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When to Call the Doctor

by Jennifer Nelson
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Your baby has a fever, a cough, and is extremely fussy.

She's not acting like herself, and you suspect she's ill. But how ill? Is it something minor? Could it be serious? And how will you know the difference? When is it time to call the doctor?

Many parents frequently face this scenario -- especially new ones, who may be uncertain in knowing when to call the pediatrician. Often times a parent may not want to "bother" the doctor for what they think might be a minor illness. However, the American Academy of Pediatrics recommends that you should always feel free to call your doctor's office, either during office hours or at any time for an emergency. Children's illnesses are rarely black and white. But the advice below can clear up some of the gray areas.

Making the Most of the Phone Call
To help open the lines of communication with your pediatrician, find out about call-in times for non-urgent matters. Some doctors' offices prefer that you call with general questions during regular business hours. Some even have special phone-in times for new parents. Before the call, have the questions you want addressed written down. This way you don't hang-up and realize that you have forgotten something important. Prepare by having readied the answers to questions that the doctor is likely to ask. The AAP says some of those questions include:
When did the child's symptoms begin?
What's the child's temperature?
Is the child on any medication? If so, what medication, dosage and when was it last administered?
Is the child drinking fluids?
Is the child behaving normally?
Has the child vomited or had diarrhea or constipation?

Be ready to gather information. Always have pencil and paper ready to write down the doctor's instructions. Remember, often the doctor will not be able to answer some questions over the phone or make a diagnosis without first examining the child.

Check with the Office
Before you need one, it's a good idea to check with your doctor's office to see if there are specific times reserved for sick appointments. Some offices save certain time-slots for sick children, and perform well-baby visits at other times. Others scatter sick appointments throughout the day. Whatever your doctor's policies are, it's a good idea to know them beforehand.

When Should I Worry?
"In general, children less than 2 years of age can fool you, not giving classic signs of serious illness, and even then, late in the disease process," says David L. Fay, MD, a family physician appointed at George Washington University, the University of Illinois and Southern Illinois University medical schools. It is especially important for parents to evaluate and stay attuned to their child during an illness. "Specifically, infants less than one month old have to be treated very conservatively," says Fay.

While there's no cut and dry formula for knowing when to call the doctor, there are some very good guidelines to help parents determine when children need medical intervention. Below are symptoms in infants and children which require parents to promptly call their physician or seek medical attention, according to Dr. Fay.

Fever
Less than one month old -- any fever
One month to three months old -- fever of 100.4 rectally
Three months to three years -- fever of 102.6 rectally

Other Signs
Fussiness in infants
Poor sleeping
Decreased fluids
Lethargy
Frequent diarrhea
Frequent constipation

"Obviously, many of the symptoms associated with serious illness are also seen in minor illness," says Fay. "This makes distinguishing the two very difficult, even for medical professionals."

Trusting Your Instincts
The American Academy of Pediatrics recommends that when you are not sure whether to seek medical advice, trust your instincts. "There is no doubt that parents are better attuned to the nuances of a child's behavior than any medical professional will be," says Fay. Parent's instincts can be beneficial in determining if a child needs medical evaluation. When in doubt, it is always better to have the child evaluated by a medical professional.

Emergencies
Emergencies are often the scary result of an illness or accident. According to statistics, children under 5 are most at risk for household accidents.

"It's important for parents to know how to access the Emergency Medical System (EMS)," says Fay. Accessing EMS is crucial during a true emergency. It's also helpful for parents to know Cardiac Pulmonary Resuscitation (CPR). Properly performed CPR can bridge the time until the EMS arrives, often saving a child's life. Learning the Heimlich maneuver or abdominal thrust for choking infants and children is also beneficial. Taking a certified course is the only way to effectively learn the procedures. "Learning basic first aid is also helpful," recommends Fay.

The most important thing is to work out a procedure for medical emergencies -- in advance. Develop and test it. Know how to access the 911 feature in your community. Have doctors and poison control center numbers visibly posted. Learn the shortest route to the emergency room. Planning decreases panic and helps ensure your child will receive the best medical care available.

It's generally easier to know when an accident requires prompt medical attention, because more severe symptoms are present. Below are some common emergencies that the AAP says require immediate medical attention.

Emergency Situations (requiring immediate emergency action)
Bleeding that cannot be stopped
Poisoning (call Poison Control Center first for guidance)
Seizures
Difficulty Breathing
Head injury
Loss of consciousness
Wound deep enough for possible sutures
Severe burns
Suspected bone fracture
Animal bites

Deciphering between a serious illness and a minor one, a true emergency and a false alarm can be intimidating especially for new parents. But with a little knowledge under your belt, the proper guidelines and experience -- deciding when to the call the doctor will become second nature. As parents, the more decisions you make regarding your child's medical care, and the more attuned you are to their patterns -- the easier it gets to trust your parental judgement, and make the proper decisions for your child's healthcare.

About the Author: Jennifer Nelson is a contributing writer with iParenting. She lives in Jacksonville, Fla. and is the mother of two children.

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