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 in this handout, 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, Night Light Pediatrics or Texas Children’s Urgent Care are excellent and relatively inexpensive pediatric urgent care facilities that are open when we are not.

Important resources:

TOPICS:

 

 

FEVER

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

 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 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:

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

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

    Infant’s Ibuprofen Drops                                                      50mg/1.25ml

Children’s Ibuprofen                                                           100mg/5ml

 

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, check out the American Academy of Pediatrics article “Fever: Myths versus Facts 

For fever reducer (acetaminophen and ibuprofen) dosing information click HERE

When to call the on-call doctor

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.

IMMUNIZATION REACTIONS

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

Prescriptions and Antibiotics

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.

 

COMMON OVER-THE-COUNTER MEDICATION DOSING

 

VOMITING

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:

 

DIARRHEA

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:

 

COLDS, COUGHS, NASAL CONGESTION

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:

Untitled

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

EARACHE AND SORE THROAT

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:

RASH

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:

PINK EYE

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:

ACCIDENTAL INGESTIONS

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

INJURIES

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.

CONSTIPATION

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

 

This information is just an aid for you after hours. If you are still uncomfortable in managing your child’s illness after hours after reviewing this information, please call us.

 

PEDIATRIC EMERGENCY ROOMS

Texas Children’s Hospital Medical Center

(832-824-1000)

6621 Fannin St,

Houston, TX 77030

Texas Children’s Hospital Katy

(832-227-1000)

18200 Katy Fwy,

Houston, TX 77094

PEDIATRIC AFTER HOURS CLINIC

Texas Children’s Urgent Care

Night Light Pediatrics