Всё о Гипертензии(гипертонии)-About Hypertension

First visit

A baby’s first visit to the doctor’s office is usually between two and four weeks after birth and this visit serves several purposes. For one thing, it gives the parent, the doctor, and the child an opportunity to meet together and begin a relationship. The parent can get to know the doctor and the customs of the practice, the doctor can get basic information about the family, and the child’s general health can be evaluated. At this first visit the doctor will take the baby’s physical measurements. This initial information is necessary so that the child’s development can be followed from the beginning of life. The doctor will also examine the baby for abnormalities. Some babies are born with physical problems and abnormalities that are obvious right away. Other inborn problems do not show up until a few weeks after birth.

At the first visit, the doctor will ask questions about the parents’ health and health history as well as examine the baby. Some medical problems can be inherited, and some can run in families. It is important for the new baby’s medical record to show such background information. If the child later shows signs of problems that have appeared before in the family, the doctor will be able to make a diagnosis more quickly.

The first visit will also include checking to see that the umbilical cord is healing as it should, that the circumcision (if it was done) is healing, and that the child has had no ill effects from labor and delivery. Feeding schedules, vitamins, and immunizations will be discussed as well. Usually a schedule of regular return visits is made up at the first visit. The number and spacing of the visits will depend on the baby’s health, the parents’ needs and wishes, and when the baby should have immunizations.

If the baby’s health and development seem to be normal, some or all of the later visits may be handled by a pediatric nurse practitioner, a physician’s assistant, or another health professional. These people are specially trained to be an extension of the doctor. They can work with you to clear up any questions you have about taking care of your baby. Of course, any question or problem that the nurse or assistant cannot handle is referred to the doctor.

Later visits

As the child grows past babyhood, questions will come up about how to handle toilet training, rivalries with brothers and sisters, obedience, temper tantrums, and the like. These are areas where your doctor and the staff can help. Go ahead and ask about them. A child’s doctor is not concerned only with the child’s physical body. Social and psychological development is also a part of every child’s growth and affects health in many ways.

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Many children cannot remain dry through the night before they are four or five. About 10 percent of all children over the age of five are bedwetters. Children of any age may have occasional accidents at night, especially if ill or in exhausted sleep—conditions that do not represent true bedwetting.

Five to 10 percent of children who bed-wet have a physical disease, such as an infection or abnormality of the urinary tract, diabetes, or a neurological (nervous system) disorder. If a trained child suddenly begins bedwetting, the cause may be physical. If bedwetting develops a year or more after night training has been established, or if a child wets himself both day and night, a physical disease is likely.

However, most cases of bedwetting are not caused by an identified physical disorder. Some cases seem to be hereditary, with brothers, sisters, and parents also having been bedwetters. Some are caused by overemphasis by the family on toilet training. Others are caused by taking children out of their night nappies too soon or by waking children to urinate in an effort to train at night. Some children have emotional problems that cause bedwetting. Still, the cause of many cases of bedwetting remains unknown.

Signs and symptoms

A child who frequently and consistently wets the bed after age five has a bedwetting problem.

Home care

Before beginning any home treatment of bedwetting, see your doctor. The doctor can perform tests to determine whether bedwetting is being caused by a physical disease, such as a urinary infection or diabetes.

If the doctor finds no physical cause, then the best home treatment is to ignore bedwetting as much as possible and to try to avoid it. Do not take a child out of night nappies until the child consistently remains dry. Do not make a big fuss about daytime training. Do not try to shame a child into remaining dry at night.

Consult your doctor before using devices which awaken the child as urination starts. Withholding liquids during late afternoon and evening hours is not usually successful and may seem like punishment to the child. Behavior modification techniques (rewarding success and reacting neutrally toward failure) rarely work. Rubber sheets and plastic pants are helpful until the child stops bedwetting. Until then, patience, calmness, and understanding may be the best treatment.

Precautions

• Do not let a minor problem like bedwetting become a major destructive factor in your relationship with your child. Anger and frustration between parent and child are more costly than extra laundry.

• Do not allow other children to taunt a bedwetter.

Medical treatment

Your doctor will insist first upon conducting a physical examination and urinalysis. The doctor may suggest X rays of the urinary tract or consultation with an urologist; imipramine (an antidepressant) by mouth at bedtime for a trial period; dextroamphetamine, phenytoin, or caffeine also on a temporary basis; or a program of behavior modification. Although many of these treatments are not always effective, they may be worth a try.

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