Sick Child? How to Know When to Call the Doctor

This is a guest post by Dr. Stephanie Dekom of @mommyhotline. 

Fall is here, and with it comes the dreaded start of cold and flu season. If you’re a parent, you know that kids get sick, and often there’s nothing you can do about it. That being said, there are times when you should have your child evaluated by a doctor—and when it comes to little kids, it can be hard to make that call.

My name is Dr. Stephanie Dekom.  I am a board-certified pediatrician who runs a helpful, super-hip Instagram account, @mommyhotline.  Follow me for the best parenting hacks, because these tiny guys don’t come with instruction manuals.  I’ve teamed up with Covered Goods® to bring you some of my best tips on caring for your kids during cold and flu season. Here are some of what I consider reasons to be alarmed, along with tips on when to call your pediatrician.

Fever in an Infant

To begin, any fever in a baby’s first month of life—and by fever I mean a rectal temperature of 100.4 F (38 C) or more—is a reason to go immediately to the emergency room.  Newborns fall into a separate and very distinct group when it comes to fevers and need to be evaluated by a medical professional immediately. 

Fever in an Older Baby or Child

For older children, symptoms of upper respiratory infections are runny nose, fever, cough, irritability, and decreased appetite.  If your child is no longer a newborn, monitor his or her fever. A fever of 100.4 (38 C) or more for over 48 hours should be considered reason to bring your little one in for evaluation.

Difficulty Breathing 

It can be difficult to tell for sure if your child is having trouble breathing if you’re not a trained professional. If you suspect your child is having trouble breathing, it’s a good time to have him or her evaluated. When you bring your child in, the doctor will look at is the child’s stomach to see if he or she is struggling, or as we say, “working,” to breathe.  If your child is pulling his or her stomach in with each breath to the point that you are able to see the bottom of the rib cage, that is alarming and requires medical evaluation.  Additionally, the use of nose muscles to help a child breathing is a concerning respiratory feature. We call this, “nasal flaring.”  The bottom line is that a child struggling to breathe requires prompt medical evaluation. 

Failure to Eat or Drink, and Irritability 

Refusing to eat is a common issue with colds, but this alone should not prompt an immediate trip to the doctor’s office.  On the other hand, if you child is refusing to drink, this can be more problematic because of the danger of dehydration.  One way your doctor will assess the possibility of dehydration is by asking how many wet diapers you’ve changed in the past 24 hours, and if this is noticeably different from usual. Lastly, irritability is a common issue with for anyone suffering from an upper respiratory infection, adults included.  However, a child should always be consolable.  If you find that your child is unable to be soothed no matter what measures you have tried, this is not normal and should prompt a trip to your pediatrician. 

What to Avoid When Your Child’s Sick, and What to Do

Did you know that the American Academy of Pediatrics does not recommend over-the-counter cough medications for patients less than 6 years of age?  These medications have not been shown to be better than placebos in this age group, in addition to being expensive and having worrisome side effects.  Save the cash and invest in a good humidifier for your child’s room to use when they aren’t feeling well.  It is also important to stay hydrated, this can be done with water or Pedialyte (they even make popsicles).  I would caution against excessive use of juices, which can cause diarrhea, or milk, as this can lead to more mucus production.  For the runny nose and congestion, I always advise my patient’s families invest in a Nose Frida, which is a great suction device that can be used for patients who are too young or developmentally unable to blow their nose.  If a child is older than 1 year of age, you can use honey as a cough suppressant, and this is surprisingly effective.  Do not use it is anyone less than 1 as it has been associated with botulism in that age group. 

Here’s the Bottom Line…

Most children with symptoms of a cold have just that.  A cold.  Colds are caused by various viruses.  Unfortunately, viruses are bugs that the scientific community really has not come up with a way to battle yet, so we may as well consider colds part of the human experience.  It should be noted that viruses are not to be confused with bacteria. Bacterial infections can be treated with antibiotics, but antibiotics have no effect against viral infections such as colds.  Still, if your child has a fever for more than 48 to 72 hours, if their symptoms are not improving after a week, or if a cough is lingering these are signs that your child may have a bacterial infection that could warrant the use of antibiotics. 

Remember, these are just guidelines.  Use your judgement, you are the expert on your child and know them best.  Your pediatrician really does not mind seeing you in the office, or hearing from you by phone.  That’s why they went into this field, to make you and your child happy and healthy.  For more tips and tricks on parenting, follow me @mommyhotline.

Dr. Stephanie Dekom is a board certified pediatrician who runs a helpful, super-hip Instagram account, @mommyhotline.  Follow her for the best parenting hacks, because these tiny guys don’t come with instruction manuals.

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