When to Call the Doctor: Fever, Diarrhea, and More (cont.)

All these patients in the above scenario need to be seen urgently. Otherwise, fever plus other symptoms may provide enough information in regard as to who should be seen by a health care practitioner, and who may stay home and self-treat.

  • Fever, muscle aches, and dry cough are likely caused by a viral infection such as influenza (flu).

  • Fever and a stuffed up head is likely due to another viral infection, the common cold.

  • Fever with a cough that produces colored sputum may be pneumonia.

  • Any time there is shortness of breath or chest pain with fever, those symptoms should not be ignored.

  • Fever and abdominal pain is not normal and the affected individual should see their health care practitioner.

  • Watchful waiting is reasonable for a person with fever and no other symptoms, as long as they feel and look reasonably well.

Nausea, vomiting, diarrhea

Vomiting and diarrhea are just plain miserable for most people. The concern with this combination is dehydration fluid loss. The key to treating vomiting and diarrhea is letting the stomach and bowel rest (generally achieved by a clear liquid diet). Clear fluids (anything you can see through like water, clear broth, apple juice, Gatorade/Powerade) taken in small amounts (small sips), may be all that is needed to avoid off dehydration.

Dynamic Picture of Rehydration

Dynamic Picture of Dehydration

Colds and coughs

Colds and coughs are aggravating symptoms because they interfere with important things (for example, a good night's sleep, and can be easily observed by teachers, coworkers, and friends. Yet, there is little to be done to make a runny nose and hacking resolve more quickly than nature can. Symptom control has to balance the benefits of over-the-counter medication against their side effects. The American Academy of Pediatrics suggests that cough medications should not be used to treat children. In adults who have underlying medical conditions, there may be unintended side effects of over-the-counter medications, and reading the fine print on the medication label is mandatory (either that or talking to the pharmacist to get advice).

Bumps, bruises, strains, and sprains

Most bumps, bruises, strains, and sprains resolve with RICE: rest, ice, compression, and elevation. It may be appropriate to seek medical advice if there is concern that a more serious injury has occurred. That concern may be resolved by the health care practitioner taking a history and performing a physical examination. Often X-rays are not necessary.

With no relatives near to give sage advice and reassurance, people must develop their own experiences for guidance. The ability to watch a first born grow and flourish should make the experience with the second child a little less frightening. That experience may be tempered by seeing a coworker or friend develop complications from what seemed a routine illness or injury. All fevers are not meningitis, and all cases of chest pain is not a heart attack, but if there is concern then a doctor's visit is appropriate. It is also appropriate for the doctor to make clinical decisions based on the history and physical examination to determine that the patient's symptoms are not of a critical nature.

It is important to remember that some illnesses are common, and that the best treatment may be none at all.

REFERENCE: American Academy of Pediatrics. Policy Statement. Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children. Pediatrics Vol. 99 No. 6 June 1997, pp. 918-920
<http://aappolicy.aappublications.org/cgi/content/full/pediatrics;99/6/918>


Last Editorial Review: 12/20/2010 4:02:28 PM



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