Dear Mamas,
We have a wonderful 3 year old son and he was recently joined by our daughter who’s now 4 weeks. My question is about when to call the doctor. We’ve struggled with this since our son was born, and still don’t feel entirely comfortable about it.
Last night, after her bedtime feeding, little Jade spit up a lot of breast milk. And I mean what looked like a HUGE volume. We were concerned that she could have lost the entire feeding and we had no clue why. We went back and forth over whether to call, and finally decided it could wait ’til morning. The next day we took her in to be checked. The pediatrician said she looked just fine and probably had just eaten more than her little belly could hold. We were pleased that we’d made the right call, but still feel like we’re in the dark. We need to know … what are the rules?
JacknJade’s Mom
Dear JJ Mom,
Great question! I think all parents (including physician parents) worry about this one. The short answer is this: You can ALWAYS call. If you’re worried, and you feel like you need advice, call. Your pediatrician and office staff are there to care for your child and give you guidance when you need it, and that includes evenings and weekends. That said, there are some important guidelines that may help. The rules are a bit different for your 4 week old than for older children, and you always want to err on the side of safety. Whenever your child is ill, hurt, or not eating or drinking normally, it’s important to get input from your pediatrician. Often these calls can wait for office hours, but here are the exceptions:
- Baby is less than 8 weeks old and has a rectal temp over 100.4
Babies this young have immune systems that aren’t working well yet. An infection that may not be serious in an older child can be severe in a new baby. Fever is an important warning sign. The new ear thermometers are just as accurate (and easier) as rectal, but under-the-arm is not, so don’t depend on it.
- Any baby is abnormally listless, lethargic, or sleepy at a normally wakeful time, with or without fever.
- Any baby is wheezing or breathing faster or harder than usual.
- Any baby falls from bed or table height and appears hurt.
- Any baby has a dark rash over the trunk that DOESN’T pale when pressed.
- Any baby is vomiting repeatedly and can’t keep down any fluids.
- You see blood in the diaper.
- Any time you are alarmed — above all, TRUST YOUR GUT.
- There is loss of consciousness for any reason.
- Any baby has a seizure, with or without fever.
- Any baby develops hives over the body WITH swelling around the mouth or noisy breathing (allergic reaction).
- Any baby is breathing irregularly.
- Any baby is unresponsive.
- You suspect your baby has ingested poison or medication. FIRST call POISON CONTROL: 800 222 1222
- You are VERY alarmed — remember, TRUST YOUR GUT.
These rules apply to all young children, but the older the child the greater the reserve in the tank. So a 5 year old with a stomach virus who’s vomiting and can’t hold down Gatorade can be given a somewhat longer time to perk up because he won’t dehydrate as easily.
A calming rule of thumb: If your child is acting, eating, and drinking normally … it can probably wait ’til morning.
So those are the bottom line rules for when to call the doctor, but I want to end with the most important take-home message. Your family pediatrician needs to be a trusted resource. If he or she makes you feel uncomfortable about calling or asking questions — any questions — that’s a HUGE red flag. It’s time to find a new pediatrician.
The information provided by MamasOnCall is not intended as a substitute for professional advice, but is for information purposes only. You assume full responsibility for the health and well-being of your family. Talk with your healthcare provider about any questions you may have regarding a medical or psychiatric condition.
Mamas on call is the best! I can’t wait to show it to my daughter who is now in her third trimester, expecting her first…with lots of questions ahead of her. This is also a great sight for Grandparents!!!