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Parenting-When to take your child to the doctor

Tuesday, 24 February 2009

Today Grainne Ryan is in studio to tell us when, and when not, to bring your child to the doctor.

(Survey hosted by parenting web site Rollercoaster.ie on behalf of HSF Health Plan, Oct 08)

Last week Grainne talked about new mums preparing for the arrival of a new baby. As new mums can be unsure of how to know when a child is really sick and when symptoms are normal.

Also with the recession deepening and more people finding money tight many people are finding GP visits hard to afford, and are more aware of avoiding unnecessary visits.

Presenter of Baby on Board Series 2. Grainne is a public health nurse and midwife and mother of three children. Areas of interest child development, parenting issues, adolescent development and post natal depression and works as a public health nurse in Ennis Co. Clare

Most childhood illness are minor and others are easily preventable: vaccinations are effective against most infectious diseases. In a baby, however, seemingly minor illnesses can cause complications: a cold that develops into a throat infection, for example, may cause breathing difficulties. You will be understandably anxious if your child appears ill or has an accident. Sometimes wondering if you should seek medical helpful can be stressful. Even if your child's symptoms appear common, you may worry that they are a sign of something more serious. My advice here is you should never feel that you are being too cautious - if you find yourself wondering whether it is worth consulting the doctor, then you probably should.

Caring for a sick child can be nerve-racking and frightening experience for any parent yet it is one that nearly every one of us as parents have to go through at one time or other. I have found that the secret of coping is knowledge - be informed and keep up to date with latest findings - and in particular a commonsense understanding of what to do and when to do it, and when to call in the professionals.

Most parents seem to know instinctively when their child is unwell: the child may not be as lively as he usually is: he may refuse food/bottle/breast, he may become clingy. It can sometimes be difficult to decide when to call medical help. Parents know their children best, so if in doubt seek medical advice.

There are some situations, for example after a serious injury, when medical help should be sought immediately. For most parents, these situations are quite obvious. There are however, many more situations where the seriousness isn't as clear-cut.

When to ask for medical help

Listed below are circumstances when you should always seek medical help.

Temperature
A raised temperature of over 39'C (102.2'F)
A raised temperature accompanied by drowsiness and a purplish rash, plus any other obvious signs of illness.
A raised temperature accompanied by convulsion or if your child has had convulsions in the past.
A raised temperature accompanied by stiff neck and headache.
A temperature below 35'C (95'F) accompanied by a cold skin surface, drowsiness, quietness and listlessness.
A temperature of more than 38'C (100.4'F) for more than three days.
Diarrhoea
If your baby has diarrhoea for more than six hours.
If diarrhoea is accompanied by pain in the tummy, a temperature or any other obvious signs of illness.
Vomiting
If your baby has been vomiting for more than six hours.
Prolonged, violent vomiting
Dizziness plus nausea and headaches.
Nausea and vomiting accompanied by right-sided pain in the abdomen.
Loss of appetite
If your baby goes off food suddenly, or is less than six months old and doesn't seem to be thriving.
If your child usually has a good appetite, but refuses all food for a day and seems listless.
Pain and discomfort
If your child has headaches and feels sick and dizzy
If your child complains of blurred vision, especially if he's recently had a bang on the head.
If your child has severe griping pains, which occur at regular intervals.
If your child has pain on right side of abdomen and feels sick.
Breathing
If your child's breathing is laboured, noisy or extremely fast.
Others
No wet nappies noticed.
Uncontrollable crying for prolonged periods

Emergencies
Always dial 112/999 for an ambulance if you notice any of the following signs or symptoms

. Your child has stopped breathing
. Your child is breathing with difficulty and his lips are going blue
. Your child is unconscious
. Your child has a deep wound that is bleeding badly
. Your child has serious burns
. Your child has a suspected broken bone
. Your child has chemical in his eyes
. Your child's ear or eye has been pierced.
. Your child has eaten a poisonous substance


How do I know if my baby has a temperature?

If your baby has a temperature it's likely that you'll notice simply by touching or kissing their forehead, don't check when your child has just come in from chasing outdoors, however to get a more accurate reading you will need to use a baby-friendly thermometer.
There are several types of thermometers on the market. It is not recommended to take a baby's temperature by the rectal method, or use a glass thermometer. Instead use a strip thermometer on your baby's head, a stick/digital thermometer under the arm or a digital ear thermometer.

Plastic strip thermometer

This is held against your baby's forehead for 15 seconds, until it changes colour to indicate the temperature.

Battery-operated, digital stick thermometer

This is a plastic thermometer that is safe, accurate and easy to read, but a bit more expensive than a strip. This digital stick thermometer can be used orally or under the baby's arm. It registers the temperature in 30 seconds with a beep signalling when complete.

Ear thermometer

This is placed in your baby's ear and gives a digital reading after a few seconds. It is quick and accurate, but expensive. The ear thermometer produces an instant, accurate reading to within 0.1 deg C on an LCD display

What's classed as a high temperature?

Your baby's healthy resting temperature will vary between 36 and 36.8 deg C (96.8 - 98.2 deg F) while a high temperature is classed as above 38 deg C / 100 deg F. You're likely to notice that your baby's body temperature is naturally cooler in the morning and warmer in the evening and this will tend to apply whether they are running a fever or not.

Taking your baby's temperature

For younger infants under 3 years of age you shouldn't use a regular thermometer to take their temperature orally, however you can use it to take their underarm temperature. You can get an underarm reading by placing the bulb of the thermometer against the skin under their arm pit and holding their arm against their side for approximately five minutes. This is likely to give a slightly lower reading than your baby's actual temperature as it measures the temperature of their skin rather than that of their core so rounding up by approximately half a degree is usually necessary ( remember to have spare batteries for digital thermometer).

Ear thermometers are ideal for use on young infants and can often provide the most accurate reading possible as the inner ear has a temperature very similar to that of your baby's core temperature. To take a reading you will simply need to hold the thermometer in your baby's ear until it displays the digital reading.

Forehead strips are again slightly less accurate however they are incredibly convenient, especially if your baby doesn't like to sit still. Place the strip on your baby's forehead, being careful not to touch your fingers on the heat sensitive strips, and hold it in place for a couple of minutes.

How do I sooth a fever?

. Keep your baby's room comfortably cool; open a window, turn down the heating or even switch on a fan if necessary.

. Dress your baby in cool, cotton clothing so that the heat can escape from their skin, this will stop them from becoming clammy. A nappy and vest may suffice until they cool down a little.

. When you lay your baby down for a nap there's no need to wrap them up in blankets, simply tuck them in with a cotton sheet to keep them cool.

. Infants will need lots of fluid and calories to battle infection when they're under the weather. If your baby is running a temperature make sure they are feeding frequently and consuming plenty of milk or cooled, boiled water.

. Infant painkillers can be used to bring down your baby's temperature as long as you follow the instructions carefully.

. Ask your pharmacist for advice.

It is safe to give babies over 2 months of age and 4kg (9lb) children's liquid paracetamol as long as they were born after at least 37 weeks of pregnancy. While infants over 3 months can be given infant liquid paracetamol or ibuprofen as long as they weight more than 5kg (11lbs). However, if your baby has previously shown sensitivity to infant painkillers or has suffered with other health problems in the past you should check with your doctor before administering any drugs. Ibuprofen is very helpful to sooth the pain experienced by your child when teething however it should not be given if your child has a history of Asthma.

Children under the age of 16 should never be given aspirin.

If you don't have a medical card and you are finding that regular trips to the doctor for your child/ children are causing you financial pressure it may be worth considering a G.P. Only card. The income guidelines for GP Visit Cards are higher than the Medical Card, and the allowances for rent, mortgage and childcare bring many people's income within the guidelines. Details available from HSE.ie.

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