Ask the Expert: How Do I Know if It’s Time to Call the Doctor?

pediatricianOur pediatrician answers your health questions below:

Question: My child has a cough and cold: how do I know if it's time to call the doctor?

Answer: Over the years, I have learned that it is quite hard to instruct a parent on when to call the doctor. There are those who hesitate “bothering” their clinician and simply wait too long, and there are those who call with every minor symptom—and I wish they would take me off their speed dial!

In general, you should call your pediatrician when you are genuinely concerned. You've tried the usual first steps and they've failed or there are symptoms that you are just plain worried about.

Here are some of the associated childhood cold symptoms that I worry most about:

  • dehydration (no urine output for 6-8 hours or more)
  • severe pain (not made better by OTC meds)
  • fever (of 100.5 F or greater) for more than 72 hours duration
  • severely disrupted nighttime sleep (not made better by OTC meds)
  • difficulty breathing/wheezing
  • seizure, severe lethargy, unresponsiveness—duh!

Of all of these, there is none more worrisome than difficulty breathing. If you have a child with asthma, you know how scary cough and respiratory distress can be. An audible wheeze is easy to figure out, but did you know that asthma can commonly present with a nagging cough that lingers for more than 10 days? Or a cough that is significantly disruptive to nighttime sleep? Neither of these are typical of a common cold.

Those types of coughs and their diagnosis can throw parents for a loop. “He’s been coughing for 2 weeks and I just wanted his ears checked. I wasn’t ready to start an inhaler!” is an exasperated parental sentiment I hear frequently during the winter months.

Special note should also be made regarding the height of the temperature. One of the most frequent nighttime calls I get is for high temperature: 103.6, 104.4, 105.7, sometimes higher. In fact, the height of fever in children over 3 months of age is hardly ever of concern in and of itself, especially now that we are fully vaccinating children. Temperatures of 105+ are fairly common these days and are most likely caused by a virus.

So if your child has a cough or cold and spikes a temp, and you happen to take that temp, and it is a big number, and your child looks exhausted….first take a deep breath. Get out your Acetaminophen bottle, start by dosing appropriately, and wait 30-40 minutes. Many times that will make a huge difference in your child’s comfort level. If your child is fully immunized, take a moment to congratulate yourself. High fever is one worry, barring the above complications, that you have effectively taken off your plate!

And if you have done all of the above measures and still are worried, don’t hesitate to call your pediatric care provider. Emergencies happen, and that’s what your pediatrician is there for.