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Automatically translated version. May contain inaccuracies compared to the original.
A child fell from a slide on the playground — when should you go to the doctor? What about a high fever? Vomiting? A cough that lasts for several days?
For the most common scenarios LB.ua asked Alexei Rykov, a pediatrician, deputy medical director for quality and clinical expertise of the Dobrobut network.
Infants
A child cries all night, screams, and parents can't soothe him.
Before three months — we go to the doctor for a visit, because it is hard to tell if the baby is bothered, whether it's colic, whether it's hot, or cold.
If the child is older, you can observe without online consultation, watching how they eat, drink, etc.
If anxiety and crying are added to the restlessness, fever, say, 38.
If it's a small child, we go to the doctor — in person examination.
No fever, but you start to sniffle, infant.
You can observe and consult with a doctor by phone to understand what to do next and what to pay attention to.
No fever, but the infant is restless and begins to cough.
If there is no fever, the same as with the sniffles.
Infant crying.
If the infant is limp, even without fever, cough, or sniffles.
100% examination, with the closest possible time. This is not even an appointment with a doctor, but a trip to the hospital emergency department.
If the child learned to roll over, mom and dad were distracted for a second and the child fell from the bed, hit themselves.
If it's a very small child, it's advisable to consult in the emergency department. If they just fell, slid down — that's one story, but if they hit their head, injuries are common in small children.
So you get in the car and go?
Yes. To the emergency department, if possible.
If this is a somewhat older child, after six months, you see they behave more or less normally, there was a small fall from some height, somewhere 50 cm, you can observe them. If the height is larger, taller than the child, and the child has some signs — it hurts, better to seek care.
The child is over six months old, started complementary feeding, but suddenly the child refuses it dramatically. Whatever you give, they start screaming and throwing it out.
You can consult online, because there can be many reasons and it's not necessarily illness. The pediatrician will give advice on what to do and if after some time new symptoms appear or the history doesn't improve, then you can go for an in-person doctor.
If the child choked while feeding but received first aid and the child seems to have turned pink, should you worry about anything?
If the child choked and after that their condition improved, two scenarios may occur. First — they coughed everything up and it's fine.
But another scenario — they could have inhaled remnants of food, which reached the lower airways, and this can lead to so-called aspiration pneumonia, an inflammation of the lungs due to what went into the airways. If the child turned pale, you may not need to go to emergency immediately, but you should show the child to a doctor afterward.
If the child started vomiting?
100% consult if it's vomiting. There is vomiting and regurgitation. Regurgitation is a physiological process, normal for a small child. If the child regurgitates, it's a smaller portion than what they ate, a couple of tablespoons. This is within normal limits. Vomiting — vomiting in a fountain, the whole portion or more, and it repeats. This 100% is a reason to take the child to the doctor.
If the child vomits once and then eats and feels reasonably well, then a planned consultation. If vomiting recurs, 100% either urgent care or hospital emergency department.
If the child has a runny nose and the nose is so congested that they cannot eat. For example, cannot suck from a bottle or breast, mom or dad worry.
If the child is feeling fairly normal, no fever, no other symptoms like shortness of breath, you can consult a pediatrician online who will tell you how to rinse the nose, what drops can be instilled.
If the child refuses to suck, from the breast or bottle, it is advisable to consult a doctor for online start; there can be various causes.
There can be behavioral issues that can be corrected, or it can be illness, for example, otitis. The child starts to suck, their pressure changes, ear pain, they cry and drop the bottle or breast. So here it's still desirable to consult a doctor online to determine whether everything is fine or you should go for an in-person consultation and look at the child's ears.
Alexei Rykov, pediatrician, deputy medical director for quality and clinical expertise of the Dobrobut network
And what if there is shortness of breath?
Shortness of breath is an emergency or admission to the hospital, because this is a life-threatening scenario.
If a rash appears, rashes come in different forms.
That's the point. Rashes vary and very often you need to look at them.
If it's a simple rash that blanches when pressed and appears slowly, we can show the child to a pediatrician via phone camera, take a photo, and so on.
If the rash is sudden, appears quickly, this could be urticaria.
Or if a rash resembles a bruise and does not go away when pressed, this is a reason to go quickly to the emergency department or call for urgent care.
Any rash that is accompanied by a deterioration in the child's overall condition or fever is a reason to see a doctor as a planned visit.
What about fever?
High? Better quickly, because we don't know what it is.
And if in infants the eye becomes crusted? I recall when the child was an infant, there was a case when the child woke up and the eye was so crusted that they couldn't open it.
If it's the first time, it's better to show the child to a doctor, because we never know the cause.
Often in small children this is congenital — narrowing of the nasolacrimal duct, drainage not occurring, could be infection. It passes on its own after some time, you can drop drops.
Or there could be another reason. So the first time you must show to either a pediatrician or an ophthalmologist. It can be planned, it's not an emergency. If it's already the second or third time, we understand the cause and parents usually know what to do.
Alexei Rykov and Irina Andreyevets
There is blood or mucus in the stool.
It is advisable to show the child to a doctor if possible. If the child feels fine, eats and drinks normally, no fever, behaves normally, but there are traces of blood in the stool, this is usually so-called alimentary proctocolitis, a reaction to dietary proteins. It used to be said cow's milk, but now it is believed that any protein can cause such a reaction.
Nothing to do with it; it passes on its own. But it's hard to assess the child's condition and the amount of blood in the stool, because blood in the stool is a red flag. If the child is in good condition, no fever, not upset, eats well, gains weight, etc., you can first consult with an online doctor and show these streaks. But if anything about the child's condition concerns you, an in-person pediatric consultation is mandatory.
What other fears about infants exist?
Just fever in a child. For a child older than six months you can observe for a few days, watch the general state. There is a pediatric illness called roseola — high fever for three days, but it is safe and passes. Or it can simply be an acute respiratory viral infection. If the child is active, eats and drinks well after giving fever-reducing medicine, you can observe for a day or two and then see whether to show a doctor.
If the child has diarrhea — water and stool several times a day, but the child feels fine, no fever, not refusing to eat or drink, you can consult online to assess the state. It can be functional diarrhea or a mild intestinal infection that doesn't require intervention.
But if the child has fever, refuses to eat, is lethargic due to dehydration, then online consultation won't suffice; you need to see whether additional treatment is required.
Preschoolers
Moving on to preschoolers, a new stage when they go to kindergarten. And the carousel of ARVI. Scenario one. The child has classic signs of ARVI: irritable, cries, nose congested. Parents can manage themselves remotely, in person?
Parents can manage themselves. In most cases, the first three to four days use fever reducers, symptomatic treatment, nasal rinses, decongestant drops if the nose is clogged, and observation, and pay attention to red flags: shortness of breath, lethargy, very high fever unresponsive to treatment, rash, anything that worries parents — a reason for an in-person consultation.
If possible, please clarify about decongestants, when they should be used and when not.
Any medicines we give a child for a respiratory infection do not cure anything. They are aimed at helping the child feel better and live a normal life.
We give fever reducers not to prevent bad outcomes of fever. Fever itself is not harmful. We give them so the child feels better.
Decongestant drops: if the child is so congested that they cannot sleep and eat, then it is worth washing the nose and dropping.
Various lozenges for throat, they do nothing except relieve sore throat. The same as giving a lozenge candy. Some also have anesthetics in them.
This is purely symptomatic treatment to ease the child's life. And decongestant drops are to help the child breathe through the nose, to eat, sleep, improve quality of life. With proper use, there will be no problems with the child.
This used to be a drug that was poorly dosed, especially for small children, and we tried to drop it in the nose constantly, which led to poisonings. Chronic nasal congestion is more typical of adults; in children it is very rare. Modern decongestants are less toxic than the old ones. So if you are going to use them, do it only when the child's nose is severely blocked, no longer than five days and no more often than three to four times a day, then nothing bad will happen.
And if the child has no runny nose but coughs a lot, wakes up at night, does it prevent them from sleeping?
Here it's advisable to listen to the child, because there can be bronchial obstruction states that are relatively common in children up to six years old during viral infections. Here the child needs specific treatment. On the one hand, they can involve shortness of breath and wheezing when it is a severe form, or can manifest just as a cough.
If a cough is related to a viral infection, i.e., upper respiratory tract illness, unfortunately there are no effective methods to relieve this cough other than warm drinks and distracting procedures.
Honey! The only folk remedy with a proven evidence base. It is believed that honey helps relieve night cough attacks in children with upper respiratory tract infections.
Honey on a spoon? In tea?
Any honey. In the West there are many over-the-counter cough remedies based on honey.
If a child coughs, a preschooler, can they use a cough syrup?
If it's a symptomatic remedy that can ease the child's condition, you can try cough syrups. But they are largely ineffective; they are extra medicines.
If we are talking about expectorants or cough suppressants that specifically lower cough reflex, it's better not to give such things to children.
If it's some herbal remedies with honey that can help the child and do not affect the cough reflex or amount of sputum produced, go ahead. But again: they are largely ineffective.
Warm drinks. If the child coughs at night and wakes up, give them warm water to drink. It distracts. Or any drink.
The viral infection will not pass in three days. On average, studies show that a viral infection has following phases. From three to five days fever may occur. Fever is not common — 15-20% of cases with viral infections in children. From two to four weeks runny nose, it can be around 80%, and 60-70% — cough, which can last from three to four weeks.
This is a normal course of a viral infection. When the child coughs for two weeks, it's not two weeks, it's just two weeks.
And if the child points to their throat and says: "Right here it hurts"?
Young children, two to four years old, poorly localize pain. They can't accurately point to where it hurts. The throat may hurt. It can be tonsillitis after age three, i.e., tonsillitis, strep infection. It can be laryngitis.
So it's desirable to show the child to a doctor, especially if it is accompanied by fever, because it could be strep pharyngotonsillitis requiring antibiotics.
In preschoolers, the first running bike or scooter appears. The child rides along the sidewalk, falls on hands and knees, cries that it hurts.
If the arms and legs move and there is no bleeding, you can observe. If the child landed on the head, it is advisable to look. Especially if they were going fast, they hit a corner, a head injury. A fracture is obvious. Unfortunately, sometimes we can't see signs of a head injury immediately; they can develop later.
But what if we didn't see the moment? It can happen that the child on a playground on a running toy flew and fell, and it's unclear how.
If there is no trace of a blow, probably they didn't hit that hard. Is there a lump? It is advisable to show to a doctor.
Preschool age is a time of active exploration: climbing onto a shelf, grabbing somewhere else. My child went to the wardrobe and in a minute managed to reach the highest shelf under the ceiling, and jumped from there. How exactly they fell, no one saw. We went to the emergency department and there they said this was the right history.
Yes. A fall from a height higher than the child's height is not just a head injury; it can be a fracture or internal injuries; it's advisable to have the child examined.
To the trauma unit?
Yes.
If a child comes from kindergarten, seems okay, active. But comes at night with vomiting that occurs more than once.
We assess the child's state. What do we do? Give any liquid at hand in small portions, drink often to avoid dehydration. If you give half a liter at once, they may vomit. Start with a spoonful every five minutes. If the condition is more or less normal, vomiting may stop, observe until morning and then decide further. If new symptoms appear, vomiting returns, or something concerns you, go to a pediatrician for a planned visit.
If vomiting doesn't stop despite giving fluids, the child becomes drowsy (this is common when children quickly lose glucose and fluids), for more 8 hours not urinating, this is a reason not to wait until morning and go to the emergency department, because of dehydration. Especially for a small child, two years old. If they are 6-7 years old, you can still observe.
You described a case of my child who was two and a bit. We had to go to the emergency department at ten at night and stay in hospital with an IV, because we couldn't cope.
There are specific medicines that can relieve vomiting. But if you give them to a small child by mouth during vomiting, they will just vomit and there will be no effect.
The main thing is to watch for the main signs of dehydration in a child. The first — the child begins to urinate less. If 8 hours pass without urination, this indicates that you will probably need to IV fluids to relieve dehydration. A dehydrated child deteriorates quickly, and it is important to give fluids in any form. Even if vomiting continues, keep trying to offer fluids in small amounts.
This liquid should be sweet. Is it important?
If possible, give a dedicated oral rehydration solution sold in pharmacies, because it is balanced for electrolytes.
If this solution is not at hand, give anything you have. It is best if the drink contains carbohydrates, which is not actually sugar. If nothing else, give sugar but ideally with some glucose or fructose.
Better, practically, juice?
Juice is not very good, due to acids. But if nothing else is available, let it be juice. If nothing else, let it be water.
I keep in reserve, honestly, for such cases cola, because it's all my daughter would drink.
Just without gas.
I am stopping.
Now these recommendations have been removed, but previously there was guidance that in such a situation cola could be given because it contains orthophosphoric acid as an antiseptic and sucrose. I won't give such a recommendation.
If a child complains of ear pain, and this is what they're expressing
It may hurt, or it may be blocked. If they complain of the ear, you can give pain relief such as ibuprofen and monitor. If this is accompanied by fever, the child feels unwell, and also complains of the ear, with runny nose, 100% you should go to a doctor to examine the ear.
Planly or urgently?
Depends on how pronounced the symptoms are. If the temperature is higher than 38, if the ears hurt so much the child cannot calm down, then go quickly. If you gave a fever reducer and the child quieted down, you can plan to observe.
It may not be an acute purulent otitis, but the so-called secretory otitis, where fluid in the ear accumulates and the child feels blocked and has discomfort, does not hear well in that ear. This requires physician intervention, but not urgently.
If diarrhea in a preschooler
If diarrhea is up to 12 times a day and the child feels relatively normal, you can wait. In three to four days it won't go away, but it will improve. If there are alarming signs when it is accompanied by fever, decreased urine, lethargy, refusal to drink or eat, these are indications to go. And in this case, if there are blood traces in the stool — red flag. This could indicate bacterial intestinal infection or another illness.
The child stuck something in the ear or nose
You cannot pull it out yourself. 100% you should go to a doctor.
And quickly?
If it is in the ear, you can wait; if in the nose, do it quickly.
How long to wait?
Make an appointment and go when you scheduled.
If the child swallowed a piece of slime gummy?
They are safe.
Depends on the composition. Because in toxicology the Okhmadyt said that if a larger piece is swallowed, go for an X-ray quickly. Usually certified for children they are safe. But if not certified and swallowed a lot, then perhaps.
We didn't know the composition. It was classic “bought in a store,” composition wasn't listed.
That's bad. Do not buy such things for children.
And if it's classic plasticine, foam dough?
In most cases these things are quite safe. What to pay attention to? If you suspect that the child swallowed medicines or household chemicals, even suspected, we don't know the composition. It is always an emergency.
When not to go to the doctor?
We did not discuss if the child swallowed something.
LEGO piece?
Yes, sometimes you may not seek help, but here are two very dangerous things:
magnets: children often swallow magnetic beads from magnetic construction sets;
batteries.
If you suspect the child swallowed some object, it's best not to rely on remote advice, but go for an X-ray, because they could swallow and choke. If they coughed and it passed, it could still be in the lungs.
What else people often don't seek help for? Vomiting. Sometimes they don't seek or try online, but the child's condition worsens, and they go to the hospital. Usually they seek care only when they should not have.
If we move on to school-age children, here there will likely be little left to discuss, but roughly the same tactics as for preschoolers. But if a child complains, in this more conscious age, 6+, that for example, sharp abdominal pain?
Even if the abdominal pain is not sharp, you can observe, but not for long. If the abdominal pain is such that it cramps the child, cannot straighten, it is advisable to go to urgent care where surgeons are available to examine. If the child says: "My stomach hurts," then runs, then hurts again, then runs again, most likely functional abdominal pain. It requires a doctor’s consultation, but planned.
Afraid of appendicitis in a child? It will progress by symptoms. If you see that within an hour or two, surgeons usually consider six hours as the window in which appendicitis develops; if the pain does not subside and increases, this is a reason to show to a doctor.
And what if a child complains quite regularly that their head hurts? Or in the morning they wake up: "Mom, dad, my head hurts terribly."
In school-age children, tension-type headaches occur. It depends on the child’s baseline state, how stressed they are, and the load. If the complaint is a significant headache that affects life quality — they can't do anything, lie down, pain not relieved by the same acetaminophen, accompanied by dizziness, numbness of something, one arm or leg not working, if it occurred suddenly rather than gradually, if it occurs at night, especially in the morning — these require heightened attention and a prompt doctor’s consultation.
The child complains of pain during urination.
Before? Or during? Girl or boy?
Basically just says “it hurts.”
You should go to a doctor. Online we can't determine the cause. Often in girls this is vulvovaginitis, a normal history.
Redness, roughly?
Yes. Irritation. Local infection can be present. Because that's how girls are structured. It requires local treatment. Nothing terrible. In boys such symptoms are much rarer, need to figure it out.
Now there are quite active shelling bombs of our medicine stockpiles. Not to alarm, but what should parents have in an autumn-winter home first aid kit for children?
Fever reducers: ibuprofen, acetaminophen, either one or the other, because you may need to alternate. Nasal drops for decongestion, some rinse for the nose. If not, saline solution could suffice. And an electrolyte solution for rehydration. There is antacid syrup that can be given to children as antiemetic, but do not give it without a doctor's advice.
Also you can have medicines like racemic epinephrine, a diarrhea medicine for children. Drugs like imodium, loperamide we cannot give to children. Also antihistamines should be in the kit.
Speaking of prep for the autumn-winter season, what else can be done for a child?
Flu vaccination is mandatory, pneumococcus, varicella, if not done, do it. Basic vaccinations should be up to date. Plus give vitamin D. Other vitamins are not needed; vitamin D is thought to boost resistance.
So you will say that multivitamin complexes are not needed for autumn-winter?
For what? Unfortunately, proven effectiveness of multivitamins in children is not established today. They are poorly absorbed because they are synthetic vitamins, not like those we eat in food. Secondly, they can cause allergic reactions, like any substance. Third, if a person eats well and does not have vitamin deficiency, they do not need any vitamin support. With the exception of vitamin D, because we believe we do not receive enough sunlight to obtain a sufficient dose.
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