Get prepared before illness strikes your child

The 9-year-old's mother paged as I was leaving the house for morning hospital rounds. She called to report that her son had woken up with a low-grade fever and headache. I spent the first few minutes of our conversation puzzled by her level of concern.

I was about to give her a few basic instructions and reassurance, when she added that one of her child's classmates had just been diagnosed with viral meningitis. Now I understood her early morning panic. Since the boy did not sound seriously ill, I advised a pain/fever reducer with a follow-up call to the office if his headache did not improve.

Before- and after-hour phone calls are a challenge. Even at this point in my career, I still find myself fielding unusual phone calls and calls that offer new twists on old problems. As in the case of my 9-year-old patient, most parents do call with legitimate concerns.

Phone advice is such an integral part of pediatrics that new parents should acquaint themselves with their doctor's on-call procedures from the get-go. Find out if your child's physician charges for phone calls so you don't get surprised by unexpected bills. It's also important to know what time the practice switches over to its after-hour answering service on both weeknights and weekends.

You'll also want to ask how long you should expect to wait between your call to the service and the phone call back from the doctor. If you don't hear back within the expected time period, call the answering service again. Have them double check your phone number to make sure the pediatrician was given the correct number to reach you.

In the event of a true emergency -- respiratory distress, severe allergic reaction, significant blood loss, etc. -- dial 911 immediately. Time spent calling your pediatrician's after-hour line, having her paged and getting a call back can mean loss of precious minutes of emergency care. Let the paramedics do their work and then, if possible, notify your child's doctor of the plan.

Before making phone calls, have pertinent information available and make sure that you are the parent with the most up-to-date information. If mom has been home all day with the sick child, she should be the one on the phone.

My most amusing on-call experiences involve the "three-way" phone call:

Dad: "Doctor, I'm worried about my son's fever." What were his temperatures during the day? Dad: "Honey, the doctor wants to know how high his fever's been." Has he had anything to eat or drink? Dad: "Honey, the doctor wants to know if he drank his bottle today." You get the picture. At this point I instruct dad to take the baby from mom (talking to mom while baby is crying in her arms is another challenge) and let mom do the talking.

It's also helpful to have 24-hour pharmacy phone numbers handy, but remember that very few conditions can be medicated over the phone. Even if you are sure your child has strep throat or pneumonia, don't expect your child's doctor to call in antibiotics before examining the child himself. Become familiar with the hours and locations of nearby emergency departments and treatment centers (accepted by your insurance plan) in case your child's doctor advises a night trip to the ER.

No one expects parents to have the presence of mind to provide all of this information all of the time. When your 15 month old has his highest fever ever and it's 2 a.m., it's hard to think clearly. That's why it helps to be prepared before illness strikes.