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317 West Hill Street, Suite 111, Decatur, GA View Location

Office Hours: Monday through Friday 8am to 5pm

Answers to Common After Hours Questions

Please note, we have a dosing chart available on our website (http://www.oakhurstpediatrics.com/helpful-resources/medication-dosing-charts/) for Diphenhydramine (Benadryl), Acetaminophen (Tylenol), and Ibuprofen (Motrin/Advil).

Fever (Please note– fever (rectal temperature of 100.4 or higher) in a baby less than 2 months old always requires a call to the doctor)

Fever is a part of the body’s response to infections, and in more than 80% of cases, the infection is viral. Fever is an appropriate immune system response to infection and by itself, is not dangerous. Normal, healthy children will rarely reach temperatures above 106 degrees Fahrenheit even if they are not treated with fever reducing medications. We treat fevers because they can make children feel miserable and look quite ill. When a child has a fever, it is important to try to think about what is causing the fever, but try not to panic about the fever itself.

When your child has a fever, we strongly encourage you to look at your child rather than the number. If your child appears ill, uncomfortable, or low energy, treat the fever with Acetaminophen and/or Ibuprofen (babies over 6 months). These medications do not interact with each other and can be given together in babies that are over 6 months old. To ensure that you are appropriately dosing these medications, please see the medication dosing chart on our website. Reassess in 30-60 minutes. It is always reassuring to see a child perk up when the fever comes down. As long as your child is not having labored breathing, acting lethargic in spite of fever reduction, is staying hydrated, and is not demonstrating signs of a bacterial infection (e.g. ear infection, strep throat, UTI, etc.), it is okay to monitor and wait to contact our office for advice or a sick visit appointment. If the fever persists for more than 3-4 days or if new, concerning symptoms develop, we recommend scheduling an appointment to have your child evaluated by a physician.

The only time that a fever warrants an immediate trip to the Emergency Department is when it occurs in an infant less than 1 month old. At this age, a fever can be a sign of a potentially more serious infection. All babies at this age who have a rectal temperature of 100.4 degrees Fahrenheit or greater should go to the Emergency Department for further evaluation. Temperatures should always be taken rectally in this age group.

Babies between the ages of 1 and 2 months are still at slightly increased risk for more serious bacterial infections. If your child is in this age range and has a rectal temperature greater than 100.4 degrees Fahrenheit, you should call the office to discuss whether you need to go to the Emergency Room.

Fast Facts
If your baby is <2 months old, please call for any rectal temperature > 100.4 F
Focus on how your child is acting, rather than on a number
Treat with Acetaminophen or Ibuprofen (or both if over 6 months) as needed
Call if your child has had a fever for more than 3-4 days, is having breathing problems, is getting dehydrated, or is showing signs of a specific bacterial infection.

 

Possible ear infection

It can be very hard when you are at home with a fussy child to know when you need to call or come in. It is also impossible for the doctor to know if your child has an ear infection without seeing them in the office. Luckily, most ear infections will resolve on their own without any treatment. Children less than 2yo should be seen in the office the following business day, and until that point, should be given Acetaminophen or Ibuprofen (over 6 months) for pain. If it is a weekend day and you feel that you cannot wait until Monday to be seen, we recommend a CHOA Urgent Care facility. We can not call in antibiotics without seeing your child due to the fact that we cannot differentiate a viral illness from a bacterial illness over the phone.

 

Sore throat

Sore throat is a common symptom in children. It can be seen in isolation, or can be accompanied by other symptoms such as fever, cough, headache, and congestion. Sore throat is most typically caused by a viral infection. Occasionally, a sore throat is caused by a Strep infection and this is a setting where antibiotics are needed. It is impossible to differentiate a viral sore throat from strep throat without getting a throat swab. Many viral sore throats will improve within 2-3 days, whereas strep tends to persist for longer than that. It is not dangerous to delay treatment of strep throat for a day or two, so waiting to see how the symptoms progress is reasonable. Pain can be managed with Acetaminophen or Ibuprofen. If you feel that you cannot wait until the office is open to evaluate your child’s sore throat, please go to a CHOA Urgent Care facility to have a throat swab done.

 

Vomiting

Vomiting is most often a sign of a viral stomach bug. Some children also vomit when they have fevers. If your child is vomiting, it is best not to try to give them anything by mouth until they have not had any vomiting for at least 30 minutes. Most children will not vomit for more than a few hours. It is common for children to initially vomit food and then, as their stomach contents have emptied, vomit clear or yellow liquid. The biggest concern with a vomiting child is maintaining hydration. The best indicator of hydration in a child is urine output. In general, if a child is reasonably well hydrated they will void at least every 6 hours (possibly longer overnight).

Once the vomiting has stopped for 30 minutes, you can begin the process of slowly rehydrating your child. You may offer clear liquids such as Pedialyte, breast milk, or diluted juice in tiny volumes to start. Start with a teaspoon or 2 every 3-5 minutes. If there is no vomiting over 20-30 minutes, you can increase to 1/2-1 ounce every few minutes. Continue to advance slowly. If at any point your child begins vomiting again, wait 30 minutes and start over, going even more slowly. Children who have been vomiting are often thirsty, but if they drink too quickly, they will very likely begin vomiting again. If your child is unable to keep fluids down in spite of very slow rehydration, or if there is blood in the vomit, please call the office.

 

Diarrhea

Diarrhea often follows vomiting when children have a stomach bug. Again, this is almost always viral. There are no anti-diarrheal medications that are helpful in children. The only thing that may shorten the course of the illness is starting your child on a probiotic. Infant probiotics can be found at Whole Foods, and many pharmacies and grocery stores carry Culturelle for Kids. Be sure to monitor hydration if your child is having diarrhea. You should offer extra fluids throughout the day. Avoid excessively sugary foods/drinks as this will worsen symptoms. Diarrhea can often last as long as 2 weeks. Please let us know if your child has blood in the stool, or if diarrhea is lasting longer than 2 weeks in spite of probiotic use.

 

Cough

Cough is a common symptom in children, especially in the fall and winter when respiratory infections are prevalent. Cough is often related to a viral infection such as a cold, and may last for several weeks. Cough is often worse at night when children are lying flat and they have mucus dripping from the back of their noses into their throats. Cough can be frustrating as it often causes sleep disruption. To relieve cough in all age groups, you can try running a humidifier, using nasal saline and suctioning, sitting in a steamy bathroom prior to bedtime, and elevating the head of the bed (place a roll UNDER the crib mattress for babies less than 1 year or use pillows for older children). Children over 1 year old can try a 1/2-1 teaspoon of honey prior to bedtime. Children over 4 years old can use over the counter cough suppressants such as dextromethorphan.

If your child’s cough is accompanied by labored breathing or persistent fever, please call the office or the on-call doctor.

 

Congestion

Nasal congestion is a common symptom associated with viral upper respiratory infections (colds). Congestion is almost always viral and may be relieved by using nasal saline spray, suctioning, running a humidifier, and sitting in a steamy bathroom. Keeping the head elevated as much as possible throughout the day and when asleep at night can also be helpful. Decongestant medication such as phenylephrine or pseudoephedrine can be used in children 6 years and older. Most children with nasal congestion will start with clear nasal discharge for 2-5 days, then thicker, yellow or green discharge for 2-5 days, and finally it will go back to clear and runny. It is not uncommon for nasal congestion to last for 2 weeks or more.