Please tell me about fevers..

[jgenie]

With all the talk about H1N1, I want to make sure I'm prepared to handle it if we get it.

Not just related to H1N1, but in general...
- At what temp do you start Tylenol?
- At what temp do you take DC into the Dr.?
- At what temp would you take DC to after hours clinic or ER?

Anything else I should be aware of? Is there anything besides Tylenol and Pedialyte that I should have on hand?

TIA

[JTsMom]

This is pretty much my approach:
http://askdrsears.com/html/8/t082100.asp

[JBaxter]

I generally dont medicate anything until it 102 or the child is VERY miserable and cant sleep. I have occasionally done a 101 before bedtime.

I find Motrin works better with my children

Fevers more than 48 hrs I call the doctor ( again it depends on how they are acting)

ER trip 105 that wont drop below 101 w/ motrin < in 45 minutes>


** ETA I have 3 family members in the nursing field 2 of which are in the ER so I call them to see whats "going around" and how busy the ER is. Im NOT going to sit in an germ infested ER waiting room for a couple hours with a child that has a fever of 102-104 which is generally what happens. 105 will generally get you skipped to the head of the line in teh ER

[slworld]

We used to give Tylenol for pretty much anything above normal temp, until the ped said you don't need to bring fever down since its just the body's way of reacting to the infection. Of course if the child is miserable (unable to eat, sleep) then its ok to give something to make them more comfortable. Chk with your doctor on the dosage (needs to be calculated according to weight).
I don't think our ped will see them for fever less than 104 (unless there are some other troubling symptoms - difficulty breathing, lethargic, etc).
Guess with a fever, I would talk to the nurse/on call to see what they would suggest. 104 or above, they may want you to come in/go to emergency room.

[brittone2]

We mostly ride them out. Our very mainstream ped that we saw in a previous state actually gave parents handouts on not fearing fevers in the absence of other concerning symptoms (or heat-related illness).

If the child was very young (meaning relative newborn), I'd be more apt to take them in for a high fever. Otherwise, we go mostly by what other symptoms there are vs. the fever itself when deciding whether the child needs to be seen by a doctor.

FWIW, whenever my DS got a fever, it was 104 or so. He never got like 101 type of fevers. He would nurse right through it, sleep, and usually wake up feeling better. Short and intense for him was his "normal".

[erosenst]

We give Tylenol when she starts being uncomfortable - usually around 100 or a little less. (She, like me, has a normal temp of about 97.5 - so 99 for us is like 100 for most people.)

Until last Friday, had never taken her to ped for fever other than one RIGHT before a plane trip. She's had a number of ear infections, and they don't bother her much - but wanted to rule it out before flying.

However, Friday early evening when I picked her up from extended care, she burst into tears. She told me she had gotten very cold about 10 minutes earlier, and had put her coat on. I brought her home; she looked worse by the minute, and had 102. Call the after-hours at our ped's, who suggested bringing her in to be looked at.

Because she looked SO sick, and it had come on so quickly, they did strep test (throat was a little funny looking) and H1N1 test. She also had some symptoms that could be nothing...or bad. (Red eyes, strawberry tongue.) Only did H1N1 because if it was positive, would know what it was. Both were neg, so they sent us to ER. Finally got some motrin in her, and she looked better - still sick, but no longer scary. We left before seeing dr.

Both dr at the after-hours, and nurse at the ER, said some kids get hit very hard and very fast with H1N1...and that because there's a 30-50% false negative, usually don't do test. Since she had flu-like symptoms (fever, body aches, some coughing) they would both call it H1N1.

Again, if she hadn't been so suddenly so sick, would have treated with alternating Tylenol/Motrin and let it run its course. Which is what we ultimately did. Did have to give Tylenol around the clock the first two nights, especially since she refused to take Motrin.

As far as things to have on hand, depends on how old DC is. But if they'll drink juice or eat popsicles, both are good to have to keep them hydrated. And since their stomach is likely to be impacted, other bland foods they like - oatmeal, saltines, and vanilla wafers were all accepted here when nothing else was.

Good luck!

[alexsmommy]

I'm like pp's - try to ride out low grade or regular fever. I find Motrin works best for my kids once we get over 102. For high fevers or fever that interferes with sleep, I will stagger Motrin and Tylenol at night.
I know my kids and what is "typical." With suspected H1N1 DS1 spiked a fever in 15 minutes. His school nurse took his temp because I suggested it when he turned up in her office due to a potty accident - unheard of for him unless he is ill - and it was normal. He was sent back to class, fell asleep on his desk within five minutes so his teacher knew something was up and the minute she could hand the class over to the aide she walked him back down the the nurse herself and requested his temp be taken again. Within that fifteen minutes he has spiked to 102.5. That is not typical for him at all so if we had been home I would have immediately medicated him and called his ped. He tends to develop a fever over the course of at least an hour and it creeps up unless he is really, really ill. The last time he did that instant spike thing he was beginning a nasty flu that turned into a very bad pneumonia. As it was there was probably a two hour lag b/w his temp being taken by the nurse and me being able to get home from work and get him to the ped. He fell asleep before my parents could even get Motrin in him so by the time we hit the peds his temp was 103.5.
Typically if the he seems to be having his normal course of illness, I'll call the ped if the fever lasts more than two days or a high fever is not responding to Motrin.
I would hit the ER if a high fever will not come down with Motrin, luke-warm bath and a popsicle after hours. By down I don't necessarily mean back to "normal" but back in what I consider the safe range under 102. We've had to make all too many ER trips due to DS1's asthma so I try to ride out what we can at home until the peds office opens.

[bubbaray]

We mostly ride it out, depends more on how the child is acting/feeling than on the actual temp itself.

I actually find Motrin works well at night -- it lasts longer so we all get some sleep with a sick child. If the fever is accompanied by tummy upset, I use Tylenol exclusively, though, b/c it is easier on the tummy.

[brittone2]

Just adding our peds/family practice doc are adamant that fevers (from non-heat related illness) do not cause brain damage, etc. and are self-limiting. You can find plenty of documentation to back this up.

eta: some good guidelines here. I like that they point out that it is possible for a relatively mild viral infection can cause a high fever (and is not necessary a major cause for concern depending on the child's age). My DS was a perfect example of this. 104 degree fevers with a relatively mild illness were not uncommon for him. They also have some good guidelines on when to seek professional consultation at different ages
http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm