What To Ask When Your Child Is Sick
January 7, 2009
This case reminds me that healthy kids can get really sick. I hope it will help you to spot a real illness, if it ever hits your own child.
A 4-year-old boy came in with a cough. He’d been feeling ill for about a week, with low fevers on and off. (A temperature over 100.4 oF is a fever, and under 102 oF is a low fever.) He didn’t look too sick, and his lungs sounded fine to me. But something about the story made me suspicious, so I ordered a chest x-ray. He had pneumonia. I put him on a standard dose of antibiotics and sent him home. A couple of days later, he was feeling better.
A week later, though, he was back, and so was the cough. This time he didn’t have a fever, but his chest was sore. I wasn’t around for this visit, so another doctor saw him and got a second x-ray. It showed a worsening pneumonia, with fluid in the space between the lung and the chest wall. The boy went home on two different antibiotics.
This was on Thursday. On Saturday morning I was in the clinic when a phone call came through: Could I see this boy? He had a fever, and his mom was concerned. On Saturdays our clinic closes as noon. I asked her to come right in and told her that I’d wait.
At 12:30, I was still waiting, so I called the mom and told her I wanted the boy to come into the hospital. With a worsening pneumonia, I thought he needed IV antibiotics. I hung up and made arrangements with the ward.
When I called the mom back, the boy was still in bed. He was too tired to walk across the room. After standing for a few moments, he had to lie back down, and he was making little “uh-uh” noises. We doctors call that “grunting.” It usually means that a child is seriously ill, too sick to ride across town in the back seat of a car.
I told the mom to call an ambulance. The child went from our emergency room to our ward to our intensive care unit. Eventually, he had to have an operation to remove the pus from around his lung. The last I heard, he was recovering well.
Not all pneumonia needs to be treated in the hospital. Most of the time antibiotics by mouth do the trick. This case could have been one of the usual ones. The clue that it was different was that the boy got worse after the second set of antibiotics, instead of better. The illness wasn’t following the rules.
Fever itself isn’t a sure sign of real illness. Lots of kids with colds have a fever. But a new symptom in a child who is being treated for a possibly serious infection rings the alarm bell. Grunting sets off the flashing lights.
So here is a tip to take with you. If the doctor treats your child for a minor illness and sends you home, don’t leave the office until you know the answers to these questions: What exactly are the signs to look out for to tell you that things are not going as expected? By what date should you be concerned if your child isn’t completely better? If it’s late at night or Saturday morning and you have questions, who should you call?
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