Fever is defined as a temperature of 100.4 degrees or higher. Body temperature changes throughout the day and may be higher in the afternoon or evening. In older children, the most accurate way to measure temperature is with a thermometer under their tongue. For babies and younger children, taking a rectal temperature is the most accurate measurement.

Fever in general is not a medical emergency. Fever is a sign that one’s immune system is functioning well and responding to an illness process. A fever does not always require medication.

There are cases when a fever is more concerning:

• If your baby is less than 3 months old and has a fever over 100.4 (taken rectally), he or she needs to be examined.
• If an older child is listless, not drinking fluids, having trouble breathing, or has chronic medical concerns and has a fever, call our office for guidance.

In most healthy children, fever can be a normal part of a viral infection. It can last 3 to 5 days. If a child does not have chronic medical concerns, is able to drink fluids normally, and is not having difficulty breathing, it is OK to monitor the fever at home for a few days. You may give children over 3 months of age Tylenol, and children over 6 months of age ibuprofen as needed. Please note: these medications may only reduce the fever and may not bring the temperature to normal. See our dosing chart for dosing levels.

If the fever persists, or for symptoms listed below, we will ask you to bring your child to be seen:

• Is your child not drinking fluids well?
• Are there symptoms of strep throat: sore throat, headache, abdominal pain, rash?
• Are there symptoms of a urinary tract infection, UTI: pain with urination, urinary frequency, vomiting, blood in urine?
• Symptoms of sinus infection: headache or sinus paid with 10-14 days of cough and congestion not improving?
• Symptoms of pneumonia: cough without nasal congestion, chest pain with cough, increased work of breathing?
• Symptoms of an ear infection: Ear pain, frequent waking at night with pain?

Most importantly, always assess the child and not the number of their temperature. If a child looks concerning even if their fever is not high, please call our office.

Cough – The “Cliff Notes” Version

Questions We Ask:

• Duration of the cough
• Any signs or symptoms of respiratory distress
• How ill appearing is your child?
• Any associated symptoms, such as fever?

Who needs to be seen today:

• Patients with significant chronic medical concerns
• Patients with fever (over 100.4) for more than 72 hours
• Patients with fever over 105
• Patients with signs or symptoms of respiratory distress
• Babies under 3 months old
• Patients with a known history of asthma, RAD or wheezing who have been using albuterol for more than 24 – 48 hour and are not getting better or are having additional symptoms
• Cough that is persisting 2 or 3 weeks or longer

Comfort Measures at Home:

• Use a cool mist humidifier

Honey:

• Do not give honey to babies under one year—it is not safe.
• For children ages 1 to 5 years: Try half a teaspoon of honey.
• For children ages 6 to 11: Try one teaspoon of honey.
• For children 12 or older: Try two teaspoons of honey.

• If honey is given at bedtime, make sure your child’s teeth are brushed afterward.
• Water. Encourage your child to drink plenty of water

What is Hand, Foot & Mouth, HFMD?

Hand, foot and mouth disease (HFMD) is a common childhood illness and is caused by the coxsackie A-16 virus. Symptoms than may arise with HFMD include:

• Fever (100.4 or higher)
• Small, painful red spots (blisters) on hands, feet and mouth

*Blisters may spread to arms, legs and face
These symptoms typically arise 3 – 5 days after exposure to the virus. Fevers typically occur in the first few days, followed by blisters.

Treatment

Since HFMD is a viral disease, antibiotics are not needed. Symptoms of the virus that cause discomfort may be treated with over the counter medication, Tylenol or ibuprofen. See our dosing chart here. It is highly recommended that children drink lots of fluids; cold drinks soothe irritation in the mouth and help children stay hydrated. There is no special treatment for blisters; wash the skin per your normal routine with soap and mild water.

Progression / What to Expect

Fever may last 2 – 3 days
Blisters around the mouth may last up to 7 days
Blisters on the hands and feet can last up to 10 days. Peeling may occur during healing.
Call our office if there are signs of dehydration, or if the fever (100.4 or higher) lasts more than 72 hours.
Children can typically return to school or daycare after the fever has been gone for over 24 hours.

• Low-grade fever is normal with GI bug
• With vomiting start with fluids low and slow
• Try to wait 20-30 minutes after vomiting episode to begin fluids
• Offer 1 tsp clear fluids (water, Gatorade, pedialyte) every 5 minutes
• Do not offer solid foods during this time
• Can slowly progress to larger amounts of fluids as they tolerate this
• Begin process from beginning if vomiting returns again
• Can slowly introduce bland diet after period of 6 hours with NO vomiting
• Start with something small and high in carbs: crackers, plain dry toast
• Slowly progress as tolerated-stick with bland BRAT diet for at least a day or so (bananas, rice, applesauce, toast, crackers, plain pasta)
• Gradually return to normal diet-avoid fried foods, spicy foods, acidic foods, etc for at least several days
• Call the office if vomiting continues for more than 24 hours, has decreased alertness, or your child shows signs of dehydration (goes longer than 6-8 hours without urinating, has no tears with crying, or the inside of mouth feels sticky).

• Diarrhea normal with GI bug
• Can last 7-10 days but should taper off and improve-less frequent and begin to bulk up and become more firm
• Call the office if having more than 12 episodes of diarrhea per day, diarrhea does not start to taper off or improve toward the end of 7-10 day range, mucous in stool, or s/s of dehydration (see above)

The most common symptoms of the flu include fever (100.4 or higher), body aches, cough and congestion and malaise. While vomiting may occur, it is not a primary symptom. Symptoms usually appear quickly.

Treatment

Treatment typically consists of comfort measures at home: lots of rest, lots of fluids, honey for cough and fever and paid reduction medications.

What about Tamiflu? Tamiflu is an anti-viral medication and may be indicated if a child has flu or flu-like symptoms. Tamiflu does NOT kill the flu virus or cure flu symptoms. It has been shown to reduce duration of symptoms by about 24 hours. It stops the virus from making copies of itself; it is most effective when given within the first 48 hours of symptoms. The side effects can include significant vomiting and diarrhea.
Tamiflu is a treatment option but is not a replacement for prevention with the flu vaccine.

Prevention

The flu vaccine is recommended every flu season, the earlier in the season the better. ALL children with egg allergy can safely receive the flu vaccine in any form.
The American Academy of Pediatrics recommends the flu vaccine for all people ages 6 months and older, especially those with chronic medical concerns. The only people who should not receive the flu vaccine are those who have had an anaphylactic or serious allergic reaction to the flu vaccine in the past.
Our office will offer the flu vaccine as early as it is available, usually mid-September. Please check with us for this year’s recommendations for type of vaccine.

• Try to refrain from using baby wipes and use plain water with a cloth
• Add some baking soda to a warm bath and allow to soak, especially after having a bowel movement
• Apply a thick layer of diaper cream. Then apply layer of Aquaphor, A&D, or Vaseline on top. The bottom layer helps to heal the skin, the top layer helps to wick away moisture