The Barky Cough Conundrum

I, too, am an advocate of the pocket prescription. In fact, I discuss wait and see reasoning (and risks of unnecessary abx). My parting comment is usually, "You know your kid better than anyone. If conservative treatment fails, fill the prescription but follow up either in UC or your child's PCP next week. or so for re-exam." I write on the rx. "Fill on demand for failure of conservative therapy. Void after (2 weeks in the future)." Explain that the child has two weeks to get better or worse. Sometimes, I note what "failure" looks like, i.e., increasing pain, fever. I had a bit of push back from pharmacists when I first started this practice years ago. Over time, I think they've come to respect my antibiotic stewardship.

One other point. Otitis externa hurts like the dickens. Ear pain makes everyone crabby. Here's my technique for an under 5 year old ear exam: (After nearly completely ignoring them during the history gathering).
I find it is much easier to examine a fearful kid if I very gently first check for tragal tenderness. Then, I show them that I have a flashlight and a special "bunny scope" to see if there are bunnies in their ear. I tell them, "I'm going to be very careful. But if it hurts, pull away." I look in and call the bunny, "Bunny. Bunny!" Then walking around front I shrug my shoulders and say, "No bunnies in there!" Most times, kids reward me with a smile and giggle. I give the kids a "high five" for being bunny free. I think this exam technique is pure gold and just wanted to share.

Kids number one job is to play and learn. Thanks for making learning fun for me.

Mary Susan Campbell, BC-FNP