After Hours

Most conditions are not life threatening and do not require immediate care. In these cases, we recommend calling the next morning and making an appointment with your child’s physician.

In general, any life threatening conditions or serious bodily injuries should be taken to a pediatric emergency room.  Typically, when choosing an Emergency Room, we recommend either Methodist Children’s Hospital in the medical center area or Christus Children’s Hospital in downtown.

Additionally, use the list below to guide you:

Emergency Room:

• Anaphylaxis (a systemic allergic reaction involving difficulty breathing, vomiting, or drop in blood pressure)
• Bleeding that won’t stop
• Extensive or complicated cuts or lacerations
• Fainting or head injury with loss of consciousness or disorientation
• Loss or change of vision
• Major fracture that breaks the skin or is at a severe angle
• Seizures without a previous diagnosis or epilepsy
• Serious burns
• Snake bites
• Spinal injuries
• Sudden change in mental state
• Sudden shortness of breath or difficulty breathing
• Vomiting or coughing up blood

Conditions that can usually wait until we open

• Cough
• Ear pain
• Fever (except in the first 3 months of life – call for this)
• Flu
• Minor burns
• Minor injuries from falls or sports
• Pink eye
• Rashes
• Sinus infections
• Skin infections
• Sore throat
• Sprains and strains
• Urinary tract infections
• Vomiting and diarrhea

Conditions which may require an ER depending on serverity:

• Croup
• Asthma
• Soft tissue infections
• Allergic reactions
• Abdominal pain
• Dehydration

When your child receives vaccines, it is quite common for your child to have fever, discomfort, swelling and redness around the injection site.

In most cases, immunization reactions are not emergencies.

When to call the on-call doctor

• If the immunization site is very swollen, greater than 3 inches in size, or has a red streak running from the injection site
• Any concern beyond what is mentioned above
  

An examination should always be done first before any medication, if needed, is prescribed.  This is in your child’s best interest!  Should issues arise with a refill request, please call during regular business hours when we are best able to handle these requests.  See the FAQ on refill guidance.

First and foremost, remember that a fever itself is not dangerous. It is simply a sign that your child has an infection.  Think of it as your “check engine light”.  Do not be afraid of the height of a fever.  We commonly see children with 104-105 fevers.

Accurately record temperatures with a thermometer. For kids younger than one year the best place to check is in the rectum.  When measuring a temperature, we recommend not adding or subtracting a degree, but reporting it as shown by the thermometer.  Remember fever is defined as any temperature > 100.4 degrees F.  If you measure a fever that doesn’t make sense to you, consider checking it again with a different thermometer or method.

When to call the on-call doctor:

• If your child is having trouble breathing or is breathing rapidly
• Severe headache
• Unusual skin rash, especially if the rash rapidly worsens
• Unusual sensitivity to bright light
• Stiff neck and pain when you bend your head forward
• Mental confusion
• Persistent vomiting
• Severe abdominal pain
• Convulsions or seizures (if actively seizing, call 911)
• Fever in the first three months of life
• Concern about irritability or lethargy despite treating fever with acetaminophen or ibuprofen.

The vast majority of patients with vomiting and diarrhea have viral gastroenteritis (aka a stomach bug). Usually, children don’t need to be seen immediately for this. The most important thing you can do is keep your child hydrated.

Vomiting and Diarrhea (Gastroenteritis)

If your child is dehydrated you should call the doctor.  Look for the following signs:

• Urine output is less than every 6 hours in infants or 2 times per day in older children.
• Your child has decreased saliva, poor skin tone or inability to form tears.
• Your child just lies around, has difficulty giving responses, is not talking to you, and is unable to walk around.
• Your child has severe abdominal pain or pain localized to the right lower quadrant.
• There is bright green or bloody vomit.
• Your child begins sustained heavy breathing for greater than an hour.
• Your child has taken only Pedialyte for longer than twenty-four hours.
• Your child has had recent head trauma or has ingested something toxic.
• Your child is having bloody stools or stools with mucous.

Most children who do not attend day care will catch 6-8 colds per year.  Children who attend day care will catch up to 8-12 colds per year.

If you do get the cold or flu, antibiotics will not help. The best cure for the common cold is time.  Your child will start to feel better within 72 hours to one week, however some symptoms can last 2-3 weeks or longer.

No medications will eliminate your child’s disease, again only time will cure your child.  Cough is a natural defense mechanism of your body which helps to keep your airways open and prevents the pooling of mucous in your lungs.  In fact, we want to encourage the cough to help clear the airway, especially for children under the age of 1.  Furthermore, for children under 1 year of age, we recommend NOT using any cough or cold medications in general.

When to call the on-call doctor:

• If your child is having trouble breathing or is breathing rapidly
• If your child has asthma or reactive airway disease and their breathing is not responding to breathing treatments given every four hours
• If the child is having fever, then consult the topic of fever on this page.

Abnormally high breaths per minute by age

*Always count breaths per minute over at least 30 seconds and multiply x 2 OR count a full minute. We do not recommend counting to 15 seconds and multiplying by 4.  1 breath = 1 inhale + 1 exhale

Please call the poison control number (800-222-1222) for all accidental ingestions. They are best equipped to answer all your questions.

In general, if your child sustained a severe injury, you will need to bring him/her to an emergency room or urgent care center. A diagnosis can only be made after an evaluation of your child. The on-call doctor in most cases will only be able to give recommendations as to whether your child needs to be seen immediately or if it can be addressed during our regular hours. 

In most cases, rash or unusual skin changes are not emergencies and cannot be diagnosed over the phone. If you are concerned about a rash, please call during regular office hours. If your child has recently started a medicine and develops a rash, stop the medication and call our office in the morning.  It is okay to give your child a dose of Benadryl if the child is itching, the rash looks like hives or you suspect the rash is from an allergic response.

When to call the on-call doctor:

• If your child is inconsolable or unresponsive or with significant fever and also has a new rash. This situation is considered an emergency. We recommend that your child be seen immediately in an emergency room or urgent care facility.
• If the rash is purple/blood-colored spots, or bright red and tender to touch, or red streaks that is spreading, or appears like a burn
• If the rash is associated with swollen lips, swollen tongue, difficulty breathing, or abdominal pain, go to the emergency room as this may be anaphylaxis.

Conjunctivitis does not require immediate therapy in most cases. If your child has developed redness in the eye or discharge from the eye, please call our office during business hours. Until your child is seen, you can treat the eye with warm compresses or artificial tear drops (available at most drug stores). The tear drops can be used as often as needed to irrigate away the discharge. Remember, conjunctivitis may be contagious, so wash your hands after caring for your child. Medication, if warranted, will be prescribed after your child has been examined.

When to call the on-call doctor:

• If your child sustained trauma to the eye
• If your child is unable to see from the eye or complaining of severe pain
• If your child cannot open his/her eye because of eyelid swelling. Wipe away any discharge with a warm washcloth to help the eye open.

In general, both earaches and sore throats are not emergencies, but you may always call for a same day sick visit Mondays through Saturdays.  Antibiotics, if warranted, will be prescribed after your child has been evaluated to ensure proper usage. If you feel that your child cannot wait until the morning to be seen, then take him/her to an urgent care center. In the meantime, pain relievers and warm compresses may provide comfort. For an older child with a sore throat, try having him/her gargle with a teaspoon of salt dissolved in 4 oz of warm water for temporary relief. 

When to call the on-call doctor:

• If your child’s sore throat includes other symptoms: excessive drooling, severe difficulty swallowing, difficulty breathing, or being unable to open his/her mouth fully.
• If your child’s earache includes other symptoms: stiff neck, loss of balance when walking, or redness and swelling behind one ear in comparison to the other ear.

Constipation is not an emergency and can be addressed during office hours.

Abdominal pain certainly can be.  If your child is having significant abdominal pain, this would be a reason to call the on call doctor.

A warm bath will often soothe abdominal pain.

When to call the doctor:

• Severe abdominal pain (e.g. showing signs of discomfort, bent over from pain, unable to walk well or affecting movement in some other way)
• Vomiting bright green (bile) or bloody emesis
• Severe abdominal pain interspersed with sleepiness in toddlers and preschoolers
• Rigid, hard abdomen
• Recent injury to abdomen
• Pain located in the right, lower quadrant of abdomen
• Child becomes difficult to arouse