How much stock should otolaryngologists put into the parental interpretations of their child’s complaints? According to Ellen M. Friedman, MD, an otolaryngologist in Houston, parental descriptions are an important part of patient histories, but you still need to perform objective measures.
Explore this issue:February 2007
Sometimes parents give vital information that can lead straight to the diagnosis, while other times they may be way off base, she told ENToday in an interview. Dr. Friedman is Professor of Otolaryngology at Texas Children’s Hospital, and presented a study at the American Academy of Otolaryngology-Head and Neck Surgery meeting last September on the topic of parental perceptions of otolaryngologic problems in their children.
In brief, she found that parental perceptions fall into one of three categories: those who underestimate a problem, those who overestimate the severity of a problem, and those who are right on target.
Consider the case of the parents who brought their young child into the clinic insisting that the child’s choking and wheezing symptoms were from a piece of lemon rind that went down the wrong way.
After looking at the history, it was found that the child had indeed choked on a lemon rind a couple of weeks earlier, but a finger swipe had apparently removed it. In addition, the child’s pediatrician had recently placed the child on medications for asthma, but the parents, who both had childhood asthma themselves, were focused on the lemon rind theory as the cause of their child’s problem.
Who Knows Best?
Whom do you believe? Do parents know best, or does the otolaryngologist have some educating to do? And, in general just how much weight should the otolaryngologist put into diagnoses by parents?
The lemon rind case happened to be one seen by Dr. Friedman, who explained what ensued.
The child’s mother brought the child to me, I did a bronchoscopy, and there was another piece of lemon rind down there. This was a case in which the parents were correct. However, she added, this isn’t always the case.
Curious about how accurate parental perceptions of their child’s illness are, Dr. Friedman did a study on the topic. Although there are numerous studies in the medical literature comparing parental diagnoses to clinical assessments, very few have looked at the topic specifically in the otolaryngology setting.
In the study, researchers conducted a survey of parents, asking about their child’s symptoms, then compared these findings to objective clinical measures. The patients fell into three different clinical categories: balance, hearing, and sleep complaints. The objective measures consisted of the Peabody Developmental Motor Scales (PDMS), audiometry, and polysomnography, respectively. There were a total of 235 children in the study (with a corresponding number of parents surveyed) who ranged in age from 8 months to 15 years.