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When to Seek Medical Care for Your Child: Part 1

Dr. David Epstein, pediatric intensivist, introduces us to a series on when to seek medical care for your child, with general principals discussed.
As parents, we are always concerned about the health of our children. One of the most common questions that I get is:
 
“When should I seek medical care for my child?”
 
My simple response is:
 
”Whenever you feel the need!”
 
As a physician, I encourage every parent to seek medical attention if there is any concern or question about their child’s health.
Nevertheless, as a pediatric intensivist and urgent care pediatrician, I have a unique perspective on what is really concerning and when reaching out for medical evaluation is very necessary. I can divide these reasons into various categories.
While this list covers some major symptoms and areas, it is not comprehensive because there are always unique situations that may arise. So, again, I emphasize to reach out to your medical provider, if you have any questions or concerns about your child’s health. These major categories include:
 
· Pain
 
· Not wanting or being able to eat or drink
 
· Injuries
 
· Foreign bodies
 
· Infection concerns
 
· Trouble breathing
 
· Changes in behavior
 
· Suspected poisonous ingestions
 

First, pain is a very common complaint of many children and may originate from an infection, an injury, or something else entirely.

Ear pain, stomachache, headache, musculoskeletal pain, and other manifestations of illness or injury are very common with children. While an injury is more easily spotted and diagnosed, illnesses that cause pain are a little more challenging to sort through. The younger a child is, the less likely they are going to be able to tell you what is bothering them. Fussiness or crying may be the only outward expressions of pain or discomfort for infants and young, non-verbal children. The younger the child or infant, the more important it is to seek medical attention to try and identify the cause of the fussiness or crying because so many things can cause this change in behavior, aside from just pain.
Identifying additional symptoms or signs on exam can help narrow things down, but this age group is often the most challenging. As kids get older, diagnosing the cause of pain may be easier, but not by much. Even children who can localize and describe their pain should be seen because the reason for their pain may stem from a number of causes.
For instance, a stomachache can be the manifestation of intestinal gas, constipation, viral gastroenteritis, inflammatory bowel disease, appendicitis, and many other sources. So, having your child evaluated for any pain is a legitimate reason for a medical visit. The cause of the pain may be something very benign, but a more thorough evaluation may be warranted to make sure that there is not something more serious causing the discomfort.
 

Not wanting or being able to eat or drink for a child is always concerning and usually worse the younger they are.

But, it is usually the degree to which there is decreased oral intake of food and fluids, along with additional signs and symptoms, that determine the degree of concern. Decreased appetite and food intake is not as concerning as not drinking enough fluids in the context of an acute illness.
If someone is drinking, but not eating, they can survive for weeks or months. However, without drinking, an individual will only survive for days. So, the importance of drinking far outweighs eating in the context of an acute illness. With children, the issue is usually caused by a viral gastroenteritis with nausea and vomiting or sores, ulcers, or infection in the mouth or throat that make eating and drinking very painful.
With all this said, decreased fluid intake puts a child at risk for dehydration. Dehydration is the ultimate concern because more intensive therapy, such has needing intravenous fluids or a hospital admission, may be required for more severe cases. Infants are at higher risk than older children, when it comes to dehydration, because infants don’t have as much of a physiologic reserve. If a child is becoming dehydrated, some important symptoms and signs to look for include dry lips, dry mouth, decreased urine output (or wet diapers in infants), fatigue, and no tears with crying.
While supportive measures such as pain control for mouth and throat pain, antimicrobial treatment a mouth or throat infections, or treatment of nausea and vomiting with an anti-vomiting medication are routinely performed, one must make sure that nothing more serious is causing the symptoms.
As with pain, there can be a number of sources for the symptoms of not wanting or being able to eat or drink. Aside from those mentioned above, there may be unusual causes such as a foreign body that is lodged in the esophagus that doesn’t let food pass through the passage way (i.e., a coin). Also, decreased desire to feed in an infant without other symptoms or vomiting may be due to an infection or mechanical obstruction in the intestines.
The bottom line is that eating or drinking issues are always a good reason for a child to be evaluated by their medical team. The issue may not be as straight forward as it seems.
 

Another good reason to have your child seek medical evaluation is an injury.

Kids suffer a variety of injuries from falls, contact with sharp objects, mild crush injuries, and other mechanisms. How the injury occurred usually determines the severity of the injury. Assuming that the injury is not life-threatening, determining whether or not a laceration, possible broken bone, or head injury is severe enough to be evaluated by a medical professional is a common question that parents have.
For lacerations, the depth and location of the wound will often determine if closure with sutures, staples, or liquid adhesive is warranted.
So, having a medical professional evaluate the wound is important. Typically, skin lacerations should be closed within 48 hours, but some medical personnel prefer to close a wound within 24 hours. So, a prompt evaluation is necessary.
With musculoskeletal injuries in kids, it is often difficult to discern the difference between a sprain, contusion, or fracture. There are obvious fractures or broken bones that can be diagnosed by the casual bystander because of significant deformity of a finger, wrist, or ankle. But, other injuries caused by falls, having a basketball “jam” a finger, a car door slam on a digit, or an accidental collision on the playground are just as likely to result in a sprain or contusion as a fracture or broken bone.
Obtaining an x-ray will often be needed to settle the issue. Finally, head injuries are a common occurrence in the pediatric population of young children learning how to walk, children walking into or falling from furniture at home, athletes playing contact sports, and any other situation that may put a child at risk for striking their head against another solid object.
Thank goodness, most of these head traumas are mild and don’t result in any brain injury or bleeding. The rule of thumb is that loss of consciousness, repeated vomiting, or altered mental status at the time of injury are indicators that something is not quite right.
Sometimes, the main issue is whether or not a head CT scan should be performed. If there is any question about how severe a head injury is or if a head CT scan should be performed to rule out a bleed or other intracranial injury, one should seek medical attention promptly.
 

An additional area of concern, in pediatrics, is the foreign body.

A foreign body is anything outside the body that is lodged or put into the body. We see a variety of objects placed in ear canals and noses in pediatrics, from beans and beads to nuts and paper. Young kids will place almost any object that is small enough into any orifice that will hold it. Wood splinters stuck in the skin on hands and feet, objects swallowed, and earrings stuck in earlobes are a few other foreign bodies that may require a certain level of expertise to remove.
The real emergencies arise when a foreign body is swallowed and gets stuck in the esophagus, a button battery is ingested, or more than one magnetic object is swallowed. Button batteries are notorious for eroding holes in the esophagus or stomach and swallowing more than one magnetic object will result in the magnets attracting each other and subsequently pinching or damaging the intestines.
It is imperative that these button batteries and magnets be removed quickly to prevent severe damage. However, the most concerning place a foreign body can lodge is in the airway.
Because of the risk of obstructing the airway and compromising breathing, an aspirated foreign body is a true emergency that can result in deadly consequences. Foreign bodies are always a good reason to visit or call your medical team to discuss their removal. If there is any obstruction of the airway by a foreign body, immediately contacting emergency medical services is critical.
 
If you have any questions about this or other topics, please feel free to comment in the comment section.
 
Stay tuned for the next part of the discussion about infection concerns to follow…

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