Seriously, do we need another visit to the doctor!

When does my baby need to see a doctor?

DISCLAIMER: The following advice is of a general nature only. For information specific to you and your child, please see your doctor.

There is no one answer to that question, so I will simply state what I tell the parents in my care. I need to see baby when you are worried about them. But, I hear some of you say, that is all of the time, in which case I will be living at the surgery! Indeed, I did once have a parent state that they should pitch a tent in the backyard of the practice! So, let’s take a step back and see if I can make this clearer.

All of us can get very sick very quickly if we meet a nasty germ or if our immune system is not working properly. This is even more important in a young child. A general rule of thumb is that the younger a child the more we check, check and check again when they are sick. Aha you say, but I don’t know when baby is sick! Oh, but you do, you really do. Let me explain.

Signs that your child is sick:

  • Fever. The younger the child, the earlier we will want to check them when their temperature is elevated, even a mild temperature. Under 3 months of age? Please see your doctor with any fever. As a general rule of thumb, temperatures are normal up to 38, mild up to 38.5, moderate up to 39.5 and high above 39.5.

  • Loss of appetite. Baby not feeding or not feeding as well as usual? We will want to know about this — when did it start, how bad is it?

  • Loss of energy. Your tornado of a toddler is limp and listless? Sleepy? Hmm, when did it start, how bad is it?

  • Irritability. Your placid, settled child is increasingly irritable? Can’t pick them up, can’t put them down? Nothing seems to help? When did it start, how bad is it?

  • Vomiting. How many times and for how many days? Little amount or big vomit? Low impact or hitting the walls? When did it start, does anyone else have it?

  • Diarrhoea. How many times and for how many days? Little amounts or big volumes? Escaping the nappy, all up the back, all over the cot? So bad it needs to be washed off in the shower? Blood? Watery, explosive, loose, soft? When did it start, does anyone else have it?

  • Fast breathing. Babies breathe faster than grown ups but if they are breathing more than 60 breaths a minute (this is a breath a second every second) then they need to be reviewed. You won’t be able to put your finger onto it straight away, but you will know that something sounds wrong. We need to listen to that chest!

  • Increased work of breathing. The main muscle we all use to breathe is the diaphragm, which is inside of us hence not visible. If we are struggling with our breath, such as with asthma or a chest infection, we might start to use other muscles, such as those above the collar bone or between the ribs. If you see the muscles sucking in around the ribs, above the collar bone or at the bottom of the neck every time that baby breathes in, we will want to listen to that chest!

  • Urine output. Is baby making wee? Are their nappies as wet as usual? The first one of the morning still heavy? If baby’s nappies are dry or much less wet than usual, they may be dehydrated and we will need to check them over.

  • Rash. Now, most rashes are simple pink or pale purple, dotty or blotchy and not harmful, like those we see in common conditions such as hand, foot and mouth, roseola or slapped cheek. (WARNING: hyperlinks take you to a NZ dermatology website with some awesome but yucky photos. It’s not for everyone!) Some however are very dangerous, such as the meningococcal rash, which does not fade when you press on it. Sick baby, purple-black rash that does not fade with pressure? Emergency review is needed, without delay.

Who you gonna call?:

  • 000 In an emergency, don’t waste time, call triple zero (000) for assistance from the ambulance service. The cost of this service varies around the nation.

  • Health direct. 1800 022 222 is a free helpline with registered nurses available to take your calls 24 hours a day, 7 days a week. They can help to advise you if baby is ok to be looked after at home or should be seen by your GP or by the hospital. Emergency departments are very used to seeing children and always happy to review your child if you are worried they are really sick.

  • Your GP surgery. Don’t have a GP? Please make finding a GP who you like and trust an absolute priority! I suggest you look for a practice which keeps appointments available for sick children or urgent cases and who has other doctors available if your GP is booked out or away. Seeing the same doctor or at least doctors in the same practice over time means that they get to know you and your baby and this helps you and it helps them to make informed decisions about the care you and your baby need.


Links

  • Kids Health information from RCH (Melbourne)