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Diagnostic Dilemma Clinic may help uncover the causes of complicated pediatric disorders

GREENVILLE, N.C.   (Feb. 5, 2003)   —   The child's colic confounded diagnosis. Seemingly without cause, the baby boy was irritable, angry and teary, and his symptoms had persisted far longer than the three or four months considered average for colic.

Hoping for an answer, the boy's mother scheduled a specialty consultation with pediatricians at East Carolina University's Brody School of Medicine.

For children like these, whose conditions defy routine diagnosis, a new Diagnostic Dilemma Clinic for Children may help provide answers. Conceived as a "brain trust" with some of the most experienced minds at the School of Medicine, the clinic offers area pediatricians the intensive evaluations, second opinions and parental consultations they need to better diagnose and treat their most difficult cases.

Dr. Dale A. Newton, section chief of general pediatrics, believes this service will allow medical school pediatricians to focus more fully on a patient's history, conducting the tests and specialty consultations they need, as well as discussing the patient with the referring pediatrician.

"We want to keep patient volume low during the clinic, so we can perform a comprehensive evaluation," he said.

Understanding what's wrong with children is often compounded by their inability to talk. They may be shy or have developmental disorders. They may not be able to pinpoint pain symptoms and may simply have an overall sense of discomfort.

That was the case with a baby who, at nearly 2 years old, cried constantly. After careful evaluation, it became clear the child's colic stemmed from reflux esophagitis, a gastrointestinal disorder. But since there was also a foot problem and signs of delayed development, the quandary intensified as doctors tried to determine whether the physical ailments and developmental delay were related or compounded each other.

Adolescents can also pose special difficulties for doctors, as they often conceal issues such as depression, headaches or drug use from their parents or their family doctor. A second opinion can help uncover the source of their problems.

Turning to peers at the School of Medicine for back-up opinions can greatly help general pediatricians sorting through complicated illnesses, said Dr. John H. Knelson, a pediatrician whose Carteret Clinic for Adolescents and Children in Morehead City sees many kinds of illnesses, including hard-to-diagnose autoimmune disorders.

"If I've got a child with a range of symptoms with a complex story and possibly multi-system involvement, what I need is a fresh opinion, a fresh perspective, from a good experienced general pediatrician," he said.

The service is intended as a one-time consultation visit for the child and family to determine the medical, psychological and behavioral reasons for dysfunction. The referring pediatrician may be called on during the evaluation, Newton said.

"We will be calling on the referring physicians to ask, 'What do you think?' That provides validation and helps us to make sure we communicate with each other," he said. Appointments will last an hour or longer so consulting pediatricians have the opportunity to fully study the case, with the patient and family present.

"In a pediatric primary care setting - a busy office - often one of the barriers to thoughtfully considering a child's complex problem is not having time to gather information and think about it," he said. Longer appointments give time to review, research and discuss the patient at length.

The Diagnostic Dilemma Clinic can also confirm a difficult diagnosis, especially helpful in cases of psychological problems such as depression. An outside specialist can persuade parents to begin treatment, even though they’ve heard the same recommendation from their own pediatrician.

"Having been a community practit


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