When to Call the Doctor

When to Call the Doctor
By Michelle Liu, R.N.

Children don’t come into our lives with a handbook on how to care for them. Often, knowing when to call the doctor is difficult. There are some guidelines that can make these choices a little easier. Before you call the doctor, make sure to have note paper available to jot down any instructions he or she may give you. It is also a good idea to write down information about your child that you want to share with your doctor, like temperature and how it was taken (orally, rectally, under the arm), any past medical history, any medication your child is taking (on a regular basis and temporally and when they were last given). And always keep a copy of your child’s immunizations at hand.

• Vomiting. Vomiting may be a concern if it is dark green. This could signal an intestinal blockage. Blood in vomit may be caused by a cut in the lining of the stomach or other tissue.

• Dehydration. Children can become dehydrated quickly if they have fever, vomiting or diarrhea. Try to keep children hydrated by offering them fluids (water, juice, popsicles) in small amounts every 15 minutes. If your child can’t keep any fluids down, has not urinated for 6 hours, or has dry lips and mouth, contact the doctor. Dehydration should be taken very seriously.

• Fever. Fever is not an automatic cause for concern, as it is the body’s natural way to fight infection. The rule of thumb is, for a child less than two months, call the doctor if the fever is 100.5 °Fahrenheit or higher. If a child is three to six months, call the doctor with a fever of 101°. If a child is older than six months and the fever is higher than 103°, make the call. Also be aware of the child’s activity level—if he or she is alert and involved or if he/she is inactive and fussy. The more inactive and fussy the child, the more cause for concern. Also note any other symptoms that accompany the fever, such as rash, vomiting, or ear pain.

• Colds. Colds are caused by a virus and generally do not warrant a trip into the pediatrician. Call the doctor if your child is having difficulty breathing, has blue lips or fingernails, has a cough that he/she can’t seem to shake, or if the cold lasts for more than two weeks.

• Ear pain. Ear infections are a very common illness in young children. If there is blood-tinged yellow fluid or pus draining from your child’s ear, contact your doctor. This could mean there is a hole in the ear drum.

• Abdominal pain. Abdominal pain is a common complaint and one that usually will go away. If the pain gets worse and is accompanied by fever, or a change in appetite, the doctor should be notified.

• Cuts. Contact your pediatrician if your child gets a large cut or a deep cut that may need stitches to close. If there is a chance that something is in the wound, such as dirt, it would need to be properly cleaned to reduce the chance of infection.

• Limping. Limping can be caused by inflammation or infection, as well as a fracture. If limping is accompanied by swelling, fever, or the child’s refusal to move the affected limb, call the doctor.

• Rash. Any unexplained rash, especially if it is accompanied by a fever, should be discussed with the doctor. There are many different types of infections that can cause a rash to appear in young children. To rule out that a rash is contagious, your doctor should be consulted.

• Head injury. Head injury can cause some pretty serious consequences, but most childhood head bumps cause no more damage than a bruise. Call your pediatrician if your child is unusually sleepy, loses consciousness, has difficulty seeing, is disoriented, or vomits.

Always call the doctor if a child under the age of one falls from the crib, changing table, or other elevated surface. Children in this age group have delicate skull bones. Even when they appear fine, it is a good idea to have them checked out just to be on the safe side.

Most importantly, you know your child best. Whenever something doesn’t feel right or look right, it is a wise idea to contact your doctor. These are only guidelines, not the rule book we all wish came with our children at birth.

Source: The American Academy of Pediatrics

Michelle Liu, R.N., is a former school nurse and the mother of four children. She has also worked in neurology and neurosurgery at Northwestern. This article was first published in the Fall 2006 issue of Early Childhood.