When Health Scares Are Serious


Although we don’t want to overreact with every childhood illness, we also don’t want to miss something vitally important to our child’s health. Doctors would certainly prefer that anxious parents call them with any questions. “Parents know their kids best; if they are concerned I want to know,” says Kristin Sleeper, M.D., a pediatrician at Centre Pediatrics in Brookline.



Causes for Alarm


If a child is cyanotic (blue) or not responding, you should call 911, not your doctor, stresses Sleeper.


Labored breathing is also cause for concern. Signs  include “nasal flaring, pulling in the neck area and/or rapid movement of the chest and/or abdomen,” cites Jenny Raphael, M.D., a Harvard Vanguard pediatrician in Kenmore. Raphael says that parents noticing any of these signs should call their pediatrician’s office immediately and should be prepared to call an ambulance if instructed to do so.


 According to Sleeper, you should call your doctor if you see any of these symptoms:


• trouble breathing


• rectal temperature higher or equal to 100.4 F. in an infant younger than 12 weeks of age;


• bilious (green) vomiting;


• decreased urination especially in the setting of vomiting and/or diarrhea;


• lasting or worsening abdominal pain;


• head injury accompanied by a worsening headache, vomiting, behavioral change, unequal pupils, loss of consciousness and/or increased sleepiness;


• not being able to bear weight or use an extremity after an injury; and


• foreign body ingestion.


Regarding how to evaluate if your child has meningitis, Sleeper says, “Typically meningitis will present as fever and headache in an ill-appearing child. There may be vomiting or sensitivity to light.” According to Raphael, “If your child has neck pain in conjunction with a fever, headache and/or vomiting … you should have your child evaluated by a medical professional. But know that if your child has a stiff neck, it is not necessarily caused by meningitis.”


When Does a Cut Need Stitches?


“[Assessing a] need for stitches or glue is best made after the cut is properly cleaned and examined, and will be based on the cut’s location, depth and width,” says Taylor Monica, M.D., a pediatrician with Harvard Vanguard Medical Associates in Wellesley, who suggests calling your pediatrician’s office. “They can best direct you from there, especially if they do not suture or glue lacerations in the office.”


Other Medical Concerns


Skin Infection – According to Raphael, “redness, swelling, warmth and pain around the site of a bug bite or puncture wound are typically seen when there is a bacterial infection; and treatment is required.” Methicillin resistant staphylococcus aureus (MRSA) often presents as pustules or small fluid-filled bumps on the skin, or as a boil or hard lump under the skin with overlying redness, warmth, pain and sometimes pustular drainage, she says. “Streaking or redness that spreads in a linear fashion from the original sight of infection is particularly worrisome and requires an immediate evaluation,” Raphael adds.


Rash – “Hydrocortisone cream is a great place to start for an itchy rash,” says Sleeper. “Hives tend to be raised up and change location. Benadryl will help with these. A concerning rash is one that doesn’t blanch – when pressure is applied to the skin, the area stays red versus turning pale with the redness returning once the pressure is relieved.”


Lyme Disease – The tick needs to be attached and feeding for as much as 36 hours to transmit the illness. Signs of Lyme include a bull’s-eye rash at the site of the bite, fever, fatigue and headache.


Cough – According to Sleeper, a cough can linger two to four weeks after a viral illness. “The child should be seen if fever is present, there are signs of dehydration – the best [sign] is decreased urination – and difficulty breathing, or if the cough is worsening,” she says.


Blood in stool or urine – “Call your doctor, especially if the child is ill appearing, to discuss the symptoms,” says Sleeper.


Stomachache – Abdominal pain “is very common in kids,” reports Sleeper, and most likely indicates constipation or anxiety. “Concerning associated symptoms would be poor growth, fever, worsening pain or vomiting. Appendicitis frequently will start at the umbilicus [belly button] then gradually move toward the right lower quadrant [right groin area],” she says.


Chest pain – Symptoms that necessitate a call are chest pain with activity, paleness, cyanosis, trouble breathing, fever and feeling as though the heart is beating fast.



Mary Alice Cookson is associate editor of Boston Papers Paper.

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16 Dec 2013

By Mary Alice Cookson