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发帖数: 7797 | 1 The wait-and-see approach is fine for some kids' health problems. But not
these.
By Kristyn Kusek Lewis
When you become a parent, you earn a medical merit badge of sorts. Whether
you're sopping up a goopy nose or extracting a dangling-by-a-thread baby
tooth, eventually few things faze you. But sometimes it's tough to tell what
warrants a call to your doctor's office: Which temperature actually
classifies as a "high fever"? What kind of tummy ache means your child has
more than your average stomach bug? And when something truly frightening
happens -- say, your child suddenly breaks out in hives -- should you call
your pediatrician or head straight to the E.R.?
"Parents should always err on the side of caution and seek immediate medical
care when they're worried about something," says Anita Chandra-Puri, M.D.,
a pediatrician at Northwestern Memorial Physicians Group, in Chicago, and a
spokesperson for the American Academy of Pediatrics. However, to give you
more specific guidelines to follow, we talked to top pediatricians about the
12 symptoms that always require medical attention.
Symptom #1: A fever that's 100.4°F or higher in a baby younger than 3
months; higher than 101°F in a baby 3 to 6 months; or higher than 103°F in
a child 6 months to 2 years
Pediatricians stress that when fever strikes, the number on the thermometer
isn't as important as your child's disposition. The one big exception:
infants under 3 months old, who need immediate medical care if fever rises
to 100.4°F. "If their fever is caused by a bacterial infection like a
urinary-tract infection, it could quickly spread through the body," says
pediatrician and Parents advisor Jennifer Shu, M.D., coauthor of Heading
Home With Your Newborn: From Birth to Reality. "It's usually just a common
virus causing the symptoms, but we have to check it out to be sure." It's
important to call your doctor right away; if it's after office hours, be on
the safe side and head straight to the E.R. In kids older than 2, fevers
aren't urgent as long as your child appears to be well hydrated and acting
normal. Call your pediatrician for guidance.
Symptom #2: A fever that doesn't go down with treatment, or that lasts more
than five days
If you've given your child a fever reducer like acetaminophen or ibuprofen
and the number on the thermometer doesn't budge within four to six hours,
call your pediatrician. This is a sign that the infection may be too strong
for the body to fight off, and your doctor may want to do a thorough
examination to determine the cause. A fever caused by a common virus like
cold or flu typically goes away within five days. One that hangs on longer -
- even when it's low-grade (100.4°F) -- may be caused by an infection like
bacterial pneumonia, which requires antibiotic treatment, explains Alanna
Levine, M.D., a pediatrician at Orangetown Pediatrics, in Tappan, New York.
Symptom #3: A fever that's accompanied by a stiff neck or headache or a rash
that's either bruise-like or looks like tiny red dots
Call your doctor -- these can be signs of meningitis and need immediate
attention.
Symptom #4: A rash that resembles a bull's-eye or consists of tiny red dots
that don't disappear when you press the skin, or excessive bruising
A ring-shaped rash with a pale spot in the center can signify Lyme disease.
Get help right away if you see pinpoint-size spots under the skin, which can
signal many serious conditions. Any inexplicable, widespread bruising may
be a sign of a possible blood disorder. In addition, a splotchy rash, often
a little raised, may be a sign of an allergic reaction. If your child also
has difficulty breathing or is agitated or lethargic, she should be checked
immediately by a doctor.
Symptom #5: A mole that's new or changing
Keep tabs on your child's moles, especially any that she's had since birth,
because those have a higher risk of becoming malignant, says Parents advisor
Ari Brown, M.D., a pediatrician in Austin and author of Baby 411. Do a
monthly skin check during bathtime. Alert your doctor if you notice a mole
that's irregularly shaped, has ragged borders, is not all one color, or is
raised. All of these are signs of a potential skin cancer.
Symptom #6: Stomach pain that's on the lower right side, or that's sudden
and crampy and comes and goes
If your child has pain on the lower right side, ask him to jump up and down
-- if it's excruciating for him to do so, it can be a sign of appendicitis.
Although the appendix is on the lower right side of the abdomen, the pain
caused by appendicitis can start around the belly button and migrate to the
right. "With a normal stomach virus, there's typically fever, then vomiting,
then stomachache and diarrhea," says Dr. Brown. "With appendicitis, it's
sometimes diarrhea, then abdominal pain, then vomiting, then pain, then
fever." If you notice these symptoms, call your doctor -- appendicitis
progresses quickly and it's most effectively treated when caught early.
Symptom #7: A headache that occurs in the early morning or wakes her up in
the middle of the night, or that's accompanied by vomiting
These could be signs of a migraine. Your doctor can determine the
appropriate treatment. Migraines in kids are not dangerous, and tend to run
in families. However, morning and middle-of-the-night headaches can also be
a signal of something more serious, and that's why you want to see a doctor
right away.
Symptom #8: Dry mouth and lips, decreased urination, a flat fontanelle (in
an infant), dry skin or skin that stays bunched when you pinch it, or
excessive vomiting or diarrhea
These signs are all associated with dehydration and need to be treated fast
because dehydration can lead to shock. Call 911 or get to the hospital if
you think your child is nearing this stage. Otherwise, call your doc and try
to get more fluid into your child.
Symptom #9: Blueness or discoloration around the mouth; labored breathing
where you can see your child sucking in his chest and abdomen; or panting,
grunting, or a whistling sound when breathing
"Breathing problems are more worrisome when the sounds come from the chest
and lungs, not the nose," says Dr. Shu. Critical breathing issues are often
due to choking, an allergic reaction, an asthma attack (which can occur in
kids as young as a few months old), pneumonia, whooping cough, or croup.
Seek help right away or call 911. If it's not obvious that your child is
having serious trouble, check his respiratory rate. Count each breath taken
in for 30 seconds and then multiply by two. A normal rate is less than 60
for newborns; less than 40 for babies under 1 year; less than 30 for 1- to 3
-year-olds; and less than 24 for 4- to 10-year-olds.
Symptom #10: Swollen tongue, lips, or eyes, especially when accompanied by
vomiting or itchiness
These often signal a serious allergic reaction (anaphylaxis). Symptoms may
include swelling, breathing problems, and severe hives and need immediate
attention. Call 911 and, if possible, give your child a shot from an EpiPen
or a dose of an antihistamine like Benadryl in the meantime. For less severe
reactions, call your doctor and ask about giving an antihistamine to quell
symptoms.
Symptom #11: A fall when your child is less than 6 months old, or has
obvious neurological changes like confusion or loss of consciousness, or
that causes vomiting and/or any damage to the body, such as broken bones
These emergency situations must be addressed by a doctor -- so head to the
nearest medical facility. Falls are generally not problematic in kids older
than 6 months if they only fall the distance of their height and don't land
on anything hard or sharp.
Symptom #12: A cut that gapes open widely enough that you could stick a
cotton swab in it, or that doesn't stop bleeding within a few minutes of
applied pressure
These are signs that your child needs medical attention (and perhaps
stitches, skin glue, a butterfly bandage, or staples). Depending on the
severity of the injury, your next step should be to either call 911, go to
the E.R., or call your pediatrician. You should also always see your doctor
if an animal bites your child or if another child bites your child and
breaks the skin. |
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