When to Call Your Pediatrician – COVID-19 Edition

As pediatricians encourage kids with cold symptoms to stay home, it becomes important for parents to know when to call their pediatrician.

Parents should always feel that they can call their pediatrician when their kids are sick, but that call might not get you a quick visit now that we are concerned about COVID-19.

Why not?

Folks realize that this doesn't actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.
Folks realize that this doesn’t actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.

Although we don’t think that kids typically develop serious COVID-19 symptoms, they probably do still get sick and can be contagious to others.

That makes it important to keep them home if they have any symptoms of COVID-19, which unfortunately, can mimic most of the other viral infections that kids get.

When to Call Your Pediatrician – COVID-19 Edition

As more and more pediatricians limit who they will be seeing in their offices, it becomes even more important that parents learn to recognize when their kids have mild symptoms that can safely be treated at home and when they might have urgent problems that need medical attention.

Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.
Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.

Fortunately, while many parents have gotten used to running to their pediatrician as soon as their kids have a fever, sore throat, diarrhea, or cough, most of these symptoms are caused by viral infections that go away without treatment.

And parents should understand that their pediatricians are still available! Most of us likely won’t be able to see everyone as quickly and easily as we usually do, but the kids who get triaged to stay at home without being seen will almost certainly be those who don’t need to be seen.

Recognizing the signs of a more serious infection will also help you trust your pediatrician’s judgment on home care so that you don’t rush to an urgent care, where they might not be triaging kids with COVID-19 symptoms and are seeing everyone who comes in.

So how do you know if your child has a mild viral infection or if it is something more serious?

Ultimately, you might need to call your pediatrician, but it might help to know that:

  • fever itself is not a disease and how high a temperature gets doesn’t tell you how sick your child is. Unless you have an infant under 2 months old with a rectal temperature at or above 100.4°F (38°C) – which is always a medical emergency – your otherwise healthy (no chronic medical problems) older child with a fever doesn’t necessarily need treatment or a visit to the doctor, as long as they are drinking and aren’t irritable and aren’t having trouble breathing etc.
  • a sore throat with a runny nose and cough is typically caused by a virus and not strep throat. On the other hand, if your child has the sudden onset of a sore throat and fever, with red and swollen tonsils (tonsillitis), possibly with white patches (exudate) and small, red spots (petechiae) on the roof of their mouth, and tender, swollen lymph glands in their neck, then they might have strep and should have a strep test.
  • the flu, although it can be a life-threatening disease, especially in those who are high risk, typically goes away on its own after 5 to 7 days of fever, runny nose, and cough. Unless they are at high risk for flu complications, kids don’t necessarily need a flu test or Tamiflu, so don’t necessarily need to visit their pediatrician when you think they have the flu.
  • a runny nose, even if it is green or yellow, doesn’t mean that your child has a sinus infection and needs antibiotics, unless the symptoms are lingering for ten or more days or the child has severe symptoms
  • ear pain doesn’t mean that your child has an ear infection and even when your child does, a 2-3 day watching period before starting antibiotics is becoming the standard of care because the great majority of ear infections go away on their own
  • a cough, even if has been lingering for a week or two, doesn’t mean that your child needs antibiotics, as most kids with coughs simply have bronchitis, which will eventually go away
  • diarrhea can be a sign of a food intolerance or an infection, typically a stomach virus. Either way, you can likely treat your child at home, unless your child has high fever and bloody diarrhea or is dehydrated.
  • vomiting, especially when it is accompanied by diarrhea, is also often associated with gastrointestinal infections, and can respond to proper rehydration techniques

Of course, if your child has a chronic disease, like diabetes, asthma, or cystic fibrosis, etc., then even mild symptoms might put them at high risk for serious disease and you shouldn’t hesitate to call your pediatrician any time they get sick.

What are some other “red flag” type things parents should look for? In general, you should seek quick medical attention if your child has viral symptoms and:

  • is truly lethargic, which means that they are hard to wake up and not that they are just sitting on the couch watching Netflix instead of running around the house
  • has vomiting or diarrhea that has led to dehydration – dry mouth, few tears, only urinating a few times a day, etc
  • has vomiting with severe stomach pain
  • is breathing fast and hard, which could be a sign of pneumonia
  • has a fever and a purplish rash
  • is not at all playful or consolable
  • is not eating or drinking anything

On the other hand, even if your child has a fever, runny nose, cough, and sore throat, if they are also sometimes playful and drinking, then you likely have less reason to need an immediate visit to the doctor.

What if it’s COVID-19?

Again, most kids are not at big risk to get severe COVID-19 symptoms, so the main reason to see your pediatrician about COVID-19 would be to get tested to help know if you need to quarantine your child. Unfortunately, as most people are aware, testing is still very limited. Your pediatrician likely does not have the ability to test kids yet.

What about well checks and vaccines and other visits to your pediatrician?For that info, you will have to call your pediatrician.

And see if they are set up to do telemedicine yet.

More on Calling Your Pediatrician – COVID-19 Edition

What to Do About Your Child’s Earache

Does your child’s ear hurt? What shold you do about it?

Kids commonly complain of earaches.

Some don’t necessarily complain of an earache (otalgia), but just tug at their ears or a little more fussy than usual, so you might just think that it’s their ears.

Surprisingly, an earache doesn’t always mean that your kids have an ear infection.

Why Does Your Child’s Ear Hurt?

Tick bites would be a rare cause of ear pain.
Tick bites would be a rare cause of ear pain. Photo by Vincent Iannelli, MD

So what else besides an actual ear infection can cause an earache?

Does your child have a new tooth coming in?

Has he been swimming? (swimmer’s ear)

Does he have a sore throat or runny nose? (although most middle ear infections come after a few days of cold symptoms, simply having a sore throat or runny nose might cause some ear pain)

As you can imagine, lots of things can cause earaches, but the most common include:

  • teething
  • swimmer’s ear (otitis externa) – unlike otitis media, these kids typically have outer ear pain, or pain when you move or tug on their ear lobe
  • middle ear effusions – fluid that is left over in the middle ear after an ear infection (has nothing to do with swimming)
  • sinus congestion – some kids associate the extra ear popping that comes with allergies or a cold/sinus infection as being painful or uncomfortable
  • pharyngitis – because of referred pain, some kids with sore throats complain of ear pain instead of throat pain

And then some younger kids simply tug on their ears because they can. They are otherwise well, sleeping all night, eating well, and aren’t fussy.

What else can cause earaches? A toothache, too much earwax, or that rock your kid put in his ear a few weeks ago…

What to Do About Your Child’s Earache

Once you know why your child has an earache, which typically means a trip to your pediatrician, you need to know what to do about it.

You’re thinking a prescription for an antibiotic is coming, right?

Many parents will be happy to hear that most earaches won’t mean an automatic antibiotic prescription. Instead, your pediatrician will likely:

  • recommend symptomatic care for teething
  • prescribe antibiotic ear drops for swimmer’s ear
  • recheck your child’s middle ear effusion in a few months, as this goes away on it’s own in most cases without any treatment
  • treat underlying congestion from allergies, colds, or a sinus infection as needed
  • recommend symptomatic care for a sore throat

But what if your child really does have a middle ear infection? Then he will get antibiotics, right?

Not necessarily.

Since most ear infections get better on their own, antibiotics are typically reserved for:

  • children under age 6 months with acute otitis media (typically ear pain and a bulging ear drum)
  • children who are at least 6 months with acute otitis media and severe signs or symptoms, including moderate or severe pain for at least 48 hours or a temperature of 102.2°F (39°C) or higher
  • children who are under 24 months with “double” ear infections – both ears are infected at the same time, even if they just have mild symptoms

For most other children, instead of having you start antibiotics right away, your pediatrician might have you wait for 48 hours – the observation option. You can then start the antibiotics if your child doesn’t get better after a period of watchful waiting for two or three days. Until then, an age-appropriate dose of Tylenol (acetaminophen) or Motrin (ibuprofen) can often help control pain or fever.

In addition to your pediatrician, a pediatric ENT specialist can be helpful if your child has persistent ear pain.

What to Know About Children with Earaches

While it is sometimes obvious to know what is going on when older kids complain of ear pain, it is important to understand that not every earache means an ear infection, and even when it does, it might not mean a prescription for an antibiotic.

More on Children with Earaches