25


Mother knows best (2)


I REMINISCE TO my Foundation Year 2 days in the emergency department. I found dealing with children and particularly neonates to be the most challenging part of my medical career so far. From this stems the utmost respect and admiration for all qualified and aspiring paediatricians. To get back to the subject


matter, I do remember taking two lessons away from my brief period spent in the department. The first one relates to history. We are indocrinated from our earliest days in medical school that over three quarters of the information you need to make a diagnosis or at least decide on the next course


critical care consultant on the ward round. Drugs are stopped, doses altered in light of altered renal function and other drugs started if they have been omitted or forgotten. Every day we check if thromboprophylaxis has been prescribed or considered contraindicated, if gastroprophylaxis has been instituted and that appropriate nutrition and anti-pneumonia measures are in place. Analgesics,


of action is in the history. In the case of the young ones still lacking language skills, we can only rely on the mother’s history, even when this is sometimes limited to a story. I always felt that a mother’s


concern was enough to take things forward, especially if a little reassurance was not adequate. There is no substitute for a mother’s sixth sense of something being amiss. None other than she would be able to discern the smallest changes and nuances in the behaviour and hence the overall condition of her baby, and this is proof enough of her worry. There is no way that you could confidently fully discern normality in


sedatives, inotropes and vasopressors are reviewed, and antibiotics and steroids stopped if they have run their course. I strongly agree that focusing solely on the initial prescriber is wrong. The inpatient care of a patient is the responsibility of all of us involved in their care. We should all be reviewing drug charts regularly to


minimise prescription errors. Chris Smith, specialty registrar, Anaesthesia, UK


the short period of contact you have with the child in the department. The second lesson is if there is


a reattendance within the last 24 hours; an expert consult needs to be sought, even if it is to reassure all parties concerned of the benign nature of the presentation. The worst thing that could happen with getting a second opinion is another medical professional doing what he was trained and is paid to do: his job! With these two skills in hand,


it should not be too difficult to navigate the delicate waters of the paediatric department in


accident and emergency. Ali Abdool, registrar in cardiology, UK


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