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The Informed Parent

Quarters and Nickels: Test for Meningitis

by Louis P. Theriot, M.D., F.A.A.P.
Published on Dec. 02, 1997

Have you ever noticed that children's health problems, to most parents, seem to be more emergent and intensive at night? While the child's complaints and symptoms seem to be worse at night, our ability to be focused, logical and composed appears to diminish as rapidly as the moon rises. It is an inversely proportional relationship. As a parent of three boys, I include myself in the group of parents whose propensity for a clear head is somewhat numbed by the nocturnal fugue...for I too have been there!

One night while I was on-call, I received a phone call from a frantic father about his five year old who he thought might have meningitis. It was around midnight, and his daughter had a temperature of 102 degrees. The fever started at dinnertime when she complained of a headache and a sore neck. They appropriately gave her some acetaminophen which afforded some relief, but now the fever was back and she seemed worse. She now complained of a sore throat. They have a neighbor who is a nurse and she correctly warned them of the possibility of meningitis: fever, sore neck etc. This is what prompted the urgent phone call.

After gathering some information from dad, I had him do a few things to determine if, in fact, meningitis was a possibility. First, I had him lay his daughter on her back and then lift her head off the bed to look at her toes. She did this with ease. Next, I had her sit in his lap and look up at the ceiling, and then down at her belly button. Again she did this with no problem or complaints of a stiff neck whatsoever. I assured dad that with meningitis there is actual stiffness of the neck, by definition. The fact that her neck was so supple made the diagnosis less likely.

I then had him get a flashlight and look at her throat. Sure enough, we found the culprit. Her throat was fiery red and there were pus pockets on her tonsils. After further questioning of his daughter, we were able to ascertain that her throat was sore, rather than her neck being stiff.

I offered to meet them in the office, but dad was very comfortable in waiting until first thing in the morning to bring her into the office. He was so relieved that it was not meningitis, and had some general questions about what meningitis was, and what it could do to you. In conversation I mentioned one other "test" that you could do at home. That was to put a quarter on the floor and have the child walk over and bend over and pick it up. Children with meningitis do this with difficulty, or refuse to do this because of the discomfort. He thanked me and assured me that he would see me first thing in the morning.

I was pleased at how well things went and started to drift back to sleep when the phone rang. This time it was the mother who sounded apprehensive. She told me that her daughter was sound asleep and doing just fine. I reviewed everything with her to allay her fears. She then said, "You remember that you told my husband to have our daughter pick up a quarter?" I confirmed that I had done so. Then there was a long pause which was interrupted by the mom chuckling. She sheepishly said, "I am so embarrassed for calling you, but...I just answered my own question. I couldn't find a quarter...just a nickel. So I had her pick up a nickel--that shouldn't make a difference should it?...I mean of course it wouldn't make a difference. What was I thinking? Forget this phone call. I am so sorry, go back to sleep."

Click. She hung up.

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