In my many years as a pediatrician, I have identified a number of “pearls,” or words of wisdom, that can help in the clinical setting. Some of these pearls are practical, but relatively little known, tips. Some of them are common but erroneous medical beliefs held by parents that must be addressed in order for families to follow through on a treatment plan or have faith that their pediatrician knows what he or she is doing. Lastly, some pearls are erroneous (or, at least, unsubstantiated) beliefs held by pediatricians themselves. In this first of several articles, I will review some of these unknown truths and known falsehoods.
Support for the statements that follow will be of various strengths. Although much of early medical school teaching is lost over time to the pediatrician without adverse events (I know I have never had to rely on a knowledge of the Krebs cycle to provide good care in the outpatient setting), some truths consistently remain vital, particularly in microbiology, pharmacology, genetics, and probability theory. Thus, some of the material presented here will be derived from these first principles. Other comments will be backed by evidence-based medicine; still others by common sense (which is a useful, but not infallible, justification); and some simply by practical experience. I believe them all to be true, and they arise with some regularity in the office. These “pearls” will be grouped into categories for easy retrieval.
1. Steinhoff MC, Walker CF, Rimoin AW, Hamza HS. A clinical decision rule for management of streptococcal pharyngitis in low-resource settings. Acta Paediatr. 2005;94(8):1038-1042.
2. American Academy of Pediatrics. Group A streptococcal infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012:668-680.
3. American Academy of Pediatrics. 2014 PREP Self-Assessment; 2014:C-116.
4. Tanz RR, Poncher JR, Corydon KE, Kabat K, Yogev R, Shulman ST. Clindamycin treatment of chronic pharyngeal carriage of group A streptococci. J Pediatr. 1991;119(1 pt 1):123-128.
5. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Eng J Med. 1984;310(11):674-683.
Eyes, ears, nose, throat:
1. Paradise JL, Campbell TF, Dollaghan CA, et al. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med. 2005;353(6):576-586.
2. Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149(1 suppl):S1-S35.
3. Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2012;9:CD004461.
1. Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2012;9:CD001211.
2. Shope TR. Infectious diseases in early education and child care programs. Pediatr Rev. 2014;35(5):182-193.
3. Bingen E, Cohen R, Jourenkova N, Gehanno P. Epidemiologic study of conjunctivitis-otitis syndrome. Pediatr Infect Dis J. 2005;24(8):731-732.