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When Is a Fever an Emergency?

While for the majority of children fever is not an emergency- there are a certain group of children that fever is considered dangerous. Think of the Three I’s

Think of the Three I’s

  • Immune compromised– children that do not have a well working immune system cannot fight off infection and therefore when they have fever they need to see their healthcare professional immediately
  • Immunization– babies less than two months of age are at higher risk for bacterial infection and if your child has not had his 2-month vaccines and has a temperature over 100 degrees rectally you should consider this a medical emergency and go directly to the emergency department
  • Intake– having a fever WILL make your child uncomfortable- especially if it is over 102.  Often this leads to poor drinking and if your child cannot drink enough they may become dehydrated. If you think your child might be dehydrated due to fever then bring them to see the doctor immediately.

Fever is Good – Most of the Time

For parents, doctors and pharmacy companies, fever has been thought to be “the enemy”. We should be scared of fever and make it go away as fast as possible. This may be a very dangerous idea for the following reasons.

Fever Facts

  • All animals, even single cell organisms, have fever. Therefore it is felt to be important in protecting us in some way.
  • Studies show that increasing the body temperature decreases the ability of bacteria to multiply and spread. That gives antibiotics a chance to work faster.
  • Newer studies also show that the increase in body temperature activates a special kind of white blood cells- aptly named “killer T cells”. The activation of these killers means that your body can fight virus infections better and may be the only “treatment” needed for getting rid of the most common form of infection.

Therefore- not letting your body have a fever when you have an infection may actually make the virus last longer and take the antibiotics longer to work for bacteria infections.

Fever Phobia

In 1980, Pediatrician  Dr. Barton Schmitt created the term “Fever Phobia” to describe the misconceptions that many parents and physicians have regarding fever. Since that initial study, many other researchers have looked at how parents react to a child with fever. Most all studies show that the majority of parents do not understand key concepts related to fever, such as what defines a fever, how dangerous is a fever and how should fever be treated.

Throughout the month of September, The Children’s Clinic will be providing daily information for parents about what defines a fever and how to treat fever in children. It is hoped that this factual information will help alleviate the myths and fears that are associated with fever and guide parents on when to call for an appointment and when to be concerned if their child develops fever.

Mouth Problems

What is Thrush?

Thrush is a yeast infection of young children which causes fever and white patches on the inner surface of the lips, gums and throat. It lasts a few days and can be uncomfortable for your child.

Treatment

  1. Encourage fluids to ensure that your child stays well hydrated. Try to avoid carbonated beverages or fruit juices which will worsen discomfort. Milk, ice cream, pop-sickles and Jello are all good choices.
  2. Your doctor may need to evaluate and treat this problem.

For mouth injuries, see Teeth section.

Leg & Arm Problems

If your child refuses to use his/her arm or leg completely, you should contact your physician. A limping child who has no fever and is not in much pain should be evaluated if the limp has failed to disappear after 24 hours. Of course, any swelling, redness or pain in the joint, associated with fever, is a cause for immediate concern and the physician should be notified.

In-toeing and out-toeing when a youngster walks is a common problem and should be discussed at a routine check-up visit.

Colds

 

At some time or another, every baby and child is going to catch cold.  Colds are caused by viruses and are usually spread person-to-person from the infected nose or throat.  Colds usually begin with a watery discharge from the nose accompanied by sneezing and watery eyes.  The child can also develop fever, cough and a sore throat.  Usually, the cough and sore throat are not particularly severe.  The child may run fever for two or three days.  As a cold progresses the nasal drainage often becomes thicker and may turn yellow or green.  This may be the final stage in the resolution of a cold and no additional treatment is needed for several days if your child is otherwise doing well.  So far, there is no cure for the common cold.  Since the infection is due to a virus, antibiotics are not helpful.  Treatment of colds is aimed at relieving symptoms and keeping the body well hydrated and nourished so that it can fight off the infection.

Treatment

  1. Get plenty of rest.
  2. Encourage plenty of fluids, especially clear liquids.  This will keep the mucus thin and prevent dehydration.
  3. Encourage your child to eat nutritious foods.
  4. Use Acetaminophen (Tempra, Tylenol) for fever and/or aches (see Dosing Guide).
  5. Saline nose drops (AYR, Salinex, Ocean) are quite helpful when placed in the nose to loosen the mucus.  You should put two or three drops in each nostril, wait a minute or so and then suction the nose with a nasal aspirator (bulb syringe) as often as needed.  Saline nose drops are particularly helpful for very small children who are unable to blow their noses.
  6. Sometimes for older infants and children, nasal decongestants and cough/cold preparations can be helpful.  If your child is less than 6 months of age, consult your doctor before using these.

You Should Make an Appointment With Your Doctor…

  • If the nasal drainage persists after the usual 7-10 days of a cold and seems to become thicker and greenish in color.
  • If the cough becomes particularly severe and is associated with a high fever above 102 degrees F.
  • If your child seems to “keep a cold” year around, your child may be allergic and should be checked.
  • If your child’s temperature persists over 101 degrees F for more than three days.
  • If your child’s sore throat is particularly severe.
  • If your child develops ear pain.

Do not start any left-over antibiotic prescriptions, as these drugs do not cure the common cold and can cause more harm than good.

Chickenpox (Varicella)

 

Symptoms

Chickenpox is a common viral infection of childhood. After an incubation period of 10 to 21 days, a child will break out with a rash which begins as small red bumps and which very quickly form clear blisters. The clear blisters then rupture and form dark crusts. These three lesions occur in sequence. Lesions generally begin on the chest or back and then spread to the face, neck, arms, and legs. Children usually run fever for several days. In addition to this, they may have a runny nose, sore throat and/or cough. Chickenpox is highly contagious. The child is contagious one day to two days prior to breaking out with the rash and remains contagious until all lesions have completely crusted over and there are no blisters or fever. This generally takes five to seven days from the onset of the rash. You can usually expect the child will break out with new lesions for two or three days after the first lesion is seen.

Complications

Chickenpox is generally a mild illness with no complications.  If complications do occur, the most common one is secondary bacterial infection of the lesions manifested by redness and/or discharge of pus.  You treat these as you would treat impetigo (see section on impetigo).  Serious chickenpox complications are very rare. These involve pneumonia and encephalitis. Signs of encephalitis include headache, stiff neck, vomiting and lethargy (drowsiness to unconsciousness).  If your child should become lethargic and begin vomiting, contact your doctor right away.

Shingles

Shingles is a reactivation of chickenpox infection and is usually seen in adults. People with active shingles are contagious and can spread the chickenpox virus to others who have not had chickenpox.  You can catch chickenpox from someone with shingles, but you cannot catch shingles from someone else. Shingles only occurs in someone who has had chickenpox at an earlier time in their life.  Parents and grandparents do not need to worry about catching shingles from their children with chickenpox.  Shingles is treated the same as chickenpox unless the child develops painful shingles which should prompt a physician contact.  Shingles is spread by direct contact with the lesions.  Keeping them covered with clothing or a gauze pad will help to prevent spread of the disease.

Treatment

  1. Keep your child away from other children or adults who haven’t had chickenpox and from pregnant patients or patients receiving chemotherapy. Although chickenpox is usually a mild illness in children, it can be quite severe in adults.  If you are unsure as to whether you have had chickenpox and your child catches the disease or has been exposed to someone with the disease, you need to let your physician know.
  2. Use an antihistamine such as Benadryl for itching and trim the child’s fingernails.  If itching is quite severe, even with Benadryl, try Aveeno baths and an emollient lotion (Do not use Benadryl Cream).
  3. For fever and the discomfort of chickenpox you may use acetaminophen (Tempra, Tylenol; see Dosing Guide) if your child is uncomfortable.  Aspirin should be avoided because of the potential for Reye’s syndrome.  Fever is actually beneficial in chickenpox and should not be treated if your child is comfortable.
  4. The child is contagious for about a week after the onset of the rash or until all sores have crusted over and have begun to dry.
  5. It is not recommended that you expose your child to chickenpox in order to get the disease.
  6. It is not recommended that aspirin be routinely used for chicken pox or fever in children.

Prevention

Varivax (live attenuated chickenpox vaccine) is now available and recommended for all children 12 months or older who have not yet had chickenpox. More details about this immunization are presented in the immunization section of this handbook. Your child’s physician can also discuss Varivax with you.

 

Bites

Dogs or Other Domestic Animal Bites

Any animal bite that breaks the skin requires two types of management. The first is local wound care. If the wound is minor, it should be thoroughly cleansed with soap and water, and then Neosporin ointment applied. The wound should be carefully watched for signs of secondary infection (pain, swelling, redness, red streaks, fever, discharge). If these symptoms should occur or if the wound is more extensive, then contact your physician.

The second part of management of animal bites involves the prevention of rabies from the bite exposure. If the animal is well known and has been vaccinated against rabies, there is little chance that your child will catch this disease. The offending animal should be kept confined ten days and observed. If the animal is healthy at the end of ten days, the child has no need for rabies prevention. If, however, your child is bitten by a stray or wild animal, an animal which cannot be found or an animal that subsequently dies, it is very important to bring this to your physician’s attention immediately. As with any other wound, it is important that the child be up-to-date with their immunization to tetanus. After an animal bite or other dirty wound, a tetanus immunization is required if the child has not had one in the past five years. If your child is not up-to-date and they suffer a wound, you should contact your physician during regular office hours.

Human Bites

Human bites should be treated like domestic animal bites.

Insect Bites and Stings

Most insect bites and stings are not dangerous unless the child is severely allergic to a particular bite or sting.

Treatment

  • If the stinger is present, remove it with a horizontal scraping motion.
  • Place a cold compress on the bite for several minutes to reduce swelling and redness of the bite or sting. Some redness and swelling are to be expected. You should contact your doctor if this becomes severe.
  • Treat with Benadryl elixir (per package instructions; for dosing for children less than 6 years of age please contact physician for dosing instructions.) and/or a paste of baking soda and water to relieve the symptoms.
  • Apply 0.5% Hydrocortisone ointment or cream to the area to help with further itching. This is available without prescription.
  • Call your physician for any difficulty in breathing.
  • Use Acetaminophen (Tempra, Tylenol) for pain. (see Dosing Guide).

Snake Bites

Non-poisonous snake bites are the same as bites from a dog or other domestic animal. Reptile bites do not cause rabies. If a child has been bitten by a poisonous snake, they should be taken immediately to the nearest hospital. You should make no effort to treat this yourself. Cutting the wound, oral suction, suction from snake bite kits, compresses, tourniquets, etc., are no longer recommended for poisonous snake bites.

Tick Bites

Most tick bites are harmless, but ticks are potential carriers for three serious diseases: Rocky Mountain Spotted Fever, Ehrlichia, Tularemia, and Lyme Disease. All three infections involve a 5 to 10 day incubation period followed by fever, muscle aches and headache. Tularemia (rabbit fever) causes swollen tender lymph nodes in areas near the tick bite. Rocky Mountain Spotted Fever and Lyme Disease can involve characteristic rashes over the entire body, but these vary greatly. If your child has a history of tick bites with any of these symptoms, it is important that they be seen by their physician. If a tick is found, it can be removed with tweezers, grasping the tick nearest the mouth and pulling it straight out with steady pressure, followed by a soap and water scrub. It is common for a small crusty sore to remain at the site for several days. This is not an indicator of severe disease. The tick-borne diseases are much less likely to occur if a tick is removed within 24 hours of imbedding.

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When Is a Fever an Emergency?

While for the majority of children fever is not an emergency- there are a certain group of children that fever is considered dangerous. Think of the Three I’s

Think of the Three I’s

  • Immune compromised– children that do not have a well working immune system cannot fight off infection and therefore when they have fever they need to see their healthcare professional immediately
  • Immunization– babies less than two months of age are at higher risk for bacterial infection and if your child has not had his 2-month vaccines and has a temperature over 100 degrees rectally you should consider this a medical emergency and go directly to the emergency department
  • Intake– having a fever WILL make your child uncomfortable- especially if it is over 102.  Often this leads to poor drinking and if your child cannot drink enough they may become dehydrated. If you think your child might be dehydrated due to fever then bring them to see the doctor immediately.

Fever is Good – Most of the Time

For parents, doctors and pharmacy companies, fever has been thought to be “the enemy”. We should be scared of fever and make it go away as fast as possible. This may be a very dangerous idea for the following reasons.

Fever Facts

  • All animals, even single cell organisms, have fever. Therefore it is felt to be important in protecting us in some way.
  • Studies show that increasing the body temperature decreases the ability of bacteria to multiply and spread. That gives antibiotics a chance to work faster.
  • Newer studies also show that the increase in body temperature activates a special kind of white blood cells- aptly named “killer T cells”. The activation of these killers means that your body can fight virus infections better and may be the only “treatment” needed for getting rid of the most common form of infection.

Therefore- not letting your body have a fever when you have an infection may actually make the virus last longer and take the antibiotics longer to work for bacteria infections.

Fever Phobia

In 1980, Pediatrician  Dr. Barton Schmitt created the term “Fever Phobia” to describe the misconceptions that many parents and physicians have regarding fever. Since that initial study, many other researchers have looked at how parents react to a child with fever. Most all studies show that the majority of parents do not understand key concepts related to fever, such as what defines a fever, how dangerous is a fever and how should fever be treated.

Throughout the month of September, The Children’s Clinic will be providing daily information for parents about what defines a fever and how to treat fever in children. It is hoped that this factual information will help alleviate the myths and fears that are associated with fever and guide parents on when to call for an appointment and when to be concerned if their child develops fever.

Mouth Problems

What is Thrush?

Thrush is a yeast infection of young children which causes fever and white patches on the inner surface of the lips, gums and throat. It lasts a few days and can be uncomfortable for your child.

Treatment

  1. Encourage fluids to ensure that your child stays well hydrated. Try to avoid carbonated beverages or fruit juices which will worsen discomfort. Milk, ice cream, pop-sickles and Jello are all good choices.
  2. Your doctor may need to evaluate and treat this problem.

For mouth injuries, see Teeth section.

Leg & Arm Problems

If your child refuses to use his/her arm or leg completely, you should contact your physician. A limping child who has no fever and is not in much pain should be evaluated if the limp has failed to disappear after 24 hours. Of course, any swelling, redness or pain in the joint, associated with fever, is a cause for immediate concern and the physician should be notified.

In-toeing and out-toeing when a youngster walks is a common problem and should be discussed at a routine check-up visit.

Colds

 

At some time or another, every baby and child is going to catch cold.  Colds are caused by viruses and are usually spread person-to-person from the infected nose or throat.  Colds usually begin with a watery discharge from the nose accompanied by sneezing and watery eyes.  The child can also develop fever, cough and a sore throat.  Usually, the cough and sore throat are not particularly severe.  The child may run fever for two or three days.  As a cold progresses the nasal drainage often becomes thicker and may turn yellow or green.  This may be the final stage in the resolution of a cold and no additional treatment is needed for several days if your child is otherwise doing well.  So far, there is no cure for the common cold.  Since the infection is due to a virus, antibiotics are not helpful.  Treatment of colds is aimed at relieving symptoms and keeping the body well hydrated and nourished so that it can fight off the infection.

Treatment

  1. Get plenty of rest.
  2. Encourage plenty of fluids, especially clear liquids.  This will keep the mucus thin and prevent dehydration.
  3. Encourage your child to eat nutritious foods.
  4. Use Acetaminophen (Tempra, Tylenol) for fever and/or aches (see Dosing Guide).
  5. Saline nose drops (AYR, Salinex, Ocean) are quite helpful when placed in the nose to loosen the mucus.  You should put two or three drops in each nostril, wait a minute or so and then suction the nose with a nasal aspirator (bulb syringe) as often as needed.  Saline nose drops are particularly helpful for very small children who are unable to blow their noses.
  6. Sometimes for older infants and children, nasal decongestants and cough/cold preparations can be helpful.  If your child is less than 6 months of age, consult your doctor before using these.

You Should Make an Appointment With Your Doctor…

  • If the nasal drainage persists after the usual 7-10 days of a cold and seems to become thicker and greenish in color.
  • If the cough becomes particularly severe and is associated with a high fever above 102 degrees F.
  • If your child seems to “keep a cold” year around, your child may be allergic and should be checked.
  • If your child’s temperature persists over 101 degrees F for more than three days.
  • If your child’s sore throat is particularly severe.
  • If your child develops ear pain.

Do not start any left-over antibiotic prescriptions, as these drugs do not cure the common cold and can cause more harm than good.

Chickenpox (Varicella)

 

Symptoms

Chickenpox is a common viral infection of childhood. After an incubation period of 10 to 21 days, a child will break out with a rash which begins as small red bumps and which very quickly form clear blisters. The clear blisters then rupture and form dark crusts. These three lesions occur in sequence. Lesions generally begin on the chest or back and then spread to the face, neck, arms, and legs. Children usually run fever for several days. In addition to this, they may have a runny nose, sore throat and/or cough. Chickenpox is highly contagious. The child is contagious one day to two days prior to breaking out with the rash and remains contagious until all lesions have completely crusted over and there are no blisters or fever. This generally takes five to seven days from the onset of the rash. You can usually expect the child will break out with new lesions for two or three days after the first lesion is seen.

Complications

Chickenpox is generally a mild illness with no complications.  If complications do occur, the most common one is secondary bacterial infection of the lesions manifested by redness and/or discharge of pus.  You treat these as you would treat impetigo (see section on impetigo).  Serious chickenpox complications are very rare. These involve pneumonia and encephalitis. Signs of encephalitis include headache, stiff neck, vomiting and lethargy (drowsiness to unconsciousness).  If your child should become lethargic and begin vomiting, contact your doctor right away.

Shingles

Shingles is a reactivation of chickenpox infection and is usually seen in adults. People with active shingles are contagious and can spread the chickenpox virus to others who have not had chickenpox.  You can catch chickenpox from someone with shingles, but you cannot catch shingles from someone else. Shingles only occurs in someone who has had chickenpox at an earlier time in their life.  Parents and grandparents do not need to worry about catching shingles from their children with chickenpox.  Shingles is treated the same as chickenpox unless the child develops painful shingles which should prompt a physician contact.  Shingles is spread by direct contact with the lesions.  Keeping them covered with clothing or a gauze pad will help to prevent spread of the disease.

Treatment

  1. Keep your child away from other children or adults who haven’t had chickenpox and from pregnant patients or patients receiving chemotherapy. Although chickenpox is usually a mild illness in children, it can be quite severe in adults.  If you are unsure as to whether you have had chickenpox and your child catches the disease or has been exposed to someone with the disease, you need to let your physician know.
  2. Use an antihistamine such as Benadryl for itching and trim the child’s fingernails.  If itching is quite severe, even with Benadryl, try Aveeno baths and an emollient lotion (Do not use Benadryl Cream).
  3. For fever and the discomfort of chickenpox you may use acetaminophen (Tempra, Tylenol; see Dosing Guide) if your child is uncomfortable.  Aspirin should be avoided because of the potential for Reye’s syndrome.  Fever is actually beneficial in chickenpox and should not be treated if your child is comfortable.
  4. The child is contagious for about a week after the onset of the rash or until all sores have crusted over and have begun to dry.
  5. It is not recommended that you expose your child to chickenpox in order to get the disease.
  6. It is not recommended that aspirin be routinely used for chicken pox or fever in children.

Prevention

Varivax (live attenuated chickenpox vaccine) is now available and recommended for all children 12 months or older who have not yet had chickenpox. More details about this immunization are presented in the immunization section of this handbook. Your child’s physician can also discuss Varivax with you.

 

Bites

Dogs or Other Domestic Animal Bites

Any animal bite that breaks the skin requires two types of management. The first is local wound care. If the wound is minor, it should be thoroughly cleansed with soap and water, and then Neosporin ointment applied. The wound should be carefully watched for signs of secondary infection (pain, swelling, redness, red streaks, fever, discharge). If these symptoms should occur or if the wound is more extensive, then contact your physician.

The second part of management of animal bites involves the prevention of rabies from the bite exposure. If the animal is well known and has been vaccinated against rabies, there is little chance that your child will catch this disease. The offending animal should be kept confined ten days and observed. If the animal is healthy at the end of ten days, the child has no need for rabies prevention. If, however, your child is bitten by a stray or wild animal, an animal which cannot be found or an animal that subsequently dies, it is very important to bring this to your physician’s attention immediately. As with any other wound, it is important that the child be up-to-date with their immunization to tetanus. After an animal bite or other dirty wound, a tetanus immunization is required if the child has not had one in the past five years. If your child is not up-to-date and they suffer a wound, you should contact your physician during regular office hours.

Human Bites

Human bites should be treated like domestic animal bites.

Insect Bites and Stings

Most insect bites and stings are not dangerous unless the child is severely allergic to a particular bite or sting.

Treatment

  • If the stinger is present, remove it with a horizontal scraping motion.
  • Place a cold compress on the bite for several minutes to reduce swelling and redness of the bite or sting. Some redness and swelling are to be expected. You should contact your doctor if this becomes severe.
  • Treat with Benadryl elixir (per package instructions; for dosing for children less than 6 years of age please contact physician for dosing instructions.) and/or a paste of baking soda and water to relieve the symptoms.
  • Apply 0.5% Hydrocortisone ointment or cream to the area to help with further itching. This is available without prescription.
  • Call your physician for any difficulty in breathing.
  • Use Acetaminophen (Tempra, Tylenol) for pain. (see Dosing Guide).

Snake Bites

Non-poisonous snake bites are the same as bites from a dog or other domestic animal. Reptile bites do not cause rabies. If a child has been bitten by a poisonous snake, they should be taken immediately to the nearest hospital. You should make no effort to treat this yourself. Cutting the wound, oral suction, suction from snake bite kits, compresses, tourniquets, etc., are no longer recommended for poisonous snake bites.

Tick Bites

Most tick bites are harmless, but ticks are potential carriers for three serious diseases: Rocky Mountain Spotted Fever, Ehrlichia, Tularemia, and Lyme Disease. All three infections involve a 5 to 10 day incubation period followed by fever, muscle aches and headache. Tularemia (rabbit fever) causes swollen tender lymph nodes in areas near the tick bite. Rocky Mountain Spotted Fever and Lyme Disease can involve characteristic rashes over the entire body, but these vary greatly. If your child has a history of tick bites with any of these symptoms, it is important that they be seen by their physician. If a tick is found, it can be removed with tweezers, grasping the tick nearest the mouth and pulling it straight out with steady pressure, followed by a soap and water scrub. It is common for a small crusty sore to remain at the site for several days. This is not an indicator of severe disease. The tick-borne diseases are much less likely to occur if a tick is removed within 24 hours of imbedding.