Nightmares are related to real or imagined things in the child’s daily life, such as stress or anxiety about school or friends or families, or may be the aftermath of a frightening movie or news item. No matter how bizarre the nightmare, the fears are very real to the child. In reassuring the child, do not simply dismiss the episode as just a bad dream, but address the issues that the child raises and respond to the fear.

After reassurance the child is usually able to go back to sleep readily. Nightmares are common and normal, and in most instances no special intervention is required. As children grow older, they are better able to cope with bad dreams.

Night terrors, while part of the spectrum of arousal disorders, are quite different from nightmares. The child wakes in the middle of the night literally in terror. He will be sweaty, breathing rapidly, with his heart racing and eyes bulging — in a state of panic. There may have been a scream which alerted the parents in the first place. The child is usually inconsolable, and may not even be aware of the parents’ presence. After a few minutes the child goes back to sleep, and will generally have no recollection of the episode the next morning.

Night terrors are frightening for parents as well as for the children. They last only a few minutes, have no long-term consequences, and they usually resolve spontaneously over time. If they are very frequent and cause major family disruption, they can usually be successfully treated with small doses of medications but this is rarely necessary. In older children meditation or relaxation exercises have been suggested, but there is little evidence about their effectiveness although they can do no harm.

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Taking back the power: letting go

The second stage involves letting go of our thoughts. It is not the avoidance of thoughts by trying to distract ourselves in some way, that only creates further anxiety. As in meditation, the secret of the letting-go process is not the avoidance or annihilation of our thoughts. It is the letting go of our thoughts. When we are aware of how our thoughts create our symptoms, we see we have a choice. If we keep on the rollercoaster we know where we are going to end up. Anxiety and panic.

Don’t fight the thoughts. Don’t try to stop the thoughts or try to avoid them. Validate the thoughts by naming them, ‘anxiety’ thought, ‘panic’ thought, ‘depressive’ thought, ‘mental abuse’ thought, ‘negative’ thought, ‘guilt’ thought and then let them go, which means we don’t concentrate on them, we stop them by letting them go. This is the hard part. As soon as we let go of one thought, another is there to take its place. We let go of that and another comes.

This is where we need to have a lot of discipline. Remember, we are learning a new skill and it is going to take time and patience. In essence, what we are doing is learning to gain control over our thoughts and in doing so take back the power from the disorder. With practice, we become caught up in the letting-go process instead of becoming caught up in our thoughts.

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Too often parents will succumb to feelings of guilt or to pressure from other people. They try something—usually whatever has been “suggested” m often—and it fails. The list under “we-tried-that” only looks like proof t nothing will ever work.

All methods of addressing sleep problems are difficult even when begun with the utmost determination. To begin before you are ready is to yourself—and your child—up for failure. That sense of failure usually la longer than if you had waited until you were fully ready.

How do you know when you are “ready?” It is a balance of be exhausted, frustrated, and prepared.

Developing a plan that feels personalized to your situation will give you more confidence to begin. Deciding what does and doesn’t feel right about current situation helps you define the problem for yourself. Trouble-shooting “glitches” before you encounter them gives you more ammunition. Work with your partner ahead of time builds a stronger, united front. Find supports before you need them means they will be there when you Examining the range of emotions and thoughts you have on the whole issue v help you give yourself permission to begin. You need to reach the conclusion that it is important to make some changes.

At five months I thought she was too young to sleep better. At seven months; was learning to crawl—and was so frustrated. At a year she wouldn’t leave side. Now she’s two and teething miserably again. Before I know it she’ll be college—1 guess then it’s okay to stay up all night!

Is it too late? “She climbs out of her crib,” “He can cry for hours,” “She still nurses every two hours,” “He has a baby brother now,” the reasons to take or not to take action are many.

It is never too late—you only have more information to take into account. Maybe it would have been easier yesterday, but chances are it will be easier today than tomorrow.

Identifying problem areas and your motivation for making changes are the f steps in problem solving. You also need solid information about children sleep.

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The third type of incontinence—urge incontinence—is when you know you need to go, but you can’t get there quickly enough. This symptom is the case of the bladder often means cystitis— perhaps due to injection, bladder radiation or cyclophosphamide. In the case of the bowels it can go with severe diarrhoea of any cause.

Now let’s go on to incontinence where urine or faeces is coming away through a passage that doesn’t normally exist. This can happen if you have a large cancer in the pelvic area, which grows through to open up an abnormal passage between the bowel or bladder and the skin or vagina (a fistula). If the opening of the fistula is through the skin of the abdominal wall or down below, this problem is easy to diagnose—it is quite obvious that the urine or faeces is coming through an opening that normally doesn’t exist. If the opening is into the vagina the diagnosis is more difficult. It shoud be suspected whenever small amounts of urine or faeces are coming away almost continuously, but you still have normal feeling in the bladder or bowel as the case may be. You could also be passing some of your urine and faeces normally, with normal control. Ask your doctor to check for a fistula if you think that urine or faeces is coming away through your front passage.

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It is postulated that there is a tight band of tissue, just inside the anal margin, forming part of the sphincter muscle which keeps the bowel opening closed.

Under a deep but short-acting general anaesthetic, the surgeon distends the sphincter, disrupting this tight band. At the same time any projecting piles or skin tags are snipped off.

The person undergoing this procedure can leave hospital the same day and usually is absent from work only for a few days.

But formal operation with excision or cutting out of the dilated veins and the overlying skin and mucous membrane which forms the pile remains the most suitable treatment for permanent control of third-degree piles.

Unfortunately, this operation has a bad reputation. Many people believe it is associated with a lot of post-operative pain.

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Sometimes the reverse happens and the periods become heavier and more frequent, due to some associated disorder.

Most women worry about the possibility of becoming pregnant at this time and are concerned about when they should discontinue contraception.

Those woman who have shown their fertility by still having children into the forties are more likely to conceive than those who may not have had a child for 10 or 15 years and yet have not been too careful in avoiding conception.

Because ovulation may still occur, most doctors would advise their menopausal patients to practise contraception until a full year from the last period.

Most women go through the menopause, or climacteric, with a minimum of discomfort and few symptoms. Unfortunately, for others this time of their lives may become a nightmare and they suffer severe physical and mental symptoms.

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You may feel that you already know a lot about diet. But athletes, like everyone else, can have their facts wrong. Many foods that you believe are good sources of carbohydrate are even better sources of fat. For example, chocolate is 55 per cent carbohydrate but also 30 per cent fat. And fat won’t help you win the race.

Dietary advice aimed at the general public needs to be modified for the serious sports person. Athletes have far greater energy needs, perhaps double that of the average office worker. Many high carbohydrate and low fat foods which are recommended for the average person are too bulky and satiating for athletes. It is their bulk that makes it difficult to consume the required amount of food. For example, a 75 gram carbohydrate portion of white bread is only five slices. Other foods that you might have believed were not so good for you, like soft drinks, confectionery, honey, sugar, flavoured milk and ice cream are actually very concentrated sources of carbohydrate that can be used to supplement your diet.

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• The psychological understanding of obesity has moved through several phases in recent times.

• Behaviour modification techniques were initially used widely to change habits.

• Cognitive approaches have been used to change thought patterns.

• Rational Emotive Therapy (RED is an example of a ‘pop’ psychology approach to changing thought patterns.

• Other approaches have examined the symbolic nature of fat.

• The task of a fat loss counsellor is complex and involves an understanding of a range of different causalities and interventions.

• Fat loss leaders should develop a close referral link with a qualified psychologist.

The simplistic view of obesity was that if a person ate too much, he or she got fat. The solution was: eat less and you’ll lose fat. This is the ‘diet as medicine’ approach. In reality, the issue is much more complex. Some people couldn’t eat less simply as a result of being told; some people could obey the injunction, but could not keep up the practice and some people experienced almost a panic reaction in the face of trying to control their eating. Studying the problem some researchers reported: ‘. . . it was our feeling that our patients perceived weight reduction, not as a happy end to a disabling disorder, but rather as a threat to the integrity of functioning’. Other research reported not only an increase in depression in overweight people undergoing diets, but also that the same symptoms—increased emotionality, irritability and anxiety—were seen in normal weight people subject to severe food restriction.

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