MINDING THE MIND IN THE CLINIC : APPROACHING CHILDRENS

BY DR ASHOK MOHANTY

EDITOR 'AUDE SAPERE'

I interact with many doctors who have querries, “How to take the mental state of an infant or child who hardly or never speak?

In my daily practice I see around 10-15 infants/children by understanding their mental state during sickness.

Let us find the possibilities of deciphering their mental state by common and uncommon behavior of these children during sickness in the clinic.

In case of infants/children we get symptoms from the following sources.

1. From the infant/child himself, if they can speak and willing to do so.

2. By observing their acts and behavior inside the clinic.

3. From the parents, if the child is sleeping or he/she is not willing to talk.

4. In case of not acute condition like Enuresis, Forgetfulness, Loss of Appetite sometimes the child doesn’t complain but you have to take the symptoms of the child in healthy condition.

5. Mind you, never take parental concern into account while prescribing in case of child, sometimes parents show more concern than the child. You have to evaluate the symptoms after seeing the child and take symptoms accordingly into merit.

6. Some children are slow to react so don’t be impatient. Repeat your question till the child understands. Never get irritated with the child.

7. Try to be friendly with the child.

8. Never look into the eyes of a child when he enters into the clinic if you find the child is nervous or having fear over his face.

9. Give some time to the child to be familiar with you and other clinic staff.

10. Take into account everything the child does inside the clinic like touching items kept on table, stamping the feet, his gestures and other acts.

Let’s discuss some cases of children where you can find medicines just by observing the child when he enters the clinic.

Case I

A small boy of four years age was brought by his parents for treatment of recurrent bronchial infection. As soon as their turn came his father came inside. His mother was behind him but the child was not entering inside the chamber. He was holding the two sides of the door with both hands and resisting his mother not to come inside. His father who was already inside told, “Sir, whenever he goes to somebody’s place first time, he does like this.”

He was still struggling with his mother not to enter. His father further told, “We are giving allopathic treatment since two weeks, but when we stop the antibiotics the problem recurs. Initially when we visited the previous doctor our child behaved same way as here but after two or three visits he became normal and even takes injection without crying and any hesitation. Regarding his behaviour, her mother added he becomes very stubborn during the episode of cough. If he wants something he will make all the efforts to get that and you have to provide the same. Nobody can make him understand that time.”

The child was still standing on the door struggling with the mother not to come inside. Her mother told him, “Let’s show to the doctor then we can eat panipuri (water balls) while going back in the market. You are such a nice son, nobody on this earth can match you.” She was telling all good things and praising him. After sometime he agreed to come inside.

There was nothing, which I could have asked further as he was reluctant to give any information. From the above conversation and observation I took the following rubrics:

1. FEAR - room, on entering

2. FEAR - strangers, of

3. PERTINACITY

4. FLATTERED - desire to be - gives everything, when flattered

A dose of Lycopodium 30 was given which brought down the cough and breathlessness in 12hrs time. The case was followed up till six months with no recurrence.

His stubbornness reduced to some extent, so as his mingling with new people for which he used to have some fear earlier.

Here in this case the child didn’t want to enter the room because of the fear of stranger and new people inside the room. He didn’t have the confidence to face them. Hence, he became stubborn not to enter the room. His mother’s pampering to great extent made him to come inside.

What is Pertinacity?

Holding firmly to some purpose, belief, or action, often stubbornly or obstinately.

Hard to get rid of; unyielding; persistent

What is Obstinacy?

Unreasonably determined to have one’s own way, stubborn, resisting remedy or treatment.

How do we differentiate between the two?

In pertinacity, there is strong reason behind his action (better known to the individual)

In obstinacy, he just wants to do it without any sufficient cause behind that.

Let me give one example each to make these two rubrics more clear.

The child is crying at night to have hot popcorns, which can’t be available at that time. You tell him that it can not be obtained at that time; he doesn’t listen and presses more for the same. He then stops talking with the parents and eating his normal food. This is obstinacy.

The child wanted to buy a toy aeroplane in the market. You told him, “I will give it tomorrow as I am not having enough money today.” Tomorrow he will ask for the same. You somehow manage to postpone the buy for next day. Next day he again asks the same. You told, “No, now I can’t buy that.” The child will not leave you till you buy the same. He will never forget the same. This is Pertinacity.

In obstinacy there is more emotional reaction to a stimulus, the child closes down himself and does not participate in any activity and stays indifferent, but in Pertinacity there is more action involved where the child will by any means makes tremendous effort to complete the task in hand for which he had made up his mind.

Case II

One of our colleague’s daughter suffered from very high fever which couldn’t be brought down in spite of changing different remedies in different potencies. We tried individually but there was no relief. The fever was continuing since two weeks.

We thought to take the case together.

Her temperature used to rise very high up to 1040F. She used to lie down or read that time. On asking during that period she tells, “I am OK.” On further questioning she tells, “I don’t feel any pain now. I sometimes feel the need to relax. But I am totally OK and comfortable. Don’t worry about me.”

When her father asks, “You have so high temperature, is there pain or any anxiety or something else?”

She replied, “Papa, don’t worry nothing is going to happen with me. I am more perturbed by your and other doctor’s queries than the disease. I don’t feel good when all of you ask and meet me to select medicine, repeatedly ask the same questions.”

She further added, “Papa I am totally comfortable and I am sure nothing is going to happen to me, please let me relax.” Further she told her mother to tell her father that she doesn’t want to take medicine.”

The following rubrics were taken:

1. WELL - says he is well - sick; when very

2. IRRITABILITY - questioned, when

3. REFUSING - medicine; to take the

8. REST - desire for

A dose of Arnica 30 brought down the fever and she was followed up with no recurrence.

Arnica child doesn’t wan anybody to come near him as any touch be it mental or physical hurts him during the process of recovery so he tells other that he is well.

In the above case the rubric which was guiding to the state of the girl was ‘WELL - says he is well - sick; when very’.

There are different reasons for which, in spite of the sickness the patient tells that he/she is well.

Let us discuss another case of this rubric to find out why they tell OK during sickness.

Case III

A boy of six years was brought to me for skin eruptions with severe itching resembling scabies.

Doctor: “How are you?”

Patient: “fBd gSA (I am alright).”

Doctor: “Once you are alright then why you came for medicine?”

Patient: “Papa brought me here.”

Doctor: “You don’t have any problem.”

Patient: “No, I am OK.”

His father told, “He tells the same way always and plays with his cricket bat and ball. When the itching is more he leaves the game and keeps on itching. If the itching doesn’t subside then he applies coconut oil on them.”

Doctor: “Why you apply coconut oil?”

Patient: “It gives me soothing effect. I feel better after applying oil.”

I took following rubrics:

1. WELL - says he is well - sick; when very

2. PLAYFUL

3. LIGHT - desire for

A dose of Belladona 30 cured the skin eruption and itching.

Belladonna child says well as he wants to play and does not want others to disturb him by taking him to doctor or wasting his play time by giving medicine etc.

Case IV

A boy of 10years age was brought to me by his parents for complete loss of appetite. Some time he complains of pain in the hepatic area.

His mother told, “Since last seven years he is having the same problem and taking treatment continuously either from Ayurvedic or Allopathic doctor.

I asked him, “How do you manage the pain?”

He replied, “I just sit down or lie down during the pain. When the pain reduces I start playing.”

His mother told, “He always plays. Even sometimes during pain also he plays on the bed by throwing the ball to the wall or to the sides of the bed. He never bothers others about his pain. Let it be any severity, he just lie down and never disturb others. He is very sober and nobody from neighbors or from school complained about him. He sometimes fights with his sister momentarily if she disturbs him in his activity or changes the channel of the TV which he used to see regularly.”

I took the following rubrics:

1. PLAYFUL

2. CARES, full of - others, about

3. ANGER - interruption; from

4. MILDNESS

A dose of Cocculus 30 settled the case.

Cocculus Ind. Child plays a very contented play, never disturbing anybody in any condition.