Bad Parenting

When your kids refuse to take medications for a condition that brings them to the ER, I cannot solve that problem. And you’re potentially subjecting your kids to more risks. Iatrogenic complications are not always trivial.

A 3-year-old patient with a fever was unwilling to take any medications. Mom had to use rectal Tylenol at home for her fever. She came to the ER with some nausea and vomiting. The patient was given anti-nausea medicine and a sippy cup with some juice. She refused to take it. The plan had been to then give her ibuprofen to help with the fever as well. However, she continued to refuse the juice.

The patient stayed in my ER for about 3 hours, playing on the bed, resting at times, covering her eyes, and playing peekaboo. She likely had a viral illness. Her testing for RSV, COVID, and influenza was negative. That does not rule out a whole bunch of other viral illnesses that my hospital does not test for. Other hospitals can test for these, but the test is a send-out and takes a long time to come back, so it is not usually useful in real time anyway.

However, mom’s concern was that maybe the patient needed more tests for the fever. She had not been complaining of any belly pain; she did not have a history of urinary infections, and she did not complain of any urinary symptoms. Yet mom was concerned that maybe she had a urinary tract infection and we should investigate that.

I explained that without any symptoms—and in kids, sometimes it is hard to get a clean sample—if she was able to provide a sample and it was contaminated, we could potentially end up treating a false positive rather than an actual urinary infection. So once we go down that path of looking for more things, we might accidentally find false positives that aren’t truly there. That does not help the patient. She does not need to be on antibiotics for a urinary infection that she does not have. And we do not need to chase a urinary infection just because of the fever when we haven’t treated the fever.

UTIs are somewhat common in children, more so in girls than in boys. We also commonly look for conditions like pneumonia. More serious infections—such as appendicitis, kidney infections, or meningitis are much rarer.

But as you can probably see, if we simply use the fever as the reason to investigate further, and we are only investigating it because it has not resolved yet, and it has not resolved yet because we are not treating it, we are potentially heading down a path that leads to a much larger workup, searching for more and more things that are increasingly less common.

So, again, when your kids do not take medication, it is a parenting problem. It is not a medical problem.