Advanced Pediatrics
The Time and Attention You Deserve
Andrew L. Satran, M.D.
Board Certified by the American Board of Pediatrics
(845) 364-9800
Urgent Problems

If your child shows symptoms of any of the problems listed here, please call our office.

Note: We have tried to address common pediatric issues. While we have written this as a guide for you, it is impossible to cover all of the possible medical problems or individual situations. If there is any situation in which you feel that your child needs medical attention, please call us.



In a baby less than three months old, a low grade fever of 100.4 or higher may be a sign of a serious infection and we must see the baby right away. Even if the baby has a cough and congestion, do not assume that this is simply a viral infection. Babies can be very sick without spiking a high fever. Take a rectal temperature for the first three months of life since it is much more accurate.

Once your child is older than 3 months, call us with a temperature of 103.5 or higher. (If the child is lethargic, inconsolable, or appears sick to you, call us no matter what the temperature is).


Remember that fever is a sign to us that the body is fighting an infection. In fact, some viruses are killed quicker at elevated temperatures. If your child is uncomfortable with the fever, you may use acetaminophen (Tylenol) if they are 3 months or older and ibuprofen (Advil, Motrin) if they are at least 6 months old. Never give aspirin to any child or adolescent.

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Lethargy implies that your child is extremely weak and is not acting normally. All children feel tired and fatigued when they are ill, but lethargic children are almost unresponsive to parents. High fever can cause your child to look very sick, but if they become playful when the fever subsides this does not indicate a lethargic child.


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Head Injuries

Infants and toddlers are clumsy and will undoubtedly bump their head. We worry about head injuries if they lose consciousness, or they are not acting normally. Look for any drainage from the ears or nose. Vomiting after a head injury is also a symptom that requires an evaluation. Monitor your child closely over the next 24 hours and call us if any of these occur.


In infants less than 12 months old, a fall from a significant height, especially onto a hard surface, can cause a head injury without some of the normal warning signs. Please call us if there is a question as to the significance of the fall.

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Pink eye (conjunctivitis) is usually harmless, but needs evaluation in our office. If there is redness, tenderness and swelling in the skin around the eyelids, call our office right away. Note: Any loss of vision or severe eye pain needs to be evaluated immediately.


If your child gets a chemical in his eye, flush immediately with water and bring him or her to the ER. Bring the bottle from the chemical if possible.

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If there is prolonged drainage from the ear with an ear infection the child needs to be re-evaluated. A child with redness, tenderness and swelling behind the ear also needs to be evaluated.


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Nosebleeds are common, especially with trauma to the nose. The majority are insignificant and can be stopped by lightly pinching the nose and tilting the head forward. Call us if there is profuse bleeding, or if the nosebleed lasts for more than 5 minutes.


If your child has a nosebleed with no obvious cause, we would still like to see the child to ensure there is nothing unusual causing the nosebleed. Please call so we can determine the urgency of the matter.

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Sore Throat

Sore throats can be caused by a virus or by the bacteria Strep. It is impossible to tell the difference between them simply by examination and significant sore throats must be cultured. Even if the sore throat has resolved, it still needs evaluation. Untreated Strep throat can lead to Rhuematic Fever. This is not an urgent situation and you can certainly wait until the first weekday if it occurs during a weekend or holiday.


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The loss of a permanent tooth from an injury is a dental emergency. The child must be seen by a dentist within 30 minutes to try to save the tooth. Do not try to clean the tooth. Simply pick it up by the end that is normally exposed and put it in milk. If milk is not readily available, it can be placed in room temperature water to keep it moist. Call us and your dentist immediately.


Keep in mind that, if present, potential medical emergencies (e.g. head injuries) take precedence over dental problems.

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Vomiting up blood is an uncommon, but serious problem that needs evaluation in the Emergency Room.


While non-bloody vomiting is very common in childhood, there are many different reasons for this vomiting and we need to know about repeated vomiting or vomiting with other symptoms.

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Abdominal Pain and Pelvic Pain

Severe abdominal pain or pelvic pain needs to be evaluated.


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Testicular Pain

Any redness, swelling or pain in the testicles is a true emergency and needs to be evaluated immediately. Please do not take these symptoms lightly. If there is a question as to the significance, call our office.


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Leg pain

While “growing pains” is a harmless condition of pain in the lower legs, it is a diagnosis of exclusion. While not an urgent situation, chronic pain must be evaluated in our office to make sure that it really is growing pains.


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Cuts (Lacerations) & Puncture Wounds

Simple scrapes should be cleaned with soap and water, but lacerations need to be stitched up within 6 hours. Call our office. If we are unable to stitch it up at that time, we will direct you to the ER or an urgent care center.


Deep puncture wounds (e.g. fork, nail, etc.) need to be seen within 24 hours. Call our office to set up an appointment.

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Animal and Human Bites

All bites that pierce the skin must be seen. They are at risk for infection. For animal bites, we will need to know the rabies status of the animal.


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Skin Rashes

Call us if your child has a flat rash that does not change color when you run your fingers over it or press down on the skin.


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