Culture and religion
Dr Lewis works in a community with a high Muslim population. She has a good understanding of the local community in which she practices and is aware of the activities and practices associated with Ramadan.
She knows that during Ramadan, Muslims fast between dawn and dusk and that it is possible to counter any serious effects on the body by properly planning meals eaten before dawn and after dusk.
Mrs Anwar takes her 11-year-old daughter Nadirah into the accident and emergency department of her local hospital on a weekday afternoon.
Nadirah fainted in the morning while standing in school assembly. Nadirah twisted her arm as she fell and it is now swollen and painful. Nadirah sees Dr Lewis in the accident and emergency department.
Dr Lewis examines Nadirah’s arm and decides that her wrist is sprained. She bandages Nadirah’s wrist and gives her some painkillers. She advises Nadirah and her mother that she should take rest and keep her wrist elevated to reduce the swelling.
Dr Lewis asks Nadirah what might have caused her to faint in school. Nadirah tells her that she has been feeling tired and having headaches for the past few days. She also mentions that she has been fasting with the rest of her family as part of Ramadan.
Nadirah explains that she wants to be involved with the rest of the family’s activities to mark the holy period. She tells Dr Lewis that her older brothers and sisters all fast at this time of year and explains that she asked her parents to be allowed to join in.
Mrs Anwar explains to Dr Lewis that she and her husband discussed at length whether to allow Nadirah to fast, stressing that she and her family keep a close eye on her for the time that she is fasting.
What the doctor did
Dr Lewis explains to Nadirah and Mrs Anwar that fasting in young children can sometimes reduce concentration and can cause several other symptoms, including headaches, tiredness and dizziness.
She encourages Nadirah and Mrs Anwar to make sure that she is getting all the main food groups in the meals that she does eat.
She also gives them some advice to help reduce the effects on Nadirah while she is fasting, such as to drink plenty of water at mealtimes and avoiding caffeine to keep hydrated.
She recommends that Nadirah avoids strenuous activity and situations in which fainting would be particularly dangerous, such as swimming or cycling.
Having talked through the issues and the things the family can do to manage the fasting period Dr Lewis is satisfied that Nadirah’s fasting is not currently compromising her welfare.
But she emphasises that Nadirah must go to her GP if her symptoms continue and advises Mrs Anwar to let Nadirah’s school know when she is fasting.
Dr Lewis also tells Mrs Anwar that she will pass on all the relevant information about Nadirah’s consultation to her GP practice.
What the doctor had to consider
- Doctors should make sure that their own cultural or religious background does not affect their objectivity, when deciding whether to raise child protection concerns with parents or other agencies doctors must consider the issues impartially (paragraph 10)
- Doctors must listen to children and young people and talk directly to them, taking into account their age and maturity. Doctors must take the views of children and young people into account, even if they are not mature enough to make decisions for themselves. (paragraphs 15 and 16)
- Doctors should develop their understanding of the practices and beliefs of the different cultural and religious communities they serve (paragraph 9 of Protecting children and young people)