Fevers are common in children. They are probably the number one reason for after hour phone calls to the doctor. Many parents feel panicky when the thermometer indicates fever. So what should you do?
First, and most important, don't panic! Keep trying to think logically and stay calm. Your sick child needs you to be able to make rational decisions. Understand that if the temperature is under 100.5 F, then it is not actually a fever, and you should simply monitor the situation. Also remember that fever can be helpful in fighting some infections.
Fever is a sign that your child's body is reacting to an infection. When there is a fever we try to figure out if the infection is a serious one. The fever itself won't hurt your child, but a serious infection can be a cause for concern. If your child has a fever, but is older than three months of age and is looking and acting just fine, you do not automatically need to call the doctor. Fairly normal behavior and energy level often mean the fever is caused by a more minor infection.
Here are some things to think about. If your child is under three months of age and has a rectal temperature of 100.5 or higher, you should probably call the doctor. You could consider unwrapping your baby, making sure that too many blankets isn't the problem. In general, though, for an infant under three months old with a fever, you should call.
If your child is over three months of age, then her behavior and appearance are important in evaluating how serious of an infection it is. There is no automatic temperature at which you should "panic" and rush to the ER. 103, 104, and 105 F are all "high" fevers. When the fever is high you also need to consider how sick your child looks. If they are very irritable or lethargic, it is more concerning.
When I am called about a child's high fever I frequently ask parents to give a dose of ibuprofen or acetaminophen, and then reassess their child in an hour. If she feels and looks much better with such a simple intervention, then it may be ok to wait until the next day before bringing her in. The goal of using anti-fever medicine is not to bring the temperature back down to normal, but to temporarily bring it down a little and to make your child feel better. It is a good sign if something basic like acetaminophen or ibuprofen can make a big difference in how your child feels.
Giving a cold bath is kind of dramatic and old-fashioned. I don't usually recommend it because I don't think it would be very soothing to already feel awful with a high fever and then get plunged into icy water. Cool wet washcloths on the forehead and back of the neck will be much more comfortable for your child.
106 F or higher makes me think of heat stroke, so at that level you should call or take your child to the hospital. 103 F and higher, in addition to a lethargic or irritable child who does not improve with acetaminophen or ibuprofen, would be another reason to call or have your child evaluated right away.
In addition, with any level of fever (that's 100.5 or higher) when your child is also very irritable or lethargic and not improving with anti-fever medicines, you should consider calling or taking your child in.
A child who is lethargic and irritable is usually not smiling, not eating and drinking, is very sleepy or won't stop crying or moaning. The child can be very restless or almost impossible to comfort and console. When the doctor asks about "lethargic" she does not mean that your child just wants to sit around and watch TV, or that they seem a little more tired than usual.
When there is a fever, this is what you should do:
Before you call the doctor, take a few seconds to think clearly about your child and his fever. What other symptoms does he have? What illnesses was he exposed to? How long has he been sick? Can you help him cool off by undressing him, using cool cloths on the forehead and neck, and giving him anti-fever medicine? Did you give the right amount of ibuprofen or acetaminophen, and did you give the medicine enough time to work? Was there improvement in his appearance, mood, discomfort, and energy level?
If you are reassured by improvement in your feverish child's appearance, then you may be able to manage this at home for the time being. You could make an appointment in the next day or two if the fever doesn't go away. If you continue to be quite concerned and worried about your child even after trying some things to help them feel better, then don't wait to check in with the doctor.
Disclaimer: As usual, my advice in this blog is general and may not apply to your specific situation, or to your child's special circumstances. This blog is not intended to be a substitute for the personal attention your own doctor can provide.
Showing posts with label after hours phone calls. Show all posts
Showing posts with label after hours phone calls. Show all posts
Monday, September 12, 2011
Sunday, September 5, 2010
Calling the Doctor After Hours
Every time I am on call I answer after hours calls from worried parents. I have been on call, on average, 7 days a month for the last thirteen years. That would be 1092 call nights/days since I joined Trestlewood. If I average 10 calls a night (weekends more, weeknights less, winter more, summer less, but averaging it all out) that means I have answered over 10,000 calls from worried parents so far in my career! I have a lot of experience answering after-hours questions from parents via my cell phone. I know what are the most common reasons people call and what advice to give them. I know what really scares parents in the middle of the night, and how to tell parents what to look for if the illness is getting worse.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
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