Hot Dog

My feisty little dog Milou hates squirrels. They’re harmless, but you wouldn’t know it the way he barks and barks when they’re running around the yard.  When we let him out a high speed chase ensues, him nipping just behind the trespasser’s tail, before the enemy slithers through the fence and is gone.  Milou continues to bark, his shrill yapping annoying everyone, particularly my back-fence neighbor, who blows an air-horn when he’s had too much.

Like Milou and squirrels, parents and grandparents are irrational regarding fevers. Their fear stems from what fevers used to mean in children, generations ago.  Before 1990, fevers could mean life-threatening illnesses like meningitis and blood infections.  Before 1950, it could mean polio or measles.  Ancient memories probably haunt dogs too, their DNA wired to attack intruders into territory and food supply meant for the pack.

Like squirrels, fevers themselves are harmless, and actually good!  They’re part of the body’s immune response to invading infections.  The brain senses evidence of infection and sets the body’s thermostat to make fever.  Just like cooking food kills germs in it, fever makes it harder for germs to grow in the body, giving the immune system a chance to overtake the infection and destroy it.  Myth buster: fevers don’t hurt the brain, and seizures that accompany fever in infants and toddlers are rare and benign.  Finally, vaccines have eliminated the vast majority of serious infections that fevers once heralded.  These days, fevers usually mean mild illnesses like cold viruses and ear infections.

More important than the fever is how your child is ACTING with the fever.  Kids in terrible pain, who work hard to breathe or drink poorly, or are lethargic; those are the ones we worry about. But if your child is drinking well, breathing comfortably, and of course tired from the fever but wakes up to act reasonably alert, then no emergency!

For feverish kids who feel rotten, give them anti-fever medicine, like acetaminophen (Tylenol), or ibuprofen (Motrin, Advil).  Sometimes fevers make kids breathe fast, have fast heart beats, and act tired.  If these improve after medicine, that tells us things are okay.

There’s a term for irrational fear of fevers, like my dog’s irrational hatred of squirrels- “fever phobia.”  This term describes that fear, and the lengths parents go to combat it.  Some examples of parents talking fevers: “It shot all the way up to 100!”  “His fever was 102, so he had to come to the ER.”  “I took her temperature every hour.”  “He was shivering, I was afraid he might catch a seizure.”

These attestations reveal misconceptions about fever.  Fever is defined as temperature greater than 100.4 Farenheit, but temperature height rarely correlates with severity of illness.  In other words, higher fevers don’t mean your kid’s more sick. Some children in the hospital with pneumonia have temps of 101, some at home with ear infections are 103.

Fevers don’t cause brain damage, and won’t rise to life-threatening levels if untreated.  But given these fears, parents go to extremes. They take their kids’ temps hourly, wake them up at night to give them medicine, bathe them with rubbing alcohol, and visit the Emergency Department, as if their babies will burst into flames like overheated race car engines.

Fevers are actually good.  As we said above, it’s part of the body’s defense mechanisms against infection.  There’s a faction in pediatrics that wonders if we should even give anti-fever medicine, that maybe without them kids would recover faster.  No one has studied that yet, and certainly giving ibuprofen or acetaminophen (Tylenol)  helps your child feel better.

Feverish kids feel bad- they have headaches, they don’t drink well, they breathe fast and their hearts go fast, and they sleep so hard they can be difficult to arouse.  Anti-fever medicine makes these better.  Kids drink better, act more appropriately, and generally scare parents less.  But give enough- as much as the box says!  While fearing fevers, many also fear overdosing their children, and don’t use adequate doses to alleviate symptoms or fever.  Then when the fever persists, they panic more. And no alcohol baths- these CAN poison children through skin absorption.

With medicine, remember you’re treating to help your child feel better, not necessarily eliminating fever.  If you can’t get the fever down, don’t panic.  As long as your kid’s breathing comfortably, drinking adequately, and arousable, that’s okay.

Is Chapped Lips An Emergency?

One of last year’s fun news stories was a 911 call from a man whose cat wouldn’t let him in his house.  After a three hour stand off, and after the police and 911 operator finished laughing themselves silly, an officer was dispatched and apparently talked the cat down.

Similar absurdities happen in Emergency Medicine.  Once when I worked in Baltimore, a mom brought her child in for chapped lips.  Thinking that no one would come to the ED for such a minor thing, I searched for the “hidden agenda,” some underlying worry explaining mom’s thinking.  Like if her Uncle Frim had lip cancer and she feared her son had it too. However, after an exhaustive history, there was no such issue: her son simply had chapped lips.

It’s sometimes difficult telling the public when to call 911 or not, and when to bring kids to the Emergency Department or not.  We want to encourage people to get emergency help so they don’t blow off potentially serious issues.  On the other hand, we don’t want the Emergency Department and EMS systems clogged with non-emergencies.

Most pediatric ED visits are not emergencies, but families come for many reasons. First, parents get scared for their kids.  They love their kids and when they get sick or hurt, parents sometimes rush for help rather than call their doctor for advice or wait for an appointment.

Often parents can’t get their kid seen in the office that day.  An appointment for next week doesn’t help when your child won’t stop vomiting, or needs x-rays.  Sometimes when the parent does call for advice, the mom is told to go to the ED, rather than office staff taking time to talk the situation through, giving advice that could keep the child home.

Sometimes when a child gets sick or hurt, a doctor’s office or school is worried about caring for a potential emergency.  They aren’t used to emergencies and don’t want to miss something, or get sued.

Almost daily we see kids in the Emergency Department who were in car crashes, seem fine, but the parents want them “checked out.”  You can’t fault this reasoning; they care about their kids and are worried.  However, when the “crash” involves cars backing into each other in a parking lot, and the child was strapped into a car seat, maybe an ED visit is overkill.  Unless the lot has cars speeding into their slots like the Indy 500 pit stop.

Too often the ED is used as a walk-in clinic, rather than for true emergencies.  The point of this blog is to inform you about what real emergencies are, what can wait to see the doctor, and what you can take care of at home.  So let’s review common issues appropriate for the ED, and things that are not emergencies.

Kids who are short of breath, tugging to breathe, belong in the ED.  Of course bring any children with possible broken bones, cuts that need stitches or won’t stop bleeding, or severe pain. When kids get lethargic (difficult to arouse), they need to get seen.  However, there are gradations of cuts and limb injuries, and lethargy: kids with fever get lethargic, but recover with anti-fever medicines.  If it isn’t obvious if it’s an emergency or not, call the doctor’s office.  If they can’t help, go to the column in this blog to the immediate right side of the page.  Click on your issue to read specifics about what is an emergency, and what can be handled at home.

Things that are commonly not emergencies: fever, coughing, rashes.  Fever doesn’t hurt kids- it doesn’t cook their brains and is rarely associated with seizures.  The height of the fever doesn’t correlate with how sick the kid is either: a child with a 104 temperature isn’t sicker than a child with 101.  Coughing also isn’t an emergency- kids cough when they get colds and if they aren’t otherwise short of breath, it can wait.  Again, see the column to the right.

This is a busy time of year for the Pediatric Emergency Departments, so use common sense when deciding to visit.  Use your doctor’s call line, or this blog when in doubt.  But if you still can’t decide, bring your child in. Better safe than sorry, but you can leave the chapped lips at home.

My Kid Has A Fever…Help!!!

This week’s guest columnist is Dr. Shauna Bienvenu, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

As a resident working in the Pediatric Emergency Department, I’ve noticed that “fever phobia” is pretty common.  Many parents rush into the ER when their child has a fever.  They’re afraid that fever is a sign of serious infection, and that a higher fever means it’s even more serious.  They’re afraid of the fever itself, that it will hurt their kid’s brain or cause seizures.  Fever can be scary for parents, but is actually harmless.  Yes, it’s harmless!  It feels bad, but doesn’t injure your child.

Here’s the good news: fever is an important part of the body’s defense against infection.  Most infections that cause fever are minor and are “self limited,” meaning kids get over them on their own.  Most fevers go away within 72 hours.

When your kid does have a fever, start by treating it at home.  Have her drink plenty of fluids.  If giving fruit juices, dilute with half water and half juice.  Children can eat and drink milk with a fever, but don’t force them.  Bland foods are better, such as breads, crackers, oatmeal, or pastas.

Use acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) to make your child feel better.  Dress him or her in lightweight clothing and light blankets.  You can use lukewarm baths to help your kid feel better too, though a bath may not bring down the temp.  Don’t use ice baths or alcohol baths- these won’t help either, and can be dangerous.

When giving medicine for fever, use the correct dosage.  A lot of parents are afraid to give too much, and end up not giving near enough to work.  The correct dose is based on the child’s weight and is on the medicine’s box, or on the internet.  Tylenol can be used every 4 hours and ibuprofen every 6 hours- more than that will not work any better.

A common myth is that if your child feels warm, they must have a fever!  Children can feel warm for many reasons such as playing hard, crying, or hot weather.  Overdressing infants can make them seem warmer too.  If your child feels warm, check the temperature before calling your doctor or rushing to the Emergency Department.  If the child’s temperature is less than 100, that’s not a fever, no matter how warm she feels.  However, some parents are so afraid of fever that a thermometer won’t convince them- “98.6, no way!  He definitely has a fever- feel him!”

Again, fevers are not bad for children.  Fever is a protective mechanism, helping fight infections.  If the fever does not come down or you cannot “break” the fever, this doesn’t mean it’s more serious.  Height of the fever doesn’t correlate with how sick the kid is either.  In other words, if a child has a temperature of 104, she isn’t necessarily sicker than a kid with a temp of 101.  How your child looks is what’s important, not the height of the temperature.

So, when do you call your doctor or go to the ER?  Again, it’s how your child looks.  If a child has a fever, but is playful and drinking, then just treat the fever.  Your child may sleep more, not eat so well, and act miserable, but this can be okay too.  As long as he feels better after fever medicine (at a decent dose!), is drinking,  and is breathing comfortably, then things are fine.

Talk to your child’s doctor or go the ER if your child is not alert after the fever is treated.  If your child is not drinking and urinating as much, this can be worrisome too.  If your child has trouble walking, cannot be easily awakened, seems confused, has difficulty breathing, has a bad headache, or has new rashes with bruising, get seen.  Infants under 3 months old with fever need to see the doctor too, as do kids with certain conditions like sickle cell disease.

Yes, fevers are scary to parents, but they are usually not an emergency.  Of course, if you are worried call your doctor.  He or she can help you sort through your child’s symptoms and nip ”fever phobia” in the bud.

Fever Is Not The Enemy!

Its happening a lot this time of year.  Parents rush their kids into the Emergency Department- for fever.  When I get to the bedside, mom is sick with worry.  The child, however, is walking about the room, opening cabinets, tugging on the bed controls.  It seems the only problem the kid is having is not being able to release the bed brakes so he can race the stretcher up and down the hall.

Its a cough and fever time of year.  The Emergency Departments and pediatric practices are full of sick kids.  Kids have been coughing on each other in school or day care for three months now, and the influenza virus has joined the mix.  Besides the amount of ill kids, the University Medical Center closed its Pediatric Department earlier this year due to state budget cuts, and thus there is one less place to bring children.  So what should you do with your child with a fever?  Keep them home!

Fever is not an emergency.  Fever is a natural response by your body to fight off infection.  Just like you cook food to kill germs in it, your body gets hotter when you are infected to make it harder for the infection to grow in you.  This gives your immune system extra help to clean the infection out. 

So what do you do for your child’s fever?  Give them fever medicine, but give enough!   Another popular reason for parents to visit the Emergency Department is that when they gave ibuprofen (Motrin, Advil) or acetaminophen (Tylenol, Pediacare), the fever did not go away.  This does not mean the fever or illness is extra bad, or that the medicine is no good.  After discussing dosing with the parents, the mom turns out to be afraid of overdosing their child, and then only gives a tiny amount.  Therefore they under-dose the kid, and no wonder the medicine did not work.  Don’t worry about overdosing with ibuprofen or acetaminophen- it is very hard to hurt a child with these medicines.  If you have trouble figuring out the dose from the instructions on the bottle, call your doctor.  The nurse on the phone can help you with dosing.

When is a fever a worry?  As I tell my patients, its not the fever, or how high it is, or whether it goes away with medicine or not.  Again, as I have said before, it is not the fever that will hurt your child- it won’t cook his brain or make him have seizures. What is more important is how the child is acting.  Are they breathing normally?  Good!  Are they drinking and making urine?  Good!  Are they waking up and talking and with it?  Good!  These are the well enough-acting kids who can wait a few days before having to see a doctor, much less go to the Emergency Room.  

The time we worry about fever is when children ACT sick.     Are they getting short of breath, meaning they are pulling for their breath or breathing faster than normal?  Are they getting more and more tired and sleepy?  Are they drinking less and less?  Kids who get sicker and sicker are the ones who parents need to call their doctors about.  And if the doctors tell them to go the Emergency Department, come on in!  Also, newborns with fevers need to get seen right away too.  Newborns are at special risk for infections that older babies and children aren’t. 

So next time your child gets a fever, don’t run to Emergency.  If your doctor can’t see your child until the next day, it can wait!  Talk to your doctor on the phone to be sure.  Give ibuprofen or acetaminophen, and give enough.  Fever is not the enemy, it is actually your child’s friend.




Fever Won’t Cook Your Baby’s Brain!

Many parents fear that high fever will hurt their children.  A common visit to my Emergency Department often starts with “My baby had a fever of 103, so I rushed right in.”  Many times I look the toddler over and he is jumping up and down on the bed, pounding it with both feet.  Just how sick is this kid?

After determining that the baby has no more serious condition than a virus or ear infection, I often start my talk with the parents with “fever won’t cook your baby’s brain,” which causes the parent to giggle nervously and say that that is exactly what they feared.

Fever is actually a good thing- it is part of how your body fights infection.  Just like you heat food or wash in hot water to kill germs, your body sets its natual thermostat higher to help your immune system get rid of germs.  In fact, there are many renowned pediatricians who say we should not treat fever with Motrin or Tylenol because that may slow the recovery process!

However, many moms have a story about how a friend or relative’s child died because of fever.  It is important to know that it was not the fever that hurt the baby, it was the infection that caused the fever that hurt the baby.  Fever is just another symptom of illness, it is not bad itself. 

What I tell parents is that the important thing about fever is not that the child has a fever, but how the child is acting with the fever.  Is the child short of breath?  Is the child difficult to wake up?  Does the child have a funny color?  Is the child drinking poorly?  Is the child under three months old with a fever?  These are the signs of serious illness, not the fever.  These are the real reasons to take a child to the Emergency Department.

Next time your child has a fever and is free of those troubling symptoms, relax.  Give your child some Motrin or Tylenol and wait.  If your child is breathing comfortably, will wake up and talk to you, is drinking ok, then you can probably hold off coming to the Emergency Department.  You can usually even wait a day or two to see if the fever will go away on its own before going to the doctor’s office.  When in doubt, you can always call your doctor on the phone to ask if your child needs to get seen sooner.