Sensible medical intervention guidelines

April 3, 2011 6:22 PM

I'd like some guidelines on how to be reasonably cautious with my child's health when I can't tell if the nurses are overreacting or not.

Three times in my 10-month old's life I've called the nurse line about a concern and have been told to go to take him straight to the ER. The ER is crazy expensive with my insurance, but I'll gladly take him if it's a necessity.

All 3 times I was able to get them to let me take baby to the minor emergency or give it a few hours and call back, but only after pushing them hard.

I'm a first-time parent and in retrospect there was absolutely no reason to go to the ER (or even to the doctor) for any of the issues (vomiting, possible skin infection, fever). I know that doctors HAVE to be cautious for liability purposes.

Moving forward, I'd like some guidelines on how to be reasonably cautious with my child's health and not to crazy overreact.

posted by kristymcj to health & fitness (22 answers total)

It sounds like you already know the number one guideline...listen to your mother's intuition! In all three cases, I'm sure that if something inside of yourself had told you to go to the ER, you would have gone straight there. Trust yourself, trust your child, and do what you FEEL is right.
posted by katypickle at 6:27 PM on April 3, 2011

I can't help with the part about being cautious with a child's health, but I just wanted to say that I have found nurse lines absolutely worthless, as seemingly no matter what I tell them they tell me to go to the ER.
posted by unannihilated at 6:28 PM on April 3, 2011 [5 favorites]

Is it the nurse line for your insurance or the nurse line for the ped? If the latter, try calling your health insurance's nurse line. They might be slightly more conservative about suggesting the more expensive treatment (of course, that could work against you, too). If there is a minor emergency there, it doesn't seem unreasonable just to take the kid there unless it seems very ER-worthy. The minor emergency will refer out to the ER if they don't think it's something appropriate for them (I've been turned away and told to go to the ER before).
posted by elpea at 6:33 PM on April 3, 2011

I've called the nurse line three times in my adult life. Twice for myself, once for my boyfriend. All three times I was told to go to the ER. (Didn't go; things turned out perfectly fine.) I imagine the ER response is especially heightened for infants. YMMV. Trust your instincts.
posted by phunniemee at 6:34 PM on April 3, 2011

Is there no on-call physician at your pediatric practice? I thought this was standard. You might consider calling around to some other local practices to see if there are any that have this service.
posted by lakeroon at 6:40 PM on April 3, 2011 [2 favorites]

Is the nurse line connected to the ped's office or the insurer? I've found our ped's nurse line to be very reasonable, often suggesting that we wait and see -- though that's especially as the kids get older and sturdier. You might mention to your ped that they seem to overreact a bit, and it makes it hard for you as a mother to know when you really do need to take the advice.

That said, we don't really know the whole story (how high the fever was, or the age of the child, for instance, could greatly affect the reasonableness of the recommendation -- speaking as someone whose 60-day-old had a kidney infection whose only symptom was a fever of 101, I'm very grateful that the nurse line sent us to the ER, where she was on IV antibiotics within two hours of her feeling warm to me).
posted by palliser at 6:41 PM on April 3, 2011

You need a book you feel confident in. The Merck Manual would be the standard and has an iphone app! For infants and toddlers specifically, I know it's totally not trendy but I still like Dr. Spock. My sister prefers the one by the hipster doctor dad (not Dr Sears) for her infant.
posted by DarlingBri at 6:46 PM on April 3, 2011

There are quite a few baby & toddler books out there written to help first time parents get a feel what is and is not normal, what should be worrisome, and what is HEAD TO THE DOCTOR NOW symptoms. I wish I could remember the name of the infants book I had; it was really helpful to be able to look up symprtoms & get a general rundown of what to expect. I know Toddler 411 was my go-to during 2 & 3, and I see they have one for baby's first year...

I did find it useful to occasionally take my baby around to old folks that I trusted. I'd ask them if the fever seemed serious, & they'd give me the straight dope. Some of my friend's parents are old enough to remember whooping cough & measles & the like, & having someone who's been there look at your kid & say, nope, that ain't it, is really reassuring.

In the end though, listen to your gut. If 12 people say your kid is fine & your gut says, no, kid's not fine, it's worth the trip to the doctor. Peace of mind DOES have a dollar value, plus one of these days your gut is going to be right.
posted by Ys at 7:02 PM on April 3, 2011

I actually would use a baby book before I'd call a nurse line--The Baby Book by Dr. Sears has all kinds of common issues and is generally reassuring vs. panicking.

Calling your pediatrician is good, too--they can even call the ER ahead of time so they know you're coming, or meet you there if it's something ER-worthy. Or they can fit you into their office hours the next day. Someone really should always be on call.
posted by the young rope-rider at 7:03 PM on April 3, 2011

You might be interested in the news stories that came out in the last month or two in re. Parents need not fear a fever, Lifting a Veil of Fear to See a Few Benefits of Fever, Don't Fear Children's Fevers
posted by kmennie at 7:26 PM on April 3, 2011

Let me chime in to the "trust your instincts" crowd here. A few years ago my daughter came down with what we thought was a viral infection. Everyone in her kindergarten class had it. Nothing to be done but wait it out. She had had a slight fever for a day or so and we were traveling to my in-laws for Christmas.

Over the next few days she just was not getting better. She was carrying a fever between 100 and 102. Well, turns out that my MIL is a pediatric nurse. So SCORE! I had her check my daughter out and she said that it was probably just a viral thing indeed. But my daughter didn't look right to me. Her eyes had a glassy look to them that only I could see. But no one thought anything of it. And dare I question my MIL's thoughts on the situation?

And then my son came down with the same bug. Still no one was very concerned. Except for me.

After 8 days of my daughter battling a fever, On Christmas Eve I finally took her and my son into the ER. Turns out they both had double ear infections and upper respiratory infections. I know, not crazy bad or anything. But all along I knew there was more to it than a viral infection. 24 measly hours on antibiotics and they were back to their old selves and fever free just in time for Christmas.

I have story after story of me knowing something was up when there really weren't many signs pointing that way. How about the time my son started throwing up and I just knew that it was strep? The nurses at the ped's office just looked at me like I was crazy. Sure enough, it was strep.

Yes, trust your instincts. Unless my kids have really wacky symptoms, I usually give them a day or two to battle the sickness before reassessing if there should be medical intervention.

As for books, I found The Portable Pediatrician by Laura Nathanson to be quite helpful.
posted by Sassyfras at 7:42 PM on April 3, 2011

My pediatrician's office has an after hours self-care navigator, that basically supplies triage guidelines. I've found it to be quite helpful, and often reassuring.

I've also called their after hours many times, talked to a doctor several of those times, and I don't think I've ever once been told to go to the emergency room.
posted by alms at 7:45 PM on April 3, 2011

I had a child before the World Wide Web, and used a book, a Family Medical Guide. Google online family medical guide and when to go to the emergency room for some good sites. I've called the ER when my doctor's office is closed and gotten good advice. I'd talk to the doctor's office about your lack of satisfaction about the nurse line. If the standard advice is "Go to the ER" that's not very helpful.
posted by theora55 at 7:52 PM on April 3, 2011

Try If Your Kid Eats This Book, Everything Will Still Be Okay: How to Know if Your Child's Injury or Illness Is Really an Emergency. It's written by a pediatric emergency doctor and tries to separate the real emergencies from the stuff that can wait until you see your own doctor.
posted by v-tach at 8:14 PM on April 3, 2011 [2 favorites]

I am a nurse, and also fine the nurse advice lines to be pretty frustrating.
I like to use the on-line symptom checker at kp.org. I find that it generally offers pretty good advice. Membership not required.

Full disclosure: I work for KP.
posted by SLC Mom at 8:35 PM on April 3, 2011

With my first child, I used the nurse line all the time and they always ended up telling me to go to the ER.

By the time I had my second child, I would just call my doctor's office or, if it was after hours, I would ask for the doctor on call. The doctor on call gave far better instructions, once had me come meet them at the office on a Sunday after hours (!), and would also tell me if we should go to the ER. They were also able to phone ahead and tell the ER we were coming sometimes, so that we could get fast tracked. It might be worth finding out if your doctor's office has a doctor on call or whether they will answer questions on the phone. (Sometimes just the receptionist can be handy.) Our doctor doesn't diagnose over the phone, but they will definitely let us know whether it's a "treat at home", "treat via the office" or "go to ER now" situation.
posted by acoutu at 11:19 PM on April 3, 2011

I highly recommend Baby 411 and the follow-up Toddler 411. They very cleary identify what is an immediate emergency vs what calls for a visit the next day vs what you should not freak out about all. The biggest surprise for me was learning that fevers are nothing to freak out about.

Really, everybody freaks out about fevers and we've all been conditioned to think that high fevers are dangerous (and cause brain damage!) and have heard some crazy things people do to fight fevers, but in fact that just isn't true! Get Baby 411 and read the section on fevers first, then read about rashes, infections, first aid, etc.
posted by ellenaim at 11:56 PM on April 3, 2011

Also, is this the nurse line/after hours line through your pediatrician's office? I would bring this up with your pediatrician. If this is a service you're getting through them and you're not satisfied, then can you change pediatricians?

During business hours, a nurse will answer our questions and determine if we should come in or how to proceed. After hours we can page the doc on call. I've used both several times over the past 4 years (3 kids) and I've never been told to go to the ER, not even when my 2 year old tumbled down a flight of stairs or my infant had blood in her stool. Both were kind of freak-out moments for me, and both happened after hours, so I paged the pediatrician.
posted by ellenaim at 12:13 AM on April 4, 2011

Don't use nurse lines. They are told to tell you to go to the ER simply because you losing a couple hundred dollars is better than you losing your baby.

Call the pediatrician's office...most likely you will get a nurse from the receptionist that always handles calls like this. She will know.

Also, the office should have a "off-hours" service. Use that.

As for intuition...ummm yeah, call the doctor's office.
posted by hal_c_on at 4:57 AM on April 4, 2011

You might want to look into alternatives to the both the ER and the nurse line. You don't say where you are, but many places have walk-in clinics staffed by advanced practice nurses; this is the one our hospital operates. I have sent friends there when I thought they needed to be seen by someone and they have reported that is is quick and very affordable even without insurance. Since they actually examine the patient they can give advice and treatment that is appropriate which cannot be done over the phone.
posted by TedW at 8:27 AM on April 4, 2011

SO MUCH great information. Thank you all!
posted by kristymcj at 6:38 PM on April 4, 2011

Apparently the my pediatricians office doesn't allow direct links to their After Hours Care Navigator. You can get there, though, by entering at the start page of their website and clicking on the "After Hours Advice" box.
posted by alms at 6:40 AM on April 5, 2011