“Kid’s a level 5. Fever starting six hours ago, runny nose. He’s fine.”
Her three-year-old son had developed a fever and rhinorrhea that day. She was worried about an ear infection. His exam showed no signs of otitis media and we discussed how a viral upper respiratory infection likely caused his fever.
“Thank god.”
The heavy relief in her sigh told me there was something left unsaid.
Acknowledging the anxiety that remained in the air, I asked what was really worrying her.
“His twin brother was just hospitalized for mastoiditis last month and they had to do surgery. That all started with a fever and runny nose. I just wanted to get in front of it, you know?”
The fear from her other son’s hospitalization bubbled underneath the surface of our conversation. She was scared that it would all happen again.
EHRs give us a wealth of information about the patient, but cannot paint the full picture. Caring for the well-appearing child in the office demands humility, because the true worry may extend beyond the chief complaint.
Pediatric ER visits and hospitalizations can be traumatizing events for parents. The experience of needing acute care or hospitalization, rather than the severity of the child’s illness, was predictive of future medical related anxiety.
Child hospitalization or ER visits are stressful events for families. The experience of needing acute care, rather than the severity of their child’s illness, was predictive of parental anxiety. These feelings extend beyond the hospitalization itself into future interactions with the health care system. No one carries negative intentions to create anxiety and stress for pediatric caretakers. My goal is not to point fingers. Rather, I want to challenge clinicians to practice humility when caring for relatively well-appearing patients with mild symptoms of illness. The act of needing acute care is a stressful event, and its effects linger beyond the end of the medical visit.
Direct medical care helps treat a patient’s symptoms, but is incomplete on its own. Caring for the mildly ill child is not the most difficult task we face. Rather, it can be more challenging to provide appropriate reassurance and empower families to actively care for their child. If it does not arise naturally, directly asking what worries the family allows clinicians to provide the peace of mind the family is seeking. Avoiding the underlying anxieties and diminishing fears will not make them go away. Rather, we risk layering a feeling of being dismissed on top of the scar.
We talked about what to look for in his viral upper respiratory infection and when to return if his symptoms progressed. I explained the pathophysiology of mastoiditis and how it progresses from otitis media.
“I’m sorry I’m that mom in your office who needs to know everything,”
Her apology was unnecessary and likely rooted in the anxieties developed during her son’s hospitalization. Whether a deluge of information was thrown at her or other health care practitioners had failed to fully explain the pathophysiology of her son’s illness, the mother demonstrated such an obvious desire to learn more about otitis media and mastoiditis that I felt the need to explain more. Taking the time to discuss pathologies she feared helped transform it from a bogeyman into an worrisome disease she understood.
Reassuring parents about their well-appearing child without taking the time to teach can accidentally dismiss or shame the patient for unnecessarily seeking care for the child they were worried about. Reassurance should not only address the immediate concern but also also equip parents with knowledge to recognize and care for illness. Taking the time to teach not only helps parents now, but also builds their toolbox to care for similar illnesses in the future.
Four months later, I cared for the same family during another febrile upper respiratory illness. This time, her child did have an ear infection.
Before I had the chance to, she began listing the reassuring signs against mastoiditis she saw in her son.
“I might be that worried mom in your office, but now you know I can remember a few things, too.”
One conversation did not remove the anxieties carried from her son’s hospitalization, but it helped build confidence in her abilities to care for her children for the next time.
How do you teach parents? Share your strategies in the comments.
Dr. Nishant Pandya is a pediatrician in Philadelphia, PA. He enjoys biking and rooting for the Philadelphia Phillies. Dr. Pandya is a 2023–2024 Doximity Op-Med Fellow.
Image by artbesouro / Getty
