Rhinitis in childrenRhinitis in children

Jacqueline M MardonJacqueline M Mardon

A collaborative modelA collaborative model

retrospective review47 children referred by ENTallergic or non-specific rhinitisineffective conventional therapyassessed by homeopathic practitioner

treated with homeopathy ± isopathyfollow-up and outcomes

retrospective review47 children referred by ENTallergic or non-specific rhinitisineffective conventional therapyassessed by homeopathic practitioner

treated with homeopathy ± isopathyfollow-up and outcomes

The integrity of the child

The integrity of the child

What is rhinitis and what is it an expression of in the child’s being?

What is the significance?(different levels this can be approached)

What is rhinitis and what is it an expression of in the child’s being?

What is the significance?(different levels this can be approached)

A very visible manifestation:flowing, stickylurid green, yellow, clear

burnyblood

Face full, tender, squeaky, stuffed-up

Unseen pain, itch - nose rub, palate scratch

A very visible manifestation:flowing, stickylurid green, yellow, clear

burnyblood

Face full, tender, squeaky, stuffed-up

Unseen pain, itch - nose rub, palate scratch

Eyes water, stick, searing tears

Ears fuzzy, bubbleSkin prickles and flakesHard to breathe - the night is not peaceful, disturbed with grunts, snorts and gasps

Eyes water, stick, searing tears

Ears fuzzy, bubbleSkin prickles and flakesHard to breathe - the night is not peaceful, disturbed with grunts, snorts and gasps

An assault to the dignity of the young individual and their integrity

Affects concentration, distorts the face. Hard to gaze outwardly.

There may be shame, mute miseryCan experience being shunned, bullied

An assault to the dignity of the young individual and their integrity

Affects concentration, distorts the face. Hard to gaze outwardly.

There may be shame, mute miseryCan experience being shunned, bullied

Conventional approaches

Conventional approaches

History, examination ± investigation (skin prick tests, RAST)

Associated asthma, eczema, foods?

Treatment nasal corticosteroids, anti-histamines

History, examination ± investigation (skin prick tests, RAST)

Associated asthma, eczema, foods?

Treatment nasal corticosteroids, anti-histamines

Self-help approachesSelf-help approaches

Allergen avoidance/reductionSaline nasal washesLight impulse probes?

Allergen avoidance/reductionSaline nasal washesLight impulse probes?

Homeopathic “holistic” approach

Homeopathic “holistic” approach

The child first and always Welcome the family Symptoms Maternal history, birth Early life, breathing, feeding and weaning

FHxOnset allergy - eczema,asthma, rashes, food

The child first and always Welcome the family Symptoms Maternal history, birth Early life, breathing, feeding and weaning

FHxOnset allergy - eczema,asthma, rashes, food

Homeopathic “holistic” approach (2)

Homeopathic “holistic” approach (2)

Movement Physical, social and emotional development

Sleeping Day rhythms TemperatureObservations; significance of ages

Movement Physical, social and emotional development

Sleeping Day rhythms TemperatureObservations; significance of ages

Review of cases(1)

Review of cases(1)

47 children: 18 girls, 29 boys

Age range: 1 - 16 years

47 children: 18 girls, 29 boys

Age range: 1 - 16 years

Review of cases (2)ENT referral/diagnosisReview of cases (2)

ENT referral/diagnosisNon-specific rhinitis - 8 children

Allergic rhinitis/multiple allergies - 37

Other - 2 children

Non-specific rhinitis - 8 children

Allergic rhinitis/multiple allergies - 37

Other - 2 children

Review of cases (3)other medical problems/Hx

Review of cases (3)other medical problems/Hx

A hetereogeneous groupCongenital heart diseaseTonsils, adenoidsCleft lip and palateNasal intubations/feeding, surgery

Grommet insertions, ear problems

A hetereogeneous groupCongenital heart diseaseTonsils, adenoidsCleft lip and palateNasal intubations/feeding, surgery

Grommet insertions, ear problems

Review of cases (4)medical hx cont

Review of cases (4)medical hx cont

Asthma (11 children)Eczema (13 children), 5 with both“ALLERGY MARCH”Urticaria/rashesFood allergies: milk protein, fish, egg, dairy

Chest and respiratory tract infections - multiple antibiotics

Asthma (11 children)Eczema (13 children), 5 with both“ALLERGY MARCH”Urticaria/rashesFood allergies: milk protein, fish, egg, dairy

Chest and respiratory tract infections - multiple antibiotics

Review of cases (5)Review of cases (5)

Allergy tests

RAST - 2 children

Skin prick tests - 39 children(9 negative results; 30 positive for one or more allergen)

Allergy tests

RAST - 2 children

Skin prick tests - 39 children(9 negative results; 30 positive for one or more allergen)

Review of cases (6)Family history

Review of cases (6)Family history

Siblings with congenital heart disease (2)

30 children with family hx of atopy

Siblings with congenital heart disease (2)

30 children with family hx of atopy

Review of cases (7)Maternal hx/birth

Review of cases (7)Maternal hx/birth

33 children recorded details

7 Caesarean Section births5 births by Forceps delivery - SCBU with bruising to head/face in 2 babies

Individual experiences eg “stuck”, purple large baby with excess mucus, lasted several months

33 children recorded details

7 Caesarean Section births5 births by Forceps delivery - SCBU with bruising to head/face in 2 babies

Individual experiences eg “stuck”, purple large baby with excess mucus, lasted several months

Review of cases (8)Review of cases (8)

Conventional medication:- one child parents declined nasal spray

- one child spray effective but parents concerned re side-effects

- In most cases the tx (steroids,antihistamines) ineffective or limited effect

- Also bronchoinhalers and antibiotics

Conventional medication:- one child parents declined nasal spray

- one child spray effective but parents concerned re side-effects

- In most cases the tx (steroids,antihistamines) ineffective or limited effect

- Also bronchoinhalers and antibiotics

Review of cases (9)Review of cases (9)

Previous homeopathy - one patient visited homeopath in Pakistan; another previous patient GHH

Previous homeopathy - one patient visited homeopath in Pakistan; another previous patient GHH

Review of cases (10)Homeopathy/Isopathy Tx Review of cases (10)

Homeopathy/Isopathy Tx Many different remedies, first consultation and beyond

No treatment (1)Single (constitutional) remedy (17)

Single (local)remedy (1)Miasmatic nosode and constitutional (3)

Isopathy and constitutional (23)

Many different remedies, first consultation and beyond

No treatment (1)Single (constitutional) remedy (17)

Single (local)remedy (1)Miasmatic nosode and constitutional (3)

Isopathy and constitutional (23)

Review of cases (11)Follow-up

Review of cases (11)Follow-up

11 children attended one appointment only- 1 was planned

Further ENT assessment/treatment?(10/46 is DNA rate of 21.7%)

36 children attended at least one follow-up (range 1 to 14 months from first seen - patient-led!)

11 children attended one appointment only- 1 was planned

Further ENT assessment/treatment?(10/46 is DNA rate of 21.7%)

36 children attended at least one follow-up (range 1 to 14 months from first seen - patient-led!)

Review of cases (12)- Outcome

Review of cases (12)- Outcome

Reduction/cessation conventional Tx No response at follow-up - 5 children (1 did not like powders): 5/36 (14%)

Partial response - 9/39 (25%) Good response with significant improvement - 22/36 (61%)

31/36 children (86%) of those seen more than once have either partial or good response - some follow-up and Tx ongoing

Reduction/cessation conventional Tx No response at follow-up - 5 children (1 did not like powders): 5/36 (14%)

Partial response - 9/39 (25%) Good response with significant improvement - 22/36 (61%)

31/36 children (86%) of those seen more than once have either partial or good response - some follow-up and Tx ongoing

Review of cases (13)Discussion

Review of cases (13)Discussion

Rhinitis is a symptom - complexity of individual’s history and circumstances

Many of these children had heavy load of interventions and Tx

Allergies on many levels Can treating early in holistic way affect longer-term outcome?

Rhinitis is a symptom - complexity of individual’s history and circumstances

Many of these children had heavy load of interventions and Tx

Allergies on many levels Can treating early in holistic way affect longer-term outcome?

Collaborative modelCollaborative model

Child at centreFamilyGeneral PractitionerSpecialists - ENT surgeon, Homeopathic/holistic practitioner

Community/environment

Child at centreFamilyGeneral PractitionerSpecialists - ENT surgeon, Homeopathic/holistic practitioner

Community/environment

ThanksThanks

Mr HA Sadiq ENT Surgeon, Royal Hospital for Sick Children, Glasgow

Elaine Hamilton, Nadja Gunneburg, Kamal Ohri, Bridie O’Dowd, Robert Leckridge

Linda and administrative staffBetty and pharmacy staff

Mr HA Sadiq ENT Surgeon, Royal Hospital for Sick Children, Glasgow

Elaine Hamilton, Nadja Gunneburg, Kamal Ohri, Bridie O’Dowd, Robert Leckridge

Linda and administrative staffBetty and pharmacy staff