On Call: When to Call the Doctor in the Middle of the Night

If there’s one question that plagues a parent at some time or other, it’s this: What conditions are serious enough to call the doctor during the night rather than waiting until the next day the office is open?

Parents agonize over trying to determine how sick their child really is. And, if he clearly is sick, does he need to go to the emergency room or will a call to his pediatrician suffice?
Some pediatric conditions that worry parents are fever, irritability and crying, cough and difficulty breathing, vomiting, diarrhea, rashes, pain and injuries. Here’s a review of these illnesses and the trigger points for calling a doctor.

• Fever – Fever is a symptom that may accompany infections and other conditions. If the rectal temperature in an infant under 3 months is 100.4° F or higher, you should call the doctor immediately, since young babies have limited immunity to fight off serious infections. In older infants and children, it’s more important to see how your child is acting and whether other symptoms are present. If your child is alert and playful and has some fever with no other symptoms, the precise number on the thermometer is not so important. In this case, you may wait until the office opens to call the doctor. If the fever is accompanied by a rash, poor feeding or other concerning symptoms, you should call the doctor. If your child is at risk for infection due to a chronic condition or medication, you should always call your doctor when he has a fever.

• Irritability and crying – If your infant has extreme irritability and crying that you cannot console with holding or carrying, you may consider calling your doctor. From 1-10 weeks of age, infant colic is very common, occurring in around 25 percent of babies. Colic is excessive crying (more than two hours per day), and is not a serious medical condition, though it understandably makes parents very upset. All babies with colic will outgrow this condition, and you may address questions about it with your doctor, usually after the office opens. But if you’re not sure whether the irritability signifies something more serious, you should call your doctor right away.

• Cough and difficulty breathing – Coughing in infants and young children is usually due to the common cold. Most of these will clear up without treatment in three-five days. If the cough is getting worse, keeps your child up at night or is accompanied by difficulty breathing, you should call the doctor. You can tell if your child is in trouble if he is breathing fast and hard, if you can see the skin around his ribs or breast bone moving in and out (retractions), or if he has a hard time catching his breath. If the breathing difficulty is severe or you see a bluish color on his face, call 911 immediately.

• Vomiting and diarrhea – Most vomiting and diarrhea are caused by viruses that infect the stomach and intestinal lining. It is essential to prevent dehydration that may occur if your child looses excessive fluids that are not adequately replaced by mouth. It’s also important to make sure that vomiting is not due to an urgent condition like appendicitis or other forms of obstruction. Red flags to call the doctor include abdominal pain, green vomit and signs of dehydration (dry mouth, less urination, no tears in infants, sunken eyes, decreased activity and irritability). Also, a severe headache with vomiting may indicate increased pressure on the brain and is an emergency, so call 911 right away.

• Rashes – Most rashes are not urgent, and may be caused by allergic conditions, infections or contact with irritant substances. But you should call the doctor if the rash is accompanied by fever, difficulty breathing or if it is purple and does not fade when you press on it.

• Pain – Any severe pain is a good reason to call the doctor at any time. Mild to moderate pain can often be treated with medication like acetaminophen or ibuprofen, or with non-medication distraction methods.

• Injuries – Injuries are the most common causes of illness and death in childhood. Children who have head injuries deserve special attention. If there is no loss of consciousness and the child seems to be moving and acting normally, there is usually no need to call the doctor. But if there is any concern that the child was unconscious or is not alert, 911 should be contacted. Any injury with significant pain or bleeding also needs immediate attention. Poisons are frequent causes of injuries, and you may get immediate advice if you think your child might have been poisoned by calling the poison hotline at 1-800-222-1222.

If you have a hard time deciding whether or not to call the doctor about your child’s health, it’s better to err on the side of calling rather than delaying. Pediatricians expect you to call anytime when your child is seriously ill. Remember, the only stupid question is the one that’s not asked!

Dr. Daniel Neuspiel is a general pediatrician at CMC-Myers Park Pediatrics. He is Director of Ambulatory Pediatrics at Levine Children’s Hospital.