Which Cold and Flu Symptoms Require a Doctor Visit?

Posted on Wed, Mar. 02, 2005

By Brenda Reilly, M.D.

RECENTLY, a mother brought her 3-year-old son into the emergency room with a cough and a fever of 101 degrees. She waited in a crowded, noisy waiting room for more than six hours, only to be told her son had a cold. He was sent home without prescriptions. The best (and only) treatment was fever control with Tylenol or Motrin; decongestants; rest; and fluids.

This and similar scenes play out often in emergency rooms, which are flooded with unnecessary visits, especially during the cold and flu season.

Parents can avoid long and unneeded waits by knowing which cold and flu symptoms do and don't require a visit to the doctor.

Children with cold symptoms (cough, mucous congestion, intermittent fever and body ache) usually don't need to see a doctor. Viruses, not bacteria or cold air, cause colds, and antibiotics won't help. Use acetaminophen (children's Tylenol) and/or ibuprofen (children's Motrin) to bring down a fever. Over-the-counter cold preparations may help the child feel better temporarily, but cool, moist air to breathe may give greater relief. Sometimes, just opening the window helps.

Diarrhea or vomiting usually doesn't need treatment by a doctor, unless there is also severe abdominal pain. Getting and retaining fluids is key - use Pedialyte or similar preparations for infants, and clear soup, Gatorade or similar drinks for children and adults. See below for worrisome signs.

Most earaches resolve on their own within a few days. Give acetaminophen or ibuprofen for pain, and be sure the child gets plenty of rest. If the earache lasts more than three days or is accompanied by a high fever, antibiotics may be needed.

However, worrisome signs and symptoms include the following:

An infant less than 4 months old with a fever of 100.4 or higher needs to see a doctor. Young infants can become seriously ill quickly, so check their temperature if warm.
A persistent fever over 103 that doesn't come down with Tylenol or Motrin. High fever is especially worrisome if it is associated with a stiff neck, shaking chills, mental confusion, low fluid intake, or refusal to wake up.
Inability to retain fluids, either because of a refusal to drink or persistent vomiting. Children that seem limp and lack energy for more than two or three hours may need to see a doctor. Young children or infants should have a wet diaper every three to four hours; older children with a dry nose and mouth, or no urination in six to seven hours may need intravenous hydration. Remember, most of us can survive weeks without food, but we can die in a couple of days without fluid.
Shortness of breath is always worrisome. Those with uncomfortable wheezing or rapid breathing should go to the ER right away.

Other situations and injuries that require a trip to the ER include suspected broken bones; drug and vitamin overdoses; head injuries; burns; and severe abdominal pain.

If you do take your child to the ER, remember to bring any medications your child may be taking. You may save yourself an unnecessary wait by calling your family doctor or the advice nurse first.

These basic guidelines can help you determine if a visit to the emergency room is needed. If in doubt, though, it may be best to go to the ER.

Brenda Reilly is an emergency physician at Contra Costa Regional Medical Center.