Friday, June 5, 2015

Fever facts

I am taking a break from my sleep series because we have seen an unusual amount of fevers circulating for early June, It is time to brush off and update my fever post.
Fevers tend to get parents very worried, but those who attended my illness class know that they are only one factor to consider when evaluating a sick child. I am always more interested in your child's overall mood and behavior than I am in any specific number on a thermometer. Kids get fevers. An adult with a high fever is more of a concern.

There are many methods out there for measuring a body temperature. I personally don't feel the need to invest in any expensive thermometers. I am generally quite satisfied with a digital underarm reading. The important thing is that however you take it, your thermometer seems accurate. Test it on yourself or other family members and take your child's temp when they are healthy to make sure you trust it. I  don't have a favorite brand.

If you have one of the new ear or temporal scanning units feel free to keep using that. Sometimes their "high" readings seem a little higher than I believe to be accurate; don't ever let a number freak you out.

Temperatures can be measured in either Fahrenheit or Celsius
Here is a quick conversion chart that might come in handy.

98.6 F=37 C

For this post, I will be referring to the temperatures on the Fahrenheit scale.

For any child older than 3 months
 As long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so. 

One of the most common questions that our advice nurse team gets is, "When do I need to worry about a fever?" As I mentioned, I am much more concerned about the lethargic, whimpering child who has a normal body temperature than I am the singing child with 104. But, here is the
Nurse Judy's rule about fevers:

If the fever is over 102 (it doesn't matter how you measure, just be consistent):

*Treat with proper dose of Acetaminophen or Ibuprofen

*Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck

*Get them drinking. Little sips at a time are fine. Popsicle s and ice-chips are good for older kids

*re-check the temp in 45-60 minutes

If it is STILL over 102 and hasn't budged at all, that is a fever that I am concerned about.
It is time to get your child seen.

When children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky. When fevers are breaking it is common to have lots of sweating.
Children with fevers may have a higher respiration and pulse rate.

One of the more frightening aspects of a fever can be a febrile seizure.  About 4% of children will have these. Febrile seizures can be terrifying to watch, but they usually stop within 5 minutes. They cause no permanent harm. Trust me, if you have never heard of this, watching your child have a seizure has been reported as the scariest experience EVER.
Knowing that that they do happen once in a while and are generally harmless should help keep you from freaking out. If your child is having a seizure they may have large jerky motions and their eyes may roll back. Your job is to stay calm. Make sure their airway is open. It is perfectly reasonable to call 911.

Once your child has had even one febrile seizure we tend to be more aggressive with fever control and will treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with. Most kids grow out of the seizures by the time they are 5 years old.

If the fever is accompanied by a very fussy child, I want them seen so that we can figure out what is going on.

Even if your child is acting just fine, if a fever lasts for more than 3 days, I consider it time to have a look so that we can make sure there isn't an infection source (like ear infection, urinary tract infection, strep throat or pneumonia.) Any fever that comes along with a purplish rash could be an emergency (this is not the singing child. They would look alarmingly ill.)

During flu season, we sometimes do see a fever that lasts for five days or longer. If there is a classic virus going around that I am seeing a lot of, I will occasionally relax my "3 day rule". If the kids seems like they are 'managing' (drinking, peeing, easy breathing, consolable, fever responds to medications) I am okay watching them for another couple of days.

This particular illness that we are seeing does have 4-5 days of fairly high fevers.  A small group of these have ended up with respiratory infections that did need to be treated, so my 3 day rule is staying in effect.

Many viral syndromes "wave goodbye" with a rash. Roseola is a classic example.

If your infant is under 8 weeks of age we want to be notified of any fevers!
However, there are a few common causes: 

*over bundling....
Seriously, sometimes the babies come in with 10 blankets wrapped around them. Please don't do that. The best rule of thumb is giving them one layer more than you are wearing. If your baby was indeed over bundled, get some of those layers off and re-check the temp in about 10 minutes to see if they have cooled down. 

..Sometimes if moms milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper. More often than not the elevated temperature will normalize fairly quickly from some fluids. 

If there is no obvious cause for an elevated temperature, and it doesn't resolve within 30 minutes your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician.

Some fever facts:

*Fevers turn on the body immune system. They are one of our body's protective mechanisms
*Many fevers can actually help the body fight infection.
*Fevers that are associated with most viral syndromes and infections don't cause brain damage. Our normal brain's thermostat will not allow a fever to go over 105 or 106.
*Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.)

Click here for my blog post about dosages for Tylenol and Advil 

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