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Ask MetaFilter questions tagged with pediatric



Questions tagged with 'pediatric' at Ask MetaFilter.



Published: Fri, 03 Apr 2015 20:17:04 -0800

Last Build Date: Fri, 03 Apr 2015 20:17:04 -0800

 



Arranging an interhospital transfer from a good hospital to a great one

Fri, 03 Apr 2015 20:17:04 -0800

My last question was about coordinating care among physicians at different hospitals. It's not working. Now I need to know the safest (but also insurance-covered) way to get my baby to the better hospital in a future crisis. Please share your interhospital transfer (or other related) experiences. Nanopanda is in the PICU at Suburban Tertiary Care Hospital (STCH) for the third time in two months (fourth total). I feel that she's receiving good PICU care, but I am NOT HAPPY with the pulmonology care she's getting, and she's on the pulmonary service so they get to call the shots. The two pulmonologists switched off hospital duty in the middle of the week and did not create any kind of coordinated care plan; instead we got two sets of diagnosis/treatment plans that are orthogonal and incompatible with each other. Determining which is correct requires a bronchoscopy which cannot be done in her current condition (it was scheduled but the anesthesiologists called it off). STCH pulmonologists are not consulting with our doctor at Downtown MegaKids Hospital. I have spoken with the doctor at DMKH, and we are going to leave Nanopanda at STCH for the duration of this admission because for the moment she is only receiving supportive care that would not be fundamentally different at DMKH.

We are scheduling the big workup ASAP at DMKH. However, in the event that we have another emergency before the big workup (or if there is a future emergency), I would like to have the option of taking Nanopanda to DMKH.

Given that both hospitals have dedicated pediatric emergency rooms, pediatric intensive care units, and pediatric pulmonary subspecialists, what is the safest way to get Nanopanda to DMKH, what are the words to say to make it happen, and what are the words to say to get insurance to cover it? (Blue Cross PPO, FWIW)

Do we grit our teeth and drive her 45 minutes (plus maybe traffic) downtown in an emergency, figuring that if I sit in the back with her and keep giving albuterol that's basically what they'd be doing for the first hour in the ER anyway? An ambulance via 911 is going to take us to STCH. Would a private ambulance take us to DMKH? Would insurance cover that? Or do we take her to the ER at STCH and then request an interhospital transfer to DMKH? Again, given that all services she needs are present at STCH, how do we word the justification? ("I think the pulmonologist is an ass" isn't going to get us very far.)

Of course this is something to discuss with our doctor at DMKH, and I will, but I find that in general physicians are not especially up on insurance related issues or how to be just the right kind of combative. This is where the Hive comes in. Please tell me about your interhospital transfer experiences, or your decision making process when you really need to get someone to a specific hospital for reasons that are good but might not sound so on paper.



Coordinating medical specialists at different hospitals

Thu, 05 Mar 2015 10:14:27 -0800

After a terrible run of illness (and another PICU admission this week) we have seen a few different pediatric pulmonologists. The doctor we like the best doesn't have privileges at our hospital. How do we coordinate care? We live in a major metropolitan area. We are located a few minutes from Suburban Tertiary Care Hospital (STCH) which has the only dedicated pediatric ER and pediatric intensive care unit in our neck of the woods. The next closest pediatric ER and pediatric intensive care unit are at Downtown MegaKidsHospital (DMKH), which is 45 minutes away. In a respiratory emergency, we really have no choice but to go to the emergency room at STCH. Overall, we are happy with the PICU care there. (Jesus H. Christ, never thought I'd be in a position to say that...)

However, STCH has two pediatric pulmonologists, Dr. McGruff and Dr. Nicer. Dr. McGruff is not a bad doctor, but we really do not get along with them. We have seen Dr. Nicer once as an outpatient, and then briefly in the PICU this last time, and were happier with them, but both times we've been in the hospital it's been Dr. McGruff's week on hospital service.

I elected to get a second opinion from Dr. Awesome, one of the pediatric pulmonologists at DMKH and I love her. She fits well with my scientifically-oriented mind, laying out the things we need to test now, what events would bump us up to the next tier of things to test for, what those would be, and what tests would be done. I like being able to see a few nodes down the decision tree, which I wasn't really getting from the other doctors. She also strongly encouraged us to contact her as minor issues arise so she can help us handle them at home, as opposed to "See us in clinic in a month" when there's a very good chance we won't make it that long without being back in the hospital.

So here's my dilemma: I want Dr. Awesome handling our outpatient care. I think she's our best shot at staying out of the hospital. But even she can't offer us a guarantee that we won't be back in the hospital, so we are likely to need to interact with Drs. McGruff and Nicer again. That means there is possibly something to be said for them knowing our child and what her care has been? I feel like it'll be a little weird if we've dumped them completely, but then again it's also weird to be seeing two pulmonologists at the same time.

Switching hospitals is not a real option because, again, in a respiratory emergency we aren't going downtown, the logistics would be a nightmare, and we might not see Dr. Awesome in the hospital anyway - DMKH has lots of pediatric pulmonologists.

I'm new to medical specialists, but this cannot possibly be an uncommon situation. How do we navigate this?

P.S. If you live in my area, have guessed which hospitals I'm talking about, and have any relevant personal knowledge, please MeMail me and we'll talk details.

P.P.S. Thanks to all who made suggestions in the last thread. They were very helpful.



Sucks to your ass-mar (and your ass-piration?)

Wed, 25 Feb 2015 12:58:19 -0800

My 16 month old has had a winter full of back to back respiratory infections of increasing severity. She has an asthma diagnosis but after a recent terrifying episode and prolonged hospitalization, the pulmonologist is really concerned about aspiration. I'm in the process of scheduling a swallow study. Obviously YANMPediatrician, but please tell me about your experiences with children with severe asthma, or chronic respiratory infections, or aspiration. I'm currently scared shitless, so positive stories and reassurance are especially welcome. As I mentioned, she's been sick all fall - multiple courses of oral steroids, a flu-like illness followed by bacterial pneumonia that she would have been admitted for if the hospital hadn't been full, an ER trip narrowly averted because our doctor was in clinic late that day.

A couple of weeks ago, the kid went from a clean checkup (where clean means cough and some crud in her lungs, but no wheeze) Friday, to an active and happy day Saturday, to a decent nap, to severe respiratory distress 15 minutes after she'd last been checked on. I raced her to the ER, she was admitted to PICU, and then spent the next 10 days trying unsuccessfully to wean off oxygen and high air flow. She was on continuous or hourly nebulizers for nearly five days. I cannot even begin to wrap my head around how suddenly this happened, or the possibility of it happening again.

She went home, was well for three days, and now has another chest cold, and it's all I can do to keep her breathing from being labored. She's on QVAR, albuterol every 4 hours round the clock, and the pulmonologist added Singulair today to help with her upper airway congestion. But the pulmonologist thinks her problems are too bad to just be asthma, and aspiration is the next thing on the list. Baby eats food well, so it's thin liquids we're most worried about. And, I guess, reflux, though we've never noticed any signs of it.

I'm scheduling a swallow study, and I've read a little about what to expect. The speech and language pathologist will call and talk with me before the study.

But I want to hear about people's experiences with these issues. Does any of this sound familiar to you? Did your toddler have a swallow study? Did they cooperate? How was your aspirating kid treated? Did their lungs get better? Are you a professional in any of these areas? How do I sleep at night?



Recommendations for pediatric healthcare while traveling in Hong Kong?

Tue, 08 Apr 2014 17:51:14 -0800

We're traveling soon with two toddlers to stay in HK. They are generally healthy kids, but we'd appreciate any information or advice in case something healthcare-related comes up during our stay. Mrs. werkzeuger is a RN and would be reassured by this kind of information. Specifically we are concerned with the kids having ear infections and finding someone in HK to evaluate.

I'm aware of this AskMe but it's quite old by now.

If you know about peds care in Hong Kong, we'd appreciate anything you'd like to share.



Five-year-old on third day of vomiting and belly pain -- stomach virus?

Wed, 22 Feb 2012 13:22:51 -0800

Five-year-old on his third day of vomiting with stomach flu? Our five-year-old vomited once on Monday afternoon, then complained of abdominal pain overnight. Continued eating and drinking, though.

Yesterday morning (Tuesday), he had a lot of abdominal pain and an acute phase of vomiting -- 5 times in 3 hours or so -- and then fell asleep and seemed to be feeling better when he woke up. He had something to eat and drink, which he held down, and he was peeing.

Nothing overnight last night, and then this morning (Wednesday) he really seemed fine -- he ate breakfast, he went outside to play, he had a mid-morning snack. Then at noon he suddenly started with the belly pain and vomiting again -- again, multiple bouts in a short period of time -- maybe 4 times in an hour.

He's been a little fevered, but not very high, while he's in the midst of the pain and vomiting -- maybe 101.

Has anyone experienced this with a child? His other stomach viruses have progressed so normally -- in fact, he's usually the mildest case in the house, vomiting maybe once or twice and then fine in 12 hours.

I've been on the phone with his pediatrician, and as of now, we're hoping he'll pee within the next couple of hours, or we'll have to take him to Children's. The pediatrician also said that if he has another recurrence (where he seems to improve and then starts up again), we should bring him in. I know YANM[child's]D, but I was hoping someone might have a similar experience to share and advise us. This seems so bizarre and alarming to me.



Eye mojo, domo!

Sun, 22 Jan 2012 23:26:52 -0800

pediatric ophthalmology; child had surgery for Infantile Esotropia, now the glasses thing.. and general questions on things around eyes So, 2nd son was born with "Infantile Esotropia" and it was pretty bad. Hard not to laugh, even now when looking at photos (with a loving smile, of course). The Hospital for Children here was fantastic, and the Dr we had/have, who was also the surgeon, was/is nothing but fantastic, and professional. The son had surgery at 7 months or so, and that all went well.

So, now he is 4 years old. Speaking as me, a layman, his eyes are generally aligned (not cross-eyed looking), except when extra tired, or "looking up" (eyes up, head forward). He clearly sees better with his left eye, as he turns his head when looking at something at distance.

The Dr check-ups go as expected, I have no complaints about that. Last report was 0.4 and 0.2. And we bought him some glasses, per Dr orders.

There is somewhat of a language barrier though, certainly with more medical terms. So some general questions;

If I understand it correctly, there is a chance that while the child is young, his eyes can be "trained" better, but not once he is past "some age". Is that correct?

So we had better be on his case early, than letting it slide until he understand the "out come" himself?

With his glasses; he does not appear to see better with them on (like I would expect from putting on my own glasses on). Is this as expected? Can I put aside such concerns that they are wrong? Sometimes if I test his vision on something, he will tilt his head back until he can look under the glasses, to attempt to see it. Typical behaviour?

Having said that, his vision seems pretty random ;) (Possibly "interest inspired" like most children, and I'm hardly qualified) He did no better, no worse, when I printed out an eye-test and hung it on the wall, with or without glasses (at 3m). But he could read the blackboard from the back of his older brother's classroom, without glasses. Certainly loves to play minecraft on ipad, and sometimes with glasses on.

If someone has already gone through this all, or even is a professional, it'd be interesting to hear something about it, and what to expect.

I do wonder if 0.4/0.2 is a life changing situation, what about driving a car? special needs in school? and all that jazz. So far he is as chirpy as any child.



Redress for a double doctor screwup?

Mon, 16 Jan 2012 16:22:37 -0800

We recently had a highly traumatic hospital experience involving a 3-year-old and two doctor errors, and we're wondering what our redress options are. Last week we took our 3-year-old daughter in for a routine colonoscopy with a (highly recommended) doctor at Hospital #1. (She'd had blood in her poop since infanthood.) After an apparently successful procedure, in which a polyp was found and removed, we took her home. But her bleeding increased drastically, and at the doctor's advice we consented to another colonoscopy later that same day, which revealed that the polyp had not been fully cauterized. Another apparently successful procedure and a night in the hospital with some serious misgivings.

The next day our daughter had a fever and bad abdominal pain. We decided to take her to a different hospital, where based on her history and symptoms the surgeons recommended an arthroscopic procedure to check for a perforated bowel. That's three procedures in two days on a three-year-old - talk about a difficult choice. We agreed, and sure enough they found one. We all spent the next three days at hospital #2. Our daughter seems to be recovering well.

We're not out to end careers or retire early on lawsuit money. We accept honest mistakes are possible in medicine as in anything else. I'm not even sure this qualifies as malpractice - and my impression from here and elsewhere is that those cases are so tough to win they're essentially not worth pursuing for anything short of death/permanent disability/six-figure amounts anyway.

But given that it was two errors by the same doctor (in one day!), we don't think it's unreasonable to have our medical bills covered, at the very least. That's not to mention the week of lost income for two freelancers staying at the hospital, much less the effects of what was easily the most stressful event of our lives to date. We're shell-shocked, and our trust in doctors may never fully recover.

What are our options here, especially since the bills will be divided between two hospitals? Is there any hope of getting hospital #1 to cover procedure #2 and/or #1? What about procedure #3 at hospital #2? Is just the threat of a malpractice lawsuit enough to convince a hospital to work with you on something like this? Email thatawfulweek@gmail.com



Should my seven-year-old son's dentist knock him out?

Tue, 03 Jan 2012 19:08:08 -0800

Just got home from a dentist appointment with my seven-year-old son. Five of his baby teeth are crowding the rest of his teeth and need to be extracted very soon. But he's extremely anxious at the dentist, and after today's ordeal, they're recommending putting him completely under using IV sedation with an on-site MD. I had IV sedation for my wisdom teeth, and it was amazing, but I'm flat-out terrified to knock out my little boy. He's never had anesthesia of any kind. Is it worth doing? Are there any risks or caveats I should know? Would it be better to stick with oral anasthetic? Help!



Pediatric psychiatry in Illinois

Mon, 13 Jun 2011 19:35:00 -0800

Is there a really great pediatric psychiatric inpatient facility in Illinois, or outside Illinois that will accept IL Medicaid? A friend of mine is having trouble with her five year old daughter, Claire. Claire had a rough start in life and has been treated both inpatient and outpatient for psychiatric issues, with and without medication, and is now living at home and having behavioral problems both with her mother and at daycare. Claire fails to respond to attempts to re-direct her behavior, to the point where she finds attempts at punishment to be hilarious.

Claire's background includes a junkie father who at best did not understand how to care for an infant. During her visitations with him, she was inadequately fed and clothed. She's described to her mom having found syringes, and visitations have since stopped. However, Claire has lingering issues - including the belief that her mother and stepfather hate her. Her acting out has gotten to the point where her mother fears for the safety of Claire's toddler half-sister as Claire has a pattern of lashing out physically by hitting, biting, and kicking other children in her day care program. Claire appears to lack empathy and has shown a history of manipulation - being sweet and angelic to hospital workers in her inpatient program and saying that she wants to run away and kill herself when she's with her mother. She has actually physically tried to choke herself several times. She is now repeatedly trying to run away, whether leaving home or running away from her mom in stores.

Claire and her mom are in Illinois and have Medicaid for insurance. My question is if anyone has experience with a facility that accepts Medicaid that has a reputable inpatient child psych program to help get some treatment for Claire's behavioral and emotional issues.



Babies, surgery and no aenthesia

Sun, 14 Mar 2010 21:48:07 -0800

Babies were often operated on with no anesthesia 30 years ago or more. Is this true? Excerpt from "The Pain Scale" ($, Harper's 2005) by Eula Biss:
But when my aunt became a nurse 25-years ago, it was not unusual for surgery to be done on infants without any pain medication. Babies, it was believed, did not have the fully developed nervous system necessary to feel pain. Medical evidence that infants experience pain in response to anything that would cause an adult pain only recently emerged.



Info Sought on Childhood Leukemia

Tue, 15 Jul 2008 16:51:30 -0800

Childhood A.L.L. Luekemia My 2 year old niece was just diagnosed with this today and we are scouring the internet trying to find out all that we possibly can. She starts CHEMO tomorrow. Any personal experience or ideas of informative websites would be appreciated. Not generic websites but detailed and resourceful sites. Her doctors will certainly keep us informed as we go but since we are in the very beginning stages its all we can think about. Anyone that has anything at all to offer, it would be appreciated. Even if its on info on CHEMO and its effects.

She had a biopsy done on a swollen lymph-node behind her right ear. Turns out it was 94% Cancer. They initially thought it was Non-Hodgkins Lymphona but a bone marrow biopsy distinguished that it is Leukemia.

Again any information or suggestions where to find information is appreciated.



Post-anesthesia for Toddlers?

Mon, 05 May 2008 20:35:02 -0800

My baby boy will undergo general anesthesia Thursday. What should I expect when I get him home? My 20-month-old son will undergo an outpatient procedure to repair 2 inguinal hernias on Thursday.

I'm stressing of course, but the doctors assure me that Henry will be fine. (They've done thousands of these operations; the hospital is excellent and the procedure involved but relatively uncomplicated.)

Parents or Caregivers:
Are there any side-effects, or latent effects of anesthesia I should know about?
What will the 24-48 hours after the surgery be like?
Any secret tips to make him extra-comfortable?
Yikes.



Ack! Weird / Fast / Mysterious Rash! Itchy!!!

Sun, 12 Aug 2007 19:31:27 -0800

SeeADoctorForThisRashFilter: Which we are going to, first thing in the morning, but I'm trying to put the Missus' mind at ease. My oldest daughter (turns 9 in November) developed a rather startling rash this morning, both in severity and speed of onset. It itches like crazy, apparently. No other symptoms (no fever, cough, nothing) and we're able to take the worst edge off the itch with liberal calamine / Benadryl / oatmeal bath application, but we can't figure out what it is. The nurse at the CVS MinuteClinic said it was very likely chicken pox, but (1) my daughter was vaccinated for that years ago, (2) she has no fever or other symptoms and (3) the rash doesn't look ... quite right for chicken pox. To wit: its distribution is odd, with hundreds of angry itchy red bumps on her trunk and extremities, most heavily where her bathing suit exposes the skin. Her back, in particular, is quite a sight. She has few to none on her face, scalp, genitals, butt, hands and feet. It's been about ... call it 20 hours since onset, and thus far none of the bumps have developed pustules. So, you know, wth? IANAD (obviously) and nothing I can find tells me whether this particular symptom set falls within the range of normal for chicken pox. Other ideas? We thought maybe Swimmer's Itch (we went swimming in her grandfolx neighborhood pool yesterday) but that apparently requires a waterborne pathogen, and presumably a chlorinated pool that's checked weekly would rule that out. Additionally, no one else in the family has any symptoms at all.

Weird, huh? Flagrant speculation and hand-waving is welcome. We'll be calling the doctor's office first thing in the morning, so we can bypass the "see a doctor" that's inevitably going to show up anyway. Thanks in advance. :)



Will suing a lousy doctor do any good?

Fri, 19 Jan 2007 09:35:48 -0800

Medical malpractice suits: What actually happens to an MD when they're sued? In terms of disciplinary actions against the MD, is there a difference between being found liable in civil court versus a settlement? A couple of years ago my 6-month old sister died after heart surgery (aortic stenosis). At birth the pediatric cardiologist discovered a murmur, but wasn't alarmed as those usually clear themselves up in the first few months of life.

What became clear only after she died, pretty unexpectedly, was that the initial tests done the day she was born showed a severe defect we weren't informed of. In fact, the technician conducting the EKG circled things and made notes, which the cardiologist ignored completely. She saw the same cardiologist at 3 months but again there was no concern. At 6 months she said the baby might need surgery soon. This is when my stepmom took her to a private children's hospital, where they said "this baby needs surgery IMMEDIATELY." She survived the surgery but coded overnight. The surgeons appear to have done everything right, as far as we can tell.

Needless to say, this has been a complete nightmare. I'm trying to help my stepmom with some decisions about how to proceed legally. She places a lot of stock in my opinion, for whatever reason, so I don't want to steer her in the wrong direction.

A medical review board found the cardiologist's care to be "substandard." Now the question is whether to proceed in court. We're not talking about a crooked car mechanic here. I figure when we're talking about this level of trust - putting an infant's life in an expert's hands - we have to do what we can to get it on record that this cardiologist ignored what a technician clearly saw, and while we'll never know if it would have saved her life, the point is we deserved that information.

Is there a benefit to taking this to court? Will just being sued affect anything like the doctor's malpractice insurance, license, etc? What about a liable verdict versus a settlement? Is it better to actually go to court, in terms of what the consequences are for the doctor? I'd really like to spare my stepmom the witness stand and cross examination about why she didn't take the baby to more cardiologists (there are 2 pediatric cardiologists within 50 miles, incidentally).

What, in short, is the deal with these kinds of things?

Sorry for all the context, I don't know enough to know what's important. Thanks for any help.



Does my daughter really need surgery?

Sat, 31 Dec 2005 20:33:49 -0800

Help my 7-year-old daughter hear me. (Medical, not behavioral issue) My oldest daughter (just turned 7) gets a stuffy nose and sinus congestion along with mild ear infections fairly frequently. Apart from the discomfort, her ears frequently get clogged and consequently she has a hard time hearing, a condition known as 'secretory otitis media' or, more commonly, 'glue ear' (from here.) We took her to a pediatrician about 6 months ago and he diagnosed her with swollen adenoids (hence the glue ear link.) His advice was to have an adenoidectomy performed. This terrifies me.

I hate the idea of subjecting my daughter to a surgical procedure that requires general anesthetic and the small but real risk that she might not wake up. I also hate the idea of her being subjected to the normal misunderstandings that come of being hearing-impaired. I remember having a perpetually stuffy nose when I was young, and I imagine that I had similarly swollen adenoids which self-resolved; I can hear fine now. So, what do I do? Are there alternative therapies out there that I can't find? Do we just wait it out and resign ourselves to raising our voices when we talk to her until she matures past the condition? Is there a chance that she might not mature past the condition, and do we risk irreparable harm by inaction?

I want so much to be the best daddy ever, and it's things like this that tear me apart.

Oh, and I do intend to get a second opinion, and ask these questions of another pediatrician. The trouble is, if the pediatrician is also the surgeon, I imagine it makes his life easier (and his paycheck larger) to recommend surgery instead of other, less-invasive therapies, if he's even aware they exist. I'm hoping there are other parents out there with similar experience that can offer advice.

Oh, and happy New Year, everyone!