PEM Source

Your source for all things Pediatric Emergency Medicine

All posts with tag: "parents"

Tips and Tricks

We are seeing unprecedented numbers of cases of RSV, and many of our patients are older school-age children. Ever wonder when those kids can return to school? RSV is contagious up to 8 days after symptom onset, so children can return to school on the 9th day after symptoms started. However, young infants and immunosuppressed children may shed active virus for up to 4 weeks.

Asking Saves Kids: Firearms are now the leading cause of death for U.S. children aged 1-19 years. While school mass shootings make headlines, suicides make up the majority of these deaths. Accidental shootings by curious children who access unsecured firearms also contribute. It should be a standard part of our practice to assess access to firearms when seeing children who are depressed or suicidal, expressing homicidal thoughts, or are current victims of gun or gang violence. But if there’s time during the visit, it doesn’t hurt to run through an injury prevention checklist (helmets, carseat/seatbelt, unsecured firearms) with all our patients / parents. Find resources here 

These come from Joe Ravera - creator of great podcast PEM GEMS - the U in BRUE stands for unexplained. So if it's explainable, it's not a BRUE. For example, if the baby vomited after eating and then choked on that vomit a bit, Joe says, "It's not a BRUE, it's a spew." And if the baby was defecating and strained and grunted and turned red in the face, "It's not a BRUE, it's a poo." Another important part of defining a low-risk BRUE is that it lasted < 1 minute. But terrified parents often report much longer times than the actual event. Some ways to better define the timing: 1) start a stopwatch (e.g. on your phone) and ask the parent to say Stop when they reach about how long it was, 2) ask the parent what he/she did - "I patted his back and he started crying" = < 1 minute, whereas "I ran to the neighbor's house, got a washcloth and put cold water on his face, then called 911, and then he started crying" is > 1 minute.

To calculate the mL of standard concentration ibuprofen (100 mg / 5 mL) or acetaminophen (160 mg / 5 mL) to give, take the child's weight in kg and divide by 2. mL of ibuprofen or acetaminophen = child's weight in kg divided by 2 Don't use for children > 40 kg for ibuprofen (as 20 mL = 400 mg is an appropriate maximum dose of ibuprofen) The math: Ibuprofen weight (kg) x 10 mg/kg x 5 mL/100mg = weight (kg) x 1/2 Acetaminophen weight (kg) x 15 mg/kg x 5mL/160mg = weight (kg ) x 0.47 0.47 is close enough to 1/2  
Respiratory virus season is here, and we all know that the FDA recommends against the use of OTC cough medications in children < 4 years old (due to too many adverse effects and lack of efficacy). Some studies have shown honey to be something useful we can recommend to frustrated parents, but how exactly is it administered? Studies tested from 2.5mL to 10gm (5mL of honey = ~ 7gm). Pulling the results together, 5mL of honey can be mixed in any non-caffeinated drink, such as warm lemon water, herbal tea, or warm skim milk, and given at bedtime or up to TID. Giving it longer than 3 days had no added benefit. There is some evidence that dark honey is more effective. (Oduwole et al Cochrane Database Syst Rev 2018 Apr 10;4:CD007094).
Part of the new AAP BRUE algorithm’s definition of low-risk BRUE (Brief Resolved Unexplained Event) is that the event duration was < 1 minute. I always ask the caretaker to walk me through what happened step by step, using “and then what” prompting. I have had parents that told me the event lasted 2 minutes whose step-by-step description varied from “I picked her up, called for my husband to call 911, and blew in her face and she started coming around” (probably < 1 minute) to “I picked her up, ran to my neighbor’s house, she was still blue, we laid her on the couch, my neighbor gave mouth-to-mouth, and I called 911” (probably > 1 minute). Another trick I use is to say, “OK let’s say it starts when I say “now”, let me know when you think it stopped… now,” while timing with a stopwatch (available on your phone) – when your baby’s not breathing, 15 seconds can seem like 5 minutes; this helps get a more realistic estimate.
Here's a quick and dirty method to recall developmental milestones Development See the zero 0 as the "o" in tone, as the eyes for gaze, and as the mouth for strong suck The word two (months) is a combination of track and coo At four, the baby finds things funny (laughs) and pushes up on forearms to roll At six, the baby sits and makes sounds Picture the number 9 in a standing position and making a pincer grasp The w in twelve is for words and walks At 2 years old, the child has 2-word sentences and runs on 2 legs
Explain to parents - colds are called colds because viruses thrive in cold temperatures, so fevers are the body's natural way to fight off the cold

Controversies

(Click the link to comment and to vote - voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You are seeing a 14 year old high school Freshman brought in for minor cold symptoms consisting of sporadic dry cough and nasal congestion. There is no fever, and the patient is negative for COVID, RSV, and influenza. The patient is well appearing and spends the majority of the visit on her mobile phone. The parent asks for a school note. What duration of time off from school do you typically give on the school note?

[poll id="74"]

(Click the link to comment and to vote - voting not working through email, sorry!)

Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="67"]

PEM Questions

(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 4 week old brought in for vomiting with every feed. The vomitus is non-bilious, non-projectile, and non-bloody. The baby is making 5 wet diapers per day and weighs 10 lbs, and has gained 30 gm per day since regaining birth weight at 10 days of age. The baby is formula feeding, taking 5 ounces every 2-3 hours. [yop_poll id="87"]

Oops! We detected that you are on mobile and in portrait mode.


Please turn your phone to landscape mode to view this website. If you are not on mobile, extend your browser window.