More power to you for suggesting the less aggressive approach!! In fact, I
am sure you don't tap all infants who are of that age that present with a
history of "febrile seizure." You rely on your clinical exam. Why not in
this case?? Especially if they are doing all the things you mentioned, in
the auditioning. I would add "blowing salivary bubbles" to that list!
Jay Pershad, MD
LeBonheur Children's Medical Center
Given that a bulging fontanel is a well described physical finding in
viral conditions such as roseola (see below),
has anyone heard of managing entirely well-appearing febrile kids
without LP in this scenario? I have to believe
that some docs in their third decade of practice have gotten tired of
doing this procedure on kids who are
104 rectal, have a bulging fontanel with normal venous pulsations, and
appear to be auditioning for a Gerber
commercial during your exam (ie - smiling, cooing, laughing, flirting).
I think the LP I did tonight on such a 9 month
old brings my total number with this scenario to about seven.
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