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Daily Dose

Coronavirus

1:30 to read

Coronavirus is here…does that cause you concern?  It is causing a lot of concern among mothers in my practice and community as they are posting “my son has coronavirus”. Of course that leads to a Google search and the next thing you know I have parents calling concerned about SARS! (a rare complication).

 

Coronavirus (which is named for the crown like shape of the viral particles under a microscope) is just another fall and winter virus that typically causes cold like symptoms with a scratchy throat, congestion, runny nose and cough. It may also cause several days of fever.  Coronavirus “acts” like many of the other viruses that we are seeing now, including rhinovirus and parainfluenza.

 

While most everyone gets a  coronavirus infection in their lifetime, knowing the name of the virus really doesn’t change anything about the treatment. Having your child’s nose or throat swabbed and sent for a fairly expensive test so that “you may have peace of mind” does not dictate any different treatment than that of any other respiratory virus.  Symptomatic relief has been the advice for treating all of these upper respiratory infections….long before we could test for them in an office setting. 

 

How do you treat it?  Treat the fever if there is one and do not send your child to daycare or school until they have been fever free for 24 hours (you also need to stay home if you have a fever). Use over the counter saline nose drops to help suction your child’s nose or to help thin the mucous so that they can “blow” more effectively. Take a steamy shower to relieve the congestion and loosen the cough. Use a cool mist humidifier in your child’s room (especially if you have the heat running). Make sure to teach your children how to “cough into their elbow” rather than their hands. 

 

I am continuing to hold a lot of hands as parents worry about all of these different respiratory viruses….but naming them is not going to change treatment in the otherwise healthy child. Making sure your child washes their hands and try to teach your older children to keep their hands away from their eyes, nose and mouth will serve you better than worrying about which virus they may have been exposed to. 

 

In the case of any illness, if you become concerned about how your child is breathing and respiratory distress, you need to place an immediate call to your pediatrician or a visit to the ER.  Do not be soconcerned about naming the illness. 

 

 

 

 

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Daily Dose

No More Fever Phobia!

1.30 to read

Parental concerns about children with fever continues to be the primary reason for phone calls to pediatricians offices, visits to the doctor and late night trips to the ER.  The term “fever phobia” is not new and one of the hardest things to “teach” parents is the mantra “fever is your friend”. What?  How can that be?  What if the thermometer reads 103.7 degrees?  Well, the latest report by the American Academy of Pediatrics reiterates that fever phobia is an unnecessary and unfounded worry, as the number on the thermometer is just that, a number, and is not indicative of degree of illness.  In other words, degrees Fahrenheit does not correlate with degree of illness. It is hard not to think that a thermometer that reads 103.7 degrees is not indicative of a life threatening illness. But fever in and of itself is a symptom and not an illness. The body’s reaction to fighting an infection is typically a febrile response, and fever may be a protective mechanism. I spend a lot of time with my patients and their parents discussing fever and what a fever means.  It is hard to discuss a fever in the abstract, and most parents say that they will not “fear a fever”. But, when the actual time arrives and their child has a fever, it is a whole different thing. Despite all of the education about “fever is your friend” the thermometer with 103.7 degrees flashing at you is a scary proposition. Of course it seems reasonable to think your child is” sicker” if their temperature is higher, and I know as a mother and pediatrician, your child does “look pathetic” with a high fever. The fever makes you feel yucky, and your heart rate goes up as does your child’s respiratory rate, this is a body’s normal response to a fever. When you have a higher temperature you don’t feel a lot like eating or playing, you are often happy to just lay on the bed or a couch and watch a movie and eat a popsicle or have a glass of Gatorade. But, taking fluids and watching a movie or quietly reading a book is a good sign that your child is not “too” sick. Young children with a fever are often whiny and pathetic, but they will have moments when they will play, or eat a cookie, and then become pathetic again soon thereafter. That up and down is a good sign. Treating a fever with either acetaminophen or ibuprofen is recommended only to make your child feel better. Treating a fever is not always necessary and some studies show that an illness may resolve sooner if the fever is left untreated. When and if you do decide to treat your child’s fever, make sure that you use the correct dosage of medication, which should be based on a child’s weight. I try to give each family a medication-dosing chart for acetaminophen and ibuprofen at their 2 month visit so that they may tape it inside the medicine cabinet and can refer to it when needed. I promise you there will be many nights of fever to face during the course of parenting!  As you learn to “relax” while reading a thermometer, each illness will become a little easier. Lastly, it is not necessary to awaken a child from a nap or during the night to take their temperature, or treat a fever. An uncomfortable child will wake up and demand your attention.  Fever does not cause “a scrambled brain” (term from a patient of mine), and you will not have caused brain damage if you let your child sleep with a fever. Sleep is usually one of the best treatments for illness, so let a feverish child rest and wait to take their temperature and treat the number on the thermometer. Chant with me “fever is your friend”!!! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Don't Fear A Fever

1.30 to read

Fever......I talk about it every day, even in the summer months, but during the winter I sound like a skip on a CD explaining the “facts that we know” about fever.There are so many falsehoods surrounding fever, and many have been passed around for years. 

To begin with, FEVER is simply a symptom, it is not a disease.  We pediatricians define a fever as greater than 100.4 degrees Fahrenheit.  Now I know many people say, “but my child’s body temperature runs lower than 98.6, therefore they have a fever when their body temperature is 99.8 degrees.”.  What about, “my thermometer must be off because my child felt hot and the thermometer only read 99.9 degrees.”  Yes, these are often heard statements by parents in my office, who are convinced that their child has a fever, even when they don’t.  That is not to say that you might not feel great when you have a cold and your body temp is 99.8, but you don’t really have a fever.

Fever frightens parents, especially with young children and over the course of parenting most of us figure out that fever is not “scary”.  I sometimes say “look at fever as your friend”  as this means that your child’s immune system is working.  When you are sick and all of those white cells go to work, they  release all of their “disease fighting chemicals”  which ramps up the body to fight the infection and fever develops.  See, it is just a symptom of many different things going on within our body when we are sick.  Other symptoms, especially at this time of year include, cough, congestion, sore throats, vomiting, diarrhea. What really stinks is when your child has ALL of these symptoms at one time.....they just feel yucky!

Another myth, fever causes brain damage and that “the higher the fever the greater chance of brain damage”. This is NOT true.  High fever usually makes your child feel worse, but their brains are just fine. Yes, febrile seizures do sometimes occur (my own son had them), but even a febrile seizure does not cause brain damage.  Febrile seizures are scary for a parent to watch, but they may occur with any degree of fever. That is to say  a seizure may occur with a fever of 101 degrees or 104 degrees, doesn’t really make a difference.  A febrile seizure does not necessarily mean your child is any sicker than another child who does not have a seizure with their fever.  I know sounds crazy, but very true.

This is just the first part of the fever story.....more fever facts to come this week.

Daily Dose

Why Fever Is Your Child's Friend

Every parent is concerned about fever and why their child is running a fever. During the "sick season" I see 20 - 30 patients a day with a fever. Every parent is concerned about the fever and why their child is running a fever. Fever is one of the most common symptoms of childhood. Younger children run fevers quite frequently when they are sick. As we have talked about before, that may be four to eight times during the fall and winter season.

"Fever is our friend" has been one of my mantras for years. It is comforting for parents to understand that fever is a symptom that the body is fighting an infection. That is usually a viral infection that only lasts a few days, and lo and behold the fever is gone. The biggest myth is that fever, in and of itself, causes brain damage. Remember again, fever is simply a symptom.

The height of a fever does not correlate with severity of illness. Once again, higher fever does not necessarily mean you are sicker. Your child may feel awful with a fever of 101 or 104 degrees. Typically, once given either acetaminophen or ibuprofen for their fever, the temperature comes down a little and they symptomatically feel better for a while. Once the anti-pyretic (fever reducing) medications wear off, the fever will often return.

Children typically have more fever in the night, seems like darkness brings out the fever monster (that is the mother in me, but it was always true at my house) and those nights of fitful sleep, and hot little bodies seem very long. The other thing I have noticed, why do children who have had little sleep due to fever, coughs etc get up in the morning and do not long for a nap like their parents?

The other thing you need to keep in mind is that the higher the fever, the faster your child's heart will beat and the higher respiratory rate they will have. It is easy to climb into bed with your "hot" two year old and feel their heart pounding away, and know they have a high fever, even before the thermometer is out. This is the body's natural way of expending heat. Once the fever comes down you will notice that they are breathing less rapidly and their heart rate has come down too. Remember to offer plenty of fluids to a child with a fever, as they need extra fluids. They can eat too, but if not interested, a Popsicle or jell may be a good alternative. Just keep chanting, "fever is our friend." 

That's your daily dose, we'll chat again tomorrow.

Daily Dose

Alert: Flu is Here!

Flu is here! I just saw 3 patients from 1 family who has tested positive. Go out and get a flu shot today!I am writing this with trepidation as I have just seen my first 3 cases of Influenza A! Does this mean that we have a long winter flu season ahead, or does it mean it will come early and leave early?  

I only wish that I had the crystal ball that would/could predict this, but what I do know for a fact, flu is not fun!! These first 3 patients, all from the same family, really did not “look like the typical influenza” that I think of when we start seeing flu.  In this family of five, only the father had already received the flu vaccine, and as of now, he is the only one in the family not to get sick.  (I am happy to report that I too got my flu shot about 2 weeks ago, hooray!) When this 5 year old girl came to the office with a 2 day history of a fever and a headache, she really looked no different than numerous other children I had been seeing with a fall viral syndrome.  She definitely looked like she didn’t feel well but was sitting on her mom’s lap, did not have a cough or congestion and had no other real symptoms.  She did complain about a “scratchy throat” and her strep test was negative. It is not unusual to see a few days of fever with any virus, so she was sent home with instructions to treat her fever, and to return if the fever persisted more than another 24 – 48 hours or if she had new symptoms etc. She improved over the next 24 hours and returned to school the day after. The following day her 3 year old sibling began running a fever, again complained of a headache and was brought to the office.  Her mother requested that a flu test be done, as “there is a lot of flu at her school”.  That was an interesting comment as the Dallas County health Dept. had reported “little to no” influenza activity to date, and our office sends flu samples to the health department for epidemiology. But, knowing that “mother knows best” a flu test was performed and low and behold, it was positive for influenza A.  I was shocked!!! How could they have flu with essentially just a fever and headache?   It was after the fever was gone that they developed the classic congestion and cough that we doctors typically associate with the flu. This is really early in the season to typically see flu and if the Health Dept. is correct based on other samples this was probably H3N2 flu.  Now we are wondering if we are going to see more similar cases or if this is just a fluke?  In talking with other docs in the community, they too did not think they had yet seen influenza, or had they “missed cases” with kids who just had a fever. Take home message for all of this is GO GET YOUR FLU SHOT or FLU MIST , as I like to say “run don’t walk” because a virus has a mind of its own and trying to predict what course it will take  is often an exercise in futility. But this I know to be true, there will be more flu cases over the next 4 months, but when the “true season” begins is still an unknown. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Fever Frenzy

1:15 to read

As a pediatrician I get “pitched” a lot of products. While many companies send me notification of new products, my patients also keep me informed as well…..they often seem to have one of everything as soon as it hits the market.

I can remember several years ago when a young mother came into my office with her baby during the winter upper respiratory season. Her baby had gotten her first (of many to come) colds and was stuffy and cranky and not sleeping well…which meant her parents were not sleeping either. So, she proceeded to tell me about this great “new” product, the NoseFrida.  I must say, I had never heard of it but it sounded somewhat like a Delee catheter that we used in the delivery room to suction a newborn’s airway at delivery.  So, she pulled out this “ingenious” NoseFrida and showed me how much more comfortable her daughter was after suctioning her nose. Within months, or maybe even weeks, it seemed that every patient that came in to see me owned a Nose Frida, and were happily “suctioning snot!”

Well, the company has a new product, the FeverFrida Thermonitor, that is being sold for recording a baby’s temperature when they are sick.  Fever is a five letter word that sets fear into the hearts of most new parents….which is why I have written so many posts in hopes of reassuring parents that fever is just a symptom, it does not cause brain damage, and is actually a sign that the body’s immune system is firing on all cylinders to fight an infection….typically a viral infection. My mantra continues to be  “fever is your friend”, but in this case this “innovative product” may only cause more anxiety.

The FeverFrida Thermonitor is a “wireless cloud connected wearable thermometer and patch worn under the arm. It alerts  your smart phone when the (baby’s) temp goes above a predetermined threshold allowing baby AND parent to rest with ease.”  This product is touted as an “innovative sleep time solution”, as it takes the baby’s temperature, EVERY FOUR SECONDS while they sleep!!!!  I mean who thinks up these things. Even a baby in the ICU does not have it’s temp taken every 4 seconds.  

So….while I am a big fan of the NoseFrida,  I am going to discourage all of my patients from buying this product. Actually, the American Academy of Pediatrics has previously stated that there is no need for a parent to wake a child during the night to monitor their temperature when they are sick, so why in the world do we need a product that will increase parental anxiety every 4 seconds.  In this case I would save the $69.99 price tag and invest in a good old $10 digital thermometer….and get more than 4 seconds of continuous sleep. 

  

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Daily Dose

Fever

1:30 to read

It’s starting….fever, fever, fever season and lots of concerned parents, so figured it was a good time to talk about fevers….AGAIN.  

 

Remember that fever is simply a symptom that your body’s immune system is working, and in most cases, in children, it is fighting a viral infection.  We docs call a fever a temperature above 100.4 degrees…but I do realize that day care and schools will send your child home when they have a temp above 99.5 degrees ( in some cases even lower). Some parents “explain” to me that their child’s body temperature is always lower than 98.6 degrees so a 99.9 degree temperature is abnormal for them….I’m just saying. 

 

The first thing to try and remember is that the thermometer is simply showing you a number and that the number should not scare you…it is only a number and a higher number does NOT necessarily mean that your child is any sicker.  Some children do tend to have a higher temperature with an illness than another, and even in the same family.  Again, the number should not make you concerned that one of your children is sicker than another…it is still just a fever.

 

Parents always ask…”what degree of fever is dangerous, and when do I go to the hospital?”  The number that registers on the thermometer should not be the deciding factor as to how sick your child is. They will look and feel worse with a higher temperature ( as do you when you are sick), but the important thing is to always look at their color (never dusky or blue), how they are breathing (you do breath faster and more shallow with a higher body temperature, but do not appear to be in any distress), and if they are hydrated (you do need more fluids when you are running a fever).  If all of this seems to be okay, the best thing to do is treat the fever with either acetaminophen or ibuprofen.  Once their temperature comes down a bit, and that may not be 98.6, look at your child again…children with lower temperatures typically “perk up” for a bit and may play or eat and drink for awhile, until their fever returns and they look pathetic again.  I would always check with my doctor before heading to the ER just because of a fever.

 

Parents also worry about their child having a seizure due to a fever…and this is true some children may have a febrile seizure. But, they can have a seizure with a temperature of 100.8 or 104.2…it does not seem to be the higher the temperature causes a febrile seizure. Febrile seizures do seem to “run in families” and they are also most common during the toddler years. (see another post on this).

 

So… as we are getting into sick season make sure you have an acetaminophen and ibuprofen dosing chart handy and always dose your child’s medications based on their weight and not age. I would also make sure to have a “working” thermometer, and I prefer a rectal thermometer for children under 12 months of age. Rectal temps are really easy to take and in my experience far more accurate (when I am really concerned if a child has a fever) than a tympanic or temporal thermometer. 

 

Be ready and relax….it is just a fever and having an anxious parent is not going to make your child feel better any faster.

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Daily Dose

Fever Frenzy

1.30 to read

More about fever and all of those fears and myths.  

Treating the symptom of fever simply makes your child feel a bit better, it does not make them get better faster nor does it mask other symptoms. I see many parents not treating their child’s fever before bringing them to the office as they “want me to see how sick they are”.  Giving your child acetaminophen or ibuprofen will make them feel better and in turn “not look quite as sick”, but your doctor wants to see this behavior as it is reassuring. I promise you, I believe the mother who says to me, “his temp was 103.8 an hour ago!”. But seeing that child now playing with their parent’s cellphone  and eating one of those pouches (another topic), reassures me that this child is most likely not extremely ill.  Treating a fever does not mask the symptom of meningitis, or appendicitis, you have to trust me on that. 

Some parents have been told by grandparents and others that a fever means that your child can’t have milk or dairy products.  Again, if the only thing your child wants when they have a fever is a milk shake, let them have it. I am just concerned that a child is getting fluids when they have a fever, and it really doesn’t matter what that fluid is.  Food when you have a fever?  Sure, if your child wants to eat, great!  But, remember how your own appetite usually diminishes when you are sick (sad but true, good for quick weight loss).  Your child can go days without eating and be just fine as long as they are drinking.  Push popsicles, jello, juice, ginger ale, etc.  No rules about “healthy” when your child is sick....back to healthy eating rules once they’re child well.  

Lastly, you cannot feel your child’s head or chest and know what their body temperature is.  I can often tell a child has a fever by their heart rate, which goes up as your body temperature goes up, but even after more than 25 years of practice and raising 3 kids I cannot feel a forehead and be accurate.  So.....go buy a thermometer. I still like the “cheap’ digital ones, but you can buy the temporal thermometers or otic ones, whatever you prefer.  If your child is sick and you think they have a fever, take their temperature to document fever. You don’t need to do it all day long, or wake them up at night, but it is important to document at least once a day.  

Lastly, no school, day care or going places when your child has a fever. Please keep them home for 24 hours fever free, to help not spread their illness.  This is fact!

Daily Dose

Warm Weather Viruses Lurking

Warm weather viruses have arrived. What every parent needs to know. We talk about viruses throughout the year, but certain viruses do tend to occur seasonally and in the summer and early fall that means enteroviral infections.  I'm seeing a lot of cases right now!

Enteroviruses are a large group of viruses that include Coxsackie viruses (that we have discussed as the most common cause of Hand-Foot and Mouth disease), polio viruses (now eradicated in the U.S, secondary to vaccines) and echoviruses. Most enteroviral infections occur in young children and I have been seeing a host of illness in the office most likely related to enteroviral infections. Enteroviruses are hardy viruses and can live for several days on surfaces etc. After oral ingestion, typically from poor hand washing, (another plug for good hand washing!) the virus sets up shop in the GI tract and may also then spread to involve other organ systems. One of the most common presentations is with a several day history of malaise followed by fever, often fairly high with temps ranging in from the 101–104 degree range. There may be other symptoms accompanying the fever, particularly related to the GI tract, with nausea, vomiting and diarrhea.  Headaches, conjunctivitis, sore throat and chest pain may be seen in older patients. In the toddler set you may just see several days of very hot, cranky kids without a lot of physical findings.  In some cases the child may develop a red, blotchy “measles” like rash after several days of the fever. The rash rapidly resolves on its own, typically within another 3–5 days. The other problem with enteroviral infections is that infants, under 2 months of age, may catch this virus (not uncommon to hear that they have had a sick sibling or visitor) and develop a fever and irritability. In this case these babies are admitted to the hospital to undergo what is termed a “sepsis workup”.  Infants are hard to “read”.  They are too little to smile or make eye contact to let us know how sick they really are. Due to the risk of getting sicker quickly,  doctors obtain blood, urine and spinal fluid (to rule out meningitis) for testing. After this the baby is started on IV antibiotics until cultures of the fluids show no bacterial growth, usually 72 hours of waiting. In many cases the baby may already be better, even before the final cultures come back and the antibiotics may be stopped. It is very traumatic for new parents to watch their baby undergo a myriad of tests, but a necessity. This is one of the reasons that I encourage all parents to try and keep their baby somewhat isolated at home for the first 6–8 weeks of life. By avoiding public areas, crowds, visits by little toddler friends etc you minimize an infant’s exposure to viral infections. Seems crazy to some, but laying low for a few weeks seems much easier than a 3-4 day hospitalization and worry about a serious infection. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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