Children are greatly influenced by their environment and by those around them. Many childhood problems are caused by problems at home (poverty, malnutrition, abuse, neglect, poor housing, unemployment) or at school (discipline, fear, bullying). The presenting complaint may be a warning of deeper social problems. Poverty and poor maternal education are the cause of many childhood problems. Some mothers bring their child to a clinic because they have a problem themselves. This may not always be obvious. Therefore, a social history must always be taken. Suspect abuse if the history does not explain any sign of injury.

Useful questions to ask are:

1. Who looks after the child?
2. Who are the other family members and are they healthy? Is there anyone with TB?
3. Who looks after the child during the day?
4. What is the family income?
5. What is the mother’s (or caregiver’s) level of education?
6. Are there problems in the home which may affect the child’s wellbeing (e.g. alcohol, violence, abuse)?
7. What type of housing exists? Is there water, sanitation, electricity?
8. Is the child receiving child support or a care dependency grant?
9. Are there problems at school or crèche?