Children are not little adults; they have different ailments, different health beliefs and they respond differently both to their illnesses and to their treatments.
They tend not to make up symptoms though events in their lives can affect their physical health more than we adults like to admit sometimes.
In the main, there is a pattern to their presentations and a good history and examination obviates any need for invasive blood tests or other expensive, and sometimes frightening, investigations. It is obvious when they are feeling better as they bounce back and start feeding or playing again.
Their health is important because hopefully they are at the start of a long, useful, enjoyable life and my job is to keep them on that track. And last, but certainly not least, they come with parents attached, the vast majority of whom would lay down their lives for their own offspring and therefore exhibit a huge range of raw emotions including fear, anger, hope, grief, relief, frustration, concern, suspicion, trust, upset, control and lack of control.
There is no magic to caring for children. Whatever their age, if you show respect and listen, they will speak. And the rest is usually fairly straightforward…
Take a look at the poem and picture below. I use it in teaching sessions to remind junior doctors that the child is part of a family and that we should never lose sight of the importance of our work.
Perforated into a certainty of symptoms, coughs, the only pink her eyelids, she’s gazing at the light, hitched upright in a chair to ease the beak-pecked bird-lungs. Her hand’s all heat, violet, relieved of the difficulty of fingers.
The mother’s shucked from her spine by grief,
a doll flopped down in the execution of prayer, under its fall of black – perhaps
comforted there, or scrabbling to recover composure. The white is harried into life behind, a migraine of much-too-bright from the starched comber of the pillow
thicker than her skull, with its face turned to a window we can never see, out
of frame: visitors with nothing to say.
The kept air’s hardly stirred, despite the curtain
drifting into shot. It is all blame composed in blocks. It is sorrow
in splurge and clots. My Sophie, my sister! we can hear it scream. Almost.
The sternness grating on despair. With bated breath, through the desperate
ghostings of the palette-knife like poor reception in a poky room
I wait for her to move, unfix from sweat and hair-loss, serene
as in Oslo in ’eighty-two, when I fell for her in the hushed museum.
This is true. I was like that then:
I could look at a painting and feel shaped by it, grain upon grain, a dune in its seawind. I had nothing hard in me, or knotted, yet.
Now it’s nearer to the juddery blur of a home movie watched after years, reckless with wear and tramlines: the stuck-out tongue, the cheeky grin, her handstands on the lawn in the sun.
Picture by Edvard Munch, The Sick Child 1907
Poem by Adam Thorpe