Fever, Fever, Fever...should be the title of a book and it would be a bestseller as well!!
I am already beginning to see a bit of an increase in office visits for fever and with those visits the parents often ask ...how high a fever is too high? Remember, that fever is just a symptom, not an illness. Fever is also a good sign that your body is fighting the infection, and in most cases it is one of those pesky viruses that are causing your child to have a fever. Keep practicing the mantra..."fever is your friend"...as we have a lot of months ahead with viruses and with that lots of children with fevers.
A fever is defined as a temperature above 100 degrees orally or above 100.4 degrees rectally. 99.6 degrees is not a fever (even if you think your child's body temp "runs lower than usual"). I also know that the school may call you to pick up your child even if we doctors don't really consider 99 degrees to be a fever. Oh well.
It is important to document that your child indeed has a fever. This needs to be done with a thermometer, and not the back of a "trained" hand. I tell my own children that I am sometimes wrong when judging with my own pediatric/mother hand, and I too rely on a thermometer. You also do not need to take a temperature every hour.
If your child has a 102 degree temperature in the morning, there is no need to take it off and on all day. Once documented, you can treat the fever as needed. Your doctor will usually want to know about documented fever on a daily, rather than hourly basis.
The height of the fever does not necessarily mean that your child is sicker! I know that seems counter intuitive right? I mean, you must be sicker if your temperature is 104 rather and 101 degrees. You may feel worse (especially if you are talking about yourself rather than a child), but many children run high temperatures with a viral illness. It is not unusual to see a toddler with 103-104 degree temperature still running around the exam room, and that is a good thing.
Behavior is so important when evaluating a sick child. The number on the thermometer is not nearly as important as how your child is behaving. They may be "pitiful" and whiny but are they playing off and on? Although they are not "as hungry" will they still take part of their bottle or pick at a sandwich or eat a Popsicle? Fluids are more important for your child than the amount of food they are eating while they are sick. No one wants a full meal when you are running a fever and just feel pathetic.
Watch your child and see if their activity level goes up and down, which often correlates with their fever, especially if they have been given some acetaminophen or ibuprofen to help with their symptoms. These medicines t do not "mask" a serious illness, so treat their fever with the appropriate dose of an anti-pyretic (fever reducing medication). Don't withhold their medicine so that the doctor can see them with the fever, better to treat them and get their fever down and they may feel a lot better.
With the end of another school year and summer knocking at the front door lots of kids will be outside doing what kids do- playing. These are the months when a child's boredom level has a short fuse...
I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.
You know there really isn't as they are both to...
You know there really isn't as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil).
Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a cosmetic problem for a baby as it looks like a yellowish plaque on a baby's scalp and is often not even noticed by anyone other than the parents.
Unlike seborrheic dermatitis in adults, cradle cap typically doesn't itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby.
These hormones cause the sebaceous glands to become over active. In some severe cases an infant's scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces.
The treatment for cradle cap is to wash the baby's scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby's eyes).
This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby's head and let it sit (I left a small amount on my children's heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily.
For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant's eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem.
As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called malessizia so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works.
I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don't like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea!
That's your daily dose, we'll chat again tomorrow.
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