When your child is sick, it’s hard to know whether you should take him to the doctor, ER, urgent care or simply treat him at home.
Pediatrician Michael McCabe says that when in doubt you should seek a doctor’s assessment.
“There’s nothing worse for a parent than being worried and not having answers,” said Dr. McCabe during a recent radio interview on WHBC AM.
Dr. McCabe, an Akron Children’s hospitalist at Aultman Hospital, explains how parents can know where and how to get answers for their sick child.
WHBC: How can parents differentiate between the common respiratory illnesses that are passed around schools and day cares and the more serious ones that require a visit to the doctor?
Dr. McCabe: That’s a very common concern and respiratory disease is a big reason why folks seek our help. Symptoms, which typically ebb and flow are usually mucous, scratchy throat, headaches, cough, and low-grade fever. If you give your child something to drink, a cool washrag, the symptoms are often relieved and the child feels better.
If the illness becomes more serious (e.g. breathing difficulty, less active) and you find that taking care of the symptoms doesn’t make them feel any better, then they need to visit the doctor. Also, if the child has a persisting or rising fever or escalates even after Tylenol or Motrin, this is concerning.
WHBC: From the pharmacy perspective, we aren’t seeing as many antibiotics ordered. Is it safe to say that we are seeing more viral infections than bacterial?
Dr. McCabe: Things have almost always been more viral but recently there has been a big push in medicine and especially in pediatrics for antibiotic stewardship – or determining who really needs an antibiotic.
When antibiotics first came out, studies showed that the kids felt better quicker after taking antibiotics for a few days but the kids who didn’t take them also felt better in a few days. Because of resistant organisms, practitioners in general are starting to ask who really needs the medicine and whose illness is going to resolve on it’s own. I think folks are being more specific in their diagnoses and treatment plans as opposed to “I’d feel more comfortable if I gave them something.”
WHBC: We’ve heard respiratory viruses are more dangerous to kids with asthma or those who were born prematurely. Why is this the case?
Dr. McCabe: For children with asthma, respiratory illnesses are probably the primary triggers for their disease. The virus sends a cascade of events creating the mucous, inflammation and wheezing. When that happens, it’s an opportunity for the practitioner to review how well the child’s asthma has been controlled.
Sometimes when the asthma has not been well controlled, the virus results in a more severe case. For preemies, that early period up to age 2 can be somewhat tricky. Some kids who were born prematurely suffered some degree of lung trauma or consequences due to having been born early – their lungs are a little bit more sensitive or touchy.
Mucous plugs up their airway and their inability to feed gets them “behind the 8 ball.” Their immunity is up and down and consequently, the germs take advantage of them. The analogy I always use is The Cat in The Hat – the germs come in and then really take over.
The most fragile preemies are the ones who can’t feed well for 24 hours, and who have a harder time breathing. It really affects them negatively as opposed to a larger child who could sustain that better.
WHBC: With new restrictions on antihistamines for children under 6, what can you recommend to parents to help their sick kids who can’t sleep?
Dr. McCabe: We used to pat ourselves on the back that there was a rhythm to all these medications. You would start with this one, then move on to the next that worked or maybe the child just got better. We started focusing more on symptoms because we did studies and found that giving a child a purple pill seemed to make the child feel better as well as the cold medicine.
Then there were some children who had unexpected reactions to the pills and cold medicines. Nobody had studied what are the right dosages for these young children. So the focus changed to keeping these infants well hydrated and more comfortable by taking care of their fever, aches and pains and keeping some type of nutrition going.
Things like cool mist, vaporizers, and saline suction nasal bulbs were just as successful as balancing all the other cold medicines in the past.
WHBC: Can you speak to warm air versus cold air humidifiers?
Dr. McCabe: I think that the key thing needs to be humidification. Period. The challenge is the heating element in the warm humidifiers, which can be a hazard to young children. Also, the aromatic treatment used in the warm air ones can be very irritating to the young child’s airway especially if they have asthma.
The cool mist seems to be safer and just as good. Again, the key thing is making the air not so dry and doing it in a safe manner – that can be done with the warm humidifier just as well as with the cold. Whichever you use, be sure to change the water daily, and keep the filters and element clear.
WHBC: A fever in a child can be very scary for parents, but often even high fevers can be treated at home. What degree of fever requires a trip to the doctor or hospital?
Dr. McCabe: All infants who are 4 weeks and younger who have a fever need to be seen. That’s a group who can get into trouble. Any of us who have been doing this for a while have had kids who looked OK but who have a very serious infection brewing. You have to be careful because they don’t give you any feedback and oftentimes there are very few symptoms.
Going forward from that, any child under 3 months of age who has a temperature of 100.4 or greater by rectal thermometer should be evaluated. The older infant or child should be seen if they have a fever that doesn’t go away after a couple days or one in which cause is unknown.
The high temps can be scary – this may just be a nasty virus but any time a child is spiking a high fever (104, 105 degrees) – it’s worth touching base with a doctor to see what’s going on.
WHBC: What other symptoms are serious enough to warrant a trip to the emergency room?
Dr. McCabe: Red flags for a really sick child include a child who is restless, won’t stop crying, has stopped eating, and is making weird noises when they breathe. All these symptoms are helpful in determining a trip to the ER, even with the non-verbal child as opposed to a child who has a fever and a cough and is still eating and drinking, able to nap and seems comfortable when resting.
Most of the time, most children won’t be severely ill but we can understand why parents get alarmed when their child is lethargic especially when they get better on our unit and they are so animated. Sometimes, it’s an educational opportunity for the family.
WHBC: When is it appropriate to use a satellite urgent care verses a hospital ER?
Dr. McCabe: I think the best way to think about that is seeing the urgent care as an extension of your doctor’s office. Especially during this busy time when office schedules get filled.
For example, you pick up your child from the sitter and they say he or she has been sick all day or you’re concerned that your child’s cough is getting worse or there’s an ear infection, the urgent care might be the first stop. They are able to evaluate and take care of common illnesses – vomiting, coughing, that sort of thing.
If they assess the patient and for example, the child is wheezing or they’re not getting better after treatment, they need to go to the hospital. Also, the emergency visit is better for the young infant who has a high fever and is going to need blood work or other tests. It’s not the personnel at the urgent care that’s so different than the emergency room; it’s the diagnostic equipment and treatment options that make the difference.
WHBC: What might warrant an admission to the pediatric care unit at Aultman Hospital?
Dr. McCabe: Admission is warranted in many different ways. Some children present to the emergency department really sick and the doctor does A, B and C and they get better. But, because they really looked sick, the plan is to watch this child in the unit to make sure they’re not going to slip backwards.
Other kids are admitted because they are going to need IV meds, while others like the asthma patient need a treatment plan until they’ve turned the corner. Sometimes, especially for infants, they are admitted because they are dehydrated or have a urinary tract infection.
Probably the scariest scenario in young infants is when parents report, “I think my child stopped breathing,” or “He looks blue and I don’t know what happened.”
Often, these kids appear normal by the time they get to the ER. We admit them to assess whether there may be something going on in the background or whether it was a choking spell. Whatever the cause, monitoring over a period of time is helpful for answers and it gives us an opportunity to educate the family. We’ll have the family watch a video on CPR or on how to avoid choking scenarios.
Above all, our goal is to avoid the return visit.