Week 2, Advanced Practice Clinical

I started my clinical rotation this week. The clinic I started at is new to me, so it was a little intimidating trying to get to know the charting system and the providers’ expectations. On Sunday the other students were not very helpful, but Tuesday everyone was nice and helpful.  

My challenges with pediatrics are the fact that I have two patients. I must address the child and make the child feel at ease at the same time as I address the parent and make them feel heard. Most of my patients in the emergency department are adults so I do not have a lot of experience with children. My preceptor told me that it will get easier with practice. One of my patients was a 6-year-old girl who has recurrent ear infections. Her father brought her in and seemed frustrated when I confirmed that she had another ear infection.

Ear infections are so prevalent that about 50% of children in the United Kingdom are reported to have been infected with Otitis Media (ear infection) within the first year of their birth. This percentage rises to as much as 90% for children aged up to six years. Globally, an estimated 278 million people live with disabling hearing impairment resulting from ear infections. Childhood hearing Impairment, even if transient, can have long-term adverse effects on behavior, speech and language development, academic performance, and future employment. (Kisembo 2018).

The child’s father stated that the child’s pediatrician had suggested tubes for the child to help prevent more ear infections and reduce the use of antibiotics. My preceptor suggested he consult an ear-nose-throat specialist.

Childhood ear infections are often treated with oral antibiotics. However, using antibiotics too often can cause bacteria to become resistant, so doctors may wait to see if mild ear infections clear up on their own. When children experience frequent ear infections doctors may recommend surgery to place a tiny tube in the eardrum, called a tympanostomy tube, to provide ventilation to the middle ear. This helps to drain fluid and prevent future buildup (Bryant, 2021).

Studies comparing ear tubes to oral antibiotic treatment for recurring childhood ear infections have had mixed results. Most were conducted before the pneumococcal vaccine became standard for young children. This protects against strains of bacteria that commonly cause ear infections (Bryant, 2021). When discussing the health history, particularly the immunization record to inquire if she had received the pneumococcal vaccination, the father stated that she has not received any vaccinations. He and her mother have decided against vaccinating their children. The preceptor here stated to me later that ear infections are still very common, even in children that have been vaccinated.

                                                                                                     References:

Bryant, E. (2021, June 8). Ear tubes or antibiotics for repeat infections in children? National Institutes of Health. Retrieved October 26, 2021, from https://www.nih.gov/news-events/nih-research-matters/ear-tubes-or-antibiotics-repeat-infections-children.

Kisembo, P., Mugwanya, F., Atumanya, P., Othin, M., Oworinawe, R., Kagimu, B., Kisakye, A., & Bagambe, F. (2018). Prevalence of Ear Infections in First Year Children of Primary Schools in A Western Ugandan Community. African journal of biomedical research : AJBR, 21(2), 117–122.