suffolk IP3 9QG
London SW1P 1PH PO Box 11126 Reading Helpline: 0808 800 1000
Helpline: 0845 300 0336 Paisley PA2 8YB Berkshire RG1 1LG Tel: (01473) 276326
Tel: (020) 7306 0606 Helpline: 0870 900 8787 Helpline: 0800 328 4257 E-mail: bsg@mailbox.ulcc.ac.uk
E-mail: info@alzheimers.org.uk E-mail: broadfoot@btinternet.com E-mail: sue@bcass.org.uk Online: www.britishlivertrust.
Online: www.alzheimers.org.uk Online: www.breastfeeding.co.uk Online: www.bcass.org.uk org.uk
311
USEFUL ADDRESSES
British Lung Foundation British Tinnitus Association Cystic Fibrosis Trust Healthnet
78 Hatton Garden 4th Floor, White Building 11 London Road, Bromley Heart care information
London EC1N 8LD Fitzalan Square Kent BR1 1BY Online: www.healthnet.org.uk
Tel: (020) 7831 5831 Sheffield S1 2AZ Helpline: 0800 454482
E-mail: Tel: 0800 018 0527 Tel: (020) 8464 7211 High Blood Pressure
blf@britishlungfoundation.com E-mail: enquiries@tinnitus.org.uk E-mail: enquiries@cftrust.org.uk Foundation
Online: www.lunguk.org Online: www.tinnitus.org.uk Online: www.cftrust.org.uk Department of Medical Sciences
Western General Hospital
British Medical CancerBACUP Dementia Web Edinburgh EH4 2XU
Acupuncture Society 3 Bath Place Online: dementia.ion.ucl.ac.uk Tel: (0131) 332 9211
12 Marbury House Rivington Street E-mail: hbpf@hbpf.org.uk
Higher Whitley, Warrington London EC2A 3JR Depression Alliance Online: www.hbpf.org.uk
Cheshire WA4 4QW 35 Westminster Bridge Road
Tel: (020) 7920 7206
Tel: (01925) 730727 E-mail: info@cancerbacup.org London SE1 7JB Imperial Cancer Research Fund
E-mail: Admin@medical- Online: www.cancerbacup.org.uk Tel: (020) 7633 0557 61 Lincoln’s Inn Fields
acupuncture.co.uk Online: www.depressionalliance.org London WC2A 3PX
Online: www.medical- Cancer and Leukaemia in Tel: (020) 7242 0200
acupuncture.co.uk Childhood (CLIC) Diabetes UK (British Diabetic
Online: www.icnet.uk
Abbey Wood Association)
British Medical Association 10 Queen Anne Street
Bristol BS34 7JU Impotence, Your Questions
BMA House London W1G 9LH
Tel: (0117) 311 2600 Answered
Tavistock Square
E-mail: clic@clic- Tel: (020) 7323 1531 Online: www.impotence-help.co.uk
London WC1H 9JP
charity.demon.co.uk E-mail: info@diabetes.org.uk
Tel: (0205) 7387 4499 Online: www.clic.uk.com Online: www.diabetes.org.uk International Glaucoma
E-mail: info.web@bma.org.uk Association
Online: www.bma.org.uk Careline Digestive Disorders
King’s College Hospital
Support for people caring for an Foundation Denmark Hill
British Osteopathic
elderly or disabled person 3 St Andrews Place London SE5 9RS
Association
Helpline: (020) 8514 1177 London NW1 4LB
Langham House East, Luton Tel: (020) 7737 3265
Bedfordshire LU1 2NA Tel: (020) 7486 0341 E-mail: info@iga.org.uk
Carers National Association E-mail: ddf@digestivedisorders. Online: www.iga.org.uk
Tel: (01582) 488455 20–25 Glasshouse Yard org.uk
E-mail: enquiries@osteopathy.org London EC1A 4JT Online: www.digestivedisorders. Interstitial Cystitis
Online: www.osteopathy.org org.uk
Helpline: 0808 808 7777 Support Group
British Pregnancy Tel: (020) 7490 8824 76 High Street, Stony Stratford
Disability Net
Advisory Service Online: www.carersuk.demon.co.uk Buckinghamshire MK11 1AH
E-mail: paul@disabilitynet.co.uk
Service for people wishing to prevent Online: www.disabilitynet.co.uk Tel: (01908) 569169
ChildLine E-mail: info@interstitialcystitis.co.uk
or end an unwanted pregnancy
Freepost 1111, London N1 0BR Online: www.interstitialcystitis.co.uk
Austy Manor, Wootton Warren Dyspraxia Foundation
Solihull Helpline: 0800 1111 8 West Alley, Hitchin
Online: www.childline.org.uk ISSUE, The National Fertility
West Midlands B95 6BX Hertfordshire SG5 1EG
Association
Helpline: 0845 730 4030 The Coeliac Society Helpline: (01462) 454986
114 Lichfield Street, Walsall
Tel: (01564) 793225 Online: www.emmbrook.demon.
PO Box 220 West Midlands WS1 1SZ
E-mail: comm@bpas.org co.uk/dysprax/homepage.htm
High Wycombe Tel: (01922) 722888
Online: www.bpas.demon.co.uk
Bucks HP11 2HY Eating Disorders Association E-mail: info@issue.co.uk
British Red Cross Society Tel: (01494) 437278 1st Floor, Wensum House Online: www.issue.co.uk
9 Grosvenor Crescent E-mail: admin@coeliac.co.uk 103 Prince of Wales Road
London SW1X 7EJ Online: www.coeliac.co.uk Norwich NR1 1DW
Juvenile Diabetes Foundation
25 Gosfield Street
Tel: (020) 7235 5454 Colon Cancer Concern Helpline: (01603) 621414
London W1P 8EB
Online: www.redcross.org.uk Youth helpline: (01603) 765050
9 Rickett Street, London SW6 1RU Tel: (020) 7436 3112
E-mail: info@edauk.com
British Snoring and Sleep Helpline: (020) 7381 4711 Online: www.edauk.com E-mail: info@jdf.org.uk
Apnoea Association Tel: (020) 7381 9711 Online: www.jdf.org.uk
1 Duncroft Close Online: www.coloncancer.org.uk Family Planning Association
Reigate, Surrey RH2 9DE (fpa) Leukaemia Research Fund
The Continence 2–12 Pentonville Road 43 Great Ormond Street
Tel: (01249) 701010 Foundation London N1 9FP London WC1N 3JJ
E-mail: helpline@britishsnoring.
307 Hatton Square Tel: (020) 7405 0101
co.uk Helpline: (020) 7837 4044
16 Baldwins Gardens E-mail: info@lrf.org.uk
Online: www.britishsnoring. Tel: (020) 7837 5432
demon.co.uk London EC1N 7RJ Online: dspace.dial.pipex.com/lrf-/
Online: www.fpa.org.uk
Tel: (020) 7404 6875
British Stammering E-mail: continence.foundation@ Gamblers Anonymous Macmillan Cancer Relief
Association dial.pipex.com PO Box 88 15–19 Britten Street
15 Old Ford Road Online: www.vois.org.uk/cf London SW10 0EU London SW3 3TZ
London E2 9PJ Tel: (020) 7384 3040 Helpline: 0845 601 6161
CRUSE Bereavement Care Tel: (020) 7351 7811
Helpline: 0845 603 2001 E-mail:
Tel: (020) 8983 1003 CRUSE House, 126 Sheen Road isomain@gamblersanonymous.org E-mail: information_line@
E-mail: mail@stammering.org Richmond, Surrey TW9 1UR Online: macmillan.org.uk
Online: www.stammering.org Tel: (020) 8940 4818 www.gamblersanonymous.org Online: www.macmillan.org.uk
312
USEFUL ADDRESSES
Medical Advisory Service National Association for Parkinson’s Disease Society St. Andrew’s Ambulance
for Travellers Abroad Premenstrual Syndrome 215 Vauxhall Bridge Road Association
Travellers’ Health Line: 7 Swift’s Court, High Street London SW1V 1EJ St. Andrew’s House
(0906) 822 4100 Seal, Kent TN15 0EG Helpline: 0808 800 0303 48 Milton Street
Online: www.masta.org Tel: (01732) 760011 Tel: (020) 7931 8080 Glasgow G4 0HR
Online: www.pms.org.uk E-mail: info@parkinsons.org.uk Tel: (0141) 332 4031
Medic Alert Foundation Online: www.parkinsons.org.uk Online: www.firstaid.org.uk
For people with hidden medical National Asthma Campaign
conditions, provides tags carrying Providence House Patient UK St. John Ambulance
information in case of emergencies Providence Place, London N1 0NT Directory of websites providing 1 Grosvenor Crescent
Helpline: 0845 701 0203 information on health issues London SW1X 7EF
1 Bridge Wharf
156 Caledonian Road Tel: (020) 7226 2260 E-mail: info@patient.co.uk Tel: (020) 7235 5231
London N1 9UU Online: www.asthma.org.uk Online: www.patient.co.uk Online: www.sja.org.uk
Tel: (020) 7833 3034 Prostate Cancer Charity
National Childbirth Trust The Samaritans
Online: www.medicalert.co.uk
Alexandra House, Oldham Terrace Du Cane Road 10 The Grove
London W3 6NH London W12 0NN Slough, Berkshire SL1 1QP
MENCAP
123 Golden Lane Tel: (020) 8992 8637 Helpline: (020) 8383 1948 Helpline: 08457 909090
Online: www.nct-online.org Tel: (020) 8383 8124 Tel: (01753) 216500
London EC1Y 0RT
E-mail: info@prostate-cancer.org.uk E-mail: jo@samaritans.org
Tel: (020) 7454 0454 National Drugs Helpline Online: www.prostate-cancer.org.uk Online: www.samaritans.org.uk
Online: www.mencap.org.uk Tel: 0800 776600
Psoriasis Association SANDS: Stillbirth and
Mental Health Foundation National Eczema Society 7 Milton Street Neonatal Death Society
UK Office, 20/21 Cornwall Terrace 163 Eversholt Street Northampton NN2 7JG 28 Portland Place
London NW1 4QL London NW1 1BU Tel: (01604) 711129 London W1N 4DE
Tel: (020) 7535 7400 Helpline: 0870 241 3604 Helpline: (020) 7436 5881
E-mail: mhf@mhf.org.uk Tel: (020) 7388 4097 Quit Tel: (020) 7436 7940
Online: www.mentalhealth.org.uk Online: www.eczema.org Charity helping people stop smoking E-mail: support@uk-sands.org
Victory House Online: www.uk-sands.org
Migraine Action Association National Endometriosis Society 170 Tottenham Court Road
178a High Road, Byfleet 50 Westminster Palace Gardens London W1P 0HA Self Help UK
Surrey KT14 7ED Artillery Row, London SW1P 1RL Database of self-help organizations
Helpline: 0800 002200
Tel: (01932) 352468 Helpline: (020) 7222 2776 Tel: (020) 7388 5775 Online: www.self-help.org.uk
E-mail: info@migraine.org.uk Online: www.endo.org.uk Online: www.healthnet.org.uk/quit
Online: www.migraine.org.uk Stress UK
National Osteoporosis RELATE Online: www.stress.org.uk
MIND Society Provides support for people who
Provides support and information PO Box 10, Radstock wish to improve their relationships The Stroke Association
concerning mental health problems Bath BA3 3YB 123 Whitecross Street
Herbert Gray College
15–19 Broadway Helpline: (01761) 472721 Little Church Street London EC1Y 8JJ
London E15 4BQ Tel: (01761) 471771 Rugby, Warwickshire CV21 3AP Helpline: 0845 3033100
Helplines: (020) 8522 1728 E-mail: info@nos.org.uk Tel: (01788) 573241 Tel: (020) 7566 0300
(Greater London only); Online: www.nos.org.uk Online: www.relate.org.uk Online: www.stroke.org.uk
08457 660163 (outside London)
Online: www.mind.org.uk NHS Direct Royal National Institute for Terrence Higgins Trust
Helpline for health problems and the Blind Provides support and information
Miscarriage Association provides links to other sites 224 Great Portland Street for people with HIV and AIDS
Clayton Hospital, Northgate Helpline: 0845 4647 London W1N 6AA 52–54 Grays Inn Road
Wakefield Online: www.nhsdirect.nhs.uk Helpline: 0845 766 9999 London WC1X 8JU
West Yorkshire WF1 3JS Tel: (020) 7388 1266 Helpline: (020) 7242 1010
Helpline: (01924) 200799
NSPCC Textphone: 0800 515152 Tel: (020) 7831 0330
Tel: (01924) 200795 42 Curtain Road Online: www.rnib.org.uk E-mail: info@tht.org.uk
Online: www.the-ma.org.uk London EC2A 3NH Online: www.tht.org.uk
Helpline: 0808 800 5000 Royal National Institute for
Multiple Sclerosis Society Textphone: 0800 056 0566 Deaf People UK Homoeopathic Medical
The MS National Centre Tel: (020) 7825 2500 19 Featherstone Street Association
372 Edgware Road E-mail: help@nspcc.org.uk London EC1Y 8SL 6 Livingstone Road, Gravesend
London NW2 6ND Online: www.nspcc.org.uk Helpline: 0808 808 0123 Kent DA12 5DZ
Helpline: 0808 800 8000 Tel: (020) 7296 8000 Tel: (01474) 560336
Pain Relief Foundation Textphone: 0808 808 9000
Tel: (020) 8438 0700 E-mail: info@the-hma.org
Online: www.mssociety.org.uk Rice Lane, Walton E-mail: helpline@rnid.org.uk Online: www.homoeopathy.org
Liverpool L9 1AE Online: www.rnid.org.uk
National Association for Helpline: 0800 665544 Women’s Nationwide Cancer
Colitis and Crohn’s Disease Online: www.liv.ac.uk/pri RSI Association Control Campaign
4 Beaumont House, Sutton Road Provides support for people with 128–130 Curtain Road
St Albans, Herts AL1 5HH Parentline repetitive strain injury London EC2A 3AQ
Tel: (01727) 844296 Provides support and information 380–384 Harrow Road Tel: (020) 7729 4688
E-mail: nacc@nacc.org.uk on parenting issues London W9 2HU E-mail: info@wnccc.org.uk
Online: www.nacc.org.uk Helpline: (01702) 559900 Helpline: 0800 018 5012 Online: www.wnccc.org. uk
313
INDEX
INDEX
This index gives entries for the major symptoms covered entire symptom chart. Page numbers that appear in
in the book as well entries for many of the diseases and italics indicate a reference to an illustration. For detailed
disorders that may be the cause of symptoms. There are advice on how to use the 150 charts, see pp.44–45. In
also entries for drug groups, parts of human anatomy, addition to this index, the chartfinders on pp.46–48
and issues covered in the first part of the book. However, (the system-by-system chartfinder and the symptom-by-
as with any index, it cannot be comprehensive. Page symptom chartfinder) can also be used to help find
numbers that appear in bold indicate a reference to an the particular charts you need.
314
INDEX
Blood oxygen 201, 201 Bronchodilators 307 back problems 134–135 with earache 193 and vaginal discharge
Blood pressure 36, 36 Bronchoscopy 199, 199 behaviour problems and hearing problems 267
Blood tests 38 Bulimia nervosa 139 94–95 190 and vomiting 210
Boils Bunions 237 breathing problems with sore throat 195 Coordination 92
and adults, ears 193 Burns, first aid for 299, 299 110–111 in babies 54 Corns 237
and children 85 Burping babies 52 child car seats 34, 34 in children 106, 106 Corticosteroids 308
ears 102 choking, first aid 294, with abdominal pain for facial use 180
Bone densitometry 239, 294 295, 295 121 Cot death (SIDS) 51, 51
239 C clumsiness 92 with coughing 108, Cough remedies 308
Bones 10, 10 constipation 123, 124 109 Coughing
broken see Fractures Caffeine 204 coughing 108–109 with ear problems 102 in adults 198–199
in children 133 and sleep problems 152 cardiopulmonary with sore throat 107 with blood 155, 198
and back pain 135 and trembling 166 resuscitation (CPR) remedies 308 with fever 154
and exercise 29 Calcium channel blockers 297, 297 Cold compresses 135, 135 with sore throat 195
growth 24, 24 307 diarrhoea 122–123 Cold, feeling the 147 with sweating 156
in menopause 21, 21 Calluses 237 drowsiness 90–91 Cold sores 180 with wheezing 197
Bottle-feeding 286 Cancer ear pain 102–103 in children 112 in babies 108
of breast-fed baby 60 breast see Breast cancer eating problems 116–117 first infection 113 when feeding 61
and feeding problems 61 cervical see Cervical eye problems 98–99 Colic 52, 53 with vomiting 57
and gastroenteritis 56 cancer faeces, abnormal-looking Colitis see Ulcerative colitis in children 108–109
making-up feeds 50 colon see Colon cancer 125 Collapsed lung 202 with abdominal pain
and weight gain 74 colorectal 36 faintness 86–87 Colon cancer 36, 149 121
slow 62–63 lung see Lung cancer febrile convulsions 55 and constipation 221 barking cough 110
Bowel control 128 lymph nodes 155 feeling unwell 66–67 and diarrhoea 220 with runny nose 78
and back injuries 134 lymphatic system 174 fever 76–77 Colonoscopy 222 and sleep problems 71
Boys oesophagus 209 foot problems 136–137 Colposcopy 265, 265 Cradle cap 65
genital problems screening for 36 genital problems Complementary therapies Cramp 233
130–131 skin see Skin cancer in boys 130–131 35 in children 133
growth charts for and smoking 31, 31 in girls 132 Conception 21 Crohn’s disease 217
26–27 testes 248 growth 24–27, 24 assisted 275, 275 in children 122
puberty 19, 19, 142 Cardiopulmonary charts 26–27 maximizing chance of and joint problems 229
Brain 14, 14 resuscitation (CPR) problems 72–73 252 Croup 76, 110
development 24, 24 290, 291 hair problems 82–83 Condoms 254, 277 Crying, babies 52–53
and exercise 29 adults 296, 296 headaches 88–89 and genital irritation 268 CT scanning 40, 40
Breast cancer 256–257 children 297, 297 healthy eating 75, 117 Confidentiality 140 Curvature of the spine 135
in males 142 Cardiovascular system 12, hearing problems Confusion Cycling safety 34, 34
screening for 36, 39 12 104–105 in adults 164–165 Cystic fibrosis 73
Breast lumps 256–257 and exercise 29 immunization 37, 37 with fever 154 in babies 59
in breast-feeding 287 and smoking 31, 31 itching 84 in children 90–91 in children 123
Breast problems 256–257 Carpal tunnel syndrome 163 joint problems 134–135 Congestion, relieving 106 and growth problems 72
and pregnancy 286–287 with arm pain 231 limping 138 Conjunctivitis 187 at puberty 142, 143
Breast-feeding 286–287 Cataracts 189 lumps and swellings 85 in children 98 Cystitis 155
and absence of periods Cells 13, 13 mouth problems 112–113 cleaning eyes 99, 99 and painful urination 226
260 tests on 38, 38 nail problems 82–83 and vision problems see also Urinary tract
and diarrhoea in babies Central nervous system 14, nose, runny 106–107 100 infections
58 14 rashes 78–79 Consciousness, loss of Cystoscopy 224, 224
feeding problems 60–61 Cerebral palsy 93 and safety 33 in adults 160–161
HIV transmission in 148 Cervical cancer 265, 265 in the sun 34, 34 and seizure 166
and weight gain (baby’s) screening for 36, 264, school difficulties 96–97 in children 86 D
74 264 seizures 86–87 with drugs or alcohol
slow 62–63 and smoking 31 skill acquisition 25, 25 91 Dandruff 177
and weight (mother’s) Cervical spondylosis 162 sleeping problems 70–71 see also Faintness in children 83
279 and faintness 161 sore throat 107 Constipation eyelid problems 187
Breasts 21, 21 Chest infections speech difficulties 93 in adults 221 Deep vein thrombosis 235
development in males 142 in adults 200 teeth problems 114–115 and bladder control and contraception 277
in puberty 143 with chest pain 202 tiredness 68–69 243 in pregnancy 283
Breath-holding attacks 86, in children 76 toilet training 128–129 with vomiting 213 Dehydration
87 with fever 111 urinary problems with weight loss 149 in adults, preventing 211
as parent manipulation Chest pain 202–203 126–127 in children 123, 124 in babies 59
95 with palpitations 204 vision problems 100–101 and soiling 128 due to diarrhoea 55, 58
Breathing 13, 13 with swallowing vomiting 118–119 in pregnancy 281 due to vomiting 56
Breathing problems problems 209 weight gain 74–75 Contact lenses 187, 187 in children 123
in babies 110 Chickenpox 79 Chlamydia 267 irritation with 186 with confusion 91
with fever 54 in adults 184 Chloasma 182, 282 Contraception 277, 277 with constipation 124
in children 110–111 in children 78 Choking 294–295, 294–295 condoms 254 encouraging drinking
asthma 111 Childbirth 285 Chronic fatigue syndrome and confidentiality 140 67
with fever 76 depression after 288 68 emergency 276 treating 118
with mouth swelling painful intercourse 270 Chronic secretory otitis for men 254 Dementia 165
112 periods after 260 media 105, 105 for women 276–277 Dental floss 207, 207
noisy and rapid heavy 262 Circulation 12, 12 see also Contraceptive Depression
breathing 108 and sex drive 272 before and after birth pill; Intrauterine in adolescents 141
see also Shortness of shortness of breath 200 23, 23 devices with suicide threats
breath with chest pain 202 Circumcision 130 Contraceptive pill 277, 277 140
Breathing rate, checking stress incontinence 259 in boys 131 and fertility problems in adults 169, 170–171
110 Children in men 244 274 after childbirth 288
Bronchiolitis 110 abdominal pain 120–121 Clumsiness 92 and heavy periods 262 with confusion 165
with vomiting 57 adolescents see Coeliac disease 72 and irregular bleeding and sex drive 250, 272
Bronchitis 154 Adolescents with diarrhoea 123 265 and sleep problems 152
with chest pain 202 arm and leg pain 133 Cold, common and missed periods 261 and tiredness 147
with coughing 199 babies see Babies in adults 194 and painful periods 263 with weight loss 149
315
INDEX
316
INDEX
Glaucoma 189
with eye pain 186
and speech problems
93
In vitro fertilization (IVF)
275, 275
J Lung disorders
adults 201
screening for 36, 188 see also Ears Incontinence see Bladder Jaundice 212 with confusion 165
with vomiting 210 Hearing tests 39 control problems in children 119 children 108
Glue ear 105, 105 for adults 190, 190 Indigestion 217 and itching 175 collapsed lung 202
Golfers’ elbow 231 for children 105, 105 with abdominal pain 216 Joints 10, 10 and smoking 31, 31
Gonorrhoea 245, 267 Heart 12, 12 with chest pain 203 in children 134–135 Lungs 13, 13
Gout 237 around birth 23, 23 with wind 219 and exercise 29 and exercise 29
with joint pain 228 tests on see Infants see Babies and facial pain 167 tests on 39
in knees 234 Electrocardiography Infectious mononucleosis painful 228–229 Lyme disease 178
Groin swellings Heart disorders 202 see Glandular fever replacing 229, 229 Lymph nodes 17, 17
in adults 174 with confusion 165 Infertility see fertility and shoulder pain 230 cancer 155
with sore throat 195 with faintness 161 problems see also Hips; Knees swellings of 85
in children 85 and palpitations 205 Ingrowing toenails 236, Lymph vessels 17, 17
abdominal pain 120 with shortness of breath 236 Lymphatic system 17, 17
Growing pains 133 200 in children 137 K cancer of 174
Growth charts 26, 26–27 and swollen ankles 201 Insulin in diabetes 149
Growth problems 72–73 with wheezing 197 Intestinal disorders Kawasaki disease 79
Growth spurt 142 Heartbeat 204–205 in adults, blockage of Kidney disorders M
and weight changes 75, Heat rash in newborns 65 intestine 213 in adults 214
139 Heatstroke in children 91 in children 125 and blood in urine Magnetic resonance
Gum problems 207, 207 Heavy periods 262 and eating problems 224 imaging (MRI) 41, 41
in children 114, 114 Height 117 in children Mammography 257, 257
bleeding gums 112 growth charts for 27 obstruction 120 kidney damage 126 Manual dexterity 25, 25
and teething 115 growth problems 73 see also individual and weight gain 74 Mastitis 287
Gynaecomastia 142 Hepatitis 31, 37 intestinal disorders pyelonephritis see and breast tenderness 256
in children 119 Intestines 16, 16 Pyelonephritis Measles 37, 79
Hernia 215, 215 Intrauterine devices 277, Kidneys 18, 18 in babies 54
H in adults, and groin 277 Knee, painful 234 in children 78
lumps 174 as emergency Knee, endoscopy of 42, 42 Medical tests 38–42
Haemorrhoids 223 in children 120 contraception 276 Medicines see Drugs
and blood in faeces 222 and greenish-yellow periods with 262 (medicinal)
Hair 176, 176 vomit 118 irregular bleeding 265 L Men
adults 176–177 and groin swellings 85 missed 261 bladder control problems
children 82–83 and scrotum swellings painful 263 Labour, onset of 285 242–243
newborn babies 23, 23 130 Intrauterine insemination Labyrinthitis 162 contraception choices
in puberty 142, 143 Herpes see Cold sores; (IUI) 275 in children 87 254
thinning, with tiredness Genital herpes Intravenous urography Lactose intolerance 122 ejaculation problems 247
147 Hips 227 in adults 219 erection difficulties 247
Hand, foot, and mouth in children 138 Intussusception 121, 121 in babies 59 fertility problems
disease 78, 79 and intoeing 137 in babies 57 in children 123 252–253
Hands replacement 229, 229 in children 118 with abdominal pain penis problems 244–245
adults HIV and AIDS 148 with abdominal pain 121 reproductive system 19,
and sweating 157 and drug abuse 31 120 Language development 25, 19
trembling 148 in men 245 with abnormal faeces 25 urethra in 18, 18
with sweating 156 and safe sex 32 125 Laparoscopy 269, 269 sex drive 250–251
blisters on 78, 79 with weight loss 149 Iritis Laryngitis 196 sex, pain during 249
carpal tunnel syndrome and fever 155 with blurred vision 187 Laxatives 309 testes and scrotum
163 in women 267 in children 98, 100 and children 124 problems 248
Hay fever 190 Hives 179 with eye pain 186 Learning difficulties 96 Ménière’s disease 162
in children 106 in children 80 Iron, lack of 69 Legs with hearing problems
with runny nose 194 in newborns 65 see also Anaemia fractures, first aid for 190
Head injuries Hoarseness 196 Irritable bowel syndrome 300, 300 with tinnitus 192
in adults 158 Home safety 33, 33 216 pain in 232–233 Meningitis
with altered vision Homosexuality 251 with abdominal pain 217 children 133 in adults 184
188 Hormone replacement with wind 219 Let-down reflex 60 in babies 56
with confusion 164 therapy 261, 310 Itching Lice see Head lice; Pubic in children 78
in children 86 Hospital care, obtaining in adults 175 lice danger signs 78
with confusion 90 35 abnormal-looking skin Lifting objects 238, 238 glass test for rash 79, 79
with eye injuries 100 Hot flushes 156 179 Limping in children 138 immunization 37
with headache 88 HRT 261, 310 anal area 223 Lipid-lowering drugs 309 Menopause 21, 261
Head lice 83, 83 Hyperemesis 278 eyelids 187 Liver 16, 16 and depression 171
in adults 177 Hyperthyroidism 172 feet 237 tissue tests on 38, 38 and genital irritation 268
Headaches Hypoglycaemia 86 genital area 227 Liver diseases and heavy periods 262
in adults 158–159 Hypothalamus 17, 17 women 268 and fertility problems and hot flushes 156
with fever 154 Hypothyroidism 196 itchy rash 184 252 and irregular bleeding
in children 88–89 Hysteroscopy 265, 265 in pregnancy 282 hepatitis see Hepatitis 264
and clumsiness 92 scalp 177 Longsightedness 101 Menorrhagia 262
see also Migraine in children 84 Loss of voice 196 Menstrual cycle 20, 20
Health checks 36, 36 I and allergic reactions Lumps and vaginal discharge
Healthcare 35–37 80 in adults 174 267
Hearing 15, 25 Illness, sex after 250, 273 between the toes 136 eyelid 187 see also Periods;
Hearing aids 191 Imaging tests 39–42 genital area 132 groin 174 Premenstrual syndrome
Hearing loss Immunization 37, 37 and insect bites 80 penis 245 Mental health 169
with dizziness 162 fever following 55 scalp 83 with sore throat adolescents 140
noise-induced 191 Immunosuppressant drugs and sleep problems 71 195 and exercise 29
Hearing problems 190–191 308 IUD see Intrauterine devices breast see Breast lumps see also Anxiety;
in children 104–105 Impetigo 81 IUI 275 in children 85 Depression; Stress
and school problems near the mouth 112 IVF see In vitro Lung cancer 155 Metabolic rate 150, 150
97 Impotence 246 fertilization and smoking 31, 31 and weight gain 151
317
INDEX
318
INDEX
Scarlet fever 79 Sickness see Vomiting Speech difficulties Styes 187 Thirst 148
in adults 184 Side effects, drug 31, 304 in adults 168 in children 99 in babies 52
in children 78, 107 SIDS (Sudden infant death with faintness 161 Sudden infant death Thoughts, disturbing 169
School difficulties 96–97 syndrome) 51, 51 in children 93 syndrome (SIDS) 51, 51 Threadworms 223
and constipation 124 Sight see Eyes; Vision Speech therapy 93 Sugar in diet 28, 28 in children 84
and feeling unwell 67 Sinusitis adults 168 babies 58 girls 132
and sleep problems 70 in adults 194 and laryngitis 196 children 117 Throat see Sore throat
Sciatica 233 and facial pain 167 and learning difficulties see also Lactose Thrombolytic drugs 310
in pregnancy 284 with headache 159 96 intolerance Thrombophlebitis 232
Screening 36, 36 in children 89 Sperm 19, 19 Suicide 170 Thrombosis see Deep vein
Scrotum 19, 19 with jaw pain 115 Spinal cord 14, 14 in adolescence 140 thrombosis
boys 120, 130 Skeleton 10, 10 damage to 238 Sun protection 34, 34, Thrush
men 248 Skin, newborn babies 23, and neck pain 240 182 genital 126
Seasonal allergic rhinitis see 23 Spinal injuries Swallowing 16, 16 in babies 65
Hay fever Skin cancer 183, 183 first aid for 300, 300 difficulties 209 in girls 132
Seborrhoeic dermatitis signs of 178 and recovery position children 110 oral 208
in adults 180 and the sun 34, 182 292 Sweat glands 157, 157 in children 113
in babies 64 Skin problems Spinal nerves 14, 14 Sweating 156–157 vaginal 266
cradle cap 65 in adolescents 144 Spine 10, 10 with trembling 166 and painful intercourse
in children 81 in adults 178–179 arthritis in 135 with weight loss 148 271
and ear inflammation facial skin 180–181 slipped disc 238 Swellings Thymus gland 17, 17
103 hard skin on feet 237 Spleen 17, 17 in adults 174 Thyroid drugs 305
dandruff see Dandruff skin discoloration and Spots 180–181 groin 215 Thyroid gland 17, 17
Seborrhoeic warts 182 moles 182–183 birthmarks 64 testes 248 overactive 172
Seizures 160 sore or inflamed skin see also Acne; Rashes in children 85, 107 underactive 221
adults 166 on penis 245 Sprains and strains 229, 229 groin or scrotum 120, Tingling 163
babies 55 in babies 64–65 arms 231 130 Tinnitus 192
children 86–87 in children 80–81 in children 133, 134 joints 134 Tiredness
and epilepsy 91 genital area 126 feet 136 mouth or tongue 112 in adults 147
first aid for 300, 300 dry skin see Dry skin treating 135 Swollen abdomen 218 and sex drive 250
see also Epilepsy in pregnancy 282 feet 236 Swollen ankles 235 in children 68–69
Semen 253 see also Itching; Rashes with joint pain 228 and abdominal swelling Tissue, tests on 38, 38
blood in 247 Skull 24, 24 knees 234 218 Toes
Senses 15 Sleep problems legs 232 and heart failure 201 and athlete’s foot 136
Sensitive teeth 206 in adults 152–153 following exercise 233 in pregnancy 283 bent toes 137
in children 115 and headaches 159 shoulders 230 Syphilis 245, 267 and gout 237
Sex drive, low in babies 50–51 Squeeze technique 247 nail problems 83
in men 250–251 in children 70–71 Squints 101 see also Ingrowing
in women 272–273 and tiredness 69 in children 100 T toenails
Sex hormone preparations Sleeping drugs 310 Stair gates 33, 33 Toilet training 128–129
310 and sleep problems 152 Sterilization 276, 276 Taste 15, 15 Tonsillitis 107
Sexual intercourse 32 withdrawal from 172 Stings see Bites and stings Teeth problems 206–207 with abdominal pain 121
adolescents 141 Sleepwalking 70 Stomach 16, 16 in children 114–115 and neck swellings 85
after illness 250 Slipped disc 238 and alcohol 30, 30 grinding teeth 167 with sore throat 77
anxiety related to 173 Small intestine 16, 16 Stomach ulcers 212 see also Mouth problems Tonsils 107, 107
HIV transmission in 148 Smell 15, 15 with abdominal pain 216 Teething 115, 115 and sleep problems 69
men, pain during 249 Smoking 31, 31 and dark faeces 222 in adults 207 Torsion of the testis 131
and pain during adults Stomatitis 208 in children 112 in boys 120, 130
urination 226 and anxiety 172 Strains see Sprains and Temperature in men 215
women with coughing 199 strains of babies’ rooms 51 Torticollis 240
bleeding after 265 and discoloured teeth Stress 32 extremes of, and teeth Touch 15, 15
pain during 270–271 207 in adults 115 Tranquillizers
with painful periods and fertility problems and absent periods 260 measurement 154, 154 and trembling 166
263 253 and anxiety 172 babies 54 withdrawal from 172
Sexual orientation 251 and palpitations 204 and babies’ crying 52 children 76, 76 Transient ischaemic attack
Sexually transmitted and voice problems and depression 170 see also Fever 161
infections 32 196 with faintness 161 Temporal arteritis 159 Transplanting hair 177,
anal warts 223 and weight gain 150 and headaches 159 and facial pain 167 177
hospital clinics for 35 with wheezing 197 and mouth ulcers 208 Tendinitis 228 Travel immunization 37
in men 245 children 109 and palpitations 205 with arm pain 231 Travel sickness 119
fertility problems social behaviour 25, and sex drive 250, 272 and shoulder pain 230 in babies 57
252, 253 25 and shortness of Tennis elbow 231 Trembling 166
in women 267 Sore throat breath 200 Testes 19, 19 Trigeminal neuralgia 167
pelvic inflammatory in adults 195 and sleep problems 152 production of hormones Tuberculosis 155
disease 263 with hearing problems and sweating 157 17, 17 with coughing 199
see also HIV and AIDS 190 and urinary problems in puberty 142 Twitching 166
Shingles 167 with rash 184 225 Testes problems 248 Tympanometry 105, 190,
and blisters 178 and swallowing and weight gain 150 cancer of testes 248, 248 190
facial 180 problems 209 in children damage to testes 142
one-sided rash 184 in children 107 and abdominal pain failure of testes to
with chest pain 203
Shock, first aid for 298,
with abdominal pain
121
121
and vomiting 119
descend 131
torsion of testis 131, 215
U
298 with ear problems 102 and weight gain 75 in boys 120, 130 Ulcerative colitis
Shortness of breath 200–201 with fever 77 recognizing 173 Tests, medical 38–42 in adults 217
with palpitations 205 with rash 78 at work 34 Therapy 171, 171 and blood in faeces
and chest pain 204 and refusal to drink 67 Stretch marks 282 Thermometers 76, 76 222
with wheezing 197 see also Mouth problems; Stretches 29, 29 for babies 54 and joint problems
Shortsightedness 101 Pharyngitis; Tonsillitis Stroke 161 Thinning hair 176–177 229
and headaches 89 SPECT scanning 42, 42 and bladder control 259 with tiredness 147 in children 122
Shoulder pain 230 Speech development 93 Stuttering 93 see also Bald patches Ulcer-healing drugs 310
319
INDEX & ACKNOWLEDGMENTS
Ulcers Urine tests 38, 38 Vision 15, 25 Weaning 63 and eating disorders 139
genital area 227 Urodynamic studies 258, Vision, disturbed or and diarrhoea 59 fertility problems
mouth 113, 208 258 impaired and frequent feeding 60 274–275
skin 181 Urography, intravenous in adults 188–189 reluctance over 61 genital irritation 268
refusal to heal 178 227 with discharge 187 Weight charts 29 reproductive system 20,
stomach see Stomach Urticaria see Hives with faintness 161 children 26–27 20
ulcers Uterus 20, 20 in children 100–101 Weight gain urethra in 18, 18
Ultrasound scanning 41, 41 cancer 265 and headache 89 adolescents 139 sex drive 272–273
abdominal 217, 217 in pregnancy 22, 22 and school problems adults 149 sex, pain during 270–271
Doppler 235, 235 see also Endometriosis 97 with tiredness 147 vaginal bleeding
in pregnancy 280, 280 see also Eyes babies 62–63 264–265
Underactive thyroid glands Vision tests 39, 39 and feeding problems vaginal discharge
and constipation 221 V adults 189, 189 60 266–267
and voice problems 196 children 101, 101 children 74–75 see also Childbirth;
Underweight adolescents Vaccinations see Vitamins 28 in pregnancy 279 Menopause; Periods;
139 Immunization Vitiligo 183 Weight loss Pregnancy
and puberty 143 Vaginal bleeding 264–265 Voice, loss of 196 in adolescents 139 Work, safety at 34, 34
Underweight adults 149 in pregnancy 280 in puberty 142 in adults 148–149 Worms see Ringworm;
and absent periods 261 see also Periods Vomiting and absent periods Threadworms
and fertility problems 275 Vaginal discharge 266–267 in adults 210–211 260
Unwell, feeling with fever 155 with dizziness 162 how to lose weight
adults 146 and painful periods 263 with faintness 161 151 X
children 66–67 Vaginal thrush 266 recurrent 212–213 with swallowing
Urethra 18, 18 painful intercourse 271 in babies 56–57 problems 209 X-rays 39, 39
narrowing, in men 242 Vaginismus 271 after feeds 52, 61 with trembling 166 see also Angiography
Urinary problems 224–225 Varicose veins 233, 233 in children 118–119 with vomiting 213
in children 126–127 and swollen ankles 235 with abdominal pain in children 116, 117
see also Bladder control in pregnancy 283 120 in newborn babies 63
problems Vasectomy 254, 254 and clumsiness 92 Wheezing 197
Urinary system 18, 18 Veins 12, 12 following head injury in children 110
Urinary tract infections 66 see also Deep vein 88 with asthma 111
in adults 226 thrombosis; with sore throat 107 Whooping cough (pertussis)
in children 126 Thrombophlebitis; in pregnancy 278 109
with bedwetting 129 Varicose veins see also Nausea in babies 57
investigating 127 Verrucas 81 in children 118
in pregnancy 281 and foot pain 136 Wind 219
self-help 226
Urination
Vertebrae 10, 10
slipped disc 238
W in babies 52
Women
inability, in women 258 Violent behaviour Warts abdominal pain, lower
increased 148 in adolescents 141 anal 223 269
painful 226–227 in children 95 in children 81 bladder control problems
with fever 155 Viral infections 68 genital 245, 267 258–259
Urine 18, 18 depression following 170 seborrhoeic 182 breast problems 256–257
appearance of 225, 225 with rashes 79 Waters breaking 285 contraception 276–277
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