Topics Addressed Below:
Fever
Fever is a normal response by your body to various causes (i.e., infections, vaccines). Our group defines fever in a child older than 3 months as a temperature ≥ 101ºF. There are many ways to take temperature including under the arm (axillary), rectally, orally, in the ear, or with a temporal scanner. Keep track of your child’s actual temperature and how you take the temperature. If your child has a fever, we recommend treating the fever only when the child is uncomfortable. In most cases the anti-fever medicine (i.e., ibuprofen (Motrin, Advil) and acetaminophen (Tylenol, Feverall)) will only bring the child’s temperature down 1º-2º degrees. For example, if your child has a 104ºF temperature, we expect the fever to drop to 102º-103ºF with medication. As an adjunct to fever reducers, you can give your child a tepid (water temperature of 85º-90ºF) bath. Notify the on-call physician of your child’s fever if it meets one of the criteria listed below.
When to call the on-call doctor:
- If your child is younger than 3 months with a rectal temperature >100.4ºF
- If your child has a very high fever (>104ºF)
- If your child is inconsolable despite giving an adequate dose of a fever reducer
Fever, resulting from an infection, of ≤ 104ºF is beneficial. It helps the body fight infections; turns on the body’s immune system; and may help shorten the course of the illness.
Fever reducers are only designed to make your child more comfortable. It will NOT stop your child from having a fever.
On average, fever reducers take up to one hour to work. Acetaminophen can last as long as 4-6 hours and can be safely given at any age. Ibuprofen can last as long as 6-8 hours and can be safely given to children ≥ 6 months of age.
With over-the-counter cold medicines, avoid preparations which also contain acetaminophen or ibuprofen in order to minimize the chance of overdosing on a fever reducing agent.
Accidental ingestions
If you know or suspect that your child has swallowed or otherwise has been exposed to a harmful substance, please call the Poison Control Center at 1-800-222-1222. This 24/7 hotline number will let you talk to experts in poisoning. They will give you further instructions.
Vomiting
There are many illnesses that will cause vomiting and/or diarrhea. These illnesses are commonly referred to as viral gastroenteritis. In most cases, children do not need to be seen immediately for these symptoms. The most important thing you can do is keep your child hydrated. The best way to keep small children (< 3 years old) hydrated is with an oral rehydration liquid (i.e., Pedialyte). Older children can take water, flat ginger ale, or Gatorade. Avoid red or green colored drinks for it may artificially make the vomit appear to be blood-stained or bile-stained. Also avoid drinks high in sugar such as apple juice. If your child has begun to vomit, let him/her rest for 1-2 hours to allow the stomach to settle then start with small sips of liquids (i.e., 5cc every 5 minutes for 1-2 hours). Some children will continue to vomit but in most cases the frequent small amount of liquid will keep them hydrated.
When to call the on-call doctor:
- If your child is unable to keep liquids down for several hours (6 hours for infants or 12 hours for older children)
- If your child is having severe pain in his/her stomach with vomiting.
- If the vomit has blood or is green in color.
- If your child appears very dehydrated (sunken eyes, not urinating for > 8 hours if your child is 12 hours if your child is > 1 year old)
Diarrhea
As with vomiting, diarrhea is most often caused by a viral gastroenteritis. The key is to keep your child hydrated with water. Avoid juices (especially apple, pear, or prune juice) or any drinks high in sugar for these types of drinks can worsen the diarrhea. For formula fed infants, continue normal feeds. In older children (> 1 year old), give more starchy foods (rice, bread, plain pasta). In most cases, diarrhea is not an emergency and can be addressed during office hours.
We do not recommend any medication to stop diarrhea. These medications may prolong the illness.
When to call the on-call doctor:
- If your child is having bloody stools
- If your child has become very dehydrated (sunken eyes, not urinating for > 8 hours if your child is 12 hours if your child is > 1 year old)
Antibiotics
In the best interest of a sick child, an examination shouldalways be done first before any antibiotic, if warranted, is prescribed. If you are concerned about your child’s illness and think your child cannot wait until the morning to be evaluated, take your child to an emergency room or urgent care center. Should issues arise with a refill request, please call during regular business hours when we are best able to handle these requests.
Immunization reactions
When your child receives vaccines, it is quite common for him/her to have fever, discomfort, swelling and redness around the injection site. For more information about shot reactions, consult the vaccine handout you received in the office. In most cases shot reactions are not emergencies.
Cough and Nasal congestion
Cough and nasal congestion are usually due to the common cold, which is, indeed, very common and is caused by a virus. Other symptoms may include fever, headache, sore throat, sore muscles and fatigue. A visit to the doctor's office is often not needed, and colds usually get better in 3 to 4 days. There are many types of viruses that can cause a cold. There are no medicines that will make the cold go away, but some may help your child feel better; for example, ibuprofen (Motrin, Advil) or acetaminophen (Tylenol, Feverall) if your child has fever or pain. Antibiotics are not used to treat a common cold. Over-the-counter (OTC) cold and cough medicines are not recommended for children under age 6. Make sure your child drinks plenty of fluids, gets enough sleep, and stays away from secondhand smoke.
Call during office hours:
- If your child’s symptoms get worse after the first 2-3 days or do not go away after 7 to 10 days
- Call the on-call doctor or take your child to the Emergency Room:
- If your child is having trouble breathing or is breathing rapidly
- If your child has asthma or reactive airway disease and his/her breathing is not responding to breathing treatments given every four hours
Earache and Sore throat
In general, both earache and sore throat are not emergencies, but may need to be seen in the morning. Antibiotics, if warranted, will be prescribed after your child has been evaluated. If you feel that your child cannot wait to be seen until the office opens, please take him/her to an urgent care center. In the meantime, pain relievers may provide comfort.
Rash
In most cases,rash or unusual skin changes are not emergencies and cannot be diagnosed over the phone. If you are concerned about a rash, please call during regular office hours. If your child has recently started a medicine and develops a rash, stop the medication and call our office in the morning.
When to call the on-call doctor:
- If the rash is associated with other worrisome symptoms or if your child looks or acts sick
Pink eye
Conjunctivitis is commonly referred to as pink eye. If your child has developed redness in the eye or discharge from the eye, please call our office during business hours. In the meantime, you can treat the eye with warm compresses or artificial tear drops (available at most drug stores). The tear drops can be used as often as needed to irrigate away the discharge. Remember, conjunctivitis may be contagious so wash your hands after caring for your child.
When to call the on-call doctor:
- If your child sustained trauma to the eye
- If your child is unable to see from the eye or complaining of severe pain
- If your child cannot open his/her eye because of eyelid swelling. Wipe away any discharge with a lukewarm washcloth to help the eye open.
Burns
Burns, especially scalds from hot water and liquids, are very common childhood accidents. They can be categorized as minor or major. Minor burns present with redness, pain, and minor swelling. The skin is dry without blisters. Healing time is about 3 to 6 days; the superficial skin layer over the burn may peel off in 1 or 2 days. Major burns produce blisters, severe pain, and redness; the blisters sometimes break open and the area is wet looking with a bright pink to cherry red color; or, with even more severe burn, the surface may appear dry and waxy white, leathery, brown, or charred. Any burn that produces blisters should be considered major, unless it is very small and does not involve the hands, feet, face, groin, buttocks, or a major joint.All major burns need immediate medical attention. If a burn occurs, you should immediately:
- Remove the child from the heat source.
- Run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area under water for at least 5 minutes. A clean, cold, wet towel will also help reduce pain.
- Calm and reassure the child.
- Over-the-counter ibuprofen or acetaminophen can help relieve pain
- For minor burns, if the skin is unbroken and after it has cooled, moisturizing lotion also can help.
- If a blister has formed, do not break it.
- Protect the burn with a dry, sterile gauze, bandage or with a clean bed sheet or cloth.
- If your child's clothing is stuck to the burned area, do not attempt to remove it. Instead, cut around the clothing, leaving the burn intact.
- Do not apply any ointments, oils, or sprays to the burned area.
If your child has burns on the hands, feet, face, groin, buttocks, or a major joint, or if the burn covers a large area, take your child to the Emergency Room or dial 911 for emergency medical attention.
For more information and topics, check out kidshealth.org
If your child is a patient of Lansdowne Park Pediatrics and you need to reach the on call doctor after office hours, please call us at
(610) 532-4924