Consider specific signs:
- Fever: Taking the temperature is essential when the illness begins; later, it may not be as important if the child is improving. Any elevated temperature in an infant less than 8 weeks of age, or a persistently elevated temperature in an older child needs prompt attention. Healthy babies may normally have temperatures up to 99.4 axillary or 100.4 rectally.
- Weakness: A weak suck, feeble cry and decreased muscle tone (limp like a doll) are signs of illness, which require medical attention.
- Irritability: Crying inconsolably, inability to be calmed and difficulty in settling to sleep also require prompt attention. Healthy babies often behave this way during the second month of life.
- Vomiting: Vomiting can commonly occur after coughing, but is of more concern when it is not related to coughing. Healthy babies may vomit or have wet burps occasionally without any illness.
- Diarrhea: Diarrhea is an increase in the number of stools or a change toward a looser consistency. Bloody stools always require prompt attention. Healthy babies may normally have loose green stools, especially if the baby is breast-fed.
- Dehydration: With persistent vomiting and diarrhea, you should look for signs of dehydration. If your child is urinating, even if it is decreased in amount, she is probably not dehydrated. Besides fewer wet diapers, other signs of dehydration are dry eyes (no tears present when crying), dry mouth (tongue, gums), and sunken looking eyes. An infant should have a few wet diapers each day. If you are not sure if your child is dehydrated, you should call the office for advice.
- Signs of Meningitis: A bulging soft spot in an infant, or the inability to flex the neck (touch the chin to the chest as if nodding “yes”) in a child older than one year are signs of meningitis. Usually these are associated with fever and persistent vomiting.
- Sneezing, coughing, nasal congestion, nasal discharge: These signs are usually not a problem in a child who is otherwise well appearing. During a common cold, secretions from the nose often change from white or clear to thick, yellow-green after a few days. This is not a sign that a bacterial infection requiring antibiotics is developing. Healthy babies normally have noisy breathing, coughing, sneezing and congestion.
- Decreased sociability, appetite and energy level: These signs are more worrisome if they are severe or change abruptly than if they are mild or change gradually.
How Sick Is My Child?
- Consider the duration of signs:
• Temperature greater than 104.5 F (rectally), continuous vomiting, persistent lethargy or irritability, severe difficulty breathing or wheezing, blood in stools or vomitus, or extreme pain are major danger signs, even of short duration, which require immediate attention.
• Respiratory symptoms (coughing, sneezing and congestion) and gastrointestinal symptoms (decreased appetite, mild diarrhea and vomiting) usually start to improve after 24-72 hours and the total duration of these symptoms is 7 to 10 days. Usually by the fifth day children are improving or appear well. The failure to improve after the acute (the first 24 to 72 hours) suggests the need to call the office for advice or examination. It is normal for secretions to change from clear and thin to green and thick with a common cold. If this is the only change, antibiotics are not necessary. - Consider the development of new signs:
• Pain: the development of severe pain (crying, difficulty to calm, inability to sleep well) may signify a bacterial complication such as an ear or sinus infection developing from a common cold.
• Lethargy or weakness: A dramatic change in energy level may signify dehydration developing from intestinal infection or a bacterial infection developing from a mild viral illness.
• Vomiting or headache: Development of these signs may signify the development of an upset stomach, streptococcal throat infection, or meningitis.
• New, but not severe symptoms develop: Children may develop OVERLAPPING infections such that before the first infection finishes (3 to 7 days), a second infection starts to develop. This is common if your child is around other children and especially, if these other children have older siblings, then the sharing of germs is much greater. The result is an apparent illness lasting for weeks, but is really many illnesses which are OVERLAPPING each other.
• If your child is suddenly more ill during the course of a mild illness,
• Your child may need prompt medical attention. - Consider the progression of signs:
• Time of day: pain is always more intense in the evening and fever rises at night. Appearing a little more ill at night usually does not mean your child is getting worse.
• Increasing fever, pain, vomiting, diarrhea: After the illness first begins, if on each subsequent day your child appears to be more ill, prompt medical attention may be needed because this suggests a more serious infection or the development of a bacterial complication.
• Progressive worsening: or a failure to improve after 24 to 72 hours suggests a more serious illness.
• Sometimes better, sometimes worse: An up/down picture where your child has good times and bad times are typical for mild viral infections. This pattern may last well beyond the 7 day course for a particular infection if there are OVERLAPPING infections.
• Was improving, now worse: A new mild viral infection or a bacterial infection may be developing. Observation over a period of hours or a call to the office may clarify how to proceed.
WHEN TO CALL, WHAT TO SAY.
Call whenever you think your child is sick and you are uncertain of what to do. Please call early in the day. Before placing the call, try to think chronologically: When did the various signs develop? When the illness has been prolonged or there have been many different problems, look at a calendar and write down some notes before calling. Before placing the call, try to think about severity; what appears to be bothering the child the most? Before placing the call, consider your level of comfort as different from the severity of your child’s signs. You are then better able to communicate and we are better able to respond to you.
“This is an emergency because my child is…”
“This is not an emergency but I think my child needs to be seen today because he is…”
“This is not an emergency but I feel very uncomfortable with her illness and I want to know that there is nothing seriously wrong with her.”
HELPFUL HINTS
Nurses in this office have excellent training, personal experience in caring for their own children and they work closely with the doctors. Please have the confidence when you call that you are speaking to a skilled professional and that she will discuss the situation with the doctor or pediatric nurse practitioner.
Have something to write with when you call, so you can make notes.
Please tell us in the beginning if the call is being placed only because of the concern of someone other than the caller. For example, your mother-in-law feels that you should call, but you do not think that your child is ill.
If your child is fairly active, sociable (smiling, playful), and interested in what is going on around him, his illness is probably not severe enough to cause you to be alarmed.
Please do not use the word “emergency” when your child’s condition has not really changed, but all that has changed is that you are now much more worried. There is a natural tendency to do this, especially when the office is closed.
ALWAYS CALL AGAIN IF YOUR CALL HAS NOT BEEN RETURNED IN A TIMELY BASIS.
Sick children may be seen at the Walk-in only at 8am Monday-Friday & only at 10am Sat-Sun.
At all other times, if you want a same day appointment, call first and press 3.
