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Symptoms Parents Should Never Ignore in Children
By Kevin Brown

It’s certain that parents will be confronted with symptoms of illness in their children. Some of these symptoms may be harmless. However, others might be warning signs of serious illness that require immediate medical attention, or, at the least, a phone call to the pediatrician.

Katie Rich, MSN, CRNP-PC, IBCLC, a nurse practitioner with the Pediatric Alliance at their Allegheny North Side office, offers the following guidelines about medical symptoms in children, some possible causes, and when parents should seek immediate help, call the pediatrician, or simply treat at home.

“Fever is common in childhood and just means the body is working to fight off an infection,” Katie advises. “Most of the time, kids with fever can be watched at home for a day or two and given over-the-counter fever reducers. Head to the doctor within a day or two if the fever persists and the child has other symptoms such as pulling at ears, a sore throat or a cough,” she says.

According to Katie, one exception is a fever of 100.4 or higher in an infant less than three months old.

“Newborns have immature immune systems and can become very ill quickly. We do not recommend fever-reducing medications in this age group because we don’t want to mask the fever. Call your pediatrician right away.”

“Another exception is when a fever is present for five days in a row. Call the pediatrician in this case because, if there is no definitive cause, the child may need further evaluation,” she notes. 

Abdominal Pain
“Abdominal pain is one of top reasons kids are taken to hospital emergency rooms and can be a tough symptom to determine the cause, especially in nonverbal children who can't describe their symptoms,” Katie says.

“Often, it is related to common causes like gastrointestinal viruses, constipation, or stress. Mild symptoms can be treated at home with rest, diet modifications and monitoring.”

Katie cautions that parents should call the pediatrician when pain lasts over 24 hours, when pain is severe and unrelenting (child may be doubled over), or the presence of blood in vomit or stools, green-colored vomit, a hard or firm belly, or pain accompanied by a fever. These symptoms could indicate more serious ailments like appendicitis or rarely, an intestinal blockage. 

“Headaches in older children can be related to other illnesses such as dehydration, lack of sleep or possibly, migraines. Minor headaches that are not persistent and aren't associated with other symptoms can be treated with rest, hydration and over-the-counter pain relievers like acetaminophen or ibuprofen,” Katie notes.

“Contact the pediatrician if a child younger than school age complains of a headache, as well as a child of any age who has neurological symptoms like balance problems, dizziness or visual disturbance; a child who is awakened from sleep due to head pain; or a child who has a headache accompanied by a stiff neck.”

“Headaches occurring two or more times per week requiring ibuprofen or acetaminophen and any headache that is increasing in frequency or severity need to be evaluated by your child’s doctor,” she cautions.

Vomiting and Diarrhea
At some point, a child will have vomiting and diarrhea - alone or together. The cause is usually a virus, particularly if they are occurring together. Many times, a trip to the doctor isn't necessary and parents can manage symptoms at home with a regimen of rest; small, frequent meals; and fluids, according to Katie.

However, sometimes vomiting and diarrhea can be severe enough to cause dehydration.

“Children should see the doctor immediately if they go more than eight hours without a wet diaper or urinating, if they are listless, or are unable to hold down any fluids,” she cautions.

“Some other signs of dehydration include dry lips and mouth, lack of tears when crying or a depressed fontanel in an infant – the ‘soft spot’ on top of the head.”

Breathing Problems
“Breathing problems in a child should always be evaluated. Common causes include viruses such as respiratory syncytial virus, or RSV; the common cold; pneumonia; allergies; or a chronic respiratory disease such as asthma,” Katie says.

“If a child is congested or has a cough, but is able to eat well and play, parents could wait for a few days before going to the doctor. Cough and cold medications are not recommended for children. Speak to a pediatrician for advice on supportive care at home.”

“Parents should call 9-1-1 or go to the nearest hospital emergency room immediately if a child is having trouble catching his or her breath; breathing hard and fast; retracting (can see ribs when breathing in); or has any sort of facial or lip swelling, color change (pale or blue) or flaring nostrils,” she says.

Katie recommends calling the pediatrician if a child with asthma requires albuterol more frequently than every four hours. 

“Rash is a very common complaint and most rashes are harmless. They can develop from viral infection, eczema or a reaction to a new substance. If a rash is widespread, not improving, or is itchy or painful, call the pediatrician for an appointment,” Katie says.

“Hives are a type of skin rash characterized by red, raised, itchy bumps. They can occur with a serious allergic reaction called anaphylaxis.  Some causes of anaphylaxis include bee stings, medications, and certain foods such as nuts. Signs of anaphylaxis include hives, difficulty breathing and vomiting/diarrhea with abdominal discomfort.  If these symptoms are occurring, it is important to be evaluated right away by calling 9-1-1 or by going to nearest hospital emergency room,” Katie recommends.

Education is the Best Medicine
Parents who educate themselves have an advantage in dealing with their children’s health challenges. Katie recommends new parents take pre- and post-natal educational classes along with basic CPR and first aid courses.

Pediatric Alliance offers baby prep courses and Baby 9-1-1 or Parent Panic classes that are geared toward new parents. It also offers a baby handbook on its website including important reasons to seek medical care.  The website also displays a link to an online symptom-checker from the American Academy of Pediatrics. 

“Our offices always welcome any questions,” Katie says. “Parents can call and speak to an experienced nurse.”

As a final bit of advice, Katie says that parents are not supposed to be the experts.

“Seeking advice through an online search engine can be terrifying and cause unnecessary worry. If parents have concerns, they should always consult their pediatrician for advice.”

Pediatric Alliance provides high quality, comprehensive primary and specialty care (asthma, allergy, immunology and endocrinology) to infants, children and adolescents through clinical expertise, advocacy, education, collaboration, research, and information management. As the largest physician- owned group pediatric practice in the Pittsburgh region, Pediatric Alliance offers 17 different office locations. For more information, please visit www.pediatricalliance.com.

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