When your child feels sick it can be nerve wracking.  It is hard not to worry about every little thing and wonder how you can help to get them better as quickly as possible. What is normal and what is something you should worry about? What are the signs that there could be more going on the just an upset tummy or common cold? Many parents have a hard time determining when they should bring in their child for a sick visit. Here are my tips of when to come in and when to wait it out.

For children under 1 year and even toddlers, it can be even more confusing because they are not able to communicate to you what is wrong. Signs that they may need to be seen in the office include:

• Inconsolable and fussy
• Very lethargic or difficult to wake up
• Sunken fontanels (a space between the bones of the skull in an infant) – sign of dehydration
• A decrease in the number of wet diapers – sign of dehydration
• Tugging on the ears. If they are continually tugging on their ears it could be a sign of an ear infection.
• Not eating or drinking well—this is a warning sign. Lack of appetite can be a signal that something is not right.

Even for older children, it is hard to know when their illness is something that will go away on its own with time or something that might require a trip to the office.  Below are some red flags that can indicate a need for your child to be further evaluated in the office.

• Difficulty breathing, wheezing or a whistling noise when they are breathing
• Complaints of pain when swallowing (e.g. a painful and sore throat that lasts more than one day)
• A bark-like cough—this could be a sign of pertussis or whooping cough, which can be dangerous.
• Persistent vomiting or diarrhea or an inability to keep down food or drink.
• Cold symptoms (sneezing, coughing, runny noise) that last longer than 7 days.
• Red eye or yellow discharge from the eye or ears
• Rash of any kind is a reason to be evaluated in the office, especially if it is accompanied by fever.

FEVERS: what is too high?

Fevers are the body’s way of helping fight off disease. Temperatures can rise in the presence of viral infection, bacterial infection, and even with teething.  Although they are not always a bad thing, they can be scary. But knowing when the temperature is too high or lasted too long can cause parents to worry. So, what temperature warrants a trip to the office?

• For babies younger than 6 weeks old: A fever of 101 degrees or higher, this is considered an emergency. You should have your infant evaluated right away whether in the emergency room or doctor’s office.
• For babies 7 weeks to 3 months old: Any fever greater than 100.4 warrants an appointment in the office for further evaluation
• Babies greater than 3 months old: A fever over 104 or a fever that does not improve to less than 101 with medication (like acetaminophen or ibuprofen) or spikes back up after medication administration
• For all ages, in the event of even a low grade fever (99-100.4 depending on age) which lasts longer than 3 days you should follow up with your health care provider for further evaluation.

Remember these tips are just guidelines. Parents know best! If you feel something is wrong do not hesitate to bring your child to the office to be further evaluated.