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Apr 6, 11 | Posted by: Kristin Bencik Boudreau, D.O.
What’s Your Diagnosis? Fever and refusal to eat in a Toddler
A 16 month girl presents with fever, extreme irritability, and refusal to eat or drink. Every time she tries to drink something, she screams as she swallows and stops and cries. She has been up crying in pain for the last two nights. She has no rashes. You correctly deduce that something is going on in her mouth, and bring her in for evaluation. The doctor sees lots of red blisters in the back of her mouth. What’s the diagnosis?
Coxsachie viral infection, or better known as Hand- Foot-and Mouth disease (HFM). HFM is a very common childhood disease, and makes both patients and parents misreable. Classis HFM will present with fever, fussiness, blisters in back of mouth, and blisters on hands and feet. It generally lasts about three to five days and is very contagious. There are many different types of the Coxsachie virus, so not every kid is going to get the classic rash. Many only get the fever and blisters as this patient, who happened to be my daughter, did.
Treatment is only symptomatic, as it is viral. Alternating Tylenol with Motrin to keep the pain down is the cornerstone to treatment, as is pushing fluids to make sure they don’t get dehydrated. In more severe cases, they may need prescription pain medications to help them. My daughter has now been misreable for three days, and is has been really sad to watch. The only good news is that we are now half way through so I know the end is in sight.
I would bring your child in if they are not responsing to traditional pain medicines, if you are unsure of the diagnosis, or if you think they are getting dehydrated.
Mar 7, 11 | Posted by: Kristin Bencik Boudreau, D.O.
Fever Phobia
My fifteen month old daughter spiked a temp to 103.5 last week, of course in the middle of the night and on the first day of my husband’s business trip. I spent the rest of the night awake with a screaming, miserable child who later went on to develop croup the next night. My story is one I hear reported over and over again, as parents are incredibly stressed about fevers. As per the most recent American Academy of Pediatrics News, “Fever, in and of itself, is not known to endanger a generally healthy child and actually may be beneficial.” Fever is a natural response to illness, and is a result of chemical mediators being released as the body fights the infection. High fevers can NOT fry the brains of children, which is also a commonly asked question.
Why then, do parents have such a “phobia” about fevers? I think physicians are partially to blame, because the moment the child is delivered we stress that everything must be done to lessen the chance of illness, and that it is an emergency if a baby develops a fever. This is true for all infants less than eight weeks old, and a fever at that point is anything greater than 100.4 rectally. However, after eight weeks of age, fevers are just a routine symptom of illness. The other reason parents are so concerned about fevers is how sick kids look with high fevers. They are lethargic to the point of looking like wet noodles, they don’t want to eat or drink, and they are just miserable.
So if fevers are a normal part of the bodies response to illness, why do we treat them with ibuprofen and acetaminophen? The only reason we recommend those over the counter medicines is just to provide some symptomatic relief to the kids. I call Motrin the miracle drug, because generally an hour after given, the “wet noodle” kid is up and jumping around again. However, yet another misconception of the treatments is that the fever needs to go back to normal range. The goal of these meds is just to provide comfort- not to normalize the fever. Fever is not dangerous. These medications need to be dosed according to the patients weight, and must be used correctly to limit the potential for overdose. Acetaminophen can only be given every FOUR hours, ibuprofen can only be given every SIX to EIGHT hours. If your child is sleeping, don’t wake them up to give them medicines. Believe me, they will wake up if they get uncomfortable enough with the fever and then you can give them the anti-fever medications.
Finally, parents always want us to give them a number that is “dangerous” and the child needs to be taken in for. This is very hard to do because the height of the fever doesn’t always correlate with the severity of th infection. Influenza can cause 104-105′ fevers, where a pneumonia can be only a low grade temperature. The other reason it is difficult to give a number is because of the error in taking accurate temperatures. Ear thermometers are notoriously horrible for providing high temperature readings. The temporal ones are not much better. The most accurate temperature in a infant and young child is rectal, and in an older child is oral. As I tell my parents, the other methods will tell you fever or no fever, just don’t depend upon the number. So if I had to pick a number what would it be? Generally, anything in the high 104′s to 105 should be seen within that day just to make sure the child is doing OK. More alarming to me is the child who does not perk up when the fever is brought down.
To Summarize:
- Infants less than eight weeks old with a temperature greater than 100.4 rectally need to be seen immediately
- Fevers in kids greater than eight weeks old are not dangerous- they are the bodies natural response to fighting illness
- Treatment of fevers is to provide COMFORT- not to bring the temperature back to normal
- Kids should be brought in for fevers >101 for more than 4-5 five days, fevers that come back after they had normalized for a few days, or temperatures greater than 105
- Kids should be brought in if they don’t perk up significantly when the fevers come down
- Ibuprofen and acetaminophen should be dosed by weight, and not given more than every four hours for acetaminophen, and every six hours for ibuprofen
There is a dosing chart on our website under For Parents tab that can assist in the appropriate dose for acetaminophen and ibuprofen.
Please contact your physician with more specific questions regarding your child’s illness and fever.
Jan 18, 11 | Posted by: Kristin Bencik Boudreau, D.O.
Quality Time with the Kids
As a working parent, I struggle with providing quality time with the kids. My husband and I try to make a special point on vacations to spend “special” time with each kid- no easy task when there are four and we have limited vacation time. After our summer vacation, my four year old asked me if next year we could do “one on one” time again. Nothing like a four year old honest question to make you feel like a horrible parent! I had to work this Christmas, so to make up for not being able to spend time with the extended family in Michigan, we took the kids on a trip to Atlanta. Why Atlanta? I really wanted to take the kids to the Aquarium there, it was a cheap direct flight, and it was warmer than here. As many of you might have known from a prior blog, we did Disney last year and it was a horrible disaster. This trip was all about the kids- we went to the Aquarium, the Children’s Museum, the Atlanta Zoo, and the Coco-Cola Factory. We went swimming in the pool every night with them, and just did “special” time hanging out and playing games with them. It was probably one of the best family vacations we have had.
I am not saying you have to travel to have quality time. There is plenty to do right here. Go to the zoo, Betty Brinn, Audubon, Discovery World, or the Domes. If you feel like driving, take the kids to Chicago’s Aquarium. Or better yet, take your child out to lunch without siblings, or play a special game with them. Let them know they have your undivided attention for that time. One on one time can also be a motivator for those kids who need a little encouragement to act better- it can be even more powerful than toys! In the midst of the chaos of day to day life, try to take that extra step to enjoy being with your special kids!
Jan 12, 11 | Posted by: Kristin Bencik Boudreau, D.O.
All drop-side rail cribs banned
Last year when I was getting ready for my fourth baby, reports came out about a recall of movable side rail cribs. Although the recall did not affect my crib, the knowledge that those cribs were being recalled because of infant deaths prompted me to convince my husband to buy the baby a new crib. I am so glad we did. All cribs that have the movable side rail that goes up and down have subsequently been banned because of the possibility of the baby getting stuck in the corner where the rail moves and being suffocated or strangulated. Over thirty infants are known to have died because of these cribs, and fourteen other deaths are suspicious. If you have these cribs, call the manufacturer immediately and stop putting the baby in them. Hotels and day-cares have eighteen months to replace these cribs, but if you see them do not allow your babies to sleep in them. Ask for a Pack-and-play instead. I feel fortunate that my other kids had no issues with the old crib.
Oct 21, 10 | Posted by: Kristin Bencik Boudreau, D.O.
Sportsmanship- Lessons for Life
My oldest son was playing in a soccer tournament over the weekend and his team was getting crushed. The team was at least a year and a half older than his, and definitely a full head taller. They were also excellent, playing positions and passing well. Near the end of the second half, their goalie took the ball, dribbled it past multiple players who couldn’t quite figure out what he was doing, and shot and scored on net. More »
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