Middle-of-the-Night Calls

Middle-of-the-Night Calls

It’s 2AM. Your baby is crying and her forehead feels hot.

Or maybe it’s 3AM and your child comes stumbling into the room looking miserable.

Should you call your pediatrician now? Or is it okay to wait until the morning? Oftentimes, it’s difficult to tell how sick your child is. The following guidelines can help you determine what to do for common middle-of-the-night cases and whether or not you should call your doctor.

First Off, Medications

Before delving into what to do when your child is sick in the middle of the night, it’s important to know what types of medications your child should not take:

  • No over-the-counter cough or cold medications if your child is under six years of age
  • Do not give Tylenol to babies under two months old
  • Do not give Motrin or Advil to babies under six months old



Let’s face it, fevers can be scary. However, learning more about what a fever is can help ease your worry and give you a plan to proceed. Your child’s normal temperature can vary with their age and the time of day, but in general, your child probably has a fever if their temperature is 100.4 or above. Don’t try to add or subtract degrees yourself­­—you just want to take your child’s temperature as accurately as possibly. Rectal is the most accurate way until your child can reliably hold the thermometer under their tongue.

A fever is the body’s way of fighting off sickness; the fever itself is not an illness. Many children will have other symptoms of the illness, such as a sore throat or an earache, but sometimes the fever is your first clue as a parent that something is amiss.

Fever may be something that cannot wait until the next morning to be evaluated. The age of your child and their other symptoms help determine if this is an emergency or not. Talk to your doctor about what your specific guidelines are. As a general rule, if your child is over two months old, is smiling, drinking, and knows where they are, you are probably safe to wait until the morning to call your doctor for an evaluation.

Ear Pain

If your child has ear pain, there are a couple things you can do to help ease the pain:

  • Give them Tylenol or Motrin unless your child is too young (see guidelines above)—remember these medicines can be used for fevers or for pain
  • Administer a warm compress—place a warm towel on the ear for 5–10 minutes to calm the child (a good hug and snuggle may help, too)


If your child has pus draining from the ear, the eardrum is probably infected. If your child has discharge, wipe the pus away, and do not plug the ear with cotton.

When to Call the Doctor

  • A severe earache has not improved within two hours after taking ibuprofen
  • A pointed object was put into the ear (pencil, stick, wire)
  • There is pus or cloudy discharge coming from the ear


Ear pain is rarely a reason to run to the ER in the middle of the night. Usually pain control is the most important thing, and being evaluated the next day by your doctor can solve the problem and avoid a costly ER visit in the middle of the night.


The main issue with vomiting and diarrhea is water loss, and if it lasts for a long time, your child may lose important minerals such as sodium, potassium, and chloride and become dehydrated.

What you can do:

  • Offer sips of clear liquids (like diluted juice, Gatorade, or Pedialyte) or water very frequently. If your child refuses, offer ice chips to suck on. Build up to one ounce an hour, then increase to two ounces an hour until the child is able to drink normally.


When to Call the Doctor

Call right away if:

  • Your child is too sick to drink adequately
  • Your child shows signs of dehydration (dry mouth, fewer tears, urinates less frequently)


Diaper Rash

The first sign of a diaper rash is when surfaces that are in direct contact with a diaper become red or start to show small bumps. Common causes of a diaper rash include leaving a wet or stool-soiled diaper on for too long, but more often, it’s just that a baby’s bum is quite sensitive. However, don’t blame yourself for not getting to the dirty diaper fast enough. Modern diapers are very absorbent and some babies are just more prone to develop rashes.

What you can do:

  • Leave your baby naked on a towel to air dry, if possible
  • Apply any over-the-counter diaper cream, spreading it liberally over the affected area as if you were icing a cake


When to Call the Doctor

Call your doctor if the rash does not improve noticeably within two to three days after applying cream.

A Final Note

It’s hard when your child is sick, and it’s understandable to feel worried. So if your child looks very ill, or has severe pain or any other serious symptom, do not hesitate to call your pediatrician right away.

If you have questions or would like to discuss any concerns you have regarding your child’s health, you can schedule an appointment with me, Dr. Kathryn Mandal, by calling 817-617-8600 or scheduling online at continuumtx.com.