When should one worry about an illness?

I have often wondered about what makes a parent who is nursing a sick child decide that it is time to take her to a specialist. In India, we often have people who cannot afford the specialist's fees: but then, I believe the same is the case even in developed countries when the family does not have insurance. So there.

Imagine, for a few minutes, if you may, that your child has started having a runny nose. I don't think you are going to run to a specialist with just THAT, are you? Now think what you will do if she has a slight cough AND a little temperature. At this point, if you have seen such a thing before, or if your child is a little older than being a baby in arms, you are probably going to do one of the following (in increasing order of anxiety):

1. Ignore the problem and say - it is no big deal, she will soon be all right
2. Make a concoction of home-based stuff like ginger tea, honey and ginger drops, an inhalation of an aromatic substance like Vicks VapoRub or roasted seeds of "ajwain"
3. Give her one of the previously prescribed cough and cold mixtures that your child's specialist had given on a previous visit
4. Go to the local chemist and ask him to give you a suitable cough and cold medicine
5. Call up your local family doctor and ask him if the medicine you have in your medicine cupboard is all right to be used
6. Go to the local family doctor and ask him to "give" you some medicine for cough and cold for your child, or at least prescribe it
7. Go to the local family doctor with the child and seek a proper check-up and prescription
8. Call up the specialist and ask him to either suggest some medicine for cough and cold or ask him if the medicine he had given to your child previously will be all right this time too
9. Go to the specialist with the child for a professional consultation

Now, based on the list above, where are you likely to be? And what has made you decide that position? In my opinion, people do an action after a lot of confounding variables are taken care of:

• Is the child really sick?
• Does she really need a professional consultation or is a phone call going to be enough?
• Can I afford a pediatrician's fees or should I make do with a local doctor?
• How old is the child?
  
• Can I afford to take a risk with this child after already having lost one to pneumonia?
• Did I lose that child with pneumonia because I neglected it or because my wife did not take her to the doctor in time ....

and so on.

Thus, as you can see, parents do not often think alike in these matters.

So, here is a guide: take the child to a specialist if:

1. She has been ill for more than two days and the medicines that you have been giving her (whether herbal, home, local doctor or specialist's previously prescribed medicine) does not seem to be working
2. She has very severe symptoms - lot of loose motions or vomiting, dry hacking cough with chest pain, severe headache or stomach pain that makes the child cry, she is unable to breathe because of a blocked nose, etc
3. She has dangerous symptoms such as bleeding from any orifice, dark coloured urine, blood in stools, a fit, a difficulty in using any part of the body - muscles and bones, I mean, a loss of consciousness however brief, a change in voice or speech, a swelling that is very painful, a very high fever more than 39 C or 101 F, change in vision or hearing, and so on.
4. She has recurrence of symptoms within a few days of stopping the medicines for the same problems
   
5. She develops fresh symptoms like a rash, high fever, visual disturbances, headaches, bodyaches, bloody vomiting, difficulty in breathing or blood in the urine etc. soon after taking a certain medicine
6. She has acute vomiting or loose motions or both within hours of consuming food - esp. in a restaurant or at a community dinner
7. She is not the only one with a particular set of symptoms: many of her school mates have the same problem, or many others in the family

Of course, this list is not conclusive, but I am sure it will be a help to parents who often get stuck about what to do next.