I wouldn't be a Pediatrician

[Cainkane1]

A Pediatrician was reported to be improperly touching his patients. The nurse reported him for "positioning" a child while doing a genital exam. She also said he hugged and kissed his patients.

Ok so an investigation was made and he was exonerated. Ok how do you "properly" examine genitalia? I mean what position could a child get in that wasn't nasty looking? If I were a pediatrition I wouldn't examine a child without the mother or father being there with me.

I'd counsel the doctor to skip the hugging and kissing but unless he did something illegal its my guess he was only doing his job.

[Mirrorglass]

Most likely if he was exonerated, he really did do something he shouldn't have. All pediatricians have to do genital exams, yet we don't hear of stuff like this often.

Not long ago, there was a case in my country of a doctor who conducted breast exams with his mouth. It was quite the scandal when it got out.

What it shows is there are some rotten eggs among all professions. It shouldn't discourage anyone from entering the field, though.

[Ziggurat]

Most likely if he was exonerated, he really did do something he shouldn't have.

Umm... are you sure you understand the definition of exonerated (http://www.merriam-webster.com/dictionary/exonerate)? Because your response doesn't make sense to me.

[One Eyed Jack]

Most likely if he was exonerated, he really did do something he shouldn't have.

Huh? Was that a typo?

[Cainkane1]

Most likely if he was exonerated, he really did do something he shouldn't have. All pediatricians have to do genital exams, yet we don't hear of stuff like this often.

Not long ago, there was a case in my country of a doctor who conducted breast exams with his mouth. It was quite the scandal when it got out.

What it shows is there are some rotten eggs among all professions. It shouldn't discourage anyone from entering the field, though.
The only thing the doctor did that I wouldn't advise is the hugging and kissing of the patients.

[casebro]

His exoneration only sounds like justice to me. Sounds more like he absconded... probably via the loop hole known as the egress.

[Skeptic]

Ok how do you "properly" examine genitalia?

With the parents being there. If they were none of this stuff would happen.

I'd counsel the doctor to skip the hugging and kissing

Agreed, but I can understand -- crying children coming to you all day makes you want to comfort them.

[Mirrorglass]

Umm... are you sure you understand the definition of exonerated (http://www.merriam-webster.com/dictionary/exonerate)? Because your response doesn't make sense to me.

Huh? Was that a typo?

Whoops. :blush: I must have mixed it up with "excommunicated" or such like. Well, at least I learned a new word today..

[Polaris]

Whoops. :blush: I must have mixed it up with "excommunicated" or such like. Well, at least I learned a new word today..

C'mon, man! When was the last time someone was excommunicated for kid-touching?

[Mirrorglass]

C'mon, man! When was the last time someone was excommunicated for kid-touching?

I just assumed it meant something similar, like being banished from the medical society. :p English isn't my first language, and this was the first time I came across the word. Usually I can deduce the meaning from context, but every now and then it fails, and embarrassment ensues.

[pgwenthold]

I wouldn't want to be a pediatrician, because I wouldn't want to work with sick kids.

I'm serious, sick kids really distress me. When I see babies in the NICU with IV lines and probes all over, I almost start crying. It started when I had my own. Sick kids are very hard for me to deal with, because I feel so bad for them.

I would love to do wellness visits for kids all day, though. That would be awesome. I'd let the nurses handle giving the shots (like our doctor does).

[fitzgibbon]

C'mon, man! When was the last time someone was excommunicated for kid-touching?

Not recently. I believe the usual practise is to assign them to a different parish.

[Mark6]

C'mon, man! When was the last time someone was excommunicated for kid-touching?
I strongly suspect it NEVER happened. As in, not once in the history of Catholic church. Back in the days, a priest careless enough to "touch" a son of local feudal lord might have been beheaded, but not excommunicated. "Touching" peasant children was of course fair game. As it ceased to be fair game, the church learned the art of cover up, blame the victim, and reassign.

[Cainkane1]

I just assumed it meant something similar, like being banished from the medical society. :p English isn't my first language, and this was the first time I came across the word. Usually I can deduce the meaning from context, but every now and then it fails, and embarrassment ensues.
Thats ok Mirrorglass everythings cool. English not being your first language explains everything. Glad you learned a new word.

[Cainkane1]

I wouldn't want to be a pediatrician, because I wouldn't want to work with sick kids.

I'm serious, sick kids really distress me. When I see babies in the NICU with IV lines and probes all over, I almost start crying. It started when I had my own. Sick kids are very hard for me to deal with, because I feel so bad for them.

I would love to do wellness visits for kids all day, though. That would be awesome. I'd let the nurses handle giving the shots (like our doctor does).
I feel the same way. Years ago my girlfriend called me and was in a semi panic. Her four year old sister had a high fever and was hallucinating. I came over to help and I've never been so nervous and unhappy in my life. We kept giving her cool water and I had some rubbing alcohol with me. My girlfriend swabbed her with the alcohol and before her parents got home from work the fever broke. Sweat was pouring off of the child but we continued giving her water and in a few days she was well.

[yomero]

I feel the same way. Years ago my girlfriend called me and was in a semi panic. Her four year old sister had a high fever and was hallucinating. I came over to help and I've never been so nervous and unhappy in my life. We kept giving her cool water and I had some rubbing alcohol with me. My girlfriend swabbed her with the alcohol and before her parents got home from work the fever broke. Sweat was pouring off of the child but we continued giving her water and in a few days she was well.

I am a pediatrician. I can tell you that it was a mistake to rub alcohol on a small child in an attempt to lower fever. A child can reach toxic levels of alcohol through the combination of cutaneous absortion and inhalation of vapors. It does happen, I saw 2 cases like that, though both were in children younger than 4 yrs. The recommended behavior is to apply cold compresses. And rush to an emergency room.

http://www.inchem.org/documents/pims/chemical/pim290.htm#SubSectionTitle:9.1.3%20%20Skin%20expos ure

[pgwenthold]

I am a pediatrician. I can tell you that it was a mistake to rub alcohol on a small child in an attempt to lower fever. A child can reach toxic levels of alcohol through the combination of cutaneous absortion and inhalation of vapors. It does happen, I saw 2 cases like that, though both were in children younger than 4 yrs. The recommended behavior is to apply cold compresses. And rush to an emergency room.

http://www.inchem.org/documents/pims/chemical/pim290.htm#SubSectionTitle:9.1.3%20%20Skin%20expos ure

Presumably the goal was evaporative cooling, but sure, too much would lead to absorption. I absolutely trust your statement about cold compresses and the emergency room. Although the question (as always) is how high does the temp need to be?

The highest we've ever encountered with the Offspring was I think 102.7 axillary, which is pretty high (far higher than we've ever had otherwise) for him but not emergency room level. When do we do that (17 mos btw)

[Dr. Keith]

The only thing the doctor did that I wouldn't advise is the hugging and kissing of the patients.

Our pediatrician is a personal friend and he always hugs our kids away from the office and only shakes their hands at the office. I guess this explains why: professional setting versus personal. (Occasionally our kids see a relative who is a pediatrician, and then it is hugs all around, but that is less common.)

And I have never left my child alone with any doctor. Was that part of this?

[paximperium]

Presumably the goal was evaporative cooling, but sure, too much would lead to absorption. I absolutely trust your statement about cold compresses and the emergency room. Although the question (as always) is how high does the temp need to be?

The highest we've ever encountered with the Offspring was I think 102.7 axillary, which is pretty high (far higher than we've ever had otherwise) for him but not emergency room level. When do we do that (17 mos btw)
Tylenol/acetaminophen/paracetamol- 15mg/kg every 6hours.
Keep out of my ER.

PS: There is no correletation between severity of illness and fevers but very high fevers can lead to febrile seizures.

[pgwenthold]

Tylenol/acetaminophen/paracetamol- 15mg/kg every 6hours.
Keep out of my ER.


That's what we did, thank you.

Now, to the question I asked: at what point DO we go to your ER? 108? 110? 120?

[paximperium]

That's what we did, thank you.

Now, to the question I asked: at what point DO we go to your ER? 108? 110? 120?
I use a rough rule of over 106F even with treatment(tylenol, motrin, cooling etc).
Technically 106F is considered hyperthermia and once you cross over to 108F, things like muscle break down and seizures become more likely.

[yomero]

That's what we did, thank you.

Now, to the question I asked: at what point DO we go to your ER? 108? 110? 120?

When there is danger of febrile convulsions, if we consider fever alone. The child mentioned by Cainkane1 was hallucinating. If there is a history of previous convulsions or if the fever is very high (over 38.5C), prompt help should be sought.

A child is very fragile. Any symptom or sign noticed, should be attended.

[pgwenthold]

When there is danger of febrile convulsions, if we consider fever alone. The child mentioned by Cainkane1 was hallucinating. If there is a history of previous convulsions or if the fever is very high (over 38.5C), prompt help should be sought.

38.5 seems pretty mild for an 18 mo old, doesn't it? I agree that if there is a history, but you say OR 38.5. Even if we are talking about medicated and axillary, I wouldn't think that would be an emergency.

[yomero]

38.5 seems pretty mild for an 18 mo old, doesn't it? I agree that if there is a history, but you say OR 38.5. Even if we are talking about medicated and axillary, I wouldn't think that would be an emergency.

Most children tolerate 38.5C without presenting seizures. However, the disease causing hyperthermia should be attended.

[pgwenthold]

Most children tolerate 38.5C without presenting seizures. However, the disease causing hyperthermia should be attended.

paximperium puts hyperthermia at 41C. Would you agree?

[Cainkane1]

I am a pediatrician. I can tell you that it was a mistake to rub alcohol on a small child in an attempt to lower fever. A child can reach toxic levels of alcohol through the combination of cutaneous absortion and inhalation of vapors. It does happen, I saw 2 cases like that, though both were in children younger than 4 yrs. The recommended behavior is to apply cold compresses. And rush to an emergency room.

http://www.inchem.org/documents/pims/chemical/pim290.htm#SubSectionTitle:9.1.3%20%20Skin%20expos ure
I wish I had known this but I was only 19 at the time and my girlfriend was only 17. My Grandmother had rubbed alcohol on me when I was sick with the measels when I was 7 so I thought it was the thing to do. The little girl did recover and we are still friends 44 years later. Thank you for this information.

[Cainkane1]

Tylenol/acetaminophen/paracetamol- 15mg/kg every 6hours.
Keep out of my ER.

PS: There is no correletation between severity of illness and fevers but very high fevers can lead to febrile seizures.
I hate to say this but my girlfriend gave her sister half an adult asperin. This was in 1966 before we knew about Reys syndrom. Despite us the girl recovered. I feel like a witchdoctor now.

[Morrigan]

C'mon, man! When was the last time someone was excommunicated for kid-touching?

Hah! Well played.

[paximperium]

paximperium puts hyperthermia at 41C. Would you agree?
I agree with Yomero.

41C is a number, it does not indicated the underlying disease in question. A child could have a mild fever and have meningitis or a kidney infection while a child with a completely benign viral illness could have a fever of 42C without too much problems.

The higher temps are only relevant when it comes to febrile seizures.

[yomero]

paximperium puts hyperthermia at 41C. Would you agree?


Perhaps I am using the wrong English terminology. In Spanish, my native language, hipertermia is used as a generic term for any temperature above normal. Hiperpirexia stands for extremely high temperature, above 41.0C, difficult to manage. I know that in English the term malignant hyperpyrexia is used for an extremely high fever, difficult to control, in relation sometimes to muscle relaxants and anesthetics during surgery or to other drugs. This is a very severe, life-threatening situation.

[pgwenthold]

I agree with Yomero.

41C is a number,


It's not a number, it is a temperature.


it does not indicated the underlying disease in question. A child could have a mild fever and have meningitis or a kidney infection while a child with a completely benign viral illness could have a fever of 42C without too much problems.

The higher temps are only relevant when it comes to febrile seizures.

Fine, but is there a temp at which the child should go to the emergency room without consideration of anything else? Above you say 106, but Yomero is dancing around so much, I can't take anything from it.

I'm not talking about seizures, I'm talking about what fever would indicate emergency treatment.

[paximperium]

I'm not talking about seizures, I'm talking about what fever would indicate emergency treatment.
You're asking a question where there is no clear cut answer.
Any fever to a child below 3months(38C or 100.4F) is considered an "emergency". Anything else beyond that has no correlation with severity.

They've looked at severity of illness, including the rate of bacteria in the blood(Bacteremia) and other factors and there is no great correlation between the temperature of the fever and the actual severity of illness.

Sorry but 41C or any temp is just a number to me. It does not tell me anything more about the child except to say that they have a fever. Are they well hydrated, mentating well, eating, breathing fine, pulsoximetry etc etc etc.

[Steve]

Sorry but 41C or any temp is just a number to me. It does not tell me anything more about the child except to say that they have a fever. Are they well hydrated, mentating well, eating, breathing fine, pulsoximetry etc etc etc.

Then, contrary to your earlier statement "Tylenol/acetaminophen/paracetamol- 15mg/kg every 6hours. Keep out of my ER." regarding a temp of 102.7(F) perhaps "your" ER is the appropriate place for the child to be so that you can professionally determine the status of all these other conditions rather that leave it to a layperson.

[paximperium]

Then, contrary to your earlier statement "Tylenol/acetaminophen/paracetamol- 15mg/kg every 6hours. Keep out of my ER." regarding a temp of 102.7(F) perhaps "your" ER is the appropriate place for the child to be so that you can professionally determine the status of all these other conditions rather that leave it to a layperson.
Sure. It was stated rather flippantly.

A fever is a fever. Take some tylenol. If you are worried about something else come on in. It gives me work to do but more often than not, most parents don't even give anything and end up wasting their time and money. I have no issue talking with parents about proper fever control and how check for other issues.

PS: I often see parents who bring their kid in for a fever and the conversation goes like this:
"He/She have a fever."
"They have a fever and...?"
"Nothing. I just want them checked out."
"Are they eating fine, drinking fine, pooping and peeing fine?"
"Yup."
"Did you give them any tylenol or motrin?"
"Nope."
*Silent facepalm*

[Checkmite]

Question: I get that a really high fever is not indicative of a necessarily severe underlying cause. But, is there a certain temperature at which the fever itself becomes a safety concern, regardless of underlying condition? In other words, is there such a thing as 'too hot'?

[paximperium]

Question: I get that a really high fever is not indicative of a necessarily severe underlying cause. But, is there a certain temperature at which the fever itself becomes a safety concern, regardless of underlying condition? In other words, is there such a thing as 'too hot'?
I kind of answered this in an earlier post but yes. The answer is not set in stone but a temp above 106F increases the risk of febrile seizures, muscle breakdowns a host of other badness if left untreated.

PS: The term fever is used rather colloquially even in medicine. Fever is technically an intrinsic process due to change in the central temp control system so it rarely rises to absurdly high levels. Hyperthermia just means an increase in body temp and can rise from a fever or some other internal(hormone problems, drug problems etc) or external problem(heat stroke etc). These temps can be very high and I've seen a malignant hyperthermia patient with a temp of over 112F before.

[Steve]

Sure. It was stated rather flippantly.

A fever is a fever. Take some tylenol. If you are worried about something else come on in. It gives me work to do but more often than not, most parents don't even give anything and end up wasting their time and money. I have no issue talking with parents about proper fever control and how check for other issues.


PS: I often see parents who bring their kid in for a fever and the conversation goes like this:
"He/She have a fever."
"They have a fever and...?"
"Nothing. I just want them checked out."
"Are they eating fine, drinking fine, pooping and peeing fine?"
"Yup."
"Did you give them any tylenol or motrin?"
"Nope."
*Silent facepalm*

Thanks. I thought I caught the "flippant" part of your earlier post but I wasn't completely sure. I think have seen enough of your posts here to be confident that you do take your job seriously. My wife has some experience as a pediatric RN and I know she would heartily agree with this post of yours.