There are often clear-cut criteria in medicine for deciding what tests to order for a particular patient. This is even more true in pediatrics, where I am learning that less is often more. Thinking about doing a lumbar puncture in a 3 month old? We have the Rochester criteria to help us decide whether there is significant risk of an occult bacterial infection. Think someone has a blood clot in their leg? Let the PERC (PE rule-out guide) be your, well, guide. No sense in getting the test if the chance of it being true positive are minutely low, or the chance of false negative supremely high. Medical decision making rules abound and honestly, make 2 am decision making in the ED a whole lot easier.
Which is why I propose there should a similar decision rule for ear-piercing in 6 year olds. Sure, it may seem like a good idea at the time to surprise your daughter with some shiny studs in reward for her hours of piano practicing. Yes, she may have begged you multiple times for earrings. She may have pulled at your heartstrings, a la “my cousin has earrings, and she is 1 year younger than me! And now I’m in 1st grade. Pleeease!”. How could you predict that she would allow one earring to be placed, and become a shrieking, wailing terror scaring other customers out of Claire’s? How would you know that you would spend a golden weekend (2 days off in residency-speak) going back and forth to the same Claire’s, and that with each attempt she would summon the strength of 3 men and the resolve of Katniss Everdeen?
Here is my handy and free rule, which is not yet available on Epocrates:
4 Point Decision Rule to Rule-Out Ear Piercing. Do not attempt if any of the following criteria are met:
1. Daughter is age 4-10, or above 20 pounds
2. Claire’s has only one employee to hold down daughter, and only one earring can be placed at a time
3. Daughter has asked and received a band aid for every scratch she has had since she’s been able to talk
4. Daughter’s father has been consulted on earring placement, and says “I’m staying out of it”.
I’d name this rule after my daughter, but then again, I wouldn’t want to scar her (more).