You are the primary care giver for an 18-month-old AfricanAmerican male. Three weeks ago he presented for complaint of feverfor three days, cough, and rhinitis. He was diagnosed with an upperrespiratory tract infection and treated with supportive careincluding children’s ibuprofen and children’s acetaminophen. Sincethat time his mother reports that he has fully recovered from theURI. Two days ago he fell while playing outside. He scraped hisleft elbow and both legs but was otherwise fine. Today his motherreports that he has pain in his left hip and is limping when hewalks. She reports that he had a temperature of 100.4 at home. Onexamination he has limited range of motion of the left hip and isunable to bear weight on the left leg. The skin abrasions that werereported by the mother are noted but appear unremarkable. Noexudate, redness, or swelling. He has a temperature of 101.9. He isalert and oriented but appears to be in pain. Given the history andphysical, you are concerned that he may have osteomyelitis. Riskfactors for osteomyelitis can include recent URI as well as a breakin the skin.
How will you relate these concerns to the patient’s mother? Whatwould you tell her about osteomyelitis and why you suspect he mayhave osteomyelitis? How would you explain the necessary diagnostictests and treatment regimen? Considering the age of the child, howwould you best communicate with him?
