I would, for example, implement a system of diagnosis that very clearly indicates the proper approach to be taken. Once an approach has been selected, the parent or guardian will be fully informed of his or her responsibilities. In the watchful waiting approach, for example, I would provide the parent or guardian with a sheet of criteria that must be followed in observing the child. Keeping in mind that few parents are medical professionals, I would recommend that they call the hospital immediately if they have any doubt about the health of their children. In order to do this successfully, parents will be provided with a 24-hour access to the relevant medical professionals should they need help or advice.
Depending upon the severity of the illness, I might even recommend that the child in question spend a few hours in the hospital to have professionals close by to monitor the situation. Parents will also be fully informed of the risks and benefits of either approach. After making my recommendation, the parents or guardians will be allowed to make an informed choice of the treatment options open to them. Unless the childs life or long-term health is in danger, the policy will be to follow the parents wishes.
Another important consideration is ethics. Ethics are particularly important when doing research that involves children. The greatest challenge is that very young children — those generally affected by AOM — do not yet have the cognitive ability to understand and be informed of their choices. They are therefore subject to consent from their parents.
According to a report by the Board on health Sciences Policy (2004, p. 59), children present greater ethical challenges than adults in terms of clinical trials.
Despite the fact that AOM is such a common condition among young children, which should make it relatively easy to investigate, parental involvement should be carefully regulated in clinical trials. The age range of children should also be taken into account, as each group presents different developmental stages. The clinical outcomes should then be appropriately presented according to these stages. Finally, young children have particular cognitive and emotional needs. Parents should therefore be directly involved in giving informed consent on the types of tests to be conducted, and how these are likely to affect the health of their children.
In general, I feel that a recommendations and guidelines should continue to develop, especially as these concern children. Children are one of the most precious social resources in the world. They should be nurtured, their needs respected, and their health optimized.
American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical Practice Guideline: Diagnosis and Management of Acute Otitis Media. Pediatrics, Vol. 113, No. 5.
Bain, J. (2001, Feb.) Treatment of acute otitis media: are children entered into clinical trials representative? British Journal of General Practice. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313930/pdf/11217628.pdf
Board on Health Sciences Policy (2004). The Ethical Conduct of Clinical Research Involving Children Institute of Medicine
Johansen, E.C.J., Lidholdt, T., Damsbo, N. And Eriksen, E.W. (2000, Mar. 13). Tympanometry for diagnosis and treatment of otitis media in general practice. Family Practice. Retrieved from: http://fampra.oxfordjournals.org/content/17/4/317.full.