It’s 2 a.m., you can’t stop coughing, and you’re feeling short of breath. Or it’s Saturday and your 1-year-old is running a high fever and won’t eat. What do you do? Wait to see your doctor or go to the emergency room?

This year, the decision about when to go to the doctor and when to go to the ER may be more frightening for some people. The news media and Internet are filled with stories of suspected cases of H1N1 that suddenly turned serious.

Although health experts continue to assure the public that H1N1 is not serious in the vast majority of cases, it can be hard to know what to do when symptoms seem to grow worse, particularly at night and on weekends.

“Most people with H1N1 have fairly mild illnesses,” said Dr. Beth Nauert, a pediatrician with The Austin Diagnostic Clinic.

“In most people, it’s much like any other flu. But that doesn’t mean there haven’t been severe illnesses.”

The reports of those severe cases are part of what can drive people to seek medical care, even when they don’t need it. “Just because you are exposed to the flu, doesn’t mean you will get it,” said Nauert. “We have people calling who want to bring their children in because they were at a birthday party and someone there developed swine flu. But your physician doesn’t need to see you if you don’t have any signs of illness.”

Dr. Michael Romain, an internal medicine physician at ADC, agrees that people who do not have symptoms don’t need to be trying to get in to see their doctors.

“If you don’t have any symptoms -- no fever, no body aches, no other flu-like symptoms -- the best thing you can do is to get plenty of rest, drink plenty of fluids, and stay away from people who do have symptoms of flu or other illnesses,” said Romain

Nauert said the idea is not to discourage people from seeking medical help, but rather to avoid unnecessary visits.

Parents may call a nurse at any time and discuss their symptoms in order to help decide if it’s time to see a doctor or stay at home, she said.

Health officials say a fever isn’t always a bad thing. Fevers are one of the body’s protective mechanisms, and most fevers are good to help fight infection. It’s also important to note that body temperatures are never constant. They actually fluctuate by several degrees throughout the day.

A temperature measured orally, for example, can vary anywhere from a low of 95.8 degrees fahrenheit in the morning to 99.5 degrees in the late afternoon, and still be considered normal.

Although people who are not displaying symptoms don’t need to see their doctors, there are cases where people should be seen by a doctor. And in some cases, the emergency room is the right place to go, said Nauert.

A child under 2 or one with a chronic illness should be treated, said the physician. “These are children we need to treat and diagnose within the first 48 hours of the start of symptoms,” said Nauert.

“For these kids, it’s important to be seen by a doctor because there is a specific treatment that has to be prescribed by a physician.”

Children older than two who do not have chronic illnesses will generally not be treated with antivirals like TamiFlu because of resistance to the drug that is emerging.

But even for older children and those without chronic conditions, there are still instances where the child needs to be treated by a doctor.

“If your child is not able to take any fluids or is dehydrated, that child needs to be seen whether the symptoms are caused by the flu or by something else.”

Symptoms of dehydration include no urination for eight hours or a totally dry mouth.

Children with chronic kidney disease, chronic heart disease or chronic arthritis also should be seen by their physicians if they exhibit symptoms of flu.

“There are also some forms of immune deficiencies or cases where children take immunosuppressing drugs that mean you need to quickly consult your doctor if you suspect the flu,” added Nauert.

In some cases, the physician said, the child can be taken to the ER by the parents. In other cases, the parent should call EMS. “If your child has signs of respiratory distress -- meaning color changes or is not able to get air in or out -- then you need to go to the ER.”

Another sign of respiratory distress is when the skin retracts or sinks in between the ribs when a child takes a deep breath. “In babies, a child who will not take a bottle or nurse for several hours -- but does not have a stuffy nose -- may also be experiencing respiratory distress.

“If your child is non-responsive -- if you cannot wake them up or get them to respond to you -- that’s not someone you should put in a car and take to the ER. That’s the time to call EMS."

While many of the reported instances of serious cases of H1N1 involve young children, older children and adults can also exhibit serious symptoms. Some people are more likely to develop complications from the flu and should be seen by their physicians as soon as they believe they have contracted the flu.

“You should call your doctor if you suspect the flu and you are over 65, have a chronic health problem, or are on medications that can affect your immune system,” said Romain.

Likewise, the physician said that any adult who runs a fever for more than three days should consult their doctor. “If your flu symptoms appear to get better but then worsen, you should immediately let your physician know,” said Romain. “It’s important that people monitor their fever, get plenty of rest, drink plenty of fluids, and stay home to avoid passing the flu on to others.”

"Adults should go to an ER if they are having trouble breathing, have blue or purple lips, or get dizzy when they stand,” said Romain. “Also, adults who are vomiting continuously and have stopped urinating should be seen by the ER.”

Extreme symptoms such as chest pains or loss of consciousness are situations that should be handled by EMS. “While these types of symptoms or problems are rare, they are serious and need to be treated by experienced medical personnel.”

Both Nauert and Romain emphasize that for most people H1N1 will mean three or four days of fever, body aches, and not feeling well. “In most cases, people will not even need to be seen by their doctors,” said Nauert. “But if you are feeling anxious about your own health or a family member’s health, you should always call your doctor’s office. They can help you feel more confident in your decisions. Knowing when to make that call or when to take action and go to the ER can help prevent more serious problems.”