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When to Call the Doctor
Guidelines for Illness: Emergency vs. Minor Illness
It is often difficult to know when to call the Doctor's office. Sometimes parents call with simple problems that can be easily handled at home. Here are some guidelines that can help parents distinguish between illnesses that can easily be handled at home, and those that require urgent care or an office visit. Keep this information close at hand; share it with grandparents, sitters, and daycare providers.The following is a detailed list of problems that require an office visit:
- A child less than 3 months old with a fever of 100.4° under the arm
- A fever greater than 72 hours (fever = temp under the arm of 100.4° or greater)
- Vomiting for greater than 24 hours in children less than 2 years of age
- Vomiting for greater than 48 hours in children older than 2 years of age
- Diarrhea - if persistent, can become serious if dehydration occurs. Signs and symptoms of dehydration are:
- Dry mouth
- Cracked lips
- A significant decrease in urine production (no wet diapers in 4-6 hours in a child less than 2 years of age OR no urination for 8-12 hours in children greater than 2 years of age)
- Complaints of ear pain, pulling or tugging at ears, visible drainage from ears
- Any obvious trauma or injury
Once the office has closed for the evening or the weekend, we prefer to handle URGENT problems that may be UNSAFE to leave until the office re-opens. The following is a list of problems requiring an after hours phone call:
- Fever greater than 104° under the arm
- Signs and symptoms of dehydration, as outlined above
- Ear pain that does not improve with Motrin or Tylenol
- Difficulty breathing, such that the child has difficulty catching breath accompanied with rapid breathing and/or is noted to have a breathing pattern of seesawing chest and abdomen or retractions (the pulling-in of the muscles around the chest), or the flaring of the nostrils when breathing in
- Rash, ONLY if purple, and does not fade when pressed on with finger, is accompanied with a severe headache, and fever greater than 100.4°, OR a rash accompanied by difficulty breathing, especially if currently taking ANY antibiotic or new medication. IF THERE IS AN OBVIOUS SUDDEN INCREASE IN MOUTH, LIP, OR EYE SWELLING, ADMINISTER APPROPRIATE DOSAGE OF BENADRYL AND CALL 9-1-1.
- Fever accompanied by lethargy. Lethargy is when the child is unresponsive, very flaccid or floppy, not just acting less perky than usual. *Remember that fever worth treating is a temp under the arm greater than 100.4°, oral temp greater than 101.4°, or rectal temp greater than 102.4°.
- Trauma or injury causing bleeding that does not stop after 10 minutes of direct pressure, a gaping wound, significant pain or loss of function
- Head injury, if a loss of consciousness or vomiting have occurred, or child appears to be unsteady or dizzy, of if unequal pupils are noted
- Abdominal pain than limits the child's activity and does not improve over the course of one hour
