Avenues in Paediatric Prescribing.

Email- rashid3027@yahoo.co.in
Presented on 19 sep-2010 conference held by HMSAI
DR. RASHID AKHTAR
B.H.M.S.(CU)
LECTURER-DEPT. OF ORGANON OF MEDICINE
BAKSON HOMOEOPATHIC MEDICAL COLLEGE
GREATER NOIDA
Avenues in Pediatrics prescribing

AVENUES IN PEDIATRICS PRESCRIBING

Introduction
The childhood shows the man,
As morning shows the day.....
by John Milton(1608-
1674)

Health is not a quantity that can be
measured. It is a quality that is complex,
multifactorial, and changeable. It is dynamic
process that shifts, moves, & has
directionality.
In fact there is no more fascinating
study in life than investigation of life itself.
Introduction

As every humble physician having legacy
of Hippocrates to Hahnemann with firm faith in
phenomenology, I perceived over the years that
the splendour & marvel of an individual’s
biopathographical development can only be best
appreciated when perceived from the most initial
stage of growth- i.e. The moment of conception.
In fact, it is the study of the beginning & its
constant evolution up to present moment of
development that constitutes the true study of life.
Introduction

This concept reverberate in
the following words of Aristotle.
We shall not obtain the best insight
into the things till we actually see them
growing from the beginning…
(Aristotle in “politics”)
Introduction

CHILD- As described by C.G.Jung
in Archetypes of Children.
“Child means something growing towards
independence.”
Dr.C.G.Jung..
Introduction

Keeping this view in mind- the child in
characterized by two fundamental factors -
(A) Growth. Growth
(B) Development.
Development
Introduction

Growth means the increase in the size of
the various parts and organs of the body by
multiplication from fertilization to physical maturity.
It is limited by predetermined
constitutional & hereditary factors. It is however
influenced by exogenous factors like- diet, climate,
race, and environment. etc.
Introduction

Development refers to the increase of
functional capacity in perfect form resulting from
production of specialized tissue.
Development indicates an increase in
skill and complexity of function.
Introduction

In any case both are interdependent
(Growth + maturation =Development)
+ =
Introduction

Determinants of Health
Nutrition
Environment Behaviour
Introduction

DIFFERENCES OF VITALITY
Four children experiencing the
death of a close grandparent may respond
in different ways, according to their own
uniqueness and the status of their
overall health. One cries daily for a week,
expresses emotion and discusses feelings
with his or her parents, ultimately
rebounding nicely, having learned valuable
life lessons.
Introduction

Another feels the emotional impact
more profoundly and becomes insecure
about taking the bus to school in the
mornings. The third does not cry, does not
want to talk about it, and develops
headaches that recur for weeks. The fourth
also does not process the emotional impact
of the event and, one month later, develops
pneumonia for the first time ever.
Introduction

In each case the resulting impact
can be seen as a function of the uniqueness
of the child’s constitutional state of resiliency
or susceptibility. The first child clearly
represents the ideal, while the others do not,
and the fourth child is perhaps the weakest
and the most susceptible to this particular
stressor.
Introduction

Stressful events can bounce off of an
individual, leaving the person unscathed, can be
observed and transmuted into energy for growth
and change, OR can penetrate into the mind-body,
causing difficulties & illness.
Introduction

Special Care in Pediatrics Case taking
The chief difference between
pediatrics case-taking and that of older age
groups is that the patient has to be regarded
against a background of a norm which not only
differs from the adult norm but changes
considerable from infancy to puberty. The
mother, or someone with an intimate knowledge
of the child, is the best person to give the history
in infancy and early childhood.
Case-taking

Even up to puberty the child does not
readily look at himself objectively. An obvious
advantage of having the mother is that she is
able to give an account of the family history,
has firs-hand knowledge of pregnancy and
labour, and has usually been in a position to
observe any outstanding episodes in the
child’s early life.
Case-taking

IMPORTANT DIVISION OF PRESCRIPTION
(1) Remedy selected on the basis of
Psychosomatic similarity
(2)Remedy for antidoting some adverse
influence of the past, including family history,
the period of gestation, labour, and
outstanding post-natal events.(as intercurrent
remedy, or to clear obstacle to recovery)
(3)Remedy for acute conditions.
Case-taking

The most important landmarks for
paediatric prescribing are :
(1) Intra – Uterine period (conception to Delivery).
(2) Delivery
(3)Achievement of proper milestone – (with chart
monitoring).
(4)Teething history.
(5)Past – history ( in chronology )
(6)Family history.
Case-taking

(7) Family environment
(8)Vaccination with any history of consequences
(9)Observation of the child.
(10)Concomitants(symptoms pertaining to the
patient).
(A) PSYHIC
(B) PHYSICAL
Case-taking

(1) Intrauterine period
The two streams of heredity join at
conception and from then on environmental
influences begin to operate in utero.
From the viewpoint of prescrtibing,the serial
history is studied to find out if there is anything
outstanding when regarded against a background of
an ‘average family and personal history’
Case-taking

Lawrence Sterne was writing in 1759
– that events at the time of conception, or during
gestation, influence not only outcome of a
pregnancy but also the developing character of
the child.
Case-taking

FIRST TRIMESTER (1-12 WEEKS)
1-14 DAYS(1st to 2nd weeks)
PRE-ORGANOGENESIS From
fertilization up to formation of bilaminar disc-
1rst 14 days of pregnancy.
Influence of teratogens acting during this
period usually result in death of the embryo.
.
Case-taking

15th -56th DAYS (3rd -8th week):
From 3rd week gastrulation
begins i.e., beginning of embryonic period.
MOST CONGENITAL
ANOMALIES ARE PRODUCED BY TERATOGENS
ACTING DURING THIS PERIOD
Case-taking

SECOND TRIMESTER (13TH TO 25TH WEEKS)
Special consideration
for mothers psychophysio, or
psychopathological reaction to the
pregnancy.
Case-taking

THIRD TRIMESTER (26TH TO 38TH WEEK)
Special
consideration for mothers psychophysio,
or psychopathological reaction to the
pregnancy.
Example-
Apprehensions, mood changes desire,
avrsion,other physical General’s, vomiting, etc.
Case-taking

We can define two forms of
developmental plasticity that are distinguished by
when the adaptive advantage appears. If the
environmental conditions in early development are
severe the fetus may have to make some
immediate adaptive response just to survive. But
most plastic responses in development are
designed to tune the phenotype for the condition
expected in later life- we term this class of
responses predictive adaptive responses.
Case-taking

The most common immediate adaptive
responses are those off reducing early growth.
This type of response is induced when the supply
of nutrients from mother to fetus must reduce its
growth rate just to survive. Another kind of
immediate response is to accelerate the
maturation of fetus so that is born early. This will
give an immediate advantage if the environment
within the mother is so threatening that premature
delivery might be safer bet. Animals, including
human, born smaller or earlier are less likely to
survive for a long time, but if they had not made
the adaptive response they might not be alive at
all.
Case-taking

The embryo, fetus, or neonates
uses them to try to adjust its biology such that
its constitution will be better matched to the
environment in which it predicts it will live, grow
and reproduce. It does so by sensing its
environment, using the information to predicts
its future environment, and then utilizing the
processes of developmental plasticity so that its
resulting phenotype will be better matched to
that anticipated environment.
Case-taking

The environment we are
exposed to during our early development from a
single fertilized egg, to an embryo, fetus, and
infant, can have long term consequences.
So the developing organism
uses information from its environment to make
choices in an attempt to match its constitution to
the environment it forecast it will inhabit.
Case-taking

Abnormal influences in intra-uterine
environment
1- Nutrition
2- Stress
3- Behaviour
4- Prophylaxis
5- Illness
(A) Systemic
(B)Infectious
6- Trauma
Case-taking

(2) Delivery
Normal
Normal Route
1- Normal delivery
2- Use of Forceps
3- Use of Ventuse Delivery
Caesarian
Reason for Caesarian
Case-taking

Crying after Birth
1- Immediate
2- Delayed
Case-taking

(3) ACHIEVEMENT OF PROPER
MILESTONE
Case-taking

 Not rolling over by six months
 Having head lag when pulled to a sitting position
after six months
 Not sitting by himself/herself without support by
eight months
 Not crawling by12 months
 Not walking by 15 months
 Not speaking a single word, (mamma, dadda) by 15
months
 Not pointing to named objects (dog, nose) between
12-24 months
 Not initiating speech sounds by 12 months
##TAKE CARE, IF
Case-taking

(4) Teething history with its
concomitants
It helps in acute prescribing
as well as in anamnesis.
eg. Shape, arrangement, decaying

(5) Past – History (with chronology )
First illness is very vital in many
cases not only in pediatrics situation but
even afterwards as it also reflects
Miasmatic inheritance.
Then sequence of illnesses is
important to prescribing.
“Never be well since then”
Case-taking

(6) Family – History
Helps in selection of
Miasmatic diagnosis as well as
tendencies and diathesis etc.
(not only disease but habbit, addiction,etc. also)
Case-taking

(7) Family – environment

(8) Vaccination history and
Consequences
Helps in miasmatic diagnosis, in
anamnesis, forms a part of totality of
symptoms.
Some times so needed for
many complaints if there is any history of
“Never be well since then”
Case-taking

(9) Observation of the Child
Case-taking

(10) Concomitants
#Symptoms pertaining to the patients
(A) Psychic
(B) Physical
Case-taking

(A) PSYCHIC
 Affection- Pulsatilla
Phosphorus
Carcinosin
Causticum
 Sensitive to music
Tarentulla h.
Sepia
Carcinosin
Case-taking

 Obstinacy-
Tubercullinum
Ad-cortex
Medorrhinum
 Fastidiousness
Arsenic-alb.
Carcinosin
Nux-vomica
Case-taking

 Fears
Aconite
Ignatia
Opium
Tubercullinum
Phosphorus
 Sleep and dreams
position of sleep and peculiar dreams -
Case-taking

 Cruelty
Abrotanum
Anacardium
 Sense of responsibility
Calcaria-carb
Mercury
Tubercullinum
Case-taking

 Jealousy
Lachesis
Hyoscyamus
Apis-mell
 Sensitive to reprimand
Medorrhinum
Carcinosin
Palladium
Case-taking

 Travel
Nitric –acid
Calcaria-phos
 Sibling rivalrity
Pulsatilla
Lachesis
Nat-mur
Case-taking

(B) PHYSICAL
1 SWEAT
Calc.carb
Silicea
Thuja
Con. Mac
Tubercullinum

2 THERMAL REACTION
Sulphur
Psorinum
Calc carb
Sanicula

3 STOOL
Calc carb
Phos
Cham
Sanicula

4 DESIRES
Calc carb
Phos
Cina
Tub b.
4 Carcinosin

5 AVERSION
Graph

6 CONDITION OF SKIN
Sulph
Silicea
Calc carb

The classification of remedy on certain
peculiar features of children that will help you for
quick perception of the desired remedy.
(A) By Dr.Douglas M. Borland
(B) By Dr.Jonathan shore

(A) Dr.Douglas M.Borland
I – Calcarea phosphorica “Fat, fair, chilly, lethargic”.
 Calcarea phosphorica
 Phosphorus
 Silicea
 Sanicula
 Aethusa
 Lycopodium
 Causticum
 Tuberculinum

II – Baryta carbonica “ Backward, delayed,
development”
 Borax
 Natrum muriaticum
 Sepia
 Aurum metallicum
 Carbo vegetabilis

III Graphites “ skin”
 Capsicum
 Psorinum
 Antimonium crudum
 Petroleum

IV – Pulsatilla “ Warm-blooded”
 Kali sulphuricum
 Sulphur
 Thuja
 Bromium
 Iodum
 Abrotanum
 Flouricum acidum

V- Arsenicum album “The nervy types”
 Chamomilla
 Cina
 Magnesia carbonica
 Ignatia
 Zincum

By Dr.Jonathan Shore
GROUP 1 DESIRE TO TRAVEL (RESTLESS AND
DISCONTENTED)
 Calcarea phosphoric
 Tuberculinum
 Rhus tox
 Sanicula

GROUP 2 THE GENTLE AND SHY:
 Pulsatilla
 Calcarea carbonica
 Silicea

GROUP 3 THE SAD WITHHELD:
 Natrum muriaticum
 Ambra grisea
GROUP 4 THE FEARFUL:
 Causticum
 Phosphorus

GROUP 5 THE MEAN AND IRRITABLE:
 Nux vomica
 Medorrhinum
 Tuberculinum
 Sanicula
 Chamomilla
 Cina

GROUP 6 THE FULL OF MUCUS:
 Mercurius
 Medorrhinum
GROUP 7 THE TERRIFIED:
 Stramonium
 Kali bromatum

GROUP 8 THE SOUR:
 Magnesia carbonica
 Rheum
GROUP 9 THE HIGH AND SUDDEN:
 Belladona
 Aconitum
 Ferrum phosphoricum
 Coffea

CLINICAL TIPS
BUT CAN ONLY BE USED IN ABSENCE OF OTHER BETTER INDICATED ONE
(1) Asthma attack, better for lying flat on back
with legs outstretched.
Give Psorunum in the attack.
(2) Aware of heart.
Spigelia 30c or 200c.

(3) Bruising persisting.
Consider sulphuric acid 200c.
Especially if there is discolouration.
(4) Cracked thumbs.
Nitric Acid 6c ( 20 minims),
Petroleum 6c (20 minims) in Calendula ointment.

(5) Despair of recovery (mainly in acute illness).
Consider Psorinum.
(6) Despair after penicillin.
Nitric Acid is almost a specific.
(7) Ingrown toenail.
Magnetic Polus Australis 200c,
3 doses every twelve hours.

(10)A craving for affection in children very often
indicates
Pulsatilla & phosphorus.
Pulsatilla accepts affection, Phosphorus accepts
and returns it.

(8) Nosebleed. Apart from other measures,
Millefolium 10 M.
(9) For the excessively obstinate child,
Tub. Bov. 200c is most often indicated.

(11) For the child who never looks clean or who is
deliberately dirty in his habits,
Sulphur 200c is nearly always the remedy.

(12)For pre-operative anticipation
Phosphorus 200c
(13) For homesickness
Capsicum 200c

(14) For post-operative vomiting induced by and only
occurring after eating.
Ferrum Metallicum 30c
(15) For Otitis media,
Hepar Sulph 200c should be given in the
absence of clear-cut indication for another remedy.

(16) Nine out of ten cases of infective hepatitis in
children need Phosphorus.
(17) For the child who makes a pretence of weeping,
but without tears,
Staphysagria 200c is almost certainly the remedy.
(18) Recurrent Boils –
Arnica- 6c,
(19) Recurrent Boils
Especially around Nose- Aethusa,Bacillinum.

(20) Recurrent abscess- in
Syphillinum or Anthrcinum
(21) Abscess or hard swelling after injection –
Thyroidinum 6c .

(22) Teething trouble of any kind –
Chamomilla.

(23) In Children
Car sickness- Coculus indica.
Sea sickness- - coculus
indica
Air sickness- coculus indica

(24) Enuresis
Pulsatilla
Nat-mur
Sulphur
Belladonna

(25) Infentile eczema-
Medo,
Throidinum.

(26) Nappy rase-
Rhus tox,
Medo.

(27) Child with strong tubercular family
history-
Tubercu,Medo,Calc.carb.
(28) Cold and cough in the earliest winter
–
Calc-carb.

(29) Lean thin, child with recurrent respiratory
trouble-
Thymus gland.
(30) Diarrhoea before exam's-
Gels, Arg.nit

(31) Vomiting before exam's-
Silicea
(32) Severely sick before exam's-
Dys.compound.

(33) No history of childhood infectious disease –
Carsinosine.
(34) Too many children infectious disease –
Carsinosine

THANK YOU

Avenues in Paediatric Prescribing.

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