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Circumcision just before or during puberty may produce considerable emotional disturbance.

Some psychiatrists talk of the psychological shock to the infant circumcised without anaesthetic but this is difficult to prove.

Your doctor is not being irresponsible if he carries out your request to circumcise your son. Many doctors still consider this a necessary procedure. Others have no strong feeling either way and will agree to operate if the parents wish, but will not recommend it. Others are strongly opposed to circumcision and will not accede to the parents’ wishes. As in other areas of medicine, there are different views on what is correct treatment.

If circumcision has been the habit in your family, discuss with your doctor whether you should go ahead and have your son circumcised. You have the right to request it but your doctor also has the right to refuse if he does not think it necessary.

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Symptom

Scaly, red rash

Home care

Apply a nonprescription antifungal ointment to the infected area until the skin is clear. If you do not know which preparation to use, ask your doctor.

Precautions

-    If a rash does not improve with home treatment, see the doctor. The rash may not be ringworm at all.

-    If home treatment seems to make the rash worse, discontinue treatment and see the doctor. The child’s skin may be sensitive to the medication you’re using.

Ringworm is actually a skin infection caused by a fungus. Ringworm spreads by direct contact with an infected person or pet animal, or by indirect contact with contaminated objects such as combs, pillows, towels, clothing, even the floor.

Signs and symptoms

Different funguses prefer different areas of the body. Ringworm of the scalp (tinea capitis) appears as scaly patches with stubs of broken-off hairs on the scalp. Ringworm of the body (tinea corporis) shows up as round or oval red, scaly patches that enlarge while healing proceeds from the center. Ringworm of the groin (tinea cruris) is characterized by a red or brown scaly rash on the crotch and the genital area and has a sharply defined margin of spread. Ringworm of the feet (athlete’s foot, or tinea pedis) affects the feet and sometimes the ankles and legs. The diagnosis of ringworm is based on your child’s history and close inspection of the rash. The diagnosis is confirmed by laboratory tests.

Home care

Antifungal ointments such as haloprogin, chlortrimazole, tolnaftate, and undecylenic acid ointments can be applied to the infected area until the skin clears.

Precautions

• Several other common rashes resemble ringworm. If a rash does not improve after several days of home treatment see your doctor.

• The preparations used to treat ringworm may cause another rash on sensitive skin. If the rash worsens or changes in any way, stop home treatment and see your doctor.

Medical treatment

Your doctor can confirm a home diagnosis of ringworm by examining your child’s rash under ultraviolet light, and by culturing a skin scraping and examining the results under the microscope. The doctor may prescribe an antifungal ointment to be applied to the skin, or a medication such as griseofulvin fungicide for the child to take by mouth.

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Nail brittleness

Nails so soft that they split into layers or split very easily once they grow beyond the fingertips.

What causes it?

No one knows for certain. Possibilities are:

• Circulatory disturbances causing poor nutrition to the nail bed, but there are usually other signs of this and it is not common in the fingers.

• An inherited tendency.

• Psoriasis. Usually the nails are also pitted.

• Iron-deficiency-the nails are usually spoon-shaped.

• Zinc-deficiency.

Prevention

• See a doctor for the treatment of any circulatory disorder you have.

• Get psoriasis treated.

• Take iron supplements or eat more iron-containing foods.

• Use nail hardeners or nail polish to prevent the ends from splitting.

• Increase the whole foods you eat and cut down on refined foods.

• Take a zinc supplement (up to 20 mg daily).

Nappy rash

It is a reddened area of skin in the nappy area of a baby. This can develop into tight, papery skin with some peeling. The common rash tends to spare the folds and creases, but babies with sensitive skins and those prone to seborrhea (cradle cap) may get a rash that extends into the folds and creases. A monilial rash (caused by thrush) has features of both and also has some spots elsewhere. It is also possible to have a rash that is purely monilial and consists just of isolated spots.

If a nappy rash is very severe there may be raised, red pustules which turn into raw, ulcerated areas. Undoubtedly a baby with this severity of rash will be irritable and will cry a lot.

What causes it?

• Common nappy rash is caused by urine irritating the skin in places where the nappy chafes. Plastic pants increase the humidity by preventing evaporation and so make this kind of nappy rash worse. It is thought that ammonia released from the urine is not the cause of this kind of rash but it can make the rash worse if the skin is already damaged.

• Diarrhea of any cause can make a nappy rash worse.

• Allergies are rarely a cause but some babies appear to be allergic to certain chemicals used in the manufacture of paper nappy liners.

• Airtight and watertight plasticized disposable nappies provide little or no ventilation and may promote nappy rashes.

• Occasionally a nappy rash is the earliest sign of atopic eczema.

• One in two nappy rashes is caused by monilia (thrush). Any rash that has been present for three days or more is likely to have monilia in it.

Prevention

Preventing the common kind of nappy rash is simple:

• Change your baby’s nappies frequently, never allowing him or her to stay for long in a wet or soiled nappy.

• Leave your baby without a nappy for as much of the time as possible-this is easier in the summer.

• Wash the bottom well and dry it thoroughly, and only then apply a barrier cream. Do this every time you change the nappy.

• Soak nappies in a sterilizing solution before washing.

• Ensure that nappies are thoroughly rinsed to remove all the soap and detergent.

• A one-way fabric nappy liner works wonders but paper ones can actually make rashes worse.

• Ideally, avoid using plastic pants, though this is the counsel of perfection because it often means soaked clothing, bedding, etc.

• If you think a particular brand of disposable nappy is the cause of your baby’s problem it could be the plastic or the deodorizer used. Try the baby in terry nappies for a few days to see if this will cure the condition. Once a culprit has been found, avoid it in the future.

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