Category: Rotation 8 – Pediatrics
Rotation 8 – Site Visit Summary
For my Pediatric site evaluations, I presented an H&P in each. The first meeting I talked about a patient who came into the Pediatric ED due to low Hemoglobin-Hematocrit readings on blood work performed at their PCP office. The patient never had a history of anemia, but described her recent menses that lasted for 1.5 months. She was also symptomatic, complaining of an episode of syncope, as well as palpitations, SOB, and dizziness. In the second meeting, I presented on a patient I saw in the Pediatric Neurology clinic, who came in complaining of 5 months of headaches after being weaned from his anti-seizure medication Depakote. I found the case interesting, since the patient was describing tension headaches like the textbook. The neurologist explained that the headaches are likely not to be due to stopping the medication, but because of online classes due to COVID and the patient’s lifestyle (ie: poor meal/water intake, excessive screen time, and taking naps during the day). In the meetings, I also presented journal articles. The first one investigated the relationship between iron deficiency anemia and febrile seizures; while the second one investigated for a relationship between migraines and ADHD patients. Pharmacology cards were also presented in both meetings, where my classmate and I took turns quizzing each other on our medications. I found this method to be different from my other site evaluations, and found it helpful to learning.
Rotation 8 – Rotation Reflection
I had grown up with a daycare in my home since the age of 5 through my early 20s. This has given me experience with children between the ages of 2.5 to 5, but rarely in the medical capacity. I was nervous about my Pediatric rotation since we were so thoroughly taught about adult illnesses during didactic year, but only had one Pediatric course. I always had challenges with pediatric practice questions as well, especially those pediatric-predominant complaints, treatments and vaccination schedules.
In the Pediatric Emergency Department, I found it difficult to examine newborns and infants. I was nervous about how fragile they were, did not want to be the reason to give them additional stress, and was also aware of how protective parents can be of their children. I would introduce myself, and interview the caretakers. Then I would just listen to the patient’s heart and lungs, and maybe examine their skin, but the rest of the physical exam was performed by the provider. Toddler to school ages fell more in my comfort zone. I knew the importance of gaining their trust in order to get their cooperation. I made sure to do this by being kind to both them and their parents, showing interest in their interests/school, and letting them talk. With doing so, they were mostly willing to cooperate with me.
I found it especially interesting to learn the techniques used to hold children to have a proper examination. From an outsider’s standpoint, it sure can appear rough to have to restrain a fighting and crying child. At first I was apprehensive, but I reminded myself of the importance of the examination, and the need to have a thorough exam to properly treat the patient. An example of this was when a child came in for a vesicular rash on their left hand and that traveled up the arm. To rule out/in Hand Foot Mouth Disease, it was necessary to hold down the child to examine her oral cavity for lesions. Another example can be seen in infants who are brought in for fever and no other complaints. Often the ear would need to be checked for otitis media/externa, no matter how much the child fought us.
Rotating in the Neonatal Intensive Care Unit was a whole other experience. It made me see how comparably stable some of the neonates/infants were who came through the emergency room. I have never seen such young and small babies in person. They looked extremely fragile, and many sick, needing multiple IV lines, tubes in their mouths/noses, and wires connected to their bodies. I had gained even more respect for the NICU nurses, seeing how they needed to step in as both the babies’ nurse, as well as their source of food and comfort during their stay. The way they cared for the babies appeared to be second-nature for them, and was beautiful to witness.
There are more than one patient that I will carry with me. I saw many unique rashes on this rotation, including Hand Foot Mouth Disease, Scarlet Fever, Pityriasis rosea, and one from taking Amoxicillin. Interviewing these patients/parents, and seeing these cases in person helped with my learning of the conditions. On a side note, in the rotation, I was surprised by the number of psychiatric cases that passed through the emergency department. It never dawned on me where children may end up if they had a psychiatric issue. One patient I interviewed was a 10 year old girl who was brought to the emergency room due to intentionally ingesting an unknown amount of medication to self-harm. The girl spoke in low tones, barely making eye contact, but was willing to engage in conversation. She was describing stress at home, where there was a custody battle surrounding her, and that her wishes of who she would rather live with was falling on deaf ears. She said that this was a major reason why she took 4 Ibuprofen the day before, and an unknown amount of another medication prior to her emergency room visit. She shared that her cousin, 10 years old as well, was also having issues at home and was the one who had brought up the idea of taking pills. Ironically enough, it was this cousin who the patient had shared the news of her pill ingestion with; and who reported it to an adult (the patient’s aunt, who ultimately was the one who called 911). This case stood out to me because of the young age of the patient, presenting with such a serious issue. I was saddened by her story, what she had shared with me. On the other hand, during the patient’s stay, I had learned about what the adults in the patient’s life had to say about the situation, as well as witnessed the patient’s interactions with the family (ie: the patient may have been simply acting out against her parent’s split custody; the patient may be talking with friends who are bad influences – which may be the reason for the patient’s recent change in attitude from “happy” to “bitter”; there was bad blood between the patient’s parents and their paternal aunt – who may have called 911 out of spite). It made me realize how we cannot assume everything in medicine at face value, and how important collateral information and patient observation can be in their diagnoses and treatment.
In the Pediatric Emergency Department, I found it difficult to examine newborns and infants. I was nervous about how fragile they were, did not want to be the reason to give them additional stress, and was also aware of how protective parents can be of their children. I would introduce myself, and interview the caretakers. Then I would just listen to the patient’s heart and lungs, and maybe examine their skin, but the rest of the physical exam was performed by the provider. Toddler to school ages fell more in my comfort zone. I knew the importance of gaining their trust in order to get their cooperation. I made sure to do this by being kind to both them and their parents, showing interest in their interests/school, and letting them talk. With doing so, they were mostly willing to cooperate with me.
I found it especially interesting to learn the techniques used to hold children to have a proper examination. From an outsider’s standpoint, it sure can appear rough to have to restrain a fighting and crying child. At first I was apprehensive, but I reminded myself of the importance of the examination, and the need to have a thorough exam to properly treat the patient. An example of this was when a child came in for a vesicular rash on their left hand and that traveled up the arm. To rule out/in Hand Foot Mouth Disease, it was necessary to hold down the child to examine her oral cavity for lesions. Another example can be seen in infants who are brought in for fever and no other complaints. Often the ear would need to be checked for otitis media/externa, no matter how much the child fought us.
Rotating in the Neonatal Intensive Care Unit was a whole other experience. It made me see how comparably stable some of the neonates/infants were who came through the emergency room. I have never seen such young and small babies in person. They looked extremely fragile, and many sick, needing multiple IV lines, tubes in their mouths/noses, and wires connected to their bodies. I had gained even more respect for the NICU nurses, seeing how they needed to step in as both the babies’ nurse, as well as their source of food and comfort during their stay. The way they cared for the babies appeared to be second-nature for them, and was beautiful to witness.
There are more than one patient that I will carry with me. I saw many unique rashes on this rotation, including Hand Foot Mouth Disease, Scarlet Fever, Pityriasis rosea, and one from taking Amoxicillin. Interviewing these patients/parents, and seeing these cases in person helped with my learning of the conditions. On a side note, in the rotation, I was surprised by the number of psychiatric cases that passed through the emergency department. It never dawned on me where children may end up if they had a psychiatric issue. One patient I interviewed was a 10 year old girl who was brought to the emergency room due to intentionally ingesting an unknown amount of medication to self-harm. The girl spoke in low tones, barely making eye contact, but was willing to engage in conversation. She was describing stress at home, where there was a custody battle surrounding her, and that her wishes of who she would rather live with was falling on deaf ears. She said that this was a major reason why she took 4 Ibuprofen the day before, and an unknown amount of another medication prior to her emergency room visit. She shared that her cousin, 10 years old as well, was also having issues at home and was the one who had brought up the idea of taking pills. Ironically enough, it was this cousin who the patient had shared the news of her pill ingestion with; and who reported it to an adult (the patient’s aunt, who ultimately was the one who called 911). This case stood out to me because of the young age of the patient, presenting with such a serious issue. I was saddened by her story, what she had shared with me. On the other hand, during the patient’s stay, I had learned about what the adults in the patient’s life had to say about the situation, as well as witnessed the patient’s interactions with the family (ie: the patient may have been simply acting out against her parent’s split custody; the patient may be talking with friends who are bad influences – which may be the reason for the patient’s recent change in attitude from “happy” to “bitter”; there was bad blood between the patient’s parents and their paternal aunt – who may have called 911 out of spite). It made me realize how we cannot assume everything in medicine at face value, and how important collateral information and patient observation can be in their diagnoses and treatment.
Rotation 8 – H&P
Rotation 8 – Journal article
Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis
By: Byung Ok Kwak, Kyungmin Kim, Soo-Nyung Kim and Ran Lee
https://www.seizure-journal.com/article/S1059-1311(16)30325-9/fulltext
For my case presentation, I presented a 16 year old female who was advised to go to the ER due to abnormal laboratory results. Her hemoglobin and hematocrit were 5.6 and 23.3, respectively. It was believed that this was caused by her abnormally heavy menstrual cycle. I wanted to find a journal article that dealt with the prevalence of menorrhagia causing anemia, however, I came across a more interesting one that looked at the relationship between iron deficiency anemia and febrile seizures. Also there had been some studies suggesting a possible relationship, however, others had conflicting results. The main objective of the study was to identify if the two variables are associated. This article was a systematic review and meta-analysis that looked for articles that were case-controls, included subjects between 3 months to 6 years old with febrile seizures, and iron deficiency anemia incidence was assessed. A total of 17 articles were included, which included 2416 children with febrile seizures, and 2387 without. Iron deficiency anemia was seen in 35.2% of the cases, and 29.6% of the controls, showing a significant association of iron deficiency anemia in patients with febrile seizures. Iron deficiency anemia that was diagnosed with ferritin levels and MCV, showed significant relationship with febrile seizures; however diagnosis with serum iron levels did not have a significant association. The study concluded that “IDA is associated with an increased risk of FS in children aged 3 months–6 years”. This study, however, did admit to the limitation of not including randomized control trials, as well as insufficient quality of some of the studies.
The peak ages between iron deficiency anemia and febrile seizures are similar. The study explained that iron is an important nutrient for proper growth, and that a deficiency of it can lead to neurological issues, problems with iron metabolism, and neurotransmitter activity issues. Therefore it may pose as a risk factor for febrile seizures.
