DOCTOR'S FAQs

Q. What is a fever?

A fever means the body temperature is above normal. Your child has a fever if…

1. Rectal temperature is over 100.4ºF (38.0ºC).
2. Oral temperature is over 99.5ºF (37.5ºC)
3. Axillary (armpit) temperature is over 99.0ºF (37.2ºC)
4. Pacifier temperature is over 99.5ºF (37.5ºC). Using a digital pacifier thermometer for children over the age of 3 months is acceptable. It is note as accurate as a rectal temperature

Tactile (touch) fever is the impression that your child has a fever because he feels warm or hot to the touch. Checking a fever this way is more accurate than we used to think. It is most accurate when you touch your child and feel that his/her temperature is normal. It is not nearly as accurate when you feel that your child is warm. It is a good idea to measure you child’s temperature before you call our office with a question about fever management.

The body’s average temperature when it is measured orally is 98.6ºF (37.0ºC), but it normally varies during the day. Mild elevations in temperature (100.4º to 101.3ºF or 38º to 38.5ºC) can be caused by:

• Exercise
• Excessive clothing
• A hot bath
• Hot weather

If you suspect that your child has a fever based on one of these causes, repeat the temperature in 30 minutes.

What is the cause of fever?

Fever is a symptom, not a disease. It is the body’s normal response to infection. Fever is helpful in the sense that it amplifies the body’s immune response. The usual fevers (100ºF to 104ºF or 37.8ºto 40ºC) associated with common childhood illnesses are not harmful. Teething is not a cause of fever.

How long will it last?

Most fevers with viral illnesses range from 101ºF to 104ºF (38.3ºC to40ºC) and last for 2 to 3 days. In general, the height of the fever does not relate to the seriousness of the illness. Looking at the temperature and deciding on that basis alone how ill your child is invites disaster. How sick your child acts is what counts. Fevers cause no permanent damage. Brain damage occurs only if the body temperature exceeds 108ºF (42ºC). Fortunately, the brain’s thermostat keeps untreated fevers well below this level.
While all children get fevers, only 4% develop a brief convulsion as a result of the fever. Since this type of seizure is generally harmless, it is not worth excessive worry. If your child has had high fever without seizures, it is unlikely that future fevers will cause a convulsion. Seizures triggered by fevers are very uncommon in children older than six.

How should I care for my child with fever?

1. Extra fluids and less clothing
Fever increases the body’s demand for fluids. Encourage your child to drink extra fluids, but don’t force him to drink. Iced drinks and popsicles are helpful. Body fluid s are lost during fevers because of excess sweating. Bundling can be dangerous. Clothing should be kept to a minimum because most heat is lost thorough the skin. Bundling your child will cause his temperature to go up. During the time that your child feels cold or has the chills, give him a light blanket.
If the temperature is less than 102ºF (39ºC), this is the only treatment necessary. Fever medicines are not needed.

2. Acetaminophen or ibuprofen products
Remember that fever is helping your child fight the infection. Use medications for fever only if the fever is over 102ºF (39ºC) and preferably only if your child is uncomfortable.
Two hours after they are given, these drugs will reduce the fever 2ºF to 3ºF (1ºC to 2ºC). Medications do not return the temperature to normal unless the temperature was not very elevated before the medication was given. Repeated doses of medication will be necessary because the fever will go up and down until the illness runs its course. If your child is sleeping comfortably, don’t awaken him to give fever controlling medications.

Acetaminophen (Tylenol®, Tempra® etc): Children older than 2 months of age can be given any of the acetaminophen products. Give the correct dosage for your child’s weight every 4 to 6 hours. You may safely give 5 to 7.5 mg per pound of acetaminophen. Example: A 20 pound child should take between 100 and 150 mgs. every 4 to 6 hours.

Ibuprofen (Advil®, Motrin®): Ibuprofen is similar to acetaminophen in its ability to lower fever. Its safety record is also similar. An advantage ibuprofen has over acetaminophen is a longer lasting effect (6 to 8 hours instead of 4 to 6 hours). Children with special problems requiring a longer period of fever control may do better with ibuprofen. Ibuprofen is best given with food as it can cause irritation of the lining of the stomach. The correct dosage of ibuprofen is 5 to 7.5 mg per pound. Example: A 30 pound child should take between 150 and 225 mgs. every 6 to 8 hours.

CAUTION: The dropper that comes with one product should not be used with other brands.

3. Sponging
Sponging is usually not necessary to reduce fever. Never sponge your child without giving him acetaminophen first. Sponge immediately only in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106ºF (41.1ºC). In other cases, sponge your child only if the fever is over 104ºF (40ºC), the fever stays that high when you take the temperature again 30 minutes after your child has taken acetaminophen or ibuprofen, and your child is uncomfortable. Until acetaminophen or ibuprofen has taken effect (by resetting the body’s thermostat to a lower level), sponging will just cause shivering which is the body’s way of trying to raise the temperature.

If you do sponge your child, sponge him in lukewarm water (85ºF to 90ºF). Use slightly cooler water for emergencies. Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. Cooling is the result of the evaporation of water. If shivering occurs, raise the water temperature or stop sponging until the acetaminophen or ibuprofen takes effect. Don’t expect to get the temperature below 101ºF (38.3º). Don’t add rubbing alcohol to the water; it can be breathed in and cause a coma.

If my child develops a fever, when should I call Dr. Patterson, Dr. Tedford, or Ellen Castellanos, RN?

Call immediately if:

1. Your child is less than 3 months old.
2. The fever is over 105ºF (40.6°).
3. Your child looks or acts very sick.

Call within 24 hours if:

1. Your child is 3 to 6 months old (unless the fever is due to the DTaP shot).
2. The fever is between 104°F and 105°F (40°C and 40.6°).
3. Your child has had a fever more than 24 hours without an obvious cause or location of infection AND your child is less than 2 years old.
4. Your child has had a fever more than 3 days.
5. The fever went away for over 24 hours and then returned.
6. You have other questions or concerns.

This information has been adapted from Your Child’s Health by Dr. Barton D. Schmitt. It is intended to provide general care guidelines. It is not intended to provide definitive advice or care and does not take the place of contact with your child’s health care provider.

Q. What can I do to assist in my child's oral health?

Every day our staff fields hundreds of phone calls about all sorts of medical and dental problems. We asked North County pediatric dentist, David Cottrell, DDS to help answer some of the common questions concerning your child’s teeth.

Should my child use fluoride?
The answer is an overwhelming yes! Fluoride prevents tooth decay, heals tiny cavities, and protects your child’s smile. When we eat, bacteria in the mouth produce acid. This acid can cause minerals to dissolve out of the tooth enamel and weaken the tooth structure. When enough minerals are lost from an area in the enamel, a cavity begins to form. Dentists call this process demineralization.

Fluoride protects the teeth from decay by preventing demineralization. When there is ample fluoride in the mouth, it combines with calcium and forms crystals that stay on the teeth. During an “acid attack,” the crystals dissolve and release fluoride directly on to the enamel where it is needed for protection.

Even better, fluoride actually “heals” tiny breaks in tooth enamel and cures small cavities that dentists refer to as remineralization. The healed cavity is actually stronger than the original tooth surface.

When should fluoride be used?
When your child begins using fluoride depends upon the source. Scientists still are not sure which source of fluoride provides the greatest benefit. They are certain that all fluoride sources– whether systemic (through pills or water) or topical (through toothpaste, gels, or rinses)- work to prevent tooth decay and protect your child’s smile.

Fluoridation of community water is an easy and inexpensive way to get appropriate amounts of fluoride. At the present time, only the San Luis Obispo municipal water has fluoride adjusted to optimal levels. If you do not live in an area of the county with fluoridated water, fluoride supplements are an excellent choice. Supplements are most effective when taken on an empty stomach and Dr. Cottrell suggests starting fluoride supplementation at age three.

• Ages 3-6 0.25mg fluoride /day
• Ages 6-12 0.5mg fluoride/day

How should I care for my infant’s teeth?

1. Get in the habit of regularly wiping down or brushing your child’s teeth as soon as they cut their first teeth. This is usually around 6 months of age. You can use toothpaste that contains fluoride to “flavor” a wash cloth or brush. Be careful not to use much, as your infant or toddler may swallow more fluoride than is needed.
2. Don’t allow your child to fall asleep while sucking on a bottle or to sleep with a bottle of juice or milk.
3. Restrict or better yet, eliminate toddler night time breast feeding
4. Plan to get rid of the bottle between ages 12 and 15 months before your toddler considers it an entitlement.
5. Plan regular dental visits for preventive care. They should start between 6 months and 3 years or at any time you suspect a problem. If he/she is uncomfortable with children, consider calling a pediatric dentist for child’s dental health needs.
6. Prepare your child for the dental visit by discussing what the dentist will do and reading age appropriate books like Open Wide!: A Visit to the Dentist, by Cecile Schoberle and Just Going to the Dentist, by Mercer Mayer.

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When you child complains that his stomach (abdomen) hurts, there are many possible causes. Most stomach aches have simple non threatening explanations like:

• Overeating
• Gas pains (example: from drinking carbonated beverages)
• Constipation
• Other types of indigestion

A stomach ache may also be the first sign of food poisoning or viral gastroenteritis (stomach flu) with vomiting and/or diarrhea soon to follow.

Recurrent stomach aches can have many causes. Constipation, food intolerances, and stress are just a few. The most common cause of recurrent abdominal pain is anxiety. Over 10% of children have recurrent abdominal pain that is stress related. When the abdominal pain is recurrent, located near the belly button and mild, consider stress as the cause. If the stomach aches are interfering with school and or play, a visit to our office should be scheduled.

How long does abdominal pain usually last?

With most harmless causes of stomach ache, the pain is usually better or gone in 2 hours or less. With stomach flu, the pain generally intensifies before each bout of vomiting or diarrhea. The cramps are generally of moderate severity and last less than a minute or two. When the cause of the pain is more serious like appendicitis, the pain will likely worsen and/or become constant. Pain from an inflamed appendix usually is located in the lower right area of the abdomen. There may be associated symptoms and signs like nausea, loss of appetite and fever.

How can I take care of my child with abdominal pain?

With suspected illness or indigestion use the following guidelines:

• Rest: Have your child lie down and rest until he feels better. You may want to try a warm wash cloth or heating pad on the abdomen.
• Diet: Keep it simple. Allow sips of clear fluids. Avoid any solid foods. Keep a vomiting bucket handy. A preschooler or young school age child is especially likely to refer to nausea as “a stomach ache.”
• Sit your child on the toilet: If constipation or diarrhea is the cause, the solution may well be a bowel movement.
• Avoid medications: Do not give any medications for stomach cramps unless you have talked with a health professional. DO NOT give laxatives, enemas, or painkillers unless so instructed.

With stress or worry use the following guidelines:

• Caution: A complete medical evaluation is in order before you conclude that recurrent stomach aches are due to anxiety.
• Children with recurrent stress related abdominal pain tend to be sensitive, serious, and conscientious youngsters. This temperament can make them more vulnerable to the normal stresses of life like a friend moving away or the death of a pet. Encourage your child to talk about events that trigger his pains and how he is going to cope with them. Consider counseling if you feel like you are not connecting.
• Make sure your child doesn't’t miss any school because of stomach aches. Sensitive children have a tendency to avoid school and stay home when the going gets tough.
• Teach your child to use relaxation exercises for mild pains. Have him lie down in a quiet place, take deep, slow breaths; and think about something pleasant. Listening to audiotapes that teach relaxation may be helpful.
• If you share a faith with your child, pray together.

When should I contact Dr. Patterson, Dr. Tedford or Ellen Castellanos, our nurse practitioner about abdominal pain?

Call immediately if:

• The pain is severe and lasts more than 1 hour.
• The pain is constant and has lasted more than 2 hours.
• The pain comes and goes and lasts more than 24 hours.
• The pain is in the scrotum or testicle.
• Your child starts acting very sick.

Call during office hours if:

• This is a recurrent problem for your child.
• You have other questions or concerns.

This information has been modified from Your Child’s Health by Barton D. Schmidt. This is an excellent source of information for all sorts of child development and health information. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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