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|Monday, February 07, 2011
|When is high too high? The truth about fevers
|by William Stratbucker, MD at 03:14 PM
Guest blogger Cynthia Norman is the nurse manager of the Helen DeVos Children's Hospital emergency department.
Chances are, if you are a parent, your child has experienced at least one fever and will likely experience another. How will you respond the next time it happens?
In the emergency department (ED) at Helen DeVos Children's Hospital, many parents bring their children in for fever each day, and we work together to help identify the source. Some of these fevers are concerning, but some are not, and I think it is important for you to be aware of this and not automatically become worried if you child has a fever. In order to help you know what to do when you child gets a fever, I'd like to offer some of my perspective on the subject.
Learn more about fevers before your child gets one.
Excellent guides are available online that describe specifically what to watch for in children with fevers and when to seek medical attention versus treating symptoms at home. Your child's pediatrician is a great source for information and it is fine to consult your child's doctor before using the Internet or the ED. Our Web site is a good resource. Look at the Should I call the Doctor feature if you are looking for advice in a particular situation. Another portion of our site Health Information from A to Z is another good resource.
Bring your child in to the doctor or ED if:
- You have an infant under two months who has a fever
- Your child's fever persists, even after two days with fever reducers (known as "antipyretics") which include acetaminophen (Tylenol) and ibuprofen (Motrin), among others
- You feel worried or need a second opinion
- Your child has a productive cough, persistent vomiting, stiff neck, localized pain, painful urination, parched mouth, is listless, overly sleepy or is not taking liquids. This is a partial list-check the online guides I referenced above for complete lists.
How you treat your child is dependent on his or her age. For children under two months old, a fever is 100.3 degrees when taken by rectum. If your child under two months of age has a fever, you need to consult your pediatrician before treating a fever. For children three to six months, we recommend using acetaminophen as directed on the label. For those six months and older, alternate ibuprofen and acetaminophen, and follow label directions. Learn the recommendation for your child's age.
Be aware that infants and young children have a higher risk of dehydration than older children.
Always offer children fluids, no matter what their age, but be especially careful that young children are not becoming dehydrated. All fluids that they will consume are good-Jello, popsicles, water, juice, Pedialyte and even ice chips.
If you follow these recommendations, but your child's fever persists and you are preparing to bring him or her to the ED, please consider the following:
- Give your child appropriate fever reducers before bringing your child to the ED. Some parents avoid doing this because they want us to see how bad the fever is, but they should not wait. Why? Fevers make children uncomfortable and their visit to the ED will be easier if they don't have the discomfort associated with fever. In fact, when children come to the ED with a fever, we give fever reducers even before the doctor sees them so the physical exam will go better.
- It can take a while to identify the fever's cause. We sometimes see parents who are distressed when we send them home without medicine-they feel like we didn't do enough. However, sometimes the cause of a fever takes a while to present itself and sometimes it's okay for a child to have a fever. For instance, we might x-ray a child for a lung infection, take a urine sample or check their blood, yet still not see anything that is readily treatable. If the fever persists and the child returns to us a day or so later, we sometimes find a cause for the fever. In these cases, some parents might assume we missed something on the first visit, but this is not necessarily the case.
- Children get better sooner when parents partner with us. Illness, fevers and treatment are sometimes a "process." It would be nice if every time a patient has a symptom we could always identify the cause, however, it doesn't work that way. We count on partnering with parents and see ourselves as consultants who can help evaluate the seriousness of the fever and hopefully determine its cause. If we don't find a cause during the ED visit, we will talk about what to watch for at home and ask parents to return or seek help from the primary care doctor. We always want to know if parents are uncomfortable with the plan or if they have questions or concerns.
Always trust your instincts and take cues from your child. If a parent says to us "something's not right" we value that and listen. Some kids feel miserable when they have a fever, but others keep playing and remain content, so the most important thing you can do is know your child well and understand how your child copes with fever or illness, then share that valuable information with us.
- Cynthia Norman BSN, RN, CEN