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Parents Face Tough Call When Child Is Ill


The chances are pretty good that Joanna Perez and her husband, Ismael, will be awake in the middle of the night sometime soon, wondering about a sick child. After all, the couple have 15-month-old quadruplets.

"Unfortunately we've had our share of ear infections, colds and fevers," said Joanna Perez, 32, of Downers Grove, Ill. "The kids pass on illnesses to each other, but the result is not necessarily the same."

For example, son Gabriel recently caught one of his siblings' colds. His symptoms worsened, including difficulty breathing. Perez went to the emergency room on a Sunday after consulting with her pediatrician. Tests revealed that Gabriel had a moderate case of pneumonia.

One of the biggest challenges for new parents is deciding just what is the right thing to do when an infant or toddler is sick, especially at night or on weekends when many pediatricians' offices are closed. There is plenty of advice out there from sources such as grandparents, friends, neighbors, co-workers, children's health books, Internet sites and, of course, nurses and doctors.

Part of making the right move is knowing which source to use when.

"New parents need the most help and sometimes are most afraid to call" their pediatrician during off hours, said Linda Czech, a pediatric nurse and director of the Kids Doc physician-referral phone line at Children's Memorial Hospital in Chicago.

"I say call for any reason that the parent is uncomfortable," said Dr. Kenneth Polin, a Chicago-area pediatrician. "Parental instinct is usually on target."

Polin said there are certain symptoms that are red flags and always warrant a consultation with the doctor, no matter what the clock reads. The list includes difficulty breathing, a baby or toddler who can't be awakened or who is having severe pain or a child who is acting quite differently from normal.

But sometimes the symptoms might be more common if no less daunting. Any new parent with a feverish baby understands the inner debate raging about whether to "disturb" a doctor away from the office. Some parents might even hesitate to call a nurse or doctor during regular hours. Same goes for the first odd rash or deep, lingering cough.

A generation or two ago the first inquiry would have been directed toward the baby's grandmother, who might even live in the same household. That's less the case these days for a couple of reasons. One is fewer multigenerational families living together or even in the same town. Another is, well, human nature.

"Advice from Mom is not always the first choice of today's daughters who have become mothers themselves," Czech said.

As a result, the pediatrician and staff nurses have never been more vital when new parents experience first-time symptoms. One of the best strategies is picking a doctor who is available and sympathetic to the steepness of your learning curve.

"Make sure your pediatrician or associate will be on call 24 hours," said Dr. Thomas Herr, a spokesman for the American Academy of Pediatrics. He urges parents to find pediatricians who are not only qualified but also "a match for your personality."

For instance, the Perezes interviewed several pediatricians before deciding on Dr. Anne Wyman. Joanna Perez liked Wyman's experience with quadruplets (who are older than the Perez kids and a source of practical tips). Most of all, she was happy about Wyman's willingness to take a call day or night.

Lots of the Perezes' medical episodes occurred on nights and weekends. Their doctor's practice, with 11 pediatricians and two nurse-practitioners on staff, eased the anxiety because it has office hours seven days a week, and doctors are available until 9 p.m. or even later on weeknights.

What's more--and not commonly offered in most practices--parents can call on weekday mornings to ask questions about a sick child or even such non-emergency issues as nutrition or hygiene.

Even experienced parents can face new situations. Injuries such as lacerations or broken bones can often be sorted out over the phone with a pediatrician, said Dr. Irwin Benuck, a faculty member at Northwestern University Medical School.

Benuck raised an important distinction between diagnosis and treatment. Several sources, including trusted family members, books or Internet sites, can help determine symptoms. Treating the condition should be more a decision between parents and the health practitioner.

The Internet can be a rich source of information for new parents. Several doctors and nurses praised sites on the Web for providing background information on symptoms and illnesses. Most often mentioned are (affiliated with the American Academy of Pediatrics), (and its partner Web site,, and

"We don't replace your doctor," said Linda Murray, executive editor of BabyCenter. "What we aim to do is give parents enough information to decide whether they need to see a doctor for their child's condition.."

And let's not forget the baby's grandparents. Perez said her mother has provided "incredible" support, including advice on breast-feeding and how to organize a household challenged by the addition of four babies.

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