Plain talk about office practices

May 1, 2018

Jon Matthew Farber, MD, shares more observations on office practice and some useful websites for patient information.

1. If a child has had severe respiratory syncytial virus (RSV), or a febrile seizure, the parents will be very worried the next time their child is ill. Acknowledge this fear, let them know what to watch for, and assure them that after a few benign illnesses, and seeing that their child does well, they will be less anxious in the future.

2. For night terrors, scheduled awakenings can be of benefit. After determining when the terrors are likely to occur, the parent can awaken the child shortly before the expected time, for several nights in a row. This apparently interrupts the cycle and can relieve the problem.1

3. Showing parents reliable images online of what you are diagnosing (eg, urate crystals in the diaper) or not diagnosing (the actual rash of erythema chronicum migrans when the family is worried about Lyme disease) is very helpful.

4. Infants and young children are much smarter than we are in some ways. Thus, an adult who has hurt his neck might try to convince his doctor that he is not really hurt, but not so for youngsters. If a child is moving his or her neck freely after an injury, he or she has not suffered a serious spinal injury, and will not need x-rays.

5. The Oralflo cup (Oralflo Technologies; Raritan, New Jersey), or others, can be useful for helping children to swallow pills.

6. TGuard, formerly ThumbGuard, devices (MED et al, Incorporated; Matthews, North Carolina) can be useful for thumb-sucking. Bitter tasting products that are applied to the thumb seem less likely to work, unless the child is motivated to stop. That is, they appear to operate more as a reminder to take the thumb out, rather than as an actual deterrent.

7. I post tidbits about children where they can be easily seen whenever I open the chart. Examples of items that might go here include how to pronounce names, the child’s accomplishments/interests, if the family brought me homegrown tomatoes, and if a parent has a serious medical condition. Most electronic health records have an easy way to do this.

8. Update your equipment when needed. Stethoscopes develop cracks that can interfere with listening. The MacroView otoscope (Welch Allyn; Skaneateles Falls, New York) is vastly superior to the ones of the previous generation.


1. Frank NC, Spirito A, Stark L, Owens-Stively J. The use of scheduled awakenings to eliminate childhood sleepwalking. J Pediatr Psychol. 1997;22(3):345-353.

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