Doc Talk: Being a Good Observer

This time of year, we see many children in the emergency department and in our urgent care center who have one of the seasonal viruses that are going around.

But visiting an emergency department, or your pediatrician’s waiting room, can expose your family to viruses that will make your child sicker, or make you sick. That is a good reason to learn about which illnesses you can manage at home, and when you need to seek care.

The key is to be a good observer of your child.

If your child seems ill, take his or her temperature (using a rectal thermometer for children under age 2), but don’t worry too much if your child has a fever. Fever itself is not a danger, just an indication that your child is fighting off an infection. Dress your child lightly to help him or her cool down. Take your child’s temperature every four hours, and give an over-the-counter medication such as Tylenol or Motrin to bring fever down.

Why try to reduce fever if it isn’t dangerous? Because kids who have fevers feel horrible. And with your child’s fever under control, you’ll be better able to monitor other important signs:

1. Respiratory status. Is your child breathing comfortably? Coughing, wheezing, sneezing and congestion are signs of illness. If your child’s nose starts flaring like a bunny, or the chest is moving in and out with each breath, your child is in respiratory distress and needs medical attention.
2. Hydration. If your child is crying without making tears, doesn’t have saliva in the mouth or is urinating less often than usual, she or he could be dehydrated, another sign your child should see a doctor.
3. Behavior. Even a child with a cold should have at least some energy for play. A child who is lethargic, withdrawn, listless and inactive could be seriously ill.

Keep a record of your child’s symptoms. How many days has the fever lasted? When did the congestion start? When did the child’s behavior change and in what ways? With this information, you can call your doctor’s office and see whether your child needs to be examined, or would be better off at home. If your child has difficulty breathing or is severely dehydrated or extremely listless, call 9-1-1 for emergency medical care.

Alan L. Nager, M.D., MHA, has been the director of Emergency and Transport Medicine at Children’s Hospital Los Angeles for the past 18 years, and is a professor of Pediatrics at the Keck School of Medicine of the University of Southern California.