Treat health scares with dose of common sense

In a recent column you talked about the fear that seems to come with the territory of parenting today. Just yesterday, I heard a mom say, "I am a parent; that means I am a worrier. When I see a bruise, I think leukemia, not bumped shin." That seems a bit extreme, but certainly parents need to exercise some vigilance. What do you think that parents should and should not worry about?

This is an excellent question, one more suited to philosophers, perhaps, than pediatricians. We spend a great deal of our time trying to be as safe as possible. Yet, we can never truly get there, just because of the nature of having an organic body, which is subject to the whims of nature.

Those of us who answer questions from the worried public almost shudder when we see certain symptoms as a sign of (fill in the blank).

Fatigue, which is quite subjective and difficult to study as a symptom, shows up for so much: depression, leukemia, AIDS, fibromyalgia, Lyme disease, lupus, kidney disease, anemia, heart disease, thyroid disease, etc.

We hear, in many instances, that fatigue may be the only sign (so far) of these conditions. You might say the same about headaches or body aches or changes in appetite.

There is always something to worry about. Our bodies are not perfect, and they do not always fit the classic mold. In a study of whole-body CT scans, researchers found an abnormality in 87% of patients, according to research from the University of California, San Diego.

Seven out of eight people have something on CT to worry about. Yet we know that seven out of eight people aren't at risk for something bad happening.

I think we have never been safer and healthier than right now.

When I was a resident (1978-'81), we saw a fair amount of meningitis, for example. There were always a few kids being treated at Children's Hospital. Now, when someone has meningitis, it is news.

Certain conditions, such as Reye's syndrome, seem to be gone for good. There is a lot less lead poisoning, better treatment for asthma, better treatment of annoying problems like gastroenteritis (stomach flu), better surveillance when an unusual organism enters the community.

There is better support for parents and for the kids who have special challenges.

But there will always be new things.

In 1970, no one worried about AIDS or MRSA, the super-resistant staph we now see. There is always a condition around the corner to challenge us, just when we are starting to feel smug.

One of our great weaknesses and strengths is our love of statistics. We love a good study, and it's amazing how many of them we can absorb.

It's the new mind candy. It is especially true when it confirms something we really wish to be true - chocolate is good for you; fat isn't so bad after all.

But our fears also arise with the strange fact. (Did you not know that a bruise could be leukemia?) We all become Adrian Monk, the detective who can't let a fact go.

Moreover, it seems to be a moral imperative to worry: I don't care so much for myself as much as protecting my child. But worry, with its stress and unhappiness, is not completely benign either.

A few points:

• For acute diseases, look at CHAOS, which stands for color, hydration, attitude, oral intake and sleep.
• Develop a good working relationship with your pediatrician. We do not mind the questions; all physicians are educators.
• Use media, including the Internet, sparingly. Remember, the Internet is mostly unedited. There is good information, but a lot of junk as well.
• Be skeptical about anyone who stands to make money off of your worry. This is what drives all these free-standing radiology/screening places. We don't have much data about their usefulness.