In the thick of cold and flu season, Julie Forbes is here again to share an interview with a doctor/mother of 3. This is good, you guys. Save it for future reference.
Do you know how many times I’ve lined up all of my kids, taken their temperature one right after the other, and determined they’ve all had fevers? I was doing two things wrong, and had no clue (I’m married to a doctor. You would think I would know these things, but I don’t.) Here’s a little bit of what else I learned from Dr. Christie Romo.
Christie Romo takes care of patients from their first cry to their dying breath. She’s been asked it all. Not only is she a Board Certified Family Medicine doctor with Sutter Medical Hospital in Davis, California, she’s also a mom of three. She breaks down when you need to see your child’s doctor.
Fevers
When Not to Worry: A fever alone is not cause for concern if there is a clear sign of why your child has a temperature. “If they clearly have a cold, if they are clearly throwing up, the fever itself is not concerning. It’s just a sign that they are sick.” Also, doctors don’t consider anything under 100.4 a fever. “If your child has a temperature of 99 degrees, it doesn’t mean they’re not sick, but it doesn’t warrant worrying. And it could just mean they are hot,” Romo says. (Here’s the first thing I was doing wrong… I used to think anything over 99 meant I needed to grab the Tylenol.)
If your child has an incredibly high temperature, like 103 or 104, it also doesn’t mean there’s extra reason for alarm. Kids are more likely to get higher temperatures than adults. “Kids can get temperatures of 103 or 104, and that doesn’t make them any more sick than a temperature of 102,” says Romo. She goes on to say, “Kids just get higher temperatures than adults do. Their immune system is just more immature, so it just responds in more flagrant fashion than adults.”
Also, did you know that digital thermometers need to reset back to room temperature before you can use them again? If you have ever taken your child’s temperature in one ear, and then moved it to the other ear, you most likely got a different result. That’s because the thermometer needs to readjust. Give the thermometer about five minutes to get used to room temperature before you use it again. (And, there’s the second thing I was doing wrong.)
When to Worry: If your child is under 2 months of age and has a temperature over 100.4, you need to get your baby to the emergency room immediately. If your child is under 3 months of age and has a temperature over 100.4, you need to call your doctor immediately. “Little babies don’t have much immunity, and any kind of infection needs to be taken seriously,” Romo says.
In older children, temperatures over 100.4 are a concern if there is no clear source of that fever. Dr. Romo says, “If your child (who is over 3 months of age) has a fever, but no signs of sickness, that is a concern, and your child should come in.”
Mucus
When Not to Worry: Kids and runny noses. The two are just as inevitable as the stains you’re going to get all over those white pants you want to wear. Unfortunately, kids are bound to have runny noses, and to have them frequently. Children are still building up their immune systems and often catch viruses. It doesn’t matter if the snot is green, yellow or clear. Despite the old wives’ tale, color and consistency are not an indication of an infection.
Colds
When Not to Worry: A typical viral cold will last anywhere from 5-10 days. It can include a runny nose, fever, and, or cough. Your child may also have a decreased appetite. If your child has what seems like a common cold, you don’t need to see a doctor. You can run a humidifier, apply vapor rub, put a warm wash cloth on their face, or use a pediatric nasal rinse to help with symptoms. Or, if you’re really brave, you can use a snot-sucker, like the NoseFrida.
When To Worry: Be concerned if the cough from that cold is making it hard for your child to breathe. You may notice their nostrils flaring, or the muscles in their neck straining as they breathe. Also, a cold that goes beyond those 10 days can become a bacterial infection, like pneumonia or a sinus infection. “Usually what happens is, you’ll notice a period of 2 or 3 days where you think your child is getting better, and then suddenly they appear much worse. That’s what we call a secondary infection and it needs to be seen,” Romo says. It may not require antibiotics, but you should still have a doctor check it out.
Also, if your child has an underlying condition, such as asthma, a cold can become more serious, more quickly. If that is the case with your child, you should see your doctor before that 10 day mark.
You should also call your doctor’s office if your child has a fever that doesn’t come down with medicine.
Vomiting
When Not to Worry: Kids vomit all of the time (parenting can sometimes be gross). Maybe it’s because they are crying too hard, or because they are coughing, or maybe because they are sick. Vomiting alone is not a cause for concern. You just need to keep them hydrated. The goal is to give them a teaspoon of liquids every five minutes. Romo says, “If they chug an entire cup of water, they may just throw it right back up. Instead, give them a teaspoon at a time.” She says it doesn’t matter if its water, Pedialyte, Gatorade or juice… just get them to keep down some form of liquid. Dr. Romo says popsicles work like a charm with her kids.
When to Worry: If you see blood in your child’s vomit, you need to take them to the doctor. (The same is true for adults.) Or, if your child’s vomit is green, you should call the doctor. “Vomit that is green can be concerning because the green stuff comes from below your stomach,” Romo says. “So, it could mean that there is something obstructing their stomach.” The green stuff could be bile, and that is a problem that needs to be seen by your child’s doctor.
Vomiting with excruciating pain is also reason for concern. “If your child is continuously throwing up, and is complaining about pain in their belly, take them to the doctor, “says Romo.
Ears and Eyes
When Not to Worry: Just because your child is pulling on their ear, it doesn’t mean your child has an ear infection. Romo says, “Babies pull on everything around them. Just because they are pulling on their ear, it doesn’t mean you have to worry.” It could be teething, an itch, or just because it’s there. Just like your hair or necklace, kids like to pull on ears.
When to Worry: If your child has had a cold lasting more than a week, and has a fever while complaining of ear pain, you should see a doctor.
Dr. Romo says eyes are actually a better indication of a problem than ears. “If your child has redness in or around the eyes, you should bring them to their doctor,” she says. That is usually a good indication that a cold has developed into some kind of sinus or eye infection, and that needs to be seen by your child’s doctor.
Persistent Coughs
When Not to Worry: If your child has a cough that lasts two weeks, without a fever, it probably just means he or she is fighting a stubborn virus.
When to Worry: If your child has a cough that is lasting longer than two weeks, it’s worth having them seen by a doctor. It could be an indication that they have an ongoing infection, or that something else is wrong, like asthma.
Falls
Here’s where things get tricky.
When Not To Worry:
A bump to the head doesn’t necessarily mean you need to rush your child to the emergency room. Romo says, “If your kid hits their head, and they’re acting totally normal, they’re probably fine.” If your child didn’t lose consciousness or if they fall from a low height (less than five feet), it’s not likely that the collision was hard enough to result in a skull fracture, and the risk of an epidural hematoma is very low.
An epidural hematoma is a fracture in the thinner part of the skull (not the top) that tears a blood vessel, which can sometimes bleed in a delayed manner after a period of a few hours. Layman’s speak: the brain is bleeding. If the collision was not particularly severe, and they didn’t lose consciousness, you’ll just want to keep your eye on them for 6-8 hours following the injury.
You may have heard that you can’t let your child sleep after they’ve hit their head. It’s not that the sleep will cause any problems… it’s because if your child is asleep, you can’t check on them to see if they’re acting normally.
When to Worry:
If your child hits his or her head and becomes unconscious, take them to the hospital immediately. Duh.
If your kid takes a bump to the head, there is an unlikely chance that an epidural hematoma can progress. In this event, your child will get drowsier. If this happens, rush them to the emergency room. The only way to rule out an epidural hematoma is a CT scan of the head.
If your child suffers a high energy collision or falls from a considerable height (more than five feet) onto a hard surface, it’s probably worth having them checked out just to be on the safe side. The rules are a little different for kids under the age of 2. For small children, it takes less energy to cause a skull fracture and a very small amount of these skull fractures can “grow” over time (something not seen in older children). In this group, have a slightly lower threshold for a trip to the hospital.
In falls that don’t involve the head: “If your child falls and isn’t using a limb afterwards, hate to say it, but it’s probably broken,” Romo says. “Kids are pretty resilient and they don’t let anything stop them. So, if they’re not walking or not using an arm, you need to have it x-rayed.”
Take comfort in knowing that all of these days filled with wiping noses and putting up with whiny, sick kids could eventually pay off. The hygiene hypothesis is an often supported theory that suggests the idea that it’s good to get kids exposed to germs and to other kids. Romo says, “Kids who are in too clean of an environment, and don’t get exposed to infectious agents and germs early on, their body may create an autoimmune or allergic reaction because their immune system is trying to work. It’s trying to find something to fight.”
Take solace in all of those kids at the daycare who are running around with runny noses. They’re helping you out in the long run. Sigh.
Above all, Dr. Romo encourages you to use your parenting instinct. You know your child, and you know when something is wrong. Don’t hesitate to seek medical attention, if you think it’s necessary. Dr. Romo says, “Doctors are here to help.”
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Note from Jill- We don’t wish any of you to take this over medical advice from your child’s doctor. If you have questions or concerns they are ALWAYS the ones to consult, not Dr. Google.