Why doctors should trust their gut in diagnosing kids

Doctors who treat children see scores of kids with minor illnesses every day, but serious infections are rare. When such illnesses strike, children greatly benefit from having their illnesses diagnosed early, but often, the early signs are missed.

One way that to ensure that children with serious infections are treated quickly is for doctors to heed their "gut feelings" in assessing the children's behavior, according to a new study from Belgium.

The study showed that in two out of six cases where a child had a serious infection, but didn't have the clinical red-flag signs of one, the doctor had a gut feeling that something was wrong.

"Gut feelings should not be ignored, but used in decision-making," the researchers wrote in their study, published Tuesday (Sept .25) in the journal BMJ.

Dr. Robert Chun, an assistant professor at the Children's Hospital of Wisconsin, said, "You have to have what I call 'a healthy amount of paranoia.' You cannot miss something that could hurt them for their life."

All kids — from those with the most severe physical or mental delays, to the most advanced children — give off signs when something is wrong beyond what their lab results may show, he said.

Where gut feelings come from

Primary care physicians often see children with serious illnesses when their symptoms have yet to develop in measurable terms, according to the study.

Chun said that doctors with experience treating children know that those who are acting lethargic or tired, despite having normal lab results, are cause for concern.

In the study, the researchers considered the cases of 3,890 children who were seen by primary care doctors for illnesses they had had for less than five days. Doctors were asked whether they had a gut feeling, beyond the child's symptoms, that the child was seriously ill.

It turned out that 21 of the children were admitted to the hospital with serious infections, such as pneumonia or meningitis. Six of these children had not been referred immediately to the hospital, because in their initial visit with the doctor, their clinical signs didn’t warrant it. In two of these cases, doctors had indicated they had gut feelings that something was wrong.

But such feelings can also be wrong. In the study, doctors had gut feelings in 44 cases where those feelings turned out to be a false alarm.

Chun said that number of false alarms is not a reason to ignore the case where gut feelings were correct.

"No one remembers the kid that you suspected, that turned out to be fine," he said. "But every one remembers the things you didn't look into — those are the ones that haunt you."

The role of parents

In the study, the researchers attempted to learn more about the basis for gut feelings by asking doctors exactly what prompted their uneasiness. They found that gut feelings were most likely to arise when a child had a history of convulsions.

Additionally, gut feelings were strongly influenced by parents' concerns about their child's illness.

Chun said, "When a child is lethargic, when the parents say, 'this is unusual,' as a clinician, you need to have a enough humility to know that even those all the lab numbers are normal, you need to look closer, and be more anxious."

In fact, Chun recently treated a 5-year-old boy with a rare infection of necrotizing fasciitis (sometimes called flesh-eating bacteria), and parental intuition played a role in the case. "Moms and dads know their kid, they know that something's not right," he said.

"There's nothing scientific about this," he said, adding that a more objective way to diagnose rare infections would certainly be desirable. Getting second opinions from colleagues can help.

But in the meantime, "when you have that feeling, you have to investigate further," he said.