Home   |  Issues  |  The Daily Star Home | Volume 3, Issue 36, Tuesday April 18, 2006



Interpreter of maladies

Dr. Nighat Ara, Psychiatrist, Counsellor and Therapist

Dear Dr Nighat Ara,
My daughter is only nine and half but she is already going through her hormonal changes. As a mother how do I deal with this? Basically, I need to know how can I tell my daughter about growing up and the changes that she is going to face. I want to know what is going on in her mind and how I can help her adapt to it.

Ans: Going through hormonal changes at age nine and a half is nothing very unusual. The average age of adolescent growth spurt for girls is 10 to 13years. In fact, onset of puberty depends on many factors like- heredity, nutritional level, hormonal level, environmental factors etc. However, an early onset of puberty also means an end to the innocent, playful childhood phase of life. The preadolescent/adolescent girls are often deprived of opportunities, rights and privileges that the society grants to younger children. A slow gradual transition rather than an abrupt exit (if you are trying to restrict her or discipline her) is helpful for proper adjustment. Authoritative parents set high but realistic standards, reason with the child, enforce limits, and encourage open communication and independence. In adolescence, the expectations from a girl changes suddenly and can become quite conflicting depending on the attitude of the parents. Girls tend to idealize their mother, and peer groups also influences the girl's outlook towards life. Femininity-achievement incompatibility (doubts around this issue and examples set by other significant adult women), attractiveness and marriage ability, competition against other girls for the attention of boys, tight knit groups of girls engaged in mutual sharing with immense amount of giggling are common features of this age. Parents' attitude toward higher education, achievement and wife-mother gender role of a girl will influence her future behaviour.

At this stage, physical changes are also associated with subtle cognitive, psychosocial and moral development which are never the less important. Nine year old children are less egocentric and realize other people have thoughts and feelings too. Logical thought process matures further and concept of reversibility (after change in shape, position or order, matter can be returned mentally to its original state) is attained at this stage (cognitive development theory). According to psychosocial development theory, at this stage children develop a sense of industry or inferiority depending on how parents and teachers react to their effort to undertake projects (some science project or household stuff like reorganizing her room, cooking, baking etc.). Parents are usually more successful if they are loving, warm, nurturing and supportive. Children of warm, affectionate parents are more likely to grow into socially accomplished adults. Few tips to enhance positive growth-
· avoid discouragement (which causes sense of inferiority) to promote optimal functioning,
· work for improvement and not for perfection,
· one's effort is more significant than one's result,
· separate the “deed” from the “doer”,
· build on strengths and not on weaknesses,
· learn to trust your child,
· Stimulate and lead the child and do not push her ahead.

According to Kohlberg's theory of moral development, moral reasoning of a 4-10year old child is governed by the standards of others. An act is good or bad depending on its physical consequence-whether it is punished or rewarded. Children tend to obey out of fear of punishment (physical punishment is not recommended). At this stage, they also have a sense of self-interest. By rewarding their positive behaviour, they can be encouraged further to move in a positive direction.

No matter how hard you try you can never be a perfect parent, so also learn to accept things as they are after you have done your best. Good luck!

Dental wise

Dear Doctor,
I am a 48-year-old diabetic patient and suffering from gum infection and having several loose teeth. I visited a dental surgeon who suggested dental extraction. Why is it happening? As diabetic patient can I get it done outside BIRDEM? I am somewhat intimidated by the hospital environment.
Tahmina Sultana

Dear Ms Tahmina
Diabetics are known to have a decreased dental healing response. Gingivitis is an infection within the gums caused by bacteria found in plaque. A diabetic's body doesn't respond as quickly to fight this type of infection as a non-diabetic. If the infection persists it can become worse leading to the infection of underlying bone that anchors the teeth in place. In addition to controlling the condition of diabetes, the importance of maintaining good oral health is essential. Brushing and flossing help to reduce plaque and bacteria that cause infection and thereby decreasing the risk of gum disease.

Many factors contribute to the loss of teeth in someone who has diabetes. A poor healing response combined with gum disease and the destruction of bone anchoring the teeth in place may result in teeth that become loose and eventually fall out. Although diabetics have no control over their response to infection, they can practice good oral hygiene habits (brushing and flossing). Removing plaque will reduce or eliminate infection. Ensuring the diabetes is controlled (taking insulin, altering diet) is also a way of decreasing the risk of tooth loss.

It should be noted that a diabetic may have excellent oral hygiene and still suffer from gum disease and bone loss. If this is the case, additional measures can be taken. Your dentist can recommend a special prescription mouthwash which kills various bacteria in the mouth that contribute to gum disease.

No it is not safe to get the extraction done outside. As a diabetic, I strongly recommend you not to go for kind of dental surgery without consultation with dental surgeons who are dealing with diabetic patients. You can consult and have all the dental treatments at the department of dentistry, BIRDEM hospital.

Dear Dr. Khan,
I have several metal fillings (Silver/black colour). One of my friend replaced all her silver filling with white ones. Can I replace mine? I don't have any pain or complain and filling are still in place. Should I replace only for colour? Previously you mentioned inlay filling; what's that?

Constant pressure from chewing, grinding or clenching can cause dental fillings, or restorations, to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up.

If the seal between the tooth enamel and the restoration breaks down, food particles and decay-causing bacteria can work their way under the restoration. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscess.

Yes you can replace your old silver filling with white colour composite filling or Inlay. Inlay is new type of cast filling, which is prepared in laboratory. Inlay is superior to silver filling and white colour composite filling, Why? Inlay is widely use in other countries because of its heavy strength, excellent shape/anatomy and accurate adaptation. First of all, consider the simple physics of the situation: each bite you take puts up to 900 pounds of pressure per square inch on the surface of the biting tooth. Over the years, this kind of pressure can easily cause silver amalgam or composite filling to change their shape and contour, crack, and possibly create fractures within the tooth as well. Then, decay can creep into the fracture lines and under the loosened filling. Furthermore, silver actually expands at an entirely different rate than tooth enamel…meaning that it's only a matter of time before the filling's changing shape fractures the underlying tooth. However, inlay isn't susceptible to these problems. You will be happy to know that we recently have introduced inlay in Bangladesh.

By the way

Don't bother with perfume when in the sun. It tends to irritate the skin. Use enough talcum powder and a good deodorant instead to smell decent throughout the day.

Under a different sky

By Iffat Nawaz

My piece

She left two weeks ago, we called her everyday since. We didn't tell her we cant wait to have her back here in the states, we didn't tell her how strange it seems for the two of us to be here without her, we definitely didn't tell her we miss her. But she knew like she usually knows.

She took with her a piece of Bangladesh that belongs to me. A piece of my Bangladeshi individuality that is neatly tied to her every day phone calls, her voice, her being around, even if hours away but still in the same country. I am alone without that piece of Bangladesh, the one that was created by her especially for me when she gave birth to me, to help me see everything around with a clearer more beautiful perspective. That piece of Bangladesh that she brought me up with since I was a child, when she taught me Bengali rhymes, read me Thakur Ma er Jhuli, made-up stories about the Bangladeshi villages with houses full of little girls like me, named Moyna and Shona and how they had small ponds full of fishes and a garden full of vegetables as she hand fed me my lunch of the same vegetables and fishes she spoke of in her stories, that was the only way she would get me to eat them, for her it might have been a technique to feed her fussy scrawny young daughter, maybe she didn't realize with each ball of rice she also fed me images of Bengal, the smell, the feelings that only a child can give the reality to in her own mind, creating a base for beauty and understanding that will rule her for the rest of her life.

I have been hurting without that part of Bangladesh inside of me. I know it will return to me as it was meant to be always only mine. And I know when it returns it will be jubilant than ever, with new memories, new colors, new scents, my refreshed piece of Bangladesh will exude clarify and splendor and it will make me shed a few tears because these feelings that my piece of Bangladesh creates are often too intense…even for a “I-could-care-less” type of girl like me.

I search each time I speak to her. I dial the numbers over and over again before my phone connects to Bangladesh usually, I don't give up until she is at the other end. The bad connections loose a few words, a few sounds, a few happy or sad strands here and there, and I try desperately to read her voice, to capture the lost strands, I try to read her words more than they were meant to be read to figure out how my temporarily lost parts are doing, floating giddily in its own milieu or sinking fast with dust and storms.

She will be back soon, with her will be my missing pieces, I will carefully put it all back inside, make sure it covers all emptiness within, make sure it carries all the new along with the old, I will make sure to thank her for giving me my piece of Bangladesh, for nurturing it, re-polishing it, redefining it.

The Bangladesh that drifts inside of me, around me, over me, is grateful to her. She lent me two eyes and made me see her piece of Bangladesh so I can create my own, her uniqueness resembling mine, our two perfect Bangladeshes taking us over, her insights and my imagination.


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