5 Assessing Changes, Recognizing and Correcting Problems of Overdose Traditional texts instruct us to pay attention to information gathered through the primary senses in order to assess a patient and decide what treatment to apply. The “four diagnoses” are the primary modes of information gathering, and among these some of the information is very malleable and sensitive, showing changes very easily and quickly. The color and complexion of the patient can be seen to change quite quickly so it is reassessable while you are applying treatment. A lusterless complexion can be seen to become more lustrous while applying treatment. Sometimes this is very clear, and the parent as well as you will notice it. But at other times the complexion changes are quite subtle, and the lighting source can make it difficult to observe them. A more useful and reliable indicator of change is the palpable texture of the skin. With proper training, one can observe this in adults, and it can be very useful. However, on babies and children it is an essential and indispensable observation, since the surface of the child’s body changes much more easily and quickly than that of an adult, and the changes are literally quite palpable and obvious with only a little training. Besides, we direct much of the treatment on babies and children to the skin, the surface of the body. To palpate the surface of the body on babies and children we need to be confident and calm. Use the palm of the hand and the whole palmar surface of the fingers. Touch very lightly so that your hand does not cause a depression in the skin. Apply simple touching and light stroking methods. The The signs of improvement in the skin condition are that the skin texture shows the following typical changes: it becomes springier, a feeling of soft fullness develops, and it may become slightly warmer. If the skin had been dry, it might feel slightly less dry. A sign of over-treatment is the skin starting to feel moist. One must pay attention to the earliest signs of increased moisture and not wait until the skin pores are quite open and the skin becomes obviously damp, or the area starts sweating. Sometimes a patient returns to us following a treatment or a parent calls to report that there are difficulties. For example, symptoms are worse, new symptoms have occurred, the child has been behaving badly or has been much more tired than usual. Our job is to figure out what happened, and to correct it if possible. One has to distinguish signs of over-treatment from: As one can imagine, this is sometimes complicated and difficult. To understand when reactions are likely to be due to over-treatment, it is necessary to briefly discuss when reactions are due to these other factors. The most common sign of over-treatment in children is that the patient is more tired. This tiredness can last for the rest of the day, in which case it is not so bad and may just be a normal healthy reaction to treatment. If it persists into the next day and especially beyond, you can suspect that you over-treated the patient. On a couple of occasions I have seen young babies become “floppy” for a while following treatment, where they were so relaxed the muscles were acutely and temporarily hypotonic. This did not last long, and while it may be distressing to the parent at the time, is not a bad sign, merely indicating that you should do less treatment next time. The more common reaction is seen while the child is still with you in the treatment room. He or she becomes quieter, less active, even falls asleep. As you observe this process starting, you know to do less and less for the rest of treatment, and possibly less on the next visit. As mentioned, unless this state of lessened activity persists for extended periods, it is not a problem; more an indication about the probable need for more careful dose regulation. On a few occasions, treatment has led to the child falling asleep and having to be carried out of the treatment room, which can be inconvenient for the parent. Sometimes over-treatment can lead to increased activity. Usually this is not a problem, but on occasion it has been. On two occasions, despite trying to be careful, first-time treatment of young (5–6-year-old) hyperactive children has triggered acute bouts of increased hyperactivity, which were not only stressful in the treatment room, but created a period of prolonged hyperactivity that was very difficult for the parents to handle. This is not common but it can happen. Thus, I recommend on a first visit with hyperactive children being even more careful than usual about stimulation levels and dose. Sometimes a parent will report on a next visit that they had difficulty getting the child to sleep during the week since the last treatment. This is most likely due to over-treatment and you need to look carefully at what you did and make appropriate modifications in the light of that. Typical culprits for this kind of reaction are the objects that you leave as mild continuous stimulation of points for a while, such as press-spheres (see Chapter 12) and especially the intra-dermal needles. Not using these things on the next treatment, or leaving them for much less time is usually enough to stop the reaction. Sometimes this type of reaction to treatment can take a couple of sessions to figure out how to adjust your approach sufficiently. These can be very complicated clinical cases to handle. There are atypical reactions to over-treatment, as may be seen in the example. They usually depend on the condition of the child as to how they manifest. Example On Dianne, a 4-year-old girl with Rett syndrome with main symptoms of autism, mental development problems, structural and postural problems, and instability (see Chapter 24 for her case study), the reaction to over-treatment was quite severe. Progress had been good and she was handling treatments well. However, she missed an appointment due to a bad cold and when she came the next week I misjudged her condition (which was weaker than usual due to the cold). Her reaction to over-treatment was a fear reaction that made her unable to take a step. After lifting her off the treatment table she would not move. It was necessary to lift her to dress her and carry her to the car. This persisted for several days, which was very distressing to her mother. After acknowledging what had happened and explaining why, her mother was happy to continue. With appropriate treatment modification, the effects were better and this never happened again. Dianne’s strong and prolonged reaction was specific to her disturbed neurological condition.
Palpating the Skin of Babies and Children
DVD shows the methods of touching and examining changes in skin condition. In general, the skin texture changes in the area one is working on, so that one should continuously monitor this. As it shows signs of change, move on to the next area. Touching is applied quickly to match the application of the tapping or rubbing techniques (which are also applied quickly—see Chapter 7).
Reactions to Over-treatment
improper treatment
healing reaction to treatment
the natural course of a disease
reactions that have little to do with your treatment but are due to lifestyle issues of the patient
