My Child Has What?
Case Studies of Common Illnesses and Problems that Five- to Twelve-Year-Old Children Face
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ADRIAN
Adrian is a 7 year old child with wheezing caught in the middle of her divorced parents beliefs regarding her asthma treatment.
Adrian is a young girl whose mother calls me as she is anxious about Adrian’s coughing. “She coughs all the time and seems to be more tired than her friends.” She brought Adrian to the Emergency Room a few days prior at which time the doctor gave Adrian a medication to inhale. Adrian inhales the medicine as ordered for the next day and improves. Now she has spent two days with her father without using any inhaled medicine. Adrian’s mother explains that she and Adrian’s father are divorced and they have shared custody. The mother is worried that her ex-husband has not followed up in giving the .medication to Adrian and that she sleeps with two cats at dad’s house. Adrian’s mother is calling me because Adrian’s breathing seems labored and she hears a whistling sound. I advise them to come to the clinic now.
Adrian’s Clinic Visit
Adrian’s mother describes her symptoms over the last day. My medical assistant checks Adrian’s breathing rate and heart rate, both of which are elevated as expected with her breathing difficulties. She then checks the oxygen level in her blood with a band-aide like sensor on her finger. Her oxygen number is slightly lower than normal. Her blood pressure is normal. We then check her Peak Flow, a test of breathing into a tube, which measures the amount of air being breathed out. Her flow number is lower than normal indicating that her breathing tubes are constricted.
During these procedures, I listen to Adrian’s breathing and hear equal sounding breathing with wheezing. I order a bronchodilating (opening breathingtubes) medicine to be inhaled. Within minutes, Adrian’s breathing and her vital signs improve. Based on her story, vital signs and symmetrical breathing, the diagnosis of asthma is confirmed. If I had heard unequal sounds, I would be concerned about an infection with fluid or an aspiration (breathing in something) of foreign material into one side of the lung.
Adrian’s physical exam other than her lungs is normal. Fortunately, she improves after inhaling the medication. For some children, there is a need for several inhaled treatments or for inhaled oxygen or for a chest X-Ray. Rarely a child will be hospitalized for continued evaluation and treatment.
Adrian’s mother has done an internet search and agrees with me and the ER doctor that her daughter has asthma. She says that Adrian has always coughed more than her friends and has gotten out of breath sooner than her friends. She adds that sometimes when Adrian tries to run, her breathing makes a whistling sound. Her dad thinks she is fine and that she just needs to breathe more deeply when she is playing. He is planning on having her take yoga breathing classes. He denies that the cats cause her to wheeze.
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About the Book
This collection of twelve case studies featuring common childhood illnesses and problems of children aged five to twelve is a must have for anyone who wants to help children.
Janet L. Stafford, M.D., highlights stories based on real clinic visits, including diagnosis, causes, and how various problems can be treated. She also shares follow-up assessments of children after treatment.
The illnesses and problems include everything from autism to obesity, headaches, asthma, seizures, attention deficit disorder, and recurrent abdominal pain.
She also highlights more sensitive topics, such as a five-year-old girl acting in a sexual manner with classmates and a seven-year-old boy whose short stature does not sit well with his family members, who are passionate about athletics.
Other case studies include a 10-year-old girl who is overwhelmed by her parents’ divorce and a nine-year-old boy who wets his bed but wants to go to camp.
The case presentations are geared for families, teachers, nurses, therapists, and anyone who wants to help children as they develop physically and neurologically.
About the Author
Janet L. Stafford, M.D., is a retired board-certified pediatrician with more than thirty years of experience. She worked at Kaiser Permanente in San Francisco, diagnosing and treating problems in infants and children. She has taught medicine to Kaiser and UCSF medical students and residents. She was raised in Michigan and graduated from University of Michigan before working in Chicago as a medical and laboratory technician and returning to the U of M for a Master of Social Work. She went on to graduate from University of California Davis Medical School and completed a three-year residency in pediatrics. She has been married fifty years and has four sons.