When Should You Call Your Pediatrician?

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Knowing how to recognize when your child is sick and needs medical attention is important, both to get your child help when they need it and to prevent unnecessary visits to the doctor or emergency room. Most parents call their pediatrician when their child has a high fever. However, it is important to keep in mind that a fever is not the only sign of a serious illness.

Whether or not your child has a fever, if they are very irritable (unusually fussy and can't be consoled), confused, lethargic (doesn't easily wake up), have difficulty breathing, or have a rapid or weak pulse, it's time to call the doctor.

Other reasons to call your child's pediatrician: They are refusing to eat or drink; they are limping or refusing to use one of their arms or legs; they have a fever with no other symptoms (such as a cough, runny nose, or sore throat) for more than one or two days, or they have specific complaints like a severe headache, ear pain, burning with urination, etc.

If a child has a fever along with cough, cold or flu symptoms, but is able to drink enough to stay hydrated, is breathing normally, and is alert, you do not need to call your pediatrician. If the fever and viral symptoms last four or five days, then check with your child's doctor.

Fever

Fever is not a disease. Instead, fever is a symptom that can accompany many childhood illnesses, including bacterial, viral, and fungal infections. According to the American Academy of Pediatrics, in general, you should call your pediatrician when:

  • An infant under 3 months of age has a rectal temperature at or above 100.4 degrees F
  • Fever persists for more than 24 hours in a child younger than 2 years old
  • Fever persists for more than 3 days in a child over the age of 2
  • Fever occurs without any other symptoms (such as cold and flu symptoms or vomiting/diarrhea) and persists for more than 1 to 2 days
  • Fever rises above 104 degrees F repeatedly for a child of any age

For kids over 2 months old, it isn't the number on the thermometer that matters, but rather how the child is acting that will tell you whether to seek medical attention or not. If your child is alert, active and playful, is not having difficulty breathing, and is eating and sleeping well, then you don't necessarily need to call your doctor immediately.

You should call your doctor if your child has a fever and another medical condition (heart disease, cancer, sickle cell, immune system problems, etc.).

Vomiting

Vomiting typically accompanies diarrhea as part of an acute gastroenteritis or stomach virus in kids. It is usually not concerning if your child has only vomited a few times, is keeping small amounts of fluids down, doesn't have significant abdominal pain, and is not dehydrated.

Seek medical attention for vomiting if your child is developing symptoms of dehydration, is vomiting dark green bile (bilious vomiting is a sign of an intestinal obstruction), is a newborn or young infant with projectile vomiting (pyloric stenosis), or if has a severe headache or abdominal pain.

Vomiting is especially concerning if it begins after your child already has abdominal pain, which often happens in children with appendicitis.

Coughing

A cough and runny nose occur commonly in children with colds. These are caused by viruses, and do not need antibiotics (because antibiotics kill bacteria, not viruses). If they are otherwise feeling well, then you don't need to go to the doctor every time your child has a cough, even if they also have a green runny nose.

See the doctor if your child's cold symptoms continue to worsen after 3 to 5 days, if they develop a new fever a few days after a cough has started, if they aren't improving in 10 to 14 days, or if they have another specific complaint, such as ear pain, a constant cough, chest pain, wheezing, or trouble breathing. Most coughs will last up to three weeks, though you should see improvement (less severe, less frequent coughing) in 10 to 14 days.

Trouble Breathing

Children often have a cough and sometimes a wheeze when they have a viral upper respiratory tract infection. If your child is having difficulty breathing, then you should call your doctor.

If you are worried that your child is having trouble breathing: Take the child's shirt off and while the child is as comfortable and distracted as possible (like watching tv or playing on a phone), look for the following:

  1. Count how many times the child breathes in 60 seconds (this is helpful to tell the pediatrician when you call, and helpful for you to know if your child's breathing is getting better or worse over time).
  2. Look at the space in between your child's ribs. Do you see the skin suck in between the ribs when the child takes a breath? If yes, this means that the child is using more of their chest muscles to breathe, and is having trouble breathing.
  3. Look at the space in between the child's collarbones. Does the child suck in there with each breath? If yes, this shows the child is working harder to breathe.
  4. Look at the child's nostrils. Are they flaring in and out with each breath? If yes, the child is working harder to breathe.

A child who is having trouble breathing may also have trouble catching their breath. You might notice that they pause to breathe in the middle of a sentence.

Dehydration

Children most commonly get dehydrated when they have diarrhea and vomiting, from ongoing losses of fluid. But it is also possible to get dehydrated if your child just isn't drinking well.

The first sign of dehydration is that your child will urinate less frequently (your child should be urinating every six to eight hours). Other symptoms of dehydration can include:

  • Dry mouth
  • Not having tears when crying
  • Sunken eyes
  • Decreased activity

Weight loss can also be a sign of dehydration.

Irritability

Fussiness accompanies many childhood illnesses. If your child is fussy and crying but is easily calmed if you just hold them, then that is less concerning than a child who is not consolable and continues to cry.

An important way to tell if your child is "too fussy" is whether or not they are consolable. An inconsolable child would usually be a reason to seek immediate medical attention, especially if they also have a fever or other symptoms.

Lethargy

If you call your pediatrician's office and say that your child is lethargic, you are likely to be told to bring your child in right away. Being lethargic, in medical terms, is usually an emergency and means your child is difficult to wake up. It does not mean that a child's activity is just a little decreased.

If your child is really lethargic and difficult to wake up, then you should seek medical attention right away. It is less concerning if they are awake and alert, and just not as active as usual.

Childhood Rashes

Children commonly get rashes, from having sensitive skin, warts, poison ivy and as part of many illnesses, such as chickenpox, fifth disease, and roseola. In general, you should call your doctor if your child has a rash and a fever, especially if the rash is purple and doesn't blanch or fade briefly when you press on it, or an itchy rash that isn't relieved with home remedies.

Red Flag Symptoms

Other symptoms that are usually concerning and require medical attention include, but are not limited to:

  • Coughing up blood, vomiting blood, or having bloody diarrhea, especially if is accompanied by a fever
  • Persistent pain, whether abdominal pain, a headache or knee pain, or severe pain, especially if it limits mobility and isn't relieved by home remedies
  • Seizures, especially if your child doesn't generally have a seizure disorder, such as febrile seizures or epilepsy
  • Testicular pain, which is usually a medical emergency
  • Head injuries, especially if your child had a loss of consciousness, is acting differently than usual and may have a concussion
  • Cuts and scrapes that require stitches, including those with persistent bleeding, or if the wound is deep and gaping or the skin doesn't come back together
  • A severe allergic reaction that includes vomiting, drooling (which can mean that the tongue is swollen), or trouble swallowing or breathing
  • A severe headache, especially if your child also has a stiff neck, irritability, vomiting or fever
  • Pain when urinating (dysuria), which can be a sign of a urinary tract infection
  • Weight loss, which is hardly ever normal in children and can be a sign of a more serious or chronic illness

For children with chronic symptoms, such as headaches or stomachaches, you should call your pediatrician if your child's symptoms seem worse than usual.

Parenting Problems

Your pediatrician should also be a good resource for you when you have parenting problems. Many parents only make appointments for medical problems.

But you can also make an appointment or call when your child has sleep or behavior problems, difficulty potty training, problems at school, etc. Don't wait until the problem is out of control. Some early help or advice may help prevent bigger problems from developing.

When In Doubt, Call

Trust your instincts and call your doctor when your child is sick, especially if you think that your child appears visibly ill. You should also call your doctor if your child's symptoms are worsening, even if they were recently seen by the doctor.

Most doctors have someone answering the phone 24/7, and that person can often help you decide over the phone whether the child is fine, or needs to come in for a sick visit, or needs to go to urgent care, or needs to go directly to an emergency room. It is always better to call if you have questions or concerns and let the medical professionals help you decide what is best for your child to get them feeling better.

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Article Sources
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  2. Cleveland Clinic. Why your child vomits – and when to see a doctor. Updated August 21, 2018.

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