A Parent’s Guide to Calling and Going to the Doctor

**By Carrie Jenner, MD**

If you’re a parent, you’re likely familiar with the woes of caring for your child when they become ill. For some, this time can be filled with a whirlwind of uncertainty and second guessing, particularly if your little one is very sick, or it’s lasted a long time. Questions start to surface like, should you wait it out or is it time to call your pediatrician?

While every situation is different, I’ve compiled the below guide that details some of the most common symptoms and issues and when it comes to your child getting sick. Here, I detail when it might be time to make an appointment or other medical intervention, so your focus can be helping your child feel better.

This guide is not meant to replace medical advice. For any concerns, please work directly with your provider.

Fever

Figuring out the best course of action when your child has a fever will depend on their age. If your baby is less than two months old and has a temperature of 100.4 F or higher, it’s imperative to head straight to the emergency room as they could have a serious infection. At the hospital, your baby will receive a full workup of tests to discover the root cause.

In older children, temperatures will vary a bit more (typically between 100-103 F), so pay attention to other factors as well, such as how your child is acting and how long their fever has been going on. For instance, if their fever is on the lower end but they’re irritable or not eating, it might be wise to give your pediatrician a ring. As a general rule of thumb, fevers tend to run for three days. If your child’s fever lasts longer than this, your pediatrician will be able to help you get to the bottom of it.

Coughing and Sneezing

Coughing and sneezing can be associated with upper respiratory infections such as colds, which children are highly prone to catching. Fortunately, the best thing to do here is to let the cold run its course – which can be up to 10 days for viral infections. As mentioned earlier, take your child in if a fever lasts more than three days.

If your child’s nasal discharge starts to thicken and turn green or yellow, this isn’t quite cause for concern as the cells in their body are likely in infection-fighting mode. However, if your child is struggling to breathe at any point or is flaring their nostrils or ribs when taking a breath, enlist your pediatrician as soon as possible. Additionally, if your child has developed a bluish color around their lips or nails, they’re not getting enough oxygen and you should call 911 right away.

Vomiting and Diarrhea

Generally speaking, stomach viruses typically last 2-3 days. They start with vomiting for 12-24 hours, then diarrhea develops and can last a few days. If your child is unable to hold down any form of liquid or solid for over 24 hours, call your pediatrician. Giving small amounts of clear liquids like Pedialyte frequently is the best way to keep your child hydrated during the illness.

While vomiting and diarrhea are fairly common symptoms, the main concern associated with these is dehydration. Some signs of dehydration to look out for include dark urine, sunken eyes, excess irritability, lack of tears if your child is crying or less than 3 wet diapers in 24 hours.

Rashes and Other Skin Conditions

These can be particularly puzzling as rashes come in many shapes and sizes and can be caused by a variety of things. If your child has a rash but doesn’t seem to be bothered by it, then it’s probably fine to treat it with over-the-counter skin creams. However, if the rash lingers for more than a few days and is accompanied by a fever, give your pediatrician a call as this could be a sign of a larger infection.

Other rash symptoms to make your pediatrician aware of include blistering or bubbling, oozing or bleeding, a rash in the shape of a “target” and rashes accompanied with difficulty breathing.

COVID-19

Though children of all ages can contract COVID-19, they typically do not get as sick as adults. Symptoms in children tend to be on the milder side and present in more of a cold-like fashion, including fever, sore throat, chills, muscle aches, nasal congestion or extreme fatigue. Lesser-common symptoms in children can include a new loss of taste or smell and gastrointestinal issues like vomiting and diarrhea.

Of course, children with underlying conditions like obesity, asthma or diabetes may experience more severe illness than children without. As we continue to navigate the pandemic, it’s better to play it safe and call your pediatrician if you suspect your child might have COVID-19, so they can be tested promptly.

It can be arduous discerning between simply letting your child’s illness run its natural course or involving your pediatrician. If at any point you’re unsure of what to do, it’s always a good idea to err on the side of caution and give them a call – they’ll be more than happy to help you identify the root cause so your child can get on the mend.


Carrie Jenner, MD, is board-certified in Pediatrics and currently practices at Franciscan Medical Clinic – University Place. Dr. Jenner enjoys working with children and their parents to develop healthy lifestyles that will continue into adulthood.

Well-Child Checks Help Keep Kids Healthy Throughout Their Lives

**By David J. Schneider, MD**

Mercer Island resident Susan George is Mom to a 6-year-old stepson. But when she and her husband became parents to newborn son Kaden, Susan admits she found it a learning experience. After being referred by a friend to Virginia Mason Medical Center, the Georges chose me to be their son’s pediatrician.

Susan George and family

From left to right: Susan, Carter, Kaden and Jake George.

Like most initial clinic visits with a pediatrician, Kaden’s first appointment was scheduled as a well-child check. These exams – which are recommended every couple of weeks for infants, every few months for toddlers, and annually for young children and teens – follow guidelines developed by the American Academy of Pediatrics (AAP) that focus on recommended screenings and assessments based on age.

“Since I didn’t know what to expect, I’ve been very happy with how easy and helpful each of Kaden’s well-child checks have been. Not only do Dr. Schneider and the team provide excellent care, they’ve been great at putting me at ease,” said Susan. “I also really appreciate that at each well-child check, Dr. Schneider points out next steps so we know what to expect.”

Benefits of well-child checks

Although the AAP’s detailed well-child check guidelines vary depending on a child’s age, all care protocols include:

  • Prevention – Children get scheduled immunizations to prevent illness. Parents can also ask the pediatrician about nutrition, as well as safety in the home and at school.
  • Tracking of growth and development – The exams allow parents to see how much their child has grown since the last visit and provide an opportunity to talk with the pediatrician about a child’s development. Parents can also discuss their child’s milestones, social behaviors and learning.
  • Time to ask questions or raise concerns – The visits allow parents to make a list of topics they want to cover – such as development, behavior, sleep, diet or getting along with other family members.
  • A team approach – Regular visits create strong, trusting relationships between the pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

“Having grown up with the same physician caring for me throughout my childhood and  teen years, I really appreciate the reassuring presence and guidance that pediatricians can provide,” said Susan.


Dr David Schneider_2019David J. Schneider, MD, is a board-certified pediatrician who practices at Virginia Mason Bellevue Medical Center and Virginia Mason Issaquah Medical Center. Areas of special interest include: sports and dance-related injuries, chronic medical conditions, childhood/adolescent obesity and nutrition, mental health concerns and LGBTQ health.  

Vitamin D Supplements Can Benefit Puget Sound Children

Vitamin D Supplements Can Benefit Puget Sound Children

Is your child getting enough liquid sunshine?

The Pacific Northwest is famous for many things. Sunshine, however, is not one of them. My family recently relocated to the area, and I knew the local weather would affect our daily activities. I also knew the weather could affect our health. Along with new rain boots and umbrellas, I made sure my family started vitamin D supplements.

Not just for bones
Vitamin D, along with calcium, is well-known for playing a critical role in building strong bones. Without enough vitamin D, bones will be weak and soft, a disease called rickets. There is now evidence that vitamin D may be important in the health of the immune and cardiovascular systems. Providing your child with correct amounts of vitamin D could also be important in the prevention of heart disease, arthritis, diabetes, lupus and some kinds of cancer. 

Milk is not enough
Our skin makes vitamin D when exposed to the sun. With an average of only 65 sunny days per year in Federal Way and the South Sound, where I practice, the sun is not a dependable source of vitamin D for residents. Additionally, clothing and the use of sunscreen interfere with the process. Vitamin D can be found naturally in only a few foods, such as fatty fish (salmon, mackerel, sardines and tuna), egg yolk and beef liver. Milk, yogurt, cereal and orange juice often have vitamin D added to them. Even with fortification, however, it is very difficult to get enough of this essential vitamin from diet alone.

Let’s talk numbers
An infant, child or adolescent generally requires about 400 international units (IU) of vitamin D each day. One cup of milk provides 100 IU of vitamin D, which means a child would need to drink a whopping 32 ounces of vitamin D-fortified milk each day to get the daily recommended dose. Most children can’t drink this amount, nor do many of them have a taste for sardines or beef liver. The American Academy of Pediatrics therefore recommends that 400 IU of vitamin D supplementation be provided daily starting soon after birth. 

Liquid sunshine
Vitamin D supplements come in many forms and can be found at your local grocery store, pharmacy or vitamin supply store. For infants and children under the age of 3, vitamin drops are used. Chewable vitamins are generally given to children over the age of 3. Most multivitamins for children include the recommended daily dose.

As long as my children call the Pacific Northwest home, I’ll make sure they get 400 IU of the sunshine vitamin every day. Speak to your pediatrician if you have questions about vitamin D supplementation for your child.

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Lauren Athay MD Pediatrician Virginia Mason Federal WayPediatrician Lauren Athay, MD, is with Virginia Mason Pediatrics in Federal Way. (253) 874-1616.