A nurse is speaking with the parent of a 6-year-old child. Which of the following statements made by the parent should concern the nurse?

A. Otitis externa, or swimmer's ear, is an infection of the outer ear canal, typically caused by water exposure, and usually presents with itching, discomfort, or drainage rather than fever and ear pain.
B. Otitis media, an infection of the middle ear, is common in children and often presents with symptoms such as fever, ear pain, and irritability. The child’s behavior of crying and rubbing the ear is consistent with this condition.
C. A viral sore throat usually presents with throat pain, fever, and sometimes coughing or congestion, but ear pain is less commonly associated.
D. A sinus infection may cause facial pain, nasal congestion, and discharge but is less likely to present with ear pain and rubbing.

A. Although facial pain could be concerning, it is not the immediate priority when the child has a history of atlantoaxial instability and is presenting with signs that could indicate spinal cord compression. Facial pain does not suggest a direct threat to the spinal cord, which is a more critical concern in this case.
B. Continuous neck pain in a child with atlantoaxial instability is a significant priority and requires immediate intervention. This could be a sign of spinal cord compression or injury to the cervical spine, which can occur after trauma such as a fall. Since this child has a predisposition for atlantoaxial instability, there is a high risk for neck instability and spinal cord injury, making this a top priority.
C. While lower extremity pain may be concerning, it is not as high a priority as neck pain in this context. The primary concern here is potential spinal cord compression or neurological injury. If the child is able to move their extremities or does not have severe pain or weakness, this may not require as urgent intervention. However, it should still be monitored closely.
D. Loss of bladder control is a red flag in children with suspected spinal cord injury. It can indicate nerve involvement in the spinal cord or cauda equina, which can be caused by injury or compression, particularly in a child with atlantoaxial instability. This requires priority intervention to prevent further damage and to initiate appropriate care (e.g., neurological assessment, imaging, and potentially surgical intervention).
E. The loss of established motor skills is another concerning sign. In this child, it may indicate neurological impairment or spinal cord injury. Since the child has atlantoaxial instability, this is a critical symptom that suggests the possibility of spinal cord compression or injury, requiring immediate evaluation and intervention to prevent permanent neurological damage.