Published in Mom’s Guide to San Diego – July 2014
ByElena Fishman, MD, FAAP
As parents, we are prepared to stay calm dealing with our own health problems. It’s amazing how quickly we shift into a panic mode when our precious children are sick. The purpose of this article is to help you troubleshoot the most common problems and stay calm.
First of all, if you are really worried you should pick up the phone and call the doctor. Most of the clinics will have an on-call physician available 24/7. Pediatricians consider answering phone calls an important part of the job. So don’t feel bad if you need our help in the middle of the night. We do appreciate if you are prepared to answer our questions. If your child is sick, be prepared to tell the doctor the child’s temperature (“he feels warm” is not enough) and respiratory rate if your child is coughing and has trouble breathing. To measure respiratory rate, count the number of chest rises in 30 seconds and multiply by 2. Be prepared to list all the medications your child is taking – both prescription and over-the-counter. Most often we take call from home, so always remember to mention your child’s medication allergies and any important past medical history.
The best tactic is to prepare for emergencies before they arise. I strongly encourage all the parents in my clinic to take a CPR class. Knowing CPR, you will be prepared in case of pediatric and adult emergencies. Most likely (and hopefully) you will never use your CPR skills to help your own child, but you might be able to help one of her playground friends.
First aid kit is another must. I have one in the house and one in the car.
Here is what is in my First Aid Kit:
Fever is the most common cause for a phone call in the middle of the night and most common cause of anxiety in parents. Fever by itself is not a problem, but it is a clue pointing to a real problem. Most fevers in pediatric population are caused by viral illnesses. Fever is a body temperature higher than 100.4 F.
Fever in a baby under 2 months of age is always an emergency. Don’t waste your time calling your pediatrician, head straight to the Emergency Room. If your baby is between 2 and 3 month old age and has a fever during the day, contact your pediatrician immediately. The baby between 2 and 3 months of age with a fever in the middle of the night should also be evaluated in Emergency room.
Babies over 3 months of age who have a fever and an obvious cold and are still eating well can be evaluated in the office in a non-urgent manner.
The child with a fever of any age who appears irritable and lethargic (despite acetaminophen or ibuprofen treatment), or has a fever lasting for longer than 3 days, or has a rash needs urgent evaluation.
If your child is like most kids, you will hear her complain about tummy aches periodically. Thankfully most of the tummy aches can be dealt with at home and do not require a trip to an emergency room. The most common reason for a young child to complain of a tummy ache in my clinic is constipation. If you feel that constipation might be the cause of your child’s belly ache, you can try an over-the-counter laxative (i.e. Miralax).
Your child needs to be seen today if the belly pain is accompanied by fever, vomiting, persistent refusal to eat and drink, bloody diarrhea, pain with urination and distended abdomen.
Allergies are another common pediatric concern. Call 911 if your child has labored breathing, lip swelling, drooling. Allergic reaction in a form of an itchy rash is less concerning and is not an emergency. An itchy rash can be treated with Benadryl. Rashes can be evaluated by your doctor in the office.
Even healthy infants and children can develop trouble breathing during viral illnesses. Your child needs to be seen immediately if you think she has trouble breathing. Most parents have never seen a child in a respiratory distress and do not know what to look for. The young child who is air hungry will have rapid and shallow breathing, nostril flaring and skin “sucked in” between the ribs (retractions). Your child needs to be seen immediately if he is “air hungry”, especially if he has a history of asthma. Children whose cough resembles seal bark have croup. Most of the time kids with croup get better next to a steamy shower and do not need to be rushed to ER.
However, kids with croup who make a high pitched sound with breathing (we call stridor) need to be treated urgently.
I hope this information will help you navigate the world of common pediatric illnesses. Most importantly, remember to stay calm and trust your instincts. If your instinct tells you your child should be seen by a doctor – follow it. No one would ever blame you for being extra cautious.