I am an Emergency Room Pediatrician (a physician that takes care of children that come to the ER). AMA.

Have you ever seen a case of Munchhausen by proxy?

Yes. Not a single one. Many. Last year there was this specific single mom early in her 30s that would go into WebMD and find a random disease. Then, she'd come up with a story and ask for her kid to have all scans possible (the kid was 5 years old and i was not going to strafe run his body with radiation from a CT and several xrays). The mom wanted us to believe that the kid had Osteogenisis Imperfecta (Glass-Bone Disease) and came up with some weird stories. The kid had bad hand-shaped bruises all over his leg (the mom actually tried to break his femur, the strongest bone in the body), and we called social service. Never heard from the mom or the kid again.

opinion on circumcisions?

Unnecessary.

How do you deal with the heartbreaking reality that occurs when a child dies?

The worst of seeing a kid dying on your supervision is that you're the one supposed to ask the parents to follow you to the social worker's office and there you have to say the same thing all the doctors say: ''We did everything we could. We followed the protocols but, unfortunatly, your son/daughter didn't survive. We are sorry for your loss and we will be here to help you in any way we can''. And then hear the relative scream: "No, you didn't. If you did everything you could do, she'd be alive. I'm going to sue you/You are a monster/Is this because of my healthcare provider?" This. THIS is a heartbreaker. Usually, they say that they are sorry, but this stays in your mind forever.

Wow, that is harsh that most people resort immediately to pinning the cause of death on you. Have you ever been assaulted/harassed when parents were in this state?

Yes. A guy punched me in the face. But then he apologized.

Wow seriously? Mind telling the full story?

Here we go then. Bad car crash on a highway, two deceased on scene (other car), other two badly injured (wife and kid), one person almost unharmed (the father). Kid was taken to the hospital by helicopter already bradicardic (his heart frequence was very low) and we were trying to stabilize it while giving him blood/ringer fluid (he had several injuries and could potentially bleed out). Then he crashed on a V-fib (ventricular fribilation, when the heart is beating abnormally and not providing the body enough blood, in this case we have to shock) then we started CPR. The whole team was very focusing on saving that life and you could hear the father crying at the ER entrance. We shocked the kid about three times or so, and he finally came back on a stable sinus rhythm. At this time, the mother was already stabilized and on her way to orthopedics to get her broken leg operated, but several minutes after, the kid entered a state of shock doing a CT scan and crashed again. We did everything we could but then we realized he had several deadly injuries inside his body (injuries that we were about to discover on the CT scan) and he didn't make it. We made the procedure of telling the father and all, and then he punched me when i said his kid died. He said he'd sue me for malpractice and neglygency because we didn't discover that his kid had splenic rupture and liver injuries. The thing is that we were busy making his child breathe again before we did a scan, and the kid crashed again mid-scan, so we couldnt know since the abdomen was not that swollen, and then he apologized.

Wow. That is heartbreaking. I can't imagine being on his or your end of that. What was your reaction when he punched you?

I had a very deep breath and walked out of the room.

How often has a child died?
[Edit: Also, what was your reaction the first time a child died under your care? I can't even imagine.]

It depends. But we do have one or two deceased children per week that reach the hospital already dead or die in the ER, but like i said, i'm not always supervising the emergency room. There are other doctors.

Wow. That is much more frequent than I would have thought. I edited my original question. When you have time, I would really appreciate you answering it as I am genuinely curious. Thanks!

My reaction was ''i killed this kid''. I was on my first days after residency and i was helping a more experienced doctor. This doctor was a very cool guy (he was an old man, like 60) and he told me that sometimes people die and we have to let go. I felt amazingly better.

Have you ever seen pretty much clear evidence of child abuse and if so, how does that play out? Like on medical TV shows where they secretly call the police and have them just show up?

If we are sure that a child is being abused, we ask the parents to follow us into the hospital's social worker's office. They wait there (alone and under vigilance) until we have a Tuteraly Council agent to talk to the parents. If the abuse is really irrefutable, the child is usually taken from the parents and we call the police. What happens next is only for the cops and the parents to know.

How frequently does this happen?

Not very often, because we work with poor, honest and humble people (the hospital is located on a poor neightborhood). But we are prepared to respond to this when it happens.

What is your favourite part of your job?

Walking out of the ER with good news for the parents.

Thanks for doing this. It's one of the most interesting AMAs I've read through and I really respect your work. Also, your English is very good for it not being your first language!

I have two questions:
1. Were there any House/True Stories of the E.R. type cases where you're genuinely confused about what is going on with the patient, the patient is exhibiting strange and confusing symptoms, and when you eventually discover what is wrong with the patient, it kind of blows your mind? (Sorry if this is a stupid question.)
2. What's the most amusing reason a child has ended up in the E.R.? You always hear about children doing silly things or shoving things up their nose or something of that nature.

Thank you! I've been to English-speaking countries so i know how to speak English... Decently?

1) Yes. One day, when we had tons of interns helping on the ER, we lacked two nurses because a big surgery was happening on the upper floor and it was pretty much a mess. Then this ambulance comes with a kid that is slowly starting to develop a lack of breathing and paralisis, but starts coming up with rashs as well. I tried to put it all together but then i talked to the mom and told her to explain me the cinematic of the incident. Turns out the kid had infectionts that led into the Guillain–Barré syndrome.

2) Mouth and chest burnings + glass infiltration on skin because the child had dropped a glass jar with hot water on herself.

What is the worst case you have had to deal with on a young child?

So... The boy (13 years old) was riding his bike down a hill and he horribly fell, broke a leg and an arm, and somehow stuck his neck into the bycicles chain. Needless to say he suffered severe trauma and had cardiac arrest on scene. EMTs tried to bring him back but he arrived into the hospital on a very poor state and after 15 minutes or so of continued CPR we called him deceased.

How are you able to balance your career and your outside life?

I'm young so i live alone, i don't have a wife or kids (i'm 31) but i do have an amazing girlfriend who's always there for me. My job is the greatest thing in my life (after her, of course) and i love it. I usually don't talk much about my job with friends unless they are fellow doctors, and i live a normal life. It's not a big deal.

Now that you are a doctor and have gone through all the hoops to get there, would you do it again? Do you feel you made the best career choice? I ask because I know it's not easy to be a doctor.

Yes, i would. Being a doctor was my dream since i had like 4 years old. I never wanted to be a famous soccer player, an astronaut or something like that. I always wanted to be a medic. 85% of my toys when i was a kid were all about medicine. I had one birthday when i asked my mom for a cheapass stethoscope and she gave it to me.

What is your opinion on the current standards of pain management during painful tests such as VCUGs?

The pain management is fine, but the more psychologic appeal the test has (like VCUGs, no 5 year old is ready to have a tube inside his private parts), the more preocupied the parents get and the more painful it is for the child. Pain management on painful tests is deeply studied so the kid feels little to nothing, but sometimes they see what is going to happen and they think that they WILL feel pain and they end up crying and actually making the pain a big deal.

I missed getting one of my kids a flu shot this year. Should I still try to get one for him or is this flu shot not effective?

Speak to your pediatrician, but i'd say yes. Better safe than sorry.

About how many children do you attend to a day?

There are three pediatricians everyday on the ER (Clinic), so i attend about 15 kids on a calm day and 30 when the ER's Clinic is filled with sick people (my shifts go 6AM-6PM). On the Emergency Room itself, about two to seven a day, if no big accidents happen. I do attend other emergency calls that don't involve kids.

That shift seems harsh.. How do you keep a social life?

My shift is not daily (but i'm going to work tomorrow and it's already midnight on my country so i should get some sleep, lol) and some doctors cover my place, but i do make friends inside the hospital as well. The interns, nurses and more experienced physicians have some cool stories.

What do you, and other doctors at your hospital (if you know) think of Obamacare?

I don't live in the United States so i don't know a thing about it. Mind giving me a heads-up?

What made you decide to go into Pediatrics?

Thanks for the AMA.

I always loved children and i always had an interest on see how the job worked. I wanted to be a Neurosurgeon but then i dropped it and went to the pediatrics internship. I don't regret it.

What is you opinion on giving kids cold medicine syrups when they are sick? Is it ok or dangerous? What about giving a child Benedryl if they can't sleep?

If you're asking for actual medical advice then you should probably call your own doctor. The OP is probably legit, but common sense says to disregard anything someone tells you over the internet when it involves administering medication.

Do not medicate your child unless a doctor says it's ok if you do (a doctor that actually takes a look at your kid and says what's better for him). There is nothing ok on giving medicine to someone sick without a doctor prescribing it.

Has there ever been an occurrence so sad that you actually started crying?

No. If you're a doctor you don't have any time to cry over an occurrence. But i know some stories about the EMTs (they are the ones who see what happened), when they arrive at the scene and the kid has just lost both the parents. It's sad.

Have you ever seen Munchausen syndrome by proxy? If so, what was the outcome?

I did answered that, didn't i? I guess someone deleted it.

Yes, i did. TL;DR: Crazy mom, tried to break the kids femur because she wanted to make him look like he had Osteogenisis Imperfecta (glass bone disease), we called social service and the kid had to go onto psychiatric care and had tons of bruises all over her body due to the mom attempting to break a bone and make us believe that the kid had the disease. Kid had no other symptoms, muscular tone was k, and i never heard from the mom again.

...will you prescribe me medical marijuana?

No.