Written by Kimiko Dunbar
Spoon Feed
Presenting to the ED with a febrile infant is stressful, and parents are usually most disturbed by the need for LP or hospitalization, both of which are generally unexpected. Parents want to be involved in shared decision making; however, discussions should be tailored individually to the family and to the strength of the medical recommendation.
It’s not one size fits all
This mixed-methods study (questionnaire followed by focus groups) examined the experiences of parents presenting to the ED with febrile infants less than 60 days old. 432 families completed post-discharge questionnaires, and a subset of 17 families participated in a video conference focus groups. Regarding the anticipated treatment course, nearly all parents expected that a physical exam would be a part of the ED evaluation, and the majority expected blood testing and urine testing. In contrast, less than a quarter expected that their child would need hospitalization or a lumbar puncture (20.8% and 10.2% respectively), which lead to significant stress. While 97.5% of parents wanted to be involved in shared decision making, their specific preferences were dependent on the strength of recommendation. For instance, if there is only one reasonable treatment plan, parents preferred to be provided with one specific recommendation, whereas if there were multiple options, families preferred an open discussion (i.e. shared decision making). The authors also found that parents wanted risks to be discussed. Thus, one should always explain the risks and benefits of options, even when parents seem to already be satisfied with the information they were given. Unsurprisingly, parents felt most comfortable with empathetic, supportive providers who provided them with consistent information and gave more time to prepare for stressful procedures.
The authors suggest a potential approach (below), for engaging in discussions with parents of febrile infants.
How this will change my practice?
This article emphasizes the need for thoughtful communication, which can be taken for granted in bread-and-butter pediatric presentations. I’ll plan to approach the subject of LP and hospitalization more delicately, recognizing it’s likely to be a surprise. I also think it’s interesting to frame “shared decision making” around whether there truly are multiple options to discuss, a concept that applies more broadly than just to the febrile infant.
Source
Parental Preferences and Shared Decision-Making for the Management of Febrile Young Infants. Pediatrics. 2024 Oct 1;154(4):e2024066420. doi: 10.1542/peds.2024-066420. PMID: 39285842; PMCID: PMC11422194.
