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Parents should trust instincts about children’s illnesses, say pediatricians
June 30th, 2013
It’s 4:40 on a Sunday afternoon and my six-year-old son has developed a slight fever and is lethargic. We live 15 minutes away from a children’s urgent care clinic, which closes in 20 minutes.
Sharyl Paley, M.D.
Do his symptoms warrant a trip to urgent care? Do I bother calling his pediatrician or am I being overly cautious?
Every parent faces these kinds of questions. Three local pediatricians all say that parents can and should trust their instincts.
“First and foremost, parents know the child best,” said Cecille G. Sulman, M.D., chief physician of pediatric otolaryngology of the Department of Otolaryngology and Communication Sciences of the Medical College of Wisconsin.
“Parents have very good instincts and if they are concerned, we want them to call,” said Sharyl Paley, M.D., a Fellow of the American Academy of Pediatrics who works at Bayshore Pediatrics, an affiliate of Children’s Hospital of Wisconsin.
Cecille Sulman, M.D.
“The bottom line, if your parent judgment tells you that you’re worried and your child isn’t acting themselves, call,” said Lisa Zetley, M.D., assistant professor of pediatrics at the Medical College of Wisconsin and a pediatrician at Children’s Hospital of Wisconsin.
“We like to help, talk, and reassure when we can,” Zetley continued. “The doctor would much rather have you call than have you stay awake all night worrying about your child. That’s what doctors who take care of kids are there for.”
Paley, Sulman and Zetley spoke of a very common concern, fever. Zetley said that most physicians consider a true fever to be 100.4 degrees or higher. She added that all parents should have a thermometer to take a temperature.
Lisa Zetley, M.D.
According to Paley, “It is not the fever that I am most concerned about, but rather what is the underlying cause. The fever is a symptom that tells us to look for something else.”
“I am much less worried about a child with a 104 fever that is drinking well and playing at times then the one that is 101 and lying on mom’s lap listless like a wet noodle,” Paley continued. “One important case when I absolutely want a call for a fever is in an infant under two months with a fever greater or equal to 100.5 [rectal temperature].”
All three doctors stated that a doctor must be notified if a child with a fever presents the following symptoms: sore neck, sore throat, vomiting, diarrhea, refusing to drink or eat, lethargy, problems swallowing or breathing.
Zetley also made it clear that, “If a child has a fever and an underlying illness that puts them at a higher risk for problems, and [if] they have a fever, they should call their doctor and not wait it out.”
Sulman said, “The younger they are, particularly six weeks old or younger, and the higher the fever, the more urgent it is to go to the emergency room because the immune system is immature and the baby has not had all her immunizations yet.”
Zetley confirmed this. “They tend to have a less robust immune system. It’s harder for them to fight off infections and it’s harder for parents to be able to recognize other signs of illness because they’re so young,” she said.
Sometimes associated with a high fever is an ear infection. Sulman said, “Symptoms of a complicated ear infection that would warrant an emergency room visit include sudden drainage from the ear, which can mean a ruptured ear drum, severe ear pain, if there’s redness and swelling behind the ear, or the ear is sticking out.”
However, in less serious cases, Sulman said, “You don’t necessarily have to treat an acute ear infection. They may not even need an antibiotic; I’d leave it to the discretion of the pediatrician who will guide you. My oldest son had an ear infection and he was not having symptoms, so I called my child’s pediatrician and just observed him and everything turned out just fine.”
In addition, a trip to the emergency room and a call to the doctor is warranted for other infectious conditions, what Sulman said is a “rapid development of symptoms in a short period of time, such as over the course of a day, like neck swelling and fever, difficulty turning the head, that may be associated with drooling and difficulty swallowing, may be worrisome for a neck abscess/pus collection in the neck or throat.”
Paley concurs. “Another time I want to know is if your child was sick and then seemed better but starts acting sick again or fever returns,” said Paley.
There are also important preventative measures. Zetley said, “Never give aspirin or medicines with aspirin to children of the risk of Reye’s syndrome, and ibuprofen is only safe for kids six months and older.”
Another preventative measure Sulman noted was to be conscious of foreign bodies, harmful objects that can make their way into the body. For example, no child under four years of age should eat popcorn, gum or nuts, as they have not yet developed molars. “They may swallow or aspirate them,” said Sulman.
Another foreign object of much concern is a battery. If a child ingested, or is suspected of having a lodged battery, Sulman urged a trip to the emergency room immediately. A battery can erode within hours in the esophagus.
In addition, children under three years of age should not play with marbles, as it’s a serious choking hazard.
Zetley recommended a website, (not in lieu of calling a doctor), www.healthychildren.org, supported by The American Academy of Pediatrics. This website has a category called, “Symptom checker: Should you call the doctor? Find out here.”
Sulman also said that the American Academy of Pediatrics has helpful guidelines at www.aap.org.
Disclaimer: This article does not offer case-specific medical advice and is not intended to be a diagnosis. If you seek medical advice, contact your physician.
Joshua Becker (joshuabecker.info) is a Spanish teacher for Shorewood Public Schools and a freelance writer.