Most parents are going to need to take their sick child to the doctor at some point before the child grows up and leaves home. In fact, even if your child is never sick, you should be taking your child for routine well-child check-ups, but more on that in a future post! So, how do you talk to the doctor? What does the pediatrician need to know about your child’s illness? What do you need to be writing/recording during their illness that the doctor will find helpful? This blog post will cover my recommendations on how to tell your child’s doctor the story of their illness so they can make the most informed diagnosis.
History Of Present Illness
Your child’s pediatrician may ask, “So, tell me what brings you in today?”. This is your chance to tell the pediatrician the history of the current illness, but the information should be organized and concise. Let’s face it – you’re not putting your best foot forward when Junior has been vomiting on you all night with a fever. You’re sleep deprived and worried! It is easy to lose track of information and make the ‘story’ into a wandering, convoluted re-telling that confuses the doctor. It could possibly cause you to forget important information!
To avoid this, one of the first things I do when my child gets sick is to grab something to write with. For me, this is often my whiteboard and dry erase marker in my kitchen, or sometimes it is a notebook I keep in my purse for shopping lists/errands, or a piece of paper/envelope and pen clipped to a board. The key is to have the information handy and to be prepared to keep a running log of events once the first symptom starts. I often use my smartphone to take a photo of my notes, so I have it handy when I leave home.
I record the illness in the following format: (a mnemonic I learned in my former days as a nurse!)
(Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, Severity)
O – Onset of symptom(s) (date/time)
L – Location of symptoms, one place or radiating (does the symptom move around?)
D – Duration of symptoms
C – Characteristics of symptoms – Fever temperature & time; Size of the injury/lump/bump/bite, Type of pain/symptom (dull, aching, burning, stabbing, pressure), etc.
A – Aggravating factors – what makes it worse? Worse with eating? Or worse with dry air? Is it worse at night? Positional?
R – Relieving factors – Have you tried anything to make it better? Medication that helped – quantity & time given? Other therapies that helped (hot tea, warm compress, ice, etc.)
T – Timing – frequency of illness or symptoms, morning vs night, the pace of illness
S – Severity of pain or symptoms – the amount of pain, difficult breathing, disrupting sleep, disrupting school, etc.
As you can probably tell, no one has ever accused me of not being organized! I know that the information format of OLD CARTS may seem overwhelming to some, but the key is to write down what you can so you can keep a timeline of events. The telling of the ‘history of present illness’ is crucial to finding the right diagnosis for your child. The majority of the time, the diagnosis can be made from this information alone. That doesn’t mean the pediatrician shouldn’t physically examine the child, but it certainly helps to narrow down the problem if you can give a good history!