Crying babies

I am the eldest of five siblings (all girls). Mum may deny it, but I did spend a great deal of time as a child helping to look after my younger sisters, from the time they were newborn up to now when they are past teenagehood. Children remember compliments well and I remembered my aunts used to say that I am an expert in babysitting, from the way I carry children. I must have been about 7 or 8 years old at that time.

A few months ago, on a particularly busy day, I was asked to help out to see some of the Green zone (non critical) patients while working at the emergency department. The first file I pulled out was a 2 month old baby, who had been waiting for almost 5 hours to be seen. Mum was angry, almost throwing a tantrum as she walked into the room, uttering 'tunggu sampai nak mati', and not making any eye contact whilst speaking to me. I apologized for the waiting. She said baby has diarrhoea and vomiting and refused to drink milk. But it was because the baby wouldn't stop crying that she was brought to the hospital. She wanted the baby to be admitted as she cannot cope with the crying anymore. At first glance, this was a well baby, fully hydrated, alert, and definitely could not have been vomiting all her feeds like her mum described. Then baby started to cry. I saw how the mum tried to console the baby. 'Nangis lagi!', obviously irritated, she attempted to rock the baby and patted the baby so fast at the same time muttering 'sleep! sleep!' with a tremor in her voice. OK. The mum was only at her teenage and it was her first baby. I took over the baby, and the baby stopped crying, starting looking around and even gave me social smile. I demonstrated to her that the baby can sense the mother's anxiety and the mother needs to have already feel calm in order to coax the baby successfully. I taught her how to give small but frequent feeding to reduce the vomiting. She seemed relieved from the moment I took over the baby for her. But she has to learn to deal with the crying baby - sickness is part of growing up and babies would cry more during illness.

Yesterday, in PICU we had another girl who would not stop her grumpy cry. The nurses and mother had failed to stop the crying for the entire night and the morning. When a baby is inconsolable like this, we get worried in case there is some sinister underlying causes. I decided to try calming down the baby myself. I carried the baby, she seemed more comfortable, stopped crying and looked all around. Mum was relieved. I asked mum to take a rest as she must have been so tired from trying to calm her down unsuccessfully for the entire morning. For half an hour I carried the child, she seemed happy. I just rocked her lightly and muttered rhetorically questions softly, occasionally singing to her. After the rest, mum returned looking more spirited and came over to played with the baby. The baby smiled and laughed. After that, mum gave her something to eat, and the baby went to sleep.

I wonder why baby behaves like that. Is that something that they see in my face? Or is it truely they can sense the emotion inside me or the mother? Anyhow, it is such a great feeling to be trusted by little souls.


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Orphanage visit

I visited the orphanage near my hospital who always sends kids to our paediatrics ward. We were supposed to check the kids and babies that the staff are concerned about. There were no MO free to accompany us to the free on that day, so it was only me and two other HOs. We saw 6 kids - 2 with scabies, 1 failure to thrive probably suckling and swallowing incoordination, 2 with URTI, 1 with some skin problem probably viral. It was good fun.

The last child had global developmental delay. There was a bony swelling on the left side of the head prominent enough to be noticed at first glance. History taking was a big problem as the staff doesn't know how did this child end up here. Notes and documentations were split between the admin office and the nurses office. For this child they didn't even have a date of birth, so we were unsure his exact age. I was discussing with my friends if we ought to refer this child to our child development clinic. They were not keen, saying that we ought to just leave it. I was disappointed. I thought if this boy belonged to a parents, there would have been someone concerned for him regarding all these and be brought to the attention of a doctor. For unfortunate kids like him, it is up to us to protect their best interest. The centre itself was unorganized and the staff had too many children on their plate. As doctors, if we cannot act as advocate to the few children that we see, what were we there for?

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