Ignorance Lead To Complication

A child who cannot sleep at night because of severe nasal congestion (blocked nose) will be crying all night. This simple common problem can often result in serious complications that most parents are not aware of. 

Today (11th Apr 2013) NHS published information about compensation claims stating they paid huge compensation. Most of the clinical negligence bill is the result of NHS errors, which have led to babies becoming brain damaged, with 100 cases occurring each year. Majority of claims are one that occurred during birth. I am  sure there are more cases that parents are not aware of and I hope this article will help learn more about anoxia (starved of oxygen) and how you can manage and reduce complications like developmental delay & spasticity.

Complication Due To Ignorance

This is a case I feel sad because I could not help this mother and the child. The nurses with the help and support of managers stopping my treatment because they did not know why and how this drug could have helped normal development and reduce complication that affect the child, parents and cost of providing care.

Why This Problem Occur?

Parents, nurses and even some doctors do not know babies do not know they can open their mouth and breath if their nose is blocked or filled with secretions. This results is poor oxygen entering chest and supply to brain. This reduced oxygen supply will produce server headache and if the chronic may result in brain damage, specificity, developmental delay and cerebral palsy.

This is very important for any clinician to notice and offer appropriate treatment to the child. I have used mild inhaled steroid to help reduce nasal congestion and ease breathing. This is mandatory to help reduce cerebral anoxia. It is also very important to make sure the child sleep well to help them grow and develop normally.

Case Senario

I was involved in managing a child with severe nasal congestion resulting in irritability, excessive crying at night. The mother had consulted doctors in the hospital, A&E, walk-in-clinics and my collegues and nurses in the surgery. She felt no one was listening to her and offering any help to ease the problem.

When I saw this child, the first thing I noticed when the mother lifted the child up was “Sissering Gait”. This happens when the child has developed “Spasticity”. I was unable to examine this child because he was very restless and irritable.

I spoke to the mother for almost 30 minutes and explained why the child is irritable and explained what I was planning to do and prescribed Budesonide (to be used via volumatic). I wanted to examine this child well before diagnosing as “Cerebral Palsy” and referring him to hospital.

I requested mother to return to see me in a weeks. After the child left, I went and told the nurses in-charge that this child has been managed wrong by other doctors working in the surgery, hospital and nurses in the walk-in-clinic. It looked as if the child has developed complication that will be difficult to reverse.

When I returned to work on Monday, I was shocked to hear the nurses had stopped the treatment because the BNF does not list Budesonide can be used to treat nasal congestion (Rhinitis). She did not know how this is mild steroid similar to Betamethasone. She had told the mother I had given a wrong treatment and instigated a complaint against me. According to her, Budesonide must only be used to treat Asthma and not used to help reduce nasal congestion. Stopping my treatment resulted in this baby developing spasticity (Stiff legs and arms, unable to walk).

Unfortunately, the NHS managers and the director of health who have no experience of managing children or the knowledge about these drugs supported the nurse claim. The child was said to have developed severe spasticity and now moved to live in another area in country.

Pulmicort & Nasal Congestion

It is true Budesonide is indicated for Asthma but not listed in BNF as a treatment for preventing nasal congestion, rhinitis (runny nose) or hay fever in children. The reason this is not indicated is because they have not conducted clinical trials in children to get license for use.

I have used Budesonide in children for severe croup and to reduce throat swelling in babies (post extubation) and found it very useful. This drug has helped us save complications in thousands of kids all over the world.

Knowing the side effects are less serious than the problem, the drug will help reduce pain and suffering it is my duty to treat and reduce complications. With holding treatment because the BNF has not listed is “Un-Ethical” and I could loose my license to work as a doctor and get suspended by GMC.

How Can Budesonide Help

Babies do not know they can open their mouth and breath but will chock themselves and die if the nasal passage is blocked. (Please read Choanal atresia).

Partial blockage often occur due to irritants and allergies that make the mucus membrane in the nostrils swell. Steroid suppresses this immune response to allergy and prevent swelling.  As a mother, do you not think it is better to treat using a known drug than allowing your child to be starved of oxygen every night resulting in cerebral palsy or developmental delay?

I would treat my child with any drug that could prevent long term problem and not care what the BNF or the experts say. Knowing how drugs act, do and their side effects is very essential because it gives the doctors to chose the appropriate treatment that helps but do no harm. Having the knowledge and experience of using a drug but not using this that may help a patient is un-ethical and could be treated as “Negligent”.

It is better to use this drug and reduce nasal congestion cerebral anoxia (lack of oxygen supply to brain) that help babies to develop normal and not diagnosed as CP (cerebral Palsy) few years later.

Using these drugs to unblock nose to help breathing help children development. and act have given the treatment or prescribed medication has the right to stop or change but no other person or organization can stop or change my decision without my consent.  I found numerous minor and few major clinical errors (Negligence) that doctors would find it hard to accept and ignore. As a doctor, returning to work and be part of a clinical setting that do not help alleviate pain and suffering is un thinkable and against my moral, principle and religion.

The physician’s fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose.

World Health Association Declaration

  1. The physician shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment.
  2. The physician shall not be present during any procedure during which torture or any other forms of cruel, inhuman or degrading treatment is used or threatened.
  3. I found the nurses working in this surgery were offering wrong diagnosis, treatment resulting complications that prolonged illness and suffering.

This is substandard care that is cruel, inhuman and degrading and so is unethical for me to work in a place, ignore and be part of an organization that I have no control.

PS: I will be soon publishing copies of complaints, reply and documents that will help you learn more about the problems that result in inflicting pain and suffering.

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