It happens. A lot. ESPECIALLY this time a year, in the colder months, when we’re all cooped up bouncing all of our germy fluids and air and God-only-knows-what back and forth for days.

As a very-soon-to-be family physician, I can tell you that babies and small kids with fevers make up a huge proportion of office and ER visits this time of year. As a mom of a 1 year old, I can tell you that there’s nothing scarier than to pick up your burning hot, lethargic, and extremely fussy baby and not know what’s wrong or what you’re supposed to do.

Don’t panic. I got you. At this point, I’ve worked in inpatient and outpatient pediatrics as well as the ER—so whether you need to go to the doctor’s office, urgent care, or the ER, I can give you an idea of what to expect when you get there and what you may or may not be able to handle at home before you decide to go. This post specifically addresses how you can evaluate your child at home and make a decision about whether or not to seek medical care.

First, take your child’s temperature so you know what you’re dealing with. Using a rectal thermometer is always best and the most accurate, but I do know from personal experience that a fussy baby can make it impossible, so under the armpit also works, as does a forehead thermometer (I got mine at Costco and it’s awesome).

Next, ask yourself some questions. Sounds like a lot, but these are questions doctors will ask you multiple times no matter which level of care you choose, and having your story straight goes a long way in making sure you get the care you need as quickly as possible.

• Is your child nauseous or vomiting?
• Is your child wheezing or having trouble breathing?
• Is the child eating and drinking less than normal? (Emphasis on the drinking).
• Do you think they’re dehydrated?
• Can you see if their throat is red or swollen?
• Are there any rashes or skin changes?
• Is the child pulling at their ears? Can you see any redness or inflammation in the ear?
• Are they sleeping or napping more or less than usual?
• Are they peeing or pooping more or less than normal? Are they having diarrhea?
• Are they acting like themselves or are they especially fussy or especially lethargic or out of it?
• Are they up to date on all of their vaccinations?

If the child’s fever is less than 100.4F (38C), they are still willing and able to drink fluids (breastmilk, formula, milk, or water), they aren’t overly fussy or lethargic, and your gut tells you that there probably isn’t anything super sinister going on, it’s ok to give a single dose of acetaminophen (Tylenol) or ibuprofen (Motrin) at home and see if it helps. If the fever comes down within an hour or two and they seem to be feeling better, you can continue monitoring their temperature at home and giving your medication of choice per the package instructions until the fever resolves.

If the fever is over 100.4F (38C), fever doesn’t seem to be getting better with over-the-counter meds, your child is having some of the symptoms mentioned in the question above, or if you just have a bad feeling about the situation, call your pediatrician or family doctor right away. Even if it’s the middle of the night or the weekend, they should always have an answering service that will relay your message to the physician on call. They should call back within an hour or so and will ask you to explain what’s going on and then give a recommendation about what to do next. If, for some reason they don’t get back to you and you’re really not feeling great about what you’re seeing, it’s reasonable to go to an urgent care or even the ER.

I cannot stress this enough—you know your child more than anyone else in this vast, ever-expanding universe. I just laid out a very step-wise approach to evaluating your child’s illness at home in a way that I hope may avoid unnecessary visits to the emergency department, but real life doesn’t always work according to an algorithm. If, at any point during this process, you just have a gut feeling that there’s something off or that there’s more going on than what you can clearly see, go to the ER. The worst that can happen is that there isn’t actually anything wrong and you get some reassurance from a professional, and in the world of parenthood, peace of mind is priceless.

If and when you do decide you need to take the case out of the house and see a professional, here’s an idea of what you can expect.

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