I looked around as I walked in. I saw just the mom and no child in sight. Within seconds, laughter emanated from behind the computer system in the room. Behold a toddler girl, adorable to say the least, her hair packed up in two high buns; cheeks so red I could hardly tell if it was flushed from joy or just her dry eczematous skin, smiling from ear to ear. Her arms up high as she ran towards me to give me a hug. Before I could decide if I am supposed to hug my patient during our period of mandated ‘social distancing’, she was in my arms. Phew! Good thing I wore full Personal Protective Equipment (PPE), some sense of safety for all of us, at least I think.

I turned to mom, and greeted her with my usual smile, “Hi, mom, I’m Dr Orajiaka. I guess I am your child’s Attending. I was confused when I peeked in the first time. The description the resident gave me didn’t fit the child I saw when I peeked, so I went back to confirm.

I see your daughter is feeling better already, what brings you in today?

“Oh! Don’t let her looks deceive you, Sonya (not real name) never stops moving”, mother replied.

“She’s had this diaper rash that has been on and off for a few months. It is really itchy and uncomfortable. But then 2 days ago, I noticed a swelling around her vaginal area, and I think it’s getting so big she can hardly walk”, mother continued.

While discussing with her mother, my patient was running around the room without any underpants. So energetic and free that I could barely believe we were talking about the same person.

“Can’t walk?” I thought to myself. “She just ran to give me a hug before either of us could stop her and there she is running around in circles.”

Mother added, She continues to be active and playful, especially when she gets some pain medicine. But, I’m not sure how much longer because it keeps increasing in size every day.

I said to her, “I totally believe you, I’ll take a look.”

As always, I examine younger kids with my ‘Vocera’ music on as a form of distraction. It’s a lifesaver and a great distraction in most cases. Still wondering how I made it this far in pediatrics without it. Sonya was very cooperative, she smiled through my initial exam but then came the struggle when I got to her diaper area. 

Once her mother and I finally held her down. I didn’t need to search for the swelling. It was right there. An abscess big enough to rub against the other side of her thigh, red and angry enough it was begging to be popped. 

Oh dear! Poor thing. “How are you able to jump up and down and run around with this? I sighed. “She must be really strong and tough”.

Mom muttered, “You haven’t seen anything. This girl never stops.” 

I discussed the plan of care with her mother. We need to drain the swelling and get the pus out and she’ll need antibiotics for a few of days. Also, because of her age and the location, I’ll need to sedate her, i.e. put her to sleep to get this done.”

You probably need to clip her nails short. I think the persistent scratching of the eczema rash caused some open scrapes on the skin, which then got infected and caused this. 

We’ll get her some steroid cream for the eczema, which might help prevent another episode. I’ll also recommend she sees a dermatologist (a skin specialist).

“That’ll be great”, mother replied.  “Anything to make her feel better”.

“Perfect!,” I said. “Hang on a few moments while we get everything set up for this.” 

While I was talking to mom, my cute, active patient had moved on to something more interesting, the lower cabinet locker which had a pillow in it. 

I shook my head, smiled, and left the room to get resources ready. As I shut the door behind me, I muttered under my breath, “What a bundle of joy, energy and hurt all in one little person.”

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