- Alternate description: Patient with annoying cough, able to perform normal activities.
Chicken Pox, Measles, or Hives
Many rashes are often interpreted by callers to be chicken pox, measles, or hives. Never accept the caller's diagnosis unless their description is consistent with that of the definition in the guideline or they have already received the diagnosis by a health professional that has seen the patient. Parents often interpret insect bites, impetigo, viral rashes, and contact dermatitis as chicken pox, measles, or hives. Eczema and ringworm are often confused, even when seen in person.
- Alternate description: Describe the rash unless it meets description in guideline.
No urine output is an obvious sign of dehydration and needs to be addressed. Callers may mean that urine output is greatly decreased or that they have not witnessed any voiding by the patient. It is important to clarify decreased urine output and no urine output. Similarly, was the diaper completely dry or slightly damp (ask if they can feel anything like jelly when they squeeze the diaper). Any urine in the diaper is reassuring.
- Alternate description: Decreased urine output, still voiding regularly.
Trouble Breathing, Wheezing
It is obviously a red flag when a caller says the patient is having trouble breathing. Clarifying questions are based on the patient's age. In infants, nose breathing is reassuring, as is the ability to drink a bottle normally. Similarly, if older children are able to talk, sing the ABCs, and play, their respiratory distress is not severe. Parents may mean their infants are congested or their children are breathing fast. Nasal congestion in infants often creates a musical sound and upper airway congestion can cause vibrations referred to the lungs described as rattling in the chest or wheezing.
- Alternate description: Nasal congestion interfering with breathing, upper airway congestion.
Constant Abdominal Pain
As with a continuous cough, constant abdominal pain, if significant, should lead to some impairment in a patient's activities. The patient likely will not be active, probably not have an appetite, and have trouble sleeping. Intermittent abdominal pain is different and often represents pain associated with intestinal motility.
- Alternate description: Intermittent abdominal pain that does not interfere with activities.
Callers often use the term diarrhea when they mean loose stools. One or two loose stools do not indicate diarrhea. Diarrhea actually refers to an increased frequency of bowel movements that usually happen to be loose.
- Alternate description: Loose stools.
The term constipation refers to infrequent stools that are usually hard and in infants pellet-like. Constipation does not mean that the infant or child is having trouble having the bowel movement. If the feces are soft and the bowel movements are regular (ranging from several a day to one every 1-2 days) then it is not constipation. Many infants grunt, turn red, and seem to be in pain with bowel movements, especially if breast-fed. This is normal.
- Alternate description: Trouble having bowel movement but soft and regular
Especially in the infants, vomiting must be distinguished from spitting up or normal reflux of gastric contents. Spitting is usually not forceful and dribbles out of the mouth. Spits usually consist of formula and not bile (green discoloration).
- Alternate description: Spits or spitting.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.