Chapter 2426: Startled
Earlier, we repeatedly mentioned in obstetrics that the key factor determining whether a child can be born naturally is the baby’s head. Therefore, during natural childbirth, the doctor’s hands must particularly protect the baby’s brain and adhere to standard delivery gestures.
When checking the fontanelle, besides assessing whether the closure timing is normal, like today’s child with a fever, feel the anterior fontanelle to see if there’s any bulging or tightness. If present, it may indicate the existence of intracranial hypertension. A fontanelle that is too large accompanying an oversized head circumference might suggest congenital hydrocephalus. A fontanelle that is very small or closed too early requires screening to see if there’s poor brain development. All these reasons represent central nervous system changes, which can potentially lead to clubfoot.
Student Xie was checking the fontanelle when Student Wei came over with a soft measuring tape to help measure the child’s head circumference.
Student Duan reviewed the temperature and blood pressure records previously taken by the nurse on the child’s medical history.
After a series of neurosurgical examinations, the child’s consciousness was still okay, without displaying abnormal states like drowsiness. The posterior fontanelle was closed, which is normal. The head circumference was 42 cm, within the normal range. The anterior fontanelle showed no bulging or depression, and there were no signs of abnormal intracranial pressure. The pupils were 3 mm, normal. The child’s spine showed no deformity or abnormal curvature. Weighing 81 kg and measuring 60 cm in length, this indicates the child is adequately nourished and is developing normally. Only the left foot is deformed. We need to take an X-ray of the bones to see if there’s any bone deformity.
However, clubfoot typically doesn’t cause the child to have a fever. The doctors need to continue investigating the fever episode further. Both Student Xie and Student Duan put on stethoscopes to listen to the child’s heart and lungs.
Student Wei picked up a ballpoint pen and notebook, asked the family, and recorded the child’s medical history.
"When did you first notice the child had a fever?" Student Wei’s pen tip tapped the notebook as he asked.
The child’s mother replied, "It should have been yesterday. We tried our way to wipe him down with alcohol to reduce the fever, it didn’t work, so we brought him to the hospital."
People understand that seeing a doctor is troublesome; some parents, seeing their child’s condition not serious, would think of ways to reduce the fever at home by themselves. If successful, it’s a small issue that doesn’t require going to the hospital.
"Do you know when this foot became like this?"
Upon receiving this question from the doctor, the child’s mother seemed to realize her son’s left foot anomaly for the first time, saying in surprise, "When we took him to get a check-up before, the doctor never mentioned his foot having a problem."
Indicating this child’s clubfoot was newly discovered. It’s not surprising, as many congenital disease symptoms aren’t prominent, only becoming noticeable when symptoms gradually emerge later on.
"Has he vomited or had diarrhea?" Student Wei asked again.
The child’s mother shook her head.
"Has there been any coughing?"
"I think so," the child’s mother said, "And crying, his voice is hoarse, we think he seems to have discomfort in his throat."
The child’s hoarse crying and throat discomfort, are the vocal cords or glottis having issues? Is it acute pediatric laryngitis? Several young doctors were startled.
Pediatric onset is rapid and progression is speedy; acute laryngitis in children epitomizes this. Due to the smaller throat cavity in children, laryngitis easily leads to swelling; their throat reflex is poorer compared to adults, airway secretions can’t be autonomously expelled, worsening blockage, eventually forming airway obstruction and suffocation. It’s one of the most common urgent conditions in pediatrics that requires vigilance.