PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Mother taking her daughter to school

The Therapeutic Car Ride to the Doctor

Scene: 10:40pm on any given night, in a clinical exam room near you. Markedly well appearing child, playful and active. Clearly getting the proverbial “second wind.” Parents exhausted.

Parent: “This is the best she’s looked all day. I swear, she wasn’t doing anything like this before we came in.”

Well, this is a daily and legitimate scenario, friends. I fondly call it “the therapeutic ride to the doctor.” The dose of this treatment is unknown, and the mechanism of action is not clear, but it has an incredible success rate and minimal side effects. Within a matter of minutes, even the sickest of children sometimes seem to make miraculous recoveries with one simple dose of this incredible medicine. A car ride to after hours care. Can you believe it?

I’ve joked about this with many a parent along the way, who I can see retracing steps in their mind to determine if the child they see in front of them is the same kid they were caring for merely an hour previous. I don’t have any great answers to explain concisely why this happens so often, but I have a few ideas.

My serious disclaimer here is that parents should absolutely, definitely, always bring their child in for evaluation or call their child’s pediatrician if they have an acute health concern. I’d rather see many false alarms and merely need to dispense reassurance than one single delay in care due to parental worry that their concern isn’t legitimate. I’m all about many fire drills; no fires. So let’s think through the chain of events that leads up to THE THERAPEUTIC RIDE TO THE DOCTOR.

First, by the end of the day, everyone’s tired. Parents and kids included. Being sick is exhausting as we all know, but so is caring for an ill or injured child. So all the people in the equation have reached their limits and there’s no reserve left. Additionally, everything is scary at night, right-? That’s why horror movies usually are set after dark and not first thing in the morning. So anxiety and fear are factors, too. Put this together and the sense of urgency is heightened, whether or not the clinical situation actually is reflective of it.

smiley sick face

The second wind

The trigger then gets pulled. The decision is made to seek medical care. Often around bedtime or an hour or two later after there’s been a struggle to get comfortably to sleep, there’s resignation to the fact that sleep isn’t coming for whatever reason, anxiety sets in, and now there needs to be mobilization to get whatever is needed for the car trip to acute care. Sometimes this is a bucket to catch any in-transit vomit; other times it’s the one specific stuffed animal that will make the trip manageable. Regardless, it’s a change up from the normal routine; more late night activity than usual, and that can be quite stimulating for kids, even if they’re quite tired initially.

Breath of fresh air…literally

Whether it’s on the way in or out of the car, there’s usually a little exposure to fresh air. This seems to have a brisk, wakening effect on kids, and you know what that means: SECOND WIND. A little burst of energy boosts everyone’s mood, right? Combine that with the bright lights and energy in an urgent care office or emergency department and suddenly there’s A LOT OF ACTION. It’s distracting for everyone. As a result, many kids perk up, and when they do they often engage in wellness-oriented activities such as:

  1. Drinking some fluids (especially if slightly dehydrated)
  2. Effective coughing once mobile and positioned so respiratory status improves.

I think we can all agree that appropriate hydration and comfortable breathing does a lot to enhance anyone’s appearance, so kids who move the ball forward in this way either on the way to the medical care or in the waiting room or during the visit tend to look a lot better than they did on the flip side. This is obviously great but can be confounding for parents given how sick their child looked just a bit ago that prompted the medical visit in the first place.

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A totally different kid

Then I walk into the room to meet the patient and family. I see an active and playful child, thoroughly enjoying the sticker they picked up on the way in, or working their way through their second ice pop. I speak with the parents and hear about what’s been going on, and they make their case that their child looked like a completely different kid an hour ago. I’m never surprised by this because I’ve seen it so often, and I make it my business to make it clear to the parents that I believe them, that their concerns are valid, and what my findings are. No one ever wants to bring their child in for a medical assessment late at night, so I know that decision isn’t taken lightly. I talk about the diagnosis or lack of one and we get a game plan for the night. Typically, truly sick children are not miraculously cured by this therapeutic trip. This is important to know.

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Does it always go like this? Of course not. There are many instances when a late night pivot in care needs to happen due to a change in condition, but I see so many scenarios like the one I describe above that I want to tell you about it so that you won’t feel alone should you find yourself in this predicament, or if you find that your child had, like so many others, a THERAPEUTIC TRIP TO THE DOCTOR.  It happens, and I’m delighted when it does.

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