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Morning sickness and nausea during pregnancy
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

In the first half of pregnancy, feeling sick or nauseated is quite common, as is vomiting. The degree of nausea and vomiting differs from woman to woman.

You may just feel a little sick in the morning and throw up once, or your may suffer from constant nausea and frequent vomiting throughout the day.

For most women, the nausea stops after the first three months of pregnancy. For a few, however, it is still a problem after four or five months.

What causes nausea during pregnancy?
The actual causes of nausea and vomiting are still not known. It is probably brought about by the hormonal changes taking place or by an imbalance in blood sugar.

Many midwives and doctors believe that morning sickness is more common in women carrying twins or triplets, but it is not clear whether this is the case.

Symptoms of dehydration
Dizziness.
Thirst.
Passing a smaller amount of urine than usual or none at all.
Passing dark urine.
The presence of ketones in your urine. Your midwife or GP can easily test this.
Is it dangerous?
If you vomit heavily and often when pregnant, you will lose so much liquid (together with nutrition and minerals) that it causes dehydration.

If you are dehydrated and can’t keep liquids down, the condition is called hyperemesis gravidarum and requires medical attention.

This usually involves hospital admission and being given fluids through a drip.

How can I avoid nausea?
In the morning
Take your time getting out of bed.
If you tend to feel really sick in the morning, eat a little as soon as you wake up and before getting out of bed.
Ask your partner to bring the food to you, or prepare a snack the night before and leave it beside your bed.
Throughout the day
Eat little and often, every two or three hours – even if you’re not hungry.
Drink a lot of liquid, preferably 10 to 12 glasses of water, fruit juice or herbal tea each day.
Avoid food containing a lot of fat or spices.
Avoid alcohol and caffeine.
Eat dry crackers, toasted bread or rusks.
Ginger tea or ginger tablets can help reduce nausea.
Rest several times a day. Lie down with a pillow under your head and legs.
Move slowly and avoid sudden movements.
After eating, sit down so that gravity helps to keep the food in your stomach.
Avoid smells that make you feel sick or throw up.
Don’t brush your teeth immediately after eating because this can cause vomiting.
Get some fresh air and exercise by going for a little walk every day.
Avoid smoking. Not only is it harmful for you and your child, it also diminishes your appetite.
At night
Before going to bed, it may help to eat a snack such as a yoghurt, bread, milk, cereal or a sandwich.
If you wake up during the night, eating a small snack may stop you feeling sick in the morning.
Sleep with the windows open to get some fresh air, if possible.
When should I consult my doctor?
If none of the remedies mentioned above seem to work.
If you vomit more than three or four times a day.
If you lose weight.
If your vomit contains blood or looks like ground coffee.
If you lose more liquid than you can keep down.
If you are dehydrated (see box above).
If you are worried about your condition, or believe that something serious is the matter.
What will the doctor do?
The doctor will examine you for signs of dehydration. A simple urine test (ketone test) is often helpful in deciding the degree of dehydration.

Anti-sickness tablets can be prescribed. Your doctor will be careful to ensure you are prescribed medication that does not harm your baby.

How to Reduce Nausea During Pregnancy
Tips to Help Pregnant Women Ease Nausea

Read more at Suite101: How to Reduce Nausea During Pregnancy: Tips to Help Pregnant Women Ease Nausea http://pregnancychildbirth.suite101.com/article.cfm/how-to-reduce-nausea-during-pregnancy#ixzz0hmkWHQY8

No one is sure exactly what causes nausea during pregnancy, but experts believe that high levels of hormones may contribute to it. It often starts around the sixth week of pregnancy, but some women experience it earlier than that. It usually ends around the end of the first trimester, or at about 12 weeks, but can continue for longer or even throughout the pregnancy.

Nausea and vomiting usually isn’t harmful for the mother or her baby because in most cases, the woman is able to eat something during the day and keep it down. This is enough to provide nutrients to the baby so growth is normal. With severe cases of vomiting, in which the woman is unable to eat for days at a time, she should consult her doctor for treatment to ensure the baby stays healthy and that she’s not dehydrated.

Tips for Reducing Nausea in Pregnancy
Here are a few things women can do to ease nausea when they’re expecting. Here are some tips from the Society of Obstetricians and Gynecologists of Canada.

Read more at Suite101: How to Reduce Nausea During Pregnancy: Tips to Help Pregnant Women Ease Nausea http://pregnancychildbirth.suite101.com/article.cfm/how-to-reduce-nausea-during-pregnancy#ixzz0hmkSpuHW

•In the morning when you wake up, eat a few crackers and stay in bed for a few more minutes.
•Eat smaller meals and snacks throughout the day so you are never really hungry or very full. This also helps if you’re suffering from heartburn.
•Drink throughout the day in small amounts, and don’t drink too much with meals.
•If odors bother you, open the windows while cooking or, even better, have someone else cook. Also, eating cold food rather than hot can help, since there is less of a smell to cold food.
•Try sniffing ginger or lemons, or eating some salty snacks such as potato chips.
•Get plenty of rest, but don’t sleep right after a meal. Being overtired plays a larger role in nausea than most people realize.
•Try taking prenatal vitamins with food, and if this doesn’t help, at night. That way if they contribute to your nausea, you can usually sleep through the feeling. If this still doesn’t work, simply take folic acid instead of a prenatal multivitamin.
•Consider taking vitamin B6 or ginger capsules. Both have been shown to reduce nausea. If you don’t want to take capsules, consider chewing on crystallized ginger or trying ginger candies.
Although nausea during pregnancy can be annoying, if you have a mild case it doesn’t have to be debilitating. Trying these simple steps and reduce or even eliminate your symptoms, so instead of worrying about what might make you sick, you can focus on nourishing your body and your baby.

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Definition

Lip cancer is a malignant tumor, or neoplasm, that originates in the surface layer cells of the epithelial tissue in the upper or lower lip.

Description

The upper and lower lips are the well-defined red (often called vermilion) areas that surround the opening to the mouth. They contain muscles and special cells (receptors) that are sensitive to heat and cold and feeling. Largely taken for granted, the lips are important in identifying types of food to the brain and in getting food into the mouth. Lips also play a crucial role in speech.

A malignant tumor, or neoplasm, that originates in the cells of one of the lips is a cancer of the lip. Lip cancer almost always begins in the flat, or squamous, epithelial cells. Epithelial cells form coverings (tissues) for the surfaces of the body. Skin, for example, has an outer layer of epithelial tissue.

If a part of the lip is affected by cancer and must be removed by surgery, there will be significant changes in eating ability and speech function. The more lip tissue removed, the greater the disturbances to the normal patterns of talking and eating.

Demographics

Nine out of ten cases of lip cancer are diagnosed in people over the age of 45. Age, or the aging process, may contribute to the way the cancer develops. As a line of cells gets older, the genetic material in a cell loses some of its ability to repair itself. When the repair system is operating normally, damage to the genetic material, or DNA, caused by ultraviolet light from the sun is quickly weeded out. When the system fails, changes in the genetic material are kept, and they multiply when a cell divides.

If the genetic material cannot repair itself, damage caused by exposure to environmental factors such as sunlight and chemicals can quickly set in motion the uncontrolled growth of cells.

The effects of factors that are known to cause lip cancer, such as smoking and exposure to sunlight, also add up as a person ages. Thus, the combination of a breakdown in the repair system in the genetic material and the considerable periods of time (decades) over which a person is exposed to cancer agents probably causes lip cancers. However, researchers are still investigating how lip cancers start.

Men are at greater risk for lip cancer than women. Depending on where they live, men are two or three times more likely to be diagnosed than women. Fair-skinned people are more likely to get lip cancer than those with dark skin. For reasons not yet understood, people in Asia have a much lower risk of lip cancer than those living on other continents. In many parts of Asia, lip cancer is extremely rare. In North America, nearly 13 out of 100, 000 men will be diagnosed with lip cancer during their lifetime. In Australia, about 13.5 men per 100, 000 will be diagnosed.

The frequency of lip cancer is often lumped together with oral cancer, although lip cancer is probably much more like skin cancer in origin. There are about 30, 000 new diagnoses of mouth and lip cancer in the United States each year.

In some places, such as South Australia, women are experiencing a striking increase in lip cancer diagnoses. There are several theories to explain the trend. Among them, perhaps fewer women regularly wear hats, which offer protection from the sun. Women might also be for-going lipstick, which serves as another barrier to sunlight.

Causes and symptoms

Exposure to sunlight and smoking, particularly pipe smoking, increases the risk of developing lip cancer. However, the way they do so is not understood. Alcohol consumption is tied to oral cancers and may contribute to lip cancer as well.

Much of the evidence about the link between time spent in the sun and lip cancer comes from a look at those who are most likely to be diagnosed. Among them are farmers, golfers, and others who spend long periods of time outdoors.

Lip cancer seems to share some properties with skin cancer in the way it originates. Yet several studies suggest that it takes more than exposure to sun to increase the risk of lip cancer. Viral infection is a risk factor, as is reduced immunity, which is a condition that may be caused by viral infection. A team of researchers in the Netherlands recently reported a link between liver transplants and a higher risk of lip and skin cancer following the transplant. The results are not unexpected. In this procedure, drugs are used to suppress, or lower, the activity of a recipient’s immune system so that a donor organ will be accepted. Thus, the immunity of the organ recipient is low, and lower immunity is linked to lip cancer.

Individuals with acquired immunodeficiency syndrome (AIDS) are at a greater risk for lip cancer. People infected with herpes simplex viruses, papilloma viruses and other viruses may also be at greater risk.

Vitamin deficiency may also be a factor that contributes to lip cancer. The sorts of vitamins found in fruits and vegetables, particularly carotene, the substance the body uses to form vitamins A and C, seem to be important in preventing lip cancer.

Particular symptoms of this cancer include white spots, sores, or lumps on the lip. Pain can also be a symptom, particularly pain in a lymph node near the affected part of the lip. This is a troubling symptom, since it indicates that the cancer has metastasized (spread) beyond the lip.

Diagnosis

Dentists frequently identify a suspicious spot, sore, or lump on the lip. A good dental exam includes an examination of the lips and the mouth. X ray and biopsy, the taking of a tissue sample for analysis, can be used to determine whether or not cancer is present.

Because spots and sores on the lips can be short-lived, people should not be alarmed by every change that appears. However, when there is a change that occurs and stays, it should be investigated. If the next scheduled dental visit is several months away, a special appointment with the dentist or a physician should be made. Dentists should tell their patients, particularly older ones, how to undertake a regular self-exam of the lips between check-ups.

Treatment team

A physician who specializes in oncology, the study and treatment of cancer, will probably take the lead on treatment. A surgeon will remove the cancer. Not all oncologists are surgeons, so it is likely that the team will include a medical oncologist, who coordinates treatment, as well as a surgical oncologist, who performs the surgery.

Because surgery on the lip can interfere with eating and talking, most teams include a nutritionist and a speech pathologist. Scars and alterations of facial features can produce changes in body image, and a social worker may participate in the team to help a patient cope with such changes. It is possible that a dentist or oral surgeon will also play a role. Nurses who administer chemotherapy and monitor the status of patients will be involved, as will radiation technicians and a radiation oncologist. If reconstruction of a lip is necessary because of the amount of tissue removed or the size of a scar, a plastic surgeon will be added to the team.

Clinical staging, treatments, and prognosis

The ability to see a suspicious area on the lips and to detect lip cancer early combine to form the staging process. (One inch equals 2.5 centimeters.)

•Stage I: The cancer is less than one inch in diameter and has not spread.
•Stage II: The cancer is up to approximately two inches in diameter and has not spread.
•Stage III: The cancer is either larger than two inches or has spread to a lymph node on the side of the neck that matches the primary location of the lip cancer. The lymph node is enlarged, but not much more than an inch.
•Stage IV: One or more of several things can occur. There may be a spread of cancer to the mouth or to the areas around the lip, more than one lymph node with cancer, or metastasis (spread) to other parts of the body.
The outlook for recovery from lip cancer is very good if it is diagnosed early. For stage I and stage II cancers, surgery to remove the cancer or radiation treatment of the affected area is sometimes all that is required to produce a cure. Decisions about which method to use depend on many factors, but the size of the tumor and the tolerance a patient has for radiation or chemotherapy are particularly important. The larger the tumor, the more urgent is its removal. Smaller tumors can be treated with radiation or other methods in an effort to shrink them before surgery. In some cases, surgery might be avoided. For stage III cancer with lymph node involvement, the cancerous lymph nodes are also removed.

Chemotherapy may be used at any stage, but it is particularly important for stage IV cancer. In some cases, chemotherapy is used before surgery, just as radiation is, to try to eliminate the cancer without cutting, or at least to make it smaller before it is cut out (excised). After surgery, radiation therapy and chemotherapy are both used to treat patients with stage IV lip cancer, sometimes in combination.

There are many new and promising types of treatment for lip cancer. For example, heat kills some cancer cells, and a treatment known as hyperthermia uses heat to eliminate cancer in some patients.

Because lip cancers are well-studied and often successfully treated, the best practices for dealing with the cancer, or a suspected cancer, are specific. In the case of how to extract and study tissue to determine whether a suspicious growth is malignant (biopsy), size is an extremely useful guide.

It is possible to take tissue from a suspected lip cancer for examination, or biopsy, by simply piercing and extracting tissue with a large, hollow needle. The technique is called a punch biopsy. However, the method is not recommended for any tumor that is thicker than about one-sixteenth of an inch. For thicker tumors, a tissue sample is better taken by cutting into the tumor, that is, making an incision.

The success with identifying lip cancer early and eliminating it means that it is not a big killer. Only 4 in 2.5 million people die from lip cancer each year, or about 112 individuals in the entire U.S. population. In contrast, cancers in the oral cavity, including on the tongue, cause more than 8, 000 deaths in the U.S. each year.

Alternative and complementary therapies
Because there seems to be some link between a chronic absence of vitamins A and C in the diet and lip cancer, some complementary therapies promote taking massive amounts of the vitamins, or megavitamins. The value of such therapy has not been demonstrated. In order to avoid possible side effects or harmful interactions with standard cancer treatment, patients should always notify their treatment team of any over-the-counter or herbal remedies that they are taking.

Coping with cancer treatment

The doctor and patient should discuss the need for a way to communicate if speech is impaired after surgery. A pad and pencil may be all that is needed for a short interval. If there will be a long period of speech difficulty, patients should be ready with additional means, such as TYY phone service.

A change in appearance after the removal of a lip cancer can lead to concerns about body image, and social interaction may suffer. A support group can help. Discussions with a social worker, loved ones, or other patients who have undergone similar treatment can be of major benefit.

If a significant portion of lip is removed, speech therapy may be necessary to relearn how to make certain sounds. Scars and alterations of the lips usually can be reduced or hidden entirely with the techniques available from plastic surgery, so any alteration in appearance because of lip cancer is typically transient.

Reconstruction of the lip will help with appearance, but it might not make it easier to talk, especially if muscle tissue is removed during the surgery to eliminate the cancer. In many cases, the reconstruction process actually damages more muscle and sensory tissue. New methods of reconstructive surgery are being developed to avoid such an outcome.

Appetite may be affected before, during and after treatment. Before treatment, the presence of a tumor can interfere with the tasting of food, and food might not seem as appealing as it once did. During treatment, particularly radiation treatment, the area of the lips and mouth might be sore and make eating difficult. After treatment, a loss of sensation in the part of the lip affected can reduce appetite. A nutritionist can help with supplements for those who experience significant weight loss and who do not have an appetite (anorexia).

Clinical trials

The Cancer Information Service at the National Institutes of Health offers information about clinical trials that are looking for volunteers. The service can be reached at or (800) 422-6237.

Prevention

The best prevention is to stay out of the sun and avoid tobacco and alcohol. Eating plenty of fruits and vegetables is a good measure. Even though the importance of fruits and vegetables is not proven to prevent lip cancer, overall fruits and vegetables are demonstrated cancer-fighters. Any precaution that is taken against contracting human immunodeficiency virus (HIV), which causes AIDS, is also likely to reduce the chance of developing lip cancer.

Special concerns

Certain diseases can mimic a possible lip cancer. They must be ruled out if a suspicious spot is found. This is particularly true in areas where diseases that cause lesions, or sores, on the lips are found. One such disease is histoplasmosis capsulatum, which is caused by a fungus. It sometimes produces an ulcer, or lesion, on the lip that leads to suspicion of lip cancer.

Sometimes lip cancer cannot be cured. It may keep recurring. It may also metastasize, particularly to the lungs. But overall, lip cancer is considered highly curable. Talking openly with the physician in charge of care is important in order for the patient to understand the course of the disease and be prepared to make decisions.

See Also Oropharyngeal cancer

Resources
PERIODICALS
Brennan, P., et al. “Secondary Primary Neoplasms Following Non-Hodgkin’s Lymphoma in New South Wales, Australia.” British Journal of Cancer 82 (April 2000):1344-7.

Haagsma, E.B., et al. “Increased Cancer Risk After Liver Transplantation: a Population-based Study.” Journal of Hepatology 34 (January 2001): 84-91.

ORGANIZATIONS
Support for People with Oral and Head and Neck Cancer (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053.(800) 377-0928. .

Diane M. Calabrese

QUESTIONS TO ASK THE DOCTOR

•Is this cancer curable?
•What is the stage of the cancer?
•What is the likelihood the cancer will recur?
•Is there a clinical trial in which I should participate?

Biopsy

—A procedure in which a tissue sample is taken from the body for examination.

Epithelial tissue

—The collection of cells that form coverings for the surfaces of the body.

Immunity

—Ability to resist the effects of agents, such as bacteria and viruses, that cause disease.

Lymph node

—A concentration of lymphatic tissue and part of the lymphatic system that collects fluid from around the cells and returns it to the blood vessels, and helps with the immune response.

Squamous cells

—Flat epithelial cells, which usually make up the outer layer of epithelial tissue, the layer farthest away from the surface the epithelium covers.

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Summary

Baby teeth, more accurately called primary teeth or deciduous teeth, are a person’s first set of teeth. They begin to form during the first trimester of pregnancy (first 12 weeks) and begin to emerge (erupt) through an infant’s gums around 6 months of age. All twenty primary teeth are typically fully erupted by the time a child is 3 years old and are later replaced by 32 permanent teeth.

Primary teeth have several functions. They help with biting and chewing, which contributes to good nutrition, and are crucial to a child’s ability to speak. They serve as a guide for permanent teeth to erupt and grow while maintaining the space. They also make a child look more attractive by supporting the shape of the face.

Proper dental hygiene is important for primary teeth, even though they eventually will be replaced by permanent teeth. Poor maintenance of baby teeth can cause them to fall out early, which in turn can cause permanent teeth to erupt prematurely and not in correct position.

If teeth are discolored when they erupt, it might indicate an underlying medical problem. Like permanent teeth, primary teeth are also vulnerable to plaque, a clear film that sticks to teeth and attracts bacteria and sugar. This can lead to cavities. Primary teeth are vulnerable to various injuries that can cause them to chip, fracture or completely come loose.

Proper care can help avoid many of the problems that sometimes affect primary teeth. After primary teeth begin to appear, they can be brushed with a soft children’s toothbrush. According to the American Dental Association (ADA), toothpaste should not be used until the child is 2 years old. As soon as two teeth erupt next to each other, they should be flossed at least once daily. Children who take good care of their teeth form habits that help keep their teeth healthy for a lifetime. Proper maintenance and care of all teeth remains crucial to maintaining good dental health.

About baby teeth

Baby teeth, more accurately known as primary teeth or deciduous teeth, are the first of two sets of teeth that people develop during their lifetimes. They begin to form during the first trimester of pregnancy and have fully formed by the time an infant is born. However, primary teeth usually remain hidden under the gums until they begin to emerge (erupt) between 5 months and 8 months of age. This process is known as teething.

A human tooth is composed of several parts:

Crown. Part of the tooth that is visible above the gum line.

Enamel. The hard, translucent outer shell that covers the crown. The enamel is hard enough to handle the strain of a lifetime of biting, chewing and grinding. It also protects the tooth from bacteria and changes in temperature when eating hot or cold foods. Nonetheless, it is brittle and may crack or chip.

Root. Part of the tooth that pushes into the upper (maxilla) or lower (mandible) jawbone. Each root has a tiny opening at the bottom called the apical foramen. Blood vessels and nerves enter the root through this space.

Cementum. Hard shell that covers the root and attaches to fibers that fasten the root to the jawbone.

Dentin. Layer of the tooth found beneath the enamel and the cementum. It makes up most of the tooth’s structure and is responsible for the tooth’s color. It typically has a whitish to yellowish hue.

Pulp. Located beneath the dentin at the core of the tooth. It is made up of blood vessels, nerves and connective tissue. The blood supply of the pulp provides the nutrients that keep the tooth alive. The pulp is made up of two parts. The pulp chamber is found in the crown of the tooth. The root canal is the part of the pulp located in the root of the tooth, where blood vessels and nerves enter the tooth.

Twenty primary teeth – eight incisors (four front teeth on both the upper and lower jaw), four canines (located in the front of the jaw behind the incisors) and eight molars (larger teeth in the back of the mouth) – typically erupt by the time a child is 3 years old. Eruption of the lower teeth generally precedes eruption of the top teeth. Eruption times for girls are generally earlier than those for boys.

The following schedule for the top primary teeth was established by the American Dental Association (ADA):

Central incisor: 8 months to 12 months
Lateral incisor: 9 months to 13 months
Canine (cuspid): 16 months to 22 months
First molar: 13 months to 19 months
Second molar: 25 months to 33 months
Eruption of the bottom primary teeth occurs as follows:

Central incisor: 6 months to 10 months
Lateral incisor: 10 months to 16 months
Canine (cuspid): 17 months to 23 months
First molar: 14 months to 18 months
Second molar: 21 months to 31 months
The first primary teeth to emerge are usually the bottom two incisors, followed by the top four incisors and then the rest of the bottom incisors. After the incisors the rest of the primary teeth begin to fill the mouth, usually with two developing at a time. The roots of primary teeth are 50 percent formed when eruption first begins, and roots are completed by the time a child is between the ages of 18 months and 3 years.

Primary teeth have several roles. They help with biting and chewing, and are crucial to a child’s ability to speak. They may also make a child appear more attractive. Finally, primary teeth serve as a guide for permanent teeth. For this reason, primary teeth usually have more space between them to allow permanent teeth more room to erupt.

Primary teeth are smaller and whiter than permanent teeth. Some of the other ways in which primary teeth differ from permanent teeth include:

Crowns are shorter in primary teeth

Enamel depth is more consistent and thinner in primary teeth

Pulp chambers of primary teeth are larger relative to the size of the tooth

Roots are longer and more slender in primary teeth
Eventually, a child’s primary teeth begin to fall out. The middle teeth in front (incisors) typically fall out at age 6. Molars in the back are shed between the ages of 10 and 12. By age 13, children usually have their permanent teeth.

A total of 32 permanent teeth replace the original 20 primary teeth. Meanwhile, permanent first and second premolars (bicuspids) replace the primary first and second molars and permanent incisors and canines replace primary incisors and canines. The permanent molars which grow towards the back of the mouth do not replace baby teeth. This is why there are more teeth in permanent dentition.

Potential problems with baby teeth

Although a child’s baby teeth, or primary teeth, eventually will be replaced by permanent teeth, it is important to care for these initial teeth. When primary teeth emerge, they should be off-white or ivory in color. Teeth that erupt with a black tint or another color usually indicate an underlying problem. Most often, this is the result of plaque growing on the teeth due to a build-up of bacteria in the child’s mouth. Liquid medications containing iron, some antibiotics and certain supplemental vitamins also can cause this effect. Other potential causes of discoloration include:

Chronic illness or recurrent fevers

Excessive fluoride, which may cause bright white spots (fluorosis)

Injury to the teeth, which may cause pink or grayish discoloration

Jaundice in newborns, which may cause yellowish or greenish tint

Use of the antibiotic tetracycline by the mother during pregnancy
Poor maintenance of primary teeth can result in premature loss either naturally or by extraction. This can cause a change in the eruption schedule of the permanent teeth, which may lead to space problems for proper eruption. The permanent teeth may erupt crooked and misaligned.

Primary teeth are also vulnerable to dental plaque, a clear film that sticks to teeth and attracts bacteria and sugar. As the bacteria feed on the sugar, they are broken down into acids that eat into the enamel of the teeth. This causes cavities in the teeth, which can be painful. In addition, plaque can cause gums to become red, swollen and sore. This condition is known as gingivitis, or gum disease.

The first risk to a child’s primary teeth often comes in the form of baby bottle tooth decay (baby bottle syndrome or bottle mouth). This condition results from leaving a bottle in a baby’s mouth for long periods of time while the baby sleeps. Sugars from milk or juices that bathe and remain on the teeth for hours at a time begin to eat away at the enamel. Pocked, pitted or discolored front teeth are signs of the condition. In its most extreme form, this condition can lead to a need to pull a baby’s front teeth until permanent teeth grow in. As a rule, parents or caregivers should only allow a baby to have a bottle during meals, and to fill the bottle only with water if it is used at night.

As children grow older, the primary teeth remain at high risk for cavities. Cavities are one of the most common chronic conditions among children in the United States, according to the American Academy of Pediatrics. Among 3-year-olds, 18.7 percent have at least one tooth with a cavity that has yet to be treated. By the time a child is 8 years old, 51.6 percent have an unfilled cavity or at least one filling. Children who were born prematurely or who had a low birth weight are at increased risk for cavities. Other factors that increase the risk of cavities include:

History of ongoing health care needs
White spots or brown areas on teeth
Failure to regularly see the dentist
Inadequate brushing and flossing regimen
Poor socioeconomic status
Diet that includes too many sugary foods and drinks
Primary teeth are also vulnerable to injuries that can cause them to chip, fracture or completely come loose. Usually, an injury causes baby teeth to loosen rather than fracture. These injuries often occur as the result of falls, mishaps during play or accidents during athletics. If a child suffers an injury to the gums or a baby tooth that causes bleeding, parents may be advised to run cold water over a piece of gauze and apply pressure gently to the injury site. Sucking on an ice pop may be recommended to reduce swelling until the child can see a dentist.

Baby teeth that are knocked out do not require special care after they come loose, unlike permanent teeth, because they cannot be reimplanted. Reimplanting a baby tooth can damage developing permanent teeth and often results in death of the pulp.

Nonetheless, a child’s tooth injury usually requires a visit to a healthcare professional. In many cases, consulting the dentist is the best option. However, a visit to a hospital emergency room may be necessary if the child has suffered a blow to the head, which can be life-threatening, or an injury to another body part. In some cases of primary tooth loss, a dentist may use a space maintainer to keep the area open until the permanent tooth erupts.

Caring for your child’s teeth
Published by Bupa’s health information team, March 2009.

This factsheet is for people who would like information about caring for their child’s teeth.

Caring for a child’s teeth from an early age will help him/her to grow up with healthy teeth and gums. Diet, oral hygiene and visits to the dentist are all important in helping to care for a child’s teeth.

About your child’s teethWhat can damage my child’s teeth?How can I protect my child’s teeth?Further informationQuestions and answersRelated topicsSourcesAbout your child’s teeth
Children’s teeth start to develop before birth. There are two sets of teeth: “milk” teeth and permanent teeth.

Milk teeth
Children usually have 20 milk teeth. They start to push through the gums (erupt) at about six months. Most children have all 20 teeth by the age of two or three. The last milk tooth will fall out at around the age of 12.

Your child’s milk teeth are important for his/her eating, speech, smile and confidence. They are also important for the development of his/her permanent teeth, so it’s very important to look after them.

Permanent teeth
Permanent teeth usually start to erupt at the age of six. Adults have up to 32 permanent teeth.

Most of these will erupt by the age of 13. However, wisdom teeth (those at the very back of the mouth) often don’t erupt until the early- to mid-twenties, if at all.

If your child’s permanent teeth are damaged or need to be removed, there won’t be another set of natural teeth to replace them.

What can damage my child’s teeth?
Many children fall over and bump their teeth accidentally. If this happens to your child, take him/her, and the tooth if it has been knocked out, to the nearest dentist for advice.

Tooth decay and dental erosion are two preventable causes of damage to children’s teeth.

Tooth decay
Our mouths are full of bacteria that build up on the teeth in a sticky layer called plaque. These bacteria digest some of the sugar in our food and drinks, making acids that can weaken the tooth enamel (the hard outer layer of teeth). If acid remains on the tooth surface for a long time, it can cause those areas of the tooth to decay. This can happen if children often have sugary foods or drinks, or don’t clean their teeth properly.

If your child has tooth decay that isn’t treated by a dentist, it will eventually reach the centre of the tooth and can cause an infection or toothache.

Dental erosion
Dental erosion is the gradual wearing away of the enamel on the whole surface of the tooth. It’s caused by acid attacking the surfaces of the teeth. These acids usually come from drinks such as fruit juices, fizzy drinks and squashes – even the sugar-free varieties. These drinks are so popular that over half of all five-year-olds in the UK have some dental erosion. Acids can also be produced if your child vomits or has stomach problems.

Dental erosion can cause sensitivity and pain. Although enamel doesn’t grow back, it doesn’t usually need treatment. If your child has a seriously eroded tooth, his/her dentist may protect the tooth with a filling.

How can I protect my child’s teeth?
To reduce your child’s risk of tooth decay and dental erosion:

take your child to the dentist regularly
don’t give him/her too many sugary or acidic foods and drinks
encourage your child to brush his/her teeth twice a day with at least 1,000ppm fluoride toothpaste
encourage your child to spit out toothpaste and not rinse with water, as this reduces the effect of the fluoride
take advice from your dentist about protective treatments such as fluoride supplements and fissure sealants (see Fissure sealants)
Going to the dentist
It’s a good idea to take your child when you go for your routine dental check-ups, even when he/she is too young to have teeth. This helps your child get familiar with the people and the surroundings at the dental surgery. Your dentist will look in your child’s mouth in an informal way, and may count how many teeth have erupted and spot any early signs of decay. Quick check-ups like this help to encourage good cooperation with the dentist when your child is older.

Your dentist will recommend check-ups at intervals suitable for your child. He/she may take X-ray images to check for decay. Children usually need dental visits more often than adults. Milk teeth are smaller and have thinner enamel than permanent teeth, so decay can spread very quickly. Regular check-ups help your dentist to help you prevent and treat decay before it causes toothache.

Diet
Reducing sugar in your child’s diet is the best way to prevent tooth decay. However, it’s how often your child eats sugar (rather than how much) that is important. Similarly, it’s how often your child has acidic food and drinks (rather than the amount) that affects dental erosion.

Keep squashes, fizzy drinks, natural fruit juices, sweets and cakes to a minimum. Don’t give your child sugary foods and drinks as snacks between meals or before bedtime. Watch out for hidden sugars in sauces, breakfast cereals, etc.

Fruit, vegetables, cheese and milk are all healthier snacks because they contain natural sugars. Remember, however, that as well as natural sugars, fruit contains acids, which can cause decay if eaten in large amounts. You can help to protect your child’s teeth against erosion by finishing a meal with an alkaline food such as milk or cheese. This will neutralise the acid in your child’s mouth.

Older children can chew sugar-free gum after meals, especially containing Xylitol, as this helps prevent tooth decay.

Plain water and plain milk doesn’t cause tooth decay or erosion. Your child may find it hard to drink plain water or milk if he/she usually has sweet drinks, but most children get used to it over time.

Toothbrushing
You should start cleaning your child’s teeth as soon as they come through the gums. There are special toothbrushes for babies.

Make toothbrushing a regular activity, after breakfast and before bedtime, so that it becomes part of your child’s daily routine. Don’t brush for one hour after eating or drinking anything acidic.

When your child is about seven years old, teach him/her how to brush his/her own teeth, using a gentle, circular motion and fluoride toothpaste. You should supervise your child while he/she is learning to brush his/her teeth. Give your child plenty of encouragement and praise. It’s a good idea to check how well he/she is getting on every few days.

Disclosing tablets are small pills that, if chewed for 30 seconds, turn plaque a bright colour – usually pink. This can help you show your child any areas that have been missed when brushing.

Toothpaste
Most toothpaste contains a mineral called fluoride, which strengthens the tooth enamel making it more resistant to decay. Fluoride is also added to the water supply in some parts of the country. In these areas, there has been much less tooth decay.

However, too much fluoride in young children can result in a spotted appearance on their permanent teeth (dental fluorosis).

The amount of fluoride in different brands of toothpaste varies. Children aged up to three years should use toothpaste that contains 1,000ppm fluoride. Children over three years should use toothpaste that contains between 1,350 and 1,500ppm fluoride. Ask your dentist which is the best toothpaste for your child.

If your child is less than two years old, only use a smear of toothpaste. After that, use an amount about the size of a small pea.

Fluoride supplements
If you live somewhere where there is no fluoride in the water or if your child’s teeth are particularly at risk of decay, your dentist may recommend extra fluoride in the form of tablets, drops or mouthwashes.

Fissure sealants
Some children have very deep fissures (crevices) in their permanent back teeth, which can be difficult to keep clean. These fissures can be sealed with a resin film to protect the surface from decay.

Fissure sealants are quick and painless to apply. The dentist cleans the tooth with a special acid, then washes and dries it. The resin is then painted on to the tooth and hardened with a bright, blue light.

Fissure sealants can last for several years but regular visits to the dentist are needed to check that they haven’t worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.

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Constipation is a very common and frustrating problem in children. It is usually defined as the passage of hard and painful stools or going four or more days without a bowel movement. Constipation is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 12-16oz/d), not drinking enough water or waiting too long to go to the bathroom.
Once a child develops constipation and has hard and painful stools, he will then begin to hold in his bowel movements to prevent it from hurting again. This creates a cycle that makes the constipation continue and become worse.

Treating Constipation
Constipation is best treated by making changes in your child’s diet. Until the constipation has improved with a non-constipating diet, your child will most likely also be on stool softeners. The goal of treatment is for your child to have one to two soft stools each day.

Diet Treatment for Infants
Constipation is uncommon in breastfed infants. Because breastmilk is digested so well, it can be common for a baby that is exclusively breastfed to only have a bowel movement every one to two weeks. If the bowel movement is soft or watery, then it is not constipation, even if it occurs infrequently.

It can also be normal for infants (whether breastfed or drinking an iron fortified infant formula) to strain and groan when they have a bowel movement. Again, if the bowel movement is soft or watery, then it is not constipation, even if your infant has to strain or groan to have a bowel movement. And remember that the iron in infant formulas does not cause constipation. You should not switch to a low iron formula because your child has constipation.

If you do think your infant has constipation, then you can:

Increase fluids: Give 2-4 oz of water or diluted fruit juices (such as apple or prune) 1-2 times each day, or try switching to a soy formula.

Increase fiber: If your infant is over four months old and has constipation, you may also try feeding foods with a lot of fiber, such as cereals, strained prunes, apricots, or spinach.

Keep in mind, that although rare, the first symptoms of botulism in infants is usually constipation. If your infant has severe or difficult to treat constipation, especially if he also has other symptoms, like weakness and poor muscle tone, ask your doctor about botulism.

Diet Treatment for Children
Constipation in children is best done by making changes in your child’s diet. Some things that you can do to treat and prevent constipation in your children include:

Increasing fluids: Increase the amount of water and fruit juices (minimum of 2-3 glasses) that your child drinks each day.
Increasing fiber: Increase the amounts of fruits and vegetables that your child eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas, turnip greens, raw tomatoes and corn) have the most fiber. Popcorn also has lots of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each day (check the nutritional label for high fiber foods and snacks with at least 3-4g of fiber per serving). Vegetable soups are especially high in fiber and also add more fluid to your child’s diet.

Increasing bran in your child’s diet by offering bran cereals, bran muffins, shredded wheat, graham crackers, or whole wheat bread.

Decreasing constipating foods: The foods most notorious in causing constipation include cow’s milk, yogurt, cheese, cooked carrots, and bananas. Drinking too much milk (your child may only be drinking 2-3 cups a day, but it may be too much for his system to handle) is heavily associated with having constipation. Switching to soy milk has been shown to soften stools. If your child is unable to drink milk, then offer a daily multivitamin or other sources of calcium (such as calcium fortified orange juice).

Stool Softeners
Most of these medicines for constipation are available in the pharmacy over the counter and do not require a prescription. They include Metamucil, Milk of magnesia, Citrucel, or mineral oil.

Unlike laxatives in adults, they are generally not considered to be habit forming. You should use them once or twice a day and work up on the dose until your child is having a soft BM each day. If you child starts to have diarrhea, then you are giving too much and you should cut back on the dose. See the table below for dosing information for treatment of children with constipation.

Senokot is also often commonly used in children, but it is actually a stimulant laxative and not a stool softener, so you may not want to use it for long periods of time.

A newer medicine, Miralax, is available only by prescription to treat constipation, but is very effective.

Changing doses of Stool Softeners
Once your child is having 1-2 soft stools each day you should continue with the doses of the medicines that you are using for 6-12 months until he is accustomed to his new non-constipating diet. You can then gradually stop the stool softeners by slowly lowering the amount you are giving every 1-2 weeks.

If stools are too loose then cut back on the dose by one-third. If stools are still too hard then increase the dose by one-third. Avoid making changes in the medicines based on one bowel movement, or you will wind up ‘seesawing’ with the doses.

Treatment for Acute Constipation
If your child has been constipated for a long time or he is having discomfort or significant pain with bowel movements then you may need to ‘clean out’ backed up stool before the stool softeners will work by using an enema, a glycerine suppository or high doses of mineral oil. See your pediatrician for information on how to start begin this treatment for acute constipation.

Behavior Modification
You should encourage your child to have regular bowel patterns. Have your child sit on the toilet for about ten minutes after meals 1-2 times each day.

The use of simple rewards or a daily calendar with stars or stickers for days that your child takes his medicine and has a bowel movement may be helpful.

Important Reminders
Be patient. Constipation in children is a chronic problem that can take time to improve. Avoid embarrassing or punishing your child.
Avoid the frequent use of enemas or suppositories.
Call your pediatrician if your child’s constipation is not improving in 2-3 weeks, if he is regularly needing to use enemas or suppositories, or he is soiling his pants because of leakage of stool

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Allergies and colds can cause your nose to become stuffed up. Both cause minor discomfort and may affect your concentration toward daily tasks during daytime hours. At night, it keeps you from receiving a full night’s rest. While congestion is inevitable during allergy and cold seasons, there are solutions that will provide temporary relief to get through the tough times.

Blow your nose with facial tissue. Cover one nostril with the end of the tissue and exert nasal force to blow out mucus and other contaminants through the other nostril. Repeat with the other nostril. Do this daily until symptoms disappear.

Step 2 Prop two fairly firm pillows on top of each other. If you only have soft pillows, you may try stacking three pillows. As you lie down, the pillows will raise your head above your vertical body to help clear up congestion in your nose.

Step 3 Turn up the humidifier to increase moisture in your room. This is especially helpful during the nighttime hours, so that you can enjoy continuous nights of uninterrupted sleep.

Step 4 Bir antihistaminik hap veya jel kap Ingest sizin alerjik rahatlatmak için. Birçok alerji ilaçları 24 saat her hap kadar geçen şekilde tasarlanmıştır yutulur. Mümkünse, marka olmayan teşvik uykulu kabartma böylece Belirtiler gün boyunca uykulu yapmadan rahatlamış olacaktır seçin. Tıkanıklığı için soğuk algınlığı için, Tylenol soğuk algınlığı ve grip veya Sudafed gibi markalar nedeniyle deneyin.

Tips & Warnings
The solutions suggested in this article will only provide temporary relief. If allergy or cold symptoms persist more than a week, your doctor may have to prescribe medication before your nose will become unplugged.

Stuffy Nose or Sinus Problems? Here’s a Fix

Thirty-six million Americans have chronic sinus troubles. Millions more—perhaps 1 in 7 people—suffer from rhinitis, a fancy name for stuffy nose. All together, that’s a lot of people who could benefit from fast, easy, cheap symptom relief. As it turns out, one of the most effective treatments for nasal and sinus problems is also the simplest, safest, and cheapest: a saltwater nose rinse. Squirting salt water into the nose works much better at relieving symptoms than commercial saline nose sprays, new research says.

Granted, the idea of squirting water up one’s nose has a certain “ick” factor. But “almost all of the patients I see, no matter how I treat them or what I treat them for, benefit from nasal irrigation,” says Melissa Pynnonen, an assistant professor of otolaryngology at the University of Michigan who specializes in treating chronic sinusitis. Most doctors who don’t specialize in it tend to recommend over-the-counter nose sprays to their patients, Pynnonen says. She and colleagues at the University of Michigan tested saline nose sprays and saline rinses in 121 adults, all of whom had stuffiness, sinus pain, and other chronic nasal and sinus symptoms. All reported fewer symptoms after eight weeks of treatment with either saline nose spray or a twice-daily rinse with 8 ounces of salt water, using a plastic squeeze bottle. But the nasal rinse group showed far greater improvement in severity and frequency of symptoms, with 40 percent of the rinse group saying they still had symptoms “often or always,” compared with 61 percent of the spray group.

“Most patients, by the time they come to my office, they’re so bothered by the symptoms that they’re beyond the ick factor,” Pynnonen says. “I tell them that it’s a strange sensation; nobody really likes the idea of doing it. But most patients, once they try [a rinse], they realize that it helps, and they don’t want to stop doing it.” Her study was published in the November Archives of Otolaryngology.

Otolaryngologists and allergists say they’ve known for decades that saline rinses help, and they often recommend them, particularly for people with sinus infections or who have had sinus surgery. Recent research, including a July 2007 analysis by the Cochrane Review, finds consistent benefits. Indeed, the whole idea of nose washing as good hygiene is thousands of years old. Indian neti pots have been sold for years in health-food stores, and drugstores now stock an assortment of saline sprays and squeeze bottles.

“A lot of people just have a plugged nose,” says Sheldon Spector, a clinical professor of medicine at UCLA and head of the California Allergy and Asthma Medical Group in Los Angeles. A few years ago, Spector reviewed older studies of saline rinses and found that rinsing improved air flow and also reduced the number of eosinophils, white blood cells that play a key role in inflammation and allergic symptoms.

The allergists and ENTs agree that people aren’t as aware of the virtues of saline rinses as they should be. Doctors often forget to mention it, says Brad Marple, a professor and vice chairman of the department of otolaryngology at the University of Texas Southwestern Medical Center in Dallas. “It doesn’t have the glamour and panache of surgery or many of the pharmaceutical products,” Marple says. “There isn’t a company that’s making a huge amount of money off of salt water. But the bottom line is, you’d be hard pressed to find people who don’t benefit.” Not only can patients reduce the need for antibiotics or surgery, he says, but it’s one of the rare medical treatments where patients are in control.

Nose washing can be a do-it-yourself affair. Here’s Pynnonen’s home recipe:

•¼ teaspoon of kosher salt (kosher salt has no iodine or other additives)
•¼ teaspoon of baking soda (to buffer the solution and make it less irritating)
•8 ounces of water
Mix and squirt gently in each nostril with a squeeze bottle.

Drugstores stock squeeze bottles designed for nasal rinsing; brand names include NeilMed, Grossan, and Ayr. These companies also sell premeasured saline packets, which are particularly handy for traveling. Some doctors recommend using distilled water or boiling the water first and letting it cool, particularly if the home water supply comes from a well that may have bacteria. The squirt bottles need to be washed periodically with hot soapy water and should be replaced “as often as you replace your toothbrush,” Pynnonen says, because bacteria gradually build up in them. There’s a lot of debate on Internet sites on what saline solution works best, hypertonic (more salt) or hypotonic (less salt). The studies conflict on that point, and Pynnonen thinks it doesn’t really matter. The take-home point: A well-washed nose is a happier, healthier nose.

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How to Tell if You Have Early Labor Pains

When you are nearing the end of your pregnancy, you will likely have many aches and pains and you think that each one is the beginning of labor. Some early labor pains are not labor at all, but false labor, which is called Braxton-Hicks contractions. They do start off in the same way as labor pains in that they feel like hard menstrual cramps, but they do not intensify and eventually stop. The early signs of labor vary from one woman to another, but most report that they do have crampy pains very similar to menstrual cramps that do start to get more painful and closer together.

During labor, the muscles of the womb start to contract to push the baby through the birth canal. They start in the upper portion of the uterus causing this part of the uterus to become tight and thicker. Generally, women report the feeling of a dull aching pain in their lower back and say they do not even realize it is the start of labor because they have no pain in their stomach. It is also possible to have aches and pains in your sides or even your thighs. The contractions occur in waves and could be 10 or 15 minutes apart at first, which is why many women don’t even realize that this is what they have been waiting for. Even in early labor, if you place your hand on your stomach you will feel that it is really tight and tense.

The contractions occur and then you have a period of relief from the pain. In order to time the period between contractions, you start timing when the contraction stops and stop when another contraction begins. If you are truly in the early stages of labour, this time period will become shorter and shorter. You can also time the duration of the contraction to see how long it lasts. As the space between the contractions decrease, the duration of the contractions increase.

Doctors will tell you that when you find your contractions lasting for one minute and occurring five minutes apart, then it is time for you to call your doctor and to go to the hospital. Your water may or may not have broken and you probably didn’t notice that the mucous plug has been released from the cervix. However these are questions that you doctor will ask. Leave yourself plenty of time to get to the hospital, but if you are a new mother you can probably delay this until the contractions become so intense that you find it difficult to breathe through them.

There are stages of labor, just as there are stages of pregnancy. In the early stage, the cervix is just starting to dilate. This first stage can last for many hours until the cervix is completely dilated. First time mothers usually have a longer first stage of labor than they will with subsequent births. The second stage is much shorter and ends with the third stage, which is the birth of the baby.

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Nosebleeds
What should I do when I get a nosebleed?
A nosebleed can be scary to get — or see — but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will slow the bleeding. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can cause irritate your stomach.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don’t let go for at least 5 minutes. If it’s still bleeding, hold it again for another 5 to 10 minutes.

Once the bleeding stops, don’t do anything that may make it start again, such as bending over or blowing your nose.

Why do people get nosebleeds?

The nose is a part of the body rich in blood vessels (vascular) and is situated in a vulnerable position as it protrudes on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to bleeding if they are taking medications which prevent normal blood clotting warfarin (Coumadin), aspirin, or any anti-inflammatory medication]. In this situation, even a minor trauma could result in significant bleeding.

The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. In addition, changes from a bitter cold outside environment to a warm, dry, heated home results in drying and changes in the nose which will make it more susceptible to bleeding. Nosebleeds also occur in hot dry climates with low humidity, or when there is a change in the seasons. The following factors predispose people to nosebleeds:

•Infection

•Trauma, including self-induced by nose picking

•Allergic and non-allergic rhinitis

•Hypertension (high blood pressure)

•Use of blood thinning medications

•Alcohol abuse

•Less common causes include tumors and inherited bleeding problems

How do you stop the common nosebleed?

Most people who develop nose bleeding can handle the problem without the need of a physician if they follow the recommendations below:

1.Pinch all the soft parts of the nose together between your thumb and index finger.

2.Press firmly toward the face – compressing the pinched parts of the nose against the bones of the face.

3.Lean forward slightly with the head tilted forward. Leaning back or tilting the head back allows the blood to run back into your sinuses and throat and can cause gagging or inhaling the blood.

4.Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding.

5.Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs.

6.Apply ice (wrapped in a towel) to nose and cheeks.

How do you prevent the nose from bleeding again?

1.Go home and rest with head elevated at 30 to 45 degrees.

2.Do not blow your nose or put anything into it. If you have to sneeze, open your mouth so that the air will escape out the mouth and not through the nose.

3.Do not strain during bowel movements. Use a stool softener (for example, Colace).

4.Do not strain or bend down to lift anything heavy.

5.Try to keep your head higher than the level of your heart.

6.Do not smoke.

7.Stay on a soft, cool diet. No hot liquids for at least 24 hours.

8.Do not take any medications that will thin the blood [aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or warfarin (Coumadin)]. If these have been prescribed by your physician, you need to contact them regarding stopping these medications.

9.Your doctor may recommend some form of lubricating ointment for the inside of the nose (see below).

10.If re-bleeding occurs, try to clear the nose of clots by sniffing in forcefully. You can temporarily use a nasal decongestant spray, such as Afrin or Neo-Synephrine. These types of sprays constrict blood vessels. (NOTE: If used for many days at a time, these can cause addiction and do not use if you have high blood pressure.)

11.Repeat the steps above on how to stop the common nose bleed. If bleeding persists, call the doctor and/or visit to the emergency room.

What precautions can you take to prevent nose bleeding?

The most common cause of a nose bleeds is drying of the nasal membranes. If you are prone to recurrent nosebleeds, it is often helpful to try lubricating the nose with an ointment of some type. This can be applied gently with a Q-tip or your fingertip up inside the nose, especially on the middle portion (the septum). Many patients use A & D ointment, Mentholatum, Polysporin/Neosporin ointment, or Vaseline. Saline mist nasal spray is often helpful (Ocean Spray).

When should you call your doctor or report to the emergency room?

•If bleeding cannot be stopped or keeps occurring.

•If bleeding is rapid, or if blood loss is large.

•If you feel weak or faint, presumably from blood loss.

If the nosebleed persists or is recurrent, see your doctor, who may then recommend stopping the bleeding with a heating instrument or chemical swab (cautery of the blood vessel that is causing the trouble) or application of a topical medicine called thrombin that promotes local clotting of blood. Blood tests may be ordered to check for bleeding disorders. If bleeding is still persistent, the doctor may place nasal packs, which compress the vessels and stop the bleeding. In rare situations, you may be admitted to the hospital or require surgical treatment or a procedure where material is used to plug up the bleeding vessels in the nose (angiographic embolization).

What should I do if the doctor has placed nasal packs?

Nasal packs are used when less conservative measures fail (see above). These packs are frequently placed in both sides of the nose. The packs are usually made of a material called “Merocel” which is a compressed sponge-like material used to help compress the area of the nose that is bleeding. The doctor usually does not remove them for several days (two to three days). This requires a follow-up appointment.

You will need someone to drive you and bring you home after the nasal packs are removed. During this time, you may be prescribed antibiotics and pain medications as needed.

It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. Your doctor may permit you to clean your nostrils with hydrogen peroxide soaked Q-tips. Finally, you should consider the prevention methods described above to help to avoid bleeding again.

Remember, patients with nosebleeds should not to take aspirin or any other blood thinning products. If patients are already taking these medications when the nosebleed is noticed, they should consult their healthcare practitioner.

Nosebleed At A Glance

•Nosebleeds are common due to the location of the nose on the face, and the large amount of blood vessels in the nose.

•The most common cause of nosebleeds is drying of the nasal membranes and this can be prevented with proper lubrication of the nasal passages and not picking nose.

•Most nosebleeds can be stopped at home.

•Consult a doctor for a nosebleed if bleeding cannot be stopped, there is a large amount of blood lost, or you feel weak or faint.

•A doctor may use nasal packs to stop nosebleeds when conservative measures fail.

•Do not take aspirin or other blood thinning products when you get a nosebleed (if they are doctor-prescribed, consult your doctor before stopping any medication).

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Cracked and Fractured Teeth

Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits. Particularly, clenching, grinding, and chewing hard things such as ice can result in cracks and fractures in teeth. Typically teeth with cracks/fractures do not show on radiographs (x-rays). Hence, cracked and fractured teeth can especially be difficult to locate. When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated. Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity. In time the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on it’s own.

How do I know if my tooth is Cracked or Fractured?

Does your tooth feel like it “zaps” you when bite on it? Well, that’s not enough to know it’s cracked or fractured. Unfortuantely, cracked and fractured teeth exhibit a variety of symptoms. If your tooth is cracked/fractured, you might feel occasional pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks and fractures are fairly difficult to diagnose because the pain comes and goes, and cracks/fractures only rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.

Don’t all Cracked/Fractured teeth hurt?

Not all cracked and fractured teeth hurt. It really depends on the severity of the crack and the pulps response to the irritants allowed into the tooth. Commonly it’s not until they become symptomatic that we get involved. A crack/fracture can make the tooth sensitive due to movement of the fractured tooth pieces and/or leaking irritants into the pulp and even allow bacteria to come right in causing eventual infection of the tooth. Let’s take a closer look at a normal healthy tooth.

Inside the tooth, under the white enamel is a hard layer called the dentin, and there is the inner soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue. The pulp is a vestige of what originally formed your tooth when you were a kid!

When the outer hard tissues of the tooth are cracked, the chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

How can you check to see if my tooth

has a crack and/or fracture?

No single test or technique provides the correct diagnosis 100% of the time. In fact, if a restoration is present, it can become quite difficult to diagnose without removing the restoration or drilling a hole into the tooth. Most of the time we use a transilluminating light and see if the light transmits from one side of the tooth to the other. Of course, fillings don’t transmit the light the same so it’s even harder to tell when cracks or fractures are present in teeth with restorations. A trained eye can spot the difference.

Normal tooth
Probable cuspal fracture
A biting test can be performed. We concentrate the biting forces commonly using an instrument as seen below. This can isolate specific areas of the tooth that might be sensitive to bite, but does not tell us the underlying cause of the discomfort.

Tooth Slooth Biting Test on each Cusp
Sometimes some dye might be used to temporarily stain the tooth, and check to see if a tooth is fractured. It is then washed off and evaluated. This is most commonly done once access to root canals is obtained.

Stained Cracked Tooth

(Blue Stain Can be fully removed after diagnosis)

Are All Cracks and Fractures

seen on the outside of teeth Bad?

Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment. They do NOT extend into dentin. Hence, these cracks are observed in most teeth and are considered normal. They are the result of “wear and tear” on teeth.
Hence, the answer is no, not all cracks seen on the outside of teeth are bad.

Does my Cracked or Fractured tooth need to be Treated?

That depends. If the crack/fracture is caught early enough, often times only a restoration that holds the tooth together will be needed. Once the pulp begins to degenerate and/or becomes infected, it must be treated endodontically if the tooth is going to be maintained. Like cracks in a windshield, cracks in teeth can often remain small or progress slowly over time. I believe that the sooner a crack or fracture is detected and appropriate treatment delivered, the better the chance of maintaining your tooth.

How will my cracked/fractured tooth be treated?

The treatment of your cracked tooth depends on the

type, location, and severity of the crack.

All of the common cracks and fractures of the crown region start on the surface and work there way into the tooth toward the end of the root.

Common Cracks and Fractures of the Crown region

(Top Part of the tooth above the gumline)

Cuspal Fracture
Cracked Tooth Split Tooth

Cuspal Fracture: When a cusp or the pointed part of the chewing surface of your tooth becomes weakened, the cusp will fracture. Part of the cusp may break off or may need to be removed by your dentist. Depending upon the extent of the fracture, the pulp may also become damaged. Endodontic therapy is needed when the pulp is damaged beyond repair and a crown will be placed to help protect the tooth and replace the fractured tooth structure.

Cracked Tooth: This type of crack extends from the chewing surface of the tooth vertically towards the root and sometimes below the gum line. A cracked tooth is not completely split into two distinct movable segments. If caught early enough, the tooth is usually crowned but endodontic therapy may be needed at a later date (typically in the first 6 months). Nonsurgical endodontic therapy (root canal) will be needed when the pulp becomes substantially injured or exposed. During endodontic therapy the inside crown portion of the tooth is stained with a temporary dye and viewed microscopically for the extent of the fracture. Prognosis depends on the severity of the crack. A full crown is needed to hold the tooth together.

Split Tooth: A split tooth is a cracked tooth in which the crack has progressed so there are 2 distinct segments that can be separated from one another. Unfortunately, with today’s technology, a split tooth can never be saved intact. The extent and position of the crack will determine if any portion can be maintained but most of these teeth will be extracted. In rare instances, endodontic treatment, possibly some gum surgery, and a crown may be used to retain a portion of the tooth.

After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.

How long will a cracked or fractured tooth last?

Good question. I don’t have a really good answer though. It seems somewhat related to if the crack/fracture extends below the gum line alot. The problem is it’s like a crack in a windshield, it can stay the same or spread. This means it’s difficult to predict how long a fractured/cracked tooth will be maintained in your mouth. I’ve got one and have had the tooth for 13 years without any problems, but I can’t say if that’s what will happen in your case. The good news is they have good success rates, typically 70% I believe.

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

Don’t chew on hard objects such as ice, unpopped popcorn kernels or pens.

Don’t clench or grind your teeth.

If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.

Wear a mouthguard or a mask when playing contact sports.

If you experience symptoms of a fractured or cracked tooth, see your dentist immediately. If detected early, a cracked/fractured tooth can often be more likely to be maintained.

Fractures of the Root which start below the Gumline

Vertical Root Fractures or ‘Split Root’

VRF

Signs & Symptoms Typically symptoms are associated with a tooth that has had endodontic therapy. If you have persistent symptoms which do not appear on a radiograph or x-ray, you tooth may have a tiny fracture in the root but keep in mind other causes can produce the same symptom. Also these teeth commonly present with bone loss around an entire root in more advanced fractures and often go unnoticed until surrounding bone and gums become infected.

Causes Commonly a complication from endodontic therapy. Sometimes believed to exacerbated by large post placement.

Diagnosis In many cases, endodontic micro surgery allows the visualization of your root to determine the problem. The gums are reflected to expose the root and a stain or dye used to make the fracture more noticeable. Sometimes during the retreatment process, the use of a microscope can detect the fracture as long as it’s not around a curve. If a fiberscope can be placed, that may also be used for diagnosis of this type of fracture.
Direction of Fracture Vertical root fractures begin in the root typically near the end and extend toward the chewing surface.
Treatment Treatment for a single rooted teeth is usually extraction. Multirooted teeth may have the affected root removed in some cases.

http://www.endodovgan.com/Endoinfo_Cracked_Fractured.htm

Craze lines

Most adults have have craze lines and they cause little concern. They are tiny cracks that only affect the outer enamel of the tooth, are painless and may affect the cosmetic appearance of the tooth. These lines allow light to pass through them to light up the whole crown of the tooth. If there is a crack, light will not pass through.

Fractured Cusp

When a cusp becomes weakened, a fracture may result. A fractured cusp rarely damages the pulp. This tooth will need to be restored with a full crown.

Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. Damage to the pulp is common. A root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth.

Split Tooth

A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. The position and extent of the problem will dictate whether any portion of the tooth can be saved.

Vertical Root Fracture

A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Treatment may involve root surgery if a portion of the tooth can be saved extracted.

________

Cracked Tooth Syndrome

Cracked tooth syndrome is a very common problem that affects teeth that have large fillings in them. Decay and large fillings causes a weakening in the remaining tooth structure over time. A hairline fracture often develops at the bottom corner of the filling.

Grinding your teeth will cause massive increase in the stress and stain on your premolars and molars increasing the risk of this condition. Also, having worn down fillings or canines will increase your risk factors toward this condition.

The reason it hurts to bite when you have a cracked tooth is the fact that your tooth is flexing which microscopically stimulates the nerve in the tooth. These hairline cracks open and close which applies pressure on tubules that run down the nerve of the tooth causing fluid to push and pull on the tooth’s nerve resulting in pain. The nerve in the cracked tooth is also being exposed to bacterial toxins that become inflamed making it sensitive allowing infection to spread to the nerve and bone tissue underneath resulting in an abscess. If the crack goes untreated it will spread and deepen like a crack in glass and a part of the tooth may break off causing a need for a root canal or extraction.

________

Symptoms:

Sensitive to hot and cold
Pain upon release of biting pressure which may come and go when you release from biting because the crack will close quickly causing pain.

________

Clinical Test To Check Diagnosis

The only way to diagnose a fracture is through interpreting a tooth’s response to temperature and touch.

Thorough dental history.
Check for a history of trauma, clenching or bruxism and chewing habits like, ice
History of bite adjustments
Examine the teeth with an explorer
Check hot and cold sensitivity. If a sharp pain is felt with temperature, and the pain rapidly diminishes with removal of the stimulus, then a fracture is more likely.
Probe the gum tissue for pocketing
Check for a cracked filling
Using a cotton roll, rubber wheel or bite stick, you will be asked to bite down liken on chewing gum to help isolate each tooth
X-ray films.
A filling might need to be removal to help visualize the crack and assess nerve involvement.

________

Solution

A fracture will probably not improve and will eventually need to be treated. Teeth do have a limited ability to heal themselves. Unfortunately, fractured teeth do not heal themselves like other bones in your body. The only real solution to hold the tooth together and to prevent the tooth from breaking is with a crown. A crown will allow chewing forces to move the whole tooth rather than splitting it apart. This full crown is bonded over the entire tooth to seal all the small cracks and prevent bacterial leakage thus allowing the nerve to recover and stabilize.

________

Considerations

About 10% of cracked teeth have nerves that can still die and need root canal treatment. Early treatment can help to minimize this from happening. If you decide to refuse treatment for this condition remember that that tooth is like a ticking time bomb that will suddenly flare up and cause sever pain, swelling, pus and possible bone loss that will put stress on your immune system and may affect your overall health.

________

Broken Tooth What causes teeth to break?

One factor is silver fillings. These fillings have been found to enlarge as they age which may cause some outward pressure as you chew or bite. Over time this can cause a broken tooth. A more common type of fracture is when the inside area of the tooth breaks off, this fracture can usually be easily repaired. Bruxism is one of the most common causes of teeth breaking.

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The word rheumatism is derived from the Greek word ‘rheuma’, which means a swelling. It refers to an acute or chronic illness which is characterized by pain and swelling of the muscles, ligaments and tendons, or the joints

Rheumatism symptoms
Fever, pain, intense soreness and stiffness
The onset of the acute variety of rheumatism is characterized by fever, intense soreness, and pain. In the acute muscular type, the area becomes so sensitive that even the weight of bed clothing aggravates the pain. It may settle into a chronic state under a wrong mode of treatment. If the disease is not treated properly in the acute stage, it may become chronic. The symptoms of chronic muscular rheumatism are pain and stiffness of the affected muscles. In the case of chronic articular rheumatism (pain in the joints), pain and stiffness are felt in one or more joints of the body, with swelling in most cases

Rheumatism causes
Rheumatism Symptoms, Causes, Remedy and Diet
Toxic waste products in the blood
The chief cause of rheumatism is the presence of toxic waste products in the blood. The liberal consumption of meat, white bread, sugar, and refined cereals leaves a large residue of toxic wastes in the system. When the vitality is low, the toxic wastes are concentrated around the joints and bony structure, where they form the basis of rheumatism

Infection of teeth, tonsils and gall-bladder
In certain cases, infection from the teeth, tonsils, and gall-bladder may produce rheumatism. The disease is aggravated by exposure to cold water

Home Remedies for Rheumatism
Rheumatism home remedies and natural cures, Questions and answers

Rheumatism treatment using Potato Juice
The juice of raw potato is regarded as an excellent remedy fur rheumatism. One or two teaspoons of the juice, taken out by pressing mashed raw potatoes, should be taken before meals. This will help to eliminate the toxic condition and relieve rheumatism. The skin of the potato is also an excellent remedy fur rheumatism. The skin is exceptionally rich in vital mineral salts, and the water in which the peelings are boiled is one of the best medicines for ailments caused by excess toxic matter in the system. Approximately thirty grams of the potato peelings should be thoroughly washed and boiled in half a litre of water till it is reduced to half. The decoction should then be strained and a glass of the same should be taken three or four times daily

Rheumatism treatment using Bitter Gourd
Bitter gourd is considered beneficial in the treatment of rheumatism. A cup of juice, extracted from the vegetable, should be mixed with a teaspoon of honey, and taken daily for treating this condition. This treatment should be continued for at least three months to provide relief

Rheumatism treatment using Celery
Celery is another effective remedy for rheumatism. A fluid extract of the seeds is more powerful than the raw vegetable. This also has a tonic action on the stomach and kidneys. Five to ten drops of this fluid should be taken in hot water before meals. Powdered seeds can be used as a condiment

Rheumatism treatment using Lemon
Lemons are beneficial in the treatment of rheumatism. The patient should take the juice of two or three lemons each day. This will bring good results

Rheumatism treatment using Walnuts
Walnuts are valuable in rheumatism. They should, however, be thoroughly masticated to achieve beneficial results. Half a dozen can be taken daily in the treatment of this condition

Rheumatism treatment using Rhubarb
The herb rhubarb has been found valuable in rheumatism. The green stalks of this herb should be pounded with an equal quantity of sugar. A teaspoonful should be taken three or four times a day. This remedy seldom fails

Rheumatism diet
Rheumatism : Home Remedies suggested by users
Orange juice and water
In the case of acute rheumatism, the patient should be put on a short fast of orange juice and water for three or four days. After the juice fast, the patient should be placed on a restricted diet for fourteen days. In this regimen, orange or grapefruit may be taken for breakfast; lunch may consist of raw salad of seasonal vegetables with raisins, prunes, figs, or dates; and dinner may comprise of one or two steamed vegetables

Well-balanced diet
Thereafter, the patient may gradually adopt a well-balanced diet consisting of seeds, nuts, grains, vegetables, and fruits. In case of chronic rheumatism, the patient may be placed on an all-fruit diet for four or five days. He may, thereafter, gradually adopt a well-balanced diet. The patient should take ripe fruits, fresh vegetables, and buttermilk in abundance

Avoid meat, indigestible and highly-seasoned foods
He should avoid all meat and fish; white bread, sugar, and refined cereals; rich, indigestible and highly-seasoned foods; tea and coffee; alcohol; sauces, pickles, and condiments

Other Rheumatism treatment
Warm-water enema
In the case of acute rheumatism, the bowels should be cleansed daily with a warm-water enema during the first three or four days of the juice fast

Appply heat and hot packs to the affected parts
Other helpful methods in the treatment of rheumatism are application of heat and hot packs to the affected parts, a hot tub bath, a cabinet steam bath, dry friction, and a sponge bath

Hot Epsom salts bath
Hot Epsom salts baths are also beneficial and should be taken twice a week for three months in case of chronic rheumatism and once weekly thereafter. The affected parts should also be bathed twice daily in hot water containing Epsom salts, after which some olive oil should be applied

Fresh air exposure and light outdoor exercises
Fresh air, deep breathing, and light outdoor exercises are also beneficial

Avoid dampness and cold
Dampness and cold should be avoided

Rheumatism

Rheumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue.[1] The study of, and therapeutic interventions in, such disorders is called rheumatology.

Terminology
The term “rheumatism” is still used in colloquial speech and historical contexts, but is no longer frequently used in medical or technical literature; there is no longer any recognized disorder simply called “rheumatism.” Some countries use the word Rheumatism to describe fibromyalgia syndrome. The traditional term covers such a range of different problems that to ascribe symptoms to “rheumatism” is not to say very much. Nevertheless, sources dealing with rheumatism tend to focus on arthritis. However, “non-articular rheumatism”, also known as “regional pain syndrome” or “soft tissue rheumatism” can cause significant discomfort and difficulty.[2] Furthermore, arthritis and rheumatism between them cover at least 200 different conditions.

The term “Rheumatic Diseases” is used in MeSH to refer to connective tissue disorders.[3]

Palindromic rheumatism has been theorized to be a form of rheumatoid arthritis.[4]

Types
The major rheumatic disorders currently recognised include:

Ankylosing spondylitis
Back pain
Bursitis/ Tendinitis, Shoulder pain, wrist, biceps, leg, knee (patellar), ankle, hip, and Achilles
Capsulitis
Neck pain
Osteoarthritis
Psoriatic arthritis
Rheumatic fever
Rheumatic heart disease (a long-term complication of Rheumatic fever)
Rheumatoid arthritis
Systemic lupus erythematosus
Temporal arteritis and Polymyalgia rheumatica
Tenosynovitis.
Although these disorders probably have little in common in terms of their epidemiology, they do share two characteristics: they cause chronic (though often intermittent) pain, and they are difficult to treat. They are also, collectively, very common.

Treatment
A vast number of traditional herbal remedies were recommended for “rheumatism”. Modern medicine, both conventional and complementary, recognises that the different rheumatic disorders have different causes (and several of them have multiple causes) and require different kinds of treatment.

Nevertheless, initial therapy of the major rheumatological diseases is with analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), members of which are ibuprofen and diclofenac. Often, stronger analgesics are required.

“Rheumatism” and weather
There has long been said to be a link between “rheumatic” pain and the weather. There appears to be no firm evidence in favour or against; a 1995 questionnaire given to 557 people by A. Naser and others at the Brigham and Women’s Hospital’s Pain Management Center concludes that “changes in barometric pressure are the main link between weather and pain. Low pressure is generally associated with cold, wet weather and an increase in pain. Clear, dry conditions signal high pressure and a decrease in pain”.[

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How to Look After A Newborn Baby

If you’re a new mother or are pregnant with your first child, you are probably excited but are feeling a bit worried about how to look after your newborn. Well, have no fear, this is completely normal and many mothers, just like you, feel the exact same way. In this article, we will provide you with some basic tips on how to look after a newborn baby. So, without further adieu, let’s get started

Take care of your needs first. It’s true that you will need to put much time and energy into caring for your newborn baby however you absolutely can’t ignore your own needs. Therefore, you must eat properly, rest when you can, and get some exercise. In addition, you must find time each and every day to relax and regroup so that you can deal with the demands of your baby. Many mothers find that a thirty minute break away from the baby will do wonders for their emotional and physical health.

Step 2 Don’t expect to be perfect. Forget about keeping your house squeaky clean. Instead, realize that you and your baby’s health and happiness is more important than a clean house. Therefore, do what you can with the housework and don’t worry about being the perfect housekeeper.

Step 3 Ask for help. Don’t be afraid to ask your spouse, friends, and relatives to help you look after your newborn. No one expects you to do everything yourself and it is perfectly fine to get support and help. In fact, most people who care about you would be happy to assist you with the care and ease the burden. So, seek out their assistance as much as possible.

Step 4 Be gentle and properly support your baby when holding them. Whenever you hold your baby, support their neck and back with your hands because they can’t hold up their heads and newborns have very fragile bones. In addition, never shake your baby as this can cause “shaken baby syndrome” which could have deadly consequences.

Step 5 Put your newborn baby to sleep on their back. Medical professionals believe that this can help prevent babies from suffocating and may also prevent SIDS (Sudden Infant Death Syndrome).

Step 6 Feed your newborn baby frequently. Newborns should be fed formula or nursed frequently. For instance, most babies will eat 8 to 12 times per day during the first month. Most medical professionals strongly recommend that you feed your newborn on demand or whenever they display signs of hunger. In addition, many of them don’t think that you should let newborns sleep longer than 4-6 hours without feeding.

Step 7 Burp your newborn baby after each feeding session. To avoid gas, your baby must be burped after each and every feeding. To do this, you should gently place your baby on your shoulders and gently pat his back until she burps.

Step 8 Use mild soaps and shampoo when bathing baby. Babies should really only be bathed 1-2 times a week as too much washing can dry out their skin. In addition, when bathing your baby use mild soaps and warm water. Never rub their skin too abrasively as this can cause skin irritation.

Step 9 Never leave your baby unattended in the bath or on an unbuckled changing table any time. Instead, always keep your newborn in your sight at arm’s reach to avoid an accident. In addition, when washing your newborn’s hair, don’t get the inside of their ears wet as this can cause an ear infection.

Step 10 Prevent diaper rash with proper care. The best way to prevent diaper rash is to change your baby’s diaper before or after each feeding and immediately after they have a bowel movement. In addition, gently wash the area with an unscented wet wipes or water and a towel. Do not allow your baby to sit in a dirty diaper as this can cause irritation. In addition, you may wish to use approved diaper rash cream after each diaper change if your baby is prone to diaper rash.

Step 11 Use the right size diaper to avoid leaks. That is, your baby’s diaper needs to be snug but not too tight. If it is too tight it can pinch or cause their delicate skin to become irritated and if it is big then it can leak.

Step 12 Trust your instincts. If something doesn’t seem right with your baby, call your medical professional right away. Don’t worry about overreacting or appearing ridiculous. It is more important to take care of your baby if they need assistance. So, if you chave any questions, call your newborn’s pediatrian.

Step 13 In conclusion, you can successfully look after a newborn baby. Just make sure that you take care of your needs first, don’t expect perfection, ask for help, properly support your baby, put baby to sleep on back,feed and burp newborn frequently, never leave baby unattended, use mild shampoos, prevent diaper rash, use right size diaper, and trust your instincts.

You and Your Newborn Baby: a guide to the first months after birth
by Linda Todd

Regardless of whether labor is long or short, whether it is hard or easy whether a baby is born vaginally or by cesarean, most parents recall the first hours and days after birth as crystal-clear images surrounded by haze. It is in this haze that you first take in your baby and make a giant leap from pregnancy to parenting.

Despite all the anticipatory parenting done before conception and during pregnancy, despite weeks of feeling movement within and fantasizing about your baby, despite months of having strange dreams, worrisome thoughts, and musings about what kind of parent you will be, the first time you hold your baby in your arms and call yourself mother or father, mama or papa, mommy or daddy, an awareness floods over you that life will never be the same again. Another human being is now dependent upon you for survival. More than anything else, you want to be the best parent possible.

Your awareness of your baby’s dependency and your desire to be a good parent will together be a great source of energy and a great source of stress. Both are part of being a parent.

Becoming a good parent means much more than knowing a lot about babies. Ask pediatric doctors or nurses what it was like for them to be new parents. They will tell you that all their knowledge about babies was not enough to keep them from being over whelmed by their own babies. All new parents feel the same way. All new parents work at knowing, understanding, and loving their babies. Your baby will work just as hard at learning to know, understand, and love you. This is the process of attachment-the work that parents and babies do together to form a deep and lasting love. It is what becoming a family is all about.

This book is written to give you some help as you make the transition from pregnancy to parenting. It offers ideas on things you can do to make this time of change easier. It is written as much to encourage as to teach you. Besides providing the information you need about taking care of yourself and your baby, it can help build your confidence in your own wisdom about your family’s needs. You will find the postpartum period easier if you know what to expect during this time, if you actively participate in health-care decisions, and if you build a network of support that nurtures your growing family.

New families in the United States face some challenges that families in most other countries do not. In the United States, where nearly 99 percent of women give birth in hospitals, the average hospital stay after childbirth is two days for a woman who has given birth vaginally, three to four days for a woman who has given birth by cesarean. In many communities, new families are discharged from the hospital within twenty-four hours of birth. Such early discharge will probably become the norm by the year 2000.

In most other countries, both industrialized and developing, the postpartum period is seen as being at least as important as the prenatal period. Because of this, women giving birth in hospitals have longer stays. More importantly, services are brought to the homes of new families. No matter how long the stay in a hospital or birth center, the family’s transition to home-and to sole responsibility for the newborn-is overwhelming. in many countries all new families are visited at home by midwives, nurses, or other trained personnel who teach parenting skills, assess the mother’s and baby’s health, and provide moral support (and sometimes, as in the Netherlands, government-paid helpers do the housekeeping!). In the United States, such services are now provided to only a small minority of women.

Other Changes You May Notice.
The day after birth, you may ache all over from the work you did in labor. Your arms and legs may be sore from pulling back on your legs while pushing out the baby.

Although achy legs are normal, tenderness, pain, or warmth in your calves and swollen or reddened veins are warning signs that you should report to your doctor or midwife immediately. These signs could indicate thrombophlehitis, an inflammation of a vein that can result in formation of a blood clot. Postpartum women are at slightly increased risk of this because the vein walls normally relax somewhat in pregnancy. To reduce the risk of thrombophlebitis, increase circulation in your legs by doing foot rotations (see page 2 1) and by getting up and walking soon after birth. Thrombophlebitis is treated with bed rest, elevation of the affected leg, hot packs, and the use of elastic stockings. Medications may also be needed to prevent infection and clot formation. The affected leg should not be massaged.

Joints that relaxed in pregnancy to allow for the baby’s growth and birth will return to their pre-pregnancy condition within several weeks of birth. Many women, however, feel that the rib cage and pelvis remain slightly expanded for the rest of their lives.

Abdominal muscles are relaxed after birth, so the abdomen is soft and still rounded. All women have some degree of separation of the abdominal muscles, which lessens with exercise.

Any stretch marks you have will seem more obvious after birth than before. Although stretch marks never completely disappear, they fade to silvery white lines in the months after childbirth. Darkened areas of the skin, such as the areola and the linea nigra, a dark line from the belly button to pubic bone, may tighten but may not completely fade.

Many women note changes in their hair after birth-most commonly, profuse hair loss. This is because pregnancy hormones stimulate hair growth. With the drop in these hormones, the extra hair that grew in pregnancy will fall out. This begins around three months after birth and usually ends within a couple of months.

Perhaps the most common feeling of new mothers after childbirth is that of being bone-tired. This seems especially true of women who have just had their first babies. Often, fatigue is combined with such excitement in the first days that sleep is difficult. The usual aches and pains of the early postpartum period can make it even harder to sleep. But beyond the first few days after birth, most women find daily naps are essential to their well-being.

Caring for Yourself after a Cesarean.
Each woman recovers in her own unique way after cesarean birth, just as after vaginal birth. Pain medications can help during the first few days (the medications given are considered safe during breastfeeding). The nurses will assist you in getting up the first time, learning to cough or huff to keep your chest clear, dealing with the gas that can follow surgery, and learning to hold your baby in ways that are comfortable for you. If assistance is not available when you need it, press your call button and ask for help.

All new parents can benefit from assistance at home after childbirth, but for a woman who has had a cesarean birth such help is essential for at least the first week. Not only are you undergoing a transformation to a nonpregnant state and learning to care for your new baby, you are recovering from major surgery. Adequate help, allowing you to rest often during the day, can make a great difference in how quickly you feel strong and well. Taking care of yourself and your baby should be your only duties until you feel ready to take on more.

These activity restrictions are usually recommended:

Limit stair climbing as much as possible.
Don’t lift anything heavier than your baby for the first two weeks.
Ask your mate or a friend to do laundry, vacuuming, and other tasks that require bending, lifting, or pushing for at least the first few weeks after birth. Then resume such work gradually.
Do not drive a car for the first two weeks.
Take showers instead of tub baths until the incision is completely healed and dry. Ask your doctor or midwife for specific instructions on the care of your incision.

Accepting Your Initial Responses to Your Baby.
Like her labor, a woman’s initial response to her baby is something she remembers for a lifetime. Women greet their babies in as many ways as there are mothers. Before they give birth, most women anticipate a rush of loving feelings, or even tears of joy. others anticipate instantly “feeling like a mother.” Some women actually experience these things. Many do not.

Sometimes, a woman experiences a temporary holding back from the baby whose birth caused pain or emotional trauma. A new mother may have a feeling of distance-which in retrospect may seem like disinterest. Or she may feel a strong need to attend to herself, pain and exhaustion compete with interest in the baby. in retrospect, she may see herself as selfish. Coolness, distance, self-centeredness-none of these fit with any woman’s conception of a “good mother.” Because of this, many women say they feel guilty about their initial responses to their babies.

Many women speak of feeling outside of themselves after labor. It is as though one’s personal boundaries are hazy. Is it any wonder that women feel they are not taking their babies in-”as they should?” They can hardly take themselves in! This is to be expected. Most women say it takes days to come back into themselves. This is the natural rhythm of things. Something amazing is going on. As boundaries are reclarified, they are also redefined. You are now a mother. Your baby is no longer one with you, as in pregnancy. But the new boundaries are extended, to connect you for a lifetime to this other person. This connection is the essential work of the first months of parenting. You may have all the loving feelings you anticipated, but if you do not, give them time to evolve, as you do the work of taking on your new role.

Signs of Illness in a Newborn.
Many parents doubt whether they will recognize if the baby is sick. When you have no experience with babies, being told that a sick baby behaves differently from a well baby is of little comfort. if everything about your baby seems unfamiliar, it is hard to have confidence that you can and will recognize changes that indicate your baby is ill. Besides, healthy babies can cry for a couple of hours each day. Crying does not tell you as much in the first weeks as it will when your baby is older. So how will you know if your baby is sick? Asking yourself these questions may help:

Is there a change in the baby’s behavior? Is the baby crying more than usual? Has the tone of the cry changed? Is the crying at a different time of day than usual? Is the baby more irritable than usual? Is the baby sleeping more or less than usual? Does the baby seem lethargic or listless?
Has the baby’s appetite or digestion changed? Is the baby eating less than usual? Has the baby vomited more than once? If the baby is vomiting, is the vomiting forceful? (This is called projectile vomiting.) Are there signs of constipation? That is, are the stools hard or more solid than usual? Are there signs of diarrhea? That is, are the stools watery, or more runny than usual? Are they more frequent than usual? Is the baby urinating less frequently than usual? Has the color of the urine changed?
Has there been a change in the baby’s breathing? Does the baby seem to have trouble breathing? Does the baby sound congested? Does the baby have a runny or stuffy nose? Is the baby coughing?
How does the baby look? Is the baby’s skin pale or flushed? Is there a rash anywhere on the baby’s body? Do the baby’s eyes look glassy or dull? Is there any discharge from the eyes?
Does the baby have a fever?
Any of these changes could indicate illness. if you notice any of them, or other worrisome changes in Your baby, call your baby’s care- giver. When you call the office, be prepared to describe:

The signs of illness about which you are concerned.
How long the signs have been present.
What you need: to have the caregiver return your call; to speak to the caregiver immediately, if you feel this is an emergency; or to arrange for the baby to be seen as soon as possible.
CRIB SAFETY TIPS if you have a used crib or are considering buying one:
Make sure it has no corner posts. older infants can catch clothing on these.
Check that the crib slats are no more than 2 3/8 inches apart. Never put a baby in a crib that has missing slats.
Make sure that the mattress is firm, and that it fits tightly within the crib rails, with no more than a 1-inch space (two fingers width) between the rails and the mattress.
Assure yourself that all guide rods and support brackets are firmly in place and secure, and that no screws are missing.
Check the locks and latches on the crib. They should be smooth, and tight enough to prevent accidental release.
Be certain the paint used on the crib is lead-free. If it isn’t, the old paint should be removed. if you’re pregnant or nursing, have someone else do the stripping, preferably away from your home, or at least outside the house and away from any play or garden area. New paint should be a high-quality, lead-free enamel recommended for children’s furniture. Some babies do chew on their cribs, and ingesting lead can cause brain damage.
If your crib is new, remove and discard all plastic packaging materials, including the thin plastic mattress cover. As with a used crib, check the guide rods, support brackets, locks, and latches, and make sure no screws are missing.
With any crib, new or old, place the crib out of reach of any cords, electrical sockets, or other hazards.
Keep crib rails up at all times when the baby is unattended.
As soon as your baby can pull himself or herself up, move the mattress to the lowest position. There should be at least 22 inches between the mattress and the top of the rail.
If you plan to use a bassinet or cradle instead of a crib, many of these same safety tips will still apply.

Some Basics about Feeding
Expectant parents know they will have a lot to learn after their babies arrive. They know it will take time to feel confident about diapering, bathing, and soothing a baby. Most have been told that feeding, too, will be a learning experience. It is not until after the birth, however, that the true meaning of this is dear. Parents often say they had not anticipated that the baby, too, would need to learn to feed. Also unanticipated is the profound concern parents have that their babies be adequately nourished.

Even as adults, many people are greeted by their mothers with the questions “Are you hungry? Do you want to eat?” These are questions you will find yourself asking your baby. It is natural for you to feel somewhat anxious when the baby’s answers are not as clear as you might like. Following are some basics about feeding that can guide you as you gain experience.

Postpartum Fathers
Feelings after Birth. Fathers who are present at birth are, more often than mothers, captured by the baby immediately. Whereas women may need minutes, hours, or a few days to feel connected to the baby, fathers often feel the power of this connection at the moment of birth. Unless the mother or baby is in some danger just after birth, the father is likely to find these moments life-changing and exquisite. These feelings are often blended with a sudden awareness of exhaustion.

A father also experiences new feelings about his mate. He may speak of his amazement at her courage, strength, and endurance during labor. He now faces the task of integrating his memory of her in labor with his previous knowledge and feelings about her.

A father may have to work through feelings he experienced while supporting the mother in labor. One of the most common feelings fathers speak about after labor is that of helplessness. Unless he is told, a man may not know how much his presence and emotional support really meant to the laboring woman.

A man may also feel that the labor experience has altered his whole life view. He may have gained a sense of the miraculous and spiritual, of a deeper meaning to life.

Not all fathers, of course, are able to share the birth experience. A lot of fathers who missed their babies’ births worry that not having been there will affect their relationships with their babies. Birth is a special moment in the parent-child relationship, but it is only one moment. The years of child rearing provide many other shared moments that are just as important in the development of a relationship between father and child.

Excerpt reprinted with permission from foxcontent.com