Friday, February 12, 2010

How to know when to take your child to the doctor

Disclaimer: I am not a medical professional.  Beyond some biology classes and an Emergency Medical Technition course, I have NO medical training.  I'm just a medical sponge and have a great pediatrician.

Growing up and even into college, I wanted to be a doctor or a nurse.  I've always been fascinated by medicine and I love researching and learning medical things.  As a mom, I've found it beneficial to learn and understand more about viruses, infections and antibiotics.

I don't like wasting money, and I really don't have any to waste.  Paying $15 per doctor appointment (and $50 for Urgent Care), I don't like to take my children in for every sniffle, cough or even vomiting episode.  At the same time, I don't want to be a negligent parent and allow an infection to worsen because I was hesitant to pay a co-pay.  I also don't like to over-medicate my children, and while antibiotics are necessary at times, there are negative attributes as well.

I have a great pediatrician who loves to explain things and even test me in my knowledge and understanding of my kids illnesses.  I'm not sure if he's like that with everyone, or if he senses that I'm a medical sponge.

Last month I was 2 for 2 in one week, taking my children in and leaving with a prescription for antibiotics, I've been patting myself on the back for making good use of my doctor and co-pay.  While mommy instinct does play a part, I think it's more due to the mental checklist I've created over the past few years.

Here's Beana's guide to diagnosing your children...It's pretty basic.

Fevers are good and normal; they fight infection.  They are common at the beginning of a virus, and usually don't require medical intervention.  Liquids, cool baths, wet cloths all help with fever.  For high fevers, I usually give Tylenol or Ibprofren.  As amazing as it sounds, fevers as high as 104 are within the "normal" range for kids.  If my kids have a low fever (below 101) I usually let it ride and do it's job without medicating.

Usually fevers lasting more than 3 days can indicate some sort of infection that may need treatment.  A lot of it depends on the other symptoms.  Recently, with the swine flu and other flues that went around, fevers lasting a week were part of the usual run of the illness.  Two of my kids went through this.

From my experience, a fever is a real issue is when a child has been sick with a cold or respiratory flu for a few days or a week, and gets a fever all of the sudden.  According to my pediatrician, this almost always indicates a secondary infection.  Which is exactly what happened recently with Lily.  She had a cold for a week or more--runny nose, coughing.  But no fever.  When she suddenly became feverish, and it climbed to 102, I knew there was something more going on.  And sure enough--ear infection.

I've also learned, a fever combined with a sore throat and no other symptoms can be strep throat.  This is what recently occurred with Miss Rose.  She actually didn't complain as much as I would have expected for how bad her throat looked.

Runny Noses
The bane of all mother's existance.  We should seriously buy stock in Kleenex.  Runny noses run so rampant in the winter.  And they can last a few weeks.  We've found (and this is my ped's rule of thumb) when a runny nose lasts more than two weeks, it's often turned into an infection.  This is especially true when the mucous is thick and it's acompanied by a cough caused by post-nasal drip.  My pediatrician doesn't go as much by color of mucous as he does duration.

I've heard it estimated that in their first few winters, children pick up a few viruses a month.  This is how the body builds immunity.  Runny noses, which come with colds, can be the cause of infections that do need treatment.  But on it's own, a runny nose is just a runny nose.

Ear Infections
These aren't too hard to pinpoint.  In my children, the primary indicator is usually when they've had a cold and suddenly get a fever.  We seem to catch them before they get too painful.  So far, it's usually the fever that tips me off, not the child complaining of pain.  My chiropractor told me once that he never used antibiotics when his children had ear infections.  He liked letting the infection run it's course and only once did it result in a ruptured ear drum.  I did let an ear infection run it's course in Lily when she was a newborn.  I just wasn't ready to put antibiotics in her system.  And she recovered just fine.

For the first two years of her life, every time Gracie got a fever, regardless the cause, she would vomit.  Usually multiple times.  Her little system was just very sensitive and that was it's response.  Quite the opposite of Miss Rose who has vomited less than a handful of times in her six years.

Dehydration is the biggest concern with vomiting.  After many conversations with triage nurses late at night, I've learned some tricks.  For small toddlers and children, they usually recommend trying 1 teaspoon of Gatorade every 20-30 minutes if there is concern for dehydration.  Have you ever actually tasted pedialyte?  It's awful.  Definitely go with Gatorade!  I think the last time Gracie went through a vomiting stint, they wanted her to urinate at least once in several hours.  She got very close to going beyond the threshold, but finally urinated.

Another trick I learned (from a friend, and also recommended by the on-call nurse) is making rice water to soothe a tummy.  You boil rice in water--just like you were making some to eat--but before all the water cooks in, pour the water off the rice.  It should look slightly milky and be a little thickened.  It's full of soothing starch.  You can feed it directly to the child or mix it with another liquid or food.  This helps tremendously with settling their tummy and even stopping up loose stool.

Bland foods are obviously the foods of choice when recovering from a sick tummy. 

So...bottom rules for doctor visits:

--fever+pain (sore throat, ears etc)
--fever that comes several days after the initial illness set in
--runny, thick congested nose lasting more than two weeks
--fever lasting more than three days

There are plenty of times I take my children in to the doctor and they don't need antibiotics or other treatment.  Sometimes as a mom, you just need that peace of mind.  And as Bean always says "that's why we have insurance."

What do you look for before you take your child to the doctor?   What was your "shining mom moment" when you hit the nail on the head with your child's sickness?  (just like I did last month--2x in one week!)

This has been a very sickly season for us and many of our friends and family.  I'm looking forward to warmer weather and less germs!


  1. These are some great tips! My daughter was congested for a little while, and I used the same rule that you did-- a two week threshold on a runny nose. It cleared up just before we reached that point, and now we're in the clear.

    I agree with you; in a way, I feel a trip to the pediatrician's without a prescription is worthless! I also take advantage of our nurse triage line-- great advice there!

    Confessions From A Working Mom

  2. yes, I love talking to the nurses!


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