Developmental assessment (DA) has always been a crucial part of learning in paediatrics. You will never be complete in paediatrics if you do not know about DA. It is single most frequent task to be asked during our short case examination. Even a post-graduate student can fail their final clinical exam when they fail this DA.
DA is easier said than done. It requires the full cooperation with the child. If the child mood is not good, you can imagine what will happen then. It is like a minefield waiting to be stepped on. If the child cries, we won't be able to finish the assessment, hence the examiner will penalized us.
This week, I was at home for my Chinese New Year break. Exam is scheduled to be next week, so there are a lot of things to practice. Naturally, my nephew is the good practice candidates. He is about 3 years old, very cute and active little chap. Now he loves scribbling and drawing and he kept a book for his drawings. Mostly were pointless scribbles, but there was a page that caught my attention...
At 3, he was drawing a man already! The features of his 'man' are a big round head,with 2 eyes, a nose and a mouth. The torso and limbs are sticks. What amused me is that he must add in a 'penis' in every man that he drew! The reason? The man need to pee!
Drawing a man is usually started at 5 years old. There is always give and take in assessing the developmental status. DA has four parts: Gross motor functions, fine motor functions, visual and speech and social behaviours. Some children has slower aspect of certain developmental status than others, but eventually most will catch up. Most importantly is adequate stimulations from the parents and caregivers.
At this point of time, he is able to speak 2 languages fluently, which is mandarin and malay, thanks to the maid. Stimulations from the start will ensure a good developmental status! Keep on stimulating, guys!
Showing posts with label child. Show all posts
Showing posts with label child. Show all posts
Sunday, February 3, 2008
DA Blues
Saturday, January 19, 2008
Neglected Child
Last week I just came back from a district hospital in Perak. Nothing great about this hospital, just a small facilities to serve the local population. Doesn't even have a CT scan machine. I was posted to paediatrics in that hospital for a week.
The patient populations mainly from the lower socio-economic status. Mostly are children of estate workers, lorry drivers and fishermans. However, there was one little girl that caught my attention...
She was admitted on Tuesday. She was about 8 or 9. Short-haired, dirty ragged shirts and worn shorts; the first look give me the impression that she is a boy! She had a very red lips. Generally, she looks undernourished. There were multiple healed scars over the shins. She was crying frantically and the father threaten to throw her into the ditch. OMG. The father was a middle-aged man, dark skin and was having walking difficulties evidenced by his walking sticks. Mother was no where to be seen. A closer up with the father revealed nothing much except that this is his daughther. He didn't even know whether she was born full term or not, vaginally or through caesarian, and what illness that she is having. So I checked out the case note. She was a case of dengue fever. Not quite... Further down the page, there was a segment mentioned that she had a heart surgery done in Institut Jantung Negara (IJN). They were supposed to be followed up in IJN, but the parents did not able to make it due to extreme financial constraints.
This poor girl had a hole in the heart that requires a 2-stage surgery. Yet she had only completed first part and the second part was already long due. So I examined her. Heart was not only enlarged, there was also cardiac murmurs. She was in cardiac failure but not taking any anti-failure maedications. This is like a time bomb waiting for the moment to come... Furthermore, she had sacral agenesis, most likely due to mother having uncontrolled diabetes mellitus when she was pregnant. Subsequently, she is not toilet-trained till now. There was walking difficulty as well as both her limbs were stiff. In fact, she was not able to attend the elementary school for this reason, despite already 8 years old.
She had 4 other sibling, 2 already given out as adoption to some other family members because the parents weren't able to rear them. Now left with an elder brother at 13 years old. The brother loved the sister very much. They slept in the same cot together (despite not able to fit both of them together) and the sister seems much happier when the brother is around.
Father had accident a year ago, left him with weakness and was unable to work as fisherman. Instead, he is doing some odd job now. The income shrink from RM 1500 a month to RM 250. Mother is a housewife. They received a minimal monetary support from government for their daughther, for about RM 190 a month. How can a family live a decent life with just RM 440 a month? To add on to the problem list, the mother is also currently a diabetic which was not on any treatment.
I can't help myself thinking, what if she was borned in a different family, will she end up becoming like this? For the least, the parent can bring her for follow up, and she might not end up having a heart failure. I don't know how is her diet, but what seems clear was she was not eating enough and well. Just few hundred km away, a girl who was loved, cared so much but was being abducted by some sick paedophiles. The whole nation is on a lookout for this child. If this patient is lost one day, will her lost even be noticed by the parents? I doubt that a search party will be conducted to look for her as well. After all, she is just a poor child borned in a wrong place at a wrong time.
The patient populations mainly from the lower socio-economic status. Mostly are children of estate workers, lorry drivers and fishermans. However, there was one little girl that caught my attention...
She was admitted on Tuesday. She was about 8 or 9. Short-haired, dirty ragged shirts and worn shorts; the first look give me the impression that she is a boy! She had a very red lips. Generally, she looks undernourished. There were multiple healed scars over the shins. She was crying frantically and the father threaten to throw her into the ditch. OMG. The father was a middle-aged man, dark skin and was having walking difficulties evidenced by his walking sticks. Mother was no where to be seen. A closer up with the father revealed nothing much except that this is his daughther. He didn't even know whether she was born full term or not, vaginally or through caesarian, and what illness that she is having. So I checked out the case note. She was a case of dengue fever. Not quite... Further down the page, there was a segment mentioned that she had a heart surgery done in Institut Jantung Negara (IJN). They were supposed to be followed up in IJN, but the parents did not able to make it due to extreme financial constraints.
This poor girl had a hole in the heart that requires a 2-stage surgery. Yet she had only completed first part and the second part was already long due. So I examined her. Heart was not only enlarged, there was also cardiac murmurs. She was in cardiac failure but not taking any anti-failure maedications. This is like a time bomb waiting for the moment to come... Furthermore, she had sacral agenesis, most likely due to mother having uncontrolled diabetes mellitus when she was pregnant. Subsequently, she is not toilet-trained till now. There was walking difficulty as well as both her limbs were stiff. In fact, she was not able to attend the elementary school for this reason, despite already 8 years old.
She had 4 other sibling, 2 already given out as adoption to some other family members because the parents weren't able to rear them. Now left with an elder brother at 13 years old. The brother loved the sister very much. They slept in the same cot together (despite not able to fit both of them together) and the sister seems much happier when the brother is around.
Father had accident a year ago, left him with weakness and was unable to work as fisherman. Instead, he is doing some odd job now. The income shrink from RM 1500 a month to RM 250. Mother is a housewife. They received a minimal monetary support from government for their daughther, for about RM 190 a month. How can a family live a decent life with just RM 440 a month? To add on to the problem list, the mother is also currently a diabetic which was not on any treatment.
I can't help myself thinking, what if she was borned in a different family, will she end up becoming like this? For the least, the parent can bring her for follow up, and she might not end up having a heart failure. I don't know how is her diet, but what seems clear was she was not eating enough and well. Just few hundred km away, a girl who was loved, cared so much but was being abducted by some sick paedophiles. The whole nation is on a lookout for this child. If this patient is lost one day, will her lost even be noticed by the parents? I doubt that a search party will be conducted to look for her as well. After all, she is just a poor child borned in a wrong place at a wrong time.
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