Pointers for the Examination Technique
With regard to physical examination, the article states that a child’s throat and ears should be inspected, and the lungs and heart auscultated, and if the child is in pain, the site where the pain is felt should be localized. This strikes me as unsatisfactory in the context of such a seminal article. Important pointers in this setting should include:
The patient should be fully undressed during the examination (one sees increasingly often mothers who are apparently used to seeing their children auscultated above/through the neckline in their rompers, at the front and at the back, in a quasi-improvised fashion that only mimics a proper examination, even in pediatric practices.
Signs of meningitis should be excluded in all febrile children.
Palpation of the abdomen and the most important lymph nodes is, of course, one of the important steps in the examination.
A sentence in Figure 2 in the article that irritates me, is “search for cause, urinalysis if cause is unclear”. I wish to remind readers that we can identify genuine causes only in very rare cases, and it is a very subjective assessment on any pediatrician’s part, whether they consider a cause as sufficiently confirmed in the concrete case scenario (for example, “viral infection,” which is usually no more than an assumption). In other words, this means that in a febrile infant, urine testing is to be done as a matter of course; the younger the child, the more urgently (even though it may be slightly more laborious—it still can easily be organized in the outpatient setting).
Dr. med. Thomas Müller
Retired Pediatrician in Private Practice, Waren
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Niehues T: The febrile child: diagnosis and treatment. Dtsch Arztebl Int 2013; 110(45): 764–74 VOLLTEXT|