"...or refusing to eat,..."
-I will one day-for sure-write an article highlighting the least useful
peaces of information on history and exam of an acutely ill child...
on top/near top of the list will be:
"my child has decreased appetite"...
having said the above, I totally agree with Lisa that asking the REAL
reason for the visit often helps cut to the chase...
BTW: Merry Christmas and Happy Holiday's to everyone...
Quoting "Lisa Amir, MD, MPH" <[log in to unmask]>:
> I may be a little late getting into the discussion but...
> One question I have frequently found helpful at clarifying the reason
> for a ED visit after several days of illness or after previous ED
> visits is to ask the parents, "What has changed or worsened to make
> you come (back) today? What worried you more today than, say,
> yesterday"? This question forces the parent to sharpen their concerns
> and often will result in a succint statement of what is truly
> worrying them. If it's frustation or exhaustion of dealing with a
> child who is on their 7th of rotavirus and is still having symptoms,
> explanation and reassurance may be all that is necessary. Many
> times, after getting a long winded history in a child who doesn't
> look particularly ill and doesn't seem to have much more than a
> prolonged viral illness (and I've lost the thread of story already a
> long time ago), the parents suddenly will throw in something like
> he's been apathetic since the morning, or refusing to eat, or a funny
> rash appeared etc., which immediately focuses me on the !
> true problem. If the parents' think the kid is just acting funny and
> I don't see it, we'll observe together. If after 2-3 hours the
> parents' seem to be reassured that the kid is fine, discharge. If
> not, I have a very low threshold for LP. When parents' think the kid
> is not OK, the burden is on us to prove them wrong. In my
> experience, 90% of the time they're right!
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