When to Call the Doctor

(Courtesy Dr. Joel “Gator” Warsh & Dr. Mary Anne)

Your Sick-Day Setup

What should be in your “Illness Cabinet” before illness hits:

  • Thermometer & Pulse oximeter
  • Electrolytes (clean ingredients), raw honey* (for kids over 12 months of age), elderberry* (under 12 months, check formulation with doctor), Vitamin C, Vitamin D, Zinc, & Probiotics
  • Saline Spray, Humidifier, & Epsom Salts
  • Activated charcoal/binder (ONLY when indicated)

Thermometer + Pulse Ox Basics

  • Normal pulse ox: >95%
  • Normal fever range: 100.4 – 103° Fahrenheit (depending on age)
  • Babies less than 2 months with a temperature greater than 100.4 rectal equivalent – call pediatrician.

When to Avoid Certain OTC Meds:

  • Avoid multi-symptom cold meds
  • Avoid cough suppressants in young kids
  • Use Tylenol sparingly – reserve for severe discomfort
  • Avoid Benadryl for routine colds

Natural Tools (That Actually Help):

  • steam showers & diffused essential oils
  • warm honey lemon water
  • saline rinses or nasal aspirator
  • warm or cool compresses

Recovery & Post-Illness Repair

Gut Repair: Probiotics, bone broth, prebiotics (banana, oats, veggies)

Immune Supportive Foods: Salmon, berries, broth, sweet potato, eggs, & leafy greens

Supplements: Zinc, vitamin-D, omega-3’s, probiotics, & magnesium for sleep

Return to Activity When: Energy is back, eating is normal, & no fever for 24 hours

Lingering Symptoms: cough can last 1 – 2 weeks, fatigue may persist a few days; monitor hydration & sleep.

Managing Symptoms

Step-by-Step Checklist

  • Check temp, breathing, hydration status
  • Offer fluids
  • Begin Vitamin C & Zinc
  • Support lymph drainage (massage, warm bath)
  • Reduce sugar immediately
  • Start humidifier & saline
  • Observe energy level and breathing

Questions to Ask Immediately:

  1. Are they breathing normally?
  2. Are they drinking?
  3. Are they responsive/alert?
  4. Any severe pain?
  5. Any significant exposures?

Hydration Triage:

Accept: water, broth, coconut water, electrolytes.

Avoid: juice, dairy (if mucus heavy)

When to Push Fluids: Dry lips; fewer wet diapers; dark urine; fast breathing

Inflammation Curve:

Normal: Mild fatigue, fever, decreased appetite.

Red Flag: Rapid worsening, lethargy, breathing changes

Early Interventions That Make the Biggest Difference:

Vitamin C, zinc, elderberry, warm baths, sleep, & quiet play

Vitamins, Minerals, Herbs & Homeopathy:

  • Vitamin C: every 4 – 6 hours; 100 – 250 mg (toddlers), 500 – 1,000 mg (kids)
  • Zinc once per day: 2–5 mg (less than age 3), 5–10 mg for kids
  • Vitamin D, acute: 2–3x baseline for 1 – 2 days
  • Herbs: elderberry (1–2x/day), echinacea, propolis
  • Homeopathy: consult provider

Signs of Improvement:

More playful, drinking better, fever stabilizing & more energy

First 24 Hours: Support the Immune System, Don’t Overwhelm It

Choose 2 – 3 core supplements, not 10. Do LESS, but do it consistently.

What Actually Helps (and What Doesn’t)

Works:

  • Honey
  • Elderberry
  • Zinc
  • Vitamin C
  • Vitamin D
  • salt baths
  • steam & saline
  • hydration

Does NOT Work Usually (or Can Harm):

  • OTC “cold & flu” combos
  • overuse of Tylenol
  • expectorants in young kids
  • constant fever suppression
  • sugar, crackers, & processed snacks
  • dairy during active mucus

The 48 – 72 Hour Window

Warning Signs:

  • Persistent high fever
  • Worsening cough
  • Dehydrated
  • New rash
  • Vomiting
  • Very low energy
  • Breathing changes

Support Lymph & Congestion:

  • Warm baths
  • Massage behind ears & neck
  • Hydration
  • Humidifier
  • Light movement

Stool Clues:

Loose stools may indicate viral progression or post antibiotic issue.

Constipation can slow recovery and prolong a fever

Dehydration Watch: No tears, sunken eyes, dry mouth, few wet diapers

Osteopathic Manipulative Medicine (OMM): OMM can support the immune system and help shorten the duration of the illness.

Respiratory Section

Coughs:

Wet:mucus clearing > saline & steam

Dry: airway irritation > humidifier & honey (over 12 months of age)

Respiratory Red Flags:

  • Flaring nostrils
  • Rib retraction
  • Fast breathing
  • Blue lips
  • Inability to speak in full sentences (older kids)

Positions That Help:

  • Upright
  • Chest elevated
  • Side-lying
  • Skin-to-skin for infants

Nebulizer Guidance:

Saline is safest.

No essential oils in nebulizer

Mucus Thinning Techniques:

  • Warm liquids
  • Steam
  • Chest PT
  • Saline rinses

Gut Illness Protocol

Vomiting Protocol (Hour-by-Hour)

Hour 1: nothing

Hour 2: 1 tsp electrolyte water every 5 minutes

Hour 3: increase to 1–2 tbsp every 10 minutes

Hour 4: add broth

Hour 5: add bland foods (banana, rice, potato)

Rehydration Formulas:

Homemade electrolytes & oral rehydration solutions. Avoid sugary sports drinks

Binders:

Use ONLY if suspected toxin exposure or severe diarrhea with cramping.

AVOID IF: constipation, dehydration, or in very young children

Diarrhea: Normal for 3 – 7 days with viral illness

Foods to Avoid: Dairy, juices, fried foods, heavy fats, & processed snacks

72-Hour Gut Reset: Broths, bananas, rice, potato, applesauce, simple proteins, probiotics (once stabilized)

Key Points Summary

When to Call the Doctor

Red Flags by System:

  • Respiratory: difficulty breathing, retractions
  • GI: dehydration, bloody stool, severe pain
  • Neuro: unresponsive, stiff neck
  • Skin: purple rash, rapidly breathing
  • General: very low energy, unable to drink

Urgent Care vs ER: Urgent Care: severe ear pain, mild dehydration, persistent fever. Emergency Room: breathing trouble, unresponsiveness, severe dehydration

Useful Tests: Strep, Flu/RSV, Urinalysis, Chest X-Ray (if indicated), CBC or Chemistry if severe or prolonged illness

The Fever Guide

Temperatures: Fevers up to 103° Fahrenheit can be normal in older kids with a virus, consult with provider. Temperature ≠ severity – behavior matters more

Fevers Are Helpful: They activate immune pathways and slow viral replication

When to Treat: Pain, poor sleep, dehydration, or discomfort

Natural Support: Warm bath, cool cloth, hydration, & rest

When Fever Requires Care:

  • 2 months of age or younger (100.4° Fahrenheit rectal equivalent)
  • 104 – 105° Fahrenheit
  • Lasts more than 5 days
  • Lethargy
  • Severe pain
  • Stiff neck
  • Trouble breathing

Febrile Seizures: Common, usually harmless, triggered by rapid temperature rise – not the number

About The Author

drmaryanne

The best medicine is not one size fits all. Each child and family is unique.Dr. Mary Anne is passionate about helping families optimize their health naturally.As a board certified pediatrician, the goal of her office is to bring the best integrative and osteopathic medicine to newborns, infants, children, adolescents and their families. She combines the knowledge of conventional medicine with the wisdom of natural medicine. As an osteopathic physician, Dr. Mary Anne utilizes the added benefit of gentle osteopathic manipulative medicine, a unique tool to release the body’s inherent healing ability in addition focusing on a healthy diet and natural remedies (unless medications are needed).After graduating from College of Osteopathic Medicine of the Pacific of Western University in 1988, Dr. Mary Anne completed a year of training in general medicine and then three years of pediatric residency at Loma Linda University Medical Center. She is also board certified in integrative medicine, holds a Certificate of Proficiency from and is recognized as a Fellow in the Osteopathic Cranial Academy. An avid student and teacher, she recently contributed a chapter to Integrative and Functional Medical Nutrition Therapy on nutrition for neurodevelopmental issues in children.Enthusiastic about the contribution that osteopathy’s holistic approach makes to children’s health and development, Dr. Mary Anne is a sought after teacher and lecturer in the United States and abroad. She enjoys sharing her knowledge at community events.In practice for over 28 years Dr. Mary Anne has extensive experience supporting parents in keeping their children healthy and reaching their optimal potential as well as treating common pediatric issues such as allergies, ADHD, asthma, autism, ear infections and developmental issues including a wide variety of neurologic and genetic issues. Newborns love osteopathic manipulative medicine which can help relieve the stress of birth as well as help with feeding issues, reflux, torticollis, misshapen head (plagiocephaly) and colic.As a young child, Dr. Mary Anne suffered from many respiratory issues. Years of suffering from allergies, eczema and asthma gave her a determination that there had to be better ways to heal the body. In osteopathic medical school, she found answers. She is thankful to her teachers, the increasing awareness of the power of natural medicine and the body’s innate ability to heal.

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