The discrepancy of hospital pediatric care
Wednesday, April 19, 2017
"Daddy, I scared," my son gasped, arms outstretched before collapsing breathlessly on the floor. And the only thing scarier than having your child falling lifeless at your feet is not knowing where to take him.
This is a story about the importance of pediatric care and why it's good practice for young parents to learn how some hospitals are better at providing it than others.
Several years ago, I was face-to-face with this horrible reality when our 3-year-old son was having an asthma attack.
I had woken in bed to my young son knocking on our bedroom door early one morning. He was whining about something, but I didn't really want to pay too much attention. It was early, yet there was something about his urgency that made me get out of bed.
My wife rolled over twice, mumbled a "whatever," and I stumbled after my son who had retreated back into his own room.
I didn't think it was serious initially. While he was breathing weirdly, but I dismissed it, convinced he'd accidentally wet the bed. I lifted his shirt to check if he was damp and saw that his lungs looked stuck in the "deep breath" position.
Hmm, I thought, something just might be wrong here. I gave my panicked son a side-eyed glance, promised him pancakes if he "cut it out" and moved on.
I decided to sit with him and watch television in hopes of calming him. It was then that one possibility suddenly dawned on me: Could he be having an asthma attack?
Nah, I thought to myself. That's stupid, he doesn't have asthma. Plus, something like that just doesn't manifest out of the blue — fun fact: it actually does, according to the Mayo Clinic.
It was only when I decided to walk away that my son jumped up, reaching out to me in a panic and fell to the ground.
Rural vs. urban
As a young parent, you have issues that never occur to you until it's too late. One such issue is living in proximity to a hospital with proper pediatric care.
We rushed to the hospital located down the street from our suburban Maryland home. On first inspection, its services were fine. It wasn't until after the entire messy affair that a relative, upon hearing which hospital I took my son to, responded incredulously, "You took him where?"
"We took him to Regional."
"Why would you take your kid there? They don't know how to handle kids there," he asked, as if I should know. "Don't ever take your kids there!"
The idea that there was — and in some cases, still is — a difference in care provided from hospital to hospital has been readily documented for decades.
According to a 2010 study titled "Pediatric Care in Rural Hospital Emergency Departments," concern about inadequate emergency care for children was raised in 1984 when researchers in Los Angeles County reported higher death rates from trauma among children in the field and at the hospital.
"In the years that followed, the U.S. Department of Health and Human Services instituted the Emergency Medical Services for Children program, and the American College of Emergency Physicians and American Academy of Pediatrics jointly issued guidelines for pediatric emergency department (ED) care," according to the study.
"Optimal emergency care for children may be difficult for rural hospitals to provide. Rural hospitals have less access to pediatric and emergency medicine trained physicians, and a low volume of pediatric ED patients makes it difficult for staff to maintain pediatric care skills.
"In addition, rural hospitals may be far from a hospital that admits critically ill children, requiring that the rural hospital receive and stabilize pediatric emergency cases prior to transfer. Previous studies have only partially investigated potential rural disparities in pediatric emergency care."
Of course, I wasn’t aware of this disparity when I scooped my son into my arms and ran, screaming like a Fraggle, to the family car, while yelling to my wife, "I think something's wrong!"
Few things are more arresting for a parent than the abject horror of one's child not being able to breathe. So we hopped into the car and rocketed to the suburban hospital down the street from us.
In hindsight, we should have gone to Howard County General Hospital, which is associated with the prestigious Johns Hopkins School of Medicine, but expedience was the key.
We arrived at Regional, and I was immediately made aware that children was not their thing. Whenever my son and I had to interact with anyone — whether doctor or nurse — there seemed to be a strange, palpable anxiety. It was as if everyone silently knew this was kind of a big deal, but no one really knew what or who should do something about it.
While awaiting a doctor, I reclined in a hospital bed with my son on my chest. Soon a doctor arrived, looked my son over and gave the diagnosis I had already predicted: asthma attack.
What he needed was a nebulizer, which was all well and good, but his approach showed this wasn't something he was especially comfortable doing. The doctor turned on the nebulizer, which resembles a snake with a mask for a head. When turned on, the snake suddenly starts exhaling a smoky mist.
Adults know the mist is a vaporized medicine that is desperately important to the young lungs of an asthma sufferer. But to a 3-year-old who has had one of the worst mornings of his life, the mist was a venomous death cloud spewing from the mouth a serpent from hell.
To say that he fought back is an understatement.
For the next five minutes, a small asthmatic child fought off what he assumed was death, along with two fully grown men. It was a wrestling match for the ages, and one that I can say with little shame that I lost.
Embarrassed and frazzled, the doctor switched nebulizer masks for one shaped like a flute that my son could suck on. Satisfied that the snake was now gone, my son began breathing in the medicine and the doctor fled, recounting to anyone who would listen the legend of the mighty child who fought with the strength of two men.
Of course, I now know that fear of the nebulizer isn't unique to my son. In fact, it's rather common among children. There are some easy ways to help a child overcome such fears such as giving the nebulizer a nickname or adding colorful, cartoon faces to the masks.
Unfortunately, the doctor either wasn't prepared or knowledgeable about attending to children.
The fear of doctors can have long-term effects for children. According to Mindy Mesneak, a child-life specialist at Cardon Children's Medical Center in Mesa, Arizona, "When a child has one negative experience, it can ruin the trust in medical facilities and staff for a long time, even into adulthood."
According to findings by the National Child Traumatic Stress Network (NCTSN), approximately 80 percent of pediatric patients and their families report some traumatic stress following an injury, hospitalization, illness or painful medical procedure. Therefore, it is important that hospitals work to ease and/or address stress and fear in their young patients
The NCTSN has provided a Pediatric Medical Traumatic Stress Toolkit online for healthcare providers.
Transferred to DC
Once my son was out of the woods with his asthma attack, my wife and I were told by the doctors that they were going to transfer him to Children's National Medical Center in Washington, D.C., for the best possible care.
There's no wonder why Children’s National Medical Center has been ranked as one of the top 20 pediatric hospitals in the country. The atmosphere was very different, with children of various ages and types running about in a building that was literally built to accommodate them.
Once I caught up with my wife, who was in a room with our son and his much more prepared doctor, we found that he had suffered an asthma attack due to his allergic reaction to the high pollen count of the changing seasons.
We were given an inhaler and instructions on how to treat this condition going forward, as well as the comforting prediction that this was something he would more than likely grow out of. He eventually did.
One thing he didn't grow out of however, was his penchant for hospital visits. Turns out, this was just the beginning for him as he would wreck and destroy his body through both curiosity and comic misadventure for the next several years.
When he somehow and for whatever reason shoved a bead up his nose a year later, I knew which hospital to choose. Unfortunately, when it comes to child care, they are not all created equal.
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