A six year old cerebral palsy spastic quadriplegic type with severe intellectual disability was admitted in ward for control of seizures Mother complained of excessive cry for few days. He used to get good sleep. He was evaluated for the usual causes. He had caries tooth, which was managed with the help of dental surgeon. No ear discharge, eardrum normal. No painful pyoderma or infected wounds . No bed sores.
He had contractures both tendo achilles and hamstrings. We checked the bed for bed bugs , possibility of mosquitos. He was constipated, and faecal mass palpated left side of abdomen, which again was addressed. We thought of possibility of too much hot environment , he was shifted to an area with good ventilation near a window under a ceiling fan. Too much sound , unfamiliar environment all were tackled. He did not have fever. System examination was normal other than the features…
