“Dr. Whyte, is Jacob* gonna be okay?” this was asked of me by the mother of a school-aged child several years ago as he laid pale and listless on the exam table. He had high fevers, fatigue, abdominal pain, headaches, muscle aches, frequent vomiting and was dehydrated. Jacob had the flu. We call lots of illnesses “the flu,” when we don’t know what they are. Jacob didn’t have the generic, nondescript, “the kid’s sick so I’m calling it the flu” sort of illness. My man had the real deal, having tested positive on his nasal swab in the office the day before.
Jacob’s mom had never seen him this sick before and she was scared. She did the right thing and brought him in. With aggressive antiviral therapy and close follow-up, Jacob recovered nicely at home. Had his mom decided not seek medical attention, however, I’m not sure that things would have turned out so rosy. Jacob, quite likely, could have been hospitalized for complications from influenza, or worse.
Deciding if a child is sick-enough to need a doctor’s visit is something moms, dads, grannies and aunties have argued about forever. I hear it all the time in the office, “I didn’t want to bring her in for nothing.” It doesn’t have to be the flu like in Jacob’s case, parents wonder all the time if their child needs to see the doctor for an ugly sore throat, a GI bug/stomach flu, or an ear ache that won’t go away. Then there are the times when the parents bring a child in and they’re so sick I send them to the emergency room instead. With kids “sick” becomes “real sick,” fast, especially when they’re babies.
Emily* was in the office for her nine month Well Child Check and she was cute as a button. She had developed a fever the night before but her mother wasn’t concerned about it, she said if it wasn’t for the well visit, she wouldn’t have brought her in for the fever. At Emily’s six-month well visit I’d tried to convince her mother to give her the first of the two-series infant flu shots, but she declined. Here we were three months later and Emily’s rapid flu test was positive.
Emily’s flu was likely in the early stages and her body hadn’t started to mount the full-scale attack that results in the same symptoms that Jacob experienced. In my office Emily looked great, she was happy and nursing well, but she was an infant with influenza and that is serious business. The flu in an infant her size nearly doubled her risk of experiencing serious complications like pneumonia, but also of passing away due to the infection.
Emily didn’t seem that sick, but that’s the best time to treat a baby for the flu, before the virus can advance and real damage can be done. I had a talk with her mom and we started her on supportive care and antiviral drugs and she got better at home. If it hadn’t been for that previously scheduled well visit, things could have turned out bad. Babies get dehydrated more easily than school-aged kids.
When I saw Jacob he was really sick, but when I saw Emily the only clue that something was wrong was her fever. So how are parents supposed to know when to treat their child at home, when to see their doctor and when to go to the emergency room? When a kid is sick, parents feel like they’re stuck between a rock and a hard place: if they’re too aggressive, they can waste time and money having their child seen unnecessarily; If they are too lax, they can miss having their kids seen for something serious.
First thing, you can always call your doctor’s office or your local ER and talk to a triage nurse about your child’s symptoms. Triage nurses (when we are lucky enough to work with them in our practice) spend much of their day answering phone calls of parents desperate to know whether to bring their children in to the office.
While most illnesses are self-limiting (meaning they resolve on their own without treatment), there are a few, general signals for making an appointment with your doctor if your child is sick, and we usually start with a fever. A fever is your body’s way of killing a virus, kind of like how dropping a bottle into boiling water kills the bacteria on it. Fevers mean an infection and the higher it goes the harder your body is fighting. The American Academy of Pediatrics (AAP) recommends parents call their doctor for a fever if:
- If your baby is three months or younger call your doctor immediately if they have a fever of 100.4oF (taken rectally);
- Call your doctor if your child is two-years or younger, has a fever of 100.4oF that hasn’t broken for 24 hours;
- If your child is over the age of two and has a fever of 100.4oF for longer than three days.
- Regardless of their age, you should call your doctor immediately if your child’s fever repeatedly rises over 104oF;
- If your child has a fever and also has an underlying health problem that involves the immune system like, type 1 diabetes, sickle cell disease, lupus or is undergoing chemotherapy for cancer.
The AAP also recommends that if your child has a fever and also develops any of the following symptoms, call your doctor immediately:
- Significant decrease in urine output (fewer diapers counts for infants and toddlers);
- Change in mental status (disoriented, confused, unusually tired, very fussy);
- Refusal to drink liquids;
- Intractable vomiting for more than just a few hours;
- Develops a stiff neck, headache, rash or severe ear pain.
- A very sore throat or problems swallowing.
Even if you have a situation outside of the parameters listed above but are still worried, you are NEVER wrong to have your child seen. As flu season is quickly coming upon us (get vaccinated!), let us keep in mind the old adage “better safe than sorry.” The reassurance from a trusted medical source (rather than a mom’s or dad’s group on Facebook) should go a long way to facilitating that calm.
There’s never a good time for a kid to get sick, but we’ve all experienced being woken up in the middle of the night by a sick child calling for you or your baby crying. Your doctor’s office is probably closed, so what do you do then? If your child has a fever and any of the symptoms listed above, the AAP recommends you take them to the ER or an open urgent care center. You can also take your child to the ER or an urgent care center if your doctor is too busy to fit them in (it happens).
I said before that parents sometimes bring their kids to be seen by me and I send them right to the ER. That seems backwards to some parents, why would I turn a kid away or make them drive someplace else and wait again to get care. Sometimes kids can be so sick they need treatment immediately that I can’t provide in my office like IV fluids and emergency meds to open up their airways. The AAP recommends that you take your child to the ER immediately if they have any of the following symptoms:
- If you suspect their symptoms are a result of accidental poisoning;
- Difficulty breathing;
- Skin or lips that look blue, purple or gray;
- Lack of consciousness or unable to waken;
- Severe neck stiffness or rash along with a fever;
- Paralysis (unable to move);
- Sudden loss of energy, becoming withdrawn or less alert;
Taking your child to the ER is something no parent wants to do, but if you do the best thing to do is to remain calm and clear-headed.
The old saying “an ounce of prevention is worth a pound of cure” is true when it comes to kids. The best ways to keep your kids healthy and out of the doctor’s office this cold and flu season: 1. Everybody wash your damn hands and 2. Get your flu shot. Here’s to wishing us all a healthy (and hopefully short) cold and flu season.
*Names have been changed to ensure patient confidentiality