When is illness serious enough to go to the doctor?

The flu and cold season is upon us, and if they aren’t already, people will be lining up in doctors’ offices and hospital emergency rooms. But many of the people who go there for treatment don’t really need to – those visits could be avoided if parents tracked and assessed the symptoms of their children at home. Dr. Paul Tompkins of Pacific Crest Family Medicine appeared on KIT 1280 on Jan. 21, 2014, to offer some tips and guidance to parents.

The first step for parents: Make some simple notes, tracking your child’s condition, and if you think you’re dealing with an emergency, contact your pediatrician.

Things to look for:

  • Your child’s temperature and when the fever began
  • A detailed list of any medications you have provided, including over-the-counter medications, which should include the time you started each medication and the last dose (even better, bring the bottles of medication to the doctor visit)
  • The last time your child had something to eat and drink
  • How often your child is vomiting or experiencing diarrhea
  • The last time your child went to the bathroom, or the last wet diaper

Any time a child is pale, clammy, won’t wake up or doesn’t know who you are, or has rapid shallow breathing, go immediately to the emergency room or call 911.

Meanwhile, here are some common problems that people worry about:

Fevers

A lot of people are worried about fevers. Fevers show us something is happening but are rarely a danger alone. (Only about 106 degrees or above is dangerous). Doctors want to know what else is happening with the fever to figure out the illness. (Fever is defined as greater than 100.5 degrees if taken orally or by ear or as greater than 99.5 if taken by armpit or forehead.)

When are fevers a concern?

  • Any baby 2 months old or younger with a fever should be seen immediately.  Call to see the doctor immediately or go to the ER in the middle of the night, say, “My 6 week old has a fever,” and you will be seen very quickly.
  • If the child is younger than 2 years and has a fever of greater than or equal to 104 degrees, will not stop crying (or in an older child – complaining), or has a stiff neck, severe headache, rapid breathing, won’t wake up or know who you are, is wheezing or has purple spots on the body, the child should be seen immediately.
  • See the doctor in the next day or so if the child is 2-6 months old, has had the fever for more than three days, has a rash, ear pain, sore throat or vaginal bleeding or discharge.

Vomiting

For vomiting, doctors worry if the patient is getting dehydrated: no urination in more than 8 hours (under 1 year of age), or more than 12 hours (over 1 year of age), has dry mouth, dry eyes, no tears with crying, dark urine, decreased activity. In these cases, see the doctor that day.

Diarrhea

If diarrhea is severe or there is blood, get to the doctor that day.   If the child is getting dehydrated, the diarrhea has been going on for more than one week, or there is pus or mucus in the stool, see the doctor within 24 hours.

Abdominal Pain

If the child is bent over, crying or screaming, unable to walk or is lying curled up, see the doctor immediately.  Also, see the doctor immediately if there has been trauma to the abdomen, a bulge in the groin area or a missed period in someone who could be pregnant. Otherwise the next 24 hours would be fine.

Convulsions/Seizures

Any seizure needs an immediate doctor visit unless the child has known epilepsy and the doctor has already given instructions for how to care for him.

Every medical clinic has someone to answer questions in the middle of the night or on weekends. It is our job and we are there to help. IT IS NOT A BOTHER.  Please find out how to get in touch with that person and call for questions. We can do a lot over the phone: get you an appointment or tell you if the emergency room is appropriate. A call can save a lot of time and money and often keep you out of the emergency room or doctor’s waiting room.

Frequently asked questions:

How do I know if my child needs to go to the doctor or emergency room?

Parents should make some simple notes tracking the child’s condition, and if you think you’re dealing with an emergency, contact your pediatrician or primary care provider.

What kinds of things should I track?

Things to look for include your child’s temperature and when the fever began, a detailed list of any medications you have provided, the last time your child had something to eat and drink, how often the child is vomiting or experiencing diarrhea, and the last time the child went to the bathroom or the last wet diaper.

Are there doctors on call to answer questions after regular business hours?

Every medical clinic has someone to answer questions in the middle of the night or on weekends. Please contact your primary care provider to find out how to get in touch with that person for questions.

 

Leave a Reply

Your email address will not be published. Required fields are marked *