Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2025-05-26 Encounter: Spruce text message CC: Infant with teething symptoms including irritability, excessive drooling, frequent loose stools, and diaper rash while traveling in Florida. HPI: Tommy is an approximately 5-month-old infant (13 lbs) presenting while on vacation in Florida with increased irritability, excessive drooling, frequent loose/poopy diapers with resulting diaper rash, and mouthing behaviors consistent with teething. Mother inquired about dosing of an over-the-counter pain/fever medication. No fever mentioned. Dr. Hobbs noted that the gastrointestinal symptoms could also be consistent with an enterovirus circulating in the community. Assessment: Presentation consistent with teething, though Dr. Hobbs noted that enterovirus (currently circulating) could also account for the irritability and loose stools. Plan: Parent advised to give 2.5 mL of medication every 6 hours as needed (based on 13 lb weight). Monitor symptoms; no further follow-up required at this time. Medications: - UNSPECIFIED (OTC analgesic/antipyretic, likely acetaminophen or ibuprofen) 2.5 mL every 6 hours as needed (new) Key clinical quotes: "You give 2.5ml every 6 hours as needed." "Can be. Can be a little tummy bug causing all of it too. There's some enterovirus going around and that can cause both symptoms" Source: Spruce conversation t_2GDBR8BFPUO00