Health & Illness
Fever protocols by age, when to call the doctor vs. go to the ER, common conditions, medication dosing, vaccination schedule, and diaper rash types.
When to Call the Doctor vs. Go to the ER
Go to the ER Immediately
- Fever 100.4°F+ in baby under 3 months (non-negotiable)
- Difficulty breathing: nostril flaring, rib retractions, grunting, turning blue/gray
- Seizures or unresponsiveness
- Inconsolable crying for 2+ hours with no identifiable cause
- Bulging fontanelle (soft spot) when baby is upright and calm
- Signs of dehydration: no wet diaper in 6+ hours, no tears when crying, sunken fontanelle
- Vomiting that is projectile, green/bile-colored, or bloody
- Bloody stool (more than a streak)
- Injury from a fall (any head impact in infant under 12 months)
- Allergic reaction: hives + swelling + difficulty breathing
Call the Doctor
- Fever 101°F+ in baby 3-6 months
- Cold symptoms lasting more than 10 days
- Pulling at ears with fever or irritability (possible ear infection)
- Refusing to feed for 2+ consecutive feedings
- Rash that is spreading, blistering, or accompanied by fever
- Diarrhea (6+ watery stools/day) lasting more than 24 hours
- Constipation (no stool in 3+ days with hard, pebble-like output)
- Eye discharge that is thick, yellow/green, or causing eyelids to stick shut
- Persistent cough or wheezing
- Not meeting developmental milestones by expected age
Fever Protocol by Age
Common Conditions
Common Cold
Symptoms: Runny nose (clear initially, may turn yellow/green), sneezing, mild cough, low-grade fever, fussiness
Treatment: Saline drops + bulb syringe/NoseFrida to clear congestion. Cool-mist humidifier in bedroom. Elevate crib mattress slightly (towel under mattress, not under baby). Plenty of fluids (breast milk/formula). No OTC cold medicine for children under 4.
When to worry: Fever in baby under 3 months. Breathing difficulty. Symptoms worsen after day 5 or last beyond 10 days. Green nasal discharge lasting 10+ days (possible sinus infection).
Ear Infection (Otitis Media)
Symptoms: Pulling/tugging at ears, fever, irritability (especially when lying down), trouble sleeping, fluid draining from ear, decreased appetite, sometimes brief hearing difficulty
Treatment: Pain relief: infant acetaminophen (Tylenol) or ibuprofen (Advil, 6+ months only). Warm compress on the ear. Many ear infections resolve without antibiotics (AAP watchful waiting for mild cases in children 6+ months). Antibiotics (amoxicillin) prescribed for severe cases, bilateral infection, or children under 6 months.
When to worry: High fever (103°F+). Stiff neck. Pus or bloody discharge from the ear. 3+ ear infections in 6 months (may need ENT referral for ear tubes).
Croup
Symptoms: Barking "seal-like" cough, hoarse voice, stridor (high-pitched breathing sound when inhaling), usually worse at night, often starts with cold symptoms
Treatment: Cool night air: bundle baby up and step outside for 10-15 minutes (cold air reduces swelling). Steam: run hot shower and sit in steamy bathroom for 15 minutes. Cool-mist humidifier at bedside. Keep child calm (crying worsens symptoms). Oral dexamethasone (corticosteroid) from doctor for moderate-severe cases.
When to worry: Stridor at rest (not just when crying/coughing). Drooling or difficulty swallowing. Blue/gray color around lips or fingernails. Retractions (skin pulling in around ribs or collarbone with breathing).
RSV (Respiratory Syncytial Virus)
Symptoms: Starts like a cold, then progresses to wheezing, rapid breathing, coughing, decreased appetite, irritability. In young infants: apnea episodes (brief pauses in breathing)
Treatment: Supportive care: saline drops, suctioning, humidifier, frequent small feedings. No antiviral medication available. Hospitalization may be needed for supplemental oxygen or IV fluids. Preventive antibody injection (nirsevimab/Beyfortus) now recommended for all infants entering their first RSV season.
When to worry: Rapid breathing (60+ breaths/min in infants). Nasal flaring or rib retractions. Wheezing audible without stethoscope. Decreased wet diapers. Pauses in breathing. Blue/gray tint to skin or lips.
Hand, Foot, and Mouth Disease (HFMD)
Symptoms: Fever, sore throat, painful sores/blisters in mouth (tongue, gums, inside cheeks), rash on palms of hands, soles of feet, and sometimes buttocks. Rash may be flat or raised, sometimes with blisters.
Treatment: Pain relief (acetaminophen/ibuprofen). Cold foods and fluids to soothe mouth sores (popsicles, cold milk). Avoid acidic/spicy foods. Maalox/Benadryl "magic mouthwash" (ask pediatrician for ratio). Highly contagious -- wash hands frequently, disinfect toys.
When to worry: Unable to drink fluids for 12+ hours. Signs of dehydration. Fever lasting more than 3 days. Symptoms worsen instead of improve after day 5.
Roseola (Sixth Disease)
Symptoms: Sudden high fever (often 103-105°F) lasting 3-5 days, followed by a distinctive pink/red rash that appears as the fever breaks. Rash starts on trunk and spreads outward. Child often seems surprisingly well despite high fever.
Treatment: Fever management with acetaminophen/ibuprofen. Fluids. Rest. The rash itself does not require treatment and is not itchy. Once the rash appears, the child is typically no longer contagious.
When to worry: Febrile seizure (occurs in ~10-15% of roseola cases -- call 911 if first seizure). Fever lasting more than 5 days. Child is lethargic or inconsolable.
Teething
| Age | Teeth |
|---|
| 6-10 months | Lower central incisors |
| 8-12 months | Upper central incisors |
| 9-13 months | Upper lateral incisors |
| 10-16 months | Lower lateral incisors |
| 13-19 months | First molars (upper & lower) |
| 16-23 months | Canines (upper & lower) |
| 23-33 months | Second molars (lower then upper) |
Safe Remedies
- Chilled (not frozen) teething rings or cold washcloth to chew on
- Gentle gum massage with a clean finger
- Infant acetaminophen or ibuprofen (6+ months) for significant pain at bedtime
- Silicone teething toys (refrigerate for extra relief)
- Frozen breast milk popsicles in a mesh feeder
CDC Recommended Vaccination Schedule (Birth to 18 Months)
| Age | Vaccines |
|---|
| Birth | Hepatitis B (HepB) -- dose 1 |
| 2 months | HepB -- dose 2, DTaP (diphtheria, tetanus, pertussis) -- dose 1, IPV (polio) -- dose 1, Hib (Haemophilus influenzae type b) -- dose 1, PCV15 or PCV20 (pneumococcal) -- dose 1, RV (rotavirus) -- dose 1 |
| 4 months | DTaP -- dose 2, IPV -- dose 2, Hib -- dose 2, PCV15/20 -- dose 2, RV -- dose 2 |
| 6 months | DTaP -- dose 3, IPV -- dose 3 (can be given 6-18 months), HepB -- dose 3 (can be given 6-18 months), PCV15/20 -- dose 3, RV -- dose 3 (if RotaTeq brand), Influenza (flu) -- annually starting at 6 months |
| 12-15 months | MMR (measles, mumps, rubella) -- dose 1, Varicella (chickenpox) -- dose 1, Hib -- booster (dose 3 or 4 depending on brand), PCV15 -- booster (dose 4), Hepatitis A (HepA) -- dose 1 |
| 15-18 months | DTaP -- dose 4 |