Calories
Sufficient to attain and/or maintain a reasonable body weight for adults, normal growth and development for children and adolescents, and increased to meet needs during pregnancy and lactation or for recovery from catabolic illness.
Reasonable body weight is defined as the weight an individual and health care provider acknowledges as achievable and maintainable, both short term and long term.
Calorie requirements are 25 calories per kilogram of the ideal body weight (IBW):
Moderate activity = 30 kcal/kg/IBW
Underweight = T 5-10 kcal/kg/IBW
Overweight = I 5-10 kcal/kg/IBW
Calories to be divided into three major meals and 2-3 snacks.

Proteins
12-15% of daily calories – should be from proteins – not less than adult recommended dietary allowance (RDA). Adjust to
0.8 g/kg/day with evidence of macroalbuminuria: 0.6 g/kg/day for reduced glomular filtration rate (GFR), adjust for very young children, pregnant and lactating women, and some elderly people.

Fats
Individualized, based on the nutrition assessment and treatment goals for those more than 2 years old.
•    Total fat varies with treatment goals.
15-30% Energy percent for normal weight and normal lipids.
< 20% for obese; elevated low-density lipoproteins.
•    Saturated fat < 10% of daily calories; < 7% with elevated low-density lipoproteins.
•    Polyunsaturated fat: up to 10% of total calories.
•    Monounsaturated fat: 10% and as carbohydrate substitutes.

Cholesterol: <300 mg/day

Carbohydrates
It is individualized, based on the patient’s eating habits.
•    55-60% Energy.
•    Distribution vary with insulin regimens and treatment goals.

Fibre
35-40 g/day, same as general population. Generally, not beneficial to glycemic control at lesser amounts.

Sodium
•    < 3000 mg/day, same as general population.
•    < 2400 mg/day in mi Id-to-moderate hypertension.
•    < 2000 mg/day with nephropathy, hypertension and oedema.

Alcohol
Moderate usage (i.e., <2 alcoholic drink daily for adult men and one alcoholic drink for women, one drink being 30 ml of whisky, gin, vodka or 250 ml of beer unless otherwise indicated) (e.g., alcohol abuse, hypertriglyceridaemia).

Vitamins/Minerals
Same as for general population.
Magnesium replacement possibly needed if at high risk glycosuria, ketoacidosis.
If at high risk, determine if replacement is necessary with laboratory test.
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The term ‘heavy petting’ was once in common use but it is so ambiguous that it is meaningless. It is supposed to mean any sexual activity up to but not including the penis crossing the entrance of the vagina. Unfortunately, without more detailed information it could be taken to mean kissing with

your mouth open, touching your partner’s genitals with your hands or even massaging each other without your clothes on none of which will result in pregnancy. ‘Heavy petting.’ It sounds so serious! When you think of ‘heavy’ you think of cumbersome, unwieldy, bulky, awkward, clumsy. Now while this may be a very accurate description of the early grope sessions of adolescence, it does nothing to help young people work out safe and unsafe activities, or to improve the attractiveness of non-intercourse options. It is more useful to talk about ‘outercourse’, referring to a number of ways of satisfying your physical needs, even to the point of orgasm, without the disadvantages of intercourse.
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Finding out that your child is sexually active can be a tremendously confronting time for parents. Kids grow up so fast that, in some respects, it can come as a shock when they are at an age when they want to do it. Parents may feel very protective of their child, fearing that they will get hurt, get pregnant or pick up an infection. Growing independence means an element of risk-taking and that always makes parents feel nervous too. While some parents might flip out at the discovery of a packet of condoms in their child’s bag, others can cope with the concept of their child being sexually active. The issue of where the kids ‘do it’ seems to create quite a dilemma for many parents. One mother said, T want to know she’s safe but I just can’t have her boyfriend stay overnight in our house with her. I appreciate the fact that she is responsible with contraception and that sort of thing but I just don’t want it waved under my nose. I can’t bear the thought of chatting with them over the cornflakes in the morning knowing what they’ve been up to.’

Helen is sixty-four. ‘After Bob and I got married we moved a fair distance away. It was virtually a weekend trip to visit his parents. At first his mother would make up the single bed for me and Bob would have to sleep on the lounge. After a while we just said we would sleep together in the single bed or we wouldn’t come and stay anymore, so she gave in and made up the double bed for us. Every couple of hours during the night she would come into the room and “tuck us in”. We laugh about it now, but it was a real pain in the neck at the time.’

Richard says he was the one who was embarrassed about his girlfriend staying overnight. ‘One night after a party my girlfriend and I just fell asleep talking and didn’t wake up till morning. I heard my mother coming down the stairs. I quickly covered Rachel with an eiderdown and tried to act nonchalant. Mum asked me if I’d like a cup of coffee and I said yes, thinking she hadn’t noticed anything. Then she asked if Rachel would like one too.’

A lot of the reaction depends on the general level of communication in a family. Parents who have bad memories of their own early sexual experiences may be reminded of those bad experiences and react to that as well. Some parents and children are very open and comfortable talking with each other about sexuality, while others are decidedly uncomfortable. Some schools have excellent relationship and sex education programs in place with specially qualified teachers but it is certainly not universal.

Jenni remembers the sex education classes they had at her girls’ school. ‘Sex education was all about periods and not getting pregnant. They showed us a pathetic film called The Yellow Dress that was so full of euphemisms that we couldn’t make head or tail of any of it. When we were about thirteen we had a doctor come to the school in our Science lesson and the main point she wanted to make was that you could get pregnant from heavy petting. One of the girls put up her hand to ask what heavy petting was and the teacher told her not to be insolent. None of us had a clue what it was.’
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Poliomyelitis is a serious viral infection, which is rarely seen now in Australia, thanks to a widely successful immunisation program.

Cause

The poliomyelitis virus is spread via coughing or sneezing, or by handling infected stools.

Clinical features

The incubation period for polio can be from 3 days to 3 weeks. Initially the child may have symptoms similar to those of a heavy cold or flu, with fever, headache and generalised aches and pains. In severe cases this progresses and the nerves are affected, causing paralysis of certain muscles, which is usually permanent. Muscles commonly affected are those of the limbs, or those used for breathing.

When to see your doctor

See your doctor if your child has any of the symptoms described above.

Treatment

Any child suspected of having polio should be seen by a doctor and admitted to hospital if there are any signs of paralysis. If your child has not been immunised against polio for any reason, make sure you let your doctor know.

Prevention

All children should be immunised against polio. Because the condition is now so rare (due to successful immunisation program), many parents have become complacent about immunisation. Make sure that your child is fully immunised.

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Deference: A young person who seems to defer not only to parents,: but peers and everyone else, is showing the danger sign of low sexual self-esteem. Make no mistake about it. Self-esteem is sexual esteem, and to ignore that dimension of development while trying! to provide more education, more experiences, more special train’ ing or therapy, will never completely overcome a self-esteem prob-| lem. There is no escaping the fact that sex and love education is al fundamental part of self-development, the development of the! child’s reputation with himself or herself.

Developmental Retardation: Much has been written about learning disabilities and other developmental problems. Unfortunately, little is written about the sexual dimension of such problems. And impact as well as a cause of some developmental problems is deprivation of sex and love education, on the part of the child and/ or the parents. When we begin to “work” on our children, to correct them, therapize them, drug them to slow down or drug them to speed up, to tutor them, test them, and place them, we sometimes forget their needs for sexual education. I have spoken for years throughout North America on the topic of sex and the impaired child. I have learned one important rule: the more the impairment, the more the need for touching, holding, and closeness and for information about sex.

Marriages who raise impaired children have their own unique stresses and joys. It is an extra challenge to remember and find time to provide good sex education when providing life experiences and education itself can demand so much energy. Parents of impaired children sometimes struggle to find enough time, even any time, for their own sexual lives, let alone find time for sex education. It is important to find this time, even at the expense of other opportunities for the child, for his or her sexual life is at the apex of overcoming and/or coping with these special disadvantages.

I have found that the questions asked of me by some of these child òåï are the best, most basic sex-education questions of all. I have included their questions here, with my brief answers, so you may see how important sex is to them, and how important those “ÂÀßÓÅ” facts really are, and how the most basic of questions can teach us all about sexuality. The questions from teenagers and their parens ts were different from the following questions only in complexity of expression, not intensity of the need to know. Try to answer each question as a marriage before reading my answer. Try to relate each question to your own life, even if the questions come from children with developmental problems. There is a wisdom and a lesson in the simplicity and honesty of these children’s won-deringgs about sexuality.

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Researcher Helen Singer Kaplan writes that lack of orgasm during intercourse “may represent a normal variant of female sexuality. ” If focus is exclusively on orgasm rather than psychasm, one would be hard pressed to understand why intercourse is so popular I with women other than for closeness and intimacy. Of the 1,000 women, 823 reported psychasms in intercourse at five-year follow-up. “Once I learned the difference and stopped working for just something in my genitals, I started to really have orgasms, I mean psychasms.” This wife’s report was typical of those women who learned, as did their husbands, that orgasm and psychasm are dif- I ferent. Brain-wave patterns change during psychasm, and even I Masters and Johnson, the third-perspective researchers, state that “the mind turns inward to enjoy the personal experience.”

The early perspectives of sex research mistook physiology for psychology. Masters and Johnson write, “The subjective experience of orgasm in men starts quite consistently with the sensation of deep warmth or pressure that corresponds to ejaculatory inevitability.” In women, Masters and Johnson report the subjective aspects of “orgasm” as a “pleasurable feeling that usually begins in the clitoris and rapidly spreads throughout the pelvis.” The women in the thousand marriages reported such sensations as “an altered state of consciousness,” “being free from everything,” “sort of merging, actually being my husband,” and being “lost, tripped out, gone but more here than ever.”

Contractions in the pelvic area accompany orgasm in both genders. Both male and female experience the anal sphincter contractions. There is a physiological phase of being “on the brink,” of being about to experience pelvic contractions. Masters and Johnson saw women as not experiencing a sexual “brink.” They write, “Women do not have a consistendy identifiable point of orgasmic inevitability.” The women in my couples group did in fact report the sensation of a “brink,” and inevitability of physical orgasm. Four hundred twenty-two of them reported this phenomenon “always,” and a total of 644 wives reported this brink sometimes.

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If it’s candles and music instead of tuna fish and potato chips on paper plates, it probably means there will be some sex that night. We like to keep up the national average, you know. Do our share for the sex revolution and the age of enlightenment. Two and one half times per week, rain or shine. Well, a little more often when it rains, because we can’t work outside.

HUSBAND

Super Marital Sex Rule: Super marital sex depends on sexualizing the entire marriage, not separating sex into a category of obligatory marital duty, afterthought, or a different “part” of the marriage. The “super” in super marital sex refers to “whole,” to making intimacy a way of living and being together, not something you do sometimes. There are more spouses having affairs within their marriage than outside of them, separating marital sex from marital love, resulting in a form of “extramarital” sex rather than an “intra-marital intimacy.”

Extramarital sex has traditionally been viewed as adultery, marriage partners having sex with a person other than their spouse. It has received good press and is statistically quite popular. More than 70 percent of husbands and 40 percent of women report sex outside their marriage. In my sample of 1,000, the number was 76 percent of the men and 47 percent of the women. Extramarital sex is variously described as forbidden, sinful, destructive, .dishonest, and dangerous by some persons and by others as constructive, evolu-tionarily natural, energizing, fun, and somehow, if done “right,” preventive of divorce and marital problems by providing “outside” stimulation.

In the thousand couples, the 760 men and 470 women who reported sex outside of their marriage were always in a marital relationship in which at least one of the partners was less than satisfied with the intimacy of the marriage. There was no evidence in my sample, and there is no evidence in anyone else’s data, that extramarital sex enhances marital sex. My work with couples indicates that at the very least, extramarital sex is distracting from the effort and time necessary to develop and enjoy super marital sex.

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Mothers feed their children not only for them to live and grow but also as a sign of love. Sometimes they overfeed a child to satisfy some neurotic need of their own, and this may lead the person later on to seek satisfaction in eating for other needs besides hunger.

Being overweight is unhealthy at any age. Obesity can lead to an early death. Coronary artery disease, high blood pressure, diabetes, gallstones and osteoarthritis are all associated with being overweight. How does one go about losing weight? What I said at the beginning is true. Eat and drink less.

Crash diets are of little use. Many people do lose weight at the start, but within weeks or months are right back where they started.

A good reducing diet should contain around 3200 kj to 5000 kj a day. The diet should be balanced and have an adequate intake of vitamins and the essential food factors. It should be low in carbohydrate, high in bulk and moderate in fat and protein.

Carbohydrate is easily converted to fat in the body. Fat on the other hand, while it is high in kilojoules, is more slowly absorbed and cleared from the blood. It is therefore more satisfying than carbohydrate and you may not feel hungry for hours after a high fat meal. Protein is difficult for the body to convert to fat and burns up energy in doing so.

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