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To Worry — or Not?

My brother always calls me before he calls his pediatrician. He's not calling me instead of his pediatrician, he always explains; he just wants to check whether his question or problem is really worth bothering the doctor about. I can usually answer the question or tell him what his doctor will tell him: No, a runny nose and a low-grade temperature three days after a DTaP injection are not reactions to the vaccination  -- your child probably just has a cold, so there's no need to call unless he looks sick. Or: Yes, you can alternate acetaminophen and ibuprofen to bring down a high fever.

Maybe it's just the convenience of relying on a receptive, if sometimes sarcastic, big sister that motivates him  -- though, to be honest, reaching me often involves just as many phone calls and messages left as if he'd called his child's own doctor. But I think it's more than that: My brother is worried about annoying the doctor with any silly-sounding questions. No matter how many times I tell him that he's entitled to call his pediatrician about anything that's troubling him, I think he still wants to be reassured that he's actually got a good reason to call.

But when I say he should feel free to call his doctor  -- that it's all part of a pediatrician's job  -- I'm not really telling the truth. Doctors and nurses are not eagerly standing by, happy to reassure you about any worry, however small or silly. Oh, we may smile at you and say, "Don't worry, there are no stupid questions." But the truth is, I think there are plenty of stupid questions  -- and silly worries too. When I get a call from a parent, one of the questions I answer for myself is "How good is this parent's judgment?"

Many different issues are at play when you try to decide whether  -- or how much  -- to worry about your child's health. There's your own experience, both the overall amount of time you've put in as a parent and the particular knowledge that comes from watching an individual child grow. First-time parents are legendary for how much they worry: "Well, he sneezed a while ago, and now he seems fine, but it's the first time he's sneezed in the week since he was born..." On the other hand, there are third-time moms who can look on calmly at a sight that would make a medical intern blanch: "So, doc, I was hoping we could get away without stitches this time, because she did look like she'd stop bleeding, even though the cut is deeper than the last one, which needed seven stitches..."

Beyond your experience, personality also influences your judgment. No question: The world is divided into worriers and nonworriers  -- or, perhaps, into different types along the continuum, from the Everything's-an-Emergency Club to the What's-the-Big-Deal Society.

At one extreme is a particular patient's mother, who believes that any minor pain or illness could lead to something catastrophic. She keeps her rather robust 7-year-old home from school (often despite his protests) for any cough (and I do mean any single cough), sore throat, or bellyache. My job, in addition to explaining that single coughs rarely prove to be serious, is to find a way to take her worries seriously  -- and still get her to send her son to school.

We're all vulnerable when it comes to our children. Even calm parents, people with well-balanced perspectives, can be easily thrown off by anything that suggests danger. You read an article about some insidious disease that overtook a child, starting with no symptoms at all, and you think, Hey, my child has no symptoms at all! Or you see a story on the news about a case of meningitis at a nearby college, and it occurs to you that your favorite babysitter's brother goes there, and you wonder whether your child could have been exposed.

I know all about these panic levels because I experience them too. Sometimes they're alleviated by what I know about pediatrics, but other times they're only made worse.

So how do you decide whether to call the doctor? What do I think is good and sensible parental judgment  -- especially considering the fact that parents who call too often are generally much safer than those who never worry or call?

I sometimes wish parents would ask themselves, "Would my mother have called the doctor about this?" If you know in your heart that she would have diagnosed it as an attack of the collywobbles and treated it with flat ginger ale and a storybook, you might think twice about calling.

It would also help for you to ask yourself, "Do I already know what the doctor is going to say? Is he likely to tell me to give my child some fever-control medicine, make sure she keeps drinking fluids, and call back if she seems sicker? Or is there some complicating factor that really makes the problem different?"

You might also wonder, "Is this something I've seen before?" If a parent calls and says, "Whenever his asthma acts up and he breathes like this, he ends up in the hospital," you'd better believe I snap to attention. But similarly, when I get a call about a 3-year-old who has a temperature of 101.5°F and a runny nose, I ask whether he usually gets a fever with a cold, and the answer is "Yes, he always does"  -- then don't you just know I'm going to tell that parent that the child probably has another one of those colds?

The fact is, you need to make a lot of judgment calls when exercising your judgment about making these calls. You have to worry more about smaller babies, of course  -- any fever in an infant younger than 3 months is reason to call the doctor. And you have to be more concerned about children with underlying illnesses, such as asthma or an immune-system disorder, and those who have shown a tendency toward certain ailments in the past. For example, a child who has had a urinary-tract infection before probably needs a urine culture taken with every fever.

Most important: Listen to your instincts. Not the knee-jerk "This child is the most precious thing in the universe, and what if something terrible happens to him?" worry. Instead, listen for the little voice telling you that something serious is going on, maybe a problem you haven't seen before.

If you look at your sick child and feel uneasy, stop and figure out why. Maybe he seems sicker than his fever alone would explain. Or the fever's gone down, but he's still miserable. If there's something needling you that goes beyond the generic discomfort of seeing your child suffer, then yes, by all means call; we'll talk it over  -- and try to figure it out.

Perri Klass, M.D., is a PARENTING contributing editor and the author of Love and Modern Medicine, a collection of short stories.

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