Case study – Joshua (three years old)

Joshua is in the paediatrics ward with pneumonia – his third visit to the hospital this winter. He has been admitted in the past for bronchiolitis and his mother Tania reports his wheezing and coughing to their General Practitioner.

tania-joshJoshua is a three year old male who presented with pneumonia, and has been admitted twice previously this winter with the same symptoms. Joshua has a history of pneumonia and bronchiolitis with several hospital stays each winter. His mother reports that he frequently wheezes and coughs, and follow-up between the paediatrician and Joshua’s general practitioner confirms this. 

Six months ago Joshua had several baby teeth removed under general anaesthetic, as he had developed extensive tooth decay. When the dentist inquired as to Joshua’s diet, particularly his drinking preferences, his mother stated that he was fussy and preferred juice to milk or water. He would have juice in his sipper bottle most days.  

Joshua’s mother has mentioned their housing conditions have changed since she separated from her children’s father, and she is now living with her parents, sister and brother in-law and their children. She is concerned about their housing conditions and its impact on Joshua’s health, particularly the “cold and damp feeling” and the mould growing on the walls, curtains and in cupboards.

Joshua​'s story
'Josh looks so small and pale there in the hospital bed. Its our third visit to the hospital this winter – this time the doctors say its pneumonia again. Josh is only three, but he has been in hospital three or four times every winter since he was born – for pneumonia and bronchiolitis, and once to get some of his teeth removed. 

He was a fussy baby and always grizzly, but loves his juice. He really seemed to settle down when he had juice in his bottle, so we gave it to him. I didn’t know that it would put so many holes in his teeth. The dentist at the hospital showed me the teeth he had taken out of Josh’s mouth, and explained that the holes were caused by the juice in his bottle, and not brushing his teeth properly. I’m at my cleaning job when he goes to bed. I tell my oldest to watch him brush his teeth.
 
Josh has a weak chest, gets wheezy and coughs a lot, so I take him to the after-hours clinic. I see the mould growing inside where we stay and I know the house is contributing to his bad health. The mould gets everywhere – even on the curtains and the ceiling. I clean it all off, open windows to let the air in, but it comes back almost as quickly. It doesn’t grow so badly in the living room, so I have all my kids sleep in there. 

When the doctor at the hospital referred us to the GP to get his vaccinations, I made sure ​Josh got them all. When we were in the waiting room, I saw a poster at the clinic about rheumatic fever. I remembered the ads on TV with the two little boys – how it all started with a sore throat. I tell my children to tell me as soon as they think they have a sore throat, and I know to take them to the doctor.' 

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