Baby

Your doctor’s well-baby examination consists of many different parts, each designed to help her find certain information. You may have to watch closely to see her do each part of the exam because she probably has developed her own tricks and techniques. Some doctors like to have the baby on the examination table; others prefer that the parents hold the baby. Sometimes the doctor will be talking to you while examining your baby.

Here are some of the major areas your doctor will consider and what she looks for in each category:

• General Appearance: cleanliness, nutrition, alertness
• Skin: color, rashes. Bruises, swelling, condition of hair and nails
• Head: Shape, softness of the anterior fontanel [soft spot]
• Eyes: redness, good movement, light reflexes [checked with an instrument called an ophthalmoscope, looking for problems with the retina]
• Ears: irritation or infection of the ear canals or ear drums
• Nose: congestion, discharge
• Mouth: gums, tongue, throat, tonsils
• Neck: swelling of the thyroid or lymph nodes, mobility
• Heart: rate and rhythm, murmurs
• Lungs: breathing rate, abnormal noises, air exchange
• Abdomen: bowel sounds [normal stomach gurglings], enlarged organs or tenderness
• Genitals: In girls-normal appearance of external genitals, redness. In boys-penis [if circumcised, check that it has healed well; if not, check that foreskin is normal], both testicles are in scrotum
• Arms and Legs: normal movement and color, absence of swelling and discoloration
• Pulses: equal femoral pulse [same on both sides]
• Neurologic: tone, muscle movement and coordination, strength

From your discussions with your doctor, you will know how she wants to deal with emergencies and after hour’s calls. Keep her guidelines in mind when you think about calling her. However, if you are very concerned about your child, then call. Most childhood illnesses can be handled over the phone, and the child won’t have to be seen by the doctor until morning.

Before you call your doctor, you need to gather some information and think about what information you want to get from the call. For example, if you feel your child is going to need some medicine, don’t wait to call until all the local drugstores are closed. In some communities, it’s next to impossible to get any medicines after the pharmacies are closed. It’s better to call your doctor earlier instead of later. Also, almost all illnesses seem to get worse as the night progresses, so if your child isn’t well at seven o’clock, there’s little chance that he’ll be a lot better by ten o’clock. If you are concerned, call at seven o’clock instead of ten o’clock. If you really want your child to be seen, tell the doctor right from the beginning. It’s helpful for her to know that. She will realize that all the reassurances she can give you over the phone won’t help if you really want to have your child examined. However, if you just want some advice over the phone, let her know that also. It will make her job easier.

Be sure your after hours call is really necessary. Think about what you would do if you didn’t have that information until morning. Would that delay change things? Remember that doctors have families and things they like to do besides practice medicine. Out of consideration for them and their families, all non-emergency calls should wait until office hours.

Once you have decided to make the call to your doctor, there’s some important information you should have on hand. By preparing for the call, it will be easier for you to let your doctor know exactly what’s going on. Here are some questions you should be ready to answer when you call:

What are the basic data on your child? Start with your child’s name, when he was last seen by a doctor, and who that was. This will help your doctor place your child. Tell her his age and weight, what medicines he’s taking, and what illnesses he’s had.

What’s wrong with your child? This may sound like a silly question to prepare for, but all too often a parent can’t answer it concisely. Think about your child’s problem and be prepared to describe exactly what’s going on. Things to think about include the following: What is your child eating [solids, liquids, nothing]? Is he urinating a normal amount? Is he having diarrhea? Is he acting normal? If not, what’s abnormal about his actions? Is he running a fever? If so. How high his temperature is and what method did you use to take it?

What’s happened or changed to make you decide to call the doctor now? This is an important question for you to think about. For example, your child’s temperature may have gone up a lot, or he may have suddenly begun to cry and pull at his ear, or he may just begin to vomit violently. Or perhaps you are just concerned and want some advice. If your questions can wait, your call can probably wait until morning.

What do you think is ailing your child? Often, parents know what’s wrong with their child. This is particularly true if their child has had many episodes of the same illness. For example, many parents know when their child is coming down with another ear infection. Or, if other members of the family have had a similar illness, there’s a good chance your child is getting the same thing. Let the doctor know what you think is going on.

Where do you want a prescription filled? You should decide which drugstore you want to use and make sure it’s opened and has a pharmacist on duty before you call. Have the phone number ready to give your doctor.

Doctors who take care of children expect interruptions and emergencies-they go with the age group. Most have no problems with appropriate phone calls at any hour. What irritate even the most caring physician are inappropriate calls and patients who abuse their services.

There’s nothing scarier for a new parent than a sick baby. Your infant is fussy, not eating well, and has a fever. Should you take her to the hospital? Should you call your doctor? Or are you overreacting? As a well-informed parent, you want to know what you should do-when to be concerned and when not to worry. You want to know when to call the doctor and what to tell him. That’s what this section is all about.

What You Need to Know

All parents need to learn to tell when their child is sick, when to seek professional help, what to do in emergencies, and how to give medicines. Once you know these facts, you will be able to make the best decisions
One of the best ways to deal with illness is to be prepared. This includes knowing about common childhood illnesses and emergency measures, as well as having and knowing how to give the appropriate medicines. There are some general steps you should take to prepare yourself for illness or accident:

• Know the telephone numbers of your doctor, the hospital you use, the local poison control center, the fire department, and the ambulance service. These numbers should be posted near the telephone. Make sure your babysitters know where these numbers are located.
• Ask your doctor what he wants you to have on hand for emergencies and treatment of common ailments. Many doctors recommend that you have syrup of ipecac and activated charcoal on hand for poisonings. Some want their patients to keep certain common medicines on hand for late night illnesses.
• Discuss with your doctor what you should do in case of an emergency. If your child eats a bottle of pills or drinks a poison, should you call your doctor, the local emergency room, the poison control center? [Most doctors recommend you call the poison center, first.] If your child is injured, should you call your doctor first, or take your child to the emergency room? Asking these questions before an accident occurs will make things easier for both of you.
• Read about childhood illnesses and accidents. Books will help you be prepared for the inevitable illnesses and injuries that befall all children.
• Take a first aid course and learn CPR [cardiopulmonary resuscitation] and the Heimlich maneuver [for choking]. Be sure the instruction pertains to both children and adults [many courses only deal with adults]. Taking a class on these topics is much better than just reading about them. In the classes you have the opportunity to practice these skills on specially constructed models that are very life-like.
• Most important, in an emergency, DON’T PANIC! Your calmness is essential if you’re going to react properly to the situation and get your child the appropriate care.