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"...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...

joe
McGill University


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!
>
> For more information, send mail to [log in to unmask] with 
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html