Survival

28 Comments / Patient Education / By

Sometimes all you want to do is to survive. This is especially true when it is 2 AM and your child has a temperature of 104 degrees and won\’t stop crying. Such experiences have made me much more compassionate in my approach to parents when they bring their sick children in to the office.
Still, I don\’t really want to spend my day taking care of the \”worried well,\” and so we have created a \”survival sheet\” for parents in our practice. The idea is for parents to first go to this sheet and see if it answers their questions. Hopefully this will cut down on unnecessary visits and phone calls.

Here are some of the sections:

10 Things to know about fever

\"clip_image002[4]\"1. If your child is under 3 months of age, bring them immediately to be seen.

2. Fever does not contribute to global warming.

3. The only good reason to treat a fever is for the child’s comfort. This is a good reason

4. Fever does not cause seizures or brain damage in normal children.

5. Fever goes away immediately upon entering your doctor’s office. This is caused by the fever gnomes who like to make parents feel silly.

6. If you do treat the fever, use the above doses of Tylenol and Motrin. Generally, Motrin works longer and is somewhat stronger, but Tylenol doesn’t upset the stomach. They can be given at the same time.

7. 90% of fevers happen at 2 AM.

8. The official definition of a fever is a temperature over 100.5 degrees.

9. Milk does not “curdle” in the stomach of a child because of a fever. It curdles because the stomach has acid in it. It always curdles in the stomach.

10. When you come in and your child’s fever has gone away, we believe you that they actually had one. Honest.

Vomiting

When your child vomits…

1. Clear liquids (Pedialyte, Gatorade, etc.), and bland food (see Diarrhea section for BRAT diet) are best.

2. Many small portions of water are better tolerated than a few large portions (even a sip every 5 minutes is better than no fluids).

3. Call for any sign of dehydration (greatly decreased urine output, very dry mouth, listlessness), or if lasts more than 3 days.

4. Stay out of the line of fire.

Diarrhea

\"clip_image002[6]\"There are 4 circumstances to be concerned about diarrhea:

· There are signs of dehydration (greatly decreased urine output, very dry mouth, listlessness).

· There is blood in the stool.

· It lasts more than 5 days.

· You are in a public place and can’t hold it in.

1 If these are not the case, these tips may help you survive this wonderful illness:

  1. Avoid milk products and strong juices (such as apple juice).
  2. Children under 12 months will do better on “Isomil DF” which contains fiber to add bulk to the stool
  3. For older children, the BRAT diet (nice name) can be used: Bananas, Rice, Applesauce, and Toast (some people add Yogurt, to make it the “BRATY”)
  4. Plenty of liquids. Dehydration is the enemy!
  5. Kayopectate or Imodium AD may be used as directed
  6. Don’t go on any long car trips unless your ventilation is good or your sense of smell is bad.

I like that last line. I couldn\’t help myself…

When antibiotics may be useful

Antibiotics are one of the great advances of medical science history. Yet, there are times when they are not helpful, and may in fact be harmful. Although there has been suggestion by some parents to put Amoxicillin in the water supply, we generally do not call in antibiotics without first seeing your child. This is because of the possibility of creating antibiotic resistance in the bacteria if we unnecessarily prescribe antibiotics.

The following is a list of circumstances when antibiotics may be useful:

1. Ear infections. Call the office if your child is not improving in 3-4 days.

2. Strep throat with positive strep test, or if family member has positive strep test.

3. Cough lasting over a week may require antibiotics.

4. Urinary infections.

If your child appears very ill, or if you are very concerned, call to have them seen.

Antibiotics will not make a cold (or virus) get better any faster.

Click on the image of the sheet below to see the whole sheet.

\"Survival

28 thoughts on “Survival”

  1. David W

    “Fever does not cause seizures … in normal children.” Does this mean children with febrile seizures are not normal??

  2. David W

    “Fever does not cause seizures … in normal children.” Does this mean children with febrile seizures are not normal??

  3. Rob

    Yes, it does mean that. A child needs to be predisposed to the seizure. A child without this predisposition won’t have seizures.

  4. Rob

    Yes, it does mean that. A child needs to be predisposed to the seizure. A child without this predisposition won’t have seizures.

  5. rlbates

    Dr Rob, can you get a laminated sheet or a large refrigerator magnet so you won’t lose this? Great tips. I e-mailed it to some family members with small children.

  6. rlbates

    Dr Rob, can you get a laminated sheet or a large refrigerator magnet so you won’t lose this? Great tips. I e-mailed it to some family members with small children.

  11. David W

    Rob said; “A child needs to be predisposed to the seizure.” Genetic studies have demonstrated some mutations in genes that control the excitability of neurons in some instances. However, I think that to say that children with simple febrile seizures are abnormal may be inaccurate. Do you have a citation that states this?

  12. David W

    Rob said; “A child needs to be predisposed to the seizure.” Genetic studies have demonstrated some mutations in genes that control the excitability of neurons in some instances. However, I think that to say that children with simple febrile seizures are abnormal may be inaccurate. Do you have a citation that states this?

  13. Rob

    David: Thanks for pushing me on this one. This is pretty much the party line from the pediatrics standpoint, but I could not find a definitive statement of the fact on the searches I did. There is a good review on the subject on eMedicine. There is also this statement on the Texas Children’s Website:Myth: All fevers are bad for children.
    Fact: Fevers turn on the body’s immune system. Fevers are one of the body’s protective mechanisms. Most fevers are good for children and help the body fight infection.

    Myth: Fevers cause brain damage or fevers above 104°F (40°C) are dangerous.
    Fact: Fevers with infections don’t cause brain damage. Only body temperatures above 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car).

    Myth: Anyone can have a febrile seizure.
    Fact: Only 4 percent of children can have a febrile seizure.

    Myth: Febrile seizures are harmful.
    Fact: Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm.

    Perhaps “abnormal” is a bad word, but “predisposed” still seems accurate to me.

  14. Rob

    David: Thanks for pushing me on this one. This is pretty much the party line from the pediatrics standpoint, but I could not find a definitive statement of the fact on the searches I did. There is a good review on the subject on eMedicine. There is also this statement on the Texas Children’s Website:Myth: All fevers are bad for children.
    Fact: Fevers turn on the body’s immune system. Fevers are one of the body’s protective mechanisms. Most fevers are good for children and help the body fight infection.

    Myth: Fevers cause brain damage or fevers above 104°F (40°C) are dangerous.
    Fact: Fevers with infections don’t cause brain damage. Only body temperatures above 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car).

    Myth: Anyone can have a febrile seizure.
    Fact: Only 4 percent of children can have a febrile seizure.

    Myth: Febrile seizures are harmful.
    Fact: Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm.

    Perhaps “abnormal” is a bad word, but “predisposed” still seems accurate to me.

  15. Amanda

    Thank you so much for this post. I knew I was reading too many med blogs when I was feeling guilty for using prescribed antibiotics (which I don’t ask for). We’ve had a few bouts with Strep this year, and flaming ear infections.
    My Mom always said: “Normal is a setting on a dryer not a child”.

  16. Amanda

    Thank you so much for this post. I knew I was reading too many med blogs when I was feeling guilty for using prescribed antibiotics (which I don’t ask for). We’ve had a few bouts with Strep this year, and flaming ear infections.
    My Mom always said: “Normal is a setting on a dryer not a child”.

  17. Liz D.

    Rob, this is so great.
    I’m hosting a baby shower for my son’s friends in a couple of weeks and copies of the survival sheet, laminated, will make great party favors.

    The “fever gnome” will be a big hit with this group.

  18. Liz D.

    Rob, this is so great.
    I’m hosting a baby shower for my son’s friends in a couple of weeks and copies of the survival sheet, laminated, will make great party favors.

    The “fever gnome” will be a big hit with this group.

  19. Clay

    I think it is important to point out that children with simple febrile seizures are not predisposed to epilepsy more than the population of children who do not have a febrile seizure. Complex febrile seizures are a different matter altogether.
    I was a little confused about a few items. The first, also under the category of fever, is that you appear to endorse giving a child motrin and tylenol at the same time. I suppose you mean that it is okay to alternate the medications, which is up for debate. It’s very likely safe but increases the risk of miscalculating dosages. My second and third questions regard the diarrhea section. It appears that you are recommending isomil DF to all children under a year with diarrhea. What about exclusively breast fed infatns? Also, and perhaps I am not up to date here, it was my understanding that products such as immodium are not recommended in children because they actually lead to prolonged illness.

    Just some thoughts. Have a great weekend Rob.

  20. Clay

    I think it is important to point out that children with simple febrile seizures are not predisposed to epilepsy more than the population of children who do not have a febrile seizure. Complex febrile seizures are a different matter altogether.
    I was a little confused about a few items. The first, also under the category of fever, is that you appear to endorse giving a child motrin and tylenol at the same time. I suppose you mean that it is okay to alternate the medications, which is up for debate. It’s very likely safe but increases the risk of miscalculating dosages. My second and third questions regard the diarrhea section. It appears that you are recommending isomil DF to all children under a year with diarrhea. What about exclusively breast fed infatns? Also, and perhaps I am not up to date here, it was my understanding that products such as immodium are not recommended in children because they actually lead to prolonged illness.

    Just some thoughts. Have a great weekend Rob.

  23. Rob

    Good point on the Isomil and and Imodium. I am actually OK with using the anti-diarrheals in older kids. As far as the Tylenol/Motrin, I recommend Ibuprofen for the fever and if there is breakthrough, I don’t know of any contraindication to using them both if needed. The mode of action is different. In general, Motrin will negate the need for Tylenol.

  24. Rob

    Good point on the Isomil and and Imodium. I am actually OK with using the anti-diarrheals in older kids. As far as the Tylenol/Motrin, I recommend Ibuprofen for the fever and if there is breakthrough, I don’t know of any contraindication to using them both if needed. The mode of action is different. In general, Motrin will negate the need for Tylenol.

  25. chris and vic

    Good educational tool for parents, especially first-time parents!
    I notice you do not warn about sunken fontanel in your fever advice . . .

    Chris and Vic

  26. chris and vic

    Good educational tool for parents, especially first-time parents!
    I notice you do not warn about sunken fontanel in your fever advice . . .

    Chris and Vic

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