Recently I had the pleasure of meeting young Master J, and I thought I would share with everyone this success story. The main points to highlight are these:

1. Trust your own judgement as a parent;
2. Seek out the right experts in order to get the right diagnosis;
3. Effective treatment gives effective results quickly!

7 year old, Master J was brought to my clinic for an assessment because his mother was concerned that Master J started to complain of neck pain, back pain and chest pain. She could see that his right shoulder was raised, and he was walking bent to his left side. His mother initially spoke to me on the phone with her concerns, and was worried that he had injured himself while skiing the week before, although there was no acute trauma that was witnessed. I immediately advised his mother to get a spinal X-ray before seeing me to ensure that we rule out any spinal fractures. In addition, his mother reported that Master J has had a 3 week history of fevers, cough and cold, where he was coughing every night and was propped up in bed to sleep. Due to this bout of respiratory illness, he has also lost weight, is pale and very lethargic. He has seen his GP several times for his cold but was not being actively treated apart from having panadol for fevers. Master J had actually just seen his GP the same morning before our appointment to obtain his spinal X-ray films, which showed severe scoliosis. His father reported that Master J was checked by the GP and again his father was told that his chest is clear, he does not have a chest infection despite the persistent wet cough. It was only on his father’s insistent that the GP prescribed some antibiotics for Master J.

When I saw Master J, he was obviously twisted to his left side, his right shoulder was raised higher than his left shoulder, he has strong wet cough, and complained of pain in his left chest wall in the front, neck pain and mid-back pain. Master J was otherwise happy and engaging, although he looked pale and according to his father visibly skinny having lost weight recently. The first thing I did was to listen to his chest, and I determined that there were no audible breath sounds in the left lower lobe of his lung. Unfortunately, his GP did not order a chest X-ray to investigate his chest, and the spinal X-Rays did not include the full view of his lungs. However, based on his clinical symptoms, left chest wall pain, wet cough, no breath sounds, I diagnosed him with left lower lung pneumonia.

When I assessed his spine, it was obvious that he was tilted to his left, as well as had tight muscles in his neck, right shoulder and along his whole spine. It was interesting to me that he should suddenly have developed a severe scoliosis recently without his parents noticing it before. As such, I questioned the cause of his scoliosis as being structural, instead I suspected it was more muscular in nature. Master J happened to have a twin brother, whom I could conveniently compare his spine to. I noticed that even his twin brother has a very slight curvature in his back when bending forward. So the diagnosis I made is that of a muscular scoliosis with an underlying slight structural spinal curvature. Given the history of prolonged coughing and sleeping propped upright, Master J most likely strained his muscles to the point that the muscle spasms pulled his spine into a severe scoliosis.

So the physiotherapy treatment including a home exercise program, involved chest physiotherapy to manage the suspected left lower lung pneumonia and manual therapy techniques to relief the muscle spasms. I also advised the parents on a referral to the Scoliosis Clinic at the Children’s Hospital for both boys to ensure that their spines are being monitored as the boys developed. I did not request for a further chest X-ray to confirm his pneumonia, as there had already been resistance from his GP to do so, and I felt that it was not necessary to subject him to more radiation from X-rays when he is receiving the appropriate treatment including antibiotics.

I reviewed Master J 6 days later and his parents were pleasantly surprised at his improvement. He was standing upright, and his scoliosis has disappeared! Master J was now producing more secretions when doing his chest physiotherapy exercises, which is expected as the pneumonia resolves. He no longer has chest pains and the muscle spasms resolved with treatment. He was sleeping better, so Master J was back to his own bright and bubbly self instead of being pale and lethargic. His parents will continue to carry out his chest physiotherapy exercises at home, as chest infections will take time to completely resolve, secretions to clear and lungs to fully re-inflate back to normal. His parents reported that they did end up going to 3 more different GPs before they finally convinced one to give Master J a chest X-ray, which did end up confirming the diagnosis of left lower lung pneumonia.

I am very pleased that Master J made a brilliant and quick recovery within a week, and it emphasizes the importance of making the right diagnosis. It is often difficult for GPs to make that determination of how well your child is, because children can often be “ not well, but not sick enough” and understandably medical staff do not want to expose children to unnecessary radiation with investigations or over-prescribe antibiotics unnecessarily causing decreased immunity and superbugs. As parents this can become a tricky situation, where you feel strongly that your child is requiring more intervention as they are obviously not right to you, while wondering if you are perhaps imagining things and becoming paranoid. There is no easy recipe, but the key is to be able have open and clear communications with your medical professionals. However, if you continue to feel that you cannot seem to get satisfactory results, sometimes you just need a different health professional to give a different perspective on your child.

If the story of Master J sounds familiar to you, and you are getting tired of your child being sick from constant coughs and colds, it may be that chest physiotherapy is the key to helping your child get better soon! Make an appointment with our clinic today and find out how our Paediatric Physiotherapist can help your child!