Self-care exclusions

Dehydration

• Infants

• failure of out-patient management; ORT

• Signs/symptoms of severe dehydration requiring IV fluids

• Diarrhea/vomiting associated with high fever lasting for several days

• Severe abdominal pain or abdominal distension

• Bloody diarrhea

• Underlying disease or illness that require closer observation with illness (ex: immunocompromised, diabetes, kidney disease, inborn error of metabolism

Constipation

• Onset before 1 month old

• Severe abdominal pain or distention 

• Blood in the stool

• Constipation seen in combination with fever, bilious vomiting, or ill-appearance

• Not relieved by appropriate first line measures in outpatient setting

• Failure to thrive or associated weight loss

• Urinary symptoms or incontinence

Fever

• Infant <3 months 

• Fever lasting >3 days

• Signs of dehydration

• Severe lethargy or irritability

• Difficulty breathing

• Seizures or persistent vomiting

Pain

• Pain that is severe, persistent, or worsening

• Pain associated with significant trauma

• Unexplained swelling, redness, or deformity

• Pain accompanied by high fever or neurologic symptoms

• Headache associated with vision changes or persistent vomiting

• Pain lasting longer than several days despite treatment

Teething

• fever greater than 38°C (100.4°F)

• Symptoms include persistent vomiting or diarrhea

• There is significant irritability or difficulty feeding

• Symptoms persist beyond the expected period of tooth eruption

• The caregiver is uncertain whether symptoms are related to teething

Cough and cold

• Difficulty breathing or rapid breathing

• Persistent high fever

• Symptoms lasting longer than 10–14 days

• Severe ear pain or suspected ear infection

• Signs of dehydration

• Persistent vomiting

• Cough accompanied by wheezing or cyanosis