Tuesday, March 1, 2011

What to do when your child has a fever

Medical thermometerImage by RambergMediaImages via Flickr
I just read an article on 7online.com regarding ED visits with feverish young children in the wee hours of the morning. It brought back many memories - some funny, others not so funny.  Most  parents are frantic and feel helpless when they awaken to check their child and  find that their young one is moaning, with red, burning hot skin to touch.  What do you do next?

I'd like to share some information from personal ED experience regarding this troublesome situation.

First things first

I can't tell you how many times I've traiged a restless child wth mom anxiously watching.  After checking the temperature and revealing my findings, many moms looked at me quite perplexedly and said something like, "Wow, she was burning up at home." My response was invariably," What was the temperature at home?" The startled mom would gaze at me innocently and respond, "I didn't take it.  I just felt her with the back of my hand."  Hmm, this method leaves a little to be desired.

Okay, now I am not trying to make fun of anyone, nor suggest that you don't take your child to the ED, but make sure you check the temperature.  How you do this will be based upon the age and cooperability of the child.  Children under age three really need a rectal or tympanic temperature.  This is more accurate than an axillary temp (under the arm).  Lubricate the bulb end of the rectal thermometer ( it is more blunt than the oral to spare trauma to delicate tissues.  Red usually indicates rectal and blue is oral) and gently insert it into the anus.  If it is electronic, just wait for the beep to indicate that the temperature is complete. If it is a mercury thermometer, wait about three minutes. Keep in mind also that rectal is generally a little higher than oral.

If your child is a little older, you might opt for an oral temperature.  Just make sure that she keeps it in place in the pocket under the tongue, with the mouth closed.  This is really important. Make sure that your child has not eaten or drinken anything immediately prior to the temperature check.  This will skew the results.

What is a fever?

Lo and behold, you find that your child has a fever of 101 or above.  (Anything under than that is considered a temperature elevation).  You might want to consider some cooling measures until you get to the ED or doctor's office.  Give the child a sponge bath in tepid or room temperature water to help her cool  down. If the temperature is really high - like 103 - immerse a towel in the water, squeeze out the excess and wrap the child in the towel on and off for about twenty minutes time total. Remove excess clothes but do not allow the child to become chlled and shivering which will drive the temperature back up.  Do not pour alcohol in the water.


Interventions

Offer fluids (as long as the child is not vomiting). By drinking fluids, the child will urinate.  This helps in bringing the temperature down.  Observe your child's behavior, if she is restless, lethargic or complaining of pain, you want to get the child evaluated  quickly.  Don't rush to push foods as the body is busy trying to rid itself of toxins.

Again, observe your child.  If she is complaining of pain and acting listlessly, lethargic and irritable, you would want to get to ED quickly.  If the child is still playing and behaving normally, you might just get instructions from the pediatrician first.

Don't delay with a child under six months of age.  Get instructions from the doctor, initiate cooling measures and get on your way.
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