Winter, more than any other time of the year, means sleepless nights for many parents of young children. Frequent viral infections peak, flu has struck, classrooms are half-empty and parents are looking after children with high fevers – often at night, frequently alone and worried about what to do next. Over the almost two decades that I have dealt with concerned parents, I have noticed few things upset parents as much as a child with a very high fever – especially in the middle of the night. It’s like the phone ringing at 3 a.m. – we tend to expect the worst rather than the best; however, there are some key things to remember that may increase your comfort level at 3 a.m.: fever is a symptom, not a diagnosis; know how to take a temperature accurately; know which medication to use; and know when to call for help.
A high temperature is defined as 39.5C or 103F or higher; however, in children, one should remember that a child is not a little adult. This means it is important to consider where the temperature was taken: orally, in the armpit, in the ear or rectally. Other factors that can influence temperature is the activity of the child, time of the day, hot baths, warm weather and excessive clothing. Rectal temperatures are probably the most accurate. One does not have to adjust by adding a degree or allowing for earwax, yet there are few parents who feel fully comfortable taking a rectal temperature. The convenience of a ear thermometer means it is here to stay, despite a great number of academic studies arguing its accuracy. As to the latter, the jury is still out and, in my opinion, will be out for years to come!
I think any new parent should spend some specific time to learn more about taking temperatures. It is best to learn when there is no stress and less midnight anxiety. The primary care doctor and the public health nurse are two great resources. In fact, a study involving a number of academic centres on the Eastern US seaboard tried to see what happened if extra efforts were made to teach parents about fevers. The outcome? More confident parents and,
important for the doctors, less calls in the middle of the night from parents with fever phobias.
An example of fever phobias include: fears that fevers will cause brain damage; fears of death; and fear that if mild temperatures are not treated, it would keep going higher. When it comes to medication there are two main types: acetaminophen (Tylenol or Tempera) and ibuprofen (Motrin or Advil.) Most doctors, including the Canadian Paediatric Society, still suggest acetaminophen as the first choice. The experience with it is longer than even aspirin (acetaminophen was introduced before aspirin in the pharmacopeia, but it was not sold without prescription before 1960.) The dose of acetaminophen is 10mg to 15mg per kilograms per dose, every 4 to 6 hours (there are 2.2 pounds per kilograms.) It comes in many forms: concentrated drops for infants; less-concentrated liquids; and chewable tablets for children. In the old days when aspirin was used more often, it led to a condition called Reyes Syndrome – a disease of the liver.
The use of acetaminophen has drastically reduced the chances of Reyes Syndrome. The window of safety for acetaminophen is small; however, in infants and small children, studies have indicated the toxic dose is less than twice the recommended dose. Studies have also shown it is very easy to mistakenly give children too much acetaminophen. Therefore, it is important to educate yourself before a crises looms and you are fatigued at night. How does ibuprofen compare? Very well actually. A study in the American Journal of Diseases of Children in the nineties concluded that ibuprofen at a dose of 10 mg/kg works as well as acetaminophen at 15 mg/kg to control fever and pain. There are two reasons I like ibuprofen better at times: it lasts longer (8 hours vs 6 hours for acetaminophen) and it treats inflammation better, which acetaminophen does not.
How the feverish child looks is important. Six observation items can help to know when to worry: if the child is not crying; if the child can be made content easily; if the child wakens quickly when stimulated; if the child is pink; if the child is well hydrated; and if the child smiles in response to social overtures, you can probably manage the fever at home without the doctor’s help. However, if the cry is weak or high pitched, continuous, if the child is excessively drowsy, pale or blue, dehydrated, or exhibiting no social smile, you should ask for help.
Remember to encourage extra fluids, dress the child in light clothing and do not use rubbing alcohol for sponging. The bottom line remains education and to do it when ‘the chips are not down.’ For more details see www.intellihealth.com
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
An informed parent is ... an empowered parent.