Most medical encounters with children involve an individual child presenting to a doctor with a symptom, such as diarrhoea. After taking a history, examining the child and performing any necessary investigations, the doctor arrives at a diagnosis or differential diagnosis and makes a management plan. This disease-oriented approach, which is the focus of most of this book, plays an important part in ensuring the immediate and long-term well-being of the child. Of course, the doctor also needs to understand the nature of the child’s illness within the wider context of their world, which is the primary focus of this chapter. The context of any symptom will affect the:

Important goals for a society are that its children and young people are healthy, safe, enjoy, achieve and make a positive contribution and achieve economic well-being (Every Child Matters, 2003 at: http://www.dcsf.gov.uk/everychildmatters). These are included in the UN Rights of the Child (see below). The way in which the environment impacts on a child achieving good health is exemplified by the contrast between the major child health problems in developed and developing countries. In developed countries these are a range of complex, often previously fatal, chronic disorders and behavioural, emotional or developmental problems. By contrast, in developing countries the predominant problems are infection and malnutrition (Box 1.1).