Let’s face it: It stinks when your kid is sick. Yes, you feel bad for them and wish you could take all of their discomfort away by placing it on yourself. But most of all, it worries you. What if the vomiting doesn’t stop? What if that cough gets worse? What if that fever gets higher? (Those questions turn even more serious for parents whose children live with chronic medical conditions: Will that vomiting land her in the ER (again) with out-of-control blood sugars? Will that cold trigger his asthma? Will that fever trigger seizures again?)
When kids get sick and parents worry, the next step is (hopefully) calling their trusted pediatric office for advice and perhaps requesting a same-day sick appointment. A pediatrician’s triage staff acts as both a barrier (keeping kids at home in bed if, after talking things over with a concerned parent, the illness sounds mild) or a sieve (bringing sick kids into the office if their illness sounds serious). Phone conversations about sick children are often three-way: Parent calls and speaks to triage staff, and triage staff discusses conversation with provider, who ultimately has the responsibility of keeping the sick child at home to get better (“watchful waiting”) or bringing them in to be seen. In conversations such as these, words matter. Dr. Christina Johns reveals 5 medical terms that will definitely get your pediatrician’s and triage staff’s attention.
Irritable. As in “My baby is very irritable.”
In medicine, particularly pediatrics, the descriptor “irritable” is a term that is used to describe someone’s neurological status indicating that something is wrong with their brain, spinal fluid, or tissues covering the brain. As in meningitis. Or encephalitis. These children are completely inconsolable and not acting like themselves at all.
“My baby is very irritable” may very well earn a trip to the emergency department for a spinal tap rather than a calm trip to the pediatrician’s office. Dr. Johns says “fussy” and “cranky” are words less likely to trigger knee-jerk panic in a doctor’s vivid imagination.
Lethargy, in any form. As in “He has been lethargic since yesterday.”
Lethargy is also a neurological term that describes altered mental status, difficulty with arousal and staying awake, and persistent change in level of consciousness. This does NOT mean more sleepy than usual, very tired, extreme fatigue, or anything in this vein.
“Very sleepy” or “decreased activity” are much more descriptive and, thus, helpful terms.
Dehydration. As in “I know he’s dehydrated.” Or “She hasn’t had anything to eat or drink in days.”
Dehydration is defined as significant intravascular volume depletion, or low circulating volume of fluid within the blood vessels. There is a spectrum of dehydration, from mild to serious, and this is one of the instances where the “art” of medicine plays as much of a role as the science, but suffice it to say that most children who have urinated within the past 8-12 hours are not significantly dehydrated. They may indeed be a bit behind on their fluid intake than their norm, but when a child is able to produce tears with crying and has a wet tongue and mouth, then dehydration is unlikely.
The next phrase has no good definition; we will definitely drill down on it to get more information:
Low grade fever. As in “She has a low grade fever, 99.3.”
As a general rule, you either have a fever, or you don’t. While there are different thresholds of what constitutes a fever for different age groups (newborns: anything over 38C or 100.4F for example), or for people with compromised immune systems, but if there’s a body temperature between 98.7F and 100F, that is not a fever of any sort. It just isn’t.
A pediatrician wants to know the number on the thermometer and the method in which it was obtained (oral, rectal, under the arm, etc.).
Wheezing/Can’t breathe. As in “I could hear him wheezing from across the room and he couldn’t breathe.”
Wheezing describes the turbulent air flow in the lower airways of the lungs caused by bronchospasm and inflammation. It is typically not a sound that can be heard without a stethoscope. A musical, noisy sound can sometimes be audible when standing next to someone in respiratory distress for a variety of reasons, but these sounds are either transmitted upper airway sounds, or coarse sounds from larger airways, or even a tight cough, but they aren’t wheezing per se.
There’s also a big difference between “difficulty breathing” and “can’t breathe.” If someone can’t breathe that means they cannot ventilate themselves at all and their respiratory rate may be zero. They may have an airway obstruction or may have a respiratory arrest.I’m not being flippant here: the difference has major clinical ramifications- both regarding necessity of urgency of treatment as well as type of treatment. If someone is able to cough or talk or cry or make noise, they should not be described as “can’t breathe.” I’m not being flippant here: the difference has major clinical ramifications — both regarding necessity of urgency of treatment as well as type of treatment. If someone is able to cough or talk or cry or make noise, they should not be described as “can’t breathe.”
If you are concerned about your child’s illness, by all means give your pediatrician a call. The more descriptive a parent can be about what is going on, the better we can gauge the severity of the illness and urgency of the situation.