Dr Sudheera A P
A child should be understood in its social, cultural and familial background. In the present era of rapid scientific progress and a consequence of advances in molecular biology, genetics , and immunology, the approaches to the management of many disorders in children are changing constantly. There is a change in the trend, which has been accepted globally to provide the care of child in totality. Consequently increasing attention is being paid to behavioural and social aspect of health. The effect of different factors, from the day of conception, on the intrauterine life of the foetus which make great contribution to the disposition of the child are well known. This is an accepted fact in medical science. A child is a product of environmental surrounding during pregnancy, birth and in the early years of rearing.
These days, parents are more and more concerned with the health care of the child. They often call upon the physician, make enquiries and seek guidance about various factors relating to the health and illness of their child. Hence a physician has to play an additional role of a guide. Some times he has to act as a counselor to the child and his family. He is also called upon to guide the parents when behavioural problems arise in respect of relationship between the child and its home, child and its school and the child and its social surrounding.
Under such a demanding situation, the physician, apart from keeping himself abreast of ever advancing knowledge in the field of his specialization, should try to understand social practices and believes of the society to which the child belongs. The physician need to be aware of cultural variations in the way a family deals with, the health care system and illness. The wide variations existing among different cultural groups in respect of believes about the causes of diseases in children must be known to the physician in order to deal with them effectively. He should also know specific believes and practices which influence health care, childhood behaviour and child rearing. Different cultural groups may have their own theories and explanations about the causation of sickness in a child. In many rural and urban areas there prevails a concept that diseases are caused due to a retribution of sins, supernatural powers or evil eyes.
Depending upon the belief system, the parents go in search of a particular type of treatment. If they believe that diseases are caused by sins or supernatural power, they would prefer to go to a spiritual healer. Sometimes, parents take their children to the physician to get relief from troublesome symptoms, at the same time they seek help of a folk healer to identify a spiritual or supernatural power which had caused sickness to the child.
In cases where in the parents relate to the diseases with their believes which are not consistent with biomedical theory and practices(but which do not have adverse effects on the outcome of the treatment), it is better on the part of the physician not to contradict the parents believes, but to offer biomedical explanation. Attempts to change long held believes during brief clinical visits would most likely fail.
Parents often do not disclose the physician about the folk treatment given. Therefore the parents should be taken in to confidence and folk measures rendered to the child must be elicited. Unless this is done it would result in a cycle of miscommunication. Most of the time even when the parents are told in the clinic that there is nothing wrong, or that the disease is self limiting, they might seek further guidance from the folk healer. As long as their believes do not interfere in the treatment they should not be criticized. There should be an attempt on the part of the physician to provide culturally sensitive child care by acknowledging and respecting variables such as ethnic values, cultural orientation, attitudes, religious believes, which play great role in moulding the health and illness.
The physician’s interview is of critical importance in understanding the child. At the time of interview, the reactions of parents, which should be keenly observed by the physician would always provide valuable in sight in to the parent child relationship. If the child is elderly enough to answer questions put by the physician, he should be addressed to directly and should be encouraged to talk. Care should be taken to make the child comfortable. Physician should also try to establish a rapport with parents who sometimes do not like to share the child’s problem particularly relating to genital and bowels. During the interview the physician should try and know the type of care and attention given to the child during health and sickness. This type of approach serves to enhance the confidence of parents and children in their role as participants in clinical evaluation.
Care should be exercised while trying to know the sensitive parents and child to avoid too much probing in to their believes and concepts. Even while examining, too much eye contact on the part of the physician is taken as aggressive. Putting too many open questions without being sensitive is sometimes taken as a hostile approach. In any case, knowing a child in totality is a delicate and difficult task and the physician should know how to strike a balance in order to get the most and the best in a clinical interview.
Apart from the above mentioned factors, a physician should be aware of the normal parameters of development of a child to understand what is wrong in each case. For example one month baby has higher respiratory rate (30 mts.) than 3 yrs. One month baby is more near sighted and tends to focus an object held within 1-2 feet of the face and may ignore objects present in peripheral fields of vision. A child of 8 months develops a sense of individuality and may be aware of strangers and frightened by separation. It might cry, and show various reactions like kicking and throwing things while examining especially when it had some unpleasant experiences like injections. Even other developmental landmark might show a wide variation in children which should be known to the physician. A slight variation in teething walking, talking etc could be normal and a physician should know at what stage he should start treatment.
The knowledge of the parameters not only helps the physician in decision making, but also enables him to convince the parents whether the treatment needs to be given or not.
No doubt these variations in development are characteristic of each child and they help to assess the individual constitution. However, these variations in themselves do not call for medicinal treatment.
The physician should be aware that the head and trunk are relatively large at birth. The knowledge of U/L ratio helps to assess the growth of baby at different age. U/L ratio is the result of division of upper body segment(full length of baby- lower body segment) by lower body segment(length from symphysis pubis to the floor). This ratio is approximately 1.7 at birth, 1.3 at 3 yrs. And 1 after the age of 7 yrs. Higher U/L ratio is characteristic of short limb, dwarfism or bone disorders such as rickets.
From the day of birth the infant undergoes lot of changes, and rapid physical and mental growth takes place. A child has to be assessed according to its age, family background as well as social cultural and religious background, so that the individuality and totality of the child is understood properly.
While taking the case, the physician should note down the necessary points and carefully observe the sick, so that nothing important escapes his notice. While recording he should intermittently look directly either at the parents or the child to establish an effective communication. A sympathetic listener who shows concern for the child and addresses the child by name, often obtains more accurate information than a hurried distracted interviewer. While putting questions the physician should also observe the interaction between the child and the parents.
In Homoeopathic Medical Repertory, Dr.Murphy has given a chapter on children. It is very useful in the management of disorders of children.
Some important rubric are
Constitutional remedies:calc.,calc.p.,phos.puls., sil.,-3
Abdomen in general
Girls at puberty:Graph-2
Swelling glands with:Mez.
Abused ailments from being
Sexual abuse from
Abusive children who insults parents
Acetonemia in child:Phenobarbitalum
Adenoids, problems with:Carc.,tub.,3
Chest complaints with:Calc.p.,phos
Lifted from cradle when
Waking , evening in:Cina-3
Asthma children vaccination after:Ant.t.,sil.,thuja-3
Bathing dislike of:Sulph.-3
Difficult to wake the child
Dramng of urinating while
Birth marks, naevi
Breast feeding ailments during
Carried desire to be
Chafing skin infants-calc.,graph.,sil.-3
Chorea, children who have grown too fast
Clinging convulsion before:Cic-3
Confidence lack of self
Constipation children Nux vom or lyco after:Verat.
Development delayed, bones of
Nutritional disturbance due to
Diaper rash buttocks:Sul.ac.
Fallin fear of
Fever constant infants
Fingers in the mouth children put
Catarrh of pancreatic duct
Jaundice stool with bilious-Elat
Jealousy ailments from
Lice, head of:Staph.-3
Lips picking of
Muscular weakness of infants
Mutinism childhood of
Puberty ailments in
Responsibility aversion to
Sebaceous cyst of
Thin sickly children
Urine retention in
Worms, behavior problems with:Cina-3
Homoeopathic Medical Repertory- Dr. Robin Murphy
Homoeopathy, Child care – Dr. Shashi Kant Thiwari
Dr Sudheera A.P BHMS,MD(Hom)