It was nearly 25 years ago. I was a registrar, part-way through my training to be a consultant paediatrician, so now there was someone junior to me on the team, the senior house officer. They phoned me after seeing a six-week-old baby girl* in A&E, whose parents had brought her in concerned about her cough. She was bright, her chest sounded clear, and she was feeding well. Because she was so young, I didn’t think we should let her go home without checking a few things first, so I asked for some blood tests to be done before I went to see her myself. The results showed an increase in the white cells in her blood, and it was a specific type of white blood cells – the lymphocytes.
I remember she was on her mum’s lap as I went to see her and talk to her parents, and her dad was standing beside them. My memory tells me the baby smiled, but I may be wrong. She certainly wasn’t particularly unwell. When I explained to her parents that I wanted her admitted to the ward, because raised lymphocytes in a coughing infant suggests the possibility of whooping cough, I remember they were quite light-hearted when they said that made sense because her nursery-age brother and her mum had both had a bit of a cough, and neither of them had had the whooping cough vaccine. Her dad, who had been vaccinated, had been fine.
And here I am 25 years later, tears falling as I type about that perfect little girl, whose death could so easily have been prevented.
I didn’t see them again. I worked in the community during the day, and only worked on-call at the hospital. My colleagues told me when results confirmed the baby had whooping cough. They told me when she started needing oxygen, and when she needed to go on a ventilator. They told me when her condition continued to deteriorate, and they told me when she died. And here I am 25 years later, tears falling as I type about that perfect little girl, whose death could so easily have been prevented. She was too young to have been immunised herself, but if her brother had had the vaccine he wouldn’t have brought the infection home from nursery.
Sometimes people tell me they couldn’t be a paediatrician because they’d be upset seeing all those sick and dying children, but that’s really not what it’s like. The majority of the time, we’re helping all these wonderfully resilient kids not to get too sick, and we’re helping them to recover when they do.
I’m worrying about the impact of poverty on child health, the impact of climate change, of air pollution, and of the commercialisation of childhood, the inequalities and culture of materialism that so jeopardise child (and adult) wellbeing
Vaccination has completely changed the experience of child health professionals. In the 1930s, my uncle died of measles at the age of 6. In nearly 30 years working in paediatrics, I’ve only seen 3 children with measles. There used to be lots of children severely disabled through their mums having had rubella in pregnancy, but not now - provided vaccination levels remain high.
I started my paediatric training in fear of epiglottitis, a condition in which it was dangerous to try and examine a child’s throat because that might cause their breathing to become obstructed. But that was in 1992 – the year the Hib (haemophilus influenzae group B) vaccine was introduced in the UK, so epiglottitis is a condition I’ve still never seen. In the late 1990s, I worked for two years in a centre that specialised in treating children with meningococcal disease, but thanks to Men B vaccine introduction in 2015, we are no longer filling paediatric intensive care units with children with that frightening purpuric rash and organ failure.
25 years on, an experienced consultant, and I’m worrying about the impact of poverty on child health, the impact of climate change, of air pollution, and of the commercialisation of childhood, the inequalities and culture of materialism that so jeopardise child (and adult) wellbeing. Would that there were a vaccine to get us out of this.
Dr Lucy Reynolds is a community paediatrician in Glasgow. In additional to clinical work, she was part of the local Child public health team during her first 10 years as a consultant.
- *. Names and other information that could identify someone have been changed.