Managing A Sick Child

 

Pediatric emergency medicine physician Sage Myers, M.D. has observed her share of illness, pain, and suffering working in a busy, urban, children’s hospital emergency department before, but she has never seen anything like November’s “tridemic” of RSV, influenza, and COVID-19:

Walking out of a shift in the pediatric emergency department (ED) lately is a heavy mix of relief, guilt, and pure exhaustion. Wading through wall-to-wall families, huddled in blankets and sweatshirts through long hours waiting to be seen, you wish you could do more, find more beds, create more staff. You’ve spent hours running from room to room, caring for sick kids who should be in hospital beds — but none currently exist. For weeks you’ve been evaluating and treating the deluge of incoming sick children and dropping everything when a child arrives in extremis and needs resuscitation; you’ve dedicated time talking to parents whose children are well enough to be cared for at home but need the courage and anticipatory guidance to do so; and you’ve been intermittently talking to physicians at smaller hospitals, supporting them as they try to care for sick children who would normally be transferred to you immediately, but there’s simply no room to take them now.

 

Dr. Diane Arnaout and her office staff are likewise swamped with sick kids. Imagine then how hard it must be for a pediatrician to work in the office from dawn-’til-dusk while her own child is at home, lying in bed, sick:

My kid’s been pretty sick.

She’s 7 years old. She’s had fevers for 3 days now, in the 102-103 range.

Her cough has been absolutely horrible. Constant and loud.

 

Dr. Arnaout’s approach for handling her daughter’s illness is instructive for every parent who, at home or at work, is managing a sick child:

Here’s my real-life thought process through her illness:

– She’s got sudden snot and cough with this fever. This probably means she has a new virus. Antibiotics won’t help this. Only time.

– Her fever worries me, and she’s puny, but she’s talking easily with me, drinking water, and is breathing comfortably. I don’t need to chase it constantly with fever-reducers if she feels okay – fever is her friend and will help her fight this off. Fever will not fry her brain. I’m not going to wake up at night to give her more medicine – if she’s sleeping comfortably, I’m going to let fever do its job.

– Her cough is also her friend. She’s coughing up phlegm that would otherwise settle in her lungs. We don’t want that in there. It’s a wet cough – she’s coughing up the crud and swallowing it down the stomach pipe. She’ll poop it out. Her poops will be loose and weird. (one day this child will realize i write about her poops for 40K people to read on the internet and she will disown me)

– She may get a pink spotty rash with this new virus. Or red eyes. Or diarrhea. She’s gonna sleep more for the first few days (she took a nap for the first time in 3 years!) This will improve as the virus is slowly going away.

– She doesn’t want to eat much, but i don’t mind because she’s drinking well.

– I will take her to see her doctor if

1) her fevers last longer than 4-5 days

2) her fevers are trending up instead of down

3) she is not producing urine every 6-8 hours

4) she is refusing to drink

5) she is wheezing, is breathing faster than usual, or seems to need a lot of effort to breathe

6) The cough isn’t starting to slowly improve 5% a day after day 5 or 6 of illness

7) she suddenly gets worse after 3-5 days of this new illness (less energy, new vomiting, higher fevers).

 

Read more from Dr. Diane Arnaout’s outstanding Facebook blog here.

 

(Google Images)

source http://www.thepediablog.com/2022/11/16/managing-a-sick-child/