Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
We just completed our series on pregnancy and it would be a
logical continuation to speak about children, a subject we
have spoken about in the past. But it is worthwhile
reviewing.
Pediatricians see different diseases and have different
approaches to disease based on the age group of the patient.
Neonates are different than infants up to three months old.
They in turn are different than infants up to a year old, who
are different than children up to adolescence. Adolescents
are very similar to adults.
Let's use as an example a very common problem, that of fever.
Fever within a few days of birth is a dangerous condition;
many infections that you and I would have no problem with can
cause havoc and serious problems at this age. Strep we spoke
about in the previous series, listeria, chicken pox and the
TORCH organisms are also causes for worry. From one week
until about 60 days, babies with fevers above 38 (100.4) are
generally admitted to the hospital and receive full culturing
which includes a spinal tap -- a scary test for parents, but
a very safe test, as spinal taps in that age group are not
difficult. Getting urine may be more frustrating. They are
however good in my opinion for older infants as a screen for
infection, as a culture may not be necessary if the urine in
the bag is clean. Often a catheter must be inserted or urine
taken from the bladder with a needle puncturing through the
abdominal wall. Again, this is a scary thing for parents, but
routine.
Let me interject at this point that it is better to leave the
room than to become hysterical while the doctor does these
procedures. Fainting by parents is especially in bad taste.
Let me also add that putting in an IV line at this age and up
to one year can be especially challenging and the child will
cry and scream. A doctor who experiences difficulty in the
insertion of an IV line is not to be thought of as a bad
doctor. A good parent helps the physician by soothing the
child, remaining calm, and being encouraging.
Remember in this age group the child can not tell us what is
wrong and urinary tract infections are commonly missed and
can be occult. The same goes with all age groups until
adolescence. Also up to one year, normal signs of meningitis
are absent, making a spinal tap a commonly done procedure if
there is any possibility of this horrible disease,
Fever in an older infant and child is investigated in a more
focused manner. Here we recognize that often children will
not localize their area of discomfort. An ear infection may
cause them to complain that their tummy hurts. We check the
more common places of infection and make sure there is close
follow up just in case a more localized area of infection
doesn't appear. I do not believe that while we are waiting
for the infection to localize that we should use antibiotics
indiscriminately, and certainly not the strongest ones. Also,
the height of fever doesn't correspond to the severity of
infection. We'll discuss this more in the next column. Write
me in care of the Yated.
A message from Glaxo, sponsor of this column. I wrote
that one should not use antibiotics without a clear reason,
and this certainly applies to Augmentin and Zinnat. However,
these drugs are indicated for tough infections and I am
confident that when I do need the strength of a stronger
antibiotic that these drugs will perform. You can depend on
Augmentin and Zinnat.
