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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

The Questions About Fever Continue

Back in the office and boy is it busy. It is going to be like this for a long time and frantic phone calls and office visits regarding fever continue.Back in the office today and boy is it busy. It seems like this has been going on a while with frantic phone calls and office visits. Many many of the questions are about fever.  You've heard me say before "fever is our friend".

I am a firm believer that the more information a parent has the easier it is to make good decisions about the care of their child. This is true for fever fears too. So, here is more information beginning with the fact that you do not have to take your child to the pediatrician or ER every time your child has a fever. Now, that is not to say that there are not times that you NEED to call the doctor’s office. But, fever in and of itself, in a child who is two years or older, who does not have an underlying chronic disease, and has classic symptoms of a “flu-like” illness, with headache, sore throat, cough and general “feels bad” does not require an immediate phone call to the doctor or an office visit. It does mean that you need to treat your child’s fever (NO ASPIRIN) to make them more comfortable, and make sure that they are hydrated and keep them home until they have been fever free for at least 24 hours. That also means no fever off of all medications like acetaminophen and ibuprofen. Masking a fever with medications does not count. Watching Elmo or Disney for a few days while recovering is never bad for anyone. This is the one time to let them be couch potatoes. Kids will always feel worse when their fever is higher, and better when it comes down with fever reducers. Being able to play with toys, play on the computer, Nintendo and Wii are all signs that your child is handling the virus and that they are not terribly sick. You should be watching for that, and be reassured, that is a good sign. Campbell’s chicken noodle soup should see record sales this fall and all of those other comfort foods like popsicles and smoothies sound good to those with a fever. Children usually do not want a full meal when they are feeling badly and neither will you if you are unlucky to also fall ill. Just push fluids and as your child feels better their appetite will return. What to watch for! #1: Any signs of breathing difficulty, or color change in your child, but remember too that your chest can feel tight with the flu, without having respiratory distress. Take off their t-shirt or pajama top and really look at their chest to see if you see any difficulty breathing. Turn the light on if you are worried and look at their coloring. Fever also makes you breathe faster, so treat their fever and watch their respiratory rate as the fever comes down. A child playing a video game is usually not in respiratory distress (note from office visit today), and will be better off at home on the couch than waiting in an office full of more sick people. #2: Any child who has a rebound fever is worrisome. That means they have the typical two to four days of fever, power through it and then several days later develop fever again. Those children should all be seen to rule out secondary infection. #3: Children with prolonged fever, who seem to be worsening rather than getting better. #4: Children with underlying chronic diseases need to be seen sooner rather than later (or at least warrant a phone call to discuss with their physician). These are some guidelines to help reassure you that you are doing all of the right things at home. You can expect your child to be out of daycare or school for three to five days, minimum, so stock up with movies and cards and pretend that you are “snowed in”. Luckily the children we have been seeing thus far have not been too ill. I work in a pediatric office with 12 doctors, in a very busy practice, and we have not had one child hospitalized or even come back because they were getting sicker. We can only hope that this will be the case for the rest of this year. Keep up the hand washing and go get those regular flu vaccines. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

A Little Review About Fever

My phone rang several times yesterday with concerned parents whose children had fever.We had a guest on our show yesterday who is a pediatrician, who also started a pediatric after hours clinic. He discussed when to call the doctor, and it must have been foreshadowing for the day. My phone rang several times yesterday with concerned parents whose children had fever. Now that the swine flu issues seem to be behind us for now, they were not concerned about flu, but they were concerned about fever. The funny thing was the calls were all from fathers who were home with the children while their wives (and mothers) were out enjoying Mother's Day. Made me giggle as I wondered if their wives would have handled the fevers, who knows?

At any rate a little review about fever seemed to be in order for the spring viral season. In spring, we still see kids with fever, although typically not as many children get sick, and they often do not have other symptoms with their virus. These spring and summer viruses are usually "quieter" than the winter variety, which was accompanied by hacking coughs lots of congestion. Fever may be the only symptom, and children may still run high fever. Fever in an infant under two to three months old is a separate issue (we'll cover that tomorrow), but for a young child it is not the height of the temperature that is important (that is what prompted the concerned Dad phone calls), but rather it is how your child is acting and responding to you. A five-year-old with 104 degree temperature will be pathetic, whiny and uncomfortable, but they should be responsive, and taking fluids and not so lethargic you can't awaken them and you should be able to console them and "your-baby" them with a little TLC until you get the temperature down. Best always to start treating the fever with an acetaminophen (Tylenol) product and have a dosage chart based on weight available to ensure that you are giving your child the correct dosage. Make sure give appropriate dosage for the product you are using (drops, syrup or caplets). If the fever persists and does not come down with that, you can alternate giving an ibuprophen (Motrin, Advil) product. Again, consult the dosage chart. The Tylenol can be given no more often than every 4 hours, and the Motrin/Advil is given every 6 hours. It helps to write down what you are giving when, as it is often the middle of the night and a tired parent may forget which medicine they gave. If there are no other symptoms other than fever, I would recommend watching your child for 24 - 48 hours to see if the fever resolves. A spring virus typically does not last as the nasty winter ones. Fever is only a symptom, and not to be feared. Thanks to all of the Dads for a great Mother's Day! That's your daily dose, we'll chat again tomorrow.

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

New Fever Research

1:30 to read

I just read an interesting article in the Wall Street Journal “Your Health” section, about a new study being done by doctors at Boston Children’s Hospital looking at the definition of fever.  As you know from all of my previous posts, fever is a symptom rather than a disease….and fever causes a lot of anxiety for many parents as well as their physicians.

For my entire pediatric career I have been taught that the definition of fever is a temperature of 100.4 degrees or higher. Pediatricians have used this number to determine when a newborn has an elevated temperature and may have an underlying infection and need to be hospitalized. We have also used this number to decide when a child may return to school after an illness, and I can also remember several occasions when I was called to pick up a child from school due to a temperature of 99.9 degrees ( which I wanted to point out was not a fever).  Pediatricians also use this “magic” number to screen for systemic illness, especially in children who have “vague” symptoms of illness without other physical findings which may be seen in the early stages auto-immune disease.

While this has been the “gold standard” in medicine, doctors also know that our body temperature fluctuates throughout the day. There has been research to show that “temperatures varied about 0.9 degrees over the course of the day “ with the lowest being early a.m. and higher temps in the evening. This information has been used for a long time to chart “basal body temperatures” for those hoping to get pregnant. There is also wide variability in temperature depending on the instrument you use to take the temperature and where the temperature is taken (oral, rectal, tympanic, temporal ).  It is not an exact science….but we use the information all of the time to make medical decisions.

Knowing that there is variability in body temperature, Dr. Jonathon Hausmann, a pediatric rheumatologist , is now going to study over 10,000 people of all ages through a crowdsourcing app “Feverprints”. This app will enable the researchers to gather data looking at body temperatures for different age groups, gender, ethnicity, weights and body types. It will also gather data looking at the effect of medications we use to lower fevers, and will try to answer the question, “can you predict the cause of the fever by looking at temperature patterns?”. At the end of the day, these “feverprints” may end up helping to develop fever curves that will be used in different populations (somewhat like a growth curve). 

This is really an exciting and interesting study and will take a large number of people (10,000) enrolling via a free “app” and committing to downloading information for 6 months.  Wouldn’t you want to be involved….I think this would be a great way for a family to have a “science fair project” in their own home!!  I just downloaded the app myself…we might just find that the definition of fever will change…it only took 150 years and an iPhone! 

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

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

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.

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When should you keep your child home from school?

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