The first purpose of  Pediatric HouseCalls Sympton Checker, 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 Symptom Checker:

Select a Guideline. 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.

Use the Guideline: There are three parts of each topic or symptom.

1. 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)".
2. 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.  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.
3. 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.
4. 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 When to Call Your Doctor 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.
• Action: Your child can be safely cared for by you at home. Follow the detailed home care advice that's provided in each guideline.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 Call Centers: Medical Directors

• Peter Dehnel, MD, Chirldren's Physician Network, Minneapolis, MN
• Andrew Hertz, MD, Rainbow Babies Children's Hospital, Clevland, OH
• Randy Sterkel, MD, St. Louis Children's Hospital, St. Louis, MO
• Debra Weiner, MD, Sirona Health, Portland, ME
• Medical Advisory Board, Skyes, Toronto, Ontario, Canada
• Elaine Donoghue, MD, St. Peter's Medical Call Center; New Brunswick, NJ (former)
• Hanna Sherman, MD, Boston Children's Hospital Call Center; Boston, MA (former)

Physician Advisory Board: The Children's Hospital, Aurora, CO

• Francesco Beuf, MD, the Boulder Pediatric Center, Boulder, CO
• Vincent DiMaria, MD, Arapahoe Park Pediatrics, Denver, 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
• Michael Kurtz, MD, Advanced Pediatric Associates, Aurora, 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, Centennial Pediatrics, Centennial, CO

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

Telephone Triage Nurses: The Children's Hospital, Aurora, CO

• Teresa Hegarty, RN
• Kathleen Martinez, RN
• Kelli Massaro, RN
• Teresa Baird, RN
• Kris Light, RN
• Ann Petersen-Smith, RN, PNP
• Liz Stober, RN

Telephone Triage Nusres: Other Sites

• Nancy Berryman, RN, Minneapolis, MN
• Barbara Byrne, RN, Tigard, OR
• Katrina Davis, RN, PNP, Salem, OR
• Jennu DuFresne, RN, Phoenix, AX
• Alane Hall, RN, Denver, CO
• Suzanne Haydt, RN, Tucson, AZ
• Nicole Leujten, RN, Denver, CO
• Melissa Masson, RN, London, Ontario, Canada
• Cheryl Patterson, RN, Evergreen, WA
• Teresa Pounds, RN, Maryville, TN
• Lisa Swerczek, RN, St. Louis, MO

Pedriatric Emergency Medicine Specialists

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

Pediatric Subspecialists: The Children's Hospital, Aurora, CO (unless otherwise noted)

• Adolescent Medicine: David Kaplan, MD, Trina Anglin, MD, Eric Sigel, MD 
• Allergy: James Shira, MD, Dan Atkins MD
• Breastfeeding: Maya Bunik, MD, Lisbeth Gabrielski, RN, Marianne Neifert, MD
• Cardiology: Michael Schaffer, MD, James Wiggins, MD, Robert Wolfe, MD Henry Sondheimer, MD
• Dentistry: William Mueller, DDS, Elizabeth Shik, DDS
• Dermatology: William Weston, MD, Joseph Morelli, MD 
• Diabetes: Georgeanna Klingensmith, MD
• Endocrinology: Michael Kappy, MD
• Gastroenterology: Rondald Sokol, MD, Judy Sondheimer, MD, Sara Fidanza, RN, PNP
• General Pediatrics: Steven Poole, MD, Stephen Berman, MD Robert Brayde, MD, Allison Kempe, MD, Maya Bunik, MD
• Hematology: Taru Hays, MD
• Infectious Diseases: Mark Abzug, MD, Elizabeth McFarland, MD, Ann-Christine Nyquist, MD, Harley Rotbart, MD, James K. Todd, MD, Mary Glode, MD, Brian Lauer, MD, John Ogle, MD 
• Neonatology: Susan Niermeyer, MD, Elizabeth Thilo, MD, Adam Rosenberg, 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, Frank Change, MD 
• Pulmonary Medicine: Jeffrey Wagener, MD, Gwendolyn Kerby, MD, Frank Accurso, MD, Scott Sagel, MD, Monica Federico, MD
• Rheumatology: Roger Hollister, RN 
• 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
• Urology: Martin Koyle, MD

American Academy of Pediatrics Appointed Reviewers

• Jack Swanson, MD, FAAP, Chair, AAP Committee on Practice and Ambulatory Medicine
• Allan Lieberthal, MD, FAAP, Memeber, AAP Committee on Practice and Ambulatory Medicine
• Jennifer Shu, MD, Medical Editor, AAP Healthy Children website, Atlanta, GA

Practicing Pedatricians

• Justin Alvery, MD, Layton, UT
• John Benbow, MD, Concord, NC
• Barbara Brundage, MD, Derry, NH
• Thomas Foels, MD, Williamsville, NY
• Fred Hamburg, MD Springfield, Mo
• George Miller, MD, Salem, OR
• Cajsa Schumacher, MD, Albany, NY
• Kiki Traylor MD, Denver, CO
• Paul Tschetter, MD, Pediatrics at DTC, Denver, CO
• Joseph, Vander-Walde, MD, Kaiser Permanente Mid-Atlantic
• Sarah Van Scoy, MD et al, Littleton Pediatrics, Denver, CO
• Wallace White, MD, Denver, CO

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 Symptom Checker

Pediatric HouseCalls Symptom Checker