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Fever

 

Stay calm, don’t panic! Fever is a sign of illness and not an illness in itself. Fever alone is not dangerous. Contrary to wide belief, fever does not cause brain damage, even high fevers of 105 to 106 degrees F.

What Causes It?

Fever should be viewed as the body’s normal response to fighting infection. Fever is caused by “pyrogens” which are substances released into the blood stream by the body’s white blood cells as they attack invading bacteria or viruses. Thus fever is a normal response of the body to infection. It is interesting that bacteria and viruses are killed more efficiently at higher temperatures. Chickenpox for instance is less severe if the fever is not treated (fewer lesions, less scarring, shorter duration of illness). In addition, with fever the degree of temperature elevation is frequently not related to the severity of the infection. Minor viral infections typically have quite high fevers and, of course, are not serious. Because of these considerations, fever alone should not cause alarm and is almost never an emergency. A much more important aspect of the management of fever is determining if your child has a serious infection as the cause of the fever.

If you feel your child has a fever, take the temperature. For children under three years of age, the rectal temperature is the most accurate and simplest to take. This is done by lubricating the thermometer with petroleum jelly (Vaseline) and inserting it into the child’s rectum approximately one inch. Remove the thermometer after two minutes. Fever is defined as a temperature above 100.5 degrees F taken rectally. The temperature may also be taken under the arm (Axillary) or under the tongue (Oral). The rectal temperature is usually one degree higher than an oral and two degrees higher than an axillary temperature. You should note the actual temperature and report the method used. If you use a tympanic (ear) thermometer and you suspect your child’s temperature is higher than the reading, re-take your child’s temperature either orally or rectally. It is not recommended to use the ear thermometer in children under 6 months of age due to their small ear canals.

Treatment

  • Acetaminophen (Tempra, Tylenol), or Ibuprofen (Advil, Motrin, See Dosing Guide). It is not recommended that aspirin be routinely used for fever in children. Ibuprofen should not be given to children under the age of 6 months.
  • Keep Clothed – Dress your child in loose fitting clothing such as a T-shirt and underwear or a diaper. Do not bundle your child tightly or cover him/her with a blanket because this will only make the temperature rise further.
  • Sponge Bath – Give your child cool liquids to drink. If your child has a high fever which does not respond to the above measures within 30 to 60 minutes, you should lower his/her temperature by giving him/her a sponge bath with lukewarm water. To do this, place your child in a tub of lukewarm water and sponge him/her off thoroughly. Use a cup and pour water over his/her head. This will even be more effective in bringing the temperature down. You can expect your child to shiver very vigorously during the sponge bath. This is no cause for alarm.

Your Child Should See the Doctor When:

  1. Your child has a prolonged fever above 101 degrees F for more than 48 hours. Contact your physician during regular office hours for an appointment.
  2. Your child has fever plus any sign of minor infection such as sore throat, ear ache, pain on urination, cough or mild rash. Contact your physician during regular office hours for an appointment.
  3. More significant problems such as breathing problems, severe headaches, stiff neck, inconsolable irritability, lethargy, seizures, a bruise-like rash, etc., of course, demand prompt attention from your doctor when they occur.
  4. Fever above 100.5 degrees F taken rectally in infants younger than three months is significant even in the absence of other symptoms. This is the only instance of a true emergency with fever as the only sign of illness. The physician should be notified with any infant with fever.

The physician should be notified with any high fever above 104 degrees F which is unresponsive to acetaminophen and sponge baths. If you child’s fever comes down with the above measures, then there is not cause for alarm from the fever.

Bleeding

 

Bleeding From the Navel

Many times in newborns, a small amount of blood is noted on the navel after the cord falls off. As long as the bleeding does not make a spot on clothing larger than a quarter, it is of no significance. The navel should be kept clean with alcohol and the bleeding will usually stop on its own. If after two or three days the bleeding continues to be a problem, contact your physician. Significant bleeding from the navel of an infant is extremely rare. If your child loses enough blood to soak a cloth diaper the size of a quarter, there is redness of the skin surrounding the navel or pus draining from the navel, contact your physician.

Bleeding From a Superficial Wound

Bleeding from an accidental cut or scrape can usually be managed by holding steady pressure over the site with a clean dry cloth. In the case of a deeper cut, the wound should receive immediate medical attention and pressure should be held on the area during transport.

Vaginal Bleeding in the Newborn

Occasionally, because of the effect of the mother’s hormones, infant girls will have a small amount of vaginal bleeding the first few days of life. This will stop spontaneously and requires no treatment.

Nose Bleeds

Nose bleeds can be caused by dryness of the lining of the nose or by picking or rubbing the nose too vigorously. Allergies or upper respiratory infections may aggravate the problem.

Moisturization of the nasal passages with saline (salt-water) nasal spray on a regular basis can help. Additionally, a child with recurrent nose bleeds can benefit from antibiotic ointment (Polysporin or Vasolene) applied to the inside of the nose with a Q-tip daily for several days.

To stop active nose bleeds, have the child sit up, and pinch the nose together or use an ice pack. After the bleeding stops, do not remove the clot from the nostril, as this may cause the bleeding to start up again. If the bleeding continues for more than ten minutes despite the above measures or if your child suffers chronic nose bleeds, contact your physician.

Rectal Bleeding

Rectal bleeding can be a more serious type of bleeding. Although it can be due to something as simple as a small tear around the rectum, children with any type of rectal bleeding should be checked by your doctor.

Other types of bleeding such as blood in the urine, coughing up blood, wounds that fail to stop bleeding, etc., of course are potentially serious and your doctor should be notified.