What to Expect the Toddler Years (201 page)

restlessness—your child cannot settle down to sleep for more than 30 minutes at a time.

continuous crying for more than 3 hours; high-pitched crying; faint whimpering or moaning.

refusal to eat at all for an entire day.

Other:

swollen glands (see page 576) that become red, hot, and tender; call within 24 hours.

severe
pain anywhere in the body, but especially in the head or chest;
call immediately
.

abdominal pain that doesn’t appear to be related to constipation or lactose intolerance and that lasts more than 3 hours, or is accompanied by vomiting, gets worse, is intermittent, or stops suddenly
(see Appendicitis Warnings, page 575);
call immediately.

Yellowing of the whites of the eyes or of the skin; call during regular office hours.

Whether it’s 3
P.M.
Monday or 3
A.M.
Friday, a Tuesday morning at the office or a Sunday morning at home, the phones of practitioners who care for children are always ringing. In fact, these practitioners spend more time in phone consultations than any other medical specialists—answering questions and dispensing advice about feverish babies, toddlers with ear infections, preschoolers with upset tummies, and first-graders who’ve just taken their first tumble off a two-wheeler.

Spending so much time on the phone often leaves pediatric doctors short on time to visit, and—despite their good intentions—sometimes a little harried and hurried. To make the most of the time your toddler’s practitioner gives you when you call, make sure to do your homework before you pick up the phone.

First of all, using the “When to Call the Doctor” list in this chapter, determine the relative urgency of the situation, whether you must speak to the doctor immediately, whether your call can wait until regular office (or scheduled call-in) hours, or whether you needn’t call at all. In an emergency, don’t waste time trying to reach the doctor; call 911 immediately or head for the nearest emergency room. Then have someone call the doctor from there.

If you decide that a call
is
necessary, have all of the following ready—in writing—before heading for the phone:

Often, just looking at your toddler is enough to tell you something isn’t right. But a physician needs more of an assessment to go on. So before you call to report an illness, check your toddler for these symptoms. Only two or three
symptoms will be present in most simple illnesses, but running down this list each time will ensure you haven’t missed anything. Make notes as you go so you don’t forget your child’s temperature by the time you get to counting respirations.

To take your child’s radial pulse, place your index and middle fingers on the inner wrist on the thumb side. Press down slightly until you locate the pulse, then count the beats for 10 seconds and multiply by 6 for the heart rate.

Temperature.
If your toddler’s forehead feels cool to the touch (see page 579), you can assume there’s no significant fever; if it feels warm, get a more accurate reading with a thermometer (see page 581). When reporting the temperature to the doctor, mention how, when, and with what kind of thermometer it was taken.

Heart rate.
A child’s heart rate can be affected by illness and may in some cases provide important medical clues. If your child seems very lethargic or has a fever, take the radial pulse (on the wrist; see above illustration) or carotid pulse (on the neck; see page 687). The normal pulse range for toddlers in the second year is between 80 and 140 beats per minute. (It can be up to 20 beats per minute slower during sleep and can get considerably faster during a crying jag.) By age three, the pulse rate ranges from 80 to 120. Report your child’s present heart rate to the doctor along with your child’s baseline pulse, if you know it. (It’s a good idea to determine this baseline pulse rate by taking your child’s pulse when he or she is healthy and has been playing quietly for half an hour or so.)

Respiration.
It’s also wise to make a note of your child’s baseline respiration rate when he or she is healthy and playing quietly. (You can check respirations by counting how many times in a minute your toddler’s chest rises and falls.) Young children normally take about 20 to 40 breaths per minute. Breathing is more rapid during activity (including crying) than during sleep, and may speed up or slow down during illness. If your toddler is coughing or seems to be breathing rapidly or irregularly, check respirations. If your toddler’s respiration is faster or slower than usual or is outside the normal range, or if his or her chest doesn’t seem to rise and fall with each breath or breathing appears labored or raspy (unrelated to a stuffy nose), report that information to the doctor.

Respiratory symptoms.
Is your toddler’s nose runny or stuffy? Is the discharge watery or thick? Clear, white, yellow, or green? If there’s a cough is it dry, hacking, heavy, or crowing? Does it
seem to originate in the throat or in the chest? Is the cough productive—does it bring up any mucus? Has your child vomited mucus during a forceful cough?