CHILDREN'S URGENT CARE
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Fever in Children Overview
Fever remains the most common concern for which parents bring their child to the emergency department. Fever has traditionally been defined as a rectal temperature over 100.4 F or 38.0 C. Temperatures measured at other sites are usually lower. The threshold for defining a fever does vary significantly between different individuals, since body temperatures can vary by as much as 1 F.
Fever itself is not life-threatening unless it is extremely and persistently high, such as greater than 107 F (41.6 C) when measured rectally. Fever may indicate the presence of a serious illness, but usually a fever is caused by common infections which are not serious. The part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever.
Fever in Children Causes
Causes of fever include the following:
Illnesses related to heat exposure
Fever in Children Symptoms
Signs and symptoms of fever may be obvious or subtle. The younger the child, the more subtle the symptoms.
Feel warm or hot
Not feed normally
Exhibit changes in sleeping or eating habits
Verbal children may complain of
feeling hotter or colder than others in the room who feel comfortable,
having difficulty sleeping or sleeping more,
and poor appetite.
When to Seek Medical Care
You should call your child's doctor if any of the following are present with fever.
Your child is younger than 6 months of age (regardless of prematurity).
You are unable to control the fever.
You suspect your child may become dehydrated from vomiting, diarrhea, or not drinking (for example, sunken eyes, dry diapers, tented skin, unarousable, etc.).
You have been to your child's doctor , and your child is now getting worse or new symptoms have developed.
Although you may have done your best to care for your child, sometimes it is smart to take your child to the emergency department. Your child's doctor may meet you there, or your child may be evaluated and treated by the emergency doctor.
You should take your child to an emergency clinic when any of the following happen:
You have serious concerns and are unable to contact your child's doctor.
You suspect your child is dehydrated.
A seizure occurs.
Your child has a purple or red rash.
A change in consciousness occurs.
Your child's breathing is shallow, rapid, or difficult.
Your child is younger than 2 months of age.
Your child has a headache that will not go away.
Your child continues to vomit.
When you arrive in the clinic or emergency department, a nurse will determine how quickly your child needs to be seen by the doctor. The nurse is usually very experienced and will bring your child immediately into the emergency room if a life-threatening condition appears to be present. Otherwise, the nurse will place your child in line to be seen ahead of people less ill but after those people appearing most ill.
The doctor will evaluate your child by obtaining a history from you and the child, if possible. The doctor will then perform a physical examination and may order tests.
A chest radiograph (X-ray) can be useful for diagnosing some conditions in the chest, lungs, or heart (including some, but not all, pneumonias). The doctor will order two views to be taken, one sideways and one from front to back. The doctor may request this test if your child displays cough, chest pain, or shortness of breath.
A complete blood count, electrolytes, and cultures are taken from a blood sample .
It is much more difficult to find and enter the small veins in children. It may take more than one attempt to draw your child's blood.
A complete blood count (CBC) is useful for diagnosing bacterial blood infections in very young children. The CBC may suggest whether an infection is bacterial or viral and can be useful in determining whether the child's immune system is working properly.
Electrolytes levels are useful for evaluating dehydration and whether certain electrolytes need replacement.
Samples of blood can assess if bacteria are present in the bloodstream. Blood culture results may take 24 hours and usually are complete in 72 hours. You will be notified if the blood culture test is abnormal.
Urine may be obtained for a urinalysis and urine culture. Your child may be asked to urinate into a sterile cup, a bag may be placed over your child's genital area to catch urine, or a catheter (which is a small tube) may be inserted into the urinary opening (the urethra) to enter the bladder and collect urine.
The urinalysis is useful to look for infections of the urinary tract and may be helpful for evaluating dehydration.
The urine culture is tested to see if bacteria are present in the urine. Results from a urine culture may take 24-72 hours. You will be called if urine culture results are abnormal.
A lumbar puncture (also called a spinal tap) is a procedure that uses a small needle to remove a sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. This test may be done if meningitis is suspected.
Your doctor will have you sign a consent form for this procedure. The doctor will review the potential complications of the procedure.
Lumbar puncture is a very safe procedure with extremely rare complications in children.
Your child either lies on his or her side or sits up, and a needle is inserted between the backbones into a space that contains fluid that flows all the way up to the brain.
The fluid is sent to the laboratory. There, specialists look at the fluid under a microscope to check for bacteria.
A machine analyzes the fluid for the presence of red and white blood cells, glucose, and protein.
Results for the spinal fluid culture may take 24-72 hours. You will be notified if spinal-fluid culture results are abnormal.
The lumbar puncture is performed to check for meningitis, which is an infection of the brain or its surrounding tissues.
Signs of meningitis may include headache, stiff neck, sensitivity to light, nausea and vomiting, or altered mental status.
If your doctor suspects this condition, it is very important that this test be performed.
Without treatment, meningitis can cause permanent disability or death in just a few hours
Self-Care at Home
The three goals of home care for a child with fever are to control the temperature, prevent dehydration, and monitor for serious or life-threatening illness.
The first goal is to make the child comfortable by monitoring and reducing the fever below 102 F (38.9 C). This is achieved using a thermometer and medications and dressing the child appropriately. A warm water bath can also be helpful but should be used for no more than 10 minutes each hour.
To check your child's temperature, you will need a thermometer. Different types of thermometers are available, including glass, mercury, digital, and tympanic (used in the ear).
Most doctors do not recommend tympanic thermometers, because their use outside the clinic is unreliable.
Glass thermometers work well but may break, and they take several minutes to get a reading.
Digital thermometers are inexpensive and obtain a reading in seconds.
It is best to check an infant's or toddler's temperature rectally.
Hold the child chest down across your knees.
Spread the buttocks with one hand and insert the thermometer lubricated with a water-soluble jelly no more than 1 inch into the rectum with the other hand.
Oral temperatures may be obtained in older children who are not mouth breathing or have not recently consumed a hot or cold beverage.
Acetaminophen (Children's Tylenol, Tempra) and ibuprofen (Children's Advil, Children's Motrin) are used to reduce fever.
Follow the dosage and frequency instructions printed on the label.
Remember to continue to give the medication over at least 24 hours or the fever will usually return.
Do not use aspirin to treat fever in children, especially for a fever with chickenpox or other viral infection. Aspirin has been linked to liver failure in some children. Ibuprofen use has also been questioned to treat chickenpox.
Children should not be overdressed indoors, even in the winter.
Overdressing keeps the body from cooling by evaporation, radiation, conduction, or convection.
The most practical solution is to dress the child in a single layer of clothing, then cover the child with a sheet or light blanket.
A sponge bath in warm water will help reduce a fever.
Such a bath is usually not needed but may more quickly reduce the fever.
Put the child in a few inches of warm water, and use a sponge or washcloth to wet the skin of the body and arms and legs.
The water itself does not cool the child. The evaporation of the water off the skin does, so do not cover the child with wet towels (which would prevent evaporation).
Contrary to the popular folk remedy, never apply alcohol in a bath or on the skin to reduce fever. Alcohol is usually dangerous to children.
The second goal is to keep the child from becoming dehydrated. Humans lose extra water from the skin and lungs during a fever.
Encourage the child to drink clear fluids without caffeine (not water). Water does not contain the necessary electrolytes and glucose. Other clear fluids are chicken soup, Pedialyte, and other rehydrating drinks available at your grocery or drugstore.
Tea should not be given because it, like any caffeine-containing product, causes you to lose water through urination and may contribute to dehydration.
Your child should urinate light-colored urine at least every four hours if well hydrated.
The third goal is to monitor the child for signs of serious or life-threatening illness.
A good strategy is to reduce the child's temperature to under 102 F (39.0 C).
Also, make sure the child is drinking enough clear fluids (not water, but preferably Pedialyte, clear broth, ginger ale, or Sprite).
If both these conditions are met and your child still appears ill, a more serious problem may exist
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Your doctor may or may not be able to tell you the exact cause of your child's fever.
Viral infections of the respiratory system are the most common cause of fever. Antibiotics do not cure or help with viral infections and increase the chance of drug reactions and potentially other problems.
If your doctor diagnoses a bacterial infection, your child will be started on antibiotics.
Urinary tract infections, ear infections , throat infections, sinus infections, skin infections, gastrointestinal infections, and pneumonia may be treated with antibiotics at home.
Your child may receive oral antibiotics, a shot, or both.
Children suspected to have bacterial meningitis are always admitted to the hospital.
Additionally, your doctor may recommend giving acetaminophen (Tylenol) or ibuprofen (Advil) for fever.
Dehydration may be treated by giving oral fluids or intravenous (IV) fluids.
If a child is vomiting, a drug to control nausea may be given by injection or by rectal suppository.
After a period of time, oral fluids will be attempted.
If your child's condition improves after reducing the fever, treating dehydration, and serious bacterial infections have been ruled out, the doctor will, more than likely, discharge your child from the emergency clinic for further care and monitoring at home.
Usually, the emergency department doctor will ask that, within the next 24-48 hours, you contact or see your child's doctor or return to the emergency department.
Your child's condition can be further observed at home or in the clinical area.
Any treatment prescribed by the doctor in the emergency department should be monitored for effectiveness.
You should receive information about any tests and cultures performed for your child and follow-up instructions if necessary.