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Should sick kid go to the clinic, or not? Doctor's rules of thumb

Certified Physician's Assistant Sue Ivankovich has seen it all working in Essential Health's Urgent Care -- vomiting, stools, burping, coughing, grunting, fevers ... the list goes on.

But according to Ivankovich, about 20 percent of the children she sees in her office don't even need to be there.

So how can parents tell whether their child needs at-home TLC or a physician's treatment?

Ivankovich says while no two children are the same when it comes to illnesses and their symptoms, there are some basic guidelines parents can follow when deciding whether or not to make that trip in.


Not all fevers are created equal in children.

"If they are running a fever but still acting normal and happy and eating fine, they can go for three days without being brought in," said Ivankovich, "but if it's more than three days or if they're acting really miserable, fussy or crying, they should be looked at."

Ivankovich says although it's difficult to pinpoint a specific number, generally if a child's fever reaches 103 degrees for several hours and Ibuprofen can't bring it down, then it's time to see a doctor.

"But otherwise if it's only been a couple of hours, a cool bath is a good idea," said Ivankovich, "and be careful not to snuggle them in too many layers -- parents sometimes do that thinking their children want to be warm and cuddly."

Ivankovich also says it's important to keep pushing liquids slowly because fevers have a way of robbing little bodies of fluids.


Right now is prime time for respiratory syncytial virus, or RSV.

This is the virus that causes all those cold symptoms that nag at healthy adults and older children, but can be more serious for the elderly and little ones.

Ivankovich says while most kids survive the untreatable virus just fine at home, premature babies or young children can develop a rapid respiratory rate.

"They're grunting and their tummy is really going in and out as it tries to help them breath -- that's when they need to be seen because they could need oxygen or a nebulizer treatment," said Ivankovich.

Coughing can also be more than menacing, but she says children don't usually need to be seen for it unless it lasts longer than seven days or if they develop a fever as well.

Stomach flu vs influenza

Getting the flu can mean two things -- the stomach flu or influenza.

"There's a big difference in the two," said Ivankovich, who says the stomach flu is once again hitting the area after a big wave in October.

With the stomach flu (or viral gastroenteritis) comes vomiting and diarrhea, and she says at-home care will usually suffice, for 24 to 48 hours.

But if it goes longer than that or if the child is unable to keep anything at all down and vomits every single time they're given water, it's time to go in.

Influenza can be more serious, especially for children.

With this, Ivankovich says there will be upper respiratory infections with fever, cough, sore throat, runny nose, and body aches -- no vomiting or diarrhea.

"If you come in quickly -- in the first 24 hours -- there's medicine we can give them, but we don't use it for a healthy person," said Ivankovich, "We will for a child with a complicated immune system or for somebody who has chronic health problems."

If this isn't the case, carve out a week to 10 days to nurse the child back to health at home.

Strep throat

Step throat is going around right now, and according to Ivankovich, who had four cases of it before noon on Monday, it can throw parents for a loop.

"A lot of people think step throat automatically means a sore throat, but in fact, some kids who have it never complain of a sore throat," said Ivankovich, "what they might complain of are headaches, tummy aches and fevers -- those typically will accompany strep throat."

And that requires a stop into the doctor for a stiff dose of antibiotics.

Eyes and ears

Pink eye might not be the most dangerous of illnesses, but it's certainly up there with one of the most contagious.

So how does a parent know whether their child simply has a cold in the eye (which is a virus and will go away on its own) or pink eye (which is bacterial and requires treatment)?

"With pink eye, there will be intense itching and intense drainage," said Ivankovich, "there will be thick gooeyness, and it needs to be treated before schools and daycares will let them return."

And because a person cannot just call it in for a prescription, Ivankovich says parents need to bring their children in to be seen.

This is to ensure there isn't something more serious than just pink eye going on.

"It's pretty common that a child will come in with a pink eye and it's actually an injury, and we don't want to miss that," said Ivankovich, "so we'll always perform a vision test on them to make sure."

Ear infections are also common among young children, and although it's been disputed as to whether or not children should always get treated with antibiotics, Ivankovich says the going belief in the medical world is that a child should be treated if they are fussy, truly having pain, or if sleep or eating is being disrupted.

"Then there really is more benefit to treating them, but if their ear is red but they're still happy, it can be argued that they might not need an antibiotic," said Ivankovich.

Arm & leg injuries, cuts

It's a given that if a child has a broken limb, they need immediate medical attention, but it can sometimes be tough to tell what's broken and what's not.

Ivankovich says for limb injuries, determine whether or not the child can actually use them with limited pain -- it could just be a sprain or twisted ankle.

"Just watch them for 24 hours, and if it continues to bother them without any improvement whatsoever, then bring them in," said Ivankovich. "But even if it still bothers them after 24 hours, just not as much, then it's probably fine."

Cuts can also be a bit of a mystery.

According to Ivankovich, the rule of thumb here is that if direct pressure is applied for 10 minutes straight (no peeking) and it still bleeds, it probably needs stitches or glue.


Even with guidelines to follow, it can be tough for parents to know for sure when to bring their child in, as guidelines are not hard, fast rules.

When there is still significant doubt lingering, Ivankovich says parents should resist the urge to call the dial-a-nurse, but instead contact the nurse of the doctor that treats their child, who is more likely to know the family and the child's medical history.

"We live in a quick-fix world now, and I empathize with parents who've been up all night with a crying child, but unfortunately, we can't rush nature," said Ivankovich "Often it just takes time for the body to heal, and sometimes what the child is going through is even helping them because it's strengthening their immune system."