45. Principles of confidential care for patients

The next question is, “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

This is an example of a question-and-answer on internet pediatric and adolescent health counseling during “Ask and answer on any child medical care question thru the Internet done by myself about 10 years ago”.

Q&A. “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

1.Subject: For 1 hour 30 minutes febrile convulsions.

Age: 28 months old, Gender: Male

Past medical history:

· 1 time at age 7 months old, fever due to the swollen throat,

· 2 times fever before the first birthday, 1 time at age 16 months old, and most of them did wake up by themselves. He was brought to the emergency room for all cases.

· There were no significant sequelae.

Family history:

· Dad said that he had twice febrile convulsion at the first 100 days old to age 6 years old and his mother also had one febrile convulsion as a child.

Examination findings:

· Febrile convulsion, no abnormal EEG finding.

· However, the convulsions that occurred at the age of 27 months old were different from usual, and I quite worry a lot as a mother.

· At one time, his throat was swollen and red and he had a fever.

· Watching the child with a fever and this time I started looking at the clock.

· After bubbling in his mouth and unconsciousness, difficulty breathing for 5 minutes, he woke up after showing a change as if crying while making a groaning sound. And the convulsions lasted more than an hour.

· His doctor seemed to regard the convulsions as a post convulsions status. The convulsions lasted for 5 minutes, but he could have post convulsions status lasted more than 1 hour.

· When he had arrived at the emergency room after 20 minutes of convulsion by the ambulance.

· The nurses there said that the child was awake and told us not to worry, but after however that the convulsion persisted, they called the doctor in charge and the doctor administered suppositories of sedatives three times as first aid.

· Still, the child did not wake up and did have the convulsions with holding fists tight, two legs stiff, eyes closed, moaning remains. After an hour and a half had passed, he repeated to sleep in pain and crying.

· The doctor gave the bad sedative three times and then he said your child had post-convulsion status.

· What is post-convulsion status and how can it be treated?

· I am curious because there is no detailed explanation of the post-convulsion status anywhere.

· He couldn’t walk after a convulsion as if a drunk person was paralyzed as if he was out of balance and bumped and fell.

· Isn’t this Todd paralysis that may appear after febrile convulsion?

· The emergency room doctor who has watched the convulsion looked inexperienced and is unreliable.

· Pediatric neurologists don’t seem to believe that he has febrile convulsion lasting

for the 1 hour and 30 minutes.

· They thought he has simple febrile seizures.

· It may be because there is no standard treatment method right now.

· The result of the EEG test is normal and at the moment, he can walk well and not showing any after-effects.

· It is recommended to use valium suppositories when convulsing only for the possible recurrence of febrile convulsion.

· As a mother with poor medical knowledge, I write down the frustration of neither trusting nor trusting doctors.

· How would you judge and deal with if he is your child?

· Please give me a clear answer. A worried mother.

To dear worried mother

· Hello. Thank you for asking. And thank you for giving me detailed information on your medical history and symptoms.

· You did well as if in the morning, when in the medical rounding for the pediatric ward at a university hospital, one of the interns reported to the head professor on the progress of the patient’s illness who he was responsible for and treated over the past day.

· Thank you.

· I understand to some extent you who has been worried a lot during that time.

· He has had a diagnosis, treatment from many famous and good doctors, but I am afraid and worry that I will be able to give you a better answer.

· Today I posted an article about febrile convulsions on my homepage, www.drleepediatrics.com”.

· Please read it.

· In my opinion, your baby had a fever every time and he had a convulsion, and again, when he had a convulsion and also he had a fever, and when he did not have a fever, there was no convulsion, I think he had a febrile convulsion.

· There are simple febrile convulsions and complex febrile convulsions and status febrile convulsion in a febrile convulsion.

· By definition, if a febrile convulsion is lasting for more than 20 minutes, it is called a complex febrile convulsion. His convulsion lasted up to an hour and a half, and he did have Todd’s paralysis, so I think he had a complex febrile convulsion.

· In addition, seeing that he had convulsions for more than 30 minutes and did not regain consciousness in the meantime, it seems that his convulsion fell into a “status febrile convulsion”.

· There are three types of febrile convulsive.

· About 5% of febrile convulsive can develop status febrile convulsion.

· He seem to have received adequate treatment.

· However, from now on, it would be a good idea to consult with a pediatric neurologist about preventing febrile convulsion from occurring again.

· There are pros and cons of its prevention, and there is no unique form of way to prevent it.

· If my child had a severe febrile convulsion, and my child had a persistent febrile convulsion, my child also received appropriate emergency treatment at the emergency medical center, hospitalized, and investigated to find what other abnormalities he had for convulsions. I will consult to other physician or send my child to a pediatric neurologist for follow-up treatment and prevention as directed by him.

· However, here is an interesting article I read, so please read it.

■ “Principles of confidential care”

· I am here to serve your health and well-being.

· I will always try to provide the most appropriate treatment and service for you.

· I believe anyone needs a little help sometimes.

· I can’t cure all the sicknesses.

· I am your doctor, not your friend.

· I will not lie to you.

· I promote your health and provide information about your behavior problems.

· I am not here to judge what is right and what is wrong.

· Parents train their children to behave morally, socially, and culturally. (Source-Dr. Ann Bruner)

· Your child doctors looked for the patient with “Principles of confidential care” in his mind.

· When a child asks his mother for bread, she does not give a stone.

· When a child asks his mother for fish, she does not give him a poisonous snake.

· Our doctors always try to give their patients good bread and good fish.

· And we stand to serve for the health and well-being of our patients.

· Goodbye.

· If you have more questions, please visit again. Thank you. Lee Sang-won.

Figure 275. Principles of confidential care. Source- Dr. Ann Bruner

Copyright ⓒ 2012 John Sangwon Lee, MD., FAAP

Praise and jealousy

The following is an example of a question-and-answer on the Internet pediatric and adolescent health counseling on “what to do with praise and jealousy”.

Q&A. Praise and jealous

1.I have a 5-year-old girl who has a 6-year-old brother and another child.

She took off her milk bottle at age 15 months and toilet training was done at age 19 months.

However, she is so taller and stronger, and healthier than other children for her age, and since she was young, she was really bigger’.

Even she’s bigger than her old brother.

She was like his older sister.

Her old brother was handsome and booty. I heard a lot about that from the others.

And this year (February), she had her younger brother, and all of a sudden, from a week ago, she just started to do pee anywhere.

I changed his clothes 7 to 8 times a day, even if I could not count a day, and even in sleep.

I gave soothing and sometimes I gave punishment.

She went to pee, but it just came out first.

And she is too obsessed with her appearance.

After going to kindergarten, she has been trying to touch her hair and applying anything.

Is it because of the younger brother or the urinary tract infection?

What should I do to help?.

Dear Yerin

Hello. Thanks for asking. That’s a good question.

Diagnosing and treatment can be done by the results of obtaining information on the child’s age and gender, past and present patient’s and family medical history, symptom and signs and physical examination findings, and appropriate clinical tests.

Ideally, I will respond with the information provided.

I have a dog called Snauger Megii Lee.

Her name is Megii Lee.

I have so much to learn from Megii Lee.

The Megii Lee reacted so sensitively to the intonation and tone of my speech, the eye contact love and the physical contact love.

If I sat too close to my wife and I made physical contact together with her, Megii Lee slipped between the two of us.

There were so many times.

Megii Lee thought of me as Megii Lee’s lover.

If I did not give good eye contact love to Megii Lee, did not pay attention to Meggie, and If Megii realized I and my wife may go somewhere with leaving Megii alone at home and Meggie could notice where we are going, Meggie bit and threw her toys, and also she made anger to us.

There was no end to the story on this Magic.

I would like to tell you another well-known old story in Korea.

This is a story about a Jeong-Seung(the high ranking government officer in Old Korea), a farmer and two cows were plowing waterfall rice fields during when the government turmoil disturbance period occurred.

A farmer was plowing with two cows in the water muddy rice field.

Jeong-Seung saw a farmer who was plowing the rice field with two cows while passing through a valley in order to flee from govermental turnoil disturbance.

Standing on the bank of the rice field, Jeong-Seung asked the farmer who was in the middle of a paddy field in the far distance, “Which of the two cows does the job better?”

The farmer, who was plowing the rice field, puts a plow and two cows in the middle of the rice field, walked out to the bank of the rice field, passes the full water field, puts his mouth on the Jeong-Seung ‘s ear, and says, “The cow on the right side is stronger and does better work.” Replied quietly.

The Jung-Seung asked, “you’re a very busy guy, Why don’t shout out to answer. You do not need to come out to answer me this far?”

“It’s because I feel it is bad when the cows hear the comparison that the cow on the left does a better job than the other does,” he replied.

Without knowingly, in front of other brothers or sisters or others, we speak out loud about the wrongdoings of our children.

Often they praise and rebuke other children in front of them.

Perhaps I did a lot of that while raising my three children.

Children are very young, but they are keenly observing their parents’ gaze and every move they do.

They know well whether the praise and training that other brothers receive or the punishment training, is fair or unfair.

They also appreciate the degree to which parents care for and love them.

As you said, she seemed to have been quite jealous of your brother. Jealousy between such brothers and sisters can also be normal.

For some reason, it seems that she had anger against his parents.

This time, a new younger brother appears, so she thought he had completely broken his heart.

So, it seems that she expressed her anger through mixed jealousy.

It seemed that one of the ways to express anger has been degenerative.

It seemed to be pissing because of that.

It seemed that she often changed clothes and the like to show her emotional desire to acknowledge herself and love him.

When I was in pediatric practice, parents brought 3-4-year-old girls to my pediatric office to give the earring-piercing for the first time.

From the 2-3-year-old toddlers, even all children are very interested in their physical beautiful condition and want to beautify their appearance.

When piercing the ear, she did not say a word that it hurt even if it really hurt, and she did not shed tears and responds gently to piercing the ear.

preschool children age 5 years old knows to some extent that men and women have different.

The instinct to make one’s body image beautiful to others is more pronounced.

Please talk to your child a lot.

Mother and dad give their children more unconditional love with eye contact love, physical contact love, focused attention love and care.

Find out what made her feel bad.

Never scold.

Also, have a medical examination at the pediatric office and do a urine test to check for urinary tract infections or diabetes.

Please consult with the child’s mental problems.

Please give more love and more.

If you have more questions, please contact me again. Thank you. Lee Sang-won, MD.

The following is an example of a question and answer for online pediatric and adolescent health counseling on “big child enuresis”.

Q&A. Big child enuresis

Hello.

Our eldest child is a 7 years old girl. But she still bedwet on the blanket in the evening.

Her body is also healthy and there are no other problems, but I am worried because she hasn’t had toilet training yet while sleeping.

She almost never knew he had peed, and she continued to sleep, or sometimes she took his clothes off and slept again.

When she was 6 years old, I went to the urology clinic, and the doctor told me to wait a little longer.

However, I am worried that there will be a problem with the child’s personality because it has not been fixed even when she was 7 years old.

Please tell me what to do.

Thank you. Sir

Thanks for asking. That’s a good question.

It is ideal to diagnose and treat the disease by reviewing the child’s past medical history, family medical history, physical examination findings, clinical lab test results and etc., but I will answer on the information provided.

I’ll give you an answer.

Please refer to the following information.

” When a child turns at 5-6 years old and cannot completely have toilet training at night, It is called nocturnal enuresis.

Enuresis is divided into organic enuresis and primary enuresis (functional enuresis).

Primary enuresis is defined if he or she does not have toilet training for at least 6 months while sleeping at night and then starts to wet the bed again. Nocturia is referred nighttime bed wet.

Nocturia enuresis caused by certain congenital organic diseases or acquired organic diseases in the urinary system, muscular system, nervous system, etc. is called organic enuresis.

Enuresis, which occurs without any abnormalities in the body, is called functional enuresis, physiological enuresis, or primary enuresis.

If there is nocturia enuresis, a physical examination and a urine test are given priority to finding out if there are any organic abnormalities in the urinary system, muscular system, and spinal nervous system.

In general, if a diagnosis of functional enuresis is made by combining past medical history, family medical history, examination findings, and urine tests, other clinical lab tests.

Usually, there is no need to test more than above for functional enuresis.
However, some doctors tell you to do an ultrasound of the kidneys, ureters, and bladder, or other tests.

In the case of functional enuresis, it is common for either parent to have a family history of having functional enuresis as a child.

Even if children with pneumonia do not want to cough, no matter how much children tried not to cough, children can’t stop cough, and she tried to stop enuresis at night, she can not stop enuresis without appropriate treatment such as nature of cough.

Even if she tries not to be wet, she can not stop bed wet at night without treatment.

You should not scold, embarrass, or punish a child for enuresis.

She urinates with nocturia wet as if she should not be scolded and embarrassed the child not to cough because he has pneumonia.

Parents shouldn’t have to put more mental pressure on her because to have enuresis.

If you make her embarrassing, scolding her, or punishing her, enuresis may become worse, and the child feels a lot more mentally and hurts mentally.

Last night, when she did not wet in the morning, “you praised her for good work, gave a star sticker, etc. As a reward, and put the star sticker on the calendar.

Enuresis can be treated with positive reinforcement therapy and delight the child by giving them bigger rewards based on the number of stars every weekend.

When older children can do laundry for a pee, there is also a negative reinforcement treatment method that allows the child to wash wet clothes with urine.

This is a kind of punishing training, so it’s better not to have those kinds of punishment such as the laundry.

PALCO WET-STOP enuresis or POTTY PAGER (www.pottypager.com) enuresis treatment alarm

You can try to treat enuresis first by using a machine above, etc.

Desmopressin, anticholinergic drugs such as Oxybutynin, and imipramine, can be used to treat enuresis.

There are also treatment options for diapers.

There is no cure yet.

Of the physiological nocturia, 98% of them are treated naturally by the age of 16, and the remaining 2% may continue to develop into adulthood.

Please consult with your pediatrician after receiving diagnostic treatment.

If you have more questions, please contact me again.
Thank you. Lee Sang-won, MD.,FAAP