Childhood illnesses range from a mild tummy ache to dramatic, forceful vomiting. Sometimes, it's obvious when to consult your child's doctor. But there are many not-so-obvious occasions when caregivers wonder whether to call the doctor.
When in doubt, consider the telephone one of your best friends. Armed with basic information about your child, call your pediatrician's office for advice. Be prepared to tell the doctor how long the problem has been going on, what differences you see in the child (or what descriptions the child can share), any details you think may be important, and what your specific concern(s) are. You know your child better than anyone. If you sense something is wrong, make the call.
Here are some general guidelines on when to call the doctor and when to manage things at home. Keep in mind that these are only guidelines, not hard-and-fast rules. When in doubt, call.
When to Call
Behavior changes — Call your doctor if your child is not acting like his usual self. Changes in behavior can include sleeping more than usual, not staying awake as expected, not playing or eating as usual, acting strangely, or not speaking clearly. Trust your instincts; you know your child best.
Head trauma — If a baby falls or is dropped from any height, call your pediatrician immediately for advice. If an older child has more than a minor head bump or falls more than a couple of feet, check with the doctor about what should be done.
Immobility — Any injury that causes your child to be unable to move his arms, legs, fingers or toes may need medical attention.
Pain — Call your doctor for severe, worsening or persistent pain, especially pain that interferes with your child's normal activities. Remember that an older child can tell you that he has pain, but a younger child may get the message across through inconsolable crying or other behavior changes.
Bleeding — Most childhood cuts and scrapes are minor. However, call your doctor for cuts that seem large, deep, or have edges that are spread apart and may need stitches. Call for emergency assistance (911) if the bleeding is severe and cannot be stopped or if your child is in shock (pale, dizzy, confused, unconscious).
Burns — Call your doctor for advice if a burn produced anything more than slight redness of the skin (first-degree burns). Second-degree burns penetrate down through the top layer of skin causing pain and blisters that may break and become infected. Third-degree burns destroy all layers of skin and may involve deeper tissues like muscle and bone.
The Gray Area
Vomiting — If a child vomits what looks like undigested food just once or twice without other signs or symptoms of illness, you probably can take care of that at home. Offer your child small sips of clear liquid to prevent dehydration. If vomiting persists, is accompanied by abdominal pain that doesn't get better after vomiting, or if your child has signs of dehydration (for example, dry mouth, decreased tears, dark-colored urine) or other symptoms (such as fever, diarrhea, headache) call the doctor. If the vomit is green, there may be a blockage somewhere in the intestines. If the vomit is red or looks like coffee grounds, it may be a sign of bleeding. Either way, call the doctor immediately.
Diarrhea — Most cases of diarrhea can be handled at home. A few loose stools for a day or two are commonly caused by a mild infection (stomach flu or gastrointestinal virus) and rarely cause major dehydration. However, frequent watery stools more often lead to dehydration, especially in infants. Call the doctor if your child has frequent, persistent diarrhea; shows any signs of dehydration; or if the diarrhea contains blood and/or is accompanied by severe abdominal pain or high fever.
Dehydration — Body fluids are lost with vomiting, diarrhea and fever. If these fluids cannot be replaced, children become dehydrated. When caring for a sick child, keep track of how much the child is drinking and urinating. A child should urinate every six to eight hours, or at least three times in 24 hours. Call your doctor immediately for any signs of dehydration, including dry mouth, dry lips, no tears, dry diapers or no urination for six hours, dry skin, weight loss, decreased activity or energy, and sunken soft spot (in an infant).
Fever — Fever is a sign of illness. Most illnesses that cause fever are mild and can be handled at home; some are more serious and require medical attention. The height of the fever, age of the child, and additional symptoms can help to determine the potential severity of the illness. With an infant younger than 3 months old, call your doctor for a rectal temperature greater than 100.4 F. With an older infant or child, it is not just how high the temperature is, but also how your child is acting. Call your doctor about a child who has any fever and appears ill, has a stiff neck, new rash, is not eating or playing, is not acting like himself, or worries you in any other way.
Rash — Localized rashes without fever, such as diaper rash, eczema or athlete's foot, usually can be treated at home. However, for rashes with fever, rashes that involve large areas of the body, or rashes of unknown cause, call the doctor for advice. The doctor may want to see your child in the office since a rash can be a sign of serious illness and can be hard to diagnose over the phone.
Colds — Colds can make children feel miserable, but rarely cause more serious problems. Colds most often are caused by viruses, which cannot be treated with antibiotics. They are treated at home with comfort measures like rest and fluids. There are occasionally complications of colds like ear infections, pneumonia or sinus infections. Infants with bad colds (bronchiolitis) may have difficulty breathing and feeding, so call your doctor immediately if this is the case. If an earache develops, the nasal congestion lasts more than 10 to 14 days, or the symptoms worsen instead of improving after three to five days, speak with the doctor.
What to Handle at Home
Poison ivy — Most cases of poison ivy can be handled at home. Soothe the itchy skin with cool, wet compresses several times a day and then apply calamine lotion. For severe cases, your doctor may recommend an antihistamine given by mouth and a corticosteroid cream for the skin to relieve itching and inflammation. Call your doctor if your child's rash affects the genitals or face, causes swelling around the eyes, involves large parts of your child's body, or if you can't control your child's itching. If your child develops a fever, or if his rash hurts, swells or oozes pus, it may be infected. Check with your doctor as soon as possible.
Minor burns — Minor (first-degree) burns involving only the top layer of skin can be managed at home. If your child has a burn over a small area (the size of a dime or nickel) that just turns red, hold the burned area under cool running tap water for about 10 minutes. Don't use ice; it can injure the burned areas. And don't cover the area with butter, creams or ointments. Give over-the-counter medicine like acetaminophen or ibuprofen to relieve pain.
Nosebleeds — Nosebleeds are common, especially in winter when indoor air is overly dry. Most nosebleeds can be treated at home by having the child sit up, tilt her head forward and pinch the entire soft part of her nose. Continue pinching her nose while she breathes through her mouth for 10 minutes. If bleeding returns, pinch the nose for another 10 minutes. Call your doctor if bleeding has not stopped after 20 minutes or if your child got a nosebleed after a head injury. To prevent occasional nosebleeds, use petroleum jelly to lubricate the inside tip of the nose and encourage the child not to pick or rub at his nose. In the winter, keep indoor air moist with a humidifier. Call your doctor if your child has frequent nosebleeds.