Case of Reactive Airway Disease

by Dr. Jayesh Dhingreja M.D. (Hom). M.Sc. (Counseling Psychology)

SUMMARY: The case presentation elicits the importance of the state of the mother during pregnancy and its effects on the state of mind and disposition of the child. The case also elicits some important parameters for a thorough anamnesis in pediatric cases.

KEY WORDS:

Reactive airway disease, vexation, Chamomilla. 

CASE: Miss S. K., 2 years old, attending Kindergarten. Her father is a businessman and her mother is in service. She consulted on 15 / 09 / 08

Since age of 4 months, she gets recurrent respiratory tract infections. She gets a continuous cough which is of a rattling kind. Her cough is worse after 7 p.m. She becomes cranky and cries and cough gets aggravated by crying. She has taken allopathic as well as homoeopathic treatment for the condition, but still the attacks repeat themselves every 15 – 20 days and the intensity also remains the same. 

She also gets a nose block with whitish, watery discharge from the nose and occasional sneezing. 

According to the patient’s mother, her appetite is reduced, she does not eat well, and has to be forcibly fed many times. She perspires profusely on her scalp. She is a hot patient.

Birth History:

She was born through a caesarian section, 3 weeks prior to her due date. She cried immediately after birth. 

Vaccination:

She had no trouble after vaccination.

Developmental History:

Dentition – 6 months

Walking – 11 months

Talking – 10 months

Mental state of the child:

She is very obstinate by nature. If her wishes are not fulfilled, then she shrieks and weeps. She is also capricious by nature. 

Basic Personality of Mother:

She is of a very emotional and sensitive nature. She gets hurt when someone tells her anything badly. She keeps the hurt in her mind and cannot forget it. She cries very easily, but does not speak out. But inside, she has a very bad temper.

Mother’s History during Pregnancy:

Mother’s age during pregnancy: 30 years

She had endometriosis and ovarian cysts and hence could not conceive after her marriage for the first few years. Her in-laws wanted a child, but she could not conceive, so there used to be a lot of problems for her in the house. She could not adjust with her in-laws and hence was in a constant state of distress. Her in-laws had compelled her to undergo 4 laparoscopies against her wishes. Her husband was never supportive of her during this time. Then she got pregnant, but during the pregnancy, she used to recall back all the past bad memories and grievances which she had undergone. She used to get very angry inside and had stopped talking to her in-laws. With this anger in mind she used to weep. She also had anger against her husband for not supporting her in the time of need and was also feeling insecure thinking that if anything happened now, then what she will do. During pregnancy she also developed mild hypertension.

Past History:

No major medical or surgical disease.

Family History:

Father – Chronic Sinusitis.

Mother – Endometriosis; Ovarian Cysts; Chronic fungal infection of skin.

Grandmother – Retinitis pigmentosa; Hypertension.

Grandfather – Renal stones.

On Examination:

Weight – 9 kg. 

General Examination:

Temperature: Afebrile; Pulse – 86 / min.; Respiratory rate – 26 / min.; Pallor – absent; Icterus – absent; Cyanosis – absent; Clubbing – absent; Lympahadenopathy – absent; Edema – absent; Skull – NAD; Skin – NAD; Spine – NAD 

Systemic Examination:

CNS – NAD; CVS – NAD; RS – Ronchi present; GIT – Liver, Spleen, Kidneys – Not palpable.

Clinical diagnosis:

Reactive Airway Disease with Behavioral Disorder.

Totality of Symptoms (Mother’s state during pregnancy):

She had a lot of anger against in-laws, but she kept it inside her, not expressing.

Anger over former vexation caused by in-laws regarding her endometriosis and inability to conceive.

Recalls past events related to her in-laws.

Weeping from recalling those past vexations.

Repertory sheet (Mother’s state during pregnancy):

Totality of Symptoms (Patient):

Stubborn and obstinate child.

Capricious.

Shrieking when her demands are not met.

Profuse perspiration on scalp.

Cough worse after 7 p.m.

Repertory sheet (Patient):

Miasm: Sycosis.

Remedy selected: Chamomilla.

Susceptibility:

DISCUSSION:

The anamnesis of this case clearly shows us how a predominant mental state of the mother during pregnancy affected the state of mind and disposition of the fetus. The mother, being extremely sensitive, went through a state of constant vexation prior to her pregnancy. When she got pregnant, even though her in-laws did not trouble her, she could not come to terms with her past vexations. She would recall those events always and would remain under a constant state of anger, which she used to just keep in her mind and never express. The only expression outside was weeping on recalling these events. There is also a sense of insecurity developing due to lack of action on the part of her husband.

The growing fetus inherits these emotions from the mother and expresses itself as aggressive and obstinate behavior. 

From the anamnesis and considering the totality of symptoms of the mother and the child, Chamomilla was prescribed as the indicated remedy.