THE SICK KID PEARLS & PITFALLS
DR.FATOUMAH ALABDULRAZZAQ
M.D,FRCPC,FAAP,PEM(C)
OBJECTIVES
• To know the barriers and pitfalls in managing children while in ED
• To know the strartegies for managing those barriers and pitfalls to have a better
outcome from the children’s visit to ED
INTRODUCTION
• 20-40% of patients presenting to the ED are children
• Children typically have a lower severity of illness than their adult counterparts during
visits to ED
• They also present with some of the most serious illnesses with potentially devastating
outcomes
• The relative rarity of critically ill or injured children means that clinical experience
potentially may be lacking or even atrophied over time
• Clinical inexperience coupled with the unique management issues of children has the
potential to create some degree of uneasiness in even the most experienced emergency
physicians
DIFFICULTIES
• Special Characteristics of Children
• Parent-Child Attachment
• Chronology of Developmental Periods
• The clinician must interpret the symptoms of a sick child within the context of the child's
unique personality and temperament
• Temperament is the personal style and way of interacting with, or responding to, the
environment
• Flexible children have a generally positive mood and adapt quickly to their environment.
• Fearful or cautious children are slower to adapt to the environment and will be shy in new
situations.
• They tend to seek out the caregiver and require the security of the parent's proximity and
more time to adapt to new situations.
BARRIERS TO COMMUNICATION
• Data Collection
• Pitfalls in the History
DATA COLLECTION
• The history acquisition sometimes is difficult
• At times, it may be necessary to seek out the best historian (child, parent, caregiver, or
baby sitter) to obtain a reliable and accurate history of present illness.
• Obtaining an accurate history from a child often is challenging and is inversely
proportional to the child's age
• Once children reach school age (5-10 years of age) they are better at communicating
their symptoms.
• However, information distortions still may occur secondary to pain, fear, anxiety, and
supplementary information from the parent still is needed
PITFALLS IN THE HISTORY
• Parents and other caregivers on occasion can provide the interviewing physician with
unreliable historical accounts.
• An over-emphasis on specific information or innocent exaggeration may occur.
• A report of "vomiting all day," when clarified, in reality might be only four episodes
throughout the entire day.
• Inexperienced or medically naive parents may not know what symptoms to look for nor
how to gauge behavioral changes indicative of a serious ailment or deterioration
• This may cause them to underestimate the symptoms or present a benign rendering of
the sequence of events that led to the traumatic incident or clinical deterioration.
• Other parents simply may be poor historians or inattentive observers.
HISTORY TAKING
• The caretaker and the child's complaint may not reflect the organ system involved (i.e.,
crying) or may distract the physician from the actual area of concern.
• An accurate history should include the evolution of the present illness or, in the case of
trauma, the circumstances that led up to the event.
PRACTICAL CLINICAL STRATEGIES
• General Principles
-The clinician's assessment should approach the child from an age and developmentally
appropriate perspective
The ED physician who understands the fears and anxieties particular to each stage of
development will be able to adjust the approach accordingly
EVALUATION OF CHILDREN WITH SPECIAL NEEDS
• Challenging.
• Differentiating what elements are new in their current clinical presentation from chronic
disease features often is difficult to ascertain.
• Here again, the child's caregivers must be relied upon to help. Another source is the
nursing staff or medical records, since these children tend to be frequent visitors to the
ED.
EXAMINATION
TAKE HOME MESSAGES
• The best practice for pediatrics require optimal conditions
• The examiner shall strive for the environmental , clinical and psychological conditions
that allows the best and most appropriate assessment based on the child’s health status