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Fever in Pediatrics: Understanding It and How to Tackle It During Those Cold Winter Months
By Dr. Calogera Perrone
                     
 
Alas, it is full-blown flu season.  All too many parents are faced with their children developing high fevers out of the blue.  Some are first time parents, not knowing what steps to take, especially if they are dealing with small infants.  Others have dealt with treating illnesses with high fevers in the past but are still at a loss as what to do when the thermometer reads temperatures up to 105°F!
 
Let’s start by understanding what fever means scientifically.  Basically, it is our body’s way of fighting an infection (caused by a virus or bacteria) making the host an uncomfortable habitat by increasing the temperature.  Therefore, it is not a bad thing unless it is very high, not responding at all to measures to bring it down or it lasts longer than it should.  It’s actually a good thing in the sense that it shows that you have a good immune system, able to fight an infection.  Having said that, let’s clarify what you need to know about fever.  The cut-off temperature officially considered to be a “fever” is 100.4°F and above taken rectally for infants, which is the most accurate way of measuring the temperature.  Other ways of taking the temperature, frontal or ear thermometers can be used for older children but may give inaccurate readings. 
 
What to do once you determine that your child actually has a fever?  That varies according to the child’s age.  If the baby is less than 8 weeks of age and has a rectal temperature of 100.4°F or above you must take the baby to the ER.  At this age a fever can indicate an infection that can be a serious medical emergency.  If the baby is greater than 8 weeks of age, you must call your pediatrician to have the baby seen.  If it is after hours and the temperature is very high (102°F – 104°F), take the baby to the ER.  For older infants and children, you can give medication to bring the fever down and call to make an appointment to be seen.  **For medications used for fever in Pediatrics refer to the Tylenol/Motrin dosing chart at the end of this article. **
 
When you give the medication, either Motrin or Tylenol, wait for it to kick in which make take 20-30 minutes.  In the meantime, you may do certain things to naturally help bring down the temperature such as lukewarm sponge baths, “Little Fevers Witch Hazel Wipes”, keeping the child well hydrated with Pedialyte, coconut water, etc.  For infants and children old enough to have Motrin, you may alternate between Tylenol and Motrin as needed for fever, that way you are not giving too much of one type of medication.  For example, if the child has a fever, you may give Tylenol, then in 3 hours if the temperature goes back up again, give Motrin, 3 hours later if it goes back up, give Tylenol again; thus alternating.  If the fever does not return, do not give anything obviously.
 
The following is very important to know about fevers:  when the fever is caused by a virus it can typically spike really high, even up to 105°F - that is typical of viruses, especially at night.  The fever will have a pattern where it goes up and down.  This can last for over a week.  When it goes up that high, you give the sponge bath, cool compresses, medication, etc. and wait for it to come down.  But it DOES NOT HAVE TO COME BACK TO NORMAL! If its 104°F and comes down to 102°F, at least its coming down but as the effect of the medication wears off, it will come back up again - expect that!  This will go on for 3-5 days.  As each day goes by, the spikes will not be as high and the intervals between the spikes will be longer until ultimately the fever breaks. 
So when you come to the office and are told “your child has a virus”, whether it be the actual flu he/she tested positive for or any other virus, be aware of how the fever pattern will be, that it will go up and down, doesn’t have to come down to normal when you give Tylenol or Motrin and that it can last for 3-5 days.
 
So, when do you call the doctor?  For all infants and toddlers with a fever, they should be seen in the office since they are not old enough to express what they are feeling.  For older children you can treat the fever as discussed above but have the child seen if the fever persists for over 24 hours.  Once seen in the office if they are started on an antibiotic for a bacterial infection (ear infection, strep, sinus infection, UTI, etc.) give the antibiotic 48-72 hours to kick in.  Thus, they can still have fever for 2-3 days until the antibiotic takes effect.  If the fever persists for >72 hours, bring the child back in to be seen.
 
This all sounds like common sense, common knowledge but when your child has a high fever with glassy eyes, all common sense goes out the door!  Refer to the dosing chart at the end of this article the next time your child has a fever.  Remember that fever is not a bad thing, it can last for over a week and the main reason to treat it is to keep your child comfortable until the underlying infection has resolved.
 
For those who like to use homeopathic measures, the following are helpful natural ways of treating fevers:
 
  • Essential oil of chamomile – apply 1 drop to the big toe, ankle, and below collar bone
  • If fever is accompanied by congestion make your own baby “Vicks” rub by mixing a drop of eucalyptus essential oil in a tbsp of either A+D Ointment or virgin coconut oil, rubbing a small amount on baby’s back
  • For teething babies – may use a frozen cotton non-dyed washcloth to chew on, BPA and Lead-Free teething rings

During sick days with fever, temporarily discontinue all supplements except Vitamin D.  Continue probiotics if not vomiting.  Give Elderberry syrup daily to boost the child’s immune system and naturally help fight the flu.
 
 -Standards of care mentioned above are all according to AAP policies and based on 18 years of experience in private practice in pediatrics; recommendations regarding homeopathic care provided by Elisa Moller, RN who has extensive knowledge and experience in this field.
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Spring Allergy Tips
by Elisa Moller, RN
 
We may be in the middle of a “Nor'Easter” this week,  watching snowflakes and making snowmen! There may not be a bloomed tree or flower in sight……

However!

We soon say our goodbyes to flu and respiratory viral season and hello to a different menace: respiratory/ environmental or seasonal allergies.

While the blooming flowers may look lovely, many cringe at the thought as looming Spring often can lead to: watering, itching eyes and running nose, hives, sneezing, and coughing. In some cases can even lead to eczema flares and asthma attacks.

Start now by taking basic measures to help prevent this allergy season from becoming worse.

Simple steps include:
- Avoid allergens as much as possible, Windy days mean blowing pollen.
-Rain washes pollen away but that may resurge quickly after drying and the ground is covered.
- Record pollen counts which are listed just about everywhere in the spring.  Keep a diary as to what your childs threshold may be by recording daily numbers and any reactions.
- Bathing and washing your clothes, body and hair after being outside so as not to encounter allergens all night long on your pillow and bed linens.
-Leave shoes at the door and have kids remove clothes once in for the day. Then right into the shower.
- Keep windows closed to keep pollen out!
- Use a hepa filter in your home
- Have allergy medicine at the ready.  Many of these medicines work by stopping histamine from attaching on to receptors.  Ask your doctor which one is right for you as some will make you drowsy and others won't.  For example; Claratin is non-drowsy, Benedryl may make you fall asleep soon after taking it. Avoid Benadryl before school. Most medicines are available over the counter such as Zyrtec, Allegra, Singular etc and indicate childrens doses.
-Immunotherapy at the Allergist could help but your child may not tolerate and it can take a long time.

For the more natural approach you can try supplements that contain nettle and NAC, such as D-Hist from Ortho Molecular. D-Hist comes in capsules and chewables for children old enough to take a chewable without being a choking risk.

Other supplements such as quercitin, vitamin C, and your multi vitamin may help.

Naet therapy and chiropractor may also help find relief.

Neti pots will help flush allergens from your nose and may help sinus drain.

When mucous builds up and becomes stagnant in your nasal and sinus caveties, that’s when it can become infected by bacteria that get trapped and find a cozy home there.

Its important if the discharge is no longer clear to see the doctor as you may need treatment for sinus infection or even a respiratory infection.

In cases of hives you can try Benedryl cream, Aveeno (avoid if oat allergy ) or calomine lotion to find relief. Scratching hives could potentiate the histamine reaction and produce more hives.

In the worst case scenario, you find your child having an asthma attack.  This is urgent and needs attention right away.  The whistling sound with breathing means the airway is closing and they need their inhaler immediately. Get medical attention ASAP.  Wearing a light scarf around your face in the spring wind can help asthmatics from breathing in so much in terms of allergen triggers.

We wish you all a happy and healthy Spring and hope you get the chance to enjoy some time outdoors.

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A View on Sleep Issues in Pediatrics by Dr. Perrone
 
 
We as parents have all encountered trying times when it comes to trying to get our children to fall asleep during their infancy.  We have received advice from family members which may follow 2 different schools of thought: either let them cry it out so they can learn to self-soothe or let them co-sleep with you as long as they want for maternal-infant bonding.  What to do?  I myself as a Pediatrician for 17 years found it challenging when I tried putting my son to sleep.  I tried to let him cry it out until he fell asleep.  It was not as easy as I thought.  He cried and cried for what seemed to be an eternity.  I made sure there was nothing physically harming him (such as hair wrapped around his toes!), he didn't need to be changed, he wasn't hot or cold, he wasn't hungry or gassy.  He still cried.  I tried putting on music (having grown up in the 70's - 80's, I downloaded 70's - 80's lullabies!).  I played them for him and they worked like a charm.  This lasted for several months, then did not have the same effect anymore.  I tried giving a little chamomile tea in the bottle, this also helped on and off - but not consistently.  Ultimately he learned to self soothe and it was not an issue anymore.

Basically my advice to all parents of small infants is to listen to your child, try to figure out what his/her needs are and know that these needs are always changing.  Every child is different.  Music may work for one baby but not have any effect on another.  Try to have patience and show your child that you are there for him/her.  Remember that our parents went through this with us, not having all the technological advances we do, and we turned out O.K.!  

For further tips on sleep issues check out  Carolina Romanyuk,
 New York’s leading sleep consultant and international children’s book author.   Please visit her website at www.achievewithcarolina.com
 

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