By Dr. John Jones
It always seems to happen at 6 p.m. You left your happy, healthy baby at the daycare center in the morning, and by the end of the day you have a cranky baby with a runny nose, cough, and a fever. You immediately think “Where did this come from, and what should I do about it?”
Since your pediatrician’s office is closed for the day, and you know you can’t wait until morning to see a doctor, should you take your child to the emergency department or urgent care center? Or are you overreacting?
As a parent of four children and a pediatric emergency physician, I can see both sides of the dilemma. Here are some thoughts to help you handle the situation.
1. First and foremost, it is never wrong to take your child to the emergency department at any hour. As an Emergency Room doctor by day, I can tell you that is what we are there for. Trust your parental instincts. If you feel that something is wrong, head to the ER or urgent care center — because you know what’s best for your child.
2. Once you get there, here’s what you can expect: With children and fever, pediatric emergency physicians break children up into three groups: 2 months and under, 2 months to 6 months, and 6 months and above.
- The grouping is based on the number of vaccinations the child has received, with the older children having enough protection against the Strep and H Flu and the younger ones at increased risk of contracting these bacterial illnesses.
- For this reason, if your child is 2 months and under with a rectal temperature of 100.4 or greater, the baby automatically gets a comprehensive work-up and spends the next two days in the hospital for observation.
- For children who are 2 to 6 months, the child will receive a work-up; however, if the lab results are normal, the child can go home with close follow-up with their pediatrician in the morning.
- For children who are 6 months and above, the work-up will depend on the child’s symptoms and how sick the child looks to an experienced pediatric provider. Don’t be surprised if your doctor does a complete physical exam, feels that a virus causes the fever, and sends you home with no antibiotics. This is standard — and good medicine — because it decreases the chances of allergies, diarrhea, and antibiotic resistance in your child.
3. About fever. Another question I am frequently asked is how a parent should handle a high fever. Worried parents often want to know, “If my child’s fever skyrockets to 104, what should I do?”
- I always reassure parents that a relatively high fever in a small child is not harmful because raising the body’s temperature is its method of fighting off infections. In some countries, in fact, doctors do not advise using ibuprofen or acetaminophen because they want to let the fever take its course.
- In the United States, we advise taking antipyretics (Tylenol or Motrin), which knock down the fever and keep both the children and their parents happy. I usually advise parents to stick with Motrin over Tylenol (and do not alternate) because a dose of Motrin lasts for eight hours while Tylenol only lasts for four hours. If your kids are anything like mine, my wife — also a doctor — and I try to avoid the medicine battle at all costs, so we minimize the frequency of giving medications.
- When determining the proper dose of Motrin, be sure to administer the dose base on your child’s weight — not their age. By using the wrong table it’s easy to under-dose the medication, and even a small amount under the required dosage based on weight will render the entire dose ineffective.
Here are some rules of thumb for administering Motrin:
- If your child is 22 pounds, give 5 mls (1 teaspoon)
- If your child is 33 pounds, give 7.5 mls (1 and 1/2 teaspoon)
- If your child is 44 pounds, give 10 mls (2 teaspoons)
- If your child is under 6 months, do not give Motrin and discuss treatment with your pediatrician, ED physician, or urgent care physician.
4. What should you do when your child has a cough? Know that a cough is a very common symptom associated with fever. It is frequently part of the viral syndrome — but it can also be a sign of pneumonia.
How can parents tell the difference? It can be difficult, so here’s my algorithm for determining which child I will order a chest X-ray on (to determine if the baby has a pneumonia). Note: While these criteria aren’t hard-and-fast rules, I find them helpful for finding pneumonia in children and at the same time helping us not over-order tests.
- Does the child look good? (Yes, he or she is sick, but you know when your child looks like something is wrong.)
- Is the child breathing well? If not, their oxygen saturation may be low.
- Has the child had a fever and cough for more than three days?
- If you answered “no” to the first two questions, and “yes” to the last one and you think your child has pneumonia, contact your pediatrician immediately or head to the ER or urgent care center.
5. Assuming your child does not have pneumonia, the next question parents ask is: “So what should I do about this cough?”
- First, I reassure parents that the cough isn’t hurting the child after I have done an exam and found the results to be normal and the child’s oxygen saturation to be normal.
- Second, the short answer is that there is no good medicine for a cough. The over-the-counter cough and cold medications are for children 6 years and older as advised by the FDA.
- The reason that they are contraindicated for children younger than 6 is because they are ineffective and have caused adverse outcomes — but mainly in children under 1 year old.
While there are no great or quick ways to alleviate a cough, I suggest that parents put a vaporizer in the child’s room, especially in the cold, dry winter.
And don’t count out old-school remedies such as mixing in a little milk with honey. In addition to reassuring parents that a cough won’t hurt their children, I tell them just to keep an eye on it for any symptoms of pneumonia (see above).
As always, feel free to contact me with questions: firstname.lastname@example.org.