Sick Child

SHOULD EVERY CHILD WITH FLU COME INTO THE OFFICE?:

Not necessarily, but no matter what you read here, if your child is acting very sick and you are worried, of course come in.
Headache, muscle pain, dry cough, fever, stomach aches or vomiting are all signs of the flu. If we confirm the flu, at least you know what to expect, about how long it will last and what to watch for. If we diagnose it within the first 1-2 days certain patients may benefit from tamiflu which can shorten the course and reduce the severity. For household members at risk of complications we can prescribe tamiflu as a preventive.
Infants under 12 months with a fever or any other symptoms should be seen promptly. They are less able than older children to fight the virus.
Children who have asthma, diabetes, immune deficiencies or any other chronic conditions that are risk factors for complications should be seen if they act sick at all.
If we have identified influenza A (presumably swine flu) in one of your children and others show the same symptoms, you need not come in with them unless they are alarmingly sick.
If your child has had the flu but fever occurs again after a seeming recovery or if fever and cough do not subside by 5-6 days, we should make sure pneumonia or some other complication has not happened.
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In a baby under 3 months, any temperature over 100.4 is a fever. Because small infants cannot fight infection as well as older infants and children, you should call us immediately.
For older infants and children, a temperature of 101 or above is considered a fever. Body temperature can be raised by playing in the hot sun or by overdressing, so unless your child is acting sick, wait a few minutes and repeat the temperature after cooling off.

What’s true:

Fever is a part of the body’s natural response to invasion by germs.
The reason to lower fever is for your child’s comfort so that drinking fluids is easier.
Fevers that develop in the course of an illness are not dangerous, even if they get to 104. Dangerous fevers are 106 and above such as occur when a child is left in a hot car or plays soccer in the noon day sun without cooling off.
If a fever does not respond to fever reducing medication be sure you are giving the right dose. See the dosing chart.
What is more important than the fever itself is how your child looks. A child with 101 who does not want to move, has poor color and seems out of it is sicker than one with 103 who is crying vigorously and reaching out for you.

What’s not true:

Treating fever cannot prevent a fever convulsion. Children develop fever convulsions no matter what you do. SEE fever convulsions link?
Fever convulsions do not cause brain damage nor lead to epilepsy. Many children under 5 get them in the first 24 hours of an illness and 10% of those will have another. It has nothing to do with how carefully you manage fever.
Treating fever does not interfere with the body’s ability to fight infection.

Call immediately or go to the emergency room if:

Your child has a weak cry
Is abnormally quiet with a vacant stare
Is difficult to arouse
Is grunting or moaning
The fever is associated with a rash
Your child was recently exposed at school or day care to a serious infection such as meningitis.
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Most children will have an episode of vomiting from time to time, usually from a stomach virus. The natural impulse for parents is to give the child something to drink immediately. Don’t. If you do, your child will likely immediately throw up again.
Wait a while before challenging the upset stomach. With an infant, wait the normal time between feedings and then try a small amount of an oral electrolyte solution such as Pedialyte. Breast fed babies can be fed some breast milk, but not a full feeding. Just a small amount at a time.
For older children, let them tell you when they feel like taking something. Limit the first feedings to sips of clear liquids such as flat ginger ale, apple juice, ice chips, etc. You can increase the volume of each drink slowly over several hours.

CALL US IMMEDIATELY IF:

Your child is under four months, especially if the vomiting is forceful. This could be a sign of an obstruction in the stomach.
Green, yellow or coffee ground type material is vomited.
Vomiting continues for more than a few hours and even clear liquids will not stay down.
Your child’s stomach is bloated, tender or hard.
Dry heaves do not stop when you are not giving anything by mouth.
Vomiting occurs after a blow to the stomach.
Vomiting is accompanied by a high fever and/or diarrhea.
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The most important fact about rashes is that it is almost impossible for us to diagnose them over the phone. Flea bites and chickenpox can look alike; viral rashes and drug rashes are hard to tell apart; rashes from shoes may seem like athlete’s foot.
Most of the time when you describe a rash over the phone it is “red spots”. We almost always have to actually see your child.

CALL US IMMEDIATELY IF:

Rashes look like bruises.
Welts that are accompanied by swollen lips or eyes.
Deeply red spots that do not blanch when you press on them, like blood spots under the skin.
Any rash that accompanies a fever.
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