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

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

Feeding your Baby: The Transition to Solids, Part 2

(This post is continued from yesterday's Part 1 segment)

So, when do you start your baby on solids? My advice is to watch your baby and see when he wants to start solids. It should not be until she has developed enough body and head control to be able to sit up in a high chair, but babies vary on when they can do this. It’s generally in the four to six month range. For my first daughter, it was at five months that she could sit in a chair, but she didn’t eat solids until six months of age. After your baby can sit up in the high chair, you’ll naturally start putting him there, likely with some toys on the tray, when you have things you need to do (like eat your own dinner!)

There will come a day when you see your baby watching the food make its way from the plate to your mouth with great interest. Then she’ll give you a look like “I’d like some of that!” This is when you need to convince him, at your next sit-down together, that what you were eating was mom’s milk (or formula) mixed with a small amount of rice cereal and "sure, you can have some." Just put a small amount in, and keep in mind that you want it to be runny at first, and the mixture will continue to thicken for a couple of minutes as the flakes absorb moisture. Put a small amount on a spoon and hold it up in front of baby. If she’s ready, she’ll lean forward and take the spoon into her mouth. If he doesn’t seem all that interested, it’s no big deal. The essential source of nutrition for a baby is human milk (or formula) from birth to six months, and from six months to one year, it’s still the major source for nutrition. You can try again later.

I do recommend starting solids by nine months, because by that time we’re talking about picking things up (like Cheerios) and learning to eat various things is an important part of brain development. Nutritionally speaking, a baby can do just fine on nothing but mom’s milk (or formula) until one year of age. Generally, everybody can’t wait to feed the baby, and I can recall only one time I’ve ever had to urge a mother to start solids with her baby at a nine month well child check.

Now, I just described using rice cereal mixed with human milk or formula because that’s been the most common first food advised over the past 40 years, and it’s what I gave my own kids. I should note, however, that not everybody agrees with this. Some feel that pureed meat should be the first food, because it is an excellent source of bio-available iron and zinc, for which some older babies have deficiencies. One thing is certain: do not give honey to a baby less than one year of age, due to the small, but real risk of infant botulism. If you’ve been nursing your baby, she’s been exposed to the variety of flavors that is in your own diet, so adding a little dried spice or herbs could be o.k., but don’t add salt or sugar to your baby’s food.

That’s all we have space for today — ask questions in the comment section and I’ll try to address them!

Dr. Julia Mason
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Feeding your Baby: The Transition to Solids, Part 1

If you have a baby, you’re probably getting advice (from all corners!) on how to feed her. Everybody can agree these days that mom’s own milk is the best food for babies, but after that, there can be a lot of confusion. I’m going to focus today on the transition from human milk or formula to “solid foods.”

Some new parents are being advised by relatives that they should start the baby on solids, (which usually means baby rice cereal) basically, as soon as possible. This may be because several years ago mothers were actually being advised by their pediatricians to start rice cereal at earlier and earlier ages. The hope was that adding rice cereal to the bottle (and that’s what we’re talking about, because a typical baby less than four months old is not going to slurp food off a spoon) would help the baby sleep through the night, or eat less often, or have less spit-up. This advice is no longer being given, except by the well-meaning grandmothers who are passing on what they were told. Still, you can find “infant feeders” in the baby section of stores which are basically just bottles with an extra large hole in the nipple, to allow the thicker cereal mixture to come through. (Just because something is sold in stores doesn’t mean it’s a good idea to buy and use, even with baby supplies.)

Giving a baby solid foods early is not going to make him sleep through the night at a younger age. Babies do tend to sleep longer periods of time as they get older, and they start solids when they get older, but giving solids to a three month old is not going to turn her into a seven month old. Babies sleep through the night when they sleep through the night (and you should know that the technical definition of this is "greater than five hours of sleep," not the eight hours you’re dreaming of). There are things you can do to encourage this behavior, but that will have to be the topic of another post. Feeding solids to a baby less than four months old is not going to get them to sleep for longer periods. It may help with spitting up, but I wouldn’t advise it unless the problem is severe. It will lead to weight gain, and I think we’ve all figured out that this is not necessarily a good thing. For many babies, rice cereal will cause constipation.

Visit again tomorrow for part 2, when I'll discuss the appropriate time to start the transition to solids.

Dr. Julia Mason

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

The Importance of Vaccinating Parents and Siblings to Protect Babies

“Whoop” This is the awful high-pitched inhaling sound people can make after a burst of coughing associated with pertussis. This sound is what gives it the common name: “Whooping Cough.” It has also been called the "100-day cough" due to the duration of the cough.

For adults, getting a case of whooping cough is annoying and sometimes painful given the severity of the cough, but usually only slightly worse than the common cold, especially early on. Many adolescents and adults don’t even develop the stereotypical “whoop.” For children, especially infants, this illness can be deadly. 85% of the deaths associated with pertussis occur in infants less than 3 months of age.

The good news is that we have a vaccine for pertussis. Fortunately, there has been a dramatic decrease in the number of pertussis cases since the introduction of the vaccine in the 1940’s, but we continue to see outbreaks every couple of years. Currently, California is experiencing an outbreak and there have been cases in Wisconsin as well.

The vaccine is given in a combination vaccine with diphtheria and tetanus, usually at ages 2, 4, 6 months, 12-18 months and 4-5 years. The vaccine is not fully effective until 3 doses are given, so children that are less than 6 months are at higher risk of getting the illness. Teenagers and adults tend to be those that spread the disease, because their illness is not as severe and many do not even know that pertussis is what is causing their illness. They also have waning immunity from the vaccines they received as a young child. Fortunately in 2005, a booster vaccine was developed.

This vaccine should be used in place of one tetanus booster. It contains tetanus, diphtheria and acellular pertussis (Tdap). Anyone that is around small children, especially new parents, should make sure they have received the Tdap vaccine. It is recommended that any new mother that is not immunized should receive it during the immediate postpartum period. If she is around children less than 12 months old during her pregnancy, she should receive it during the pregnancy.

If you have questions about your or your child(ren)’s immunization status, please be sure to discuss them with your primary care provider.

Dr. Dana Johnson
Pediatrician
Meriter McKee
3102 Meriter Way
Madison, WI
608.417.8388
meriter.com/pediatrics