Flu

Call our office or page operator (after hours) if your baby is younger than three months of age and develops a fever (rectal temperature of more than 100.4°F).  Do not give Tylenol to a baby less than three months old without talking to us first.  The medicine can confuse the situation by altering the fever’s course.

For older infants, we are more concerned about how your baby looks and acts rather than the height of the fever.  For any age, a child with fever that looks ill and has other symptoms (stiff neck, bad headache, seizure, sore throat, ear pain, foul smelling urine, burning with urination) which cause you to worry, please call the office.  We handle fever differently based on your child’s age and the context of the fever.  We are happy to teach you on an individual basis how we think fever should be handled.  The scope of detailed fever management is beyond the capabilities of this booklet.

Always accurately record temperatures with a digital thermometer.  The best place to check is in the rectum (especially for babies less than three months old) or axillary if > one year old.  Write this number down on a piece of paper and show it to your doctor.  Fever is defined as any temperature more than 100.4° F for infants less than three months old.  For older children (children older than three months), we consider 101° F a fever.

Taking a Rectal Temperature

• Lubricate the tip of the thermometer with a water-soluble lubrication. (KY, Vaseline, etc.)

• Place your baby face down across your lap, supporting their head, or lie them down on a firm flat surface such as a changing table.

• Press the palm of one hand firmly against your baby’s lower back to hold them still.

• Using your other hand, insert the lubricated thermometer through the anal opening, about 1/2 to 1 inch into the rectum. Stop at less than 1/2 inch if you feel any resistance.

• Steady the thermometer between your second and third fingers as you cup your hand against your baby’s bottom. Soothe your baby and speak to them quietly as you hold the thermometer in place.

• Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and record the number on the screen, noting the time of day that the reading was taken.

 Treatment for Fever

Fever is not harmful itself. Fever is usually a symptom of an infection.  It is a sign that your child’s body is fighting the infection.  Treatments for fever offer only temporary relief.  The decision to treat a fever should revolve around how the fever is affecting your child.  If your child has a fever and feels great, medication is probably not necessary.  Medicine might be warranted if your child feels achy and weak or if your child also has a headache or sore throat.  Please do not treat the fever of a child less than three months old.  We need to know about it.  Should you decide to treat a fever, we recommend the following measures:

• Acetaminophen (Tylenol, for children any age) and ibuprofen (i.e. Advil or Motrin, for children older than six months of age) are excellent medicines for fever treatment. Studies have shown that selecting a single medicine and using it appropriately controls fever as well as alternating medicines.  Therefore, we recommend using a single fever reducer every six hours. In general, ibuprofen is preferable as a first line medicine for fever because it lasts longer and controls aches and pains better than acetaminophen.  If the fever returns before it is time to give ibuprofen again, you can then use acetaminophen to bridge the gap, if necessary.  Again, do not use ibuprofen for children less than six months old.
• Do not use aspirin to treat a child’s fever.
• If your child vomits the fever medication, you can use rectal acetaminophen (Feverall) sold over-the-counter at the pharmacy.
• You also can give a lukewarm sponge bath for ten to twenty minutes (26-28C° is optimal) for comfort purposes. Repeat this every two hours as needed. Evidence shows this does not reduce fever, however it can be done for your child’s comfort.

Be certain that you are giving the right dose of medicine. This can be confusing as seen below:

Infant’s Unconcentrated Acetaminophen Drops*                160mg/5ml

Children’s Acetaminophen                                                             160mg/5ml

*Concentrated Infant Acetaminophen drops (80mg/0.8mL) are no longer available

Infant’s Ibuprofen Drops                                                                50mg/1.25ml

Children’s Ibuprofen                                                                        100mg/5ml

Do not use ibuprofen any closer than every six hours and do not use acetaminophen any closer than every four hours.

You can safely follow the dosing on the box.  If you want to be safe and want to double check the dose, the general dosing of acetaminophen is 15mg per kg per dose or 7mg per pound per dose (2.2lbs = 1kg).  The dosing of ibuprofen is 10mg per kg per dose or 4.5mg per pound per dose.

Occasional colds are unavoidable in babies and children.  The average baby will contract eight to twelve colds per year! Colds which involve no more than a runny nose and a mild cough and even fever can be handled at home.  If your baby has other worrisome symptoms, however, we’d like for you to call us.

What causes a cold or flu?

There are several different types of viruses which cause the common cold or flu.

What is a viral infection?

A virus is different from a bacteria and cannot be killed by antibiotics.  A virus cannot reproduce by itself.  It makes you sick by taking over some of your cells in your body in order to multiply.  When it takes over cells in your nose, this leads to a runny nose.

 What are the symptoms of a cold or flu?

Common symptoms include weakness, cough, headache, fever, muscle ache, and/or runny nose.

What is the treatment?

If your child does get the cold or flu, antibiotics will not help.  The best cure for the cold or flu is time.  We can treat symptoms as needed with:

• nasal saline washes and bulb suction
• cool mist vaporizers
• elevation of the head of the bed at night

Usually, your child will start to feel better within one week, although some symptoms can last four to six weeks.  Symptoms get worse before they get better with day three and four of the cold being the worst days.

What medications can my baby take?

No medication will eliminate your child’s disease.  Again, only time will cure your child.  No studies have ever shown cold medicines to be helpful for children, and plenty have now shown these medications to cause harmful side effects, especially in children younger than 4 years old.  People are always disappointed with the ineffectiveness of cold medicines and often switch from one brand to another.  That is why there are aisles and aisles of them in the store.  Additionally, coughing is a natural defense mechanism of your body which helps to keep your airways open and prevents the pooling of mucus in your lungs.  For these reasons, we discourage the use of cough medicines during a cold.  The best treatment measures for symptoms are listed above.

Do the following to prevent dehydration from excessive vomiting:

• After your child vomits, do not give fluids for 30 minutes.
• Use Pedialyte for infants and Gatorade for older children (>1 year old).
• Give 1 teaspoon every 5 minutes for 30 minutes (even if your child is crying for more fluids, you must pace them or they will throw-up).
• After 30 minutes of sipping every 5 minutes, wait 30 minutes without drinking fluids.  If they do not vomit during this time you can allow them to begin drinking Pedialyte/Gatorade freely.
• If at any time they vomit again, repeat the above cycle.
• Advance quantity slowly as your child demonstrates tolerance to fluids.
• Stop giving milk, soft drinks, or fruit juices if not staying down.
• Milk should be attempted only after tolerance of other fluids has been demonstrated.
• Once tolerating fluids (generally 12oz of fluids without vomiting), advance to breads, pastas, crackers, soups, and then other bland foods such as baked chicken or baked potatoes without much seasoning or fat.

Do the following to prevent diaper rash:

• Use barrier creams (Dr. Smith’s, Aquaphor, etc.) liberally with each diaper change.
• Clean the bottom with a soft cloth and use gentle strokes to prevent further abrasion.

Call the office if:

• Your child is dehydrated (look for the following signs):

• Urine output is less than every 8 hours.
• Your child has decreased saliva, poor skin tone or inability to form tears.
• Your child just lies around, has difficulty giving responses, is not talking to you, and/or is unable to walk around.
• Your child has severe abdominal pain or pain localized to right lower quadrant.
• There is green or bloody emesis.
• Your child begins sustained heavy breathing for greater than an hour.
• Your child has taken only Pedialyte for longer than twenty-four hours.
• There are other symptoms such as ear pain or burning with urination.
• Your child has had recent head trauma or has ingested something toxic.
• Always call if you are worried about the condition of your child and need more guidance.

Think of your child as a closed fluid container.  What comes out must be gradually replaced or they will eventually become dehydrated.  Most of the vomiting illnesses cause intense vomiting in the beginning that gradually dissipates over the first twenty-four to forty-eight hours.  If we can keep ahead of the fluid loss during that time, usually the vomiting will pass and the threat of dehydration passes with it.