Naughty? or sick?

Naughty! Your child s just being naughty! This is a common response by doctors when they hear about difficult behavior of babies and toddlers. But is this true? Naughty? or sick?

I see so many mothers who are frustrated with their doctors. These parents think that there is something wrong with their baby but their doctor will often dismiss the problem by saying that Your child is just being naughty. Who is right?

Naughty? or sick?

Ben – “manipulative!”

Ben is two years old. He has recently been waking in the night and demanding comfort. His mum said to me,

Ben is miserable. Surely it must be for a reason. I do not think that he is being naughty – because when he is well he is such a different boy. But last week his doctor suggested that Ben was being manipulative and should be ignored. What should a mum do?

Jerry – “He’s just like that!”

I have just seen another boy, Jerry, who is three years old. In my opinion he is quite unwell and his parents have been worried for over a year about his poor health. He has not grown well and he is a poor eater. He is run-down with any illness seeming to linger on. His parents are very concerned. But whenever they see his GP, they are told he s just like that! When seen by his child-health-nurse, they were told he is growing slowly but steadily .

But these parents do not feel reassured.

This disregard of Jerry s parent concerns has led to a sense of frustration. They told me: We are now too embarrassed to talk to our GP or his Nurse any more about Jerry s issues. We feel that they are just brushing us off .

Medics have been let off the hook

Unfortunately, this brush off of children s symptoms has a long and glorious tradition! This formal brush off was formalised by two giants in paediatrics, R. Illingworth and J. Apsley. Both of these professors of paediatrics wrote text books fifty years ago. Their erroneous viewpoint now echoes into the present time. They had both recognised that more than one in ten children had chronic symptoms – headaches, or tummy pains, or poor eating, or tantrums, or irritability, or diarrhoea, or constipation or sleep problems. Because they could not find any physical illnesses to assign to these symptoms, they went on to stipulate that these children were normal children . They unilaterally declared that there was nothing wrong with these children. The result was to dismiss their symptoms as normal . In other words they are just like that! However, modern investigations can now find out the problems.

The domino effect of their pronouncements has let the medical profession off the hook. Now, when parents come along who are concerned about abdominal pain, or diarrhoea or constipation, or headaches, or tantrums, etc – the GP can just say Well, he s just like that! They have taught to use this approach. The outcome of this strategy is that the parents feel that they are not being taken seriously. The parents often feel belittled. They feel too embarrassed to talk.

Ill health is often progressive

Added to this disregard of subtle symptoms, is the slow progression of symptoms. These children are born healthy but their symptoms may come on gradually, bit by bit. This means that a little tummy pain or irritability early on is initially acceptable. Subsequently, as the symptoms get more severe and more established, the parents tend to readjust themselves to these symptoms and still try to cope. Remember, they have been told that your child is just like that!

Slow growth

The same goes for assessing growth. Every week I see children who have not grown well. Medical professionals will frequently watch these children slide off their growth charts but do not investigate. Jerry was one such child, his growth chart drops through the lines, but nothing was done to seek an answer for this.

To interpret growth charts, your child should be steadily growing along, or parallel to one of the lines. Falling down through the chart is an indication that something is wrong. Jerry s growth was abnormal from after six months when solids (including gluten) was introduced.

Jerry is sick he is not naughty!

I took the parent s concern about Jerry seriously. I listened. He was tired and irritable. He had been called naughty. He was refusing to eat. He had tantrums. But Jerry was sick! I investigated with blood tests. His blood tests were abnormal.

Jerry had coeliac disease! Coeliac disease is a very common condition occurring in one in every hundred children and adults. In susceptible people, it is caused by the toxic effects of gluten on the bowel. These sufferers can have quite subtle symptoms and can present with behaviour disturbances (check out the list of possible symptoms). You would do better betting that your child has coeliac disease (1-in-100) than buying a lotto ticket where you have less than one in a million (1-in-1,000,000) chance of winning.

Unwell children need blood tests

Any child with any chronic symptoms or any ongoing behaviour problems should have a blood test. Doing a blood test for a child with Jerry s symptoms give you a one-in-two (1-in-2) chance of finding an underlying illness.

Naughty? or sick?

In my opinion we should all think carefully before calling any child naughty. Some children are naughty , but they will always have a valid reason to be so. In my experience, once the child s illness has been discovered and treated, they are no longer naughty! If they feel well, then they will behave well. If in doubt get some blood tests. More stories about children like Jerry and Ben can be found in my book: The Book for the Sick, Tired and Grumpy .