During my pediatric rotation, I encountered many patients, but one case that stood out involved a three-year-old with a history of an unwitnessed fall three weeks prior. The child presented with tenderness and swelling over the mastoid bone, along with a slight protrusion of the ear. Given the presentation, I was concerned about mastoiditis. We started the patient on Augmentin and advised the family to follow up the next day to monitor for any worsening symptoms.

A few days later, the patient developed otorrhea and was taken to the ER, where an ENT specialist recommended continuing the Augmentin. Fortunately, the patient recovered. However, this case highlighted the importance of maintaining a high suspicion for mastoiditis. Despite the absence of imaging, the patient’s history, including the prior trauma, could have led us toward a different diagnosis, potentially distracting us from considering mastoiditis. This experience reinforced the importance of balancing the most likely diagnosis with the most concerning “do not miss” diagnosis.

During this rotation, I also improved my pediatric physical exam skills and learned to consider the social determinants of health. By asking questions about a patient’s life outside of the clinic, I gained a more holistic understanding of their overall well-being.