toddler fever

On 21 Sep 2004 05:11:20 -0700, (CBI) wrote:

I also agree that I often doubt the diagnosis. On many ocassions the
parents have brought the kid in the morning after a midnight trip to
the ER (so within hours) and I have found a completely normal drum.

Indeed, I saw a child hours after being diagnosed with an "ear
infection" after she had presented to an urgent care clinic with
fever. After starting amoxicillin, she developed palpable purpura on
her legs and abdominal pain. They thought maybe she was allergic to
amoxicillin. She had the most pristine ear drums I had ever seen. Oh,
and she had Henoch-Schoenlein purpura, too.

However, there is one thing I am surprised that you did not comment
upon. She really does not give us enough details to know if things
have been excessive. Information on how many of these ear infections
have been diagnosed over what course of time would be helpful.

True.

I agree - a second opinion from a good general pediatrician would be
more likely to give a corrent course of action. Both due to the issues
of correct diagnosis of the ear and, as you allude, to looking at
other causes of fever. The ENT is not likely to order a urinalysis or
consider other diagnoses such as JRA.

Exactly. If you see an ENT for fever and ear pain, the ENT is most
likely to tell you either: (1) It's an ear infection, or (2) It's not
an ear infection.

Furthermore, evidence is pointing away from the conventional wisdom
that you will suffer irreparable damage to your hearing and speech
development if you don't get ear tubes for chronic middle ear
effusion, so tubes for this reason are being done less often.

A point that bears repeating. The recent literature has been
surprising in how little harm seems to be done by waiting.

Although, you and I both have probably had the experience of the
speech-delayed 2-year-old boy with COME and conductive hearing loss
who immediately starts talking up a storm the day he gets his tubes.
Although I am less apt to worry about COME in a child with normal
language development, especially if I get a normal tympanogram or
audiogram at some point, I do believe there may still be a subset of
kids who can benefit.

PF

PF Riley wrote:

Although I am less apt to worry about COME in a child with
normal
language development, especially if I get a normal
tympanogram or
audiogram at some point, I do believe there may still be a
subset of
kids who can benefit.

Sure - but the recent studies are reassuring for being less
dogmatic about rules such as x# of infections over y period
of time and you get tubes. It leaves more leeway to look at
the kid and decide what is appropriate without having to
worry that lack of an early referral is doing some as of yet
undectable damage (speech delay would be detectable damage).

--
00doc

undectable damage (speech delay would be detectable damage).

Thats true, but once speech dely has happened, kids have missed out on
SOUNDS, ai, ee, oo, u, etc, and then they have trouble with reading, and
spelling.

The earlier to get to these problems the better.

My son only had speach delay till 3, not too bad, but no grommits till 5 and
is now 9 with major problems in reading.
He has no concept of sounds, well, he has NOW, cause we have had him to a
speech therapist. But its taken a yr of training to get him back to the
basics.....very hard to teach a child, "ai" when they cannot hear the
sound...when they have missed out on a key clue younger.

Fiona

Fi wrote:
undectable damage (speech delay would be detectable
damage).

Thats true, but once speech dely has happened, kids have
missed out on
SOUNDS, ai, ee, oo, u, etc, and then they have trouble
with reading,
and spelling.

Actually, that is not true. If it is being carefully
followed and a referral is made as soon as there is evidence
of it then the kids generally do fine.

Besides, the point is that even kids with documented
persistant fluid and decreased hearing usually don't end up
with delayed speech. It seems that even kids with a lot of
ear infections and fluid in the ear (not the same thing)
usually don't have persistant deficits in both ears for
enough of the time to delay speech. When you think about
it - it makes sense that both ears would have to be pretty
socked in for a lot of the time to do that.

Of course, persistant fluid in the ears/recurrent infections
and any sign of speech delay are an indication for the
tubes. I am not saying that no kids need them - just not
most of them with recurrent infections.


My son only had speach delay till 3, not too bad, but no
grommits
till 5 and is now 9 with major problems in reading.

Letting a known delay go for over 2 years is not quite what
I have in mind.

--
00doc