Babies A to Z

PAEDOPHILIA

Paedophilia is a psychiatric disturbance that results in the sexual abuse of a child by adult men (most commonly) or women. It may develop from childhood abuse of the paedophile by his or her parents, or other psychological traumas as a child. Paedophilia is NOT more common in homosexuals, but pederasty is by definition a homosexual act between a man and a boy.

The condition involves mentally disturbed adults who use children to become sexually aroused to the point of orgasm. Sexual contact varies from feeling, to oral sex, or sexual penetration that may progress to serious injury or rarely murder. Paedophiles have difficulty in establishing normal intimate relationships with adults of the opposite sex, have inadequate personalities, low self esteem, and male paedophiles are often impotent.

Treatment involves prolonged counselling by a psychiatrist and sometimes medications to reduce sexual desire and increase control. If discovered, paedophiles are invariably charged in the courts, but courts are more likely to treat leniently a person who comes forward voluntarily and seeks help. Unfortunately the long-term success of treatment is very poor.

See also CHILD ABUSE

PARAPERTUSSIS

Parapertussis is a bacterial infection of the nose, throat and lungs that resembles, but is far milder than, pertussis (whooping cough). It is caused by the bacteria Bordetella parapertussis, and the symptoms include fever, cough and a sore throat. It is treated in the same way as whooping cough.

See also WHOOPING COUGH

PERTUSSIS

See WHOOPING COUGH

PHARYNGITIS

Pharyngitis is a very common bacterial or viral infection of the throat (pharynx). The vast majority of cases are caused by viruses, while a minority are due to bacteria. The most serious bacterial pharyngitis is caused by Staphylococcus aureus (golden staph), but by the most common is caused by Streptococci. The infection is passed from one person to another in tiny water droplets in the breath, and most cases occur in winter.

The symptoms may vary from one day of mild discomfort to a severe infection that may cause dramatic swelling of the throat for more than a week. The patient may have a fever, throat pain and soreness, pain on swallowing, dry cough, headache and sometimes enlarged lymph nodes in the neck. Severe bacterial infections may rarely cause a throat abscess.

Most cases require no investigation, but if the infection is serious, a throat swab may be taken to identify the responsible bacteria and appropriate antibiotic. Blood tests may be performed if diseases such as glandular fever, which also cause throat pain, are suspected.

The treatment of a viral pharyngitis is aspirin, paracetamol or ibuprofen; anaesthetic gargles, and soothing lozenges. Bacterial pharyngitis is treated with antibiotics such as penicillin as well as the medications for a viral infection.

Viral infections last for a week or ten days, while antibiotics will cure a bacterial infection in a day or two.

See also COLD, COMMON; LARYNGITIS; TONSILLITIS

PNEUMONIA

Pneumonia is a bacterial, or rarely fungal, infection of the lung alveoli (tiny air bubbles that form the major part of the lung and enable the oxygen to cross into the bloodstream), which fill with pus. Usually only one part of the lungs, often at the bottom of the chest, is affected, but it may spread to other parts of the lung. Once one type of bacteria is present, a second type may also infect the lungs as well to cause double pneumonia. Almost invariably the bronchi (main air tubes) are also infected, so the disease should correctly be called bronchopneumonia.

The infection starts when bacteria are inhaled into the lungs, and overcome the body's defence mechanisms, particularly if the patient is tired, run-down, overworked, elderly, bedridden or suffering from other illnesses. Aspiration pneumonia occurs if phlegm, vomit or other material is inhaled into the lungs.

The symptoms of pneumonia may be obvious with fever, productive cough and chest pains, but some infections are more insidious and cause minimal symptoms for some months while the patient feels tired, short of breath and has intermittent sweats.

Chest X-rays are diagnostic, and are repeated at regular intervals to ensure that the infection is resolving. A sample of sputum is taken before treatment is started, and is sent to a laboratory to identify the infecting bacteria.

There are many different types of pneumonia, defined by the different bacteria responsible for the infection. These include Streptococcus pneumoniae (also known as pneumococcal pneumonia), Streptococcus pyogenes, Mycoplasma pneumoniae (the usual cause of atypical pneumonia), Staphylococcus aureus, Klebsiella pneumoniae (Friedlander’s pneumonia), Pseudomonas aeruginosa and Haemophilus influenzae. Rarer forms of pneumonia may be caused by Legionella pneumophilia (Legionnaire’s disease), Bacillus anthracis (anthrax) and Bacteroides.

One or more antibiotics are given by tablet, injection or drip into a vein to treat the infection. Expectorants to open up the airways and loosen the phlegm are also prescribed, along with cough mixtures and painkillers. Regular physiotherapy is very important to drain phlegm and pus out of the chest, while rest and the cessation of smoking are vital. Occasionally oxygen is required for seriously ill patients, and in rare cases, surgery to drain out collections of pus or remove areas of chronically infected lung is required. Some forms of pneumonia can be prevented by a vaccine (Pneumovax).

Inadequately treated pneumonia can cause chronic ill health, an abscess may form in the lung and lead to permanent lung damage. Once the lung is damaged, the chances of developing a subsequent attack of pneumonia is increased, and passive smoking will accelerate this process.

With correct treatment the majority of patients recover in a couple of weeks. Up to half of all patients affected died before the advent of modern antibiotics in the 1940s.

See also BRONCHITIS

POSTNATAL DEPRESSION

Postnatal depression (PND, postpartum depression or the baby blues) is a spontaneous form of depression that occurs in some women just before, or soon after childbirth, and is a response to the effect on the brain of sudden changes in hormone levels.

In its mildest form most women have some feelings of up and down emotions with teary episodes in the first week after delivery. This is normal and passes within a few days.

Women with true postnatal depression experience constant unhappiness for which there is no reason. They are unable to sleep, lose appetite and weight, and feel there is no purpose in living. They may feel unnecessarily guilty, have a very poor opinion of themselves, feel life is hopeless, find it difficult to think or concentrate, worry excessively about their infant or neglect the child. Rarely it may lead to attempted or actual suicide. It is diagnosed after careful psychiatric assessment.

Emotional and practical support from the partner, family and friends are vital in assisting an affected woman in her recovery. Counselling and support groups may also be beneficial. If necessary medications are prescribed to control the production of depressing chemicals in the brain (eg. fluvoxamine, moclobemide, nefazodone, paroxetine, venlafaxine) while hospitalised or given intensive home support. About one in every 500 mothers are hospitalised for postnatal depression. Shock therapy (electroconvulsive therapy - ECT) may be used as a last resort for those women whose depression is prolonged and life threatening. Virtually all cases settle with support and medication in a few weeks.

PREMATURE BABY

The survival of a baby born before 37 weeks of pregnancy depends more upon the weight of the baby than the actual number of weeks of pregnancy. Babies under 500g have only a 40% chance of survival, under 1000g a 65% chance, and over 1500g a nearly 100% chance of survival. These figures are for the best hospitals in developed countries, but babies born prematurely in remote areas will have a far lower survival rate.

The problems that very premature babies face include liver failure and jaundice, inability to maintain body temperature, immature lungs, inability to maintain the correct balance of chemicals in the blood, patent ductus arteriosus, increased risk of infection due to an immature defence system, bleeding excessively, and eye problems including blindness. The smaller the baby, the greater the problems, and the more intensive the care required from specialised units in major hospitals.

The activity and processes of immature babies must be monitored carefully. Tubes and leads to and from the infant may appear to overwhelm it but are necessary to monitor the heart and breathing, supply oxygen, assist breathing in some cases, feed the baby, drain away urine, keep the temperature at the correct level, and maintain the correct chemical balance in the blood.

Even some of the treatments to help these babies can have serious complications. Many require oxygen to allow them to breathe, but too much oxygen can cause a condition called retrolental fibroplasia that damages the retina (light sensitive area) at the back of the eye to cause permanent blindness. Premature babies also progress better if their intensive care nursery is darkened and quietened for the twelve night hours.

A baby born prematurely will be a little later in reaching the milestones of infancy and should have routine immunisations in the first six months slightly delayed. The delay is roughly the number of weeks of prematurity before 37 weeks (ie. a baby born at 31 weeks is 6 weeks before 37 weeks, and can expect its milestones and vaccinations to be delayed by 6 weeks). The delay is halved by the time the child reaches six months of age, and disappears completely by one year of age.

See also RESPIRATORY DISTRESS SYNDROME



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