If abdominal pain is located in the right lower part of the abdomen, is associated with frequent projectile vomiting, is associated with green or bilious vomiting, is severe enough to stop regular activity, is not relieved with antacids or pain medication, or is persistent in nature, the patient needs to seek immediate medical care.  Mild abdominal pain can be associated with viruses, as well as many other causes, including but not limited to constipation, reflux, gas or indigestion, and may be handled in a non-emergent fashion during regular office hours. 

If reaction is associated with hives, tongue swelling or breathing problems, call 911 or proceed directly to the emergency room.  If an EpiPen has been prescribed and is available, administer immediately and dial 911.  If mild rash appears, or if patient has ingested a substance to which he or she is allergic, immediately take Benedryl and observe for more severe symptoms. 

For mild constipation, increase fluids such as juice or water (if child is over six months of age) as well as fibrous foods such as raisins, dried fruit, or fruit with the skin on.  Decrease constipating foods such as bananas and cheese.  For infants, add one ounce of prune juice to breast milk or prepared formula.  This may be repeated in one hour if no bowel movement occurs.  Decrease pureed bananas and increase pureed prunes.  If patient is in acute pain, you may try a pediatric Fleet’s enema, available at most drug stores.  If pain persists or is long-term in nature, seek medical care during regular office hours. 

We do not recommend cough suppressants, as they allow drainage to proceed down the back of the throat and can increase the risk of pneumonia.  Decongestants are not recommended for children under six years of age.  They have not been shown to be effective and can have many severe side effects including respiratory problems and death. Decongestants have been taken off the market for children under the age of six by recommendation of the FDA.  Elevation of the head, sleeping in a car seat or bouncy seat, a cool-mist humidifier, or saline nasal drops with or without bulb suction can be very helpful for young children.  If absolutely necessary, because child is unable to sleep with above recommendations, Benedryl may be used in children over six months of age.  See Benedryl dosing section for more information.

If associated with dehydration (if patient has fewer than two urinations within 24 hours, is crying with no tears, or has a dry tongue), blood or mucous in stool, or symptoms for seven days or more, seek medical care.  Decrease juice, as it can increase diarrhea, and increase other fluids such as water or electrolyte drinks (Pedialyte).  Increase cheese, bananas, rice, and toast.

Ear pain can be due to inner or outer ear infections (swimmer’s ear), as well as ear fluid, tooth pain, or sore throat.  Each condition is treated differently.  As a result, it is very difficult to diagnose the problem over the phone.  Please see section on Tylenol and ibuprofen dosing for treatment of pain.  Another treatment our doctors have found to be helpful (for patients who do not have ear tubes) is the administration of a few drops of oil (sweet oil, olive oil, or mineral oil) into the ear canal.  Ear pain which can be relieved by pain medication may wait to be seen in the office the next day.  If patients call after hours on Saturday, or early in the morning on Sunday, and symptoms are severe, the doctor on call may be able to see the patient in the office on Sunday morning.  If you are out of town and calling with a possible ear infection, it is helpful to have the telephone number of the local pharmacy in case the doctor on call determines treatment is appropriate.

We consider a fever to be a temperature (no degrees added) greater than 99.5 F degrees as measured under the arm, 100.0 F degrees as measured orally, or 100.4 F degrees as measured rectally.  We do not recommend using ear or temporal thermometers, as they tend to be inaccurate.  Any child younger than three months of age who has a fever needs to be seen by a doctor immediately.  For patients 3 months of age and older – if a temperature lasts five or more days, temperatures greater than 105 F degrees, temperatures associated with seizures, and temperatures associated with lethargy or severe headache need to seek medical attention. As many viruses can lead to temperatures, it is a good sign if when fever reducers take effect, the patient is active, alert and drinking.  We do not recommend alternating Tylenol and ibuprofen unless instructed by the medical staff.  See dosing section for Tylenol and ibuprofen dosing, to ensure appropriate dosage. 

Any head injury involving an open wound, loss of consciousness, lethargy or confusion, vomiting two or more times, unequal pupil dilatation, fever or other obvious symptoms, need to be seen immediately.  If your child simply hit their head, did not lose consciousness and responded immediately, simple observation is recommended.  If your child’s medical condition changes seek medical care.

Extremely severe headaches and headaches associated with changes in vision, high fevers, inability to bend the neck, or repetitive vomiting need to be seen immediately.  For moderate headaches, see section on pain medication dosing.  If headaches persist, seek medical care during regular office hours.

Lethargic children are defined as children who are not drinking and cannot be easily awaken.  If a child becomes more interactive following treatment with Tylenol or ibuprofen, and is drinking fluids, they are not considered to be lethargic.  If a child is truly lethargic, he or she needs to be seen immediately. 

It is impossible to diagnose a rash over the phone.  Unless the patient appears extremely ill, is having difficulty breathing, or is experiencing other urgent medical symptoms, the rash may be seen during regular office hours.

It is not considered good medical practice to prescribe antibiotics over the phone, as it is impossible to tell whether a sore throat is strep without a rapid strep test or throat culture.  As long as strep throat is treated within seven days, antibiotics will prevent cardiac side effects.  Strep throat can generally wait to be seen in the office the following day.  In the interim treat the sore throat with Tylenol or Ibuprofen (see dosing section).  Children who are having breathing problems as a result of their swollen throat need to be seen immediately.  If patients call after hours on Saturday or early in the morning on Sunday, and symptoms are severe, the doctor may be able to meet the patient in the office on Sunday morning to perform a throat culture. 

A urine culture needs to be obtained to ensure proper treatment.  Due to the possibility of antibiotic resistance, we do not feel it is good medical practice to treat urinary tract infections over the phone.

If patient is vomiting blood or bile (green vomit), if patient has frequent projectile vomiting, or if patient is dehydrated (if patient has fewer than two urinations within 24 hours, is crying with no tears, or has a dry tongue), seek medical attention immediately.  Repetitive vomiting related to viruses usually stops within 12-24 hours.  Administer small amounts of formula, breast milk, or electrolyte solution, less than one ounce at a time, every fifteen minutes.  For older patients, Gatorade and popsicles (or Pedialyte popsicles) are a good way to administer fluid in small amounts.  Avoid solid food until the patient has not vomited for four to six hours. 

If patient is an asthmatic or a child who has wheezed previously, administer Albuterol, Xopenex, or Accuneb as prescribed.  If treatments need to be administered more than every four hours, or do not relieve symptoms, seek medical care.