Kids' symptoms

What doctors want you to know

Your two-year-old is flushed and blazing hot. She’s been sniffly for two days and feverish since this morning when the underarm thermometer showed 38°C (100.4°F). You gave her Children’s Tylenol twice through the day, but her temperature stayed the same. Now it’s suppertime and you get out the thermometer again — it’s risen to 38.5°C (101°F)! Time to call the doctor?

Not necessarily, says Cathryn Tobin, a paediatrician in Markham, Ont., and author of The Parent’s Problem Solver. “What’s important with a fever is not so much the number or whether it comes down with acetaminophen. It’s how the child appears, how long the fever has lasted, and whether she has any specific complaints.” Is she smiling, alert, eating? Is she interested in her toys? If the answer is yes, she probably doesn’t need a doctor right away. On the other hand, a child who is lethargic and unresponsive, crying inconsolably, or showing symptoms such as a strange rash or headache, may be much sicker even with a temperature that’s just a notch above normal.

Fever scares parents and accounts for a great many calls to the doctor’s office and late-night trips to emergency. However, doctors emphasize that fever is not an illness in itself but rather a sign that your child’s body is battling an infection. The underlying condition is what determines how sick your child is and whether he needs immediate treatment; signals like behaviour and appearance are much more telling than temperature. (The exception is fever in infants: If your baby is younger than three or four months, get medical attention right away. )

We asked physicians about other symptoms that appear frightening but that, on their own, seldom indicate a major problem. And we asked for the flip side too: symptoms that tend not to worry parents, but that should be checked out, if only to rule out serious illness.

All our sources emphasized that you know your child best and it’s never wrong to call her doctor (or your local or provincial health line) if something is nagging at you. Armed with a little extra information, however, you may find the reassurance you need to ride out a rough patch, or seek help when it’s really needed.

Scary
[But Probably Fine]

Infrequent bowel movements in a nursing infant
When a baby is breastfed, she can produce anywhere from 10 bowel movements a day to just one a week. It’s all within the normal range, says Cheryl Mutch, a paediatrician at BC’s Burnaby Hospital and a member of the community paediatrics committee of the Canadian Paediatric Society. That can be hard to believe for parents who get more fretful with each day that goes by without a poopy diaper. But if the baby is feeding well and gaining weight, there’s probably nothing to worry about. (The exceptions: In the first week or two, regular BMs help show that nursing is getting established; and in a formula-fed baby, scarce BMs could indicate constipation, which should be treated.)

Breath-holding spells
A toddler who holds her breath until she faints? It can be frightening to watch, says Toronto paediatrician Janet Saunderson, but your child is in no danger of depriving herself of oxygen. Nor is she doing it to manipulate you. Breath holding is fairly common among toddlers frustrated by restrictions they don’t understand. It can also be a shock reaction to a sudden trauma such as a finger pinched in a drawer.

Reaction after immunization
“I get a lot of calls from parents who see a red, angry spot” at the site of a recent needle, says Tobin. While many are convinced it’s an infection, she reassures them that it’s likely a routine local reaction and no cause for concern. Expect the spot to be tender and itchy for a couple of days, and your child may be cranky. Infection is rare and is indicated by streaky red marks around the site, pain and sometimes a squishy swelling like a balloon filled with water.

Stuttering in a preschooler
A three-year-old who suddenly starts stuttering can send his parents into a panic about speech disorders, says Saunderson. She usually tells them to relax; in most cases, stuttering and articulation problems resolve without intervention by age four.

Nosebleeds
Your six-year-old wakes with a gushing nosebleed — his third in two days. What’s going on? “Nosebleeds mostly come on when kids pick their noses,” says Pat Hose, a family doctor in Toronto. Then a cycle can start, with the scabs and irritated membranes encouraging further picking — and more bleeding. As long as the nosebleed stops within five minutes, says Hose, it’s unlikely your child needs to see a doctor, even for repeat episodes. She recommends using petroleum jelly inside the nostrils to keep them moist; a humidifier can also help.

Skinny kids
You can count your eight-year-old’s ribs, and his shins are like sticks. Is he literally wasting away? Unlikely, says Tobin, as long as the weight loss is not sudden and your child is not lacking in energy or coming down with more than his share of illnesses. Some kids are just thin, and more important than his overall size is whether he’s making steady upward progress on growth charts that plot height and weight.

Dry, scaly patches
Especially in the winter months, Hose sees a lot of kids with small areas of red, flaky skin or eczema — and parents worried about some dire skin disorder. She reassures them that it’s just dryness, and urges them to cut back on baths and use lots of moisturizing cream or petroleum jelly.
Symptoms
[That Need Attention]

A limp
Growing pains are common — cramps or aches in the legs, especially at night. But a limp is not. So if your three-year-old suddenly starts keeping his weight off one leg, there’s a reason, says Saunderson, and it should be checked out. The explanation could be as simple as a splinter in his heel, or there could be an underlying joint problem or arthritis — more likely to be the case if the stiffness is worst in the morning and gets better through the day. In rare cases, a limp can signal leukemia.

Redness around the eye
Pink eye is a common infection that’s easily treated and indicated by — yes — a pink irritation in the whites of the eyes. While that is generally no cause for alarm, says Hose, keep watch on the area around the eye. If the eyelid and surrounding tissue become puffy, red and tender, you should get your child to a doctor. It could be a sign of orbital cellulitis, which can damage the vision if it’s not treated.

Teen moodiness that lingers
Your 14-year-old has stormed away from the dinner table for the third time this week. Annoying — but pretty much what you expect from a teen, right? Maybe not, says psychiatrist Stan Kutcher of Dalhousie University in Halifax. Kutcher says parents and teachers may be too quick to accept difficult behaviour as the norm. “Teens are more erratic and moody as part of normal brain development. The problem is that some have extensive and prolonged difficulties. Those are not usual.” They could be signalling depression, drug abuse or, in rare cases, psychosis, says Kutcher. Watch for behaviour that is more intense than passing moodiness and persists for weeks or months without a break; it may interfere with the child’s friendships and school, and is likely disrupting family life.
Constipation in preschoolers
A two- or three-year-old with infrequent bowel movements is nothing to get frantic about, says Saunderson, but it can be a good idea to seek help sooner rather than later. The reason? While the constipation itself is not serious, when a stool finally passes, it can be large, hard — and painful enough to convince a child that she never wants to use the toilet again. A cycle of withholding can quickly develop, with abdominal pain, soiling as liquid leaks around the mass in her colon, and traumatic bathroom battles. In most cases, adds Mutch, your child’s doctor can suggest simple ways to ease the constipation with diet changes or sometimes a stool softener. But if you wait to get help, you may have a much bigger job to get back to normal toilet routines.

Any symptom that persists without improvement
For most parents, a mild scratchy cough or a bout of diarrhea isn’t particularly worrisome. But keep track of how long things have been going on. If your child doesn’t improve within a few days or a week, says Hose, it’s a good idea to call the doctor. This applies even if — perhaps especially if — your child has already seen the doctor and started a course of treatment. If you’re not seeing the expected improvement (and make sure you understand what to look for and when), a return visit is definitely warranted. Mutch notes that parents who themselves have experienced chronic symptoms may be more likely to assume that certain kids’ maladies are just part of life. So they may miss opportunities to clear up a simple problem.

Resources
The 3 A.M. Handbook: The Most Commonly Asked Questions About Your Child’s Health edited by Dr. William Feldman, revised by Dr. Jeremy Friedman, Key Porter Books 1998.

The Parent’s Problem Solver by Cathryn Tobin, MD, Three Rivers Press 2002.

How to Take Your Child’s Temperature
Ear thermometer or rectal? Under the arm or under the tongue? With more types of thermometers available, the only certainty is that each will give a slightly different reading of your child’s temperature. So which should you use? The answer depends on your child’s age, according to the Canadian Paediatric Society. Babies and toddlers under two: An armpit thermometer will help you check whether your child has a fever. But to confirm an accurate temperature, you need a rectal thermometer. Ear thermometers don’t fit baby ears well.

Kids age two to five: Again a rectal thermometer is the most accurate. Ear or armpit readings are acceptable — and face it, who enjoys having a rectal temperature taken? Mouth thermometers are not recommended for children this young.

Kids age six and up: A mouth thermometer under the tongue is best. Ear or armpit temperature will also work.

The CPS recommends using only digital thermometers, to avoid the risk of mercury exposure if a mercury thermometer breaks. For more information, visit cps.ca.