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Cruel to Be Kind: Part 2 of 3: Saying no can save a child’s life

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2018
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‘He was probably stressed. Have you heard him wheezing?’

‘No. He gets out of breath easily, but there’s no wheezing.’

‘He would get out of breath, carrying all that extra weight around. It puts a huge strain on the cardiovascular and respiratory system. To overfeed a child to this extent is a form of abuse.’

I glanced at Max again. I felt uncomfortable that he had to hear all of this, but it was the truth, after all. ‘He’s only been with me a short while,’ I said, feeling culpable.

‘Does he exercise?’ Dr Jhaveri asked.

‘Not a lot. He joins in PE at school, but he doesn’t like walking.’

‘That’s because it’s uncomfortable for him, but walking is a good form of exercise. Incorporate it into his daily routine.’ I nodded. ‘So what has his social worker told you to do?’ She looked at me.

‘To keep everything as it has been and leave it to his mother to deal with once he’s home.’

‘Clearly his mother hasn’t been dealing with it so far,’ Dr Jhaveri said firmly. ‘What makes her think it will be different in the future?’

‘I don’t know.’

‘Is his mother badly overweight too?’

‘Yes.’

‘Any siblings?’

‘Three older sisters.’

‘All obese?’

I nodded.

‘I’m really shocked that no one has been advising the mother on her children’s health, especially when the social services are involved. I see families here. We have a clinic that offers advice and support, and a weekly weigh-in. Obesity is a massive problem in the Western world and we are storing up huge health problems for the next generation. Is his mother in good health?’

I shook my head. ‘She’s in hospital now, that’s why Max came to me.’

‘What’s the matter with her?’

‘She had two toes amputated – I understand it’s a result of type 2 diabetes.’

She let out a heartfelt sigh. ‘Yet she’s allowed her son to go the same way.’ Dr Jhaveri was clearly a conscientious paediatrician whose outspokenness was a result of her concern for Max. ‘I’ll speak to his social worker. Perhaps she’s not aware of the help available. I have her contact details on the letter of referral.’ She then turned to Max. ‘Hi, Max. How are you today?’

‘OK,’ he said quietly, obviously chastened by what he’d heard.

‘Pleased to have the afternoon off school?’ she asked, being friendly.

Max wasn’t sure what to say.

‘He likes school,’ I said. ‘He’s doing very well and he loves reading.’

‘That’s good. My children like reading too. So do I. Now, I’m going to examine you. I expect you had an examination at your doctor’s when he prescribed the inhaler.’ Max nodded. ‘We’ll start by looking in your ears. Can you hear all right?’

‘Yes,’ Max said.

She took an otoscope from the top drawer of her desk and looked first in one of Max’s ears and then the other. ‘That’s fine,’ she said. Returning the otoscope to the drawer, she took a wooden tongue depressor from a sealed packet and then asked Max to open his mouth wide so she could look in. ‘Thank you,’ she said. Throwing the used spatula into the bin, she picked up the ophthalmoscope from where it lay on her desk and looked in his eyes. ‘Do you have glasses for reading?’ she asked. Max shook his head.

‘And you can see the board the teacher writes on?’

‘Yes.’

‘Good. Can you read the letters on that chart?’ she asked him, referring to the Snellen wall chart. Max read all the letters without any problem.

‘Excellent.’ She returned the ophthalmoscope to the desk and, looping her stethoscope around her neck, listened to his chest and then his back. ‘His chest is clear,’ she said and made a note on the form for the medical that Jo had sent. ‘Now, let’s measure you,’ she said to Max. ‘Can you take off your shoes and stand just here for me?’ She took the few steps to the height recorder as Max leaned forward and began struggling to take off his shoes. It wasn’t that he lacked the motor skills to undo the Velcro and pull off his shoes, but the fat around his middle stopped him from leaning far enough forward. I helped him and he padded across to the doctor. She gently placed him in front of the height bar and then lowered the ruler so it was just touching his head. ‘Three feet, eleven inches,’ she said. ‘That’s average for his age.’ She went to her desk, made a note on the form and then returned to Max. ‘Now, let’s weigh you. Stand on here, please.’ Max stood on the scales. I watched and waited. I knew he was overweight, but I had no idea by how much. It came as a huge shock. ‘One hundred and nineteen pounds,’ she read out. ‘That’s eight and a half stone – more than twice the weight he should be.’ Then, as she walked to the desk to record the figure, she frowned. ‘Do you realize that’s the weight of the average fourteen-year-old? Perhaps the social worker will do something now.’


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