Three year old(almost four) son has pnuemonia, wtf??

[lendaddy]

I'm a little upset with his doctor and maybe I shouldn't be. We had him in on Monday with a fever 103-104 and they said it was viral. At noon today he was above even that at 105+(I'm not sure of the accuracy) so we rushed him in. Low and behold he has a bad case of pneumonia and 2/3 of one lung is filled(which was characterized as "really bad"), other is clear. Doc gave him a antibiotic shot that she equated with a nuclear bomb that should produce very fast recovery. His oxygen level was at 93.

She says she missed it because she couldn't hear it in his lungs and even now she says she can't which is odd. I'm having my wife swing by another doc just to have them listen so I can see if his current doc is full of it.

Doc says he'll be just fine and not to worry but I'm still upset that it didn't get caught two days ago. This doc is highly regarded but.....

I know docs get tired of people bringing their kids in for every sniffle but we are not that way and I feel like she didn't take this seriously enough. Am I being to hard on the doc? FWIW I did not express any anger to the doc, I don't want her to associate my kids with a hassle if you get what I mean.

[M.D. Holloway]

Hopefully all is OK wit the lil guy. The anti-biotics should help if it is bacterial but it could be viral to which the shot won't much but stave off other infections. I have had it at least 7 times in my life. The first and worst the docs didn't hear any rattle in my lungs either but 2 days later I was in the hospital with Plurasy and a severe case that kept me there for 8 days.

Keep in mind, kids are built to last (like Snap-On tools!) - they can really pull through so much more then us and come out of it unharmed.

I know how you feel though. Stay strong brotha. It'll be alright.

[JeremyD]

My son went through the same think Len - and I felt exactly the same - unfortunately you have to get agressive with some doctors these days...

[lendaddy]

Yea, he's a strong little guy and I "know" he'll be OK but when it comes to your kids it's hard to be objective. Part of me wants to give the doc a "would your kid have gotten an X-ray on Monday" talk and the rational part of me understands how these things go down.

[stevepaa]

yeah, I have been there with three kids. Sometimes you wonder, but then I remember that medicine sometimes is more art than engineering. You are his first defense. Keep up the good work.


BTW being protective about your children does not stop even when they move out. trust me.

[Palum6o]

Definitely let the doctor know how you feel... sometimes I think these doctors lose a little bit of reality as they themselves are being squeezed between seeing as many patients as they can in 10 minutes and getting paid for what they are worth. I would be pissed off if I were you.

[Jims5543]

Same deal with our 4 y/o doc missed it on the first 2 visits then picked it up on the 3rd.

It would be awesome if he didn't charge for 2 of the 3 visits.

Once on the right meds he recovered quickly.

[gr8fl4porsche]

Learn as much about his symptoms right now while he still has them. Once you get pnuemonia, you are inclined to get it again. If he gets the same symptoms - you know what to do.

My wife gets pnuemonia every 4-5 years like clockwork. As soon as she feels the familiar pain in her chest, it's time to go to the emergency room.

[frogger]

Does he have asthma?

[lendaddy]

Originally Posted by frogger

Does he have asthma?

No, no other heath issues. My two year old does have asthma though.

[frogger]

Just curious. My wife has asthma, and seems to be more susceptible to pneumonia after an attack. Well, best wishes to a speedy recovery for your son.

[Nathans_Dad]

It's simple probability, really. Kid comes in with a cough and fever. 99% of the time it is viral. So, you treat it as viral. Once it declares itself as something more, then you move forward.

If you reversed the equation in order to treat every possible bacterial pneumonia then you would have everyone on antibiotics all the time.

By the way, just because he has infiltrates in his lung does not mean it isn't viral, viral pneumonitis can be pretty bad as well. I'm sure he is getting antibiotics but that is really to cover the increased possibility of bacterial infection now that you have a chest film with infiltrates on it.

It sounds like your doctor acted appropriately.

As said above, kids are super tough, like those super bounce balls. Your son will be fine!

[Jeff Alton]

My son had it right at his 4th birthday. He was fine, had a cough that lingered and lingered and was low on energy. I was surprised how well he handled it in terms of his disoposition and how well he continued to just be a happy little kid through it all!!

Cheers

[BGCarrera32]

Originally Posted by Jim Cesiro

.
It would be awesome if he didn't charge for 2 of the 3 visits.

Especially since they call it "practicing medicine."

"So if you're practicing, you don't charge for it, right?"

[lendaddy]

Originally Posted by Nathans_Dad

It's simple probability, really. Kid comes in with a cough and fever. 99% of the time it is viral. So, you treat it as viral. Once it declares itself as something more, then you move forward.

If you reversed the equation in order to treat every possible bacterial pneumonia then you would have everyone on antibiotics all the time.

By the way, just because he has infiltrates in his lung does not mean it isn't viral, viral pneumonitis can be pretty bad as well. I'm sure he is getting antibiotics but that is really to cover the increased possibility of bacterial infection now that you have a chest film with infiltrates on it.

It sounds like your doctor acted appropriately.

As said above, kids are super tough, like those super bounce balls. Your son will be fine!

Thanks Rick, like I said it's hard to be objective when it comes to your own children.

[Rot 911]

From personal experience: I got double pnuemonia years ago and the only way they could actually confirm it was with an x-ray. Apparently listening doesn't always give a good indication. So don't be too mad at the doctor in this case. Oh and I went into the hospital for IV antibiotics and was back home in 2 days feeling great!

[lendaddy]

We had a nurse listen to him and she said she also could not hear anything, so I'm relieved that his doc is being straight up. I had no reason to doubt her other than the paranoia

Rick, he has had a chest X-raay and it's definitely filled with fluid. Are you saying that even then it's still likely viral? I really got the impression that she knew it was bacterial now. She did do a couple other tests (urine and something else) would those have told her? Thanks again.

[Nathans_Dad]

Well first of all you would have to define what you mean by filled with fluid. If you mean fluid in the pleural space (outside the lung itself but inside the chest cavity) then that is called a pleural effusion and might have to be drained. The more likely thing is that the little guy has an infiltrate on his chest film which basically indicates inflammation of the lung tissue. It gets inflamed, the tissue swells (fills with fluid) and then it becomes more radio-opaque on chest film. So basically all an infiltrate tells you is that the lung tissue is inflamed. It does not tell you anything about what is doing the inflaming. It could be viral, could be bacterial...the only way to really tell for sure is to either culture a bacterium out of the sputum (lugie) or get a bacteria out of the blood. Then you could infer reasonably that the bacteria got into the blood via the lungs.

It is standard of care to start antibiotics on patients who meet clinical criteria for pneumonia, even though the problem COULD still be viral. The reasoning is that when you have an infection serious enough to produce an infiltrate on chest film (see above) the likelihood of a bacteria being the problem increases. Not only that, even if it isn't a bacteria in the first place, the inflamed lung doesn't fight off infection as well so getting a secondary bacterial infection is possible too. Plus, if you withhold antibiotics in a situation like that the patient could get much sicker if it is in fact bacterial and then you are up ***** creek, so to speak.

Make sense?

The urine test I would assume is a urinary strep antigen, streptococcus pneumonia (also called pneumococcus) is a common player in bacterial pneumonias. Whatever antibiotics your son is on would cover the common organisms including strep so it really is just trying to sort out what the source was.

[lendaddy]

Thanks Rick,

That does make sense. He is feeling much better already and his temp is normal. This is after the antibiotic shot, is this a sign that it was bacterial or is it too soon to tell. I get the idea that we may never know? FWIW, they also did a throat swab and I am told that was "normal" if that tells you anything. Regarding the fluid, the doc said he would eventually "bring it up through coughing" does that make sense?

[Nathans_Dad]

Yeah, some of the "fluid" you see on chest film is basically phlegm, a combination of lung mucus (which is produced at an increased rate during infections), dead bacteria or viruses and dead white blood cells. This stuff tends to collect in the airways (think dead bodies piling up during the war) and eventually he will cough it out. Again, most of what you see on XRay is edema (swelling) of the tissues and inflammation.

The throat swab was probably a rapid strep test, looking for streptococcal infection in the throat.

As to whether the antibiotic is working or not, antibiotics really take 24-48 hours to start having a true effect on an infection so if his fever is already gone it shouldn't be the antibiotics, assuming he got the shot today.