Doctor, My child is complaining of pain in the abdomen after meals and at night. Deworming is a must.Ask the child to show where exactly it paints.“Child pointing to the umbilicus has worms inside”Does the child eat mud? "Yes" Look at the sclera in bright sunlight for icterus.“Is the anorexia due to jaundice”Inspect the tongue for pallor. (anemia is both cause and effect of anorexia and must be treated first)Make the child lie down, and palpate the abdomen gently all over. Mild tenderness around the umbilicus is due to pain from small intestine, usually due to worms.If there is tenderness over the colon, it may be amoebiasis.Palpate carefully for live.Does the child get wheezing at night?(A common symptoms associated with worm infestation.)Auscultate the chest for Rhonchii, and murmur.Anemic patients have a flow murmur = Ejection systolic murmur in pulmonary area. Ask if there is itching at anus? If yes,inspect the anus. (You may see tiny worms there)Action:Deworm weekly for one month. Treat anemiaDeworm everyone at home, children, and also servants.If anemia is sever or resistant, ask for Hb, WBC, PS, Stools, KUB.
