I Know Your Child Has a Fever
This is not medical advice, nor does it proport to diagnose or treat any health condition.
As an ER nurse, the most common complaint I deal with during the cold and flu season is the pediatric fever. It seems to be an evolutionary imperative for children to build their immune systems by exposing themselves to disease.
They do this by picking their nose and eating it, ignoring the five second rule, poor hand hygiene, swapping spit balls, and basically anything else that as an adult, we would never do.
Last week I saw a two year old running his matchbox car across the ER floor then happily dipping it in his apple juice and sucking on it again and again. His parents observed this behavior but thought nothing of it...Alas.
George Carlin once said, "Parenting, now that's a tough job...easy one to get, though."
This brings us to the pediatric fever. As a parent you fall into one of two categories, either you are totally clueless and have no idea even how you keep getting pregnant, OR you are interested and engaged in the development of your child and can easily spot problems as they occur in your child's health.
Parent A...when your child has a fever, by all means bring the creature to the ER and let us take a look at him when he has a fever. You may know you are parent A because you don't have a thermometer or Tylenol in the house anyway.
Parent B, your child has all his or her immunizations up to date and at the first sniffle, you basically panic and start calling your pediatrician. He, of course tells you to bring the child into the ER. That's his job, covering his ass.
Let me first interrupt your panic and ask you to do a couple of things. First remember that the fever is your body's way of killing germs. It's turning up the oven in the hopes that some of the virus or bacteria will die off with the change in environment while it mounts a more concerted attack on the interloper. Kinda' like what the earth is doing to humans now.
Having a fever isn't exactly a bad thing, it just takes a lot of your kid's constitution to throw one. So we want to first find out how high it is. You have probably three different thermometers in the house. Use the digital one that goes in the bottom. Don't bother with the ear one. Don't put it under your child's armpit. Lubricate it and stick it about an inch and a half up his little butt. Here we are assuming a child under say about 4 who can't take a thermometer in his mouth yet. If you child is older and can sit still for an oral temperature then that will do fine.
If the temperature is under 101.5 and isn't accompanied by any symptoms scarier than a runny nose, you can take a watchful waiting approach. Ask for the next available appointment and cancel it if the kid gets better. The most common diagnosis by far is the URI or upper respiratory infection. It is caused by a virus. Your body does a fairly good job of fighting off viruses all by itself. Medical science does a fairly poor job of fighting viruses. Antibiotics don't work for viruses and that's about all medicine has to offer except bloodletting so lets just keep an eye on the kid for a day and see what happens.
Runny nose, sore throat (when the child is able to take fluids), cough, and congestion are the hallmarks of the URI and treatment is limited to Tylenol for the fever when it's over 101.5. Cold concoctions are of dubious benefit at best in the pediatric URI. Say you have a virus in your nose. Your body reacts by turning on the nose spigot to decrease the amount of virus in that area while it makes antibodies to fight this particular virus. Giving a medicine to stop the runny nose is counterproductive.
So what we have is a mild cold, your kid is eating, drinking, peeing, and pooping. He's able to go about his duties. You can give Tylenol every four hours or Motrin every six and soldier on. Your body takes two weeks to fight off a virus. Deal with it. Generally there are 4 days of increasing symptoms then 10 days of spotty recovery that ends when the runny nose and fever are gone.
Ear aches often accompany the URI for reasons that are physiological to the anatomy of children. An earache can be the most exquisitely painful thing. This is, in my opinion, a good reason for an ER visit if the kid doesn't respond to Tylenol or Motrin. Some other good reasons are vomiting more than once, swollen lymph nodes, lethargy, fever uncontrolled by Tylenol, not wetting diapers, sunken eyes, neck pain, barking cough, difficulty breathing, rash, or diarrhea. The dirty dozen, if you will.
So your child has a fever greater than 101.5. First thing is fever control. When your body has a fever, is it too cold or too hot? If you answered too hot, you are correct. When your body is too hot, it has no sensation of the increased temperature, only that the difference between the outside temperature and the inside temperature has increased, thus leading to the phenomenon of chills. Your body is hot but you feel cold because the normal room temperature has, to your body's senses, dropped. Resist the temptation to dress up your child in layer upon layer of clothing topped off with her Dora the Explorer viscose blanket. This will inevitably lead to problems. Once the fever goes away, the chills will too. This usually takes about 20 minutes after you give the tylenol.
Strip the kid down to nothing but a diaper and give the Tylenol. The danger is not the fever. The danger is in the fever climbing too rapidly. This leads to the febrile seizure. The febrile seizure is a terrifying thing for a parent to witness. While it's generally well tolerated by the child, the parent's don't cope too well. Once the fever comes down the seizure activity is gone and leaves behind no trace. The parents, however are scarred for life.
Your kid's temperature has climbed to 101. 5 or greater (I usually don't get too excited about pediatric fevers until they go over 103 so don't panic yet), you've stripped her down and given her Tylenol at 15mg per kilogram (take her weight in pounds and divide it by 2.2 to get kilograms). NOW it's time to take a breath and make an assessment. Does the kid have any of the dirty dozen? If so it's time to go to the emergency department. If not, you fall back to watchful waiting while you make the next available appointment with her doctor. If she gets better before the appointment, you cancel. If she gets worse, you trade up to the ER visit.
Remember that Tylenol last for 4 hours. It does nothing other than control the fever. In my whole career I've never seen Tylenol fail to work when given at 15mg per kilogram, never. After four hours, what are you going to do? Yes, you are right, give Tylenol again.
The third thing you are going to do after stripping the child down and giving Tylenol is to encourage her to drink fluids. Fluids don't mean soda. You can give juice that has been watered down but you already know that. Juices contain more sugar than there is water to process it so they lead to further dehydration, don't they? Best to give Pedialyte or Gatorade and water.
You can use the tepid bath if the fever has climbed so high you are having difficulty controlling it quickly. However, if you are having to use the tepid bath you would probably be better served by a trip to the ER, AFTER you strip the child down and give Tylenol. It's better to sit in the triage chair with a kid with no fever than to run in in a panic with a seizing child. Trust me here.
Now all this is assuming that your child is up to date with her immunizations. Shots, shots, shots, they are THE most important thing you can do to raise a healthy child.
Parent A, I know your child has a fever because she is wrapped up in every layer of clothing she has and is topped off with a blanket. Also you don't have so much as a diaper or a sippy cup of water for her while she waits with her untreated fever in the ER lobby. I feel sorry for your children. I wish you worked at a condom factory.
As an ER nurse, the most common complaint I deal with during the cold and flu season is the pediatric fever. It seems to be an evolutionary imperative for children to build their immune systems by exposing themselves to disease.
They do this by picking their nose and eating it, ignoring the five second rule, poor hand hygiene, swapping spit balls, and basically anything else that as an adult, we would never do.
Last week I saw a two year old running his matchbox car across the ER floor then happily dipping it in his apple juice and sucking on it again and again. His parents observed this behavior but thought nothing of it...Alas.
George Carlin once said, "Parenting, now that's a tough job...easy one to get, though."
This brings us to the pediatric fever. As a parent you fall into one of two categories, either you are totally clueless and have no idea even how you keep getting pregnant, OR you are interested and engaged in the development of your child and can easily spot problems as they occur in your child's health.
Parent A...when your child has a fever, by all means bring the creature to the ER and let us take a look at him when he has a fever. You may know you are parent A because you don't have a thermometer or Tylenol in the house anyway.
Parent B, your child has all his or her immunizations up to date and at the first sniffle, you basically panic and start calling your pediatrician. He, of course tells you to bring the child into the ER. That's his job, covering his ass.
Let me first interrupt your panic and ask you to do a couple of things. First remember that the fever is your body's way of killing germs. It's turning up the oven in the hopes that some of the virus or bacteria will die off with the change in environment while it mounts a more concerted attack on the interloper. Kinda' like what the earth is doing to humans now.
Having a fever isn't exactly a bad thing, it just takes a lot of your kid's constitution to throw one. So we want to first find out how high it is. You have probably three different thermometers in the house. Use the digital one that goes in the bottom. Don't bother with the ear one. Don't put it under your child's armpit. Lubricate it and stick it about an inch and a half up his little butt. Here we are assuming a child under say about 4 who can't take a thermometer in his mouth yet. If you child is older and can sit still for an oral temperature then that will do fine.
If the temperature is under 101.5 and isn't accompanied by any symptoms scarier than a runny nose, you can take a watchful waiting approach. Ask for the next available appointment and cancel it if the kid gets better. The most common diagnosis by far is the URI or upper respiratory infection. It is caused by a virus. Your body does a fairly good job of fighting off viruses all by itself. Medical science does a fairly poor job of fighting viruses. Antibiotics don't work for viruses and that's about all medicine has to offer except bloodletting so lets just keep an eye on the kid for a day and see what happens.
Runny nose, sore throat (when the child is able to take fluids), cough, and congestion are the hallmarks of the URI and treatment is limited to Tylenol for the fever when it's over 101.5. Cold concoctions are of dubious benefit at best in the pediatric URI. Say you have a virus in your nose. Your body reacts by turning on the nose spigot to decrease the amount of virus in that area while it makes antibodies to fight this particular virus. Giving a medicine to stop the runny nose is counterproductive.
So what we have is a mild cold, your kid is eating, drinking, peeing, and pooping. He's able to go about his duties. You can give Tylenol every four hours or Motrin every six and soldier on. Your body takes two weeks to fight off a virus. Deal with it. Generally there are 4 days of increasing symptoms then 10 days of spotty recovery that ends when the runny nose and fever are gone.
Ear aches often accompany the URI for reasons that are physiological to the anatomy of children. An earache can be the most exquisitely painful thing. This is, in my opinion, a good reason for an ER visit if the kid doesn't respond to Tylenol or Motrin. Some other good reasons are vomiting more than once, swollen lymph nodes, lethargy, fever uncontrolled by Tylenol, not wetting diapers, sunken eyes, neck pain, barking cough, difficulty breathing, rash, or diarrhea. The dirty dozen, if you will.
So your child has a fever greater than 101.5. First thing is fever control. When your body has a fever, is it too cold or too hot? If you answered too hot, you are correct. When your body is too hot, it has no sensation of the increased temperature, only that the difference between the outside temperature and the inside temperature has increased, thus leading to the phenomenon of chills. Your body is hot but you feel cold because the normal room temperature has, to your body's senses, dropped. Resist the temptation to dress up your child in layer upon layer of clothing topped off with her Dora the Explorer viscose blanket. This will inevitably lead to problems. Once the fever goes away, the chills will too. This usually takes about 20 minutes after you give the tylenol.
Strip the kid down to nothing but a diaper and give the Tylenol. The danger is not the fever. The danger is in the fever climbing too rapidly. This leads to the febrile seizure. The febrile seizure is a terrifying thing for a parent to witness. While it's generally well tolerated by the child, the parent's don't cope too well. Once the fever comes down the seizure activity is gone and leaves behind no trace. The parents, however are scarred for life.
Your kid's temperature has climbed to 101. 5 or greater (I usually don't get too excited about pediatric fevers until they go over 103 so don't panic yet), you've stripped her down and given her Tylenol at 15mg per kilogram (take her weight in pounds and divide it by 2.2 to get kilograms). NOW it's time to take a breath and make an assessment. Does the kid have any of the dirty dozen? If so it's time to go to the emergency department. If not, you fall back to watchful waiting while you make the next available appointment with her doctor. If she gets better before the appointment, you cancel. If she gets worse, you trade up to the ER visit.
Remember that Tylenol last for 4 hours. It does nothing other than control the fever. In my whole career I've never seen Tylenol fail to work when given at 15mg per kilogram, never. After four hours, what are you going to do? Yes, you are right, give Tylenol again.
The third thing you are going to do after stripping the child down and giving Tylenol is to encourage her to drink fluids. Fluids don't mean soda. You can give juice that has been watered down but you already know that. Juices contain more sugar than there is water to process it so they lead to further dehydration, don't they? Best to give Pedialyte or Gatorade and water.
You can use the tepid bath if the fever has climbed so high you are having difficulty controlling it quickly. However, if you are having to use the tepid bath you would probably be better served by a trip to the ER, AFTER you strip the child down and give Tylenol. It's better to sit in the triage chair with a kid with no fever than to run in in a panic with a seizing child. Trust me here.
Now all this is assuming that your child is up to date with her immunizations. Shots, shots, shots, they are THE most important thing you can do to raise a healthy child.
Parent A, I know your child has a fever because she is wrapped up in every layer of clothing she has and is topped off with a blanket. Also you don't have so much as a diaper or a sippy cup of water for her while she waits with her untreated fever in the ER lobby. I feel sorry for your children. I wish you worked at a condom factory.
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