paediatricians – Ask The Paediatricians Foundation

UNDERSTANDING THE MEDICAL PROCESSES

Many parents do not understand that there are medical processes followed by medical professionals in making diagnosis. As a Paediatrician who often provides free medical advice online especially on our Ask The Paediatricians Facebook Group we often receive complaints from parents and members when we asked to go to the hospital or see a doctor after they have asked us questions about their child’s health. They wonder why we can not provide diagnosis simply by what they have told us and also tell them the treatment right away. After all, they already have access to the doctors on the group!

Well, this is what I will be addressing in this article. Parents and caregivers need to understand these medical processes we undertake. I will be explaining a few of these processes to understand why it is important to see a medical professional irrespective of whatever medical information you have online.

First, you need to know that no doctor can give you a diagnosis based on just one symptom or even a group of symptoms only.

For example let us look at a child with abdominal pain. What is the diagnosis? For the complaint of abdominal pain alone, just telling us where the pain is located is not enough to make a diagnosis!

There are so many other questions to ask. There are more than 10 questions about the pain alone before asking asking so many other questions not even about abdominal pain. I am sure some of you have wondered what the age of your husband, whether he smoke or is hypertensive and how many other children you have to do with this abdominal pain! I mean what has your religion or recent travel got to do with abdominal pain? A lot and you just don’t know it yet.

This is what we call HISTORY TAKING and it is even just step one of the medical process in making a diagnosis.

After some minutes of taking adequate history; maybe as short as in 5 minutes or long as in 30 – 60 minutes depending on what we are dealing with, then the second step is PHYSICAL EXAMINATION where the doctor actually examines the body; the area you are complaining about and those that you have not complained about as well. Your eyes will be checked even if you only complained of abdominal pain!

After these two processes, the doctor can sometimes know your diagnosis. At other times, he is not sure and may be suspecting 2, 3 or 6 possible diagnoses! We call them DIFFERENTIAL DIAGNOSES. S/he will then need to investigate that is what you often call LABORATORY TESTS or XRAYS/SCANS to really confirm which of the possible diagnoses is the correct one. Usually, we start with simple investigations and if those are not sufficient to still help to confirm the diagnosis, we go ahead to do more complex and usually more expensive ones.

It is AFTER completion of most if not all the above medical processes that TREATMENTS can be recommended. This process is even not what we do in EMERGENCY!! The medical processes will be rearranged with focus on keeping the person alive first before addressing diagnosis and treatment.

So you now see and hope you can appreciate why it is not appropriate to expect us to give you diagnosis based on two sentences of symptoms you wrote and expect us to recommend treatment as well.

It is also obvious that the ABOVE MEDICAL PROCESSES can not be done online. Even if we attempt to ask you all the questions (HISTORY TAKING) online (which will require a lot of back and forth and which is not even suitable on a public platform as DOCTOR-PATIENT CONFIDENTIALITY will not allow such, it is obviously obvious that we CAN NOT DO PHYSICAL EXAMINATION on Facebook!!!

This is the reason we always TELL YOU TO SEE A DOCTOR when your question is about an illness! We are not being hard or difficult. We are doing the right thing and following DUE PROCESS! That is being ETHICAL! Our professionals are not like many experienced mothers and self-proclaimed “doctors” who often make diagnosis based on one symptom hearsay and go on to recommend treatment not remembering that there are many conditions that can present with same symptoms!

This also by implication extends to treatment and why it is difficult to “copy and paste” treatment from one child to another child because they have same or similar symptoms. The diagnoses may be poles apart.

Going back to the case study of abdominal pain again. Abdominal pain in one child may be due to something simple as constiaption that taking fruits, water and vegetables alone will be sufficient. In another child, abdominal pain may be due to intussusception that requires the child to have surgery immediately.

It is EXTREMELY DANGEROUS to copy treatment without seeing a doctor.

Please also BEWARE of going to Google Medical School for diagnosis and treatment. You better read the disclaimer there first. Medical information provided online and even on platform like Ask The Paediatricians does not replace consultation with your doctor!

This is one reason we also do not like to comment on treatment recommendations by your own doctors who supposedly have carried out all these medical processes first before giving you treatment. Please read ATP disclaimer as well as we are not liable for any outcome based on advice given here.

I hope this helps! So please don’t get upset when we say “See a doctor or Paediatrician” or “Go to the hospital”. In most instances, it is the best advice for you at the time and may be live-saving! It is many times in your best interest.

MUCH ADO ABOUT TONGUE-TIE!

Tongue-tie is another mother’s favourite topic for the Paediatricians! Oh yes! You can not be a Paediatrician; no, you cannot say you are a practising doctor in Nigeria, West Africa if at least one mother has not asked you to help check if her newborn or infants has tongue-tie or not!!

An average Nigerian mother believes that the number one cause of speech delay in children is the so-called “tongue-tie”!!! They strongly believe this “tongue-tie” must be cut or else the child will not be able to speak on time or the speech will not be clear. So it is not unusual for us who are Developmental Paediatricians to be asked to check if a child brought to us on account of speech delay has tongue-tie or not! Indeed many would have gone ahead to cut the “tongue-tie” maybe once or twice before coming to you after realizing there is no improvement in the child’s speech despite the tongue-tie surgeries.

This worry is so prevalent that some unscrupulous hospitals have decided to take undue advantage of ignorant and unsuspecting parents by telling them they will “cut” the tongue-tie for a fee! They do this “surgery” routinely which is highly unnecessary in all newborns just for profits. Some parents who want a cheaper option use the untrained “local surgeon” to do the cutting. The latter often use unsterilized instruments putting the baby at risk of infections and tetanus. The cut may also heal with fibrosis leading to more complications.

It takes a lot of efforts to convince the mothers otherwise; some do not even believe you when you tell them the child does not have tongue-tie or that tongue-tie is not the cause of the child’s speech delay. On the Ask The Paediatricians Facebook Group, the tongue-tie issue is one of the most frequently asked questions hence the need to address the issue. This post is to inform parents and deliver them from the unnecessary worry and anxiety about tongue-tie.

The tongue is normally connected to the floor of the mouth by a thin membrane called frenulum in medical jargon. This frenulum is a normal structure in the body and usually very thin and does extend to middle of the back of the tongue. This is to allow the free protusion of the tongue out of the mouth when necessary. However, this is what many interpreted as tongue-tie. It is not a tie….it is normal.

There are rare instances when the frenulum instead of being a thin membrane can be thick, muscular or extend further to the tip of the tongue leading to limitation of the movement of the tongue. This is called anklyoglossia or the true “tongue-tie”. It is only in cases of anklyoglossia that surgery is necessary to free the tongue so that it can move freely.

Ankyloglossia is usually something very obvious! You will see it and will not need to ask someone to check. It also has obvious symptoms. These include difficulty with breastfeeding in the baby, unclear speech due to difficulty with pronunciation of certain consonants in older children (not speech delay). There may also be difficulty with some oral activities like licking ice-cream and oral hygiene. If you see all these symptoms in a child with suspected tongue-tie, then see a doctor.

However if your child can lift out the tongue, cries and sucks well, s/he does not have tongue-tie. Please do not mistaken the normal frenulum for tongue-tie or go around cutting it. If you are not sure, you can ask your trusted Paediatrician to examine the baby. Let me also conclude by saying that tongue-tie, even the confirmed one does not cause speech delay. That is pure myth!

THE MEDICATIONS-REFUSING CHILD: WINNING STRATEGIES!

One of the most frustrating situations parents especially mothers have to deal with especially when a child is sick; is that child who refuses medications!!!

Yes, try all you will, the child will not budge. Most will keep their mouths shut so tight, not even a drop will slip through. Sometimes, this has pushed some mothers to force-feeding approach just to give medications.

Just imagine after all the stress and anxiety of a sick child; then you manage to go to the hospital to see a doctor or the Paediatrician. Perhaps you have to endure a long wait at the Government Hospitals just to see the doctor. Wait forver for laboratory results to confirm the diagnosis. After a long day, you finally got the prescription and arrive at home to start the drugs hoping for quick relief only for the World War 3 to start.

The child refused to take the drugs. Sometimes you harass and forcefully give the medications with lot of cryings and shouting. Just after you are congratulating yourself for mission accomplished, you heard a small retch, before you can blink, the child has vomited all the medications!!! Back to Square 1!!!

I can imagine the frustration. In fact I have been there as well.

For those mothers with amazing children who promptly swallow all their medications even the bitter ones, you may not understand how blessed you are.

So for those of us who have to battle their children each time just to give 5ml of Paracetamol; this article is for you. God even help you when you have to give 3 or 4 different medications at same time. This situation can be quite overwhelming for the already stressed mother.

So I will be sharing a few simple strategies on how to give oral medications to the unwilling child.

Of course you know as Paediatricians, we frown heavily on forceful administration of drugs. So that is not allowed at all!!!

SIMPLE WINNING STRATEGIES

1. GIVE MEDICATIONS ON AN EMPTY TUMMY EXCEPT WHERE CONTRAINDICATED

I know most mothers believe that medications must be given immediately after food. That is not always true. Indeed, there are few medications that can must be given after food. Some can be given before food.

So for the reluctant children, you may want to give them their drugs before food. This will reduce the chances of vomiting compared to when medication is given on a full tummy.

Also the very young infant is more likely to take the medication when hungry before they realize it is not food and if you give food afterwards, they will easily forgive you and not vomit out the drugs. Try it and see.

2. GIVE DRUGS IN SMALL QUANTITIES

You may also want to give one drug at a time and in small sips instead of combining all the various medications each 5ml each together and hoping to give at once in one gulp. It is far easier to take 2.5ml first then later another 2.5ml till you are done rather than attempt to give all 20ml at once!!! Chances of throwing up the drugs is also less.

In fact you can use syringes to give one drop at a time in very young babies.

3. GIVE DRUGS AT INTERVALS

This applies when you need to give 3 – 4 or 5 different medications to the one and same child.

For example for malaria treatment, you will likely have been asked to administer syrup ACT antimalaria, Paracetamol, Vitamin BCo or Multivitamins. There is no need to give all at once!!

You may want to start with the most important or the sweetest for example the ACT. Then wait 30 minutes before giving the Paracetamol and another 30min before giving the vitamins. This will also help the child tolerate or cope easier rather having to deal with 3 or 4 drugs all at once.

4. YOU CAN HIDE DRUGS IN FOOD

If like in most African setting, the child is already taken solid food especially the bolus (aka swallow) with soups, you can hide tablets inside such boluses and allow the child to swallow with copious amount of lovely tasting soups especially the so-called draw soups like okra or Ewedu.

Most children will swallow such drugs without even knowing they have taken it.

For children who like ice-cream and the medication is not bitter (and compatible with the Pharmacist’s advice), you can mix drugs with small ice-cream for the child to take. Other options include tea, juice or other sweet-tasting multivitamins that the child will regularly take.

5. ALWAYS TASTE MEDICATIONS YOU GIVE TO KIDS

You must always taste them. Most children do not like bitter drugs and as much as possible avoid such.

For example, always try and buy the pleasantly-flavored brands of medications. For example I will rather give Paracetamol Suspensions rather than the syrup to a child who is fussy about taking medication. The suspensions are sweet while the syrup is bitter.

You can always ask your Paediatrician and/or Pharmacist assistance as regards the appropriate brand for the fussy child.

6. YOU CAN REPEAT MEDICATIONS VOMITED BEFORE 30 MINUTES

If a child vomits medications given immediately or shortly after, you can wait for 30 minutes and repeat the medication.

7. KNOW YOUR LIMITS AND GO FOR ALTERNATIVES IF NO LUCK

No matter what you do, some children will still not tolerate drugs. If the child continues to vomit the medications despite repeats or using all the above strategies, then it is time to get professional interventions.

Kindly take the child back to the hospital. Such medications may have to be given via the intravenous or intramuscular routes.

I hope these strategies help or at least reduce the stress of giving drugs to children for parents who struggle in this regards. Let me know your thoughts. Drop your questions or concerns in comments section below. Thank you for reading.