The case presented below concerns a four-year-old boy, accompanied to the clinical office by the mother. She reported that the boy had endured illness for five days, manifesting symptoms such as fever, loss of appetite, abdominal pain, and pain in the leg. Despite the reported leg pains, the child seemed to walk with no difficulty. System review presented fevers, myalgia and chills. The mother also explained that the child experienced a running nose and occasional coughs. Further, the mother also ruled out dizziness, hearing impairments and headaches. The patient reported a stomachache, witnessed by a lack of bowel movement. There was no vomiting, nonetheless, nor were there changes to the patient’s skin. The mother held the belief that the patient was describing body aches in his reports of pain in the legs. The patient’s weight and height both lay in the 50% percentile. The physical examination nonetheless reported positive findings such as a clear rhinorrhea and a temperature of 37.9ºC .
Pertinent family (and individual) history
The mother recounted of a recent visit that the family made to an uncle on a small farm in Texas. The child had played and petted the animals, but had been absent during slaughter and animal deliveries. The illness kicked off two days after the visit, but the mother could not recall any ill contacts the child might have made. All the immunizations were up to date, and there was an absence of any significant medical history. Further, the child had attained all the milestones expected at this age. The home environment consisted of the child and its two parents, in addition to two pet dogs. The mother explained of the absence illegal drugs, liquor, or any such hazardous substances.
Differential diagnosis
The family dynamic including the patient’s role and relationships within the family.
The way family members relate to each other is important to the wellbeing of all members to the family. Since human beings change throughout their lives, the dynamics within the family also keep changing. The members of a family determine the dynamics within the family. In this case, the patient exists within a family where the father is the principle provider, and leader. The mother on the other hand is responsible for most of the home tasks, such as making meals for the family. Nonetheless, the husband occasionally helps out with chores around the house, whenever he is around. This approach has also seen the child take an interest in the things its parents do, and often tries to copy them. This has helped him develop habits such as cleaning after himself after meals, by taking the utensils to the kitchen
The family developmental tasks
At this age, the child is highly mobile and show interest in learning how to do things on their own. He is excited upon seeing his father, and always stays with him whenever he is at home. He also tends to ask a lot of questions, in a bid at trying to understand his world in a better way. It is crucial that the parents support the developmental tasks of this age, and engaging the child in their make believe plays, where they assume different characters. The mother also reports the child as showing signs of resistance to her instructions, a normal developmental hallmark at this age, as the child experiments with power balance in the family relationships . At this age the parents are expected to provide authority to the child’s behavior, and decide on what to do when rules are broken. The relationship between the child and its parents with regards to boundaries is fairly developed, with both the mother and the father enacting a series of sanctions when rules are broken.
Possible impact of clinical encounter on the family functioning
While the boy is most likely to have picked the illness from his encounter with animals in Texas, this is not an indication of regular neglect of the child to unsupervised play in a hazardous environment. However, it is prudent that the child is made to understand that certain actions have consequences, and should avoid playing in hazardous places. This knowledge may prove beneficial if properly applied, and possibly avoid illnesses caused by vectors picked in the environment.
Reflection
The encounter was a huge success, largely owing to the cooperation of the parents, especially the mother. The patient also responded well to the treatment administered, which was a relief to the parents as well as me. The patient also showed responsiveness to the directions offered, which is crucial if he is to avoid picking vectors in a similar manner.
References
Aktar, F., Tekin, R., Bektaş, M. S., Güneş, A., Köşker, M., Ertuğrul, S., . . . Yolbaş, İ. (2016). Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Italian Journal of Pediatrics, 42(3) Web.
Bosilkovski, M., Krteva, L., Caparoska, S., Labacevski, N., & Petrovski, M. (2015). Childhood brucellosis: Review of 317 cases. Asian Pacific Journal of Tropical Medicine, 8(12) 1027-1032.
Uhlendorff, U. (2004). The Concept of Developmental-Tasks and its Significance for Education and Social Work. Social Work and Society International Online Journal, 2(1) Retrieved: http://www.socwork.net/sws/article/view/240/415.
