Case 1: African-American infant and family

A 3-year-old African-American infant is brought to the Emergency Department by her 19-year-old mother and her 55-year-old grandmother. The infant is febrile to 104.2 °F and is inconsolable, pulling on her left ear and clinging to her mother. The infant is wrapped in several blankets and dressed in flannel long-sleeved pajamas. In the patient treatment area, the resident, a young white man, undresses the infant to examine her. The exam is remarkable for a dull left tympanic membrane with decreased movement on pneumatoscopy: the rest of the physical exam is unremarkable. The doctor, believing the child to be overdressed, prevents the mother from replacing all of the layers of clothing and blankets. The infant’s grandmother becomes so hostile that she has to be removed by security.