Sick-Child Visits
Hopefully most of the visits to your pediatrician during your baby's first year will just be for well-child visits, but there may be times when your baby is sick and needs to see the doctor. Keep in mind that just because your child doesn't have a runny nose, cough, or fever, it doesn't mean that she isn't sick. Other symptoms or illnesses that might prompt a sick visit, especially during the first year, include:
Eczema
Allergies
Colic
Poor weight gain
Diarrhea
Constipation
Thrush
Blocked tear ducts
Developmental delays
Behavioral problems might also be a good reason to schedule an appointment with your pediatrician, instead of just trying to get advice over the phone. Such problems might include the child not sleeping well, being very fussy most of the time, not feeding well, or refusing solid foods.
When your child is sick, don't wait until the last minute to make an appointment. The earlier you call once your pediatrician's office opens in the morning, the sooner you will get an appointment. If you wait until late in the day you might be asked to wait until the next day for an appointment, even for a problem that has been going on for several days.
You should usually expect a same-day appointment when your child is sick, unless your child's condition is a long-term or non-urgent problem, such as acne or bowlegs. It is unreasonable to expect a parent or child to wait even one or two days when the infant has an ear infection, fever, or difficulty breathing. You probably should look for another doctor if you are regularly made to wait several days for appointments when your baby is sick.
What to Expect
During sick visits your child should be weighed and have his temperature taken. Next, after talking about your child's problems and symptoms, your pediatrician should perform a complete physical exam. Doctors who quickly prescribe an antibiotic each time you walk in the door or regularly leave out parts of the exam, like not looking in your baby's ears or mouth, may not be providing adequate care. If your child has a fever and was up all night crying, your doctor should look at her ears before concluding that she has an ear infection.
Questions the Doctor May Ask
Parents often assume that a doctor can tell what is wrong with a sick child just by the physical exam. In reality, the history (or story of the child's illness) is often even more important. For example, suppose a child has a cough and runny nose. If she is eating and drinking well, isn't too fussy, isn't having trouble breathing, and the symptoms just started yesterday, then she likely just has a cold and doesn't need any antibiotics. If, however, she has had two weeks of symptoms that are now worsening, and has developed a fever, she might have a sinus infection and may need antibiotics. Both cases would likely have the same physical exam; it is the description of the illness that would get her the right treatment.
Some questions that you should be prepared to answer during each visit can include:
How long has your child been sick?
What are all of her symptoms?
When are the symptoms worse?
How have the symptoms been changing?
What makes the symptoms better?
How has being sick affected her eating and sleeping?
Has she been around anyone else who's been sick?
What medications have you been giving her?
Why do you think she hasn't been getting better?
What are you most worried about with this illness?
Questions to Ask Your Doctor
Parents seem to have a million questions that they want to ask their pediatrician, but they often forget them during the visit. Preparing a list of questions and bringing them to your visits can help to make sure that you get all of your questions answered. Some good questions to start with at a sick visit include:
What is my child's diagnosis?
What causes this?
What treatments are you prescribing, if any?
What are the side effects of those treatments?
Are there any alternatives to those treatments?
When should she start getting better?
What are some signs to watch for that might mean she is getting worse?
When can she return to day care?
Do I have to limit her diet or activity?
Should I bring her back for a recheck?
Getting answers to these questions (and making note of the answers) is especially helpful if only one parent can make it to the visit and needs to explain everything to the other. (See the Sick-Child Visit Worksheet in Appendix B to help you prepare for these visits.)
Don't leave your pediatrician's office if you are not sure that you understand everything you have been told about your child's illness, prescribed treatments, or what changes indicate that she is getting worse.
Rechecks
Parents often tend to overlook visits to the doctor that are mainly to recheck a previously diagnosed condition, such as reflux, asthma, or an ear infection. After all, what is the point in going to the doctor when your baby is better?
These visits are very important, though. They can help your doctor recognize when a condition such as poor weight gain or failure to thrive is worsening, and help him decide when to start or stop a daily medication for conditions such as allergies or asthma. If your pediatrician recommends that you return for a recheck, be sure to schedule and keep the appointment.
