We have mentioned repeatedly in obstetrics that the key factor that determines whether a child can be delivered naturally is the baby's head. For this reason, the doctor's hands during normal delivery must pay special attention to protecting the baby's brain and have standardized delivery gestures.
When the doctor examines the fontanelle, in addition to checking whether the fontanelle closes normally, like the child with a fever today, the doctor will touch the anterior fontanelle to see if it is bulging or tight. If so, it may mean that the child suffers from intracranial hypertension. If the fontanelle is too large and the head circumference is too large, you should suspect congenital hydrocephalus. If the fontanelle is too small or closes prematurely, it is necessary to check whether the child's brain is underdeveloped. All of the above reasons represent central nervous system diseases, all of which may cause clubfoot.
While Xie was checking the fontanelle, Wei came over with a tape measure to help measure the child's head circumference.
Student Duan checked the medical records of the nurse's previous measurements of the child's temperature and blood pressure.
A series of neurosurgical examinations were performed. The child's consciousness is still good, and he does not show any abnormal symptoms such as drowsiness. The posterior fontanelle is closed, which is normal. The head circumference is 42cm, which is within the normal range. There was no bulging or depression of the anterior fontanelle, and no abnormal intracranial pressure was found. Pupil 3mm, normal. The child's spine had no deformities or abnormal curvatures. The child weighs 8kg and is 60cm long, which means the child is well-nourished and developing normally. The only thing that is deformed is the left foot. We need to take another X-ray of the bones to see if there is any bone deformity.
However, clubfoot generally does not cause a child to have a fever. The doctor needs to continue to check the child's fever. Students Xie and Duan put on stethoscopes to listen to the child's heart and lungs.
Wei picked up a ballpoint pen and notes, asked the family members and recorded the child's medical history.
"When did you find out that your child had a fever?" Wei asked, tapping on his notebook.
The child's mother replied: "It should be yesterday. We tried to wipe him with alcohol to reduce his fever, but it didn't work so we brought him to the hospital."
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Ordinary people know that seeing a doctor is troublesome. Some parents, if they see that their children’s condition is not serious, will try to find ways to reduce their children’s fever at home. If the fever can be reduced and it is a minor illness, there is no need to go to the hospital.
"Do you know when his foot became like this?"
When the doctor asked this question, the child's mother seemed to have just discovered that her son's left foot was abnormal. She said in surprise: "When I took him for a physical examination before, the doctor didn't say there was anything wrong with his foot."
This means that the child's clubfoot was discovered now. It is not surprising that many children have mild symptoms of congenital diseases, and the symptoms are not noticed until they become more and more prominent in the later stages.
"Did he vomit or have diarrhea?" Wei asked again.
The child's mother shook her head.
"Are you coughing?"
"It seems so." The child's mother said, "He was crying and his voice was hoarse. We think he had a sore throat."
Your child's crying is hoarse, his throat is uncomfortable, or there is something wrong with his vocal cords and glottis? Is it acute laryngitis in children? Several young doctors were startled.
Pediatric diseases develop rapidly and progress quickly, and pediatric laryngitis is a perfect example of this. Because children's laryngeal cavities are small, laryngitis is prone to swelling. Children's pharyngeal emission is poorer than that of adults, and airway secretions cannot be discharged autonomously, further aggravating the blockage and eventually causing laryngeal obstruction and suffocation. It is one of the most common emergencies in pediatrics that requires the most vigilance.
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