Fevers – Not Always a Cause for Alarm

26 07 2012

Few symptoms cause as much confusion and concern as fevers do. Dr. Katherine Vaughn, PKIDs’ medical director, answers questions about this worrisome symptom (check with your child’s doctor to determine what course of action is best for your child):

Why do Fevers Occur?

A fever is a resetting of the body’s thermostat to a higher temperature. This usually occurs in response to an infection, although other conditions can cause fever as well. Fever is an indicator that the immune system is working.

What is a Fever?

We all tend to think of 98.6 as a “normal” temperature, and anything above as a fever. In fact, temperature varies from person to person, and will also fluctuate by about a degree in any given person over the course of a day. We typically run about a degree lower in the morning compared to the evening. A temperature of over 100.4 is considered a fever.

How should a Temperature Be Taken?

Rectal temperature is considered the “gold standard”, and it’s most important to obtain in this way in an infant under 3 months of age. An axillary or ear (tympanic) temperature can be obtained in older infants and children. Forehead and pacifier thermometers are not as reliable a measure of temperature.

When Do I Worry About a Fever?

Always notify your doctor if an infant 3 months of age or younger has a rectal temp of over 100.4. The fever itself isn’t harmful, but babies this age can be quite ill without showing other signs, and will likely need to be seen.

For children over 3 months of age, it’s less likely they will be seriously ill and not have other signs and symptoms. A child’s behavior and activity level are more important clues to the severity of illness. A 6 month old who is playing and happy with a temperature of 103 would be less concerning than a 9 month old with a 101 temp who is listless and lethargic. A fever has to be quite high (generally felt to be greater than 106) for the fever itself to be harmful.

Other symptoms, such as rash, trouble breathing, lethargy, or other indications of a sick-looking child should prompt a call to your physician or visit to the ER. Fevers over 104 degrees, or any fever lasting more than 3 days should prompt a call to your physician to help assess for the need for a visit.

When Should a Fever Be Treated?

The main reason to treat a fever is for comfort. A happy child with a fever does not have to be treated. However, as temperatures rise over 101, many children become uncomfortable, with headache, body aches, increased heart rate, etc.

Treatment can be with acetominophen or ibuprofen at the appropriate doses. Never give your child aspirin for fever. It has been linked to a condition called Reyes’ syndrome.

Lukewarm sponge baths can also be used, as well as offering plenty of fluids. Don’t worry if your child doesn’t want to eat much for a few days, as long as they’re drinking.

Avoid alcohol sponging (it will raise the temperature) or cold water baths (increases discomfort).

Fever Myths

  1. “The temperature came down a few degrees and my child feels better, but the temperature still isn’t normal. My child must be really sick.” A child’s response to acetominophen or ibuprofen (in terms of degrees a fever decreases) is not an indicator of severity of illness. We don’t expect the temperature to come down to normal. Remember, treating the fever is done mainly for the child’s comfort, but it doesn’t make the illness get better any sooner.
  2. “Fever can cause brain damage.” A temperature probably has to be over 106 to cause problems like this, and in a normally healthy person, that doesn’t happen.
  3. “What about febrile (fever) seizures? They can occur at temperatures less than 106.” True. Febrile seizures are frightening. They occur in 3-4 percent of children, usually between 6 months and 5 years of age. They are typically brief and don’t cause any lasting problems. Always notify your child’s doctor if they have a febrile seizure.

Take Home Message

Fevers are rarely harmful. In a child under 3 months of age, call your doctor for any temperature over 100.4 . In older children, you can feel more comfortable evaluating the child, giving medicine to bring the fever down if they are uncomfortable, and calling the doctor if you’re concerned about how they are looking or acting.





Celebrating Prevention! NIIW 2011

18 04 2011

Protecting babies from infectious diseases is a big deal around here, as evidenced by disease prevention taking up a chunk of space in our mission statement.

National Infant Immunization Week (NIIW), observed April 23-30 this year, is part of a larger global vaccine education initiative with WHO. For the past 17 years in the U.S., the CDC, health departments, and immunization organizations across the country have marked the week as a time to showcase immunization achievements and raise awareness of the need for continued vaccination of babies.

We asked our child immunization friends to share their planned activities, and we did some research of our own to find novel programs to share. To learn about activities in your area, visit the CDC’s NIIW site for details. Here’s a sampling of events coming up for NIIW:

  • Arizona – The Cochise County Health Department is giving free diapers to parents who bring in up-to-date immunization records. Children who need vaccines will also be vaccinated at the event and parents will receive free diapers. Scientific Technologies Corporation is doing a blog series during NIIW and promoting the week on their homepage.
  • Connecticut – The New Britain Immunization Program has collaborated with the New Britain Rock Cats Minor League Baseball Team to give free tickets to stadium visitors who have their children’s immunization records reviewed. The Southwestern Area Health Education Center will honor WIC moms and dads at a Mother’s Day Social where attendees will get education and play CIRTS (Connecticut Immunization Registry and Tracking System) BINGO.
  • Illinois – The Chicago Area Immunization Campaign has partnered with Jewel Osco, a local pharmacy chain, to distribute 15,000 immunization information cards with people’s prescriptions.
  • Nevada – The Northern Nevada Immunization Coalition will host “Give Kids a Boost: Sun Valley Health and Safety Fair” (GKAB Fair) to alleviate the barriers of health care access and transportation.
  • Rhode Island – The Rhode Island Department of Health has partnered with birthing hospitals and childcare centers to have area children to draw pictures inspired by the story “The Flu and You,” by Geri Rhoda, RN. The pictures will be used on placemats designed for use in the maternity wards and will include the infant immunization schedule and information about the importance of vaccinating caregivers with Tdap.
  • Texas – The Hidalgo County Health & Human Services Department will host an event with speakers from Mexico and Texas educating promotoras (health educators in Latino communities) on vaccine preventable diseases, the importance of vaccines, and the Mexico/US immunization schedule. The Immunize Kids! Dallas Area Partnership is reaching out to Hispanic families and women’s centers with education packets and presentations.

Do you have great activities planned for NIIW? Post a comment and tell us about it!

(photo courtesy snorp on Flickr)





Preventing Baby Strep

10 02 2011

Group B strep (GBS aka Baby Strep)  is the main cause of meningitis and sepsis in newborns.  If left untreated, this bacterial infection can cause serious harm, but with the proper course of treatment, only five percent of newborns exposed to the bacteria will develop GBS disease.

One out of four pregnant women carries GBS bacteria in their vagina or rectum, although some pregnant women remain free of symptoms (vaginal burning or irritation, unusual vaginal discharge, or bladder infections), making infection a silent risk for newborns.

Symptoms of a baby infected with GBS include red or tender skin, discolored skin due to lack of oxygen, and difficulty breathing. Group B strep in babies can cause sepsis, pneumonia, meningitis and other serious illnesses.

Coupled with the potential impacts of GBS infection on pregnant women (preterm labor and early onset of water breaking), the lack of symptoms led to the U.S. and Canada specifying screening for GBS as the proper standard of care for women who are 35 to 37 weeks pregnant.

The CDC suggests the following for the prevention of GBS:

  • Testing of all preterm deliveries
  • Closer monitoring and treatment for pregnant women who are allergic to penicillin
  • Following the recommended testing guidelines at 35 to 37 weeks pregnant
  • Testing of pregnant patients who report bladder infections, unusual vaginal discharge, or vaginal irritation and burning.

Pregnant patients and their families should be aware of these recommendations and check with their doctor to ensure compliance.





Pregnant Women and Infants: Flu Targets

15 11 2010

(courtesy of CDC)

The first and second U.S. deaths from the 2009 H1N1 pandemic were in a 22-month-old child and a 33-year old pregnant woman. These deaths were a sad sign of the toll this pandemic would take on young children and pregnant women. While pregnant women and young children have been considered at “high risk of flu-related complications” for years, 2009 H1N1 flu hit them really hard.

The risk from flu is greater for pregnant women because pregnancy can reduce the ability of the lungs and the immune system to work normally. This can be bad for both mother and baby. According to a study done during the first month of the 2009 H1N1 outbreak, the rate of hospitalizations was four times higher in pregnant women than other groups. Also, although pregnant women are about 1% of the U.S. population, they made up about 5% of U.S. deaths from 2009 H1N1 reported to the Centers for Disease Control (CDC) from April 14 – August 21, 2009.

Young children, whose immune systems are still developing, are also at-risk for flu-related complications. Each year about 100 flu-related deaths in children are thought to occur in the U.S. During the 2009 H1N1 pandemic, more than 300 deaths in children were reported to CDC. CDC believes that many more deaths in children may have gone unrecognized or unreported.

Experts think the 2009 H1N1 virus will be around again this flu season. In fact, one of the three parts of this season’s flu vaccine will protect against the 2009 H1N1 virus. While CDC is now encouraging everyone six months and older to get vaccinated against the flu, there is a special message for pregnant women and parents: “Don’t pass up this easy way to protect yourself and your children against the flu,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC Director of the National Center for Immunization and Respiratory Diseases.

“Getting a flu vaccine during pregnancy can reduce the risk of getting the flu while pregnant and after,” says Dr. Schuchat. “And babies younger than six months can get very sick from flu, but are too young to get vaccinated. The best way to protect them is to have their caregivers and close contacts vaccinated.”

Seasonal flu shots have been given safely to millions of pregnant women and children over many years.  Though there is no proof that thimerosal (a preservative) is harmful to a pregnant woman, their babies, or young children, some worry about it. So, as before, vaccine companies are making plenty of preservative-free flu vaccine as an option for pregnant women and small children.

Usually worse than the common cold, the flu can cause fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and weakness. Some people also have diarrhea and vomiting. Pregnant women and parents of children younger than two years of age should call their doctor or nurse right away if they, or their children, become sick. A doctor can prescribe flu antiviral drugs.

Vaccination continues to be the best protection. Get yourself—and all of your children 6 months of age and older—vaccinated against the flu to keep all family members healthy this flu season. One shot will last all flu season, even if you get it early in the season.

For more information, talk to your doctor or contact CDC at 1-800-CDC-INFO or www.cdc.gov.





Hepatitis B Vaccine Birth Dose

12 05 2009

Hepatitis B virus (HBV) infection has the reputation of being a sexually transmitted disease.  That’s because it is an STD.  But, it’s also a virus that can pass from a mom to her newborn at or soon after birth.

Pregnant women can become infected with HBV and not know it, then pass it on to their newborns. OBs will test at-risk women early in the pregnancy and again at birth, but what if you’re not considered at-risk and you get infected? 

Giving a newborn the birth dose of the HBV vaccine is important because if a newborn becomes infected with hepatitis B, that baby has a 90 percent chance of staying infected – being chronically infected – for life.

This infection may never cause any harm, but it could cause liver damage, liver cancer or even death. 

Treatment options are not great and, because there is a vaccine for HBV, not a lot of money gets put into this research.  They’re not even searching for a cure, just possible ways to stop the damage caused by the viral infection.

Get vaccinated.  Get your babies and children vaccinated.  Hepatitis B is around and no one can say how it will act in any one body.  Why take the chance?