How to keep kids asleep
Q: I've got three kids and none of them have managed to sleep through the night until they reach the age of five. Cumulatively, I've been sleep-deprived for nearly a decade now. I have to admit that I resort to dosing my two-year-old with a couple of liberal teaspoons of Piriton syrup, since my GP told me that's what she did with her kids. Is that OK and is there anything better?
A: When my first child finally slept through the whole night (aged about six), my mother-in-law warned me: "You'll never sleep properly again, you know!" And she was right. One in five under-threes and one in 10 four to five-year-olds sleep badly enough for their parents to seek help, often from a health visitor or GP. It makes mums feel ill, and relationships suffer. Sedation with antihistamines or more powerful prescription drugs is a common response, but it doesn't work in the long term: it can buy you one night's sleep, but won't have any impact after four weeks.
Giving drugs to children is not ideal - they might become drowsy during the day or you might be one of the unlucky minority whose child becomes more active when given antihistamines. A recent report in the British Medical Journal confirms the benefits of a 20-minute wind-down routine which is begun five to 10 minutes earlier each week until you arrive at the desired bedtime. This needs to be coupled with ignoring bedtime tantrums for preset time intervals.
For kids who wake several times a night, waking the child 15 to 60 minutes before they usually wake, then resettling them, can help. No one behavioural strategy works better than any other, but all are better than drugs in the long term.
Q: About a year ago, after prolonged breathlessness, I was diagosed as having an irregular heartbeat. My GP referred me to a specialist and I was prescribed amiodarone and warfarin for six weeks. When this had no effect I had cardioversion. This resulted in a regular pulse but when the amiodarone was stopped I reverted to the irregular heartbeat. The specialist said that nothing else could be done and that I should come back when I get worse. My GP is "not worried". I continue to take warfarin plus beta blockers and train regularly at a fitness centre. I do not push myself, but my pulse varies wildly: up or down 10-15 bpm is not unusual. Should I be worried?
A: It sounds as though you had an irregular heartbeat known as atrial fibrillation (AF). The upper chambers of the heart (atria) fire off ineffective, chaotic, irregular and rapid bursts of electrical activity. It can cause palpitations, breathlessness or merely an irregular pulse, often picked up by chance. AF can be a sign of underlying heart disease, high blood pressure or an overactive thyroid.
If there's no underlying cause, as in your case, it's known as "lone AF". Cardiologists usually suggest one go at giving the heart a big electric shock to try to tip it into normal electrical activity (cardioversion). Your blood is thinned with an anticoagulant, warfarin, before and after cardioversion because there's a small risk that when the heart changes from AF to normal rhythm or vice versa, small clots can be thrown out of the heart, which may cause a stroke. A lot of people slip back into AF after cardioversion.
Drugs such as amiodarone, digoxin or beta blockers (eg sotalol) may not return the heart to normal rhythm but they make it beat more slowly so you get fewer symptoms, and there is less strain on the heart.
Foreskin trouble
Q: My foreskin keeps adhering to the lower part of the glans of my penis. It becomes itchy and feels painful during sexual intercourse. To counteract the effects, I pull it away, which hurts and causes bleeding, but gradually it sticks again. Circumcision has been recommended, but at the age of 54 I do not wish to have surgery if a less radical solution can be found. Is there one?
A: Your unfortunate condition is called a paraphimosis and tends to happen if the foreskin is a bit tight. As you say, the retracted foreskin gets trapped behind the glans, especially when the penis is erect. The glans gets engorged and swollen so it becomes even harder to slide the foreskin forward again. You can squeeze the glans for half an hour to reduce the swelling (ouch!) or soak a piece of gauze in a sugar solution and hold over the glans for an hour. But if it happens time and again, circumcision may be the best option.
• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o the Health Editor, the Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
