It is unfortunate for
parents that the book, "Your Baby: A Complete User Guide" has yet to be
published. Children are not born with an instruction manual or troubleshooting guide to
help parents during periods of health or illness. Many a first time parent would love to
be able to check the index for chapters on "fever," "not eating," and
"when to worry." Once identified, their problem could be easily handled and
parenthood would not be so difficult.
Since no such handy reference exists, parents
often feel uncomfortable and inadequate in determining how sick their child is. Are fears
about life-threatening illness realistic? Is there real cause for concern? Is the
condition serious enough to call the doctor? .
Parents are sometimes surprised to learn that the
people best able to judge the seriousness of a child’s condition are the same people
who sometimes feel least qualified: themselves! Recent medical studies have demonstrated
repeatedly that when it comes to judging illness, "mother’s (and father’s)
intuition" is usually right in catching early symptoms of serious illness: no one
knows a baby as well as their parents! In addition, personal experience combined with
medical knowledge is a pretty good predictor as to whether or not a child is sick. Based
on my own professional experience as a pediatrician but also as a father of three, the
following generalized points may be helpful:
1) What is the child’s temperature? Fever
is one of the most anxiety provoking of all symptoms, yet it may be one of the least
important! A crucial exception is the infant under three months of age who may fail to
show any other symptoms other than fever while becoming seriously ill. Older children who
have high fevers may simply have a minor cold or viral illnesses. Children with more
serious diseases sometimes have no fever at all. A child who hasn’t moved in two
hours with a temperature of 100 degrees may be sicker than a child with 104 degrees who is
leaping off the couch at 8:00 in the morning. So look closely at your child and don’t
rely too much on thermometer. How sick your child looks or acts is much more relevant than
the level of fever.
2) How much eye contact is present? The
first clue to illness could be in your child’s eyes. Inattention, a "vacant
stare," and inability to follow movements are worrisome There is less to be concerned
about if your child is alert, looking around, and making eye contact with you.
3) Is the child very active? An active and
busy youngster probably is not seriously ill. On the other hand, if the child is lethargic
and has little spontaneous activity, call your doctor. Another useful hint is to compare
your child’s activity and appearance during past illnesses with this one.
4) How hungry is your child? Children who
are not feeling well will have a poor appetite. Solid food intake may be non-existent, but
it is only the seriously ill child who refuses liquids as well. If the infant is still
nursing or taking a bottle, or the older child is still drinking from a cup, then their
condition may not be too bad. Vomiting, especially if occurs when the child has not had
anything to eat, is a cause for concern.
5) What is the skin color? This observation
also gives parents another important insight into their child’s illness. Skin that is
pale, bluish, dusky or gray in color usually is worrisome. Normal skin color is a healthy
6) Is the breathing pattern unusual? A
noisy breathing sound (stridor) during inspiration, shallow rapid breathing, or grunting
at the end of expiration means something is amiss. Look at the child’s nostrils--if
they are flaring or moving with each breath, the child is having a problem breathing.
Children who are having difficulties getting in enough air often look anxious.
7) How has the illness changed? The
severity of the child’s illness can also be judged by the progression of symptoms. If
the child steadily gets worse, minute by minute, hour by hour, then something is wrong.
If, on the other hand, the child gets better and then gets worse, and then repeats this
pattern again over a period of hours and days, the child may not be seriously sick.
I can not emphasize strongly enough that these are
generalized observations and that the safest course of action is always
contact your child’s doctor if you have any questions concerning the severity of an
illness. As time goes on, parents can become quite proficient at sorting out the ordinary
illnesses from the serious ones. Careful observation can relieve anxiety and can help
determine whether your child is really sick or just a little "under the
weather." You and your child will definitely feel better!