ABSTRACT
I have never seen a paper or chapter of a book devoted to pitfalls and mistakes in developmental diagnosis. This paper is designed to try to fill the gap. It concerns the avoidance of mistakes in developmental diagnosis and is based entirely on mistakes that I have made myself and now learned to try to avoid and on mistakes that I have seen, most of them repeatedly. I have made no mention of mistakes that could theoretically be made but that I have not personally seen. I believe that most assessment errors are due to overconfidence and to the view that developmental diagnosis is easy. Many other mistakes are due to reliance on purely objective tests with consequent omission of a detailed history and physical examination, so that factors that profoundly affect development but are not directly related to the child's mental endowment are not weighed up before an opinion is reached.
Subject(s)
Developmental Disabilities/diagnosis , Child , Child Development , Diagnostic Errors , Humans , Medical History Taking , Physical ExaminationSubject(s)
Child Development , Psychology/methods , Child , Child, Preschool , Humans , Reference ValuesSubject(s)
Colic/etiology , Animals , Circadian Rhythm , Colic/drug therapy , Colic/physiopathology , Dicyclomine/therapeutic use , Food Hypersensitivity/complications , Humans , Infant , Infant, Newborn , Intestines/physiopathology , Milk/adverse effects , Mothers/psychology , Tobacco Smoke Pollution/adverse effectsABSTRACT
It is irrational to ascribe a child's so called 'brain damage' to labour or delivery without considering other factors. 'Brain damage' occurs without difficult labour or perinatal hypoxia and caesarean section is no guarantee against it. Severe difficulties in delivery and severe hypoxia at birth are in the great majority not followed by evidence of 'brain damage'. In the maternal history there is a significantly greater incidence of relative infertility, and of pregnancies associated with low birthweight or intrauterine growth retardation, postmaturity, antepartum haemorrhage, pre-eclampsia or infections. There are often genetic factors, more congenital anomalies and pathological evidence of underlying abnormality. There is an interaction of numerous factors, prenatal, perinatal and postnatal and it is simplistic to ascribe 'brain damage' to single factors, such as breech delivery or hypoxia at birth, without considering the antecedent causes of those factors.
Subject(s)
Birth Injuries/complications , Brain Injuries/etiology , Abnormalities, Multiple/etiology , Cerebral Palsy/etiology , Delivery, Obstetric , Female , Humans , Hypoxia/complications , Infant, Low Birth Weight , Infant, Newborn , Obstetric Labor Complications , Postnatal Care , Pregnancy , Pregnancy ComplicationsABSTRACT
Mothers are easily worried and this cannot always be avoided. But mothers are often worried unnecessarily by insensitivity, unwise choice of words, failure to determine what they are really concerned about, by criticizing them for being over anxious and ignoring their fears, or by inadequate explanation and counselling. Much anxiety is caused by unwise remarks in an assessment clinic or by a doctor's failure to know the normal and abnormal variations in development, behaviour, or physical growth and physical features with resulting unnecessary medicines, surgery, or special investigations. It is easy to implant a feeling of guilt by putting the blame for a child's behaviour or handicap on the parents. Screening procedures in the newborn may cause much parental anxiety.
Subject(s)
Anxiety , Mothers/psychology , Child , Child Behavior , Child, Preschool , Developmental Disabilities , Female , Humans , Infant , Infant, Newborn , Male , Physician's Role , Physician-Patient Relations , Pregnancy , Truth DisclosureABSTRACT
Three years' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work.
Subject(s)
Child Health Services , Child, Preschool , Developmental Disabilities/prevention & control , England , Female , Genetic Diseases, Inborn/genetics , Humans , Immunization , Infant , Infant Nutritional Physiological Phenomena , Infant, Newborn , Male , OrthopedicsABSTRACT
Because of superficial thinking obstetricians have been blamed unjustifiably for causing brain damage, cerebral palsy, mental subnormality, congenital torticollis, and facial palsy. It is essential to look behind obvious difficulties in labour, such as abnormal presentation or anoxia, to the underlying causes, which are often genetic or social, or concern other prenatal factors.
Subject(s)
Infant, Newborn, Diseases/etiology , Obstetrics , Adult , Asphyxia Neonatorum/complications , Birth Injuries/complications , Cerebral Palsy/etiology , Cerebral Palsy/genetics , Child , Child, Preschool , Female , Fertilization , Fetal Death/etiology , Fetal Hypoxia/complications , Humans , Infant, Newborn , Intellectual Disability/etiology , Intellectual Disability/genetics , Labor Presentation , Obstetric Labor Complications , Pregnancy , Pregnancy Complications , Time FactorsSubject(s)
Meningitis/diagnosis , Seizures/diagnosis , Spinal Puncture , Age Factors , Diagnosis, Differential , Humans , Infant , Suppuration/diagnosisABSTRACT
Published reports on the treatment of large strawberry naevi have been reviewed. It is suggested that they should normally be left untreated, and that corticosteroids, given for a short period only, should be reserved for massive naevi close to the eye, or interfering with respiration or suckling, or associated with thrombocytopenia. Serial colour photographs of one child illustrate the good result of inactivity.