Opinion: Tongue blade and tylenol


Readers comment on a method to distract pediatric patients, and the unproven Tylenol test

Asphyxiating the tongue blade

To the editor:

I'm always looking for novel ways to distract patients and their sibs during a history and physical. I enjoyed Dr. Belamarich's Clinical Tip ("The art of distraction," June 2008), except that a toddler might be tempted to quiet his crying newborn sib by putting a blanket over the baby's face. I will utilize the technique, but will probably call the sleeve a sleeping bag and omit the covering of the face.

The Tylenol test, unproven yet frequently used

To the editor:

I returned from a weekend off-call, and had the usual large pile of emergency room and cross-covering physician' notes to review on my patients. Looking at them, it was frightening how often the response to anti-pyretics was used in clinical decision-making by other physicians. Furthermore, my experience is that parents also widely believe this misconception. This practice is not founded in evidence, nor supported by guidelines.1 I suggest that pediatricians educate their colleagues and parents much more aggressively on this erroneous and dangerous belief.

Mark Dickinson, MD, MPH Concord, Mass.


1. American College of Emergency Physicians, University Association for Emergency Medicine. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med 2003;42:530

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