The 'maternal grimace' sign. A clue to the importance of the contextual diagnosis
C. C. Butler
Department of General Practice, University of Wales College of Medicine, Cardiff.
Parents sometimes present illness in a child as an expression of their own
distress, and patient-centered medicine attempts to address the underlying
causes of problems by incorporating psychosocial factors in the diagnosis.
However, in the real world of busy primary care, it is not always possible
or appropriate to broaden every consultation, and the clinician may have to
rely on certain clues that suggest the importance of exploring hidden
reasons for consulting. Two cases are presented in which a mother's
dramatic grimace during the gentle examination of a comfortable child
alerted the clinician to parental anxiety disproportionate to the child's
illness. Addressing parental anxiety proved fruitful. This "maternal
grimace sign," pointing to the importance of the contextual diagnosis,
underlines the usefulness of careful observation of all those involved in
the consultation and may have implications for the way clinicians choose to
position children and parents during physical examinations.
