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Pediatric record keeping has two complicating aspects. First, most visits are for minor illnesses. Second, the records must track growth and development, which is not an issue in adult medical practice. The difficulty with a practice that is overwhelmingly devoted to minor illnesses and well-child care is that it is easy to miss subtle developmental problems and rare, fast-evolving illnesses such as meningitis. This is particularly a problem in children with atypical presentations. It can be impossible to tell the early onset of meningitis from an upper respiratory infection. If the disease progresses very quickly, the child may be permanently injured before the physician could reasonably have expected to make the proper diagnosis.

Juries will be unsympathetic to a physician's claims unless the medical record carefully documents the child's condition and the physician's plans. The problem is that many physicians keep sketchy records on children with minor illnesses. These records are adequate for the vast majority of patients who are not seriously ill, but they may mask the progress of a severe illness. This increases both the chance of prolonging the misdiagnosis and the probability that a jury will rule against the physician. Physicians caring for children must make a special effort to record the presence and absence of diagnostic signs that indicate serious illness.

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