The first purpose of  Pediatric HouseCalls Online, is to help you determine how sick your child is and if you need to call your child's doctor. The second purpose is to help you treat your child at home when it is safe to do so.Your doctor's advice and your good judgment should always take precedence over information in these topics.

Here are some instructions for using HouseCalls Online:

1. Choose the Appropriate Topic. Choose the topic that most closely matches your child's symptoms.
   • If your child has more than one symptom, address the most serious symptom. Serious means the symptom that potentially could cause the most harm to your child. (Example: for nosebleed and head injury together, use the Head Injury guideline.) If you aren't sure which topic to use, use more than one guideline.
   • Caution: don't use the fever guideline unless fever is your child's only symptom. If your child also has a cough, diarrhea or other symptom, go to that topic instead of fever.
   • Choosing the appropriate symptom is very important because it leads you to the best information for your child's illness or injury.
2. Read the Definition. Go to the chosen topic and read the Definition to be sure it's a good fit for your child's problem. If not, consider related symptoms listed under the section, "See More Appropriate Topic (instead of this one)".
3. Read the When to Call Your Doctor - Decision Chart Section: Following the Definition section in each topic, there is a Decision Chart, which gives options for what action you should take, including Call 911, Call Your Doctor Now, Call Your Doctor Within 24 Hours, and so on. Below each response is a list of symptoms/reasons for using that option. Read through these bulleted items. Read from top to bottom and don't skip any symptoms or reasons. The purpose of these is to help you determine the seriousness of your child's illness or injury.
4. Follow the Action Suggested in the Decision Chart. If your child has even one of the serious or other "Call Your Doctor" symptoms, stop reading the list of other reasons to call your doctor and take the action suggested in the heading at the top of the list. If the recommendation is to call your doctor within 24 hours or during weekday office hours, refer to the Home Care Advice section to help you keep your child comfortable until then.
5. Follow Home Care Advice. If your child has none of the "Call Your Doctor" symptoms, follow the Home Care Advice listed in the final section. But watch your child carefully for any worsening or new symptoms. If your child's condition changes for the worse, calling your doctor again is a good idea.
6. Reader's Responsibility. Finally, you are in control of this process. If you think or feel your child needs to be seen, call your doctor for assistance or go to the nearest emergency department.

Note: If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW! 

And when in doubt, call your doctor NOW or go to the closest emergency department.

Parent Responses to Illness and Injury

One of the purposes of these guidelines is to help you determine how sick your child is. Then it is time to make a decision and act. By reading the questions and using your common sense, you should be able to fit your child into one of the five following When to Call Your Doctor categories:

Call 911 Now (your child may need an ambulance)

• Definition: Your child may have a life-threatening emergency
• Action: Immediately call 911 or your Emergency Medical Response system.

Call Your Doctor Now (night or day)

• Definition: Your child may have a non-life-threatening emergency or urgent condition
• Action: Call your child's doctor immediately. If you can't reach your doctor within 60 minutes, go to the nearest emergency room by car. If you don't have a doctor, go to the ER now.

Call Your Doctor Within 24 Hours (between 9am and 4pm)

• Definition: Your child probably has a nonurgent illness that may require a specific test (such as a throat culture) or an antibiotic (such as for an ear infection). Your child may need to be seen, but it can safely wait for up to 24 hours.
• Action: If the office is open, call now. If the office is closed now, but will be open within 24 hours, call when it opens. If the office won't be open within the next 24 hours, call your doctor's answering service between 9 AM and 4 PM on any day of the week (including weekends and holidays) for assistance. If you don't have a doctor, go to an urgent care center or ER within the next 24 hours.

Call Your Doctor During Weekday Office Hours

• Definition: Your child has a nonurgent symptom or illness that has lasted longer than expected (such as a persistent cough or localized rash) but usually carries no risk of complications. Your child may need to be seen in the office but can safely wait a few days if it's the weekend or a holiday.
• Action: If the office is open, call now. Otherwise, call during scheduled weekday office hours on Monday - Friday. (This category therefore excludes weekends and holidays.) If you don't have a doctor, choose a doctor and make an appointment to be seen within the next 3 days.

Parent Care at Home

• Definition: Your child has a mild illness that's usually self-limited or harmless. Follow the detailed home care advice that's provided in each guideline.
• Action: Your child can be safely cared for by you at home. Call your doctor if your child's condition becomes worse.

Note: If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your doctor NOW or go to the closest emergency department.

The Author is grateful to the following individuals, for their time and expertise in reviewing the triage content that has been incorporated into these guidelines.

Pediatric Emergency Medicine Specialists

• Joan Bothner, MD, Denver, CO
• Louis Hampers, MD, Denver, CO
• David Thompson, MD, Berwyn, IL (adult emergency medicine)
• Peter O'Hanley, MD, Moncton, New Brunswick, Canada

Medical Directors or Advisors, Pediatric Call Centers

• Andrew Hertz, MD, Rainbow Babies Children's Hospital, Cleveland, OH
• Randy Sterkel, MD, St. Louis Children's Hospital, St. Louis, MO
• Physician Advisory Board, St. Louis Children's Hospital, St. Louis, MO
• Medical Advisory Board, Clinidata, Toronto, Ontario, Canada

Telephone Triage Nurses

• Teresa Hegarty, RN, Denver, CO
• Kathleen Martinez, RN, Denver, CO
• Kelli Massaro, RN, Denver, CO
• Melissa Masson, RN, London, Ontario, Canada
• Cheryl Patterson, RNC, Evergreen, WA
• Ann Petersen-Smith, RN, PNP, Denver, CO
• Teresa Pounds, RN, Maryville, TN
• Lisa Swerczek, RN, St. Louis, MO
• Suzanne Wells, RN, St. Louis, MO

Physician Advisory Board: St. Louis Children's Hospital, St. Louis, MO

• Jay Epstein, M.D., Community Pediatrician, Forest Park Pediatrics
• David Jaffe, M.D., Washington University School of Medicine, Emergency Medicine
• James Keating, M.D., Washington University School of Medicine, Gastroenterology/Diagnostic Center
• Katherine Kreusser, M.D., Community Pediatrician, Children’s Clinic
• Steve Lillpop, M.D., Community Pediatrician, Jacksonville Pediatrics
• Jerome O'Neil, M.D., Community Pediatrician, Southwest Pediatrics
• Rachel Orscheln, M.D., Washington University School of Medicine, Infectious Disease
• Isabel Rosenbloom, M.D., Community Pediatrician, Tots Thru Teens Pediatrics
• Harold Sitrin, M.D., Community Pediatrician, Suburban Pediatrics
• Randy Sterkel, M.D., Answer Line Medical Director, Community Pediatrician, Esse Health Pediatrics
• Mary Tillman, M.D., Community Pediatrician, Tillman Pediatrics

Colorado Primary Care Pediatricians: Expert Panel

• Francesco Beuf, MD, The Boulder Pediatric Center, Boulder, CO
• Vincent DiMaria, MD, Arapahoe Park Pediatrics, Littleton, CO
• Matt Dorighi, MD, Cherry Creek Pediatrics, Denver, CO
• Max Elliott, MD, Fort Collins Youth Clinic, Fort Collins, CO
• Daniel Feiten, MD, Greenwood Pediatrics, Centennial, CO
• Nancy Greer, MD,  Broomfield Pediatrics, Broomfield, CO
• Jay Markson, MD, Children’s Medical Center, Denver, CO
• Robert Mauro, MD, Greenwood Pediatrics, Littleton, CO
• Martha Middlemist, MD, Pediatrics at 5280, Englewood, CO
• Stefan Mokrohisky, MD, Kaiser Permanente, Denver, CO
• Michelle Stanford, MD, Centennial Pediatrics, Centennial, CO

Pediatric Subspecialists: Targeted Reviews

• Adolescent Medicine: David Kaplan, MD, Trina Anglin, MD
• Allergy: James Shira, MD, Dan Atkins MD
• Breastfeeding: Lisbeth Gabrielski, RN, Marianne Neifert, MD
• Dentistry: William Mueller, DDS
• Dermatology: William Weston, MD
• Diabetes: Georgeanna Klingensmith, MD
• Gastroenterology: Judy Sondheimer, MD, Sara Fidanza, RN, PNP
• Infectious Diseases: Mark Abzug, MD, Elizabeth McFarland, MD, Ann-Christine Nyquist, MD, Harley Rotbart, MD, James K. Todd, MD
• Neonatology: Jacinto Hernandez MD, Susan Niermeyer, MD, Elizabeth Thilo, MD
• Nutrition: Nancy Krebs, MD
• Neurology: Paul Moe, MD, Paul Levinson, MD
• Ear Nose and Throat: Kenneth Chan, MD
• Ophthalmology: Robert King, MD
• Orthopedics: Robert Eilert, MD
• Pulmonary Medicine: Jeffrey Wagener, MD, Gwendolyn Kerby, MD
• Sports Medicine: Brooke Pengel, MD
• Toxicology: Richard Dart, MD, Medical Director, Rocky Mountain Poison and Drug Center; William D. King, RPh, MPH, DrPH, University of Alabama School of Medicine; Erica Liebolt, MD, FACMT, University of Alabama School of Medicine

Note: All subspecialists practice at The Children's Hospital, Aurora, Colorado unless otherwise listed.

Copyright Protection Notice: All rights reserved. No part of this program can be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the author and publisher. It is prohibited to make or distribute any unauthorized copies of these guidelines for personal or business purposes, to create derivative works, etc. These guidelines are copyright protected and are not available for any of the following purposes:

• To use as a template or model for writing a commercial product, be it printed or software.
• To use as a reference when writing a commercial product, be it printed or software.
• To use as a resource for updating a commercial product.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Content Set: Pediatric HouseCalls Online

Pediatric HouseCalls Online