What to Expect the Toddler Years (197 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
When you’re unhappy, don’t keep it to yourself.
If the partnership with your toddler’s doctor isn’t working, take steps to remedy the situation. First, discuss your discontent and the perceived reasons for it with the doctor. See if you can jointly come up with a solution or solutions. If it doesn’t look like the problem can be fixed, if you feel you’re not getting anywhere with the doctor, or if you feel your concerns aren’t being heard, consider switching to another practice. But make sure to find one you like before giving up what you have; a child should never be without health care.
HEN TO CALL THE DOCTOR
New parents tend to call the doctor at the drop of a symptom. By the time a child turns one, these parents, more experienced and more confident, generally pick up the phone less often. Nevertheless, there are still times when a call for medical advice or reassurance is necessary.
Deciding which symptoms say “Call immediately,” which say “Call sometime today,” and which say “Wait and see” isn’t always easy. And a call-the-doctor symptom in one child or in one situation may be a wait-and-see symptom in another. That’s why you should ask your child’s doctor or nurse-practitioner for specific when-to-call recommendations for your child. Jot down these recommendations in the space provided at the end of this list. This is particularly important if your child has a chronic condition (such as heart, kidney, or neurological disease; sickle-cell or other chronic anemia; diabetes or asthma, see
Chapter Twenty-three
).
No matter what instructions you’ve been given, call immediately (or go to the emergency room if the doctor can’t be reached), if you feel that there is
something very wrong with your child—even if you can’t confirm it with the help of the entries on this list and even if you can’t quite put your finger on what it is.
LOOKING FOR DR. RIGHT
Many parents of toddlers are fortunate to be in a satisfying partnership with a doctor or group of doctors they consider “right.” Others, however—either because the family has relocated, their previous doctor has left town or retired, there has been a change in their insurance coverage, or because of dissatisfaction with their present provider—find themselves once again on the lookout for that special someone (or those special someones) to care for their child’s health.
Finding Dr. Right is never easy, but the odds that you’ll locate him or her are better if you ask the right people. Look to your obstetrician-gynecologist, midwife, or internist (but only if you’re satisfied with the care you’re getting from them); to friends and acquaintances (especially any who are pediatric health professionals); other parents at the play group, day care center, or preschool your child attends; members of your religious community; and colleagues at work. Recommendations from people who share a similar lifestyle and temperament as well as many of the same child-rearing philosophies as you do will best serve your search. If you’re new to a community, call the local medical society for the name of a doctor. Or try a respected local hospital; they may have a referral service. If they don’t, request the pediatric floor and ask a nurse for a suggestion. If all else fails, turn to the Yellow Pages (but keep in mind that some very busy doctors don’t list themselves in the Yellow Pages and some doctors who do list themselves as specialists are not board-certified; so be sure to check out such claims by looking the name up in the Directory of Medical Specialities at the public library or by asking the doctor directly if he or she is board-certified).
Of course, if you belong to an HMO or other health-care group that specifies providers, you will probably be furnished with a list of providers to choose from; asking other group members who they use and what their experiences have been with them can help you make your choice.
Ideally, you should schedule a consultation with a potential candidate before you sign on—to compare philosophies on topics of importance to you, discuss office atmosphere and protocol, and generally test the chemistry. But if you’re short on time (a checkup or immunization has come due, or an emergency situation has arisen), you may not have that luxury. If that’s the case, you’ll need to learn about the physician’s approach, style, philosophy, and degree of competence “on the job.”
If your child develops any of the following symptoms, call as noted. If a symptom that calls for a
call during regular office hours
appears on the weekend, you can wait until Monday to contact the doctor. If a symptom that requires a
call within 24 hours
appears on the weekend, call within that time frame, even if you have to call the doctor’s answering service.
Fever:
over 105°F (40.5°C), rectally, or the equivalent using another method, such as orally. (Unless otherwise specified, temperatures given in this section are for rectal readings. See page 587 for corresponding equivalents.)
Call immediately.
between 104°F and 105°F (between 40°C and 40.5°C); call within 24 hours.
between 102°F and 103.9°F (between 39°C and 39.5°C); call during regular office hours.
under 102°F (39°C) rectally (low-grade), with mild cold or flu symptoms, that lasts for more than three days; call during regular office hours.
that lasts more than 24 hours when there are no other detectable signs of illness; call within the next 24 hours.
that isn’t brought down at all by a fever-reducing medication within an hour; call within 24 hours;
call immediately
if 105°F (40.5°C) or above.
that suddenly rises after being low-grade (under 102°F or 39°C) for a couple of days; that suddenly develops in a child who has been sick with a cold or flu (this may indicate a secondary infection, such as an ear infection or strep throat); call within 24 hours, unless the child appears sick or has a history of febrile seizures, in which case,
call immediately
.
with onset following a period of exposure to an external heat source, such as the sun on a hot day or the closed interior of a car in hot weather;
immediate emergency medical attention
is required (see heat illness, page 673).
that suddenly increases when a child with a moderate fever has been over-dressed or bundled in blankets. This should be treated as heat illness;
call immediately
.