Tuesday, May 01, 2012

There's an obese kid in the room...cant u see??

Oncall again. Another resuscitation. Despite all we did, another child dead.

 This is the one thing about my job that I hate the most. But most times, I am able to deal with it, and tell myself that we had tried our best. I know as well that my colleagues and I have to often remind ourselves and each other, that no matter how bad we want to, we cant save everyone. I usually am most aggrieved when the child that died had been a relatively "well" child, no known illness, pretty much a normal kid. But in this case, although the family claims their child had been "normal & healthy" prior to getting this bout of infection few days ago, I really have to disagree.

One look at the patient you can tell that he has a serious medical condition. It was so obvious. But probably the family never saw it as a medical problem. I'm sure most of the people who knew him and had seen him (or other children like him) didn’t think so either.

The patient was 5 years old. He weighed more than 40kg.

He was morbidly obese! So much so that we couldn’t see his neck, and when he collapsed, the doctors in the ward knew right away that they would have difficulty intubating him but fortunately they manage to get the anaesth in to help.
But all was not well. His heart stopped 3 more times after that, and we couldn’t revive him anymore after the 3rd round. He died less than 12 hours after he was admitted.
It was so sad to see the doctors huffing & puffing doing CPR on a 5-year old kid! They should have been able to do the chest compressions using only one hand! But because of his big size, they still had to climb on the bed and do the compressions with both hands. And because his weight was waaay off the chart for his weight, his meds were given based on the ideal weight for his height, which was not as accurate as compared to giving meds to a kid with proper normal weight.
He had an infection yes, but his heart was actually already hypertrophied, and that's most probably why he succumbed quite fast. His heart was already in trouble no thanks to his obesity, and all the infection did was tip it off the edge.

Like I said, I know that many people do not see obesity in children as a serious medical problem, just like it is in adult  (and even that is only recently recognized and accepted by the public), because when I do see an obese child and pass the comment to the parents, the reaction I usually get from the parents (who would have brought the child in for another complaint usually eg. Fever/cough/runny nose/etc) would range from -- "Eh tak baiklah doktor ni cakap anak saya gemuk" or "ha-ah la doktor, tapi dia ok, main semuanya ok, takde apa2".

So in this case, although I am still aggrieved that we couldn’t save him, I cant help but feel that the adults are still to be blamed for letting him get as fat as he is. People need to recognize that obesity is a SERIOUS problem in children as well as adults, and that chubby fat kids do not equal cuteness, and do not especially portray healthiness (observe that many people will say "wahhh…sihatnye anak awak ni" instead of "wahh..obes-nye anak awak ni"). I understand that we dont want to hurt their feelings, we wanna be sensitive, which is fine, dont say it to the parents' face in public, or dont say it in front of the kid, but dont mask or hide the problem by implying that it's ok to be fat, the kid is still really cute. (in my defence, when I do make the comment above, that a kid looks obese, it is honestly out of concern for the kid, not passing judgement to the parents..but ok, I get it, people are sensitive... I should be more sensitive too..).

And when I say people, I do mean EVERYONE of us, including doctors and medical staff, because I know for a fact that there are doctors who prescribe vitamin supplements, and other supplements like omega-3-fish oil and colostrum to kids with cough and cold, in addition to the usual meds. It's one thing if it's for a skinny kid or even a normal kid with perhaps poor appetite, but if it’s a real chubby obese kid sitting in front of you in the clinic, you should findout why he/she is so, and then try and get them to lose the weight instead of supplying them with more multivitamins, colostrum and fish oil! (if it's simple obesity of course.. Other diagnoses need to be ruled out as a cause for the obesity ie metabolic syndrome etc whereby you would then need to refer them to the experts, but reducing weight still plays a huge part in the treatment).

Anyway, I'm definitely not an expert, but I do believe that we need to be able to identify that there is a problem first before we can actually try and solve it.

Kids, eat healthy, play more!
Parents, get ur kids to eat healthy and play more!!


Jody said...

Noted doctor!

Anonymous said...

and what have u to say with regards to your own BMI doc?