[Journey in Health: The Continuous Health Supervision of Children] [Copyright MLMLX, Smart Family Foundation] [Presented by The Smart Family Foundation] [in cooperation with the American Medical Association and the American Academy of Pediatrics] [Music] [Dr. Fowler:] Take the policeman at theschool crossing. He's a pretty good symbol of our concern for the safety and welfare of our children as they travel along this perilous journeywe call growing up. Of course, many other people are concerned with the health of our children: the private physician and dentist, thehealth officer and the school nurse, the school counselor, and certainly the teacher with whom the child spends so much of his time. And you can think of others. But when you come right down to it, the continuing supervision of the child's health is primarily the job of his parents. After all, he's your child, and it's your responsibility to help him make his journey in health. Good health means a state of feeling well in body, mind, and spirit, and a sense of... Oh, Martha, I'm not a speaker; I'm a doctor. What makes them think I could makethem a good talk? [Martha Fowler:] Lots of them have heard you in your office, in their homes. [Dr. Fowler:] Well, that's different when I'm talking to one family. But up there on that platform, trying to make all those people seethe importance of continuing healthsupervision of... Well, that's rough. [Martha Fowler:] Would it help to forget about all those people and just think about one child? [Dr. Fowler:] What do you mean? [Martha Fowler:] I mean a specific youngster and what it would mean to that boy or girl. [Dr. Fowler:] Well, I could certainly think about little Judy Bemis. Anyone who saw her, as I did this afternoon, would understand right away why it'sso important for a child's healthsupervision to begin at birth and continue on a regular schedule. [Martha Fowler:] Well? [Dr. Fowler:] You know, the first time I laid eyes on her was in the office, oh, several weeks ago. She was a sweet little thing, a realpicture of health... until she walked. Judy was three years old, and this was the first time she had ever been taken to see a doctor. Her mother told me they had, ofcourse, noticed her trouble as soonas she started to walk, and even before. But they just assumed that she wasborn deformed and that there wasnothing to be done about it. So they did nothing until a visiting nursesaw the child and persuaded the motherto see a doctor. The case looked pretty clear. And x-rays confirmed a congenitaldislocation of the hip. At three years of age, this meant surgery and many months of living in a cast. That's the way I saw Judy this afternoon. The pity of it is that if her mother had followed a program of regular periodic checkups, the difficulty would have beendetected much earlier, and correction might have been as simpleas having her sleep with a pillow betweenher legs. Or if surgery had been necessary, well, living in a cast doesn't interferewith the physical and emotionaldevelopment of an infant as it does with a three- or four-year-old. Of course, in such a case, I believe most parents would havetaken upon themselves to seekmedical aid much sooner. But there are other things less obvious that early diagnosis and treatment... No, it'll sound like I'm up there tryingto drum up business. [Martha Fowler:] I suppose some people may take that attitude. But after all, dear, they invited youto come and talk. I should think that the only thing you can do is to present the facts as you know them. [Dr. Fowler:] Well, just the same, I wish they had chosen someone else to... [Telephone rings] Well, I'll get it. [Martha Fowler:] It's probably one ofyour patients going to drag you awayfrom the joys of speech writing. [Dr. Fowler:] Hello? Oh, yes, Mr. Martin. Tommy? Yes, I'd better. Why don't you bring him over hereto the office? Yes, this evening. Fine. And don't worry, Mr. Martin. Oh, about ten or fifteen minutes. Good. Goodbye. [Martha Fowler:] What happened toTommy Martin? [Dr. Fowler:] He cut himself, and his father wants me to check him. Say, maybe that's an idea for my speech. You know, the physician is still in the business of treating people when they're ill or injured, but these days, a good deal of our time is given over to preventive medicine. And it's a good thing too. You asked me to think about specific children. Well, I can recall when Tommy made his last visit to the office for his regular checkup. I remember because Tommy madequite a pronouncement. [Tommy Martin:] Dr. Fowler, I've decidedI'm too big now to undress every time Icome to your office. [Dr. Fowler:] Well, you are growing up, there's no doubt about that. [Tommy Martin:] I sure am. [Dr. Fowler:] Well, Tommy, let meask you something. If you wanted to check on the engineof your car, wouldn't you have to look under the hood? [Tommy Martin:] Well, I... maybe... [Dr. Fowler:] Wouldn't you? [Tommy Martin:] I suppose so. [Dr. Fowler:] There's no set pattern fora health examination. Every physician develops his ownmethod and procedure. The important thing is that theexamination be thorough, a complete study of the child's growth and development, his total fitness. Well, it looks like you're feeding himall right, Mrs. Martin. [Mrs. Martin:] Oh, he eats. [Dr. Fowler:] [Laughs] All right, let'scheck those feet, Tommy. All right, now make a muscle for me. [Tommy Martin:] Why? [Dr. Fowler:] Well, I want to check all your parts, and I want to see how these parts fit together into that machine called Tommy. Bend over and touch your toes. Okay. You know, Tommy, how an airplane pilot has millions of gauges and things in front of him to tell him how well his airplane's working? [Tommy Martin:] Yeah. [Dr. Fowler:] Well, he has otherways of knowing, too. He can tell by the sound of the engines and by the feel of the plane. Hop up here. He can tell by how well the planebanks and climbs and turns, by how well it behaves just generally. And you know, it's much the same waywith a doctor. He's had a lot of experience withhuman machines, some that are running well and some that are beginning to cause trouble. And like a pilot, he gets to be pretty good in spotting trouble in lots of ways. Mm-hmm. [Tommy Martin:] Find something, Captain? [Dr. Fowler:] Well, there's a gland hereseems a little too big. But we'll check the nose and throatto see what's happening. But right now, I want to see how the machine responds to the controls. You see, Tommy, you make a lot of movements without really thinking about them. When you walk, when you eat... [Tommy Martin:] Or swat a baseball. [Dr. Fowler:] Right. If the reflexes aren't normal, it's a signthere may be a disturbance in thespinal cord or the nervous system. Well, let's see how that lazy eyeis coming along. [Tommy Martin:] Oh, the eye doctor says it's not lazy anymore. [Dr. Fowler:] You know, it's a good thing we found that lazy eye when you were little, and that your eye doctor made itwake up and go to work. If your folks hadn't been looking outfor your health, and that eye had gone until nowwithout being detected, chances are it would have been too late, and you'd be going through life with one weak eye. [Tommy Martin:] It's okay now, isn't it? [Dr. Fowler:] Yep, those muscles aremuch stronger now. We'll check iton the chart before you go. All right, now let's see the mouth. [Mrs. Martin:] There's nothing wrongwith his talking. [Dr. Fowler:] [Laughs] So I've noticed. How long is it since he's seen his dentist? [Mrs. Martin:] Well, he is overduefor a visit, but... Oh, it's just so hard to fit thingsinto a schedule that... Well, you know, so many things. [Dr. Fowler:] Yes, I know. There are some spots here thatseem to need some care. I'd take him to a dentist pretty quick. Now, Tommy, open up a mile andpant like a dog. [Tommy Martin:] Like this? [Panting] [Dr. Fowler:] That's it. Yes, the right side of that throat doeslook a little red. That may accountfor the gland. Has he had a fever in the last couple of days? [Mrs. Martin:] Why, no... at least not that I've known anything about. [Dr. Fowler:] Has your throatbeen hurting, Tommy? [Tommy Martin:] No. [Dr. Fowler:] Well, then, it's probablysomething mild. But just to make sure there's noinfection to worry about, we'll take a throat culture and do a blood count on you before you go. [Tommy Martin:] Now you're goingto listen to the engine. [Dr. Fowler:] That's exactly what I'mgoing to do. To listen to the engine, to see that all parts of this human machine are working properly and growing properly, that's the reason for regularperiodic examinations. But it goes deeper than that because this is a human machine. We're concerned not only withhis physical growth but with the total developmentof the whole person. So all during the examination, I am observing other things about him: the way he talks, his responses to things I say, his reactions to things I do, his interest in what's going on,his total relationship with me. These things measure hisemotional development much the way this sphygmomanometer measures his blood pressure or the chart measures his vision. All right. Now, Mrs. Martin, before he goesback to school, take him to the ophthalmologist for a regular check, would you? [Mrs. Martin:] We were planning onthat, Dr. Fowler. [Dr. Fowler:] Oh, fine. Miss Carlisle, Tommy's going to need a throat culture and a blood count. Tommy, would you go with Miss Carlisle, and she'll tickle your throat, and she'll prick your finger and take out just one little drop of blood, all right? [Tommy Martin:] I guess I could spare it. [Dr. Fowler:] And then I'll give youyour booster shot. [Tommy Martin:] Oh, do I have tohave a shot again? [Mrs. Martin:] Now, Tommy. [Tommy Martin:] Oh, all right, butnot in my throwing arm. [Dr. Fowler:] It's a deal, son. [Miss Carlisle:] All right, Tommy, youget dressed and meet me in the lab. [Dr. Fowler:] [Laughs] Well, Mrs. Martin, it looks like you're doing a fine job with that boy. [Mrs. Martin:] We try. Oh, I'd like you to make the notes in our health record of Tommy. [Dr. Fowler:] Okay. Yes, he's developing well physically and emotionally. Anything you'd like to discusswith me, any problems? [Mrs. Martin:] No, nothing special. Is this gland something to worry about? [Dr. Fowler:] Oh, I don't think so, unless something shows up in our tests. If it doesn't go down in a day ortwo, give me a call, will you? [Mrs. Martin:] I certainly will. [Dr. Fowler:] I'll expect to see himagain next year. Oh, are you back already? [Tommy Martin:] Sure, nothing to it.What's that? [Dr. Fowler:] Well, Tommy, bothyour parents and I keep a record of how you're doing in thisbusiness of growing up. It's sort of a running story on youright from the beginning. Now, young man, let's get thatshot over with, shall we? [Tommy Martin:] Okay. No, that's my pitching arm. I guess you know an awful lotabout me, don't you? [Dr. Fowler:] Well, that's mybusiness, your parents and I andyour school working with us. You see, your teachers have toknow a lot about you too sothey can do their best for you. And their observations of youday in and day out are mighty important in helpingkeep track of the way you growup and the adjustments you make. [Tommy Martin:] The what? [Mrs. Martin:] He means the kind ofa man that you're growing up to be, how you treat other people, and how you take things that happen to you, the good things and the bad things. [Tommy Martin:] You mean like being a good winner and a good loser too? [Dr. Fowler:] That's right. Here, catch. [Tommy Martin:] What's this for? [Dr. Fowler:] [Laughs] You said youwere a good catcher, and I justwanted to try you out. By the way, how's your sister Kate? [Tommy Martin:] All right, I guess. You ought to know. You're the doctor. [Dr. Fowler:] [Laughs] Yes, I ought to know. [Mrs. Martin:] Goodbye, Dr. Fowler. [Dr. Fowler:] Goodbye. [Tommy Martin:] So long, Dr. Fowler. [Dr. Fowler:] Yes, I ought to knowabout his sister. Let's see. Kate was four years old last April. Four years old, and I've been seeing her regularly since the day she was born. The first years are the most important for the early detection of possible difficulties. That's why I recommend that parents take their children to a physician on a regular schedule: during the first year, every four to six weeks; during the second year, every three months; from age two to six, every six to twelve months; after that, once a year. Parents sometimes comment that this is a pretty full schedule, but we generally have our automobiles checked over regularly, and most of us think childrenare even more precious. The physical examination of a four-year-old is much the same as for an older child, but what we call the interview is quite different. Techniques vary, but our objective is to test the child's emotional development. The child who performs the tests for his or her age level and does it freely and smilingly, this child we know is, generally speaking, making a successful adaptation tothe world and to the family in whichhe or she is growing up. We also learn a great deal abouthow successfully the family isadapting to the child. Sometimes, we see a child who frets and fusses and resists the little game we play. Of course, one such experiencetells us very little. But if we've been seeing the child regularly, and we know he has the ability toperform the tests but still doesn't, then we look for the cause. Does, uh, Fred object to, uh,oh, getting up in a barber chair? [Mrs. Blake:] Oh, he puts upan awful fuss. Yes, he does. [Dr. Fowler:] Does he sometimes put up an awful fuss at home, too? [Mrs. Blake:] Oh, yes. His fathersays... Well, yes he does. [Dr. Fowler:] I see. Well, Mrs. Blake, you know, when a child exhibits such a resistance to adults, it may mean that somewhere he's being pushed beyond his capacity. I wonder if you or your husband aren't expecting Fred, at the age of four, to conduct himself in waysthat belong to a child, say,of six? [Mrs. Blake:] Oh, I don't think so. Of course, he is four, and he should be making some progress towards maturity. [Dr. Fowler:] Yeah. [Mrs. Blake:] And he actually wants to read, so I have been helping him with a few words. And, well... But I couldn't saywe're pushing the boy. [Dr. Fowler:] Counseling with parents on a child's emotional needs is every bit as important as counselingwith them on diet and exercise andother physical needs. But parents so often shy away from discussing behavior problems. [Martha Fowler:] Is that because they're less tangible, more difficult to work with? [Dr. Fowler:] Possibly. Of course, there's no way of drawinga line between physical health andemotional health. The case history we develop outof regular visits, though, is oftena very valuable guide. I'm thinking of the case of Susan Worth. Susan entered second grade this year, and soon after school opened, she started being the funny girl in class. Of course, health supervision of children is a three-way responsibility shared by parents, physician, and school. Observing Susan, her teacher was puzzled because all through first grade, thechild had been well-behaved and had done better than average work. When Susan's mother brought her to me for examination, I was puzzled, too. Susan was one of my regulars. I'd known her from infancy, andshe seemed to be developing normally and making satisfactory adjustmentsalong the way. Clearly, something new had comeinto the picture. A complete examination revealedno physical impairment. But when I started talking with herabout school, she said she didn't like it, didn't want to go anymore, and wasn't going to go anymore. I gave her a few simple arithmeticproblems at her level, and she had no trouble whateversolving them. Then I printed a few words that she ought to know and asked her to read them to me. [Tree, Cat, Climb, Home] [Susan Worth:] Three, c... cat, light, walk. [Dr. Fowler:] Here was that"something new" about Susan. In second grade, she was being called upon to do more reading, and our full diagnosis revealed her problem to be what we call dyslexia, or word blindness. Her behavior then was her way of fighting back, of compensating for her inability to see words as well as the other children could. Once this was known, her parentswere able to take it up with the school and work out a solution to the problem. Now, Martha, I don't want my audienceto get the impression that every childmay be developing a physical or emotional disorder. If I can just get my point across by stirring up an active concern without spreading alarm, I'd... [Doorbell rings] Well, I'd better step over and open the office for Tommy and his father. All right, Tommy, let's hop up hereon this table, shall we? Attaboy. Sit down, Dad. [Mr. Martin:] Thank you, Doctor. [Dr. Fowler:] Now, tell me, how'd youcut this finger? [Tommy Martin:] Well, I was helping Dad straighten up the garage, and... You know the kind of shears you use for cutting flowers and things? [Dr. Fowler:] Things like fingers? [Tommy Martin:] Yeah, fingers! [Dr. Fowler:] Well, young man, I neverwant to hear any more complaintsout of you about having your booster shots,because this is one of the reasonsfor having that protection. [Tommy Martin:] It didn't protect mefrom cutting my finger. [Dr. Fowler:] No, but if you had seenthe boy who came into my officea week or so ago, he punctured his hand with a wire. He had never had any shots, buthis parents thought that becausethe wire was clean, there was no danger. And then the wound healed up by itself. [Tommy Martin:] But you said hecame to your office. [Dr. Fowler:] That's right. And now,quite a bit later, he complained thathis neck was stiff. By the time they brought him tomy office, he had lockjaw. Do you know what that means? [Tommy Martin:] Like this? [Dr. Fowler:] That's right. That boy had a painful time of it, and he'll be a long while getting well. [Tommy Martin:] Gee. [Dr. Fowler:] So you'll be gladto get another little booster shotnow, won't you, just to be on the safe side? [Tommy Martin:] Sure, go ahead, just as long as my finger's okay by Saturday. [Dr. Fowler:] Oh, are you catching a game? [Tommy Martin:] The big one. [Dr. Fowler:] You know, Tommy, you have your parents to thank for that. If they hadn't made it their business to keep checking up on your health, whether you seem to need it or not, we might not have caught that lazy eye in time. Steady now. [Tommy Martin:] [Flinches] [Dr. Fowler:] And if that eye hadgrown up weak, you might have missed out on baseballand some of the other things you'regoing to want to use your eyes for. Now let me see that finger. [Tommy Martin:] Well, sure want you to keep checking me every year. [Dr. Fowler:] Fine, Tommy. [Tommy Martin:] Every year? For how long? [Dr. Fowler:] Till you're throughhigh school, anyway. As a matter of fact, Tommy, you never outgrow your need to look after your health. Isn't that right, Dad? [Mr. Martin:] You bet. [Dr. Fowler:] Okay, son, all fixed. [Mr. Martin:] Thanks a lot, Doctor, for taking time out of a busy evening to look after Tom. [Dr. Fowler:] You're entirely welcome. [Mr. Martin:] Thank you. [Tommy Martin:] Yeah, thanks a lot. Why don't you come out to the game Saturday? [Dr. Fowler:] Say, I might just do that, too. [Mr. Martin:] Thank you, Doc. Goodnight. [Dr. Fowler:] Goodnight.[Tommy Martin:] Goodnight. [Mr. Martin:] Okay, Tom. All right, Tommy, I guess you'llbe in shape for the game. [Tommy Martin:] Sure, I'm ingood shape. But, Dad? [Mr. Martin:] Yes? [Tommy Martin:] How long sinceyou had a checkup? [Music] [The End]