February 28, 2014

The Facts About Fever

Parents are wired to beware of fever in their children. But their fear often is misplaced.

According to Melissa Arca, a pediatrician writing on KevinMD.com, a moderately elevated temperature is not necessarily a bad thing; in fact, it can be beneficial. Lots of kid problems cause fever — the flu, colds, croup, ear infections…. The better you understand the reasons a child is feverish, and the purpose fever serves, the better you will be able to determine a minor problem from one that your doctor should address.

Arca offers four fever facts that should help you tell the difference between one that needs hot soup, and one that needs a doctor’s care.

1. Fever is a symptom, not a disease.

Fever is a reaction to illness. It’s a warning to rest and drink fluids. Treating your child’s fever won’t “cure” whatever infection he or she is fighting. “Think of it like disabling your car’s ‘oil change needed’ light,” Arca suggests. “Sure, you can turn off that light but it doesn’t negate the fact that your car’s oil still needs changing.”

Even if you suppress the fever — for example, with ibuprofen — the child still needs time to rest and recover from the infection.

2. Fever can wax and wane for three or four days.

Most fevers persist for a few days before they completely depart. So even if you treat it with acetaminophen or ibuprofen, expect it to recur after a few hours. That’s normal.

3. The number on the thermometer is not as important as how your child looks and feels.

Arca knows that most parents get a little panicked when their child’s temperature reaches 103 or 104. But that number does not communicate the seriousness of the illness. So resist the panic. Give the child a fever reducer for comfort and keep him or her well-hydrated. Fever makes the heart beat faster and increases the child’s insensible water loss (fluids lost through the skin and respiratory tract). Keep a bottle of water by the bed, and anywhere else your child is resting.

Remember, the goal is to help the child feel better, not to get rid of the fever.

4. A true fever is a temperature of 100.4°F (38°C) or higher.

Children’s temperatures naturally fluctuate throughout the day. So knowing what is a true fever is important.

In summary, resist the urge to treat a slight temperature elevation. Remember, says the National Institutes of Health, fever is an important part of the body's defense against infection because most bacteria and viruses that cause infections in people thrive at 98.6 °F. Many infants and children develop high fevers with minor viral illnesses, and although that’s a signal of the body waging battle, the fever is a weapon favoring the child. So unless you’re dealing with a temperature of 102°F or higher fever, let the fever run its course and provide comfort through fluids.

Brain damage from a fever generally doesn’t occur with fever less than 107.6 °F (42 °C). Untreated fevers caused by infection seldom exceed 105 °F unless the child is overdressed or trapped in a hot place.

Arca says these red flags demand a pediatrician’s intervention:


  • infants younger than 3 months with rectal temperatures of 100.4°F or higher;

  • fever that persists more than five days;

  • your child just doesn’t look well, is having difficulty breathing or has had a febrile seizure (one caused by fever);

  • your child’s fever is 105°F or higher. Although such a high temperature usually isn’t harmful, it merits a call to the pediatrician and the right dose of acetaminophen or ibuprofen.


Because acetaminophen, especially, can be harmful to youngsters, see our blog about proper dosages here.

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February 21, 2014

How to Avoid a Shopping Cart Injury

Parents with kids in tow welcome the use of shopping carts to contain the offspring as well as the merchandise. But as a recent report by NBC News notes, the convenience of a cart should come with a big dose of caution.

According to a study recently published in Clinical Pediatrics by Nationwide Children’s Hospital in Ohio, 66 children are hurt in shopping cart mishaps every day. “That’s one child injured badly enough every 22 minutes to go to the emergency room, or more than 24,000 children a year,” said NBC.

Voluntary safety standards for shopping carts were implemented in 2004, and they’ve had about as much effect as you would expect — none. In fact, it’s worse than none. The number of concussions each year resulting from shopping carts injuries to children younger than 15 jumped nearly 90% — almost double — according to data collected from 1990 to 2011 by Dr. Gary Smith, director of Nationwide’s Center for Injury Research and Policy.

“This is a setup for a major injury,” Smith told NBC. “The major group we are concerned about are children under 5.”

Newborns to 4-year-olds accounted for more than 8 in 10 injuries. More than 7 in 10 accidents were by falling out of the carts. Other common accidents were running into a cart, and carts tipping over.

It’s easy for a parent to focus on the shopping if he or she believes the child is secure, but a moment’s inattention can be tragic. “A wiggly baby in an infant seat or a toddler reaching for a bright box of cereal can easily cause a fall that results in serious injury,” NBC explained. “Children’s center of gravity is high, their heads are heavy and they don’t have enough arm strength to break a fall.”

Smith said the lack of stability standards for U.S. shopping carts that have been adopted in other countries is a contributing factor to the high incidence of injury. But that doesn’t means parents can’t improve the safety of a shopping trip. To be safe:


  • If possible, choose alternatives to placing your child in a shopping cart.

  • Always use using the shopping cart safety belts. Ensure that the child is snugly secured in the straps and that his or her legs are placed through the leg openings. If parts of the cart restraint system are missing or are not working, choose another cart.

  • Use a cart that has a child seat low to the ground, if one is available.

  • Make sure your child remains seated.

  • Stay with the cart and your child at all times.

  • Don’t place infant carriers on top of shopping carts. If the child isn’t old enough to sit upright in the shopping cart seat, use a front- or back-pack carrier, or a stroller.


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January 24, 2014

Sharing Is Good, Except for Germs

If there’s an echoing theme among parents with small children, it might be “Don’t put that in your mouth, you never know where it’s been.” As it turns out, according to a new study, bacteria are in a lot of places you don’t expect them to be, despite your best efforts.

As published in the journal Infection and Immunity and interpreted on AboutLawsuits.com, the study by researchers from the University of Buffalo suggests that cultures of certain bacteria can linger on cribs, toys, books and other children’s items long after scientists originally thought was possible, posing a potential risk of spreading common infections.

Researchers analyzed cultures, or biofilms, of Streptococcus pneumoniae and Streptococcus Pyogenes, and found that bacteria survived outside of the human body, the typical host necessary for growth, and they lasted for months as viable forms of infection.

S. Pyogenes is the culprit behind strep throat and skin infections. S. Pneumoniae attacks the respiratory tract, ears and other sites common among children and elderly people, and can cause death.

The researchers tested surfaces and items kids touch every day. There were high levels of both types of bacteria many hours after the surfaces had been cleaned; 4 in 5 stuffed toys tested positive for S. Pneumoniae and other surfaces yielded colonies of S. Pyogenes.

Because bacteria might survive in environments other than the human body, they have the potential to be continually infectious. The thinking used to be that their transmission required humans to breathe in infected bodily excretions from sneezing or blood exposure.

Rethinking cleaning procedures seems to be in order for day care facilities, schools, home nurseries and hospitals.

The best defense against this kind of bacterial exposure is what experts have preached forever: Wash hands often — yours and your kids — and use warm water and soap. Lather for at least 20 seconds.

Wash hands especially after touching particularly germy surfaces, such as toys, door handles, faucets, computer keyboards, touch screens and remote controls. Try not to touch your face after touching these surfaces.

Ask the people who look after your children — day care providers, baby sitters, teachers — what they do to prevent little ones from sharing the things they shouldn’t. Simply letting these folks know that you’re interested in hygiene can help them adhere to a healthful regimen.

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October 25, 2013

When Kids Get Headaches

Almost everyone gets the occasional headache, even children. Almost always, they’re insignificant in the grand scheme of health.

As described on KevinMD.com by Dr. Roy Benaroch, a pediatrician and author of “A Guide to Getting the Best Health Care for Your Child,” so-called “primary” headaches are those without a specific cause or association to a specific medical condition.

Often, he writes, headaches in children are are caused by a minor infection, dehydration, hunger or stress. “If they’re recurrent,” Benaroch says, “they’re likely to be one of the common primary headaches, like tension headaches or migraine or chronic daily headache. Headaches that are progressive (worsening), or associated with other prominent or worsening symptoms, need an urgent medical evaluation, but those are fortunately rare. More typically, headaches just need to be treated like, well, headaches.”

And what does that mean? As is often the case, it’s simple: a kiss to make it better, rest, a cool compress, something to help the kid relax. “In the long run,” Benaroch says, “those are probably better headache remed[ies] for children than any medication.”

Benaroch’s primer on primary headaches:

Migraine. This might be the most common of the more severe headaches. In children it’s often bilateral (not limited to one side of the head, as is common with adult migraines), and fairly brief. Sometimes it’s accompanied by vomiting, and gets worse with light or sound. Often the best treatment is to go to sleep. Migraines often run in families.

Tension. This creates a constricted feeling in the head, and isn’t usually severe. Kids of all ages get tense.

Chronic daily headache. This often occurs in addition to occasional more severe headaches, like migraines.

To treat chronic daily headache:


  • Avoid daily Advil or Tylenol. Using them more than three days a week perpetuates the headaches.

  • Follow a healthful lifestyle—good, regular sleep, sound diet without a lot of preservatives and chemicals, regular exercise.

  • Try not to miss school; it makes headaches worse.

  • Consider massage/yoga/relaxation therapy.

  • Address any depression/anxiety/mood issues. They often have a psychological component, either contributing to the headaches, or being caused by the headaches and missing school and activities.

  • Consider a daily medicine to control the headaches. Not painkillers, but meds that prevent headaches, which require a physician’s guidance.

CT scans are almost never necessary for chronic, ongoing, stable headaches, which come and go in a stable pattern. Imaging is useful only for acute, worse-in-a-lifetime headaches, those associated with other symptoms, such as seizures, or progressively worse headaches. CTs (or MRIs) are completely unnecessary in the workup of most children with headaches, and will sometimes give misleading results that lead to overtesting and misery. (See our blog, “CT Scans for All Kids with Head Injuries?”)

Most people who believe they have sinus headaches don’t. Truly recurrent sinus headaches are uncommon. When they do occur, they’re associated with persistent nasal congestion and cough that precede the headache. Migraines, which are far more common than recurrent headaches from sinusitis, can cause nasal or sinus symptoms that begin about the same time as the headache.

Another uncommon association with recurrent headaches in kids is vision problems. Some nearsighted people squint, and by the end of the day might develop pain from contracting the muscles of their face and scalp, but that, too, is uncommon.

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