Babies Don’t Read Medical Textbooks

David Epstein, MD, addresses how, in pediatrics, children don't always respond to medications as expected, or present with typical symptoms during illnesses.

When we see that a patient is responding appropriately to a medical intervention or presenting with typical symptoms of a disease or illness, we say that they “read the textbook”.

Unfortunately, kids (babies included) sometimes don’t “read the textbook” when it comes to pediatric illnesses and treatments.

They can present with atypical symptoms and respond to treatment plans in an atypical manner as well.

Unusual Symptoms

Sick kids can present with unusual symptoms sometimes.

In infants, an overwhelming infection in the body can present with a body temperature that is lower than normal (rather than having a fever).

Younger children can actually have abdominal pain when they have pneumonia, in addition to respiratory symptoms.

A young girl may have fever and vomiting as the presenting symptoms of a urinary tract infection. Sometimes, the actual symptoms don’t always match the expected symptoms of an illness or disease.

Sick kids can present with unusual symptoms sometimes. Click To Tweet


Variable Medication Response

For treatments with medications, kids may have a variety of responses.

It is definitely hit or miss with many of the over-the-counter “cold” medications. You never know whose symptoms will or won’t respond to these medications.

Also, some children respond better to acetaminophen than ibuprofen for fever reduction and vice versa.

A small number of kids will have a paradoxical reaction to diphenhydramine, as it is given for allergic reactions or nasal allergies, and become extremely active or agitated versus most kids who become sleepy.

Finally, some children sedate well with traditional sedatives in the intensive care unit while others aren’t sedated at all and become delirious.

Reassess and Adjust

The unusual ways in which children can present with symptoms of an illness or respond to medications is really a lesson in expecting the unexpected and trial and error of treatment.

One has to keep a high index of suspicion for particular disease presentations by knowing the broad array of symptoms and understanding that kids may not present with stereotypical symptoms.

Furthermore, a treatment that works for one child may not work for another and the same treatment that worked in a child may not work in that same child at a later date.

So, while we expect kids to act and respond in the ways that we anticipate in pediatrics, they don’t always “read the textbook” and we just have to reassess and adjust.


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