Fever What to Do When Your Kid Has a Temp

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Her pajamas are rumpled, her face flushed and the tendrils of hair on her forehead are damp from sweat.

When your child seems feverish, your first instinct is probably to try to cool her off. But a warm child may not necessarily be running a temperature, and even if she is, lowering the fever isn't always the best solution, says A. Gayden Robert, M.D., a pediatrician and head of general pediatrics at the Ochsner Clinic in New Orleans.

Any concerned parent will call the doctor as soon as fever starts to escalate--and with good reason. It's important to find out what's causing the fever. But that doesn't mean you have to bring the fever down right away.

''The fever is a symptom, not an illness,'' says Dr. Robert, noting that fever is often caused by a viral or bacterial infection, such as the measles or flu. ''It's a defense mechanism that helps a child fight the infection.''

Most doctors agree, however, that you may need to treat a fever so your child can rest more easily. If your child is crying or irritable from the fever, you'll definitely want to lower it enough to make him more comfortable, says Carol Kilmon, Ph.D., R.N., a certified pediatric nurse practitioner and assistant professor at the School of Nursing at the University of Texas Medical Branch in Galveston.

So here's how to deal with high temperature to bring your child back to the comfort zone.

Taking the Temperature

Time your reading. The body's temperature fluctuates throughout the day, points out Sanford Kimmel, M.D., pediatrician and associate professor of clinical family medicine at the Medical College of Ohio in Toledo. It's generally highest in the late afternoon or early evening, and lowest in the morning. It can also be affected by exercise or hot foods. To get the most accurate reading, you should take your child's temperature 30 minutes after he has quieted down or 30 minutes after he's had a hot meal or drink, advises Dr. Kimmel.

When to See the Doctor

Fever doesn't usually require medical care, but there are certain red flags that indicate the need to consult with a doctor, according to A. Gayden Robert, M.D., a pediatrician and head of general pediatrics at the Ochsner Clinic in New Orleans.

If you have any concerns about your child's fever, check with the doctor, of course, but always call if your feverish child:

* Is crying inconsolably.

* Remains irritable even after the fever drops. (If you're giving acetaminophen--Children's Tylenol--to make the fever drop, allow 30 to 45 minutes for the medication to take effect.)

* Is difficult to awaken.

* Is confused or delirious.

* Has just had a seizure or has had them in the past.

* Has a stiff neck.

* Is having difficulty breathing even though the nose is clear.

* Has persistent vomiting or has diarrhea.

* Has had the fever more than 72 hours.

A Different Kind of Fever

Your child's fever has stayed high for three days now, but your pediatrician has told you not to worry. Suddenly on the fourth day, the fever drops and a rash appears on her trunk, neck, face, arms and legs.

Do give your doctor a call--but don't panic. This isn't the onset of a new disease. It's a sign that what caused your child's fever was a harmless disease called roseola, says Daniel Bronfin, M.D., a staff pediatrician at the Ochsner Clinic and assistant clinical professor of pediatrics at Tulane University School of Medicine in New Orleans.

''You can't always diagnose it before the rash appears, but when we see a playful child one or two days into a fever in the 103° to 104° range without symptoms, we suspect roseola,'' he says. Roseola is caused by a virus and occurs most often in infants between the age of six months and two years. There's no medication required, and you should only try to bring down your child's temperature if he's uncomfortable, says Dr. Bronfin. Realize that you'll only be able to bring it down a few degrees, however.

Although it seems to make your child irritable, the rash isn't itchy or uncomfortable and doesn't require treatment. It will disappear in a few hours to a few days. When the rash appears, the child is no longer contagious.

Take the right approach. A baby's temperature is most accurately measured with a rectal thermometer, which is shorter and has a thicker bulb than an oral thermometer, says Dr. Kimmel. Grease it with petroleum jelly, then insert the thermometer slowly no farther than 1½ inches, and hold it gently in place for at least three minutes. To do this you can put the baby on the dressing table or in your lap in the diaper-changing position, and lift the baby's legs for easy access. Or you may prefer to lay the child stomach down across the lap, spread the buttocks and then insert the thermometer.

Switch to oral. When a child is four or five, he'll usually be able to cooperate in holding an oral thermometer under his tongue for at least four minutes, says Dr. Kimmel. Digital thermometers are fast, accurate and a little safer than traditional glass mercury thermometers, but they are also more expensive. Regardless of the type of thermometer used, make sure your child sits quietly, since any activity will raise the temperature.

Assess the readout. Although 98.6° has long been considered the classic ''normal'' oral temperature, some people routinely have a higher temperature--so your child could have a slightly higher reading and still be perfectly normal. Your child has a fever if his temperature is more than 100.4° measured rectally, 99° under the arm or 100° measured orally, says Dr. Robert.

Lowering the Fever

Give acetaminophen. Pediatric acetaminophen (Children's Tylenol ) will help bring the fever down, says Beth W. Hapke, M.D., a pediatrician in private practice in Fairfield, Connecticut. These products come in liquid form for infants and toddlers and chewable tablets for older children. Check the package directions for the correct dosage for your child's age and weight. If your child is under age two, consult a physician.

Doctors caution that you should never give your feverish child aspirin, however, as it has been linked to a serious brain and liver ailment called Reye's syndrome.

Try a sponge bath. Give your child a lukewarm sponge bath for 15 to 20 minutes, says Lynn Sugarman, M.D., a pediatrician with Tenafly Pediatrics in Tenafly, New Jersey, and an associate in clinical pediatrics at Babies Hospital, Columbia Presbyterian Medical Center in New York City.

Put your child into a tub with tepid water, and sponge the water over her arms, legs and body. ''As the water evaporates, it cools the body, which helps bring down the fever,'' Dr. Sugarman explains. Don't use water so cold that the child shivers. Shivering will actually raise the body temperature, defeating the whole purpose of the sponge bath.

If you don't want to take your child out of bed to bathe her, you can just loosen her clothing and sponge her from a basin.

Leave the alcohol on the shelf. Parents once rubbed down feverish children with rubbing alcohol, but doctors today discourage this practice. ''Besides causing shivering, alcohol can be absorbed through the skin and cause a toxic reaction in your child,'' says Dr. Robert. And breathing the fumes can irritate your child as well.

Febrile Seizure: A Scary Experience

If your child has ever had a febrile seizure, you won't soon forget it. It's triggered by a rapid rise in temperature--often from an infectious illness such as tonsillitis--which apparently causes a change in the brain's electrical patterns.

Febrile seizures occur in about 1 child in 25, and in some cases, the feverish child lapses into unconsciousness. Other seizures can mimic an epileptic seizure with arms and legs twitching and jerking uncontrollably. You should alert your doctor of every febrile seizure.

When the seizure begins, follow these guidelines, advises John Freeman, M.D., a pediatric neurologist and professor of pediatrics and neurology at the Johns Hopkins Hospital in Baltimore.

* Turn your child on his side and make sure he can breathe

freely; This way saliva or vomit won't block the windpipe

* Move harmful objects out of the way

* Don't try to wedge your child's mouth open; he will not swallow his tongue

* If the seizure lasts only five to ten minutes, call your doctor as soon as it ends

* If the seizure lasts more than ten minutes or your child has trouble breathing, get him to a hospital where he can receive anti-seizure medication

Supply lots of fluids. A child with a fever breathes faster than usual, which makes him lose extra fluid. If he has diarrhea, even more fluid is lost. ''So make sure your child sips some liquid--whatever his stomach will tolerate,'' advises Dr. Kilmon. ''Make the drink cool, not hot, and give frequent, small amounts rather than trying to get lots down at once.''

Any beverage kids will drink is fine, as long as you steer clear of colas, tea or coffee (these are diuretics that encourage fluid loss). And you can add some variation by supplying soup, a Popsicle or gelatin.

For nursing infants, regular feedings will provide enough liquid. If your infant has had diarrhea more than 24 hours, ask your doctor about giving him Pedialyte,an oral electrolyte solution available at drugstores,suggests Dr. Kimmel.

Keep clothing light. A child in flannel PJs or bundled in a quilt will overheat quickly, making the fever worse. ''Keep your child lightly dressed, and have her sleep under a thin blanket or sheet,'' advises Dr. Sugarman.

Make meals optional. If your feverish child doesn't want to eat, don't urge her, says Dr. Kimmel. On the other hand, if she asks for pizza, that's okay, too. ''If your child is in the mood to eat a certain food, it's probably okay to give it to her,'' he says.

A child who has had a stomach virus or upset stomach, however, will likely prefer something simple such as toast or crackers with some jelly. Other ''comfort foods'' such as oatmeal and mashed potatoes as well as bananas and pudding are also good choices, says Dr. Kimmel. Avoid fruit juices, however, as these can contribute to diarrhea.

Don't expect normal. Neither acetaminophen nor sponge baths will bring your feverish child's temperature down to normal, says Daniel Bronfin, M.D., a staff pediatrician at the Ochsner Clinic and assistant clinical professor in pediatrics at Tulane University School of Medicine in New Orleans. ''If the fever was 104°,'' he says, ''you may be able to get it down to 101°.''

Keep your child home. As long as your child has a fever, it's best to keep him home. ''The rule of thumb here is that a child can return to school after his temperature has been normal for 24 hours,'' says Dr. Robert. ''Although we don't know for sure, we believe if the fever is gone, then the infectious risk is, too.''

Reference : web .mothernature.com

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