As I place my stethoscope gently over the chest of a sleeping child, I
am suddenly alarmed by the loud shrill cry of another child in the
waiting room. The crying is disturbingly loud and echoes down the
hallway of the outpatient department. The loud sound not only wakes up
the sleeping child in front of me, but sends the other calm children in
the waiting room into a crying frenzy. The serene atmosphere of the
clinic is now one of pandemonium and chaos. The toddlers are screaming
and crying; there’s kids running around scared, and parents are trying
in vain to pacify their children. The scene reminds me of security
guards trying to control enthusiastic spectators at an Indo-Pak cricket
match. Utter chaos! All of this started by one crying child!
As pediatricians, we have all experienced this at
some point in time. Some of us have become immune to the noise; a few of
us tolerate it and there are some of us who even fear it. But the crying
child is unavoidable!
So what makes a child cry? The most common things
that come to mind would be the discomfort due to the illness and of
course, the more common cause… fear. As a kid, I too feared doctors.
Well not doctors in particular, but anyone in a hospital, wearing a
white coat, was capable of giving me an injection, or so I thought. And
even today, the fear is very real for children. After all, how do
parents discipline their children or get them to eat their food? By
simply frightening them with a visit to the doctor who will give them a
BIG injection. And so the fear begins…
The fear of injections is universal. Adults and
children alike, shudder at the thought of a sharp pointed object
entering their body. The stinging pain and the sight of blood is enough
to send ones heart racing. So just imagine undergoing this same trauma
nearly every month or at regular intervals! No doubt children fear
injection days! I mean, who wouldn’t? Parent’s telling their kids – that
it won’t hurt at all – only makes matters worse on subsequent visits. I
think that a better approach would be to tell the child that it will
hurt a bit, but that the injection will just make them stronger in the
future. Children appreciate honesty! Although some things such as this
are easier said than done.
Whatever be the reason, a crying child not only makes
the parents anxious, but also alarms us. It heightens our senses. It
sort of awakens us, on an otherwise lethargic day. A young doctor might
panic; a seasoned veteran might ponder about the cause and a stressed
resident might lose her/his temper. But how you handle yourself and the
crying child at that moment would surely prove your mettle. Staying calm
and holding ones bearings would definitely garner brownie points with
the parents.
Young parents are often concerned that their baby is
always crying because of "hunger". They are convinced they know what a
hunger cry is and adamant to think that it could be anything else!
However, to an experienced pediatrician, the nature of the cry itself
may be helpful to come to a diagnosis. So at times, a crying child may
not always be a bad thing in the clinic. Just like a crying newborn in
the labor room…..The sound is music to a pediatrician’s ears!
I think the biggest challenge is examining a crying
child. A crying child squirming in his/her mother’s lap is not a
pleasant sight and makes examination a near impossible task even for the
most experienced of us. We then tend to rely more on taking a good
history from the mother and then prescribing medicines based on a
provisional diagnosis we’ve come to, much to her dissatisfaction. Some
would suggest distracting techniques like offering a chocolate or toy.
Whereas others suggest avoiding eye contact. A consoling mother’s voice
maybe as effective. Our tendency is to finish with the child quickly and
move onto the next patient. After all, some parents might even blame the
doctor for the chaos.
If only there was some magic potion to make a child
stop crying or for that matter completely well! It would make our lives
so much more peaceful and parents’ lives so much less stressful. But at
the end of the day, there is no definite formula. Each child is
different and each child responds differently to both pain and fear. A
crying child should not be feared. They should be handled with the
utmost of care. Empathy and patience will go a long way. Sometimes even
a gentle smile can do the trick!
