The Technique of Taking Children's Cases
Homeopathic Journal :: Volume: 4, Issue: 10, Aug 2011 (General Theme) - from Homeorizon.com
|Article Updated: Sep 18, 2011|
Children, we all know, are remarkably sensitive to strangers, new places and new environments. Remembering this well known fact we should adopt the following methods in dealing with them.
Observation of the patient without disturbing him
Observing the patient when he is brought to the physician by the guardian.
However much be the haste, the child should not be approached abruptly and directly. Rather he should be given some time to adjust to the new place and environment, in the mean time we should occasionally have friendly talks with the guardians to make the child realize that we belong to the friend circle of his family. These talks with the attendants should never have any direct reference to the child, as that will rouse his suspicion and shyness, without paying any direct attention to him, offer him various trashes, like snuff box, empty cigarette case, key ring, tuning fork, knee hammer, some picture etc., or occasionally some plain cane sugar globules, to earn his friendship. All the time we can tactfully take note of the following data:
1} General appearance:
- Of Calcarea type, Graphite type, Baryata carb type or Natrum mur type, Argentums type, Opium type and so on
2} Attitude and mood:
- Dull (sycotic), curious (psoric), over agile (tubercular), violent and impulsive, mischievous (syphilitic), taciturn or suspicious (sycotic,) restless (arsenic, rhus tox etc.,) irritable and difficult to please (chamomilla, cina, nux vom, etc.,)
- weeping ( pulsatilla, sepia, sulphur, lycopodium, medorrhinum etc )
- crying due to any pain or colic which may be localized by the patient by various gestures or placing hand or due to hunger or any inconvenience or due to spoiled nature.
- Chilly or hot blooded demanding the fan on or off, requiring over clothing and so on
i.e., the aspect and expression of patients face. Face being the index of mind, most of the subjective symptoms like pain, anger, joy, greed, comfort, aversion, vexation, jealousy, mischievous impulse etc., etc. can be observed by facial expressions. Apart from that physiognomy would help in the very diagnosis of various conditions e.g:
- Anxious expression in acute virulent diseases like pericarditis, peritonitis, severe pneumonia etc.
- Dilated nostrils and flushed cheek; acute pericarditis or croupous, pneumonia; flapping nostrils in lobar pneumonia (in the 3rd or 4th stage).
- Facies, hippocratica, fore runner of death from exhaustion;
- Risus sardonicus, pathognomic of tetanus, then again we are acquainted with the Pthisical face, syphylitic face, leprotic face, adenoid face, paralytic face (eg. bell’s palsy )
Facies of disease -
It must be clearly distinguished from physiognomy means, the art of judging the character of the person or diagnosing the disease from the face. Facies of disease means the totality of all the objective manifestation of a disease as expressed in:
- The physiognomy,
- The attitude, decubitus or gait,
- The alterations in the general confirmation of the body, various diseases have typical and characteristic facies e.g., congenital syphilis, congenital heart disease, rickets, hydrocephalous, microcephelus, cretinism. Graves disease, mongolism, post diphtheritic paralysis, chorea, tetanus, marasmus, tubercular meningitis, peritonitis and so on.
Observing the little patient at his residence
All the points mentioned before with respect to the little patient coming to the consulting chamber of the physician apply equally when physician visits him at his residence. Here also he should not enter the house or room of the child as an extra ordinary person but as a normal visitor of friend of the family and earn the acquaintance and friendship of our charge gradually by the various maneuvers mentioned before. Here also one can gather all the important data just stated by careful and tactful but apparently casual observation. In addition one can gather the following data by visiting the patient at his residence:
- The nature of the house and the particular room or place where the little patient stays, with respect to light, air, humidity.
- Cleanliness and other hygienic conditions, any bad odour, noise etc., and also the reaction of the little patient to each of the environmental items – whether deliberately prefers and feels comfort by those or has been forced to accommodate with them by economic conditions may be taken as the exciting or maintaining cause of the disease
It signifies the position which a patient most commonly assumes often gives a valuable clue to the nature of the diseases and the modalities of the case, for example:
- a} orthopnoea - in extreme breathlessness which occurs in advanced cardiac pulmonary or renal diseases, also in some severe acute diseases like pneumonia, peritonitis etc.,
- b} Lateral decubitus - in various diseases manifested in the lungs, pleura, abdominal viscera
- c} curled up position - certain forms of meningitis also certain forms of colic.
- d} dorsal decubitus - generally signifies grave illness with marked prostration - e.g., the " typhoid state " severe peritonitis ( with legs drawn up to relax the abdominal muscles )
- e} opisthotonos (arched backwards) - in tetanus, hystero-epilepsy, strychnine poisoning )
- f} pleurothotonos -(bending sideways) - in various pleural or spinal diseases.
- g} Retraction of the head - is characteristic of cerebro spinal meningitis, post basal meningitis. Also found as mengismus in infants with digestive disorders, otitis media or febrile states and in dyspnoea due to laryngeal obstruction and rare cases of cervical caries.
- h} Restlessness - as a chronic condition signifies tubercular diathesis, children often become restless in any painful condition; but of grave importance in severe acute diseases like pericarditis, pneumonia, typhoid, cholera etc. Some special forms of restlessness:
- -1} carphologia or floccitatio (picking at bed clothes or imaginary things)
- -2} subsultus tendinum ( muscular twichings) in the same state
Various forms of fears, deliriums and hallucinations
By observing patient’s reaction to various external stimulus like to light and darkness, sight of water, drinking, touch, loneliness etc.,
Various forms of convulsion or choreiform movements
Epilepsy, hysteria, worms, chrores, various acute diseases like meningitis, malignant malaria etc. we should also remember that any severe illness specially if attended with high fever, may be accompanied by convulsions in infants and children.
Gresus gallinious ( waddling gait like a duck), greases vaccines (cow like gait), ataxic gait, spastic gait high stepping gait etc., are often clues to the diagnosis of various conditions, these are best and more naturally elicited at patient's house, but may also be observed at our chamber.
After obtaining such large number of highly important data without at all disturbing our little patient and in the mean time, establishing a fairly normal relation with him, the physician can proceed on to the following subsequent steps
Interrogation of the patient
In this matter we should be careful about the following –
- The questions should be as simple and as straight as possible.
- Leading questions eliciting answers in the form of yes /no should be scrupulously avoided.
- Taxing memory intelligence or judgment of the little patient should as far as possible be avoided, such as putting complicated and ambiguous questions and trying to elicit modalities from him .The modalities should be best elicited by the physician's own observation as discussed before and by interrogating the attendants some sample questions, what is your trouble ? (if any pain) where is your pain ? And so on...
Interrogation of the attendants
This may be started at the outset while making acquaintance with our little friend - without exciting his shyness, nervousness or annoyance and may be continued while interrogating the patient to elicit the history of onset of the various symptoms and their modalities and also after that stage for further addition, qualification and amendment of the data already obtained, particularly about the modalities of the various symptoms, apart from all these the following information are to be especially obtained from the attendants:
- Birth - full time or premature, natural or instrumental, any birth injury, any asphyxia neonatorum or any other complication.
- Feeding -natural or artificial -the type of artificial food, mother's health during the period of lactation any troubles in relation to feeding.
- Age of teething, sitting, standing, walking, talking -any abnormality about any of them.
- Past history -all the indispositions, disorders and illnesses - since birth till date, in chronological order, especially about skin disease and vaccination in any form.
- Any illness of the mother -during carrying the baby up to its birth or there after.
- Family history - especially for
- The evidence of any miasmatic stigmata in the blood relations or
- Contact with any specific diseases like tuberculosis, syphilis, skin disease etc.
- Physical examination of the child : this should be deferred to the last and should be performed as gently or even playfully as possible without frightening or rousing the resistance of the little patient.
I often make a mock examination of the attendant to rouse the interest and co-operation of my little friend e.g., ask the mother to show her tongue or throat, before asking the baby to do the same, making a mock use of the stethoscope on the attendants before applying it to the baby, these maneuvers always earn for me active co-operation of any little friend in this physical examination.