Have your druggist's phone number available.
To assist in preparing answers to most of the questions your physician may ask, use the following list of observations. Note them before placing the call.
CHECKLIST OF OBSERVATIONS OF YOUR CHILD WHEN ILL
Important: For any positive answer, tell how long the observation has been present.
1. Temperature:
Is there fever? Yes ____ No ____
What is it now?
What was the highest degree?
Have you given the child medicine to reduce it? Yes ____ No ____
When did you last give this medicine?
What did you give?
2. Eyes:
Is there a discharge of pus? Yes ____ No ____
Are they red? Yes ____ No ____
3. Nose:
Is it running or stuffy? Yes ____ No ____
4. Ears:
Is there an indication of pain? Yes ____ No ____
Is there a discharge? Yes ____ No ____
5. Mouth:
Is there a complaint of sore throat? Yes ____ No ____
Difficulty in swallowing? Yes ____ No ____
Can the child swallow water? Yes ____ No ____
6. Neck:
Is it stiff or painful? Yes ____ No ____
Can the chin be bent to touch the chest? Yes ____ No ____
Are the glands swollen? Yes ____ No ____
7. Chest:
Is it heaving? Yes ____No ____
Pulling in? Yes ____ No ____
Is there a wheeze? Yes ____ No ____
Is there a cough? Yes ____ No ____
Is the cough dry, moist, barking? Circle the most appropriate.
When does the cough occur?
Does the cough produce vomiting or awaken the child from sleep?
Yes ____ No ____
Is there rapid breathing? Yes ____ No ____
(Count the child's breathing rate for 1 full minute and report.)
Is there hoarseness? Yes ____ No ____
8. Abdomen:
Is vomiting present? Yes ____ No ____
How many times the past day?
Is diarrhea present? Yes ____ No ____
How many times the past day?
When did the child urinate last?
Did the bowel movement contain mucus or blood? Yes ____ No ____
Where is it tender when you press on it?
Is the abdomen bulging? Yes ____ No ____
Is there a bulging in the groin? Yes ____ No ____
If yes, where? ____ navel
____ upper right
____ upper left
____ lower right
____ lower left
Is there a bulging in the scrotum? Yes ____ No ____
9. Limbs:
Can the child's limbs be moved freely without pain? Yes ____ No ____
Is there a limp? Yes ____ No ____
Is there swelling? Yes ____ No ____
10. Skin:
Is there a rash? Yes ____ No ____
Is it red, pink, purple, blistered, raw? Circle the most appropriate.
Is it painful, tender, itchy? Yes ____ No ____
Does it remain in one spot or change areas? Yes ____ No ____
11. Contact:
Are any family members ill? Yes ____ No ____
Is there any illness in the neighborhood or school? Yes ____ No ____
Has there been any contact with a contagious disease? Yes ____ No ____
12. In what way is the child acting differently?
13. Have you given any medication for this illness? Yes ____ No ____
If yes, what?
For how long?
Do you think it helped? Yes ____ No ____
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