Fever: What Parents Need to Know

When should a parent worry about a fever in their child? With the flu and cold season lurking just around the corner, now is a good time to know how to treat a temperature and when to report it.

First of all, some basic information is good to know. Fever is a normal response of the body’s immune system, and everything designed to kill infection works better when the core temperature of the body rises. When we sense a foreign invader, our “thermostat” resets to a higher temperature—101.5 taken rectally usually being the cut-off. (Remember that rectal temps are better indicators of core temperature and will generally run about a degree higher than one taken under the arm.)

It is important to note that very few fevers are dangerous, the rare exceptions being a “broken thermostat” which only happens in severe hyperthermia (heat stroke) and malignant hyperthermia (a rare condition brought on by anesthesia). As a matter of fact, many children go on with their normal routine and act happy.

So when do you treat fever? When the child is uncomfortable or it becomes difficult to determine just how sick they are. For instance, I only gave anti-pyretics to my kids when they looked sick—never simply in response to what the thermometer read. In these instances, Tylenol (acetaminophen) is the drug of choice, Ibuprofen as a second line drug. (Aspirin is never used in children because of the risk of Reye’s syndrome.)

It is important to be more aggressive when the diagnosis underlying the fever is in question—always in infants under two months of age. Also, because a child with a high fever can look very ill, observing what happens when the fever is brought down reassures us that nothing serious is going on in terms of infection. So, always call for fever in an infant under two months, and in children who don’t respond to anti-pyretics.

To Summarize:
• Most of the time fever is beneficial, helps us to get rid of the infection
• Treat only for comfort and to help aid in the diagnosis
• Call for any fever in children under two months, and also in children who you think may be ill (fever lasting more than a couple of days, or children who don’t respond when the fever comes down)
• While anti-pyretics such as Tylenol and ibuprofen are safe, they are not always necessary
• Always call if you are unsure about what to do!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

National Turnoff Week

This week, September 19-25th, is National Turnoff Week. The Center for Screen-Time Awareness organizes this challenge which is endorsed by the American Academy of Pediatrics (AAP). Families are challenged to turn off their television sets, computers, electronic games and other electronic devices for the entire week. Most people in the United States, children included, watch too much TV and spend too much time in front of their computers.

Besides the negative health effects from these sedentary activities, studies have shown that children who watch too much TV are more likely to have behavioral and aggression problems. The AAP recommends that children have no more than 2 hours of “screen” time per day (TV, computer time, video games, etc.) and that children younger than the age of 2 years watch no TV at all. Despite these recommendations, the average American child watches 3 hours of television a day.

This week, think about stepping up to this challenge. Right now, you are probably thinking, “what on earth are we going to do instead?” Think about reading books, playing board games, putting together puzzles, doing an art project or redecorating a room in the house. If the weather is nice, take a nature walk, visit the zoo, clean up your neighborhood or plant some flowers. Visit an apple orchard, pick some apples and make an apple pie together. The possibilities are endless! The goal is to have fun and reconnect as a family.

Once you have done this for the week, think about making this part of your routine. Pick two or three days a week to unplug the electronics and “tune in” to each other. Your family will be happier and healthier because of it! Are you and your family up to the challenge?

I would love to hear what you think about this challenge and what activities you and your family have planned! Post your comments under the article on facebook.com/meriter.

Dr. Nicole Baumann-Blackmore
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Child Passenger Safety Week: What you need to know (Part 2)

As we approach Child Passenger Safety Week, here are some important things to think about and remember:

Even though it is not required, REAR FACING UNTIL TWO YEARS of age is safest. Children who are 12 to 23 months old are FIVE TIMES SAFER if they face the rear rather than the front. Some folks worry about injury to the legs, but lower extremity injuries are rare in the rear-facing position which offers much better protection against spinal injuries. Many car seats available today have higher height and weight limits allowing you to use them longer than older seats. Every seat has a height and weight limit, and these limits can vary depending on whether the seat faces the rear or the front.

Children younger than 13 years old should ride in the back.

Car seats have an expiration date, usually 6 years after the manufacture date. Please do not use a seat that is more than 10 years old.

Car seats need to be replaced after an accident. Some insurance companies will cover the replacement cost. It may be possible to reuse a car seat after a minor crash. See http://nhtsa.gov/people/injury/childps/childrestraints/reuse/restraintreuse.htm for guidelines.

Avoid secondhand seats unless you are sure it has not been in an accident and it has not been recalled. It should have a sticker stating the manufacturer, the manufacture date, and the model number. You will need an owner’s manual which is often available online.

Car sear injuries can happen OUTSIDE of the car, especially in children younger than 4 months of age. Suffocation or head injury due to falls can occur. If the seat must be elevated (like on a counter), then the child should be strapped in, the surface should be firm, the seat should be far from the edge of the surface, and there should be constant supervision.

If you plan on using a car seat on a plane, it should be FAA certified. Car seats are recommended on flights for children up to 4 years of age. Install them just as you would in a car with a lap-only belt. The car seat should be put in a window seat.

For an overall reference, check out http://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Information-for-Families.aspx.

Be safe and enjoy the ride!

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Child Passenger Safety Week starts 9/19 and ends with National Seat Check Saturday on 9/25

Motor vehicle accidents are a leading cause of injuries and fatalities in children. Many of these injuries can be prevented, but OVER 75% OF CAR SEATS ARE USED OR INSTALLED INCORRECTLY. In some places, that number is as high as 95%.

What goes wrong? The car seat is not fastened tightly enough to the car. The child is not strapped in tightly enough. Clips, straps, or the seat itself is in the wrong position. The child is advanced to the next level of restraint too soon. Not all car seats will fit all cars. That’s why it’s important to get your car seat checked.

Even if you can’t make it on Seat Check Saturday, you can find a nearby certified technician who will check your seat for free at http://www.nhtsa.gov/Safety/CPS.

Wisconsin law states that ALL passengers are supposed to be restrained regardless of age or position in a car. Straps should be at or BELOW the shoulders for rear-facing children. You must be BOTH 1 year old AND at least 20 lbs to face the front. Straps should be at or ABOVE the shoulders for forward-facing children. You must be BOTH 4 years old AND at least 40 lbs to sit in a booster seat. Booster seats help to position children so that they fit appropriately under a lap/shoulder belt (which is why booster seats are not appropriate for airplanes).

Children are not required to use a booster seat when they are 8 years old, OR they are at least 4 years old and over 57 inches, OR they are at least 4 years old and over 80 lbs. However, when graduating from a booster seat, the child should be able to sit up against the seatback with knees bent comfortably at the edge of the seat. In this position, the seat belt should be over the collarbone and hips, NOT the neck or belly. Children who move out of booster seats prematurely are at increased risk of internal injuries from the seat belt or even ejection from the car.

For more about child seat laws in Wisconsin, see http://www.dot.wisconsin.gov/safety/vehicle/child/docs/booster-seat-law-facts.pdf.

Check back tomorrow when I'll post additional important car seat safety facts!

Dr. Tracy Lee

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

Backpack Tips

I remember seeing a child with a complaint of shoulder pain in the office during the last school year. Did she have a history of trauma? No. Was she in athletics? Perhaps it was overuse. No. Did she ever injure her shoulder in the past? No, but she did complain of numbness and tingling in her arm as well. Was she sleeping on a lumpy or worn out mattress? No. It turns out that the problem was her backpack. She routinely carried about 40 pounds of books on her right shoulder every day and eventually she developed shoulder pain and nerve irritation.

Kids haul around a lot of stuff in those backpacks and they are a known source of shoulder and back pain in children. So much so, that there are medical studies devoted to the subject. As the school year begins, it's a good time to make sure your child's backpack meets criteria for carrying her homework, books and personal items in as safe and comfortable manner as possible.

Here are some things to look for in a backpack:

• The straps should be wide to distribute weight evenly. They should be easy to adjust.


• The pack should always be worn on both shoulders in order to allow easy balance. Some packs have a waist belt that can help to distribute weight better. Padding in the backpack reduces pressure points on the back.


• The pack itself should be fairly light-weight so that it doesn't contribute much weight to the load. Some packs have wheels that allow them to be rolled like luggage. This is helpful, but keep in mind that in the winter they can't roll through the snow.

You may also talk to your child and help her to organize her things efficiently in all of the compartments of the backpack. Heavier items should be centered on the back if possible. Encourage your child to make stops at her locker throughout the day rather than carry all of her supplies for the day at once. If despite these measures the pack seems to be too heavy (more that 20% of your child's weight) talk to the school and other parents to encourage changes. Hopefully, with these measures you won't need to worry that your child will come home complaining of a back ache.

Dr. George Idarraga
Pediatrician
Meriter McKee
meriterkids.com