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Making the decision to call your pediatrician can sometimes be a tricky one, especially late at night. On one hand, you don't want to cry wolf -- bothering your doctor every time your child sneezes. On the other hand, you certainly don't want to miss any critical symptoms. Pediatrician Angela Thompson-Busch M.D., Ph. D., believes that it's better to err on the side of caution. "I think parents should let the doctor decide whether or not a trip to the doctor's office is necessary," she advises. Here, she helps you decide on the severity of your child's illness as well as the best course of treatment.

1. Vomiting: After an episode of vomiting, it is best to wait for one hour before allowing your child to drink anything. Then give your child a few small sips of clear liquid (electrolyte solution, soda pop, Popsicles). If this stays down for 15 minutes continue to give fluids in moderation every 15 minutes for at least four hours before progressing to food. When these measures don't work, the child may ultimately become dehydrated. Persistent vomiting for more than 24 hours should be evaluated by your child's doctor. This is especially true if there is no accompanying diarrhea. Vomiting and fever alone may be signs of a urinary tract infection, strep throat or appendicitis. If your child is having episodes of vomiting that are bloody, a thick green color or projectile, this could indicate an injury or a blockage in the bowel and should be considered a medical emergency.

2. Dehydration: Dehydration can be very serious. A child who is vomiting and having diarrhea may become dehydrated quickly. In addition some children with illnesses that cause a sore throat will stop drinking, which could ultimately lead to dehydration. It is important to try to hydrate your child with clear liquids slowly but consistently when they are sick (see above). The signs of dehydration include urine production less than three times in a day, headache, lethargy, a sunken fontanel (soft spot on the head of infants) and dry lips or tongue. Any of these symptoms warrants a trip to the doctor's office.

3. Fever: A fever of 100.4 degrees or more in any newborn under six weeks of age should be considered a medical emergency and requires calling the physician immediately. In children older than six weeks, a fever (temperature greater than 100.4 degrees) is often helpful in fighting an infection and may not present the same urgency for medical intervention. While the actual height of the fever is not always critical, the way the child is behaving is very important. If a fever-reducing medicine (acetaminophen or ibuprofen) is given, and your child is still fussy, whining, crying or lethargic an hour later, a physician should be seen immediately even if the fever was only 100.5 degrees. On the other hand, if the child is interactive and will engage in some activity after a higher fever is reduced with medication, waiting a few days before seeing the doctor will not hurt. If a fever persists more than 72 hours, you should always call your doctor.


4. Difficulty breathing: Many things can cause a child to have difficulty breathing. High fevers alone can often cause children to breathe quickly but quietly. If medicine relieves the fever and the breathing returns to normal, then you do not need to consult your pediatrician right away. But if the breathing is rapid, yet there is no fever, you should contact your doctor immediately. Noisy breathing can signify croup, asthma or an inhaled foreign body. Croup is a viral illness that causes noisy breathing when your child breathes in. It often includes a barky cough that gets worse at night. Breathing the cold air outside or warm mist from the shower will often improve the noisy difficult breathing. If these interventions don't help, call your pediatrician. Wheezing is noisy breathing when breathing out. You may not be able to hear the wheezing but instead notice that your child is having a difficult time breathing, complaining of a tight chest or coughing continuously. These symptoms all warrant a visit to the doctor's office. If a child has been eating a hard food, is noted to choke and then continues to cough frequently it may be a sign that they have inhaled a piece of food into their lung. Call your physician to ask their opinion on how to proceed. Your physician will likely suggest that you take your child in for a chest X ray in the office or an emergency room. An inhaled foreign body in the lung must be surgically removed.

5. Excessive sleepiness, lethargy, confusion or belligerence: Many things can cause a child to have any of these symptoms and all warrant a call to your doctor or trip to the office or emergency room.

• A seizure typically characterized by a rhythmic jerking motion of some part of the body. There are many causes for this including a head injury or high fever. Immediately after a seizure, a child will be very difficult to arouse. You should always notify your doctor if you think your child has had a seizure. Or call 911 if the seizure lasts for more than two or three minutes.

• Head injuries are very common in children. The most important time for monitoring a child with a recent head injury is four hours after the accident. Many children will be drowsy and complain of a headache. Occasionally there will be an episode of vomiting after the accident. It is all right to let the child sleep, but awaken them every 30 minutes for four hours after the injury to ensure that they are arousable. If your child loses consciousness, seizes, acts unusual or vomits repeatedly after the injury, call your doctor immediately.

• An accidental ingestion of medication or poison is common in young children and must be addressed immediately. All homes with children should have a phone number for the poison control center near the phone and Ipecac syrup (a medicine that induces vomiting) in the medicine cabinet. If your child ingests something, call poison control, not your physician, immediately. They will tell you whether to induce vomiting with the Ipecac syrup and if there is a need to see your physician or go to the local emergency room.

6. Belly Pain: Many things cause abdominal pain including constipation, acid indigestion and the stomach flu. Any time that belly pain is persistent and accompanied by a complete lack of appetite or is accompanied by thick green vomit or bloody stool, a medical professional should be seen. If a child is refusing to walk because of the pain or is doubled over in pain, call the physician immediately.

7. Bloody stool: Anytime that blood is seen in the stool, a physician should be consulted. If possible, bring a stool sample in to the office for testing. Be sure to tell your doctor if your child has consumed any red foods, such as Jello, since this can often mimic blood in the stool. The cause of the bleeding may be a small tear in the rectum or hemorrhoids, both of which result from constipation. Although the bleeding may be benign, many serious diseases need to be ruled out.

8. Limping: Since children are very active and often try new things, limping is very common. If a limp occurs after a mild injury and is not accompanied by significant swelling and bruising it is all right to treat it at home with cold compresses and ibuprofen. If the injury does not improve after 48 hours consult your physician. Any time that a limp is accompanied by a red, swollen joint, a fever or a refusal to walk, an office visit should be made as soon as possible.

Dr. Busch received her M.D. degree from The Johns Hopkins University School of Medicine in 1995 after completing a Ph.D. in pharmacology at The University of Michigan in 1991. She finished her pediatric residency training at Children's Hospital Medical Center in Cincinnati, OH and spent one year in sub-specialty training in pediatric hematology/oncology at Michigan. She is on staff at the All About Children Pediatrics center in Eden Prairie, Minnesota.
 

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