In adults we can bravely attempt some manoeuvres but the same will cost a child’s life. Medicines have to be administered based on weight or approximate weight and all equipment has to be used in approximate sizes. The team does all this in the midst of a wailing uncooperative child and panicking parents. It is extremely difficult to make a diagnosis when the patient cannot vocalise his problem and sometimes we cannot reach definite conclusions.
Paediatric practice differs depending on region and population. Having worked in different parts of the country I can tell you that diseases present differently depending on the environment. It takes us a while to know patterns where we practise and unlearn our previous policies. Paediatricians working at a community level as in primary health centres work with low cost medications that are easily accessible to them while those in the referral centres may be in a position to administer the newest effective remedy. While both will work it might just take different timeframes. One renowned paediatrician told me that it is very easy for him to keep up his reputation. It is because disease evolves gradually and by the time he gets a referral the picture is quite clear. He gets to treat right often because the juniors wait and watch and do the necessary tests. It is unfortunate that they don’t get the credit they deserve.
Paediatrics is also about philosophy. Some colleagues would prescribe for aggressive symptom relief and then there are those like me who feel that the ordeal of medicating too often is no better than minor temporary discomfort. For instance I may not be keen on vaccination for chicken pox unless the child is close to the age of writing board exams because a natural infection is mild and gives complete immunity. Somebody might feel that vaccination with 85% effectiveness can minimise school absenteeism and unnecessary anxiety and help eradicate the disease itself. Both of us are right.
Paediatrics will always be a science with a heart. We advise against some traditional practices simply because they are not beneficial as they were thought to be. For instance the ingredient in gripe water that calms down the infant is alcohol. It does no good and habituating its exposure so early may have unnecessary discomfort later. Research traces many diseases to exposures early in life. Please don’t refuse our advice blindly.
All said and done, even ruminators like me we love our jobs. We fall hopelessly in love often. We are the faces that welcome tiny eyes into the world. We become a part of some families. We are needed.