Cough/trouble breathing, runny nose, fever, ear pain

Call 911/go to ER if:

• Infant < 4 weeks old with fever ≥ 100.4.
• Respiratory distress.
• Child becoming unresponsive.

Call for same day appointment today if:

• Fever for more than 48 hr without any other symptoms > 100.4 in a child < 12 months old or > 101 in a child < 5 years old.
• Child very lethargic but responsive.
• Infant/child < age 5 years with suspected influenza desiring treatment.
• Cold/cough symptoms with 5+ days of persisting fever, or turn for the worse after 3 days of fever.
• Difficulty breathing, but not in distress.

Call for a 1-3 day range appointment if:

• Ear infection concern/ear pain
• Strep throat concern/sore throat
• Progressively worsening cold symptoms not resolving in typical 5-7 days

Everything else

• For cold/flu symptoms that don’t have signs of needing medical treatment as above, follow our advice pages here: colds, flu, fever, hydration.

Sore throat

Call 911/go to ER if: unable to swallow or breathe

Call for same day appointment today if: severe pain, difficult to swallow but able to.

Call for a 1-3 day range appointment if: mild to moderate pain, able to swallow (though might hurt a bit), breathing normal.

Is home care appropriate? Any sore throat that is or was significant should be checked for strep especially if fever, headache, nausea/sick to stomach, rash on trunk, even if the sore throat is improving. But if it's been nothing more than a mild scratchy throat associated with a classic common cold (runny nose, cough) that resolves pretty quickly on its own, it's usually safe to monitor at home.

COVID concerns/exposure

• Test your children/family at home with home COVID tests, and follow the OHA’s recommendations on what to do with results/exposures. Tests can be purchased at many local pharmacy or grocery stores or delivered via services like Instacart. Some, like Walgreens, may be able to bill your insurance.
• We are temporarily reserving in-house COVID testing only for situations where there is an active concern needing medical management/treatment. If you are only needing to rule in/out COVID such as to return to daycare or travel, please use home COVID tests or other local resources like Curative so we can devote as many resources as possible to those needing medical treatment until things settle back down.

Pink eye/eye discharge

Call 911/Go to ER if:

• Signs of severe eye infection (severe eye pain, child appears very ill with worsening redness and swelling of area around the eye).

Call for same day appointment today if:

• Signs of ear infection: Fever, cough, ear pain/sleep disrupted by pain, vomiting, or heavy nasal discharge.

Request a prescription for eyedrops if:

• For redness and/or discharge of eye(s) without any of the symptoms above, we can simply send a prescription for eye drops in. Email clinic@trailheadpediatrics.com, include your child’s full name, pharmacy, and that this page advised you to start eye drops. We will send it within 24 hr, in the meantime wipe away any discharge with a moist soft cloth.
• If this doesn't resolve symptoms within 24-48 hours on drops, or other symptoms as above develop, call for an appointment.

Vomiting, diarrhea, dehydration, stomach ache, other GI issues

Call 911/Go to ER if:

• No urine output for > 8 hours not responsive to our rehydration instructions.
• Severe abdominal pain with abdominal rigidity/unable to move/touch abdomen.
• Massively bloody stools (if small amount of blood, you can see us if child is otherwise well).

Call for same day appointment today if:

• Severe abdominal pain +/- fever, but more writhing/cramping type without abdominal rigidity and able to move/touch abdomen/walk.
• Moderate abdominal pain or diarrhea with some blood in stool (but not massively bloody as above).

Call for a 1-3 day range appointment if:

• Persisting moderate abdominal pain > 3-4 days.
• Strep throat concern/sore throat.
• Diarrhea lasting > 2 weeks.
• Infants < 12 months with stooling concerns.

For suspected constipation in children >12 months:

• Try course of Miralax and call for an appointment if that doesn't resolve symptoms. Dissolve in water, with at least 1 ounce liquid per each teaspoon of Miralax. Increase dose until stools remain softer than usual for 2-3 weeks then slowly taper off over another 2 weeks. Common ranges: 2-4 teaspoons daily in kids 1-2 years old, 3-6 teaspoons daily for kids 3+ years, but go as high as you need.

Treat at home:

• Diarrhea +/- vomiting without other symptoms above: follow instructions on our hydration page, call for appointment if diarrhea lasts > 2 weeks.

Injury

call 911/Go to ER if:

• Head injury with loss of consciousness, vomiting, seizure, altered mental status, unable to balance, poor responsiveness.
• Grossly deformed body part (eg extremity is bent in a way it’s not supposed to be, more than just swollen).
• Severe abdominal pain and/or vomiting, blood in urine or blood in stool after trauma to abdomen.
• Respiratory distress/shortness of breath.

Go to either ER or Urgent care if:

• Laceration through full thickness of skin (i.e. not just a scratch) that is gaping open, more than a half-inch long, or has debris inside of it.

Call for same day appointment today if:

• Moderate head injury with uncertain changes, e.g. alert but more tired, headache, trouble focusing but stable/not worsening, slightly clumsy, etc., or falls > 3 feet onto head without symptoms.
• Child/infant not using arm or leg, can’t bear weight.
• Puncture wound without any lacerations.
• Fever present along with bone or joint concern.
• Bleeding/bruising underneath nail that is under pressure and painful.

Call for a 1-3 day range appointment if:

• Suspected fracture without any gross deformity apart from swelling (immobilize/splint until appointment with us).
• Most other injury concerns (call us and we'll triage appropriately).

Home care appropriate for:

• Ankle sprain but not severe and able to bear weight, improving within 3-4 days and completely resolved within 10-14 days. More info about sprains here and here.

Seizure

Call 911 right away. If after calling 911 seizure subsequently resolves in 2-3 minutes, child does not have head injury and looks great/acts normal, can call us for same day appointment instead going to ER). Watch closely and change course back to ER/911 if child appearing worse as day progresses such as change in mental status/responsiveness or any repeat seizure.

Rash

Call 911/Go to ER if:

• Widespread non-blanching rash with fever or unwell child —> medical emergency!
• Localized purple spots AND severe abdominal pain, child appears really unwell, or stops producing urine.
• Hives AND signs of life threatening allergic reaction (swelling of lips/face/tongue/throat, wheezing, trouble breathing, profuse vomiting, appears very ill).

Call for same day appointment today if:

• Localized bruising-type rash where there wasn’t any trauma, e.g. purple spots from the waist down but otherwise well appearing with normal urine output.
• Other concerns in addition to rash, e.g. hives or target shaped lesions with fever and joint pain.
• Skin infection that is warm to the touch, painful, swelling/growing, abscess.
• Severe or rapidly progressing condition, ulcerations.

Call for a 1-3 day range appointment if:

• Hives in children who otherwise do not appear urgently ill.
• Eczema not able to get in control with your usual measures.
• Other various rashes not listed above or under home care below that you'd like us to evaluate. Using our rash guide may also be helpful.

Home care for:

• Hand foot and mouth: more info about this here and here. But come see us if not sure what it is, if severe or progressing.
• Itchy bumps after hot tub use: see this web page about hot tub folliculitis, if that seems to fit, it’s not worsening and gradually clears on its own in a week or so there’s no need to come in unless it recurs.
• Small (< 1/2 inch) scattered pink/red spots all over the trunk (and often arms/legs/face too) somewhere around day 5-7 of an amoxicillin course. Unless you’re seeing larger hives coming and going, target-shaped lesions, fever, or joint swelling, this is not usually an allergic reaction and can safely be monitored at home. You don’t even need to stop the medication, as that won’t usually change the rash, it will go away in about 3-6 days either way.

Urinary/genital issues

Call 911/Go to ER if:

• Hernia that is stuck (sudden, painful/tender swelling in the groin). If this resolves while heading to ER you can change course to see us today instead, but don't wait to find out.
• Unable to urinate for > 12 hr despite adequate hydration.

Call for same day appointment today if:

• Pain with urination
• Blood in urine but well appearing and maintaining good urine output
• Significant swelling/redness/pain of a genital area, with or without discharge (if milder, see sections below).

Call for a 1-3 day range appointment if:

• Increased urinary frequency without pain, fever, abdominal pain, vomiting, or blood in urine.
• New swelling in groin that is not painful and may come and go.

Home care for:

• Mild vaginal discharge without severe redness/pain: follow these instructions, schedule an appointment if not improving in 3-5 days.
• Mild swelling/redness/painful tip of penis, with or without mild discharge: soak penis in warm water with a little plain salt two to three times per day, avoid irritants like soap or bubble bath but hypoallergenic cleanser (e.g. CeraVe) ok. Call for appointment if doesn't resolve in 3-5 days, if recurs, or sooner if worsens.