How do you know when it is time to take a child to the Doctor?

Question

Our children have recently been sick and I am wondering when is the right time to take them to the doctor. They both have had runny noses with coughs, diarrhea, and fevers off and on for a week, between the two of them. We have treated symptomatically. I don't want to be a hypochondriac parent who rushes the child in for every little thing, but I also don't want to be negligent when there is something seriously wrong that we may not see.

Answer 1

A good pediatrician should have an on-call service 24/7 - or there should be some type of hotline or service you can call, organized by the local governement, your health care provider or similar. First time parents especially may not always know when it's serious and when it's not. A good pediatrician (and nursing staff) also will say that you should at least call in rather than not. When in doubt, err on the side of caution!

You may not need to take the child to the doctor, but one call can reduce concern. It is entirely justified to say that one of the roles of a pediatrician is to make the parents feel better, too.

Call in more often than not. Remember, even if your child is not sick, it is not "wasting the doctor's time" to call and ask.

Also, you can ask your doctor when they think you should call them. It is a question they are very used to hearing, and they will give you guidelines.

Go to the doctor when:

• you know there's a need for treatment (some obvious case of illness to be treated)
• you're concerned that there might be a need for treatment,
• you're in doubt about the cause, seriousness, treatment, or anything else!

Don't hesitate; it's okay. In the course of several visits, you'll gain more experience to evaluate which of the above 3 you're facing, and the last one will become rarer.

Specific symptoms that are good signs to contact the doctor are:

• Changes in appetite (refuses several feedings in a row or eats poorly.

• Changes in mood (lethargic, unusually difficult to rouse, persistently irritable,or inconsolable crying).

• Tender navel or penis (umbilical area or penis suddenly becomes red or starts to ooze or bleed).

• Fever. ANY fever if younger than age 3 months, 3 months or older an oral temperature of 102 F (38.9 C) or higher, give your baby acetaminophen (aka paracetamol, Tylenol, others) and contact doctor if the fever doesn't respond to the medication or lasts longer than one day or is unusually irritable, lethargic or uncomfortable.

• Diarrhea (especially loose or watery stools.)

• Vomiting or spiting up large portions of multiple feedings or vomits forcefully after feedings.

• Dehydration (if baby doesn't wet a diaper for six hours or longer, the soft spot on top of your baby's head seems to sink, or your baby cries without tears or has a dry mouth without saliva).

• Constipation (fewer bowel movements than usual for a few days)

• Colds that interfere with his or her breathing, lasts longer than two weeks, or is accompanied by severe coughing.

• Ear trouble (baby doesn't respond normally to sounds or has fluid draining from his or her ears).

• Rash (covering a large area, appears infected or sudden unexplained rash — especially if the rash is accompanied by a fever).

• Eye discharge (one or both eyes are pink, red or leaking mucus).

• Excessive bruising

Seek emergency care for:

• Bleeding that can't be stopped

• Poisoning

• Fits, convulsions or seizures

• Trouble breathing, fast breathing, grunting while breathing, or if your child is working hard to breathe, for example, sucking their stomach in under their ribs

• Head injuries

• A sudden lack of energy or inability to move

• Unresponsiveness, reduction in activity or increased floppiness

• Large cuts or burns

• Neck stiffness

• Blood in the urine, bloody diarrhea or persistent diarrhea

• Skin or lips that look blue, purple, gray, very pale, mottled or ashen

• a high-pitched, weak or continuous cry

• in babies, a bulging fontanelle (the soft spot on a baby's head)

• not drinking for more than eight hours (taking solid food is not as important)

• a high temperature, but cold feet and hands

• a high temperature coupled with quietness and listlessness

• your baby or child is unusually drowsy, hard to wake up or doesn’t seem to know you

• your child is unable to stay awake even when you wake them

• a spotty, purple-red rash anywhere on the body. (This could be a sign of meningitis)

• repeated vomiting or bile-stained (green) vomiting

Specific advice regarding temperatures:

If you're worried speak to your General Practitioner (or, in the UK, call NHS Direct on 0845 4647). If the surgery is closed, contact your GP out-of-hours service. If you're still concerned, or if your GP or out-of-hours service can’t come quickly enough, take your child straight to the Accident and Emergency (A&E) department of your nearest hospital.

Always contact your GP, health visitor, practice nurse or nurse practitioner if:

• your child has other signs of illness as well as a raised temperature
• your baby’s temperature is 38°C (101°F) or higher (if they’re under three months), or
• your baby’s temperature is 39°C (102°F) or higher (if they’re three to six months)

Additional Thoughts:

1. If you're asking on the Internet, you should be asking the doctor or nurse.

2. If you wonder if you should bring your baby in for a visit, then you should.

3. If you have 1 question, at least call the doctor's office.

4. If you have more than 2 questions, set up a consultation so you're not bombarding the doctor over the phone and have more time for follow-ups and note-taking.

5. If you have any questions, it helps to bring a notepad with questions written down in advance and write the answers.

6. If the doctor doesn't take you and your questions seriously, then it's time to find a new practice.

People can give you general advice, but none of us have access to your baby's medical chart, and general advice may not work for some children for subtle reasons. For example: my baby had severe diaper rash. Ordinarily diaper rash isn't too much to worry about, and if I'd asked about it online, I think I would have gotten a lot of answers that consider it part of being a baby. But I have a strong family history of allergies, and my baby's diaper rash turned out to be the result of a milk allergy. We figured it out between my husband's and my observations, my parents supplying info about my medical history, and the doctor's expertise. No one on the internet would have been able to confirm it, even if they might have raised the red flag.

Sources:

Mayo Clinic

NHS Choices - Temperature

NHS Choices - Symptoms

Pediatrics.about.com

Answer 2

A good pediatrician should have on call 24/7. First time parents especially may not always know when it's serious and when it's not. A good pediatrician (and nursing staff) also will say that you should at least call in rather than not.

You may not need to take the child to the doctor; but one call can reduce concern. I often joked that the purpose of my child's pediatrician was to make my spouse and I feel better.

Call in more than not because the worse thing you can do is wave off something serious because you're concerned about seeming too hypochondriac.

Answer 3

The following list is a summary of ones listed at Mayo Clinic

Changes in appetite (refuses several feedings in a row or eats poorly.

Changes in mood (lethargic, unusually difficult to rouse, persistently irritable,or inconsolable crying).

Tender navel or penis (umbilical area or penis suddenly becomes red or starts to ooze or bleed).

Fever. ANY fever if younger than age 3 months, 3 months or older an oral temperature of 102 F (38.9 C) or higher, give your baby acetaminophen (Tylenol, others) and contact doctor if the fever doesn't respond to the medication or lasts longer than one day or is unusually irritable, lethargic or uncomfortable.

Diarrhea (especially loose or watery stools.)

Vomiting or spiting up large portions of multiple feedings or vomits forcefully after feedings.

Dehydration (if baby doesn't wet a diaper for six hours or longer, the soft spot on top of your baby's head seems to sink, or your baby cries without tears or has a dry mouth without saliva).

Constipation (fewer bowel movements than usual for a few days)

Colds that interfere with his or her breathing, lasts longer than two weeks, or is accompanied by severe coughing.

Ear trouble (baby doesn't respond normally to sounds or has fluid draining from his or her ears).

Rash (covering a large area, appears infected or sudden unexplained rash — especially if the rash is accompanied by a fever).

Eye discharge (one or both eyes are pink, red or leaking mucus).

Trust your instincts. Seek emergency care for:

Bleeding that can't be stopped

Poisoning

Seizures

Trouble breathing

Head injuries

A sudden lack of energy or inability to move

Unresponsiveness

Large cuts or burns

Neck stiffness

Blood in the urine, bloody diarrhea or persistent diarrhea

Skin or lips that look blue, purple or gray

Answer 4

I'm the mother of a 14-month-old girl. My policies with regard to doctor calls/visits are:

1. If I'm asking on the Internet, I should be asking the doctor or nurse.
2. If I wonder if I should bring my baby in for a visit, then I should.
3. If I have 1 question, I at least call the doctor's office.
4. If I have more than 2 questions, I set up a consultation so I'm not bombarding the doctor over the phone and have more time for follow-ups and note-taking.
5. If I have any questions (which is always have), I bring a notepad with questions written down in advance and write the answers.
6. If the doctor doesn't take me and my questions seriously, then it's time to find a new practice.

People can give you general advice, but none of us have access to your baby's medical chart, and general advice may not work for some children for subtle reasons. For example: my baby had severe diaper rash. Ordinarily diaper rash isn't too much to worry about, and if I'd asked about it online, I think I would have gotten a lot of answers that consider it part of being a baby. But I have a strong family history of allergies, and my baby's diaper rash turned out to be the result of a milk allergy. We figured it out between my husband's and my observations, my parents supplying info about my medical history, and the doctor's expertise. No one on the internet would have been able to confirm it, even if they might have raised the red flag.

The issue may be nothing more than a virus, but a doctor may be able to give you advice for treating symptoms. Given that this is flagged with "infant" and "toddler" I'm assuming your children are quite young; you NEVER want to mess around with diarrhea and fever in very small children. As a parent, it's your prerogative to be a bit of a hypochondriac, so if I were you, I'd at least call.

Answer 5

This is not medical advice; I have no medical training; if in doubt see a doctor.

This is a nice bit of advice:

http://www.nhs.uk/Planners/birthtofive/Pages/Childhoodillnesshub.aspx

When it comes to your child's health, it's always better to be safe than sorry. If you are ever in doubt about your child's health, talk to a health professional. Serious childhood illnesses are extremely rare. But, if you think your child might be affected, always trust your instincts and get medical help straight away.

Here's their advice about recognising serious illness:

The following symptoms should always be treated as serious:

• a high-pitched, weak or continuous cry
• a lack of responsiveness, reduction in activity or increased floppiness
• in babies, a bulging fontanelle (the soft spot on a baby's head)
• neck stiffness (in a child)
• not drinking for more than eight hours (taking solid food is not as important)
• a temperature of over 38°C for a baby less than three months old, or over 39°C for a * baby aged three to six months old
• a high temperature, but cold feet and hands
• a high temperature coupled with quietness and listlessness
• fits, convulsions or seizures
• turning blue, very pale, mottled or ashen
• difficulty breathing, fast breathing, grunting while breathing, or if your child is working hard to breathe, for example, sucking their stomach in under their ribs
• your baby or child is unusually drowsy, hard to wake up or doesn’t seem to know you
• your child is unable to stay awake even when you wake them
• a spotty, purple-red rash anywhere on the body. (This could be a sign of meningitis)
• repeated vomiting or bile-stained (green) vomiting

For temperatures:-

http://www.nhs.uk/Planners/birthtofive/Pages/Treatinghightemp.aspx

If you're worried speak to your GP or call NHS Direct on 0845 4647. If the surgery is closed, contact your GP out-of-hours service. If you're still concerned, or if your GP or out-of-hours service can’t come quickly enough, take your child straight to the Accident and Emergency (A&E) department of your nearest hospital.

Always contact your GP, health visitor, practice nurse or nurse practitioner if:

• your child has other signs of illness as well as a raised temperature
• your baby’s temperature is 38°C (101°F) or higher (if they’re under three months), or
• your baby’s temperature is 39°C (102°F) or higher (if they’re three to six months)

You mention concern about being seen as a hypochondriac parent: Please, medical staff prefer worried parents to call or visit rather than delay.

Answer 6

Ask your doctor when they think you should call them. They will give you the parameters.

We don't have paediatricians available or on call unless it's through the emergency department. We do have access to "Telehealth" so we can personally speak to a Registered Nurse.

This site has some guidelines that sounded similar to what my doctor told us.

Answer 7

It is hard to give a definitive answer here.

You might not worry about a runny nose as long as the fluid is clear.

You might not worry about one day of diarrhea when you know what it might have come from (too much vegetables at once for instance). However a child must compensate for the increased loss of fluids.

Coughs are hard to classify here for many different things can cause them.

You should visit the doctor when the fever climbs above 38.5 degree celsius.

As I said: It is hard to give a definitive answer here.

Answer 8

I can't recommend Dr. Michel Cohen's book, THE NEW BASICS, enough. He is a very well trusted pediatrician based in New York City. The whole book is organized around when to seek professional care. It catalogues every ailment alphabetically and after each entry is a "when not to worry" and "when to worry" list. Each list is very specific and extremely useful for this exact dilemma.

Answer 9

If my child is experiencing any of the symptoms that you mentioned, I will immediately bring him to the doctor. It is better to be given proper treatment early on, so it will not get worst. Babies cannot articulate what they are actually feeling, so it is best to leave it all to the experts. I would not mind going here and there to the doctor, as long as I know that my baby is okay. Besides, paying consultation fees for check up and some medicines are more affordable compared with your child being confined in a hospital.