By Dr. John Jones
Simplicity Urgent Care
It always seems to happen at 6 p.m. You left your happy, healthy baby at the daycare center this morning, and now you have a cranky baby with a runny nose, cough, and a fever. You immediately think: “Where did this come from, and what should I do about it?”
Since your pediatrician’s office is closed for the day, and you know you can’t wait until morning to see a doctor, should you take your child to the emergency department or urgent care center? But are you overreacting?
As a parent of four children and a pediatric emergency physician, I can see both sides of the dilemma. Here are some thoughts to help you handle the situation.
1. First and foremost, it is never wrong to take your child to be seen in the emergency department at any hour. As an Emergency Room doctor by day, I can tell you that is what we are there for. Trust your parental instincts. If you feel that something is wrong, head to the ER or urgent care center — because you know what is best for your child.
2. Once you get there, here’s what you can expect: With children and fever, pediatric emergency physicians break children up into three groups: 2 months and under, 2 months to 6 months, and 6 months and above.
The grouping is based on the number of vaccinations the child has received, with the older children having enough protection against the Strep and H Flu and the younger ones at increased risk of contracting these bacterial illnesses.
- For this reason, if your child is 2 months and under with a rectal temperature of 100.4 or greater, the baby automatically gets a comprehensive work-up and spends the next two days in the hospital for observation.
- For children who are 2 to 6 months, the child will receive a work-up; however, if the lab results are normal, the child can go home with close follow-up with their pediatrician in the morning.
- For children who are 6 months and above, the work-up will depend on the child’s symptoms and how sick the child looks to an experienced pediatric provider. Don’t be surprised if your doctor does a complete physical exam, feels that a virus causes the fever, and sends you home with no antibiotics. This is standard — and good medicine — because it decreases the chances of allergies, diarrhea, and antibiotic resistance in your child.
3. About fever. Another question I am frequently asked is how a parent should handle a high fever. Worried parents often want to know, “If my child’s fever skyrockets to 104, what should I do?”
- I always reassure parents that a relatively high fever in a small child is not harmful because raising the body’s temperature is its method of fighting off infections. In some countries, in fact, doctors do not advise using ibuprofen or acetaminophen because they want to let the fever take its course.
- In the United States, we advise taking antipyretics (Tylenol or Motrin), which knock down the fever and keep both the children and their parents happy. I usually advise parents to stick with Motrin over Tylenol (and do not alternate) because a dose of Motrin lasts for eight hours while Tylenol only lasts for four hours. (If your kids are anything like mine, my wife — also a doctor — and I try to avoid the medicine battle at all costs, so we minimize the frequency of giving medications.)
- When determining the proper dose of Motrin, be sure to administer the proper dose base on your child’s weight — not their age. By using the wrong table it is easy to under-dose the medication, and even a small amount under the required dosage based on weight will render the entire dose ineffective.
Here are some rules of thumb for administering Motrin:
- If your child is 22 pounds, give 5 mls (1 teaspoon)
- If your child is 33 pounds, give 7.5 mls (1 and 1/2 teaspoon)
- If your child is 44 pounds, give 10 mls (2 teaspoons)
- If your child is under 6 months, do not give Motrin and discuss treatment with your pediatrician, ED physician, or urgent care physician.
4. What should you do when your child has a cough? Know that a cough is a very common symptom that is associated with fever. It is frequently part of the viral syndrome — but it can also be a sign of pneumonia.
How can parents tell the difference? It can be difficult, so here is my algorithm for determining which child I will order a chest X-ray on (to determine if the baby has a pneumonia). Note: While these criteria aren’t hard-and-fast rules, I find them helpful for finding pneumonia in children and at the same time helping us not over-order tests.
- Does the child look good? (Yes, he or she is sick, but you know when your child looks like something is wrong.)
- Is the child breathing well? If not, their oxygen saturation may be low.
- Has the child had a fever and cough for more than three days?
If you answered “no” to the first two questions, and “yes” to the last one and you think your child has pneumonia, contact your pediatrician immediately or head to the ER or urgent care center.
5. Assuming your child does not have pneumonia, the next question parents ask is: “So what should I do about this cough?”
- First, I reassure parents that the cough isn’t hurting the child after I have done an exam and found the results to be normal and the child’s oxygen saturation to be normal.
- Second, the short answer is that there is no good medicine for a cough. The over-the-counter cough and cold medications are for children 6 years and older as advised by the FDA.
- The reason that they are contraindicated for children younger than 6 is because they are ineffective and have caused adverse outcomes — but mainly in children under 1 year old.
While there are no great or quick ways to alleviate a cough, I suggest that parents put a vaporizer in the child’s room, especially in the cold, dry winter.
And don’t count out old-school remedies such as mixing in a little milk with honey. In addition to reassuring parents that a cough won’t hurt their children, I tell them just to keep an eye on it for any symptoms of pneumonia (see above).
If you have any questions, please contact your pediatrician, or feel free to stop by Simplicity Urgent Care at 3263 Columbia Pike in Arlington, VA, 703 746-0111. Or make an appointment online at www.simplicityurgentcare.com.
About John Jones, MD, FACEP, FAAP
An emergency physician at INOVA Fair Oaks Hospital who is certified in both pediatric and adult emergency care, Dr. John Jones is a graduate of George Washington School of Medicine with an undergraduate degree from Dartmouth College.
He earned several departmental awards in research and medicine during his course of study. He completed his residency in emergency medicine at George Washington University, then began working at the Quincy Medical Center, where he taught residents and was also a clinical instructor at Boston University.
Dr. Jones then completed a two-year fellowship program at INOVA Fairfax Hospital for Children, and is now boarded by the American Academy of Pediatrics and the American College of Emergency Physicians — one of the few physicians in the country who is double boarded in both emergency medicine and pediatric emergency medicine.
Most recently, he worked as an emergency physician at Shady Grove Adventist Hospital in Rockville, MD, in both the pediatric and adult emergency departments. He also taught residents and is a clinical instructor at Georgetown University. He maintains affiliations with several professional organizations, including the American Academy of Pediatrics and The American College of Emergency Physicians. He is also active with the Urgent Care Association of America.
About John Maguire, MD, FACEP
In addition to being the owner and founder of Simplicity Urgent Care in Arlington, VA, Dr. John Maguire is the medical director for three of INOVA’s freestanding emergency rooms in Northern Virginia where he is responsible for clinical operations and other administrative duties, and annually oversees more than 75,000 patient visits. He has also served as operational medical director for the PHI Air Medical Group, AIR CARE, and helicopter transport services.
A 1997 graduate of Georgetown University Medical School, Dr. Maguire graduated magna cum laude from Radford University with an undergraduate degree in Biology. He completed his residency in emergency medicine at Geisinger Medical Center in Danville, PA, and he became board-certified the following year, in 2001.
He frequently lectures on medical topics, conducts peer reviews, and participates in research studies. His professional affiliations include American College of Emergency Physicians, American Academy of Emergency Medicine, Air Medical Physicians Association, National Association of EMS Physicians, the American Medical Association, and the Urgent Care Association of America.