Common Medical Problems

How to decide whether or not to call us for an urgent sick visit.

This information is intended as general information, not specific medical advice, and is only for patients registered with our office. Contact our office if you have any medical concerns about your child. Call 911 for any life-threatening medical emergency. This information is for our registered patients only, and is only to be used in consultation with us. Do not use this guide if you are not a patient.

***Important note: This information offers guidelines as to whether or not your child should be evaluated by us in our office. If you ever determine that your child should be seen by us, and this guide suggests it may not be necessary, please follow your own judgement and contact us to be seen.


Here are situations that likely do NOT warrant an evaluation by us:

  • Newborns or young infants with nasal congestion. Virtually all newborns go through a few months of nasal congestion as their airway adjusts to life. If there is no dripping runny nose or cough, then this is not an illness. Saline drops or breastmilk in the nose can relieve this.

  • Anyone with a runny nose and general cough who has no fever or in whom a fever has now resolved, and has no rapid labored breathing, likely has a common cold or mild respiratory illness that will resolve without medical intervention.

  • Even junky coughs with mucus (bronchitis) likely don’t need to be seen if there is no persistent fever (more than a few days) and no rapid labored breathing as antibiotics are rarely necessary in such circumstances. Normal coughs from cold viruses can normally last from 1 to 4 weeks, then go away.

  • Green runny noses generally do not need antibiotics, as most common colds have a “green” phase, and even most sinus infections will go away without antibiotics (see sinus infection below).

Common colds and coughs can typically last from 1 to 3 weeks, and likely don’t need to be seen.  

Here are scenarios that may require an evaluation by us:

  • Croupy coughs (cough sounds like a seal barking, your child has lost her voice or has a raspy voice or cry): Croup is a viral illness and doesn’t require antibiotics. Most mild cases don’t need to be seen by us. Search croup on our web site for more information. If your child has labored breathing and stridor (see our web page on croup) – not just while coughing, but persistently for hours – she should be evaluated by us. 20 minutes of cold, humid night air or in a bathroom with steamy shower running often settles down croupy coughs and stridor. Go to an ER if your child is blue or acting like she isn’t getting enough air.

  • Cough and/or runny nose with fever for more than 3 days.

  • Rapid labored breathing that persists for hours.

  • Ear pain with fever and cold/cough symptoms (see Ear Infection section below). Ear pain does NOT simply mean touching or grabbing the ears as an infant, as babies are prone to doing that due to teething or for no reason.

  • Wheezing, chest retractions (chest caving in with each breath).

  • Any infant 3 months and younger with a fever of 101 or higher should be seen.

  • Sinus infection: most of these don’t need antibiotics. If sinus headaches and pain, green nose, and fever persists for 5 or more days, we should see your child to discuss antibiotics.

  • Prolonged, severe coughing fits that last 20 or more seconds that make the face turn red, with “whooping” gasps between fits of coughing in which it seems your child has some difficulty inhaling, often ending in gagging or throwing up. This may be whooping cough – search for this on our website for more info.

  • What about Pneumonia? Kids with pneumonia typically have 3 or more days of fever, severe cough, possible chest pains, and rapid labored breathing even when fever is down. These scenarios are listed above as reasons to be seen. If your child does not fit this scenario, then being seen just to rule out pneumonia is likely not necessary.

Treating colds and coughs. Search our “medications to treat coughs and colds” guide on for guidelines on this for kids 4 years and older. For infants and toddlers, use steam (hot shower steam or humidifier), suction out the nose, sleep a bit upright (with a pillow under the mattress), and try natural decongestants like Sinupret liquid (find online – follow dose on bottle for kids 2 and older; give half dose for kids under 2) and cough remedies like Zarbees, or any other natural remedy.

Also, see our handout on “Natural Supplements During Illnesses” for ways to help support the immune system while sick.


IF YOU KNOW YOUR CHILD HAS COVID, such as exposure to a family member who tested positive, your child was seen somewhere and tested positive, or obvious symptoms including unusual loss of taste are present, we can evaluate your child if necessary. Please continue reading the guidelines below, however, as most cases do not require medical evaluation.

If you are worried that your child has Covid, realize that virtually all cases in children are mild and don’t require evaluation or prescription medical care. Please refer to for more information.

If you feel your child should be tested, we can do a rapid nasal antigen swab test (not deep nasal, just about one inch into the nose) and get an immediate result. This is likely only accurate if there is a runny nose. We can also swab the mouth and throat for a send-out PCR test that takes about 2 to 3 days to get back (likely more accurate). All positive results (nasal or oral swabs) are reported to the California Department of Public Health so that they can contact you to assist you in quarantining your family.

You can also elect to not seek testing and simply keep your child at home for 10 days from the onset of symptoms.

If your child has respiratory distress (rapid labored breathing, wheezing, chest retractions, blue color around the mouth, feels like not getting enough air) then you should NOT wait for your phone appointment, and just go to an emergency room as we are not equipped to handle serious Covid emergencies like this.

If your child is acting very ill (high fever, severe flu-like symptoms), but does not have respiratory distress, we can evaluate your child by phone to discuss testing and prescription treatment, and decide during the phone appointment whether or not you should be seen by us in person the following day.



Here is what may be helpful to take when you are sick with Covid and/or are exposed to someone with COVID.  Only take this high dosing for 10 days, then you can still take the supplements but at the regular dosing for age. 

Zinc     2-6 yr old: 5 mg/day, 

7-12 yr old: 10 mg/day

adults 20 mg/day

Vit D   2-6 yr old:  2000iu/day

7-12 yr old 5000iu/day

Adults 5000iu/day

Vit C   2-6 yr old 250mg 3x/day

7-12 yr old 500mg 3x/day

adults 1000mg 3x/day

Quercetin: Follow the dosing on the bottle

NAC: Follow the dosing on the bottle (but it’s generally 1/2 of the vitamin C dose for the above ages 2x/day)

Colds, Coughs, and Flu

Take Zinc, Vit D, and Vit C as described above, plus the following supplements to help reduce flu symptoms and severity:

Sinupret – a liquid herbal remedy to help support runny noses and sinuses when sick. Find online.

Echinacea – dose the same mg as Vit C

Elderberry extract – follow dosing on the package, twice daily.


Fever in and of itself isn’t dangerous. It’s the body’s natural way to respond to infection and helps the immune system fight infection. Most such infections are viral and don’t require antibiotics. Even many bacterial infections won’t require antibiotics as our immune systems are equipped to fight most things.

  • Don’t treat a fever with Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) unless a child is miserable. Use cooling measures (luke-warm baths) as needed. Use medication if a child is in significant pain or is miserable from the fever. Otherwise, allow the fever to run as it will help the body respond to infection. We prefer ibuprofen over acetaminophen if you do need to give a medication. Search ibuprofen on for our dosing chart.

  • Any infant younger than 3 months with a fever of 101 or higher should be seen that day.

  • Any child who has a fever of 101 or higher for more than 3 days (72 hours) should be seen.

  • Any child with fever and signs of meningitis should be seen: painful stiff back of the neck such that your child won’t look down at her belly button without pain, severe headache, lights hurt the eyes, and nausea or vomiting.

  • Any child who is lethargic with a fever should be seen. Lethargic means limp, won’t open eyes and focus on you, semi-conscious, and not moving much. Simply being less active and more quiet than usual, or wanting to be held more and not wanting to play, are NOT lethargy, but are normal responses to fever.

  • Any child with a petechiae rash should be seen. These are small red spots on the skin that don’t disappear (don’t blanch) when you stretch the skin around them. There usually would be several dozen on an area of the body. They look as if someone wrote small red dots on the skin with a red felt tip pen. If you stretch the skin around the spot (pulling away in two directions away from the spot) and the spot disappears, then these are NOT petechiae and likely not an emergency. If they are on the face or neck, they are likely just from the pressure of coughing or vomiting and likely not an emergency. If your child has fever and petechiae anywhere else on the body, it’s possibly a bleeding disorder or serious bacterial infection and you should call us to be seen if during the day or go to an ER if after hours.

Likely causes of fever and when to be seen:

  • Roseola: This is the most common cause of fever in young children 6 months to 2 years of age when there are no other symptoms besides fever. This harmless virus causes 3 days of moderate to high fever and fussiness, then a rash. Search it on for details. If an infant reaches 4 days of fever, with no rash yet, we recommend being seen.

  • Common colds and coughs: These are expected to cause 1 to 3 days of fever. See guidelines above about whether or not to be seen.

  • Flu: if it’s flu season, and your child has flu symptoms and fever, then it’s likely the flu. Search Flu on for several articles on treatment, prevention, and when to be seen. Also, see our “Natural Supplements During Illnesses” handout above.

  • Fever and sore throat: For kids under 4 years old, sore throat infections are usually viruses and don’t need antibiotics, especially if the throat/tonsils don’t look red and there is no pus on the tonsils. We likely don’t need to see a young child for this. Kids four and older with fever, sore throat, swollen lymph glands in the neck, and a red throat and/or tonsils with or without pus means it could be Strep throat. We can see your child to test for this. If you see what look like canker sores (white blisters surrounded by red) in the back of the mouth and on the throat, this is a viral sore throat that likely doesn’t need to be seen.

  • Hand/foot/and mouth disease. If your child has several days of fever, canker sores in the mouth or on the back of the throat, and/or blisters on the hands or feet, this is likely HFM disease. This is ultimately harmless, requires no medical treatment, and usually isn’t contagious to teens and adults. We usually don’t need to see this. See more (with pictures) by searching it on

  • Ear infection. If a baby is just pulling on his ears, but doesn’t have a runny nose and fever, then it’s likely not an ear infection and doesn’t need to be seen. Infants pull on their ears because of teething or simply curiosity. If sick with runny nose, fever, and ear pain or extreme fussiness, see the Ear Infection section below for info on home treatment and whether or not to be seen.


Children can get many different types of rashes, and most don’t need to be seen in our office. The best place to go to read about your child’s rash is – search rash and read our article on “Common Rashes.” You will likely find your child’s rash among the 15 common rashes we describe in this article, along with guidelines on home treatment and when to be seen by us.

  • The main rash emergency is Petechiae. Any child with a petechiae rash should be seen. These are small red spots on the skin that don’t disappear (don’t blanch) when you stretch the skin around them. There usually would be several dozen on an area of the body. They look as if someone wrote small red dots on the skin with a permanent red felt tip pen. If you stretch the skin around the spot (pulling in two opposite directions away from the spot) and the spot disappears, then these are NOT petechiae and likely not an emergency. Petechiae spots will stay visible even when you stretch the skin. If they are on the face or neck, they are likely just burst capillaries in the skin from the pressure of coughing or vomiting and likely not an emergency. If your child has fever and petechiae anywhere else on the body, it’s possibly a bleeding disorder or serious bacterial infection and you should call us to be seen if during the day or go to an ER if after hours.

  • Hives can be another type of urgent rash as part of an allergic reaction, but these can often just be treated at home and don’t need to be seen (unless a severe allergic reaction is progressing). Our hives page on will give you guidance on how to track down the cause (often simply part of a viral illness, or possibly a food allergy) and gives you a dosing chart for Benadryl if you child is uncomfortable. See us if hives keep coming back for a few days.


Most cases of pink eye are viral or allergic and don’t need to be seen by us. Search “pink eye” on and read about the various causes of pink eye and home treatments.

Here are some additional guidelines that are not on the website:

  • Many cases of pink eye, either viral, allergic, or bacterial, can resolve with time and by soothing the eyes with homeopathic eye drops (like Optique One, by Boiron, or Similasan eye drops).

  • If the eye is red and itchy, with no pus, then it’s likely allergic. If homeopathic drops don’t help, oral Benadryl may help, or OTC antihistamine eye drops (like Naphcon A or Opcon A) may bring relief.

  • If the eye is red and painless, or mildly irritated but not itchy, and no pus, it’s likely viral. Viral may have some mild pus upon waking.

  • If the eye is red and has pus draining out throughout the day, it’s likely bacterial.

It’s not too critical to diagnose whether your child’s pink eye is viral, bacterial, or allergic – natural OTC treatment may address it regardless. If the condition doesn’t improve after a day or two, call us. Viral and bacterial are contagious until the redness has subsided.

THE MAIN REASON TO WORRY is if the eyelid becomes red and swollen as well, in addition to pus draining from the eye. This could mean a bacterial infection of the eyelid that needs oral or IV antibiotics. This redness would be very red (not just mildly pink like allergic swelling would be).


Most cases of abdominal pain do not need to be seen by us urgently. You can likely figure it out by searching “Abdominal Pain” on and reading about the 20 causes we discuss there.

The main reason to see us urgently on the same day is if you think your child has appendicitis. Here is how to tell:

  • Most cases or appendicitis occur in children over five years of age.

  • Pain is focused in the lower right front of the belly, or may start around the belly button then move down to the lower right.

  • Pain is severe, likely stays almost constant, and gradually worsens.

  • Pain gets worse with movement, especially with coughing or sneezing, or when you press in on the lower right side of the belly. Ask your child to jump up and down. If pain gets much worse with this, then that’s a concern. If your child is in too much pain to even stand and try to jump, that’s a concern.

  • Fever, loss of appetite, nausea and/or vomiting, along with the pain characteristics above.

Children who complain of sharp abdominal pain, even severe, but who then can run around and play a few minutes later, and don’t have many of the above signs, likely don’t have appendicitis.

Chronic Abdominal Pain is a common problem in children, and usually takes a long appointment with us to figure out (not a same-day quick urgent appointment). In most cases, constipation is the culprit. Read about this and other chronic causes in our website article and follow the guidelines there before calling for an appointment.


Search this on for a complete discussion. Most cases can be solved without seeing us.

For infants younger than 4 months, taking cow’s milk products out of a breastfeeding mom’s diet can help. Using a children’s suppository from any drug store can relieve this (cut in half lengthwise for infants 6 months and younger). See us if your infant continues to struggle.

For babies 4 months and older, start diluted prune juice or pureed baby food prunes or peaches every day to keep the stools softer and moving. Avoid rice cereal and bananas for a couple months.

For babies 9 months and for children, here is a list of more effective remedies:

  • Fiber foods – search online

  • Prune Juice – 2 to 4 ounces daily diluted in water or other juice

  • Magnesium – Vitality Natural Calm brand online – 100 mg daily for toddlers and 200 mg daily for kids 2 and older.

  • Aloe Juice – George’s brand is good if you can find it. ¼ cup daily mixed into juice for toddlers, and ½ cup daily in juice for kids 4 and older.

  • Benefiber powder – from any drug store. Follow dose on bottle.

  • Fruit-Eze – a jelly to eat daily. Find online or in some stores.

  • Probiotics – any brand. Follow dose on bottle.

Start 1 or 2 of these daily, or alternate between 3 or 4 of these. Give everyday to keep the stools moving well for 2 to 3 months, then wean off.


If your infant is simply pulling on her ears, but does not have a fever and runny nose, then it’s not an ear infection. Infants need to have cold symptoms and moderate nasal congestion in order for an ear infection to develop. Babies who are not sick, but are just pulling on the ears, are likely just doing so out of curiously or because of teething.

Children who are sick, and complaining of ear pain or pulling on the ears, may have an ear infection. If there is no fever, and the ear has only been hurting for a day or two, and there is no pus, mucus, or liquid draining out of the ear, then you may find that using mullein garlic oil ear drops from any health store (warm the drops in your hands, then put 3 drops in each affected ear and let sit for several minutes, 3 to 4 times daily) may provide enough relief that you don’t even have to be seen.

If pain and/or fever persist for more than a day or two, or drainage comes out of the ear, we should see you. If there is severe redness and pain behind the ear, or the ear is sticking out more than usual, or severe tenderness when you press behind the ear, we should see you.

You can read more about evaluating ear infections by searching it on

Swimmer’s Ear is different than an ear infection. This is caused by water getting stuck in the ear after swimming. You can tell by the fact that there will be moderate to severe ear pain when you press in on the ear or move the ear. There may or may not be drainage coming from the ear. We can see your child and can prescribe antibiotic ear drops. has a good page on how to evaluate swimmer’s ear.


Most cases of this don’t need to be seen by us. The main reason to be seen urgently the same day or next day is if there is blood in the diarrhea. This can indicate an infection that may require medical treatment. Virtually all other causes of diarrhea in kids don’t need medical treatment. Search “diarrhea” on for a very detailed discussion on how to solve this without seeing us. If diarrhea persists for a few weeks, and you’ve tried the steps on our website, call us to be seen.


Search this on for a complete guide on how to assess and treat this as well as dehydration. Most cases of acute vomiting are caused by intestinal viruses, do not require medical treatment, and do not need to come into the office. If your child is getting moderately to severely dehydrated, or has severe abdominal pain (as discussed above), we should see you that day.


Many people worry about getting tetanus after an injury if they haven't had their tetanus shots (usually given 6 times over childhood in the DTaP vaccine). Here are some things to know as you decide with your health care provider if you should get a shot:

  • Fortunately, only about 1 child five years and under catches tetanus every year in the U.S. It is a rare condition. Between 1 and 5 older kids/teens catch it each year.

  • Tetanus can happen without even having a known source of injury, but again this is rare. 

  • Clean cuts that can be washed out and even may need a few stitches are very low risk wounds. A minor poke or scrape by a metal dirty object is also low risk.

  • The highest risk wounds are when someone is impaled by rusty metal that is dirty with animal feces-contaminated soil, such as on farms, and the wound cannot be adequately cleaned out. Any cut from a dirty or rusty object that is open and can be thoroughly cleaned is lower risk.

  • If you are unvaccinated and suffer a high-risk wound, you can get an immediate-acting tetanus immune globulin shot (called TIG) that works right away to neutralize any tetanus from that current wound. Getting a regular tetanus vaccine for the first time after a wound usually doesn't help. 

Call us for an appointment if you would like to discuss this further.