FEVER

DEFINITION
Your child has a fever if any of the following apply:

• Rectal temperature is over 100.4ºF (38.0ºC).
• Oral temperature is over 99.5ºF (37.5ºC).
• Axillary (armpit) temperature is over 99.0ºF (37.2ºC).
• Ear (tympanic) temperature (taken in the ear) is over 100.4ºF (38.0ºC)
  (if set in rectal mode), or >99.5ºF (37.5ºC) (if set on oral mode).
  (Note: Not reliable if your child is less than 6 months old.)
• Pacifier temperature is over 99.5ºF (37.5ºC). (Note:
  Not accurate in general. New digital ones are accurate.
  This mode is okay for screening if your child is over 3 months old.)
• Tactile fever (the impression that your child has a fever because he or she feels hot to the touch) is evident. Tactile fevers are more accurate than we used to think; however, if you're going to call your child's doctor about a fever, actually take his or her temperature.

The body's average temperature when it is measured orally is 98.6ºF (37ºC), but it normally fluctuates during the day. Mild elevation (100.4ºto 101.3ºF or 38º to 38.5ºC) can be caused by exercise, excessive clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an effect on the temperature of your child, take his or her temperature again in
one-half hour.

Causes

Fever is a symptom, not a disease. Fever is the body's normal response to infections and plays a role in fighting them. Fever turns on the body's immune system. The usual fevers (100º to 104ºF [37.8º to 40ºC]) that all children get are not harmful. Most are caused by viral illnesses; some are caused by bacterial illnesses. Teething does not cause fever.

Expected Course

Most fevers with viral illnesses range between 101º and 104ºF (38.3º to 40ºC) and last for 2 to 3 days. In general, the height of the fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts. Fever causes no permanent harm until it reaches 107ºF (41.7ºC). Fortunately, the brain's thermostat keeps untreated fevers below this level.
Although all children get fevers, only 4% develop a brief febrile convulsion. Since this type of seizure is generally harmless, it is not worth worrying excessively about. If your child has had high fevers without seizures, your child is probably safe.

HOME CARE

Treat All Fevers with Extra Fluids and Less Clothing.
Encourage your child to drink extra fluids, but do not force him or her to drink. Popsicles and iced drinks are helpful. Body fluids are lost during fevers because of sweating. Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child; it will cause a higher fever. During the time your child feels cold or is shivering (the chills), give him or her a light blanket.

Acetaminophen Products for Reducing Fever.
Children older than 2 months of age can be given any one of the acetaminophen products. All have the same dosage.
Remember that fever is helping your child fight the infection. Use drugs only if the fever is over 102ºF (39ºC) and preferably only if your child is also uncomfortable. Give the correct dosage for your child's age every 4 to 6 hours, but no more often.
Two hours after they are given, these drugs will reduce the fever 2º to 3ºF (1º to 1.5ºC). Medicines do not bring the temperature down to normal unless the temperature was not very elevated before the medicine was given. Repeated dosages of the drugs will be necessary because the fever will go up and down until the illness runs its course. If your child is sleeping, don't awaken him for medicines.
Caution: The dropper that comes with one product should not be used with other brands.

Dosages of Acetaminophen. See accompanying table.

ACETAMINOPHEN DOSAGE (FOR FEVER AND PAIN)

Child's weight (lb) more than	7	14	21	28	42	56	84	112
Total amount (mg)	40	80	120	160	240	325	458	650
Drops (80 mg per dropper)	½	1	1½	2	3	--	--	--
Syrup 160 mg/5 mL (1 tsp)	--	½	¾	1	1 ½	2	2 ½	4
Chewable 80-mg tablets	--	--	1½	2	3	4	5-6	8
Chewable 160-mg tablets	--	--	--	1	1 ½	2	3	4
Adult 325-mg tablets	--	--	--	--	--	1	1-1 ½	2

Ibuprofen Products. All ibuprofen products are now available without a prescription. Give the correct dosage for your child's weight every 6 to 8 hours as needed. (See accompanying table.)

IBUPROFEN DOSAGE (FOR FEVER AND PAIN)

Child's weight (lb) more than	12	18	24	36	48	60	72	96
Total amount (mg)	50	75	100	150	200	250	300	400
Drops (50 mg per dropper)	1	1 ½	2	3	4	--	--	--
Liquid 100 mg/5 ml (1 tsp)	½	¾	1	1 ½	2	2 ½	3	4
Chewable 50-mg tablets	--	--	2	3	4	5	6	8
Adult 200-mg tablets	--	--	--	--	1	1	1 ½	2

Ibuprofen and acetaminophen are similar in their abilities to lower fever, and their safety records are similar. One advantage that ibuprofen has over acetaminophen is a longer-lasting effect (6 to 8 hours instead of 4 to 6 hours). However, acetaminophen is still the drug of choice for controlling fever in most conditions. Children with special problems requiring a longer period of fever control may do better with ibuprofen.

Avoid Aspirin. The American Academy of Pediatrics has recommended that children (through 21 years of age) not take aspirin if they have chickenpox or influenza (any cold, cough, or sore throat symptoms). This recommendation is based on several studies that have linked aspirin to Reye's syndrome, a severe encephalitis-like illness. Most pediatricians have stopped using aspirin for fevers associated with any illness.

• ALTERNATING ACETAMINOPHEN AND IBUPROFEN
  We don't recommend combining these medicines for the following reasons:
• No added benefit in reducing fever compared with either product used alone. (Reason: both drugs have the same mechanism of action.)
• Can cause dosage errors and poisoning (especially if you give one product too frequently).
• You don't need to control fever this closely.
• If you are instructed by your physician to alternate both products, do it as follows:
  - Use both if the fever is over 104ºF (40ºC) and unresponsive to one medicine alone.
  - Give a fever medicine every 4 hours (acetaminophen every 8 hours and ibuprofen every 8 hours).
  - Only alternate medicines for 24 hours or less, then return to a single product.
  
  

  Sponging. Sponging is usually not necessary to reduce fever. Never sponge your child without giving her acetaminophen first. Sponge immediately only in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106ºF (41.1ºC). In other cases sponge your child only if the fever is over 104ºF (40ºC), the fever stays that high when you take the temperature again 30 minutes after your child has taken acetaminophen or ibuprofen, and your child is uncomfortable. Until acetaminophen has taken effect (by resetting the body's thermostat to a lower level), sponging will just cause shivering, which is the body's attempt to raise the temperature.

  
  If you do sponge your child, sponge her in lukewarm water (85º to 90ºF [29º to 32ºC]). (Use slightly cooler water for emergencies.) Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. Cooling comes from evaporation of the water. If your child shivers, raise the water temperature or wait for the acetaminophen to take effect. Don't expect to get the temperature below 101ºF (38.3ºC). Don't add rubbing alcohol to the water; it can be breathed in and cause a coma.
  
  

  CALL OUR OFFICE, BYRDSTOWN MEDICAL CENTER, AT (931) 864-3178

  IMMEDIATELY if
• Your child is less than 3 months old.
• The fever is over 105ºF (40.6ºC).
• Your child looks or acts very sick.
  
  

  Within 24 hours if
• Your child is 3 to 6 months old (unless the fever is due to a diptheria-pertussis-tetanus (DPT) shot).
• The fever is between 104º and 105ºF (40º to 40.6ºC), especially if your child is less than 2 years old.
• Your child has had a fever more than 24 hours without an obvious cause or location of infection.
• Your child has had a fever more than 3 days.
• The fever went away for more than 24 hours and then returned.
• You have other concerns or questions

FEVER PHOBIA: UNDERSTANDING THE MYTHS

Misconceptions about the dangers of fever are commonplace. Unwarranted fears about harmful side effects from fever cause lost sleep and unnecessary stress for many parents. Let the following facts help you put fever into perspective.

MYTH: All fevers are bad for children.
FACT: Fevers turn on the body's immune system.
Fevers are one of the body's protective mechanisms.
Most fevers are good for children and help the body fight infection. Use the following definitions to help put your child's level of fever into perspective:

100º-102ºF - Low-grade fevers are beneficial. Try to keep the fever in this range.
(37.8º-38.9ºC)
102º-104ºF - Moderate-grade fevers are beneficial.
(38.9º-40ºC)
>104ºF(>40ºC) - High fevers cause discomfort but are harmless.
>105ºF(>40.6ºC) - Higher risk of bacterial infections with a very high fever.
>108ºF(>42.2ºC) - The fever itself can be harmful.

MYTH: Fevers cause brain damage, and fevers over 104ºF (40ºC) are dangerous.
FACT: Fevers with infections don't cause brain damage. Only body temperatures over 108ºF (42.2ºC) can cause brain damage. The body temperature only goes this high with high environmental temperatures (e.g., confined in a closed car).

MYTH: Anyone can have a febrile seizure.
FACT: Only 4% of children ever have a febrile seizure.

MYTH: Febrile seizures are harmful.
FACT: Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm. Children with febrile seizures have no higher incidence for developmental delays, learning disabilities, or seizures without fever.

MYTH: All fevers need to be treated with fever medicine.
FACT: Fevers only need to be treated if they cause discomfort?usually fevers over 102ºº or 103F (38.9º or 39.5ºC).

MYTH: Without treatment, fevers will keep going higher.
FACT: Fevers from infection top out at 105º or 106ºF (40.6º or 41.1º C) or lower, because of the brain's thermostat.

MYTH: If the fever doesn't come down (if you can't "break the fever"),
the cause is serious.
FACT: Fevers that don't respond to fever medicine can be caused by viruses or bacteria. It doesn't relate to the seriousness of the infection.

MYTH: If the fever is high, the cause is serious.
FACT: If your child looks very sick, the cause is serious.

MYTH: The exact number of the temperature is very important.
FACT: How your child looks is what's important.

MYTH: Temperatures between 98.6º and 100ºF (37.0º and 37.8ºC)
are low-grade fevers.
FACT: The normal temperature changes throughout the day and peaks in the late afternoon and evening.

• A reading of 99.4ºF (37.5ºC) is just the average rectal temperature. It normally can change from 98.4ºF (36.9ºC) in the morning to a high of 100.3ºF (38.0ºC) in the late afternoon.
• A reading of 98.6ºF (37ºC) is just the average oral temperature. It normally can change from a low of 97.6ºF (36.5ºC) in the morning to a high of 99.5ºF (37.5ºC) in the late afternoon.

Antibiotics are strong medicines that can kill bacteria. They have saved many lives and prevented many serious complications. However, antibiotics have no impact on viral infections. One of the more important decisions made daily by every physician is whether a child's infection is viral or bacterial. Parents can learn to make some of these decisions themselves.

VIRAL INFECTIONS

Viruses cause most infections in children:

• All colds
• All cases of croup
• Most (99%) coughs
• Most (95%) fevers
• Most (90%) sore throats
• Ninety-nine percent of diarrhea and vomiting

BACTERIAL INFECTIONS

• Most ear infections
• Most sinus infections
• Ten percent of sore throats (strep throat)
• Whooping cough (pertussis)
• Some pneumonia (lung infection)
  
  Some symptoms are overrated as indicators of a bacterial infection. Yellow nasal discharge is more likely to be a normal part of the recovery from a cold than a clue to a sinus infection. Yellow phlegm (sputum) is a normal part of a viral tracheitis or bronchitis, not a sign of pneumonia. High fevers can be due to a virus or bacteria.
  
  

  PREVENTION OF BACTERIAL INFECTIONS

  Another false belief is that children with colds need antibiotics to prevent ear or sinus infections. In some cases the antibiotic does work, but in most cases the antibiotic just selects out a resistant germ to cause a secondary bacterial infection. It's smarter to save the antibiotic for those children who go
  on to develop a bacterial infection. After a cold, about 10% of children develop an ear infection (otitis media) and 1% develop a sinus infection (sinusitis). Why give antibiotics to the other 89% who don't need them?

BACTERIAL RESISTANCE

When bacteria become resistant to an antibiotic, that antibiotic can no longer kill that type of bacteria. Excessive use of antibiotics is the number one cause of resistant strains of bacteria, and research shows that 50% of prescriptions for antibiotics are inappropriate (mainly when they are given for coughs and colds). This makes future treatment of bacterial infections more difficult. Many bacteria are now resistant to antibiotics that used to control them. When we turn to newer and more expensive antibiotics, bacteria develop resistance to them as well. In the battle between antibiotics and bacteria, the bacteria seem to be winning.

SIDE EFFECTS OF ANTIBIOTICS

If your child doesn't need an antibiotic, giving him one is a bad idea, because all antibiotics have side effects. Some children taking antibiotics develop diarrhea, nausea, vomiting, or a rash. If a rash occurs, we are left with the difficult question: is it a drug allergy or an unrelated viral rash (such as roseola)? Since it's difficult to be sure, many children are mislabeled as allergic to a family of antibiotics, and a potentially useful antibiotic is not available when the child really needs it.

SUMMARY

Don't wish your child were on an antibiotic unless he or she really needs one. Don't pressure your child's doctor for an antibiotic. If your child has a viral illness, an antibiotic will not shorten the course of the fever or help the other symptoms. Antibiotics will not get your child back to school or you back to work sooner. If your child develops side effects from the antibiotic, he or she will feel worse instead of better.
Let's save antibiotics for ear infections, sinus infections, strep throat, and other bacterial infections. Let's not waste them on yellow nasal discharge, yellow phlegm, high fevers, and other normal symptoms associated with coughs and colds. Treat your child's symptoms with over-the-counter medicines or home remedies. Many just need extra TLC (tender loving care) until they feel better. Call back if your child develops any new signs that suggest a bacterial illness. Usually antibiotics are not the answer when your child becomes sick

DEFINITION

• Runny or stuffy nose
• Usually associated with fever and
  sore throat
• Sometimes associated with a cough,
  hoarseness, red eyes, and swollen lymph nodes in the neck
• Also called an upper respiratory
  infection (URI)

Similar conditions

1. Vasomotor rhinitis. Many children and adults have a profusely runny nose in the winter when they are breathing cold air. This usually clears within 15 minutes of coming indoors. It requires no treatment beyond a handkerchief and has nothing to do with infection.
2. Chemical rhinitis. Chemical rhinitis is a dry stuffy nose from excessive and prolonged use of vasoconstrictor nose drops (more than 1 week). It will be better within a day or two of stopping the nose drops.

Cause

A cold or URI is a viral infection of the nose and throat. The cold viruses are spread from one person to another by hand contact, coughing, and sneezing?not by cold air or drafts. Since there are up to 200 cold viruses, most healthy children get at least six colds each year.

Expected Course

Usually the fever lasts less than 3 days, and all nose and throat symptoms are gone by 1 week. A cough may last 2 to 3 weeks. The main things to watch for are secondary bacterial infections such as ear infections, yellow drainage from the eyes, sinus pressure or pain (often indicating a sinus infection), or difficulty breathing (often caused by pneumonia). In young infants, a blocked nose can interfere so much with the ability to suck that dehydration can occur.

HOME CARE

Not much can be done to affect how long a cold lasts. However, we can relieve many of the symptoms. Keep in mind that the treatment for a runny nose is quite different from the treatment for a stuffy nose.

Treatment for a Runny Nose with Profuse Discharge: Suctioning or Blowing. The best treatment is clearing the nose for a day or two. Sniffing and swallowing the secretions are probably better than blowing because blowing the nose can force the infection into the ears or sinuses. For younger babies, use a soft rubber suction bulb to remove the secretions gently.
Nasal discharge is the nose's way of eliminating viruses. Medicine is not helpful unless your child has a nasal allergy.

Treatment for a Stuffy or Blocked Nose with Dried Yellow-Green Mucus
Warm-Water or Saline Nose Drops and Suctioning (Nasal Washes).
Most stuffy noses are blocked by dry mucus. Blowing the nose or suction alone cannot remove most dry secretions. Nose drops of warm tap water are better than any medicine you can buy for loosening mucus. If you prefer normal saline nose drops, mix ½ level teaspoon of table salt in 8 ounces of water. Make up a fresh solution every day and keep it in a clean bottle. Use a clean dropper to insert drops. Water can also be dripped or splashed in using a wet cotton ball.

• For the younger child who cannot blow her nose: Place 3 drops of warm water or saline in each nostril. After 1 minute use a soft rubber suction bulb to suck out the loosened mucus gently. To remove secretions from the back of the nose, you will need to seal off both nasal openings completely with the tip of the suction bulb and your fingers. You can get a suction bulb at your drug store for about $2.
• For the older child who can blow her nose: Use 3 drops as necessary in each nostril while your child is lying on her back on a bed with the head hanging over the side. Wait 1 minute for the water or saline to soften and loosen the dried mucus. Then have your child blow her nose. This can be repeated several times in a row for complete clearing of the nasal passages.
• Errors in using nose drops: The main errors are not putting in enough water or saline, not waiting long enough for secretions to loosen up, and not repeating the procedure until the breathing is easy. The front of the nose can look open while the back of the nose is all gummed up with dried mucus. Obviously, putting in nose drops without suctioning or blowing the nose afterward is of little value.
• Use nasal washes at least 4 times per day or whenever your child can't breathe through the nose.

The Importance of Clearing the Nose in Young Infants. A child can't breathe through the mouth and suck on something at the same time. If your child is breast- or bottle-feeding, you must clear the nose so she can breathe while sucking. Clearing the nasal passages is also important before putting your child down to sleep.

Treatment for Associated Symptoms of Colds

• Fever: Use acetaminophen or ibuprofen for aches or mild fever
  (over 102º F [38.0º C]).
• Sore throat: Use hard candies for children over 4 years old and warm chicken broth for children over 1 year old.
• Cough: Use cough drops for children over 4 years old and corn syrup for younger children. Run a humidifier.
• Red eyes: rinse frequently with wet cotton balls.
• Poor appetite: Encourage fluids of the child's choice.

Prevention of Colds. A cold is caused by direct contact with someone who already has one. Over the years, we all become exposed to many colds and develop some immunity to them. Since complications are more common in children during the first year of life, try to avoid undue exposure of young babies to other children or adults with colds, to day care nurseries, and to church nurseries. A humidifier prevents dry mucous membranes, which may be more susceptible to infections. Vitamin C, unfortunately, has not been shown to prevent or shorten colds. Large doses of vitamin C (e.g., 2 grams) cause diarrhea.

Common Mistakes in Treating Colds. Most over-the-counter cold remedies or tablets are worthless. Nothing can shorten the duration of a cold. If the nose is really running, consider a pure antihistamine (such as chlorpheniramine products). Especially avoid drugs that have several ingredients because they increase the risk of side effects. Avoid oral decongestants if they make your child jittery or keep her from sleeping at night. Use acetaminophen or ibuprofen for a cold only if your child also has fever, sore throat, or muscle aches. Leftover antibiotics should not be given for uncomplicated colds because they have no effect on viruses and may be harmful.

CALL OUR OFFICE BYRDSTOWN MEDICAL CENTER AT (931) 864-3187

IMMEDIATELY if

• Breathing becomes difficult and no
  better after you clear the nose.
• Your child starts acting very sick.
  
  Within 24 hours if
• The fever lasts more than 3 days.
• The nasal discharge lasts more than
  10 days.
• The eyes develop a yellow discharge.
• There is any suggestion of an
  earache or sinus pain.
• You have other questions or
  concerns.

Travel Tips for Families :

Include :
First Aid Kit
Sunscreen and bug repellent sprays
Emergency numbers of travel locations
Local doctor office numbers
Ambulance
Sheriff
Local Hospital numbers
Bring a complete list of medicines and allergies
Bring Health Insurance information