In an unwell infant, the history of intake is the least reliable thing the parents will tell you, and not because they are careless. A frightened parent cannot reconstruct how many minutes the baby fed or how many millilitres went in, and the question 'is he feeding well?' invites a reassuring answer from a person who badly wants the answer to be yes.
So replace it with things that can be counted. How many wet nappies since this time yesterday, and was the last one heavy or barely damp. When was the last one. Then weigh the child, and compare it with the last recorded weight rather than against a centile — a well-grown infant who has dropped weight since the last visit is a different problem from a small infant who has not.
The same substitution works for the older child. 'Is she drinking?' gets a yes. 'How many times has she needed the toilet today, and how does that compare with a normal Saturday?' gets a number, and a number you can repeat at the next review.
- Ask for wet nappies in the last 24 hours and when the last one was, not whether feeding is going well
- Weigh every unwell infant and compare against the last recorded weight, not a centile
- Ask for urine output in countable terms in older children too
- Write the number down so the next clinician has a comparator
Why it matters
The reassuring answer is the one a frightened parent is most likely to give, and the least likely to be accurate.
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