Anamnesis in Children: The Importance of the Maternal State during Pregnancy
by Dr. Jayesh Dhingreja M.D. (Hom). M.Sc. (Counseling Psychology)
Anamnesis in children is a difficult process for any homeopathic physician to undertake. The physician has to rely on his observation skills and on the history which he gathers from the relatives of the patient especially the mother. The physician often gets very few subjective symptoms, the case is dominated by objective symptoms. A primary challenge in such cases is the accuracy of these symptoms. How much can the physician rely on the information gleaned and and how can the selected symptoms be validated? These problems arise because many times the child cannot provide the symptoms, therefore we depend upon the perception and nature of the relative, especially the mother. The mother, if she is of an anxious and over-caring nature, may consider certain symptoms more important which may have no value at all. On the other hand, if she is not alert or observant enough, then even after getting a good number of symptoms, we may still be unsure of our totality.
For anamnesis in children, the physician has to take into consideration the thorough physical and mental state of the child. Another aspect which the physician should inquire into thoroughly is the prenatal state, i.e. the state of the mother during pregnancy. It is in this intrauterine environment where the life of the human being begins and it is here where the fetus experiences emotions both pleasant as well as painful. These emotions condition their state of mind and body.
So, for a thorough anamnesis and understanding of the state of the child, the mother’s history during pregnancy has to be considered. A remedy which correlates both the child’s present state as well as the mother’s state during pregnancy will not only be able to address the child’s diseased state, but also the child’s inherited miasmatic load. Aristotle was very right in saying, “He who sees things grow from the beginning will have the finest view of them.”
Dr. Samuel Hahnemann understood this concept back in the 1800’s. He acknowledged that the health of the mother during pregnancy has an effect on the the development of the fetus. Hence, he was the first to talk about specific maternal therapy during pregnancy and the positive impact of this therapy on the growth and development of the fetus.
He mentions in Footnote 164 to §284:
“…But the case of mothers in their (first) pregnancy by means of a mild antipsoric treatment, especially with sulphur dynamizations prepared according to the directions in this edition (§ 270), is indispensable in order to destroy the psora – that producer of most chronic diseases – which is given them hereditarily; destroy it both within themselves and in the foetus, thereby protecting posterity in advance. This is true of pregnant women thus treated; they have given birth to children usually more healthy and stronger, to the astonishment of everybody. A new confirmation of the great truth of the psora theory discovered by me .” [1]
Many authors have mentioned their observations on the value of mother’s state during pregnancy affecting the child, e.g.,
Dr. Sherwood mentions in an article in the journal, The Homoeopathician:
“I have a very strong conviction that many actual murders, as well as many degenerates, originate in the mother, who, before conception and during pregnancy, wishes that the child was not; wishes murder itself. Think ill- of murder will develop it later. An experience tending to that conviction comes to me from one family where, of two children, a girl of fifteen and a boy of ten, the boy, while not a strong child, was bright and particularly intelligent. The girl is completely idiotic, not able to feed herself nor to care for nature's calls, needing her mother's every care.” [2]
A similar kind of observation is also quoted by J. T. Kent in his lectures on Homoeopathic Materia Medica under Borax:
“Many times I have used Borax when the mother could not nurse the child, she talks about always having a little, thick milk, "The milk is too thick and tastes badly." This condition of the milk prevents the mother from nursing her child. This is a constitutional state, and Borax if given in the beginning of pregnancy, to a Borax patient will so change the milk as well as the rest of the constitution that the mother will be able to nurse the child. I have a number of times, when a mother has brought forth several children that she was unable to nurse, given Borax and it has so affected the case that she could nurse the next child. If the mother was a Borax mother, the child is very likely a Borax child. It is not an uncommon thing for the mother and the baby to need the same remedy.” [3]
Dr. Donald Foubister states the importance of the role played by infections in the mother at the time of pregnancy in his article “The significance of past history in Homoeopathic prescribing”. He states, “Enquiry should always be made, when possible, as to whether or not the mother suffered from any acute infection during pregnancy. The influence of German measles and probably other infections in causing malformation of the foetus has been established, and it is therefore likely that less obvious after-effects occur in the same way that post-natal illness may leave their marks.” [4]
Further, he notes that emotional upsets during pregnancy can affect the health of the baby later in life. He cites a case of a sixteen-year-old girl who was slow in recovering from influenza. There was sluggishness in recovering from every acute illness for no obvious reason. Going back over the history, he discovered that the mother had been frightened by a doctor during pregnancy on being told that she might lose her baby. She said "I felt the shock go right through me." The girl was given Opium CM and made a quicker recovery, but not only that, she became physically more robust and her ability to study increased quite definitely. [5]
Finally, he cites examples of where drugs given to the mother during pregnancy can affect the child. He narrates a case of a mother who had been given Pethidine during pregnancy on account of osteomyelitis. Her son even though intelligent as stated by his teachers “could not use his brain.” Pethidine 30 given to the child increased his ability to study and concentrate at school. [6]
Dr. H. A. Roberts gives a philosophical view to this phenomenon in his book “The Principles and Art of Cure by Homoeopathy”:
“The growth and development of each individual progresses as it draws upon the physical energy, and upon the dynamic energy as it is manifest in the brain, and upon spiritual energy. These different manifestations of energy are essentially different in their workings. The law of growth is the same in one as in another. The mingling of these expressions of energy is the united personality, and when the energy functions properly in all the three manifestations the whole personality grows harmoniously, for the energy is the power house that supplies the impetus of growth for the whole economy, the whole individual. When the energy functions improperly there is greater growth on one plane than on another and the personality is not symmetrical in its development.”
“The nature of energy is dynamic, and this dynamis penetrates every particle, every cell, every atom of the human economy. Any disturbance of this vital energy or force results in a disfigured or disturbed development of the whole human economy. Such a disturbance may come from pre-natal influences, such as the effects of sudden fright; it may be caused by indulgences on the part of either or both parents at the time of conception; the cause may lie in excessive worry during gestation; it may be due to hereditary stigma of either one or both of the parent cells, which may perhaps be due to hereditary diseases or miasms. Like an indelible brand, the warping of this dynamic energy is a stain that "will not out".”
“On the other hand, after the separate individual life has been established, we know how terrific are the consequences of fright: the fright of the mother who transmits the effects to the nursing child, with a consequent disturbance to the vital energy long after the incident is forgotten. Or the mother's vital force may be disturbed by worries, or by sudden fright, and she herself may suffer from the consequent serious disturbance. These are but a few instances where there may be serious disturbances of the vital force.”
“The influence of this vital force on the whole organism is so delicately adjusted and so intimately connected with every part, that seemingly distant organs or unrelated symptoms show the effects of any disturbance of the vital force; and no one can prophesy what the influence may be on the part of the economy or what direction will be taken by the manifestations in each individual, but his vital energy will direct the course with unerring precision.” [7]
Dr. Peter Nathanielsz, MD., PhD., an obstetrician from the United States of America, has done considerable research on this topic. In his book, “Life in the Womb – Origin of Health and Disease”, he mentions that during gestation, there is a constant interplay between our genetic inheritance and the environment in which we develop. When the pregnant woman is healthy, the environment in the womb is conducive for the fetus to develop under optimal conditions. But, when this environment is suboptimal or adversely affected, especially during the critical periods of development, then there can be substantial immediate and long term consequences for the developing fetus. [8]
He calls the alteration of function by the conditions that are present during development in the womb as programming. He has further highlighted ten principles of programming, which are as follows:
1.) During development, there are critical periods of vulnerability to "suboptimal" conditions. Vulnerable periods occur at different times for different tissues. Cells dividing rapidly are at greatest risk.
2.) Programming has permanent effects that alter responses in later life and can modify susceptibility to disease.
3.) Fetal development is activity dependent. Normal development is dependent on continuing normal activity. Each phase of development provides required conditions for subsequent development.
4.) Programming involves structural changes to important organs.
5.) The placenta plays a key role in programming.
6.) The developing baby will attempt to compensate for deficiencies in the womb. But that compensation carries a price in later life.
7.) Attempts made after birth to reverse the consequences of programming might have their own unwanted consequences.
8.) Fetal cellular mechanisms often differ from adult processes.
9.) The effects of programming might pass across generations by mechanisms that do not involve changes in the genes.
10.) Programming often has different effects in males and females.
There is numerous other research conducted worldwide studying the effects of the state of pregnant mother on the health of the fetus. The prominent ones amongst them are as follows:
The Dutch Hunger Winter Study (September 1944 – May 1945): [9, 10, 11]
Prenatal and Postnatal Exposure to Cell Phone Use and Behavioral Problems in Children. [12]
Nausea during pregnancy: relation to early childhood temperament and behavior problems at twelve years. [13]
Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? [14]
Relation of maternal stress during pregnancy to symptom severity and response to treatment in children with ADHD. [15]
Considering the above mentioned points, I decided to conduct a study in homeopathy regarding the importance of the state of the mother during pregnancy and its effects on the health of the child and how this history helps us in management of pediatric cases. For this purpose 30 cases were selected and a thorough anamnesis was done for each of the cases as per § 6 of 6th edition of “Organon of Medicine”. A thorough state of the mother during pregnancy was elicited and correlated with the portrait of disease of the child.
From this study the following points were concluded. Most of the illnesses which occur in a child may have a direct or indirect link with the mother’s state during conception, pregnancy and labor. A thorough anamnesis of the case will surely let us know about this link. The following inquiries should be made for a thorough anamnesis:
Try to identify the disease, i.e. a proper diagnosis must be made in each and every case.
Try to identify the organs and the systems affected by the disease process.
Classify the disease as per Hahnemannian Classification of disease, whether dynamic or adynamic, acute or chronic, miasmatic or non-miasmatic, etc. This will help us in deciding the line of management of the case.
Try to get the complaints of the patient in its exact details especially pertaining to its character, onset, duration and progress.
Try to identify the ethnic and genetic factors that influence the disease process in the child.
Try to identify the developmental, growth, psychological, social, geographical and ecological factors that affect the disease in the child.
Try to get a thorough knowledge about the state of the mother during pregnancy and whether that state has any co-relation with the present condition of the child.
Guidelines for taking the state of the mother during pregnancy:
Basic personality of the mother.
Her intention to becoming pregnant.
The environment surrounding her during pregnancy, including any effects of bad news or events on her state of mind (e.g. hijacking, terrorism, war, riots, religious war, etc.)
Her feeling and state of mind (especially strong emotions like grief, shock, fright, disappointment, hatred, neglect, etc.) during pregnancy and labor.
Her interpersonal relationship during pregnancy.
Any history of injury during the pregnancy.
Any medical problem like prenatal or postnatal complications.
Any history of intake of any drugs or alcohol or smoking.
Attempts to abort the child.
Her socioeconomic and cultural background.
Her immediate feeling on hearing or seeing the baby following the completion of labor.
Her feeling while she is breastfeeding.
The following external stress factors in the mother can affect her child:
Emotional stresses during pregnancy – When a woman becomes pregnant, there is a significant change in her emotional state. Her mindset towards pregnancy is very important. For some women, pregnancy is a time of depressions, anxiety, and worry about childbirth, having a deformed child, or responsibility of raising a child; for others, it is time of joyful anticipation.
Relationship with husband – How is the personal relationship between the husband and wife? Is it cordial or are there tensions between them? How does the wife react to this stress? Is she angry or in a state of grief? All these will have an effect on the child.
Relationship with other family members – How is the relation with other family members? What is her feeling? If the relationship is not good, her reaction will be very important. Is she defiant and in revolt? Is she mutely bearing the suffering? Does she feel neglect? These and all other related questions become obligatory.
Attitudes of close friends and relatives – If a close friend and relatives is having some problem, then the mother also gets emotionally involved and she remains unhappy or sad. If there is some misunderstanding, then the mother might feel guilty, and indirectly all these affect the development of the child.
Economic status of the family – If the parents are having financial problems, or if the financial condition was not favorable for the arrival of the child, it adversely affects the development of the child.
The following internal stress factors in the mother can affect her child:
Not wanting a baby at all – Some family members may not want the child for different reasons. However, when the parents intend to have a child, the child is always wanted. If for some reason they did not intend to have a child, the negative feeling will percolate to the developing baby’s psyche.
Not wanting a baby at that time – If the child is conceived at an “inconvenient” time probably interfering with their educational, vocational or social plans or shortly after marriage or the birth of another child or because of economic problems in the family and the husband blames the wife for being “careless” she could feel guilty about not preventing the unwanted pregnancy. Guilt, remorse, shame and similar feelings in the mother can deeply affect the fetus.
Strong desire to have child of a particular sex – Many family members and relatives have a strong preference for the sex of the child. If the child is not of the sex they wanted, their disappointment often leads to psychological problems in the child.
Wanting to have miscarriage or abortion – When a child is unwanted, parents may secretly hope for a miscarriage or they may contemplate an abortion. If a child’s life is ended by a miscarriage or an abortion, they may feel guilty and carry over an unhealthy attitude towards subsequent children. If a miscarriage or abortion fails, they are likely to express their guilty in different ways, e.g., by becoming over- protective of the child as a form of compensation.
Scorn for the child – Relatives, neighbors, or friends of the family may develop attitudes of scorn if the child is illegitimate, the product of an inter-racial or inter-faith marriage, or if there is some stigma associated with the mother or father’s side of the family such as insanity, chronic alcoholism, drug addiction etc. These unfavorable social attitudes, expressed by outsiders, may affect the parents and in turn cause problems in the developing fetus.
If the unfavorable environmental condition affecting the fetus in the uterus lasts for a brief period, it will not have a very profound effect on it. But if it continues for long, it causes serious constitutional problems.
Mothers having excessive nausea and vomiting during pregnancy and lasting for the whole gestation period may predispose their child to become hyperactive later in life. Further study needs to be done on this phenomenon to confirm this observation.
Mothers who were advised bed rest on account for various reasons during pregnancy may predispose their children to become hyperactive later in life. Further study needs to be done on this phenomenon to confirm this observation.
The ideal age for the mother to become pregnant and deliver the child may be between 24 years to 28 years. Further research is needed to confirm this observation.
Dr. Hahnemann mentions in § 3 and § 4 of the Organon of Medicine, 6th edition, about the different types of knowledge essential for a physician to know in order to treat rationally and judiciously. One of the types of knowledge he mentions is how disease occurs in man and how to prevent it. This study helps us to understand the origin of health and disease in man. By understanding the origins of diseases, we can do a lot to prevent them from occurring again. Attention should be paid to the following points:
To form good habits of respect and concern for pregnant women through the warm atmosphere of family harmony, enough rest, a healthy and civilized culture and entertainment, and create a favorable living conditions and environment.
To avoid as far as possible emotions like temper, fear, depression and other negative feelings that affect the mother.
To form good habits which are more conducive for a positive physical and mental development of both the mother and the child.
Thus, understanding the history of the mother during pregnancy will not only help us in treating and curing diseases in children, but also help to formulate different ways and means to prevent the disease from affecting the child.
REFERENCES:
Hahnemann S. Organon of Medicine, 6th edition, Translated with Preface by William Boericke. B. Jain Publishers Pvt. Ltd., New Delhi, § 284, footnote 164.
Sherwood. Transaction of Society of Homoeopathicians, Bureau of Philosophy of homoeopathy, Hysteria of Eugenics; its prevention and cure; discussion. The Homoeopathician (A Journal of Pure Homoeopathy). 1914. No. 5 – 6.
Kent J. T., lectures on Homoeopathic Materia Medica, Borax venata. Lectures on Homoeopathic Materia Medica. B. Jain Publishers Pvt. Ltd., New Delhi. Low Priced Edition. 2006.
Foubister D. M. Acute Infections. The Significance of Past History in Homoeopathic Prescribing. Homoeopathic Medical Publishers, Bombay. 1967.
Foubister D. M. Psychic Factors. The Significance of Past History in Homoeopathic Prescribing. Homoeopathic Medical Publishers, Bombay. 1967.
Foubister D. M. Drugs. The Significance of Past History in Homoeopathic Prescribing. Homoeopathic Medical Publishers, Bombay. 1967.
Roberts H. A. Vital Force. The Principles and Art of Cure by Homoeopathy. B. Jain Publishers Pvt. Ltd., New Delhi. 1990. Page 35 – Page 36.
Nathanielsz P. W. Life in the Womb – the Origin of Health and Disease. Promethean Press Ithaca, New York. 1990.
Ravelli G. P., et al. Obesity in young men after famine exposure in utero and early infancy. New England Journal of Medicine. 295 (1976): 349 – 353.
Ravelli A. C. J., et al. Glucose Tolerance in adults after prenatal exposure to famine. Lancet 351 (1998): 173 – 177.
Lumey L. H. Decreased birth weights in infants after maternal in utero exposure to the Dutch famine of 1944 – 1945. Pediatric Perinatal Epidemiology. 6 (1992): 240 – 253.
Divan H.A., Kheifets L., Obel C., Olsen J. Prenatal and Postnatal Exposure to Cell Phone Use and Behavioral Problems in Children. Epidemiology. 2008. May 7.
Martin R. P., Wisenbaker J., Huttunen M.O. Nausea during pregnancy: relation to early childhood temperament and behavior problems at twelve years. Journal of Abnormal Child Psychology. 1999 Aug; 27(4):323-9.
Talge N. M., Neal C., Glover V. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal Child Psychology Psychiatry. 2007 Mar; 48(3-4):245-61.
Grizenko N., Shayan Y. R., Polotskaia A., Ter-Stepanian M., Joober R. Relation of maternal stress during pregnancy to symptom severity and response to treatment in children with ADHD. Journal of Psychiatry Neuroscience. 2008 Jan; 33(1):10-6.