Hot to Trot
My chances against pneumonia are great!
This guy might have a good chance against pneumonia, if that was his problem.
He looks like he’s having a massive anterior MI.
Or his wife’s meatloaf keeps repeating on him.
I think he’s having an acute anaphylactic reaction to the decor.
Who puts an ass (pardon me, I meant donkey), complete with a saddle, on their end table as a decoration?
The child will need theraputic counseling for years after this traumatic attempt at fever assessment.
Do you know, when a patient tells me they think they are running a fever, I instinctively feel their forehead and then I take their temp?
I have no doubt that the first humans did the same thing. I imagine this scene, set in a pre-historic cave:
Caveman: “Feel hot!”
Cavewoman: “No. Have pain in head.”
Caveman: “Not that. Skin hot!”
Cavewoman: “Me feel face.” (Puts hand on forehead.) “Skin hot. Eat two of berries. Call giver of health when light comes.”
Caveman: “Me sick. No care for self. Must have all things done.”
Sorry guys, but some things never change.
Do you take your child’s temperature under their arm because, well, who wants to do a rectal temperature?
Do you get nauseated at the thought of taking a rectal temp?
Do you become faint when the triage nurse takes your child’s temperature and tells you that the number 40.6 centigrade is actually 105 degrees?
Are you concerned when your child’s temperature does not “break” after a dose of Tylenol?
Are you amazed when the temperature comes back to its pre-Tylenol level approximately four hours after the last dose?
What, you say? You can give ibuprofen for fever?
Does the fact that your child even has a fever cause your pulse to race, your breathing to become labored and your anxiety level to skyrocket?
You, my friend, are suffering from acute fear of fever, or, as it has been coined in the literature I’m familiar with, “Fever Phobia”.
You are not alone.
Here are some things to keep in mind. These are things I’ve picked up regarding pediatric fevers in the ER and during my stint as an advice nurse in a pediatric clinic.
- Fevers are not dangerous.
- They are the body’s way of fighting off an infection, either viral or bacterial.
- Fevers are more likely to be bacterial and should definitely be evaluated if
- They last longer than three days.
- They go over 105 degrees.
- The exception to the rule: fevers in any child under 8 weeks old should be evaluated immediately by a physician.
- The height of the fever is not as important as how the child is acting/looking.
- Febrile seizures are the scariest things you will ever see as a parent.
- They are also harmless.
- Usually it is related to how fast the fever rises or drops.
- They will stop on their own.
- Turn your child on their side to allow any secretions to drain.
- Protect them from injuring themselves on surrounding items.
- The child should be evaluated immediately after the first febrile seizure.
- The doctor will need to confirm that the seizure was truly due to the fever and not an underlying medical condition.
- Discuss with your pediatrician what steps you should take if your child has repeated febrile seizures.
- Both acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) can be used for fever.
- There is some difference of opinion on whether or not both medications can be used together, i.e. alternated. Ask your pediatrician what they prefer you to use.
- Pediatric dosages are based on weight. The dose your child took six months ago will not be the correct dose today. If your child’s weight is not listed on the bottle, call your pediatrician or an advice line to get the correct dosage for the weight.
- Ask your pediatrician at what age they suggest using Motrin. It has been my experience that ibuprofen is not used under six months old.
- Expect the fever to return as the medication wears off. It will.
- Do not wrap your child up if they have a fever.
- Right: a diaper and light covering – just enough so they do not shiver.
- Wrong: a diaper, two onesies, a terry-cloth one-piece with “footsies”, a sweater, a blanket-sleeper with “footsies”, a coat, a hat and a fifty pound afghan hand- crocheted by grandma. At the same time.
- Most children with fever will not want to eat, but they will be thirsty. Fluids are important.
- Encourage them to drink as much as they want of whatever they want.
- Make sure the fluid has calories in it. That sounds silly to mention, but offering diet sodas will not contribute calories or nutrition.
When I worked in pediatric triage, my facility used protocols written by pediatrician Barton Schmitt, MD. I have to recommend this book as one of the best books on child health that I have ever read. It is based on the same protocols we used at the clinic. I have given it as a gift at at least six baby showers. Apparently it has been updated in 2005. Here is the amazon.com link for those who are interested:
