Local pediatricians offer tips on which symptoms warrant a visit to the doctor, and which don’t.
Run-of-the-mill runny nose? No problem. Twenty-four hour stomach bug? We got this. But when the thermometer hits 103 or the cough starts sounding croupy, even experienced parents could feel conflicted about when it’s time to contact the pediatrician.
We spoke to local doctors about some of the most common childhood maladies, to help you decide when it’s time to make the call to your pediatrician or visit your local urgent care center. We break it down by the most common symptoms, injuries or illnesses for children and infants, and asked the experts when it’s time for them to step in.
When a child has a fever, parents’ concern level is usually directly proportional to the reading on the thermometer. But Dr. Anthony F. Napoli, Jr. of CHOP Primary Care in Gibbsboro, says that parents shouldn’t be so number-focused. “The height of the temperature is not indicative of the severity of an illness,” he says. The child’s overall demeanor is a better indicator. For instance, if a child with a fever is still active, playing, eating and drinking, it’s probably not a big concern, he says. But if the fever is accompanied by lethargy, listlessness, irritability or respiratory distress, it’s best to call the physician. Likewise, if a fever lasts four days or longer, the child should be seen.
“A lot of parents get nervous with fevers and want to give medicine to bring it down,” says Dr. Diana Lee of Advocare Lerch & Amato Pediatrics, with offices in Gibbsboro and Sewell. “But fever is not always a bad thing. It’s a sign [that] the immune system is revving up to fight the illness.”
But physicians warn that a fever in a child less than three months of age should be evaluated by the doctor. “Parents should call at the first sign of fever in a young infant, before giving any medication,” says Dr. Ira LaVoe of Advocare Woolwich Pediatrics.
Whether it’s a middle-of-the-night bark or the wet-and-phlegmy variety, coughs are among the most concerning symptoms for parents, and one of the most frequent source of calls to nurses’ hotlines at pediatric offices.
According to Lee, most coughs are viral in nature and typically resolve on their own within seven to 10 days. But, she says, if the cough persists, worsens, begins to sound deeper in the chest, or is accompanied by a spiking fever, it’s a good idea to call for an appointment so the doctor can listen to the child’s chest.
Other red flags: flaring of the nostrils and “belly breathing,” which is when you can see the rib cage when inhaling. “These are signs that the child is experiencing some respiratory distress and should be seen by his or her pediatrician,” says LaVoe.
Cold vs. Flu
It can be difficult for parents to determine whether their child has a cold or the flu because many of the symptoms – congestion, runny nose, cough and headache –are similar. With the flu, these symptoms typically come on suddenly, are more intense and are often accompanied by body aches, vomiting, diarrhea, fever and a general, overall discomfort or unease.
“In a healthy child, the flu will generally run its course,” explains Napoli. “But if the child has an underlying chronic condition such as asthma, it’s better to bring him or her in to be seen.” Lee says the best line of defense against the flu is the flu vaccine. “We strongly recommend it for our patients,” she says.
Not much causes a child – or parent – more misery than the vomiting, diarrhea and the accompanying belly pain of a stomach bug. But this doesn’t always warrant a trip to your local health care professional. “Fortunately, most times a stomach bug is a virus that parents can manage at home,” Lee says. The key is to keep the child hydrated.
“Children can dehydrate quickly when there is more output than input,” cautions LaVoe. Warning signs include infrequent urination, crying without tears, lethargy, or lack of skin elasticity – it will “tent up” rather than fall right back into place when pulled. If parents notice any of these symptoms, the child should be seen by a doctor to determine if IV fluids are needed.
To fight dehydration at home Lee recommends an electrolyte replacement like Pedialyte, rather than sugar-laden sports drinks, which can exacerbate diarrhea. “Even if you have to offer one spoonful at a time to keep it down, it helps,” she adds. Another cause for concern – and a doctor’s examination – is blood in the vomit or stool. “This could be indicative of a bacterial or parasitic infection,” notes Napoli.
Sports or Play Injuries
Bumps, bruises and scrapes are inevitable childhood mishaps. And while antibiotic ointment, a bandage, an ice pack and a kiss from Mom or Dad can alleviate most “booboos,” there are some warning signs that an injury could be serious. If parents notice swelling, significant bruising, limited range of motion, a limp, redness, heat, or any type of deformity in the limb, it could be a sign of a fracture or other more serious injury, and warrants a visit to the doctor, experts say. The same goes if a child complains of pain at the site for more than a few days, or if redness, swelling and fever develop about a week after the injury. These could be signs of an infection, Napoli says, and should be checked out.
If you suspect your child might have a concussion – symptoms include headache, dizziness, mental fogginess, visual impairment, nausea, vomiting, light or noise sensitivity, or lethargy – the child should “absolutely be evaluated,” advises Lee.
According to Napoli, allergic reactions can be triggered by food, medicine or environmental factors, but most times the cause is not determinable and the reaction is a one-time occurrence.
Mild allergic reactions such as hives or itchiness can usually be treated at home with an antihistamine like children’s Benadryl. But if a child is having an allergic reaction involving two or more symptoms – such as skin rash or swelling along with vomiting –LaVoe suggests calling a doctor.
Be on the lookout for skin-color changes, difficulty breathing or swelling of the lips or tongue, as these could be signs of a serious and potentially life-threatening situation, adds LaVoe. “If you notice any of these symptoms, call 911.”
There are no hard and fast rules to indicate when a child should be seen by a physician versus treated at home, say the experts. “A better guideline is whether a child is looking or acting atypically and there is a change in status from their ‘normal,’” explains LaVoe. “In that case, it’s a good idea to at least call and speak to the nurse who can help determine if it’s medically necessary for the child to be seen. It’s always better to be proactive than reactive.”
It’s up to the parent to decide whether they would be more comfortable discussing symptoms over the phone with a nurse first or making an office appointment from the get-go, says Napoli. “Every parent has a different worry level, so if you’re concerned, go ahead and bring the child in to be evaluated.”
Most doctors say there’s one thing they won’t discuss over the phone, however: prescriptions. “Parents should not call to ask for a prescription to be phoned in to the pharmacy without the child being seen first,” says LaVoe. “A reputable physician will want to evaluate symptoms before prescribing any medication.”
Of course, all the experts stress if it’s a true emergency, parents should not delay by calling or visiting the doctor’s office. “Instead, call 911 immediately,” emphasizes LaVoe. “It’s better to err on the side of safety.”
But when it comes down to it, sometimes parental intuition is right on target. “The bottom line is [that] every scenario and every child is different,” Lee says. “I recommend parents listen to their gut instinct and if they believe something is not right for their child, they should call the doctor.”
Advocare Woolwich Pediatrics
300 Lexington Road,
Building B, Suite 200
Advocare Lerch & Amato Pediatrics
63 N. Lakeview Drive, Suite 202
239 Hurfville Cross Keyes Road, Suite 260
CHOP Primary Care
13 S. Lakeview Drive
Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 5, Issue 6 (August, 2014).
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