‘Is a medical like when I go to my doctor’s?’ he asked a little anxiously as we left the building.
‘Similar, but the clinic is in a different building to the doctor you go to. Don’t worry, I’ve taken children to have medicals before and it is fine.’
‘Will I have to have an injection?’ he asked.
‘No. The doctor just wants to check you over to make sure you are fit and well.’
I’d already explained to Max what a medical involved, but understandably he was anxious. He was quiet in the car and I reassured him again that there was nothing to worry about. Once we were in the health centre and he saw the other children, babies and toddlers waiting – a number of different clinics ran in the same building – he relaxed. Having given his name at reception, we were told to take a seat. Some of the children were playing with the toys provided at one end of the room, but Max just wanted to sit beside me. We chatted about school and the book he was reading. Shortly after our appointment time Max’s name flashed on the digital display screen together with a recorded voice telling us to go to consulting room three. He slipped his hand into mine and we crossed the waiting area and then went down a short corridor until we came to a door marked Room 3. I knocked on the door and a female voice said, ‘Come in.’
As we entered a young woman doctor rose from her chair behind her desk and greeted us with a warm smile. ‘Hello, lovely to meet you. I’m Doctor Seema Jhaveri.’
‘Cathy Glass,’ I said, returning her smile. ‘And this is Max.’
‘Hello, take a seat.’ I saw her look Max up and down and then frown.
We sat in the two chairs at right angles to her desk and she opened the file in front of her and read what looked like a letter of referral. ‘You are his foster carer?’
‘Yes.’
‘And Max is six.’
‘Yes.’
‘He’s badly overweight,’ she said, looking up – first at Max and then at me.
‘I know.’ I suddenly saw an ally. ‘He won’t be with me for long, so I’ve been told not to do anything about it.’
‘Why ever not?’ she asked, shocked.
I glanced at Max. I didn’t like talking about a child in front of them but there was no choice, so I phrased it as best I could. ‘His mother doesn’t see there is a problem and his social worker doesn’t want her upset.’
‘But that’s ridiculous. The child is obese and probably has been all his life. He should be on a diet and exercise programme. It’s cruel for him not to be.’
‘Thank you,’ I said, relieved. ‘I feel like I’ve been fighting a lone battle. I wanted to make changes to his diet but I’ve been stopped.’
She frowned again. ‘That’s not good. Does he eat a lot of sweet and fatty foods?’
‘Usually, yes.’
‘I see from here’, she said, referring to another page in the folder, ‘that he has already had four teeth extracted due to decay. And there are two more that might need to come out. That’s appalling for a young child.’ I nodded in agreement. ‘Does he have a lot of fizzy drinks, squashes and juices? You know the acidity in fruit juice is as bad for teeth as sugary drinks.’
‘Yes, I know. He was used to having fizzy drinks, but I mainly give him water with the occasional glass of juice. We only have fizzy drinks as an occasional treat.’
‘That’s all right. But a lot of the damage will already have been done, as I’m sure the dentist would have told Max’s mother. And he has asthma,’ she said, reading on.
‘It’s been diagnosed, but he’s only needed his inhaler once since he’s been with me – when he first arrived.’
‘He was probably stressed. Have you heard him wheezing?’
‘No. He gets out of breath easily, but there’s no wheezing.’
‘He would get out of breath, carrying all that extra weight around. It puts a huge strain on the cardiovascular and respiratory system. To overfeed a child to this extent is a form of abuse.’
I glanced at Max again. I felt uncomfortable that he had to hear all of this, but it was the truth, after all. ‘He’s only been with me a short while,’ I said, feeling culpable.
‘Does he exercise?’ Dr Jhaveri asked.
‘Not a lot. He joins in PE at school, but he doesn’t like walking.’
‘That’s because it’s uncomfortable for him, but walking is a good form of exercise. Incorporate it into his daily routine.’ I nodded. ‘So what has his social worker told you to do?’ She looked at me.
‘To keep everything as it has been and leave it to his mother to deal with once he’s home.’
‘Clearly his mother hasn’t been dealing with it so far,’ Dr Jhaveri said firmly. ‘What makes her think it will be different in the future?’
‘I don’t know.’
‘Is his mother badly overweight too?’
‘Yes.’
‘Any siblings?’
‘Three older sisters.’
‘All obese?’
I nodded.
‘I’m really shocked that no one has been advising the mother on her children’s health, especially when the social services are involved. I see families here. We have a clinic that offers advice and support, and a weekly weigh-in. Obesity is a massive problem in the Western world and we are storing up huge health problems for the next generation. Is his mother in good health?’
I shook my head. ‘She’s in hospital now, that’s why Max came to me.’
‘What’s the matter with her?’
‘She had two toes amputated – I understand it’s a result of type 2 diabetes.’
She let out a heartfelt sigh. ‘Yet she’s allowed her son to go the same way.’ Dr Jhaveri was clearly a conscientious paediatrician whose outspokenness was a result of her concern for Max. ‘I’ll speak to his social worker. Perhaps she’s not aware of the help available. I have her contact details on the letter of referral.’ She then turned to Max. ‘Hi, Max. How are you today?’
‘OK,’ he said quietly, obviously chastened by what he’d heard.
‘Pleased to have the afternoon off school?’ she asked, being friendly.
Max wasn’t sure what to say.
‘He likes school,’ I said. ‘He’s doing very well and he loves reading.’
‘That’s good. My children like reading too. So do I. Now, I’m going to examine you. I expect you had an examination at your doctor’s when he prescribed the inhaler.’ Max nodded. ‘We’ll start by looking in your ears. Can you hear all right?’
‘Yes,’ Max said.
She took an otoscope from the top drawer of her desk and looked first in one of Max’s ears and then the other. ‘That’s fine,’ she said. Returning the otoscope to the drawer, she took a wooden tongue depressor from a sealed packet and then asked Max to open his mouth wide so she could look in. ‘Thank you,’ she said. Throwing the used spatula into the bin, she picked up the ophthalmoscope from where it lay on her desk and looked in his eyes. ‘Do you have glasses for reading?’ she asked. Max shook