Symptoms and diagnosis in children
 
News 2013
'Normal' Symptoms may not necessarily lead to Normal Diagnosis in Children

March 6, 2013

When the parents of a seven year old boy with a persistent cough brought him to the paediatric casualty at the Aga Khan University Hospital, Nairobi, they expected to return home with some cough medicine, or at worst an inhaler for asthma. They were shocked when the doctor told them that the little boy had a hole in the heart and would require surgery.

According to Christabel Wesonga, the Paediatrics Manager at the Hospital, this is not unusual. Children unlike adults are not able to describe their symptoms in detail, especially those that are not visible. It is therefore important to carry out a thorough assessment of any child who is brought to the paediatric casualty to rule out serious hidden illnesses and to be sure that the treatment given is appropriate.

Christabel explained, “The full health check sometimes results in incidental findings that are far from expected. The boy had a “normal” cough and if he had not been thoroughly examined, he would have returned home just to collapse at a future date. Luckily for him and his parents, the diagnosis led to a successful surgery.”

“Many children brought to the Aga Khan University Hospital paediatric casualty come with seemingly standard symptoms but it is our job to investigate further.  The Hospital runs paediatric speciality clinics where we refer cases that need further determination by a specialist. For example those suspected to have a heart problem will be sent to the paediatric cardiology clinic.”

Christabel gives another example of a five year old boy who was brought to the paediatric casualty and was referred to the chest clinic. He had been coughing persistently had been treated for chest infection, breathing and pulmonary complications in various hospitals. An endoscopic examination showed a twenty shilling coin lodged in his oesophagus, it had been there for two years causing breathing problems. 

Other speciality clinics available at the Hospital include the endocrinology clinic which looks into illnesses related to hormonal imbalance, including childhood diabetes, disorders of growth, obesity, abnormalities of development of the reproductive system and thyroid illness.  Many specialists in this field have been trained through the Pan-African Endocrinology Training Center for Africa hosted by a partnership of Nairobi based health and academic institutions in conjunction with visiting European Society of Paediatric Endocrinology specialists.

Christabel elaborated, “Cases of children suffering from hormonal disorders especially type one diabetes and obesity are on the increase. The issue of sexual differentiation (ambiguous genitals) is more sensitive as some parents consider it taboo and hide their children until it is too late to effectively intervene medically. It is very important to bring these children for treatment while they are still young as interventions are likely to be more successful.”

Children with persistent diarrhoea, constipation and vomiting are referred to the Gastroenterology Clinic which cares for those with illnesses relating to the digestive system, including the stomach, intestines, liver, bile system and pancreas. Those with ulcers, food allergies, hepatitis and recurrent abdominal pain are also seen in this clinic.

The present society exposes children to a lot of pressure which they handle in different ways. When initial investigations show no physical cause for an ailment for example, vomiting, fainting or abdominal pain in children and teenagers, they are referred to a Child & Family Well Being clinic.  In this clinic, paediatric psychiatrist and counsellors talk to them and eventually unmask the underlying cause of sickness including seeking attention from a parent, abuse, or a child not liking the school he/she is attending.

Cases of cancer in children are on the increase. It is estimated that there are 3,000 new cases of childhood cancer every year, three quarters of which are curable and locally treatable if diagnosed early. The Aga Khan University Hospital, Nairobi is the only private hospital in Kenya with a dedicated paediatric blood and cancer clinic.

Children suffering from neurological disorders such as cerebral palsy, epilepsy, seizures, autism, hydrocephalus and attention deficit hyperactive disorder have a special clinic which also provides follow up care after meningitis and attends to children with delayed development.

These clinics and other departments in the hospital work closely together for successful diagnosis and treatment of children. The Kidney clinic, for example, will refer diabetic or obese children to a nutritionist for advice on diets. The neo-natal clinic assessing growth in infants might discover children with problems best handled by the endocrinology clinic like stunted growth, or ambiguous genitalia. As a rule, specialists will not manage what they are not confident in as that delays appropriate care. There are however general clinics to handle non-complicated paediatric conditions.