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Monday, December 15, 2008

Calling Your On-Call Pediatrician: How To Get The Most Out Of The Conversation

Invariably it happens, your child gets sick when your doctor's office is closed. You call the on-call pediatrician but you are not sure you are describing your child very well. What’s worse is that you forgot to tell her that he also has this weird rash and now your not sure if you should call back or not.

These situations can be frustrating both for the parents and the doctor as it is sometimes difficult for the parents to convey, and the doctors to get a sense of, how sick a child is over the phone. By following a few simple steps before calling your child’s doctor, you will be able to better provide the information your pediatrician will need to give you the best advice. Your pediatrician will ask a series of questions to tease out whether what your child is suffering from is a simple viral illness and the child can stay home or something more serious. As you will be the pediatrician's eyes, prior to calling your child's doctor, assess your child for yourself.

1. Does he have a temperature? Take your child's temperature. For younger children, especially infants, the temperature should be taken rectally.
2. Does he have a rash? Remove all your child's clothing and look for rashes. If your child does have a rash, you will be asked for how many days he has had the rash. What part of his body it started on and has it spread? What does the rash look like? Is it red and raised like hives? Is it lacy? Is it blotchy?
An important feature of a rash is whether or not it blanches. (This means does it turn from red to skin color when you push on it.) An easy way to tell this is by using a clear glass cup. Push the bottom of the glass cup against the rash and see if the rash turns from red to skin color. If it does, it blanches.
3. Is your child dehydrated? Ways to assess for dehydration are: Is he peeing often? Are you changing the same number of wet diapers as usual? Does he have tears when he cries? Is the inside of his mouth moist? Do his eyes look sunken? How is he eating and drinking? Often sick children don't feel like eating, which is fine. What we are concerned about is liquids. Is he still drinking and about how much has he had? Next, is he keeping the liquids down? Does he have vomiting and diarrhea? If so, has it been one episode of vomiting or multiple? Is he vomiting food or greenish, yellow fluid, called bile?
4. How is your child breathing? Do you hear grunting, wheezing or whistling when he breathes? Is his breathing normal or labored? Is he working harder to breath? To assess this observe your child breathing without his shirt on. Do you see his ribs sucking in when he breathes? Does it look like he is using his chest and abdominal muscles to breath? Are his nostrils flaring?
5. Is he inconsolable? Most children are more cranky than usual when they are sick. It is important to determine if they are just a little more cranky or inconsolable.
6. Is he lethargic? Being more tired than usual is normal when you are sick but having difficulty arousing the child, or not being able to keep him up for even a short period of time may mean that your child is lethargic.

Add to this list any other information that is relevant to your child’s health, such as he has been pulling on his ears, or he has a dry hacking cough, or his sister is home with strep throat. Be sure to know the names and dosages of any medicine he is taking. Also have on hand the phone number to a local 24-hour pharmacy.

By going through a list such as the one above before you call your child’s doctor you will be able to organize much of the information you will be asked to provide. Having the answers to these questions when you speak to your pediatrician will enable you to give a better description of your child, which will allow your child’s doctor to give you the most appropriate advice.