5 Medical Terms That Get Your Pediatrician’s Attention

Other than swear words, did you have any words or phrases that you were just Not. Allowed. To. Say when you were growing up? At my house it was “shut up.” That was a big no-no. My parents felt like it was a demeaning, rude, and crass phrase that should not be uttered by any young mouths in their house, particularly my brother’s and mine, without significant punishment and revocation of privileges. The notable part of this is that while I clearly recall thinking at the time that it was THE MOST ridiculous rule ever created, to this day I rarely use that phrase, and neither do my own children. The heavy duty meaning laden in those 2 words is reserved for very few (yet serious) circumstances. (And yet oddly enough I’ve been known to fire up some varsity level swear words with very little provocation. Go figure.)

This does relate to what I want to get to today: reviewing and defining several words and phrases used casually and frequently by people who aren’t in the healthcare field, but whose meaning has sufficient gravitas for professionals who are, that deserve some time in the public forum. I even asked a bunch of colleagues for their input on this so that this list wouldn’t just be a tour through my own idiosyncrasies. Let’s get started then!

Irritable. As in “My baby is very irritable.”

In medicine, particularly pediatrics, the descriptor “irritable” is a term that is used to describe someone’s neurological status indicating that something is wrong with their brain, spinal fluid, or tissues covering the brain. As in meningitis. Or encephalitis. These children are completely inconsolable and not acting like themselves at all.  If I see a patient who truly appears irritable then the chances are good that I’ll be performing a spinal tap (lumbar puncture) to obtain some cerebrospinal fluid to send to the lab for analysis, searching for meningitis or some other infection or abnormality that could explain the irritable behavior.

Acceptable alternatives: Fussy, Cranky.

Lethargy, in any form. As in “He has been lethargic since yesterday.”

Lethargy is also a neurological term that describes altered mental status, difficulty with arousal and staying awake, and persistent change in level of consciousness. This does NOT mean more sleepy than usual, very tired, extreme fatigue, or anything in this vein. It means that potentially a wide variety of testing should be done to determine if there has been a poison/drug exposure, serious infection, seizure activity, or some other medical problem that affects the central nervous system.

Acceptable alternatives: very sleepy, decreased activity.

Dehydration. As in “I know he’s dehydrated.” Or “She hasn’t had anything to eat or drink in days.”

Dehydration is defined as significant intravascular volume depletion, or low circulating volume of fluid within the blood vessels. There is a spectrum of dehydration, from mild to serious, and this is one of the instances where the “art” of medicine plays as much of a role as the science, but suffice it to say that most children who have urinated within the past 8-12 hours are not significantly dehydrated. They may indeed be a bit behind on their fluid intake than their norm, but when a child is able to produce tears with crying and has a wet tongue and mouth, then dehydration is unlikely.

Acceptable alternatives: Decreased intake by mouth, not eating or drinking as much.

Low grade fever. As in “She has a low grade fever, 99.3.”

As a general rule, you either have a fever, or you don’t. While there are different thresholds of what constitutes a fever for different age groups (newborns: anything over 38C or 100.4F for example), or for people with compromised immune systems, but if there’s a body temperature between 98.7F and 100F, that is not a fever of any sort. It just isn’t. In otherwise healthy people there’s no good data in the medical literature that “some people run low” and so therefore a temperature in the 99’s is a “fever for them.” In order to have a fever, the body temperature has to be elevated enough to cause the chain reactions of the inflammatory cascade in the body, and this doesn’t happen with a mild spike.

Acceptable alternatives: none. Simply report the number.

Wheezing/Can’t breathe. As in “I could hear him wheezing from across the room and he couldn’t breathe.”

Wheezing describes the turbulent air flow in the lower airways of the lungs caused by bronchospasm and inflammation. It is typically not a sound that can be heard without a stethoscope. A musical, noisy sound can sometimes be audible when standing next to someone in respiratory distress for a variety of reasons, but these sounds are either transmitted upper airway sounds, or coarse sounds from larger airways, or even a tight cough, but they aren’t wheezing per se.

There’s also a big difference between “difficulty breathing” and “can’t breathe.” If someone can’t breathe that means they cannot ventilate themselves at all and their respiratory rate may be zero. They may have an airway obstruction or may have a respiratory arrest. I’m not being flippant here: the difference has major clinical ramifications- both regarding necessity of urgency of treatment as well as type of treatment. If someone is able to cough or talk or cry or make noise, they should not be described as “can’t breathe.”

Acceptable alternatives: Short of breath, difficulty breathing, noisy breathing.

What do you think of those 5 words/phrases? Are they part of your clinical vocabulary? I know that there are more like this. Perhaps I’ll write a second edition of this post to help further clarify, but please know that what I’m not telling you to do is to “shut up,” (!!!) but rather be in the know about the inside scoop on hot button words and phrases in medicine, so that should you come face to face with an acute care situation, you’ll know how best to describe the scenario to get precisely the right response and care from the clinicians you encounter. Sometimes, as in much of life, it’s all about word choice.