1st visit: April 4, 2013
A 19-month-old girl has problems with restless sleep after midnight (3). She starts crying and shrieking from sleep and this happens every night. Everything started without any apparent etiology when she was six months old. She suffers from atopic dermatitis in winter and it has her scratching herself at night (2). She has seborrhea on her scalp which she used to have in the past and now it has returned. She had late dentition. Her first tooth started growing as late, at the age of one year. She was nursed until she was one year old. She had no problems with milk. During the night episodes, it is impossible to calm her down and when the mother takes her in her arms she trembles. These episodes with trembling occur once a week. Sometimes she moans in her sleep and the other times she screams hysterically. She sleeps in a knee-elbow position (2). In the first year and a half, she used to be very irritable and she cried was angry. Now she has calmed down a bit, but she is still angry. When she does not like something she starts screaming, slapping herself and turns her head quickly from side to side (2), and has to fling something on the ground to calm herself down (3).
Investigation of the key information and analysis of the case:
The main complaint is the sleep problem which manifests as restlessness and night terrors. The child is angry and the anger gets better when she smashes something. The child is also self-destructive during the anger in the sense that she slaps herself or she bangs her head against the ground. The main remedy which has the self-destructiveness, restlessness and also the destructiveness as keynotes is Tarentula Hispanica.
So I am asking the mother about keynotes of this remedy (the extent and degree of restlessness during the day, the aggression during the anger and biting herself during the anger), but the only things I can find out is that the child is restless mainly during sleep, she is not hyperactive during daytime, she hits her head against the ground and she has a tendency to break something. At the moment the mother said that, I started considering Tuberculinum, for which this is a keynote, as well as the destructiveness during anger, specifically the need to break something during anger, which is the only thing that brings a Tuberculinum patient relief. However, just in case, I asked whether the child has a need to eat (or likes) indigestible things like soil, sand, etc., which is a very important keynote of Tarentula, but the mother does not affirm that. I cannot therefore confirm Tarentula and I am turning my attention back to Tuberculinum, because I connect a combination of two symptoms in my mind – the typical course of the anger and the sleep in the knee-elbow position, which is a keynote of this remedy as well as of several others like Carcinosinum, Calcarea phosphorica, Medorrhinum and Kali carbonicum.
I am asking about an occurrence of tuberculosis (hereinafter TBC) in the family medical history and about reactions to TBC vaccines. The mother does not confirm the family anamnesis. The child has not even been vaccinated for TBC. Another remedy that belongs to the group of remedies, sleeping in the knee-elbow position is Calcarea phosphorica that also has late dentition as a keynote. But Calcarea phosphorica does not correspond with the anger and its destructive element. I decided to start asking about key food modalities of Tuberculinum, because the child in her age already eats regular food and we often find important symptoms in food modalities of children. The mother does not confirm a desire for milk and on the contrary, she says that the child refuses bottled milk (dried milk for children). I am asking about an attitude to bananas, which is, apart from fatty meat and smoked food, the most significant food modality of this remedy (particularly a desire for bananas) and I am getting an answer: “Bananas are the only kind of fruit my daughter eats.” “This is a very strong confirmation of Tuberculinum”, I told myself. But I am going on with the investigation in order to be sure that there is no other information in the case that I am not aware of or which could further confirm or on the contrary, contraindicate Tuberculinum. The only extra piece of information I can get is fear of dogs. However, the mother finds it very mild. At this moment, another remedy to consider is Stramonium, which has night terrors as a keynote, as well as fear of dogs. But this fear isn’t so strong in this case and other keynotes of Stramonium are missing (aggressiveness towards others during temper tantrums, intensity of anger and fear of the dark). I was not able to find any more symptoms in the child.
Depth of the disturbance:
Complaints manifest themselves mainly on the emotional level (the anger and night terrors). A general rule in homeopathy is the more the complaints appear on the mental and emotional level, the worse the prognosis. What, on the other hand, makes the prognosis better is the fact that the organism is still able to manifest the disturbance at the level of skin, although in this case, only during winter time and not throughout the whole year. The child gets conjunctivitis once every three months, however, without high fevers. From the medical point of view, the complaints are not very serious.
Prognosis and level of health:
With regard to the age of the child, we cannot say that it automatically belongs to a lower level of health due to the absence of fevers. Although at higher levels of health (group A and B) the organism has sufficient vitality to produce high fevers during acute diseases if needed, though the fever does not have to be present during every acute disease. Because of this and with respect to the age of the child, we cannot consider the absence of fevers to be an expression of a low level of health with certainty. Night terrors and anger are indeed emotional symptoms and that by itself makes the prognosis rather worse, but the fact that the child suffers from skin complaints and the organism is therefore able to manifest a part of the disturbance on the skin makes the prognosis significantly better. Due to the young age of the child, we cannot determine the level of health with certainty, but the supposed level is either B4, B5 or C7 and that is because of the frequency and character of the acute diseases. Conjunctivitis is a relatively superficial inflammatory disorder and it does not occur very often in this child. The course of the inflammation is not serious and it usually disappears in a few days with the help of commonly available non prescription eye drops. However, there is also the less favorable possibility of level C7 as well where we can see mild acute diseases without fevers. In these kinds of cases where the level of health is not clear enough at the moment of taking of the case, we often derive the answer from the remedy reaction.
- Restless sleep after midnight
- Itching at night
- Late dentition in the child’s medical history
- Sleep in knee-elbow position
- Throwing things during anger
- Destructiveness and damaging things during anger
- Desire for bananas
- Knocking head against the ground during anger
- Rolling head during anger
Repertorisation in RADAR software with Synthesis 9.1 repertory
The repertorisation is done using a technique of summary of symptoms with regard to the intensity of symptoms (For Radar users: Sum of symptoms and degrees – intensity is considered)
|1||1234||3||SLEEP – RESTLESS – night – midnight – after||34|
|2||1234||2||SKIN – ITCHING – night||79|
|3||1234||3||TEETH – DENTITION – slow||21|
|4||1234||2||SLEEP – POSITION – genupectoral||13|
|5||1234||2||MIND – ANGER – throwing things around||11|
|6||1234||2||MIND – DESTRUCTIVENESS||47|
|7||1234||2||DREAMS – NIGHTMARES||156|
|8||1234||3||GENERALS – FOOD and DRINKS – bananas – desire||5|
|9||1234||2||MIND – STRIKING – himself – knocking his head against wall and things||15|
|10||1234||2||HEAD – MOTIONS of head – rolling head||47|
Tuberculinum comes out in the first place in the repertorisation as far as the totality of symptoms is concerned. Apart from that, we find out that the main symptoms of the case as the restlessness, destructiveness during the anger with smashing things and subsequent relief, the knocking of head against the ground, strong desire for bananas and the sleep in the knee-elbow position are also keynotes of this remedy.
Silicea covers the totality and unlike Tuberculinum, we can find in it the rubric for restlessness after midnight in the 3rd degree. Silicea also has slow dentition as a keynote. However, we cannot confirm Silicea on the basis of the psychological picture, where the anger and the destructiveness are dominant in the child which is exactly the opposite to the mental picture of Silicea.
Sulphur is a remedy which comes out generally high in the repertorisation because of the big number of symptoms its picture covers. The “bigger” the remedy (polychrest), the more we have to confirm it with keynotes. In this case no symptoms of the child are keynotes of Sulphur.
Tarentula hispanica is one of the most hyperactive remedies of the whole materia medica and children who need this remedy have excess of energy, especially on the physical level. In these children, the symptoms are often caused by excessive irritability of the nervous system and the first symptoms to appear are often tics and twitching. If the child is not treated correctly, emotional symptoms as anger which first appears in a form of injuring herself (especially biting), manifest later on. This child is not restless in general, only during sleep. There is a much stronger tendency to smash something than to hurt herself during the anger. These facts somewhat lessen the probability of this remedy, however, we have to admit that it might be a similimum, especially when we consider that sleeplessness particularly connected with restlessness is highly typical for Tarentula.
Phosphorus can be very angry and we can find it in the rubric for the hitting of the head against the ground as well. However, it is not a keynote of Phosphorus. The strong desire for bananas does not correspond to this remedy either. It is typical for the anger of Phosphorus that it comes quickly and also goes away quickly on its own. In this child, though, the anger eases off after she smashes something, which is typical for Tuberculinum.
Belladonna covers the fear of dogs as a keynote. However, the destructiveness of Belladonna manifests mainly during fever, particularly as biting, like in Stramonium.
Stramonium is another remedy to consider, especially because of the nightmares. It is typical for Stramonium that the anger comes suddenly, without warning and often without any triggering factor. A child is often “out of his mind” and is not fully aware of what he is doing. “As if some dark power took possession of him”, that is the description in our materia medicas. We cannot either confirm this nor the fear of the dark that we find in the big majority of children needing this remedy. Yet, we cannot exclude this remedy just because of the absence of the fear of the dark because the child does not have to have all the symptoms of Stramonium. If we find keynotes of this remedy in other areas, then it is not a problem. The main trouble with Stramonium is that except for the nightmares we do not find any confirmation in the character of the anger with the relief from breaking something and, of course, the absence of the fear of the dark. There is nothing more which would confirm Stramonium. The answer of the mother to the direct question about the fear of dogs was that her daughter is a bit afraid of dogs but it is not pronounced. Although fear of dogs belongs to keynotes of Stramonium, it is not accentuated in this child and therefore we cannot take it into account.
Choice of the remedy, potency and dosage:
As Tuberculinum is the only remedy that we can confirm on the basis of the totality of symptoms and also by keynotes, I decided to recommend this remedy. Because we cannot determine the level of health precisely, I counted on the worse option (that the girl is at the level C7) and I recommended the highest possible potency for this level, namely 200C.
Prescription: Tuberculinum 200C single split dose
Follow-up 1: July 16, 2014
The mother comes for a follow-up after more than one year and says that her daughter had been doing very well all the time. She had slept without any problems and the anger had ceased. In winter, when the mother got pregnant, some behavioral problems appeared in the daughter. She started being very negative, she had hysterical fits and nothing helped her. Her sleep started getting gradually worse, but after 3 months she calmed down in general on her own. Until June, she was all right and she slept the whole night, but since June she has had problems with her sleep again.
It is not possible to get her to sleep for one and a half hours. When she is lying, she is very restless physically, she has to move her arms and legs and it takes her very long time to calm down. Then she sleeps calmly to 1-2 a.m. She wakes up afterwards, goes to the toilet and because she is as awake as during daytime, it is not possible to make her sleep for another 2 hours. The second option is that she starts raging in sleep (3), it wakes her up and she starts crying and pushing everyone away (3). Her father must not approach her at all, only the mother can. In this state she is hysterical, she is screaming and it is impossible to calm her down, for instance for half an hour. This has happened about once a week since June. The sleep troubles lasting for one and a half months are her biggest problem. She has an aversion to change and she always wants to do things in the same manner. For example, half a year ago, she was at the zoo for the first time and her parents bought her a bubble kit there. Yesterday, when she was at the zoo again and she came with her parents to the place where she got the toy the last time, she wanted them to buy it for her again. Or when she bumps into something and hits herself or when she is forced to do something she does not want, she screams a lot (3). But it is not crying, it is rather shrieking. She tolerated dentition very badly and according to her parents it was a terrible period. She is very sensitive to pain (2). She has vomited from anger several times. Since June she has had an aversion to be covered. She is very cautious about herself and she does not want to be touched (3) in general. It is prominent during the nightmares when she does not want anybody to touch her. She is afraid of noises (3). She plugs her ears, which means she is not only afraid of them, but she is also very sensitive to them. She is extremely afraid of doctors. When she knows they are about to touch her, she starts crying and shrieking.
Analysis of the first follow-up and investigation of information
First, it is important to find out whether Tuberculinum was a correctly selected remedy. Unfortunately, we do not have any details concerning the initial aggravation and we do not even know if there was any at all. We only know that the child was free of complaints for about three quarters of the year. Given that the keynotes of Tuberculinum disappeared, the child was stable for several months after one dose of the homeopathic remedy and all the original complaints improved significantly, the remedy seems to have acted correctly. After the mother got pregnant in the winter, the child started getting worse, then she improved spontaneously and her state got worse again one and a half months ago, not only concerning the sleep, but also regarding her psyche. Therefore, what is going on now is most probably a relapse. It seems from the follow-up that even though the child has got worse, the symptoms of Tuberculinum have not come back, i.e., it is probable that the child has relapsed into a picture of another remedy. We tend to see this kind of situation in people at lower levels of health.
The first remedy that came to my mind was Kali carbonicum because the mother says that her daughter wakes up between 1-2 a.m. and then she cannot fall asleep (although more typical waking time for Kali carbonicum is at 2-3 a.m.). This piece of information together with the fact that the girl has to do things in the same manner every time is a strong combination of keynotes leading us to this remedy. If we consider that the aversion to be touched is another strong symptom of Kali carbonicum, this remedy seems to be a good choice. Unfortunately, another description of the girl’s state reveals that the girl not only has the aversion to be touched, but she is also worse from touch that can be seen not only during the nightmares but it is also connected to the strong fear of doctors and the sensitivity to pain. We cannot find Kali carbonicum in the rubric “fear of doctors” at all but it is the strongest fear this child suffers from. At this point I started doubting Kali carbonicum and my mind turned focus towards a remedy for which the fear of being touched, aggravation from touch, fear of doctors and the nightmares are typical. The remedy is called Arnica. We can also find a confirmation for the strong restlessness in bed during falling asleep in its picture and we cannot find this symptom in Kali carbonicum. For Arnica it is a keynote. The difference between the sensitivity to touch in Kali carbonicum and Arnica is the following: Kali carbonicum gets easily startled from touch and is ticklish so the person gets bothered by touch at the moment when somebody touches him, whereas the Arnica patient has, in addition, a fear of being touched that manifests in our case as intolerance of being approached by anyone (except the mother) and the patient screams even before somebody really touches her. This was confirmed by the mother spontaneously when she was describing how the child is afraid of doctors – she is already screaming before they touch her. A mere look at an incoming doctor makes her scream instantaneously. I also knew that the child tends to have the eczema and that Arnica has symmetrical eruptions as a keynote, so I asked the mother: “Does your daughter still have the eczema?” She answered spontaneously: “Yes, she has the eczema and what is strange is that she always has it precisely mirrored.” That was the ultimate confirmation of Arnica for me. It should be noted that we can find Stramonium in the rubric “fear of doctors” as well and this remedy is also important for nightmares. Stramonium is, however, contraindicated because these patients actually seek contact and touch and snuggle up to anybody who is around when they are afraid (especially during the nightmares).
Prescription: Arnica 200C single split dose
Follow-up 2: August 20, 2014, e-mail:
“I am contacting you one month after the administration of the homeopathic remedy to my daughter as promised. Her state is 100% better in every aspect. She does not have the temper tantrums, she is obedient, does not get “stuck”, she cooperates during everyday activities, e.g. getting dressed, bathing, falling asleep, etc. She even wants to be caressed and she is cuddly. She sleeps calmly at night without any bouts or nightmares. In short, everything is superb. So I want to thank you very much for your help and I hope that her state does not get worse again.”
Analysis of the second follow-up:
There was direct amelioration on all levels without initial aggravation after the remedy and the girl is now completely free of complaints. The reaction therefore appears to be the best possible and it is necessary to wait without interfering by repeating the remedy or giving another one.