Wednesday, November 21, 2012

when to take your child to the doctor

When to take your child to the doctor.

It’s an age old question, answered many ways by many people, but forever the quandary is ‘I don’t want to wait too long’ or ‘I don’t want to go too early’.
For years my smart aleck answer to the ‘ideal patient’ was one who had a $35 copay or a 35 mile drive. They wouldn’t come in too often but they weren’t prohibited from being seen if necessary. But they wouldn’t just ‘pop in’ ‘because it was worth the 10 bucks and I was just around the corner’.
Different illnesses have different thresholds of concern. For instance, a cold can go on for several days before a mom gets concerned enough to be seen. However, fever and a rash might be cause for concern sooner.
The difference in even 20 years ago and now is amazing. The fear of meningitis and epiglottitis is pretty much gone. Scarlet fever, whooping cough, measles, mumps, rubella, all are things of the past…for the most part.
While grandmothers are helpful in advising moms in areas of concern, we in the grandparent age group have had different experiences and live different realities as parents. Another smart aleck response I have for grandmothers is that ‘if you act concerned, she will tell you why you’re being silly and overcautious, but if you act less than worried, she will say you should rush the child to the ER’. Selective memory is a joke for the most part, but it can be difficult if grandma is remembering serious illnesses that are gone now, or if she is chiding her daughter/daughter in law about illnesses that are relatively new and concerning in this new world. Funny how grandmothers remember (or misremember) the day you peed in the potty the first time (always earlier than the actual event) but they seem to have forgotten what it was like to have a baby keep you up at night crying.
So…some basic tenets: fever for 3 or more days should be looked at. If the child is under 2 months, the fever is over 102-103, the child is acting sick (won’t eat, won’t stop crying, won’t wake up), that’s a different story.
Vomiting is usually self limited and doesn’t cause dehydration by itself. Give clear liquids and 12 hours and most vomiting will be gone. Same story as above – age, severity, sickness level, these mean different things.
Diarrhea is usually not a big deal either. Give it a few days unless it’s associated with vomiting at the same time and the child is unable to hold down liquids.
I usually give a cough 2 weeks if it’s not too bad, but after 2 weeks, if the cough has been consistent and not responding to time and humidity and OTC medicines as needed, it’s generally bronchitis until proven otherwise. Wheezing, trouble breathing, coughing til she vomits, stridor (noisy breathing in), those mean different things.
Rashes are usually not serious. Unless they are. It’s a hard call with rashes, but in the absence of fever or other illness symptoms, it’s generally ok to give them a few days or weeks if they aren’t progressing/spreading quickly or bothering the child.
Bleeding is generally not a good thing for a child to do. Vomiting with blood, coughing with blood, diarrhea with blood…these would hopefully alarm most parents and prompt at least a call to the pediatrician. As far as cuts and scrapes, bleeding is to be expected, and one of my (many, apparently) smart aleck phrases, shared by many in the health care field is…all bleeding stops. Well, it does. It’s just at what point it stops that matters. Head and face wounds bleed more than other areas. Firm pressure on a wound will usually stop bleeding, and if as the pressure is removed the bleeding begins again, your child might need medical attention.
Injuries are a subject all to themselves, but I’ll give an overview.
            If the bone is sticking out, if the child is unconscious, if a joint is swollen and getting bigger, if your child is making no sense after being hit in the head or falling, if your child can’t walk (once able to walk) or use an extremity, those are reasons to seek medical attention.
Unfortunately, emergency rooms have become a place for people to go when they have nothing better to do.  People with colds, mild fevers, obviously mild problems, come to the ER because..because..well, because it’s there. ‘Build it and they will come’. And they do. If only emergencies went to the emergency room, I’d tell everyone with an emergency to go there, but that’s not the case. Now there are urgent care centers on every street corner, but there is no sign of that slowing the tide of bored people with mild vague complaints on Saturday night to show up in the ER demanding to be seen, and taking up the room of someone who is really in need of the level of care available in the ER.
That said, the ER is sometimes the place to go. Sometimes you even have to call 911. Unconscious children (after a fall, an ingestion of something, with a fever…unconscious is on the level of bleeding as something that is generally not good) and massive unstoppable bleeding and total unresponsiveness need 911. Unfortunately, like the ER, 911 is abused. If only people in real trouble called the ambulance, we wouldn’t need so many ambulances.
But that’s sort of the point of this article, right? When is it an emergency? When should I worry? What do I look for?
The internet is a treasure trove of paranoia. The second year of medical school is the year we learn pathology, the science of disease. All the diseases known to man are in one big book and every day you learn about a few more and you go home with the same headache and fatigue and insomnia and anxiety and nausea and stomach pain and each day you interpret those symptoms in a different way based on the disease you just learned about. One day you have African sleeping sickness, the next a brain tumor, and one day you have some illness like Chaga’s disease seen only in South America, to which you’ve never traveled.
The point is, the internet and Google have made that big old pathology textbook available to everyone and so everyone interprets their headache as a brain tumor, their child’s stomachache as appendicitis, their rash as measles, and their fever and stiff neck as meningitis. Thankfully, rarely are they right.
Finally, and in summation, use common sense and as much of a rational brain as you have left at the end of a sleepless night/week and interpret your child’s symptoms in light of the time, severity, appetite, sleep, likelihood, exposure,  of the illnesses you’re considering in the list of possibles (what we doctors call a differential diagnosis) and act accordingly, ruling out the Chaga’s disease early. New parents are given a pass for the first year or so, but after kid #3 you probably know about as much as your pediatrician, so we expect you to do most of the ‘ruling out’ job for us. 


Saltwater Daisy said...

Hilarious. And helpful. Thanks for putting up with us :)

Candice said...

LOL! It is easy to be paranoid these days, that is for certain! I think I need to save this article...sarcasm and a go-by. We just did the whole ER thing for the first time because Cole complained of sever tummy pain for hours to the point he was writhing on the floor and I didn't know what else to do but call his doc who directed me to the ER concerned maybe with ruptured appendix. It wasn't and I felt a little silly, but it was alarming the way he was acting! Anyway, I don't know why anyone would ever want to go to the ER for anything if it was not some sort of was not a bad experience, but I hope one that we don't go through again!

Jay Emory said...

Uh.. I am thinking you must have MapQuest the exact drive from El Reno to your office!! It is eerily close to 35miles... :>