After Hours

After hours, all non-urgent phone calls may be subject to an out-of-pocket $25 service fee.

This page has been designed to help you with questions which may arise when our office is closed and to help distinguish between what is an urgent and non-urgent problem. Please respect the doctor’s family life and hold non-urgent calls for business hours; your consideration is greatly appreciated. To schedule an appointment, please call during business hours. Review this information before paging the doctor to determine if a call is required. For advice related to issues not covered on this web page, visit the Health Topics link on our website or check our Blue Fish Newborn Book.  The following information is divided into topics based on symptoms.

Sometimes, our children’s illnesses are not emergencies, but we would like them to be seen so we can all sleep better!  For those parents who would like their child to be seen by a pediatrician before the Blue Fish office opens, Texas Children’s Urgent Care is an excellent and relatively inexpensive pediatric urgent care facility that is open when we are not.

Important resources:

Common After Hours Topics

Common After Hours Topics

For conditions that are not life threatening but require immediate care, an urgent care center may be more appropriate.

In general, any life threatening conditions or serious bodily injuries should be taken to an emergency room.

Additionally, use the chart below to help guide your selection of an afterhours care facility.

Emergency Room Urgent Care
Bleeding that won’t stop

Extensive or complicated cuts or lacerations

Fainting or head injury with loss of consciousness or disorientation

Loss or change of vision

Major fracture that breaks the skin or is at a severe angle

Seizures without a previous diagnosis or epilepsy

Serious burns

Snake bites

Spinal injuries

Sudden change in mental state

Sudden shortness of breath or difficulty breathing

Vomiting or coughing up blood

 Abdominal pain

Allergic reactions

Asthma

Cough

Croup

Ear pain

Fever

Flu

Minor burns

Minor injuries from falls or sports

Pink eye

Rashes

Simple lacerations

Sinus infections

Skin infections

Sore throat

Sprains and strains

Urinary tract infections

Vomiting and diarrhea

When your child receives vaccines, it is quite common for your child to have fever, discomfort, swelling and redness around the injection site. For more information about shot reactions, consult the vaccine handout you received in the office.

In most cases, immunization reactions are not emergencies.

When to call the on-call doctor

  • If your child is unresponsive or has a fever >105ºF after the immunization
  • If the immunization site is very swollen, greater than 3 inches in size, or has a red streak running from the injection site

In the best interest of a sick child, an examination should always be done first before any medication, if warranted, is prescribed. If you are concerned about your child’s illness and think your child cannot wait until the morning to be evaluated, please take your child to an emergency room or urgent care center. Should issues arise with a refill request, please call during regular business hours when we are best able to handle these requests.

Please refer to the Medication Dosing Chart in Health Topics.

We have a Fever video available on YouTube: https://www.youtube.com/watch?v=D96e6XI7ouY

First and foremost, remember that a fever itself is not dangerous. It is simply a sign that your child has an infection.  Do not be afraid of the height of a fever.  We commonly see children with 104-105 fevers.

ALWAYS accurately record temperatures with a thermometer. For kids younger than one year the best place to check is in the rectum.  For kids older than one, refer to the thermometer article attached to this handout.  When measuring a temperature, we recommend not adding or subtracting a degree, but reporting it as shown by the thermometer.  Other information that can be helpful include: serially measured temperatures, when they were taken, where they were measured, and when the last time a fever reducing medication was given.  A simple chart documenting these items can be very helpful.  Fever is defined as any temperature > 100.4 degrees F.

Please refer to the link below for instructions on how to check a rectal temperature, Tylenol and Ibuprofen dosing charts, and more information:

Fever

When to call the on-call doctor:

  • If your child is having trouble breathing or is breathing rapidly
  • Severe headache
  • Unusual skin rash, especially if the rash rapidly worsens
  • Unusual sensitivity to bright light
  • Stiff neck and pain when you bend your head forward
  • Mental confusion
  • Persistent vomiting
  • Abdominal pain or pain when urinating
  • Convulsions or seizures

We have a Vomit and Diarrhea video available on YouTube: https://www.youtube.com/watch?v=F5Ur4VexXMw&t=2s

There are many illnesses that will cause vomiting and/or diarrhea. These illnesses are commonly referred to as viral gastroenteritis. In most cases, children do not need to be seen immediately for these symptoms. The most important thing you can do is keep your child hydrated.

What can I do at home?

Please refer to the link below for our rehydration protocol and refeeding diet recommendations.

Vomiting and Diarrhea (Gastroenteritis)

When to call the on-call doctor:

  • If your child is dehydrated (look for the following signs):
    • Urine output is less than every 6 hours in infants or 3 times per day in older children.
    • Your child has decreased saliva, poor skin tone or inability to form tears.
    • Your child just lies around, has difficulty giving responses, is not talking to you, and is unable to walk around.
    • Your child has severe abdominal pain or pain localized to the right lower quadrant.
    • There is bright green or bloody emesis.
    • Your child begins sustained heavy breathing for greater than an hour.
    • Your child has taken only Pedialyte for longer than twenty-four hours.
    • Your child has had recent head trauma or has ingested something toxic.
    • Your child is having bloody stools.

As with vomiting, diarrhea is most often caused by a viral gastroenteritis. Diarrhea will often last 2 weeks or longer. The key is to keep your child hydrated with water. Avoid juices (especially apple, pear, or prune juice) or any drinks high in sugar for these types of drinks can worsen the diarrhea. For formula fed infants, continue normal feeds. In older children, if there is no vomiting, resuming a normal diet (as tolerated) is best. In most cases, diarrhea is not an emergency and can be addressed during office hours.

We do not recommend any medication to stop diarrhea. Such medications may prolong the illness.

What can I do at home?

Please refer to the link below for more information.

Vomiting and Diarrhea (Gastroenteritis)

 When to call the on-call doctor:

  • If your child is dehydrated (look for the following signs):
    • Urine output is less than every 6 hours in infants or 3 times per day in older children.
    • Your child has decreased saliva, poor skin tone or inability to form tears.
    • Your child just lies around, has difficulty giving responses, is not talking to you, and is unable to walk around.
    • Your child has severe abdominal pain or pain localized to the right lower quadrant.
    • There is bright green or bloody emesis.
    • Your child begins sustained heavy breathing for greater than an hour.
    • Your child has taken only Pedialyte for longer than twenty-four hours.
    • Your child has had recent head trauma or has ingested something toxic.
    • Your child is having bloody stools.

Most children who do not attend day care will catch 6-8 colds per year.  Children who attend day care will catch up to 8-12 colds per year.

If you do get the cold or flu, antibiotics will not help. The best cure for the cold and flu is time.  Your child will start to feel better within one week, however some symptoms can last 2-3 weeks or longer.

No medications will eliminate your child’s disease, again only time will cure your child.  There has never been a study which has proven that cough medications work in children.  Additionally, cough is a natural defense mechanism of your body which helps to keep your airways open and prevents the pooling of mucous in your lungs.  For children under 1 year of age, (and really any age) we really recommend NOT using any cold medications in general.

What can I do at home?

Please refer to the link below for more information

Colds

When to call the on-call doctor:

  • If your child is having trouble breathing or is breathing rapidly
  • If your child has asthma or reactive airway disease and their breathing is not responding to breathing treatments given every four hours
Abnormally high breaths per minute by age
Age Respiratory Rate (RR) W/ Fever RR
< 1 Yr > 60 5 bpm higher for every 1 degree Fahrenheit above baseline
2 Yrs > 50 3 bpm higher for every 1 degree Fahrenheit above baseline
3 Yrs > 40 3 bpm higher for every 1 degree Fahrenheit above baseline
4-6 Yrs > 30 3 bpm higher for every 1 degree Fahrenheit above baseline
6-12 Yrs > 25 3 bpm higher for every 1 degree Fahrenheit above baseline
> 12 Yrs > 20 3 bpm higher for every 1 degree Fahrenheit above baseline

*Always count breaths per minute over at least one minute. 1 breath = 1 inhale + 1 exhale

Call our office or page operator (after hours) if your baby is younger than three months of age and develops a fever (rectal temperature equal to or more than 100.4°F).  Do not give Tylenol to a baby less than three months old without talking to us first.  The medicine can confuse the situation by altering the fever’s course.

For older infants, we are more concerned about how your child looks and acts rather than the height of the fever.

Always accurately record temperatures with a digital thermometer.  The best place to check is in the rectum (especially for babies less than three months old) or axillary if > one-year-old.  Write this number down on a piece of paper.  Fever is defined as any temperature more than 100.4° F for infants less than three months old.  For older children (children older than three months), we consider 101°F a fever.

Taking a Rectal Temperature

  • Lubricate the tip of the thermometer with a water-soluble lubrication. (KY, Vaseline, etc.)
  • Place your baby face down across your lap, supporting his head, or lie him down on a firm flat surface such as a changing table.
  • Press the palm of one hand firmly against your baby’s lower back to hold him still.
  • Using your other hand, insert the lubricated thermometer through the anal opening, about 1/2 to 1 inch into the rectum. Stop at less than 1/2 inch if you feel any resistance.
  • Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your baby and speak to him quietly as you hold the thermometer in place.
  • Wait until you hear the appropriate number of beeps or other signals that the temperature is ready to be read. Read and record the number on the screen, noting the time of day that the reading was taken.

 Treatments for Fever

Fever is not harmful itself; it is usually a symptom of an infection.  It is a sign that your child’s body is fighting the infection.  Treatments for fever offer only temporary relief.  The decision to treat a fever should revolve around how the fever is affecting your child.  If your child has a fever and feels great, medication is probably not necessary.  Medicine might be warranted if he feels achy and weak or if your child also has a headache or a sore throat.  Please do not treat the fever of a child less than three months old.  We need to know about it.  Should you decide to treat a fever, we recommend the following measures:

  • Acetaminophen (Tylenol, for children any age) and ibuprofen (i.e. Advil or Motrin, for children older than six months of age) are excellent medicines for fever treatment.  Studies have shown that selecting a single medicine and using it appropriately controls fever as well as alternating medicines.  Therefore, we recommend using a single fever reducer every six hours. In general, ibuprofen is preferable as a first line medicine for fever because it lasts longer and controls aches and pains better than acetaminophen.  If the fever returns before it is time to give ibuprofen again, you can then use acetaminophen to bridge the gap, if necessary.  Again, do not use ibuprofen for children less than six months old.
  • Do not use aspirin to treat a child’s fever.  If your child vomits the fever medication, you can use rectal acetaminophen (Feverall) sold over-the-counter at the pharmacy.
  • You also can give a lukewarm sponge bath for ten to twenty minutes (26-28C° is optimal) for comfort purposes.  Repeat this every two hours as needed. Evidence shows this does not reduce fever, however it can be done for your child’s comfort.

Be certain that you are giving the right dose of medicine. This can be confusing as seen below:

Infant’s Unconcentrated Acetaminophen Drops* : 160mg/5ml

Children’s Acetaminophen: 160mg/5ml

Infant’s Ibuprofen Drops: 50mg/1.25ml

Children’s Ibuprofen: 100mg/5ml

*Concentrated Infant Acetaminophen drops (80mg/0.8mL) are no longer available

Do not use ibuprofen any closer than every six hours and do not use acetaminophen any closer than every four hours.

You can safely follow the dosing on the box.  If you want to be safe and want to double check the dose, the general dosing of acetaminophen is 15mg per kg per dose or 7mg per pound per dose (2.2lbs = 1kg).  The dosing of ibuprofen is 10mg per kg per dose or 4.5mg per pound per dose.

For more information on fever, see Fever in the Health Topics section.

When to call the on-call doctor

  • If your child is younger than 3 months with a rectal temperature >100.4ºF
  • If your child has a very high fever (>105ºF)
  • If your child is inconsolable or unresponsive despite giving an adequate dose of a fever reducer
  • If your child has a severe headache or stiff neck (in addition to a fever)

Fever reducers are only designed to make your child more comfortable. It will NOT stop your child from having a fever.

On average, fever reducers take up to one hour to work. Acetaminophen can last as long as 4-6 hours and can be safely given at any age. Ibuprofen can last as long as 6-8 hours and can be safely given to children 6 months of age.

With over-the-counter cold medicines, WHICH WE DO NOT RECOMMEND, avoid preparations which also contain acetaminophen or ibuprofen in order to minimize the chance of overdosing on a fever-reducing agent.

Please call the poison control number (800-222-1222) for all accidental ingestions. They are best equipped to answer all your questions.

In general, if your child sustained a severe injury, you will need to bring him/her to an emergency room or urgent care center. A diagnosis can only be made after an evaluation of your child. The on-call doctor in most cases will only be able to give recommendations as to whether your child needs to be seen immediately or if it can be addressed during our regular hours.

In most cases, rash or unusual skin changes are not emergencies and cannot be diagnosed over the phone. If you are concerned about a rash, please call during regular office hours. If your child has recently started a medicine and develops a rash, stop the medication and call our office in the morning.

What can I do at home?

Please refer to the link below for more information

Insect Bites and Rash

When to call the on-call doctor:

  • If your child is inconsolable or unresponsive or with a high fever (>104ºF) AND also has a new rash. This situation is considered an emergency. We recommend that your child be seen immediately in an emergency room or urgent care facility.
  • If the rash is purple/blood-colored spots, or bright red and tender to touch, or red streaks that is spreading, or appears like a burn
  • If the rash is associated with swollen lips, swollen tongue, difficulty breathing, or abdominal pain, go to the emergency room as this may be a severe allergic reaction.

Conjunctivitis is commonly referred to as pink eye. Pink eye does not require immediate therapy in most cases. If your child has developed redness in the eye or discharge from the eye, please call our office during business hours. Until your child is seen, you can treat the eye with warm compresses or artificial tear drops (available at most drug stores). The tear drops can be used as often as needed to irrigate away the discharge. Remember, conjunctivitis may be contagious, so wash your hands after caring for your child. Medication, if warranted, will be prescribed after your child has been examined.

When to call the on-call doctor:

  • If your child sustained trauma to the eye
  • If your child is unable to see from the eye or complaining of severe pain
  • If your child cannot open his/her eye because of eyelid swelling. Wipe away any discharge with a warm washcloth to help the eye open.

In general, both earaches and sore throats are not emergencies, but may need to be seen in the morning. Antibiotics, if warranted, will be prescribed after your child has been evaluated to ensure proper usage. If you feel that your child cannot wait until the morning to be seen, then take him/her to an urgent care center. In the meantime, pain relievers and warm compresses may provide comfort. For an older child with a sore throat, try having him/her gargle with a teaspoon of salt dissolved in 4 oz of warm water for temporary relief.  For ear aches, over-the-counter medications such as Similasan Ear Relief drops are safe to try.

When to call the on-call doctor:

  • If your child’s sore throat includes other symptoms: excessive drooling, severe difficulty swallowing, difficulty breathing, or being unable to open his/her mouth fully.
  • If your child’s earache includes other symptoms: stiff neck, loss of balance when walking, or redness and swelling behind one ear in comparison to the other ear.

Constipation is not an emergency and can be addressed during office hours.

What can I do at home?

Please refer to link below for more information

Constipation