The eight-year-old running a temperature and complaining of a headache turned out to be suffering from encephalitis. “It was her alert mother’s observation that saved her life. The mother realised that her daughter was irritable and confused when she returned from school and rushed her child to the clinic,” recalls senior consultant paediatrician Dr Pradeep Kidangoor, from Thiruvananthapuram.
Paediatricians often rely on parents and caregivers for a clear picture of symptoms of illnesses. Sometimes, they have to play Sherlock Holmes and ask the right questions to get details from the parents.
Dr GR Nandakumar, a veteran paediatrician based out of Thiruvananthapuram, says: “It is not enough to say ‘my child is unwell’. Explain and describe what is wrong and why she has been brought to the doctor.” In fact, Dr Kidangoor says that it is better to write down all that you want to ask the doctor and your observations about why you feel your child is unwell.
So, for a smooth consultation, what would a paediatrician like parents to ask them and share with them?
little asian boy sick
In case of fevers
“Infants and children with fever account for about 50% of consultation in a paediatric outpatient clinic,” says Dr Dinesh Kaul, Consultant Paediatrician, Infectious Diseases and Immunology, Sir Ganga Ram Hospital, Delhi.
“In a nutshell, the duration of fever, intensity, periodicity of fever, rash, headache, vomiting, dysuria (discomfort during urination), sensorial changes, history of seizures, ear discharge and history of recurrent fever or hospitalisation should be shared with the doctor,” he says.
He elaborates: “We need to know if the fever is associated with any rash or mucosal eruptions. Infants with fever and ear discharge or increased irritability or colic or vomiting need to be seen on priority basis, and may warrant intravenous antibiotics for serious brain infection i.e. meningitis or encephalitis.
Children with fever and acute pain in the abdomen need to be evaluated for any evidence of acute appendicitis, peritonitis (inflammation in the abdomen) or pancreatitis (inflammation of the pancreas). Children with longer duration of fever of one to two weeks are screened for urinary tract infections, tuberculosis and typhoid fever. So mention every symptom.
Children who have unpasteurised milk and milk products are susceptible to a bacterial infection called brucellosis, which goes undetected for a few weeks before proper history is taken and appropriate tests are ordered for. Talk about this, too.
Were there any symptoms like a cough, cold, running nose and history of wheezing? The doctor may suggest an antiviral agent initiated within 48 hours of symptoms. So do visit the doctor within the time period.
Seemingly minor details are also important. Children going to summer camps being bitten by scrub typhus mites or lice infestation or travel to mid-western areas of the US are important to be taken in the history. These children get fever and rash after a week or two after initial travel to endemic areas.
Breathe easy
Respiratory illnesses and problems related to it are common among young children and babies. What does one need to observe to tell the doctor? Dr Ganesh Mohan, RMO of Government Medical College, Ernakulam, explains:
Tell him succinctly what is wrong. When did it start? Were you travelling or has there been a change in the surroundings of the child? Was the house being painted? Is there some kind of road work in the vicinity? Is there a fever? What kind of a fever: intermittent or with spikes in temperature? Is there someone in the house with TB? It is curable and treatment should be started immediately. Changes in diet and what the child has been eating. For instance, sometimes children develop pneumonia when a peanut goes into the windpipe and gets trapped in the lungs.
What about headaches?
A headache can manifest in a child for several reasons. Dr Kidangoor explains what a parent should jot down while consulting a paediatrician.
What kind of a headache? Other symptoms that might occur with the headache, the time it occurs and its severity. Is there a trigger like exposure to sunlight or too much screen time? Location of the pain is also important: one side, the entire head, like a band around the forehead or below the eye. If there is a cold, the frequency of the cold must be conveyed to the doctor.
Any signs of vomiting, pain in the ear or difficulties in vision are important pointers for the doctor. Has your child fallen somewhere or has she hit her head against something? Are there any signs of emotional distress, irritability or confusion, fits or fainting spells?
The bottom line, say the doctors in one voice, is to trust the doctor and let him get on with the job of treating your child.
