What degree of fever is dangerous for my child?

The body’s temperature has some variability over the course of its 24 hr cycle (usually peaking in the late afternoon). Fever is defined as an elevation in body temperature above 100.4ºF (38ºC) measured in the rectum; above 100ºF (37.8ºC) measured in the mouth; or above 99ºF (37.2ºC) measured in the armpit. Fever most commonly represents the body’s protective defense against an infection. Therefore, it is an appropriate and helpful response that activates the body’s immune system and should NOT be considered dangerous. What is more important is how your child responds to the rising and falling of the fever. Elevated body termperature does not cause brain damage at levels below 108 degrees, and temperatures above this level in a normal child will only occur in cases of extreme environmental temperatures (e.g. unattended infants in a hot car or exercising in extreme heat and humidity). Since the brain is regulating and, indeed, telling the body to generate a fever, most fevers in a child with a normal brain do not exceed 104-105. Although febrile seizures (which occur in 4% of children) are frightening for parents, they DO NOT cause brain damage and are caused more commonly by how quickly the temperature is elevated rather than the height of the fever.

Bottom Line: “fever is one of the good guys” and should only be treated for the child’s comfort.

When should I keep my child home from daycare or school?

This is a very difficult dilemma for parents, in that Maryland’s formal policy (which guides schools and day-care establishments) is often at odds with the formal recommendations from the American Academy of Pediatrics and the physicians in our office. Any child < 2 years of age who has a fever of undetermined cause, who appears ill (makes you worried), or who appears to be getting worse, should be seen in our office. Basic reasons to keep your child at home include:

  • fever (until the cause has been determined and do not fall in the following disease specific guidelines)
  • diarrhea with blood or mucous in stools or diarrhea unable to be contained in the diaper
  • vomiting of more than 2 times in 24 hrs (until determined to be of a non-infectious cause)
  • mouth sores with drooling (unless of non-infectious cause) scabies or impetigo (a bacterial skin infection) until treated for 24 hrs.
  • Measles, mumps, rubella, chickenpox, pertussis, hepatitis A and polio (all preventable with vaccines) are absolute reasons for exclusion from school and day-care.

Additional factors to consider:

  • Any bacterial infection (e.g strep throat or impetigo) should be considered non-contagious after 24 hrs of antibiotics.
  • Children with ring-worm (fungal infection of the skin or scalp) should not be excluded after 24 hrs of treatment
  • Any visible rash should be kept covered.
  • Head lice should be treated for 24 hrs, but a “no nit” policy is NOT VALID and is not medically necessary.

A general rule of thumb is that your child may go to school or day-care when the illness does not prevent participation in activities, does not require care greater than the staff can provide without compromising the health or safety of others, and does not pose a risk of spread of HARMFUL disease to others.

Bottom Line: most children are contagious and have already exposed others to their infection BEFORE you know they are ill. Once children with treatable infections (those needing antibiotics for a BACTERIAL cause) are beyond 24 hrs of therapy, they are no longer contagious. Viral infections are best prevented by following the office recommendations for immunizations and careful attention to hand-washing.

Are there any medications that can help with vomiting and diarrhea?

Since most causes of vomiting and diarrhea are viral, the focus of attention should be on the diet. Breast milk or an oral rehydration solution are the best fluids to give when vomiting- be sure to give small amounts frequently. Probiotics ARE helpful whenever your child is dealing with an intestinal infection. Small amounts of starchy foods are best to help overcome diarrhea. Blood in the stool would be a red-flag for a bacterial cause and should be evaluated in the office.

There is a medicine, developed originally for nausea associated with chemotherapy, that is frequently used in the ER setting and may help with vomiting. However, most children do NOT need any medication, and this drug would only be carefully considered after an examination in the office.

There is no medication to safely control diarrhea in children. Although drugs may slow down the “gut” and appear to help with diarrhea, they really just interfere with the body’s own defense mechanisms.

Bottom Line: there are no outpatient medications used routinely for vomiting and diarrhea. Attention to hydration with appropriate oral fluids and progression to solid foods, with consideration of probiotics, is all that is necessary.

Why is the flu vaccine recommended for virtually all children?

Influenza (types ‘A’ and ‘B’) infect many children each year. Because influenza is a viral infection, antibiotics are of no value. As a widespread and highly contagious illness, which can lead to hospitalization and/or bacterial complications (e.g. pneumonia), it is highly beneficial to do all you can to protect your child. Every year, a new dose of the vaccine is required because each year there can be a change in the strains that become the predominant mix of flu virus transmitted in the population. Yearly administration of the vaccine also serves to maintain a high level of circulating protective antibodies against the influenza virus. Notable considerations for the flu vaccine as are follows:

  • Children younger than 6 months are the only group not eligible for vaccination.
  • Patients at particularly high risk for complications or the need for hospitalization include children < 2 years of age, asthmatics, cancer patients on chemotherapy, diabetics and children with heart or kidney disease.
  • Children with an egg allergy are now much more likely to be able to safely receive the vaccine (killed version only) after being cleared by the allergist.
  • Children with asthma or diabetes should only receive the killed virus vaccine.
  • The live vaccine is able to be administered to most children older than 2 years, and is often available thru the school system.

Bottom Line: The flu vaccine is SAFE, does not cause influenza itself, and has a high likeliehood of generating enough antibody protection to help keep your child safe and healthy from an illness that otherwise may cause hospitalization or bacterial complications.