“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw
Many medical terms are thrown around in pediatrics, and some terms are confusing. There can even be differences in the definition of medical vocabulary between medical personnel and the public. This does not mean that either party is wrong. It just means that there is an opportunity for miscommunication because the interpretation of the medical terminology may be misconstrued.
Here is a list of 6 medical terms that deserve to be clarified from a medical perspective and that parents should know.
“My child is lethargic” is a phrase that we frequently hear from parents at clinical visits. However, this term means something very different to a physician. When a child is lethargic, we envision a child who is not moving or communicating, is overly sleepy, and is not very responsive to their environment. When we envision a lethargic child, we remember the infant, child, or teenager who had a needle poked into their arm for an intravenous catheter or a blood draw and did not even flinch. They didn’t flinch because they were brave. They didn’t flinch because they were so “out of it”.
When a child is lethargic, we envision a child who is not moving or communicating, is overly sleepy, and is not very responsive to their environment. Click To Tweet
My feeling is that parents see their children as less active, not eating as well, or not running around or playing as much with their friends as they normally do. This is definitely a change in their behavior and is worth noting because there is something different going on. It can absolutely be a sign that they are not feeling well. But, from a physician’s standpoint, this falls under the category of fatigue or something less severe than lethargy. Lethargy signals something very grave and concerning to medical personnel.
Technically, a fever is defined as 100.4o F or 38o C. Usually, it signifies that the body is trying to fight an infection of some sort. There may be a body temperature elevation that doesn’t qualify as a fever. This non-fever, temperature elevation may still represent that an infection is present, but it can also mean the child was in a warm environment or too many clothes or blankets were piled on the child. In practice, I take the number into context, even if the temperature doesn’t qualify as a fever. A temperature that is not defined as a fever can still be useful information, especially when correlated with other symptoms or concerns. But, anything under 100.4o F or 38o C is not typically considered a fever.
One interesting caveat is that neonates and young infants can actually have a body temperature that is lower than the normal 98.6o F or 37o C body temperature. If this is the case, it is actually more concerning than a fever. The body’s inability to properly thermoregulate itself in neonates and young infants can be the harbinger of a severe infection.
The bottom line is that all temperature irregularities are worth mentioning at the medical visit because irregularities in body temperature can represent a childhood illness, even if the temperature doesn’t qualify as a true fever.
All temperature irregularities are worth mentioning at the medical visit because irregularities in body temperature can represent a childhood illness, even if the temperature doesn’t qualify as a true fever. Click To Tweet
For many families, the term, diarrhea, seems to be used to define anything softer than the normal bowel movement consistency. Commonly, the medical team defines diarrhea as the watery consistency of stools. Softer-than-normal stools, stools mixed with mucus, or mushy stools are worth mentioning, but they are not typically considered diarrhea by most clinicians. We want to know if the bowel movements are watery or liquid.
While diarrhea, in and of itself, is not overly concerning in the US and something that we see quite often, there are a few important, additional characteristics that should be considered. The frequency of diarrhea, the length of time that one has had diarrhea, the presence of blood in diarrhea, and other associated symptoms are important pieces of information that should be relayed. If a child is having 20 watery stools per day, that makes us concerned that the child may be on the way to becoming dehydrated (because he or she can’t drink enough to keep up with the fluid losses from the high frequency of watery stools).
Globally, diarrhea is one of the leading causes of death in children under 5 years of age because of severe dehydration. If a child has had diarrhea for more than a few weeks, that makes us concerned that there may be a particular infection that requires treatment or a particular non-infectious disease that is present. Blood in diarrhea speaks to a more serious infection than the typical viral gastroenteritis and may represent issues with the intestines that are not related to infection as well. Finally, noting additional symptoms is important to put diarrhea into context and will affect the list of possible diagnoses and the inclination to perform additional testing. While diarrhea is defined as watery or liquid bowel movements, additional characteristics of the stool and other symptoms are important to bring into the conversation.
While there is a component of thirst to dehydration, clinically significant dehydration is more than just feeling thirsty. If a child is dehydrated, the clinical symptoms include dry lips, dry mouth, no tears with crying, fatigue, and decreased wet diapers or urine output. These are the general, clinical dehydration symptoms that we are concerned about in the medical setting. There is definitely a spectrum of severity of dehydration ranging from just needing to drink fluids a little more to needing intravenous fluids or worse. But, when declaring that a child is dehydrated, the medical team’s definition often represents something more severe than that of the family.
5. Fractured Bone and Broken Bone
To make a long story short, a broken bone is a fractured bone.
A break is a fracture and a fracture is a break.
The terminology is used interchangeably.
However, there are a variety of different types of fractures or breaks. But, the bottom line is that there is no difference in the meaning when a clinician says that a bone is fractured or broken.
6. Trouble Breathing
When someone mentions that a child is having trouble breathing, a certain image is conjured up in my mind. I see a child who has increased work of breathing by using accessory respiratory muscles that cause retractions which are defined by a “sucking in” of a part of the thorax area just below the ribs or above the suprasternal notch at the base of the front of the neck. I see a child breathing faster than normal and whose nostrils open wider as he or she takes a breath inward (nasal flaring). I see a child who may appear blue. All of these features characterize true difficulty breathing and even respiratory failure.
For the most part, I often hear parents describing their children as having trouble breathing when they come to the clinical setting. What they usually mean is that their child is not breathing comfortably. Their child’s nose may be congested which creates trouble breathing through their nose, but it is not the respiratory distress image that goes with the kind of trouble breathing that pediatricians and medical staff are actually concerned about. With that said, it is not bad to err on the side of reporting trouble breathing to your physician and letting them decide if it is concerning or not. It is always better to be safe than sorry when it comes to breathing issues. Just know that the words, “trouble breathing”, are buzz words for describing a very sick child and will get the immediate attention of any clinician.
The definitions of various medical terms can vary amongst medical staff and the general public. It is important to create a more universal understanding of this terminology to prevent miscommunication. If we all speak the same medical language, there will be less confusion and greater opportunity to deliver a higher quality of care. Just because we communicate doesn’t mean that we necessarily understand one another!
If you are in the medical field, which medical terms do you think require more clarification for the general public?
If you are the general public, which medical terms are confusing for you?