Parents and care of sick children

Press, Volume CXV, Issue 33917, 9 August 1975, Page 10

Parents and care of sick children

Childhood Illness. By J. G. Shiller. Allen and Unwin. 255 po. N.Z. price $8.50. Beyond the Best Interests of the Child. By J. Goldstein, A. Freud and A. Solnit. Free Press. 171 pp. N.Z. price $2.20. (Reviewed by 8.H.E.) The parents are a child’s most important doctor. In most sicknesses it is they who first observe the symptoms, make a preliminary diagnosis, communicate with the general practitioner, administer the drugs and therapies, nurse the child, and pronounce her recovered. Historically, such training they received was handed down from mother to daughter through sucessive generations. But since the war medical science has exploded, while new life styles have made it more difficult for parents to learn from grand-parents even where the old medical knowledge is relevant. Thus the parent is becoming increasingly ill-prepared to carry out the medical responsibilities to the sick child. Dr Shiller. an American pediatrician, has recognised this gap and attempts to cover it in his “Childhood Illness”, a handbook for parents of sick children. To make it quite clear, the intention is not that by reading it the parents will be able to treat and cure their child’s sickness. The aim is to enable the parents to give maximum support to the professional medical staff treating the child. This involves both knowledge as when to call your general practitioner and when not to. and to have enough understanding to be able to follow out hts instructions. <How many parents understand that the instruction to use : an antibiotic even though the child appears recovered much earlier is not a miscalculation on the part of the doctor, but necessary to ensure that the dormant bacteria is totally destroyedi. Dr Shiller also recognises that the txpical child development book is

weak on issues of child sickness. For instance, in his book “The New Zealand Child and the Family” the director of the Plunket medical services, Dr. N. C. Begg, devotes less than 30 pages — Dr Spock is proportionally about the same. So Dr Shiller has produced a much more comprehensive book with 11 chapters arranged by symptom group, and a 46 -page glossary of medical terms. However, the book is not as successful as one would hope. Dr Shiller has not thought through what the parents need to know and what they are capable of knowing. Quite a lot of important information is not given or is difficult to locate. Dr Shiller airily sta- .-s that he will assume that the children have received their immunisations without listing what they are and when they are given. There is little general guidance on the question of “self-medication” — that is medication without doctor’s advice, or when to call your doctor. There is no guidance <.s to what should be kept in your medicine cabinet. Furthermore the text is prone to jargon—like “voided", “upper respiratory infection”, and “Roseola is more commonly associated with febrile convulsions” — in each case before the technical word is explained. This is a major problem in the medical profession. A number of studies have showed that parents often misunderstand instructions because of the terminology. Many potential readers are likely to be put off by the complexity of the language.

Understandably the book does not cover child development, confining itself to sickness and accidental poisoning; but the excluding of ordinary accidents is curious. The lawyers make the distinction for

accident compensation but the rest of the population think of a child as sick whether it is a broken leg or a cold. There is also little discussion on prevention: even though there are some who wpuld argue that prevention is better than erne. And, probably because doctors do not know much about it, there is nothing to help a parent keep that sick child in bed, under supervision, or whatever. Overall then, it is a book of good intentions, which does not quite suceed. Those who will use it will be middle-class, well read, and have had some biological training. But the vast majority will find it of little use and even incomprehensible. One day someone is going to note that each year we have 40,000 new parents, the majority of whom care very much about their children and would value a manual which simply explained care of sick children and hew best to co-operate with the medical profession. But the book which is written may well have to be a joint effort between a medicallytrained doctor and a medicallyignorant parent. “Beyond the Best Interests of the Child” discusses that sad situation when there is a legal wrangle over custody of a child which occurs in some divorce, adoption, or fostering situations. In essence the eminent writers’ argument is that biological and legal parenthood Should not take precedence over psychological parenthood as it does in American, British, and our law. They advocate criteria for custody should be changed and that the child should have its own counsel in Court.

No doubt we shall be hearing more of this issue, Lawyers, social workers, and child developmentalists should read this study at an early stage.