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Question:
My 15 month old had a fever of 103.7 last night. I
called my doctor and she did not seem too worried.
When should I worry about fever?
Answer:
After the age of 8 weeks fever is no longer an
emergency. Before a baby is 2 months old, it is
always an emergency because newborns are more
susceptible to meningitis. In a newborn the
definition of fever is anything greater than 100.4
rectally. Despite not being popular among parents,
the only way to accurately take a baby’s temperature
is rectally. After 2 months, fever really becomes
just a symptom. The brain causes the body
temperature to increase in an effort to fight
infection. The temperature is not dangerous even
when it is well above 100. That said, it is still
the number one reason why parents call. A quick way
to make your pediatrician crazy is to spend lots of
time giving a long litany of temperatures. ie “It
was 102.5 this morning then I gave Tylenol and it
came down to 100.4 then it went back up to 103.7 and
then she took a nap and it went down to 99.9”.
That’s a lot of numbers for no real value. Once we
have established that your child has a fever, that’s
all that is important. What you should focus on when
your child has a fever is how they are doing
otherwise. What other symptoms are accompanying the
fever? Any signs of a serious infection like
meningitis? That would be: headache, stiff neck, or
mental status change. If those symptoms are present
then your child should be seen by a healthcare
provider immediately. If there are more mild
symptoms like sore throat, runny nose, or cough but
your child is able to drink and stay hydrated then
it is fine to wait it out. You do not have to treat
fever. Many parents feel that if they do not bring
the temperature down their child will be in danger.
This is not true. That said, spending a lot of time
at 102 degrees can be quite uncomfortable and you
may want to treat for that reason. The important
thing is to evaluate the child, not the fever, and
decide to give medicine based on how you think they
are doing. If you choose to trea,t we typically
recommend acetaminophen (Tylenol) or ibuprofen
(Motrin, Advil). Ibuprofen is not safe in anyone
under 6 months. Children can do scary things when
they have a fever. They sweat a lot. They may have
nightmares or night terrors. They may even speak as
if possessed! But the scariest thing for a parent is
a febrile seizure. Stay tuned for another column
about them, but briefly, febrile seizures are caused
by a rapid rise in temperature, they have nothing to
do with the actual height of the fever, just to do
with how fast it went up. Typically they are brief
and self limited. They are most common between ages
2-5 and most children outgrow them. They do not
leave any permanent effects and do not cause brain
damage. If the seizure lasts more than 5 minutes
then it is a sign of a different problem and you
should call 911. If your child has had fever for
more than five days then it is a good idea to have
them checked by a healthcare provider. Many viruses
can cause fever for up to 10 days, but after 5 we
usually like to take a look and make sure nothing
needs to be treated. So the next time your child has
a fever try to stay focused on how he/she is doing
and not on the temperature. If you have a child
under 2 months of age seek help immediately,
otherwise assess your child for any worrisome
symptoms, consider how long he/she has had the
fever, and evaluate them for signs of dehydration.
If anything is worrying you call your child’s
healthcare provider, but stay calm, most fevers go
away as fast as they come.
Question:
My 2 yr old has a fixation with hair. When she was
just months old, she would wind my hair around her
fingers while sucking her thumb when I held her.
Touching my hair always calmed her. As she got
older, she would look for other sources of hair -
barbies, My Little Pony, she'd even look in the tub
drain for mine. It was quirky and endearing, but I'm
getting worried. Now she'll twirl her own hair, and
even pull on it to get a strand or two to wind
around her fingers. I'm concerned she will start
pulling out her hair whenever she's upset. Our
pediatrician recommended that we keep her blankie on
hand as an alternative to the hair, but it's not
working. Any ideas?
Answer:
Trichotillomania, or compulsive pulling on one’s own
hair or someone else’s hair is actually quite
common. In this case, it would be considered “early
onset” (before the age of 3) and therefore is
considered benign and self limiting. This means that
it is unlikely to correlate with a psychiatric
disorder later in life. In fact, some might argue
that at this age it is merely a coping mechanism
which the child has developed to calm herself, and
to deal with stress. The development of coping
mechanisms, no matter how strange, is a positive
developmental sign in a preschool age child. Later
onset trichotillomania (after age 6) has been shown
to correlate with anxiety disorders and low self
esteem and should serve as a warning sign of a
bigger problem. For your two year old, I would
suggest you do very little. Lay down some rules (no
digging in the drain, no eating the hair, she must
tell Mommy if the hair is stuck etc) and then try to
ignore it. She will likely stop by herself around
the age of 5.
Question:
If this is a silly question, please don't take the
time to answer it. But it's one that is increasingly
posed by parents I know: Do children who are not
vaccinated pose health risks to children who are?
What are the wider implications for the general
population, and how serious is this?
Answer:
If your child is completely vaccinated and healthy
then there is no risk to him/her from unvaccinated
children. Where this gets complicated is in three
populations: 1. pregnant women 2. children who are
too young to be completely vaccinated (typically age
15 Months and under) and 3. Anyone, including a
child, who is immunocompromised. Immunocompromised
may mean they are getting chemotherapy for cancer,
or long term steroids for an inflammatory disease,
or that they have an immune deficiency. If you or
your child fit into any of the above three criteria
it may be prudent to avoid unvaccinated children.
Children who are not vaccinated can be susceptible
to diseases like pertussis, measles, rubella, or
varicella all of which can have complications in the
above situations. It is for the very young, and
immunocompromised patients that many physicians,
including myself, feel strongly that parents have an
obligation to humankind, in addition to the health
and safety of their child, to vaccinate.
Question:
There are white spots on my baby's tongue. they look
like formula spots- is that what it is? how do I
know if it's serious?
Answer:
White spots on a baby's tongue can be one of two
things. Most commonly it is just breast milk or
formula which accumulates on the tongue. This
usually appears like it was painted on the tongue
and often can be scraped away with a washcloth or a
tongue depressor. Less commonly, it can be what is
known as thrush. Thrush is an over growth of yeast
or candida which affects newborns because they do
not yet have an immunity to yeast. It typically
appears as irregularly shaped white patches on the
tongue, gums and inside of the cheeks. Thrush can be
painful and sometimes may cause the baby to be fussy
or to eat poorly. It should be treated with an
antifungal medicine called Nystatin. If your child
has thrush any nipples he/she uses (bottles and
pacifiers) should be soaked in hot soapy water for
15 minutes. Diaper rash can also be associated with
thrush and will need a prescription cream. If a
child is breast fed, it is usually necessary to
treat Mom as well.
Question:
My 6 year old has had a chest cough for two weeks
now. She has no other symptoms (no fever, runny nose
or eyes, etc). She coughs more at night and first
thing in the morning. Is this something I should see
my pediatrician about? Could it be allergies?
Answer:
Yes, I think this is a circumstance where I would go
see your health care provider. Typical viruses
causing your basic cold will usually resolve in 2
weeks. This is most likely allergies, cough variant
asthma or potentially even a sinus infection. In
most children it is safe to try an over the counter
anti histamine like Children’s Claritin, so you
could consider trying that. If it works, then most
likely it is an allergy of some sort; however, if it
does not work, you have not really ruled anything
out, as some allergies are initially unresponsive to
antihistamines.
Question:
My 7 ½ month old daughter is exclusively breastfed.
We have food allergies in the family, so we are
holding off on introducing food. I have always fed
her on demand and she eats frequently, usually every
two-three hours including throughout the night. Each
feeding only lasts about five to seven minutes, and
so we call her a “snacker”…like her mom. I am
hypoglycemic and wonder if she is too since she has
not grown to lengthen the time between feedings or
the length of feedings. Is there a way to test a
child at this age for hypoglycemia and should I be
concerned? I am a stay-at-home mom, so the frequency
of feedings is not an issue. In addition, she was at
the 73%ile for weight at her six-month check-up, so
she is obviously gaining and getting the amount she
needs.
Answer:
Congratulations on your success and commitment to
breastfeeding. It is my, and all pediatricians, goal
to get more Moms breast feeding until one year of
life. Currently we are around 22% breastfeeding at
one year, the target goal for 2020 is 34%, and I for
one am very excited about reaching this target.
Being a “snacker” may be in part due to hypoglycemia
but it is an almost impossible thing to diagnose.
You basically would have to do blood sugar levels in
your daughter both before and after meals and also
randomly for about a week to get any consistent
data. Because this form of hypoglycemia is never
life threatening, it really is not worth the
risks/pain of all those pricks to try to diagnose
it. The treatment is frequent, high protein meals,
which is what she is doing. However, she may be a
snacker for other reasons that might be worth
exploring. 1. It could be hunger. Around 6 months we
know that babies often need a different source of
nutrition beyond breast milk. The American Academy
of Pediatrics has very strongly come out with a
statement that delaying solid introduction or
delaying certain foods does not prevent food
allergies or lessen their severity. This statement
is backed up by lots of studies and literature. So I
would encourage you to start some solids. There also
is a new campaign that I support which is referred
to as “White Out” which is designed to end the
recommendation of starting rice cereal as the first
food. It is now recommended that first foods be
whole grain cereal and fruits and veggies. You can
read more about this on the White Out web site . 2.
It could be habit. Babies become routinized very
easily in terms of sleeping and eating. So it may
just be that she is programmed to eat that
frequently. You could try committing to stretching
out her feedings by 15 minutes each day, especially
at night, just by walking her, or distracting her in
other ways.
Question:
2 1/2 yr. old holds bowel movements until he is in
terrible pain and then screams. Is there anything I
can give him besides more fruit and veggies and he
drinks plenty of water. Would mineral oil help?
Thank you.
Answer:
This is a very common problem amoung this age group.
They typically do this because they had one painful
bowel movement and are afraid of more pain so they
hold it in. This combined with the typical two year
old strong will can make for a very challenging
problem. First you should take your child to your
health care provider to ensure that there is not a
more extensive reason that he is having pain with
bowel movements. Things like hemorrhoids, polyps, or
colitis can make bms painful. Once other problems
have been ruled out, you should take a few steps to
make sure his stool is soft and that it is actually
impossible for him to hold it in. You can do this by
increasing the fiber in his diet (fresh fruits and
veggies, whole grains etc) and by using an other the
counter fiber supplements like Benefiber. There is
also an over the counter stool softener called
Miralax which works well, but should be used under
the advise of a health care provider. Mineral oil is
not considered safe at this age. Once you have the
stool soft then you need to make it known to your
son that everyone poops (there is actually a great
book called :”Everyone Poops”) and that it is his
body working correctly that makes him poop. You do
not say if he is potty trained or not, but if he is,
insist that twice a day he sit on the potty and try
to go. If a child is fearful of passing a painful
stool, allowing them to sit in a warm soapy bathtub
and to go in there will actually make it less scary
and make the stool pass easily. It makes for harder
clean up, but usually if the child can go once
without pain they will stop holding it in. Be
reassured that this is age appropriate and that with
time this problem will resolve.
Question:
My daughter (nearly 12) spent a recent Saturday at
an amusement park. With all of the activity, I
didn't realize until the next day that she had a
single bug bite that caused a 6-inch diameter of
swelling. Her skin was hot and hard. I gave her
Benadryl, which helped, but her reaction lasted
nearly three days. Her extreme response has become
the norm in recent years.Should I be alarmed? Should
she be tested? And should I always be equipped with
certain medications?
Answer:
Large reactions to mosquito bites are more of a
sensitive skin thing than an actual allergy. Any
kind of systemic reaction to mosquito bites (ie
breatheing problems etc) is VERY RARE. No testing is
indicated here nor is an epi pen. When the mosquito
bites it injects a small amount of saliva, the
saliva has anticoagulant properities in it which
allows the human blood to flow easily to the
mosquito. The mosquito needs the blood in order to
lay its eggs so it’s a matter of survival for these
little buggers which is why they can be so
persistent. Our bodies will react to the foreign
proteins in the saliva and create an immune
response. Everyone is different as to how much
response they will mount. People with sensitive skin
will often have big, hard, tender wheels of redness.
An antihistamine like Benadryl and a local steroid
cream is the best treatment for these reactions. The
sooner you start these treatments the less likely
you are to have a large reaction so carrying them
with you is probably not a bad idea. If you know
your child is going to be out, taking a 24hr non
drowsy anti histamine like Zyrtec or Claritin might
decrease the reaction to the bites. And of course
using bug repellents will decrease the chances of a
bite in the first place. Because the bites often
itch, and our fingernails are rarely germ free there
is always the chance of infection of a bite. This
would take a few days to happen typically and would
likely make the bite appear worse after it had been
getting better. You often will see yellow pus form
around the site of the bite, or red streaking around
the area. This needs antibiotics and you should see
your health care provider.
Question:
My son likes to net fish at Drumore park and
occasionally will wade to his hips in search of
critters. My husband worries about hepatitis should
we stop him from entering this creek?
Answer:
I love this question because my little boys are
creek stompers too and there is nothing like the joy
of a caught crayfish or salamander! But is it safe?
Probably. Specifically hepatitis would be an
extremely rare thing to be found in a creek in our
area. Hepatitis A can be transmitted through water
sources, but a common source like a creek/lake/pond
would be very unusual especially in the north east.
Plus most children are vaccinated for Hepatitis A
which would protect him. The Environmental
Protection Agency does not specifically monitor
local streams/creeks etc for bacteria levels however
they do report that there have been no waterborne
illnesses in the area recently. Pharmaceutical waste
levels are measured periodically and remain low in
our area. Any water source that runs through an
agricultural area has the risk of bacteria and
parasite contaminants. But the water would have to
be ingested, and probably in a fairly large amount.
Just simply playing in the water does not place your
child at risk. He should make sure he rinses off and
particularly washes his hands immediately
afterwards, to avoid ingesting any water borne
germs. There are lots of studies to support that our
children are “nature deprived”. The lessons and
skills that are gained from playing in a creek are
priceless. The minimal risk of a waterborne illness
should not stop you from letting your son
participate in this valuable activity. Tell him not
to drink the water and to wash his hands after he is
finished, but otherwise let him have fun. According
to the Township website there is a “Creek Stomp” in
Drumore on Wednesday June 24th at 6:30pm, there will
be an environmentalist on site to help identify
critters and educate the kids!
Question:
Warning signs about SIDS are everwhere. I have a 4
month old baby and I am a chronic worrier. I follow
all of the recommendations on how to reduce the risk
. How common is it?
Answer:
SIDS (or the new acronym is SUIDS (sudden unexpected
infant death)) is the leading cause of death among
infants ages 1-12 months in the United States. There
were 4,500 deaths due to SUIDS last year. In most
cases the autopsy shows some form of suffocation. So
that is the scary part. Here is the comforting part:
If you do the following things then you greatly
reduce the risk of SUIDS: Place your child to sleep
on his/her back. Not side, not stomach, back only.
Since we have been putting babies to sleep on their
backs, the incidence of SUIDS has dropped by 60%.
Make sure your baby sleeps on a firm surface. A crib
mattress should be hard. There should be absolutely
nothing soft in the crib. No stuffed animals, no
blankets, no pillows, no bumper… nothing. Lower your
heat. High temperatures seem to be an unexplained
risk factor. Give your baby a pacifier. It keeps the
airway open. Do not allow your child to be exposed
to cigarette smoke. Other risk factors are:
prematurity, being African American or Native
American, and viral illnesses. These are beyond your
control. What does not reduce your risk: Monitors
(of any type, video, sounds etc), sleep positioners,
or co-sleeping/cobedding. If you are doing
everything you can, then your child has a very very
minimal risk of SUIDS. I wish I could take the worry
away entirely, but I cannot. Focus on prevention and
it will all be okay.