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Caring for Your Child

The First Year Infant
Weight Gain

First year is most critical as this is the time baby's development and growth become established.
It is common for baby to lose weight during the first week of life. For a larger baby, this may be as much as 1lb (450g), or for smaller babies, 6-8ozs (200g). After this, the average weight gain is about 1oz/day (28g). Average weight gain to be expected over the first year is:
6 months - twice the birth-weight
at 1 year - three times the birth-weight.

But every baby is different, so variations should be expected. If your baby is 15% below or above expected weight, seek medical advice. Failure to gain weight may be due to feeding problems or problems of absorption.

Possible causes are:

Baby may have difficulty fixing to nipple due to:

Mother might not produce enough milk because of:

If in doubt, seek medical advice.

Breast Feeding And Bottle Feeding
Breast feeding has the following advantages:

However, mother may feel breast feeding is socially unacceptable or time consuming. Poor breast development, or inadequate milk supply can also be restrictive. The advantages far outweigh disadvantages.

If mother and baby have problems, particularly if baby is failing to gain weight, the only satisfactory solution is to introduce artificially produced milk. Artificial milk may be given in addition to breast milk in order to satisfy baby, and give mother enough time to establish total breast feeding.

If artificial milk is used, certain essential principles must be applied:

Artificial feeding may be introduced to supplement breast milk or to replace breast feeding. The type of artificial milk will depend on advice by your doctor, midwife, or health visitor. When starting bottle formula, dilute it initially. Make up powdered milk with 1 scoop (provided in packet) to 2ozs (57g) of boiled, cooled water.

Offer the bottle to baby after breast feeding and if tolerated, up feeds to three-quarter strength, until baby is taking full concentration (i.e. 2 scoops to 2ozs (57g) of water). If the flow and quantity of breast milk becomes sufficient, baby will not take bottle formula. Should breast feeding fail, it is necessary to change to complete bottle feeds. Begin with diluted formula and up feeds to full strength as described earlier.

Regarding quantity, all proprietary powdered milk formulas contain instructions, however the following general guidelines should help you work out baby's needs:
Weigh the baby and if up to expected weight, multiply weight (in lbs) by 2.5. The total gives the amount of milk required (ozs) over 24hrs (e.g. 10lb baby needs 10 X 2.5 = 25ozs in 24hrs). If baby is slightly underweight, calculate correct weight and use this figure to make calculation. Young babies usually need 6 feedings in 24 hours. Based on the previous example, offer bottles containing 4ozs. As baby grows, weight increases with quantity of milk and should be weighed at weekly intervals.

With feeding, there are 2 different viewpoints:

  1. Feed on demand. (Baby in control)
  2. Feed at set intervals, say 4 hourly (Mother in control).

Demand feeding simply means feeding when baby wakes and cries. This method suits many babies and they often settle into routine, waking regularly (mothers who breast feed may find this exhausting in the first 6 weeks). A developing infant may take up to three months to drop night feeds, particularly boys.

Feeding Problems

Poor Sucking
Often occurs in premature babies. If breast feeding, gentle support of the lower jaw will often help. If bottle feeding, use a nipple with a large hole.

Vomiting
Often confused with posseting, which occurs naturally as baby regurgitates some feed when being winded. Vomiting large amounts is abnormal, particularly if it occurs after every feeding, so seek medical advice. If vomiting is projectile (i.e. vomit pumps out like a jet of water), seek medical advice urgently.

Wind
After feeding, you must bring up wind. When sucking at the nipple, the baby will suck in air. This passes into the stomach and usually forms a bubble above the milk. Put baby over your shoulder so the head and jaw rests over your shoulder. Gently pat the back or rub in a circular motion. Air is usually expelled with an obvious 'burp'.

Colic
Occurs when wind is not brought up and forms a bubble in the stomach, causing pain. Baby cries, draws its knees up to its chest and is very difficult to comfort. If in doubt, seek medical advice.

Diarrhoea
May occur if formula (artificial milk) is too strong. Breast fed babies tend to be constipated. Diarrhoea and vomiting in combination may be lethal for small babies and medical advice must be obtained.

Nappy Changing
Babies are like all animals. The act of feeding triggers the lower bowel to contract and expel waste products. Therefore, nappies must always be changed after a feeding. It is usual to clean the bottom with moist wipes and apply a cream, (e.g. zinc oxide), before using a fresh nappy. Disposable nappies are water absorbent and should be water tight, providing the correct size is used.

Nappy Rash
Usually caused by fungal infection called thrush. The skin is red over nappy area and sometimes blistered. The infection is passed from mother to baby at birth. The cells of the mother's vagina contain fungus spores called monilia albicans. The spores are ingested during the passage of the baby through the vagina and enter the baby's intestine where they multiply. During excretion, some of the spores invade baby's skin and cause the typical rash.

Application of fungicidal cream may be used to control skin condition, however re-infection occurs from the baby's intestine. Seek medical advice.

Heat Rash
Caused by overdressing baby in warm weather or by maintaining nursery at excessive temperature. The rash appears as fine small red spots around collar area and at nape of neck. Treat by dressing baby correctly and applying baby talc to infected areas. If in doubt, seek medical advice.

Waking At Night or Excessive Crying
Usually has simple causes, so check the following:

If in doubt, seek medical advice.

Mouth Fungal Infections
Thrush in the mouth is recognised by white patches on the inner surface of cheeks and tongue. In severe cases, the throat can be infected, which causes pain to baby and interferes with swallowing. Seek medical advice.

Eczema
A rash which occurs behind knees and in front of arms at the elbow. The rash is itchy, often scaly and sometimes becomes  infected. Seek advice from your doctor regarding treatment.

Dummies
Pacifiers (or 'dummies'), should be avoided. They are unhygienic which is why they are one of the main causes of gastro-enteritis, often a fatal disease in young babies.

Cutting Nails
From an early age, finger nails have to be trimmed, since babies tend to scratch themselves and cause abrasions if the nails are too long. The same applies for toe nails.

Frustration
Occasionally, everybody experiences frustration with a new-born baby. Continual crying, the enormous change in lifestyle  adapting to the new addition in the family, pressures on your own relationship...

Here are a few useful tips to help you through those exasperating times:

Bathing
You should have seen a demonstration bathing in the maternity hospital. Remember to fill bath with water to a depth of 4 inches (10cm), no deeper and check the temperature (water must be at blood-heat temperature - around 37 degrees Centigrade, 96 Fahrenheit).
Test the water with your elbow, if it is comfortable, the temperature is correct. Now proceed by undressing baby.
Holding baby with both hands, lower into bath, always supporting the head. Baby skin is delicate, so don't use adult bubble bath, only baby soap and lotion. Use baby shampoo for hair. Remove from bath. Dry baby gently with a soft towel. Apply cream to bottom. Apply nappy and dress.

Putting To Bed
NEVER USE A PILLOW.
Wrap baby in a cotton sheet with arms folded across chest, so that the sheet is wrapped fairly tightly. This gives baby a feeling of security. If the weather is cold, wrap a crib blanket around the sheet, lie baby on side and cover with a light cover. Young babies should be kept in a temperature of 65-70F (19-21C).
In hot weather, it's a mistake to over-clothe and over-wrap as they become too hot and sweat. During the day, if baby is put out in a pram, cover pram with a net.

Mixed Feeding
At 3 months night-feeds are not normally necessary. It's important to remember that all babies require additional fluids; this may be given as VERY diluted fruit juice, preferably sugar free (see 'Dental Care').
Growth rate tends to slow a little and this is the time to try mixed-feeding. Usually a gluten-free cereal is introduced. This is mixed with some artificial milk and spoon-fed. Over the next 3 months, introduce different fruits (seedless, in a pureed form).
Gradually increase the amount of solids until at 6 months, baby is usually taking 3 bottles of milk or 3 breast feeds/day and solids. An early start at 6 to 8 weeks is to be discouraged, since baby will become overweight, which may become a life-long problem.

Weaning
Weaning can start at 6 months when baby has some teeth with which to chew (see 'Dental Care'). This should include rusks. The aim is to give 3 main meals per day. This will only be achieved slowly. There is a multitude of convenient baby foods on the market, but these tend to be very poor value. Your own food liquidised is much cheaper, nutritious and will introduce a variety of flavours.
Breakfast may consist of a gluten-free cereal, 1 or 2 rusks, pureed apple, small slices of bread dipped in egg yolk, followed by milk feeding.
Lunch could be pureed chicken, pureed potato and pureed fruit, followed by milk feeding.
An evening meal of cereal and pureed fruit will be enough. Vary diet so that by 1 year, the infant is taking 3 meals per day, with little need for a bottle or breast feeding.
From 8 months, try and teach baby to drink from a cup. Most will be able to handle a baby-beaker, but drinking from a cup requires a different skill.
Offer baby an egg cup with milk, it is surprising how quickly they learn to lift it to the mouth and drink.
Once they have mastered the egg cup, give a small cup, gradually increasing the size cup as needed.

Cot Death

Fortunately, crib deaths are rare. The cause is unknown but usually the victim is under 6 months. Research indicates that most deaths are not caused by asphyxia. It is thought to be caused by a virus infection which overwhelms the immune system. There are no obvious symptoms and can strike down a perfectly healthy baby when asleep.
Apnoeic attacks are also rare, but cause breathing to stop, and unless aroused and stimulated, may be fatal. Apnoea mattresses are available which monitor breathing and sound an alarm if breathing stops.

Milestones at birth

Before leaving hospital, a paediatrician will have performed the following examination on baby:

Milestones at 6 Weeks
The first developmental examination is carried out at 6 weeks and consists of:

Eye Testin

Hearing And Speech Development

Play And Behaviour

Milestones at 3 Months

Speech And Hearing

Play And Behaviour

Milestones at 6 Months

This examination is usually carried out by a doctor...

Muscular And Skeletal Development

Visual Developments

Speech And Hearing Developments

Milestones at 1 Year

Posture And Movement

Visual Development

Speech Development

Social Behaviour

Milestones at 3 Years

Visual Developments

Speech Development

Play And Social Behaviour

Milestones at 5 Years

Mobility

Vision

Hearing And Speech

Behaviour And Play

Infant Vaccinations

You should consider vaccinations before your child attends school. This is excellent preventive medicine as theoretically the occurrence of infection becomes so low that the disease is completely eradicated. As memories fade of terrible outbreaks in the 1950's, recent studies indicate that parents are becoming too relaxed regarding immunisation.

The following vaccinations are suggested before going to school:

The vaccines are commonly grouped together as follows:

Immunity can be induced, either actively or passively, against a variety of bacterial and viral organisms.
Examples of active immunity include:

Examples of inactive immunity include:

Vaccine works by stimulating the body's defences to manufacture antibodies (which fight infection). The first injection produces a small response. Additional injections lead to an accelerated response. Following a full course, the antibody level remains high for a few months or years. A booster dose will raise the antibody level rapidly.

Active vaccine (e.g. measles, mumps, rubella) provide long-lasting response after a single dose. Remember, oral or written consent must be given before each injection.

No child should be denied immunisation without serious thought to the consequences, both for individual child and the community. If there is any doubt, advice should be sought from a consultant paediatrician.

None of the following conditions should influence your decision regarding vaccination:

Certain vaccines should not be given, but this will depend on specific circumstances. For example, oral poliomyelitis vaccine should NOT be given to brothers, sisters or household contacts of immuno-suppressed children (inactive poliomyelitis vaccine should be given).

The whooping cough vaccine has caused more controversy than any others. There is unsubstantiated evidence that the vaccine may cause brain damage. There are a few considerations with whooping cough immunisation such as acute illness (postpone vaccination), or if severe local, or general reaction to a previous dose (delay vaccination until stable). In children with problem histories, the advantages of protection against whooping cough must be very carefully weighed against the consequences of no protection.

If in doubt seek the advice of a consultant paediatrician. Some examples follow:

All vaccinations, except oral poliomyelitis are given by injection, either into the muscle or deep under the skin. Sometimes the baby may have a high temperature lasting 24 hours, or a raised red swelling at the site of injection. Tepid sponging may help, but if in doubt seek the advice of a paediatrician.

The following table is a general guide to vaccinations. However, it is important to consult your paediatrician for the best schedule for your own child.

Age Vaccination
2 months 1st DPT and polio
3 months 2nd DPT and polio
4 months 3rd DPT and polio
12 to 18 months MMR, influenza
4 years Booster, diphtheria, tetanus, and polio
10 to 14 years Rubella (girls only)
10 to 14 years Possible BCG
15 to 18 years Booster, tetanus and polio

Infant Infectious Diseases.

The following are common infectious diseases likely to occur in children (which may also affect adults with little immunity, with much more severe symptoms):

Others, not commonly seen include:

Gastro-enteritis in children may result from bacterial or viral infection.
Upper respiratory infections and middle ear infections, although not strictly infectious diseases, are included in this section. If you suspect your child has contracted any of these diseases, it is important to seek competent medical advice.

Measles

Seek medical advice immediately. Isolate child for 4 days after appearance of rash. Disease is viral and can be prevented in children by vaccination. Complications may include: bronchopneumonia, middle ear infection, severe conjunctivitis, with perforation of cornea (in malnourished), encephalitis.
If any of these complications are suspected, seek medical advice.

Mumps

Seek competent medical advice. Isolate child for 10 days after appearance of swelling. Often one parotid gland (the largest salivary gland) swells, followed by the opposite side a few days later.

Chicken Pox
Usually a relatively minor illness in young, well-nourished children:

Seek competent medical advice. Isolate child for 11-14 days, or 6 days after appearance of last crop of spots.
Pregnant women are at risk, as the infection can be passed to baby in womb and may result in miscarriage.

Rubella (German measles)
Occurs in unvaccinated children:

Seek competent medical advice. Isolate child for 11 days from onset of illness and 4 days after rash has disappeared.

Whooping Cough
Disease which attacks lungs in children, early signs include:

Seek competent medical advice. Isolate child for 7 days after contact, or 3 weeks after onset of disease.
Complications may occur, resulting in permanent damage to lungs, leading to chronic respiratory problems in later life. The disease can be fatal in infants.

Scarlet Fever

Seek medical advice. Isolate child for 1 day if treated with penicillin, if untreated isolate for 11-21 days.

Diphtheria

Seek competent medical advice. Infection of the skin by the diphtheria germ can occur in desert regions and may damage nerves, resulting in localised paralysis such as foot drop. Therefore, protection by vaccination is very important.

Meningitis
Less common nowadays having been controlled by vaccination.

Seek competent medical advice urgently. The disease must be recognised early since if untreated, it is always fatal. Vaccine is available to protect those at risk.

Poliomyelitis
Polio is less common having been controlled by vaccination.

Seek competent medical advice urgently. If paralysis occurs, complete recovery is unlikely.

Tuberculosis T.B.
Less common having been controlled by vaccination. However, it must always be considered, particularly with immigrant workers. The disease is still prevalent in developing countries, but curable with the aid of drugs.
Better nutrition and accommodation have played a large part as has vaccination against the disease. The disease may present in many ways and can mimic many others.
Look for:

Seek competent medical advice urgently. Transmission of the disease is by droplet spread, or unpasteurised milk.

Tetanus
Less common having been controlled by vaccination. Disease found in spore formation in soil and plants where organic manure has been used.   Look for:

Seek competent medical advice urgently. Vaccination gives complete protection for up to 10yrs. Booster tetanus injections at 5-10yr intervals are recommended. If full disease develops, it may be necessary to use muscle paralysing drugs and provide respiratory support mechanically.

Influenza
Occurs in epidemic form mainly during the winter months. It is a viral infection with a very short incubation period (18 hours - 3 days). Although uncomfortable, it is usually self limiting. However, in elderly patients and those with chronic respiratory and heart problems, secondary chest infections can prove fatal.
Those at risk should seek competent medical advice. Look for:

Treat with bed rest, keep warm and drink lots of fluids. Your doctor may prescribe acetaminophen or paracetamol. The illness usually lasts 4-5 days.
Complications may occur such as bronchopneumonia and encephalitis. There is a well known post viral phase when the patient may feel unwell and depressed for up to 3 weeks after the end of the disease. If in any doubt, seek medical advice.

Gastro-enteritis
May be extremely serious in small babies and, if not treated, could result in death from dehydration. Commonly contracted through food which has been contaminated by food handlers. Look for:

Seek competent medical advice. The dual effect of diarrhoea and vomiting causes loss of fluid and dehydration. In small babies, because they have relatively small amounts of fluid in their body, dehydration develops rapidly.

Upper Respiratory Infections
Rarely fatal, but may give rise to secondary chest infections which in turn can be fatal. The whole of the upper respiratory tract becomes inflamed with outpouring of mucus and fluid from the nasal passages. Because the Eustachian tubes become inflamed, the middle ears can become infected causing acute middle ear infection.
Look for:

Seek medical advice.

Nursing a sick child
Nursing sick infants and young children is mainly common sense and knowing when to call for professional help. If in doubt, seek medical advice. Typical day-to-day symptoms may include:

Fever
A temperature with no other symptoms can be treated for one day only with acetaminophen or paracetamol, but be sure to follow the manufacturer's recommended dosage. If in doubt, seek competent medical advice.
NEVER EXCEED THE RECOMMENDED DOSE - IT IS VERY DANGEROUS.
Tepid sponging helps to lower a temperature but must be done correctly.
Use water which is at blood heat (similar temperature to baby's bath). With a sponge, wash forehead, trunk, abdomen and legs. If high temperature persists, seek competent medical advice.

Difficulty Breathing (Asthma)
Rarely diagnosed early enough, indications of asthma are:

Always seek medical advice, learn the technique of using inhalers and when to give medicine.
A good tip for a child who suffers from croup is to put them in a steamy atmosphere: Run a hot bath and sit with the child in the bathroom breathing the steamy air. This has a soothing effect and can encourage sleep when the coughing fit has subsided. Similarly a vaporiser can be placed in the bedroom, but in a safe place where a child cannot reach it.

Child Exercise

Exercise must be linked with diet. This starts after birth. Early introduction of solids before 3mths leads to excessive weight gain. A fat, bouncing baby may win beauty contests but can be destined for respiratory problems and coronary artery disease in later life.
Exercise helps to develop muscles. A baby bouncer and baby walker allows baby to exercise and gain confidence in walking without aid.
A good, balanced diet (with adequate fibre, fruit, white meat, fish, green vegetables and calcium sources) is an important requirement for normal development and growth (see 'About Your Diet'). When old enough, children should be encouraged to play with others. This provides them with enough exercise for their age.
When between 5-7yrs, teaching a child to ride a bicycle gives them plenty of enjoyment, as well as exercise.
Later, encourage them to take part in physical training, swimming and competitive sports.
Many schools in the U.K. have abolished compulsory sporting activity. This fact, combined with little regard for diet (favouring convenience food), creates unfit and overweight children. Every parent wishes the best opportunity on their off-spring. So why disable them by over-feeding and lack of exercise?

Overweight, under-exercised children can suffer:

There are no excuses, so invest in your child's future health now!

Child Abuse

Forms of abuse include: physical, mental, sexual abuse or physical neglect. It is often very difficult to discover children who are mentally or sexually abused. Very few statistics are published, since the subject is highly emotive and difficult to quantify. However, most researches agree that child abuse is alarmingly high and generally goes unreported.

This section provides simple guidelines which may help you detect child abuse. ALWAYS seek professional advice should you have cause for concern.

Physical abuse and neglect are reasonably easy to identify. Battered baby syndrome is indicated by:

Neglect and privation can be normally suspected when the child is ill clothed, unkempt, dirty and undernourished. Research has shown that children are at greatest risk of sexual abuse from relatives or close family friends. Experience shows that children very rarely lie about sexual abuse.

Small clues may include:

There are several preventive measures you can take to alert your children to the dangers of abuse and how to avoid it. This will require building a trusting and open relationship between you and your child. What you tell your child will depend on their age, but even young children can understand simple messages:

Psychological Problems In The Young Adult
In the process of changing from a child to a young adult, many hormone changes occur in the maturing body. This period is known as puberty. It is a time of considerable stress and psychological problems.

Often the parents have not recognised that their child has developed into adult, and, as an adult, they require an amount of freedom and independence. For example, in young men independence often causes difficulties between father and son. The relationship must be maintained by giving more freedom and treating the person as an adult, not as a child.

There may be temper tantrums, resentment and, if not handled correctly, the young adult may become rebellious or even run away from home.

'House rules' MUST be maintained, but recognition of the needs of the young must be remembered to keep a healthy and loving relationship between parents and child.

For a young adult, this is the time of great experimentation which may involve drugs, smoking and alcohol (see 'Substance Abuse').

Drug abuse may lead to addiction and death, smoking is medically proven to be dangerous to health, alcohol can kill. A stable home environment is the best preventive measure.

Common problems include:

Depression
Can be severe in teenagers. It arises from internal family conflicts. The desire to become independent of the family, although perhaps not a financial reality is normal.
The attitude of the teenager to rebel against authority often leads to conflict with parents. The teenager feels constrained and frustrated because they lack the confidence to lead an independent existence.
These factors, combined with the requirement of self-discipline in following higher educational training, can lead to under-performance. In turn this may cause anxiety and an inability to cope with day-to-day problems.

Anxiety may disturb normal sleep patterns leading to depression. It is important that depression is recognised at an early stage.
Look out for:

Should any of the above occur, seek medical advice. Ignoring these symptoms may have tragic consequences.
The sufferer may feel so worthless, that he or she believes there is no point in carrying on and so attempts suicide.

Suicide
Always related to severe depression. Recognise symptoms early and seek professional advice. Symptoms may include:

Anxiety
May result from overwork and excessive worrying. It can present itself in many different ways:

These symptoms can be overcome by learning relaxation techniques and talking over problems with a sympathetic adviser. If in doubt, seek medical advice.

Schizophrenia
Often develops in early adulthood. The cause of this psychotic illness is unknown, although it is relatively rare. The onset of the illness is subtle and can be missed in the early stages. Some guidelines are:

Should any of these signs appear obtain medical advice. The illness can be controlled providing the person is prepared to keep up treatment.

One of the problems in treatment is as soon as the patient feels well, they are unable to accept there is anything wrong in the first place, and stop treatment. However, reinstatement of treatment results in control again.

Anorexia Nervosa
Formerly confined to young women and now appearing in young men. The subject starves themselves and the condition is recognised as a psychiatric illness. It's more common in young dancers and singers who have a 'fat' image of themselves. Their self-image is of obesity, which results in stringent dieting to such an extent that they become emaciated unless there is expert intervention.

The condition is often associated with low self-worth and ultimately, depression. The desire not to eat is a form of suicide as the individuals are unable to face the outside world as they see themselves.

It is not easy to recognise in its early form. Most women diet occasionally. If it appears your child is losing weight, that they pick at their food and miss many meals, seek medical advice.

Female Puberty
Puberty is the time when a child develops physically into a young adult. The age at which this occurs can vary. For girls this can start as early as 11 years when periods first start, but may be as late as 14.

Female problems in puberty include:

Despite more frankness in teaching sexual development and sexual problems in schools, there is still ignorance among the young. Parents often avoid discussion with their offspring, mainly because of embarrassment and ignorance.
Menstruation is signalled by stomach discomfort and sometimes backache, followed by vaginal bleeding. If a young woman is not prepared for this, fear of this naturally occurring event may ensue. Advice regarding the wearing of sanitary towels (or tampons) should come from the parent. Menstruation is often irregular initially and it may take up to 18mths for a regular pattern to develop. The period normally lasts for 5 days and occurs every 28 days. It must be impressed on a young woman that this is a normal event. She must be encouraged to lead a normal life, attend school and take normal exercise. If pain before the onset of a period is extreme, medical advice is recommended. Sometimes at the onset of a period, bleeding may be very heavy and medical advice is required.
Breast development starts with onset of menstruation. Breasts normally fully develop by 16. At this time, a young woman may be very sensitive about her body and become shy, choosing to wear heavy baggy sweaters disguising her shape.
Advice from mother on the correct brassiere is important. An open discussion between mother and daughter to explain what is happening to her body is invaluable.
A young woman of 15 or more becomes aware of her sexuality and often feels pressured by her friends of the need for a (freqeuently disastrous) sexual relationship.

Self Abuse is a common natural occurrence.
Young people are highly fertile and information on contraceptive techniques must be available. Self-control has to be encouraged and the consequences of lack of control illustrated.

During puberty the common skin complaint acne often occurs. Small septic painful spots may appear on the face, chest and shoulders. Usually by the age of 18 the condition disappears. It is caused by the secretion of a male hormone called androgen, which makes the skin greasy. The small sweat glands of the face and shoulders become plugged by grease and sweat, often forming blackheads. These can develop into infected spots which in extreme cases can cause scarring. Cleanliness is not a factor. However cosmetics can make matters worse.
In extreme cases seek medical advice. Some antibiotics can be used as well as certain contraceptive pills.

Male Puberty
The onset of the maturing process starts later in boys, usually from 14 onwards. The first sign is the voice 'breaking' (deepening). Young males often have a very pure soprano voice, but as they develop the voice deepens. As the voice settles, hair begins to grow on the face, in the pubic area and in the armpits.
The penis and the testes become enlarged. It's not uncommon to have wet dreams.
It is quite common for the young male to have erections at the most unexpected times, frequently if in the company of the opposite sex who he may find attractive. This is a natural reaction and he soon learns to control his emotions. Many young males experiment to obtain an erection and ejaculation. This is so common that it is a natural occurrence.
It's estimated over 90% of men and 65% of women mast-urbate at some time during their lifetime. There is no medical evidence to suggest that it has any harmful effect on health. If, however, it becomes an obsession seek medical advice.

During puberty a common skin complaint, acne, often occurs and is usually more severe in young men. Small septic painful spots may appear on the face, chest and shoulders. Usually by the age of 18 the condition disappears. It is caused by secretion of a male hormone called androgen which makes the skin greasy. The small sweat glands of the face and shoulders become plugged by grease and sweat, often forming blackheads.
These can develop into infected spots which in extreme cases can cause scarring. Cleanliness is NOT a factor. In extreme cases seek medical advice. Some antibiotics can be used.

Experimentation with drugs, alcohol and tobacco are more common in young men. Most western cultures put a high social value on a young person's ability to drink excessive quantities of alcohol. Smoking was previously considered fashionable for both men and women. However, both drinking to excess and smoking are equally dangerous pursuits and carry high medical risks.

Despite more frankness in teaching sexual development and sexual problems in schools, there is still widespread ignorance among the young. Parents often avoid discussion with their offspring, because of embarrassment and ignorance.

External links  from Kids Health for Parents
Disciplining your child  http://kidshealth.org/parent/emotions/behavior/discipline.html  and Questions about Sex . http://kidshealth.org/parent/emotions/feelings/questions_sex.html 


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