Search for tag: "fever"

"Should I call the on-call pediatrician?" It's a question you've probably asked yourself when you have a question for your child's doctor and the clinic is closed. I'll help you figure out when it's appropriate to call and when a question can wait until the next office day.

As a pediatrician, we all take call, meaning that we rotate with our colleagues when we answer after-hours phone calls from concerned parents.

Usually, the questions parents have are very appropriate. Sometimes parents are just looking for reassurance that they're doing the right supportive care for their little one. Sometimes they're wanting reassurance that taking their child to urgent care or the emergency room is the right decision and that they're not overreacting. And sometimes they just want to know how much fever reducer to give.

One thing I don't think most parents realize is that the job of the on-call pediatrician is to help determine if their child needs to be seen urgently or not.

We cannot diagnose anything over the phone. Parents will often tell me that they know their child has an ear infection, or strep throat, or a urinary tract infection. I can't tell if your child has any of those over the phone, so they need to be seen.

We absolutely cannot call in medications like controlled substances. We cannot call in medications in general, because if your child needs an urgent medication, they should be seen.

If they need a refill of a long-time medication, that's better to be addressed by your child's pediatrician specifically during office hours. Questions that are not urgent should wait until the clinic is open.

I have one colleague who answers her calls, "Hello, this is the on-call doctor. What is your emergency?" One reason for this is we've gotten questions like, "I'm in the baby food aisle at the store. What food should I get my 6-month-old?" or, "My toddler won't take a nap. What can I do to force them to take one?" or, "How old does my daughter need to be to get her ears pierced?" These are all questions I've gotten.

One thing I've noticed in my years of taking call are that parents often think I'm sitting in the clinic just waiting for their calls. More than once, I've been asked if they can just come in and see me or if I can meet them at the emergency room.

When you call the on-call pediatrician, we are at home with our families. We are not in the office. I've answered phone calls from soccer games, while doing landscaping, when I'm doing hospital rounds in the newborn nursery, when out to eat, and of course, from my bed in the middle of the night.

As pediatricians, we want to be there for you when you have concerns. Kids don't come with instruction manuals, and often things happen when the office is closed. If you have an urgent concern, you are always welcome to call and we will give you the best advice we can. If your concern is not urgent, it will be better handled by your pediatrician during office hours.

Your pediatrician knows your child and your family. They can address non-urgent concerns better than one of us who has never met your child before.

Interviewer: You have a pretty bad sore throat. Dr. Tom Miller, is that worth a trip to the doctor?

Dr. Miller: It might be. Most sore throats are caused by viruses. But if you have tender, swollen lymph nodes in your neck, if you have a fever of greater than 100 or 100.5, and if you look in the back of your throat with a penlight and you see sort of plaques on your tonsils, there's a good chance that you have strep throat, especially if you live with young kids who also get strep throat more commonly than adults. It might be worth a trip to the doctor.

He'll evaluate those same things. If you have all three of them, he's likely to give you an antibiotic. If you have one or two of them, he'll do what's called a rapid strep test. That will tell him if you have strep throat, and if you do, you'll have an antibiotic. That will reduce the symptom duration by one or two days and you'll feel better and get back to work.

Interviewer: So strep throat pretty much the only sore throat that you're going to get an antibiotic for.

Dr. Miller: There are others but more rarely.

updated: November 11, 2021
originally published: July 13, 2017

Interviewer: You may have heard or seen the alarming headlines about dry drowning, but does it really happen? The short answer, not exactly the way the media has been portraying it. We'll talk about that next on The Scope.

Announcer: This is From the Frontlines with emergency room physician, Dr. Troy Madsen, on The Scope.

Interviewer: It's a scary scenario if you think about it. The fact that you could be or your child could be swimming, you inhale some water. Everything seems to be fine. But then, a few days later, you die as a result of swallowing that water. It's a term that the media has been using to describe this is dry drowning, and that's not exactly accurate. And also, I think, a little clarification needs to happen around the term and actually how this manifests itself in somebody, because otherwise it could be a very scary prospect.

Dr. Troy Madsen's an emergency room physician. And hopefully, we're going to shed a little light on these two terms and maybe bring a little calm to the conversation. So help me understand the difference between dry drowning and secondary drowning, and if I should be concerned.

Dr. Madsen: Well, it's probably important just to understand how this term has come up in the media. It sounds like there was a case of a preschooler who was playing in the water, knee-deep water, was hit by a wave, seemed like he was fine. A week later, stopped breathing, went to the ER, and died. So this term has come up where the parents reported that they were told the child had suffered from dry drowning. So I think there's been just a little bit of confusion here in terms of the terms.

From the ER, dry drowning is if someone actually drowned. They go in the water. They do not breathe. They're pulled out. They're not breathing. And then, when you examine their lungs, there is no water in the lungs. All that's happened is they've had laryngeal spasm, meaning their vocal cords have shut off. It's a natural response. None of the water got in their lungs, but they still drowned because they got no oxygen to their brain. That's what we call dry drowning.

What's happening here is more what is better termed secondary drowning. Another term for it would be aspiration. It's the same process that would happen if, you know, you or I, or just say passed out on the ground for some reason, and we vomited, and we breathed that in to our lungs, and we didn't cough it out. I would get all that stuff in my lungs.

Probably, I'd be breathing okay at first. But then, say 24 hours or several days later, all that stuff in my lungs is going to cause a whole lot of inflammation. The body is going to respond to that. It's going to try and attack all this foreign material. It's going to cause swelling in the lungs, cause this inflammation that's going to make it really hard for me to breathe. And I'm not going to feel that effects of that for several days.

That's what we're seeing here. This is a case where, I think, this child, probably when that big wave hit him, he breathed a lot of that water in his lungs and he coughed, then I feel fine. And then, over several days, the body had an inflammatory response where it's responding to this water that got in his lungs. He seems to be breathing okay.

My suspicion is that, you know, before he had this episode where he just stopped breathing, he was probably having some trouble breathing. By not knowing all the details of the story though, I would expect that would happen. Maybe fevers, maybe coughing, all these sorts of things that then progressed to where a person or a child really can't breathe.

So that's the difference, I think, between this term we're seeing a lot in the media called dry drowning and what's more of what we would call secondary drowning or aspiration, which is the same process that would happen to any of us if we breathe a whole lot of water in our lungs, or someone's passed out, they vomited, and it gets in their lungs, any time you get that stuff in there, it's going to cause this kind of response. It's going to get worse over time.

Interviewer: And it takes time. It's not like it's all of a sudden going to happen. So, if a parent has their child out of the pool and they do swallow some water, but otherwise seem okay, is that a reason at that point to maybe run off to your doctor or to the ER?

Dr. Madsen: It's not. Because if you came to the ER, they would look at you, they would take the child's vital signs. They'd say, "Hey, he's breathing fine. His vital signs look great. Keep an eye on him." It's the same thing you do in any situation. You'd watch him. If he started to be coughing more, he started having trouble breathing, then that would be a reason to go the ER.

Interviewer: Right. And probably, part of this is connecting the dots that this might not just be another sickness. If those additional symptoms come on, it could have been caused by the swallowing of the water.

Dr. Madsen: Exactly. And you just look back. If I saw a child in the ER then who was having trouble breathing, that has had an inflammation in their lungs, they've been swimming recently, breathed some water in, I'd say, "Hey, this maybe what we call secondary drowning or aspiration. They breathe a lot in their lungs. We're seeing inflammation as a result of that."

Interviewer: Got it. So there is time to react to it. It's not something that's going to strike out of the middle of nowhere. And just really, you just have to be patient and see if something comes of it. And it nothing does, great. No problem.

Dr. Madsen: That's exactly right. I can't imagine this sort of thing just coming completely out of the blue. And I think this whole dry drowning term has probably created a lot of fear where people imagine someone on dry land and suddenly being overwhelmed, essentially drowning, just as if you'd fallen in a lake or something. It's not going to happen like that.

I'd expect over some time a child's going to be coughing more. They may develop a fever. Things are going to progress to where they would eventually get to a point where someone just couldn't breathe.

Announcer: Want The Scope delivered to straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source straight from the doctor's mouth. Here's this week's Listener Question on The Scope.

Interviewer: Dr. Tom Miller, we have a question here from Lisa in Sandy, Utah. She apparently had a cold and feels like she's over her cold, but yet this cough kind of is persisting. Is that something to be worried about? What is that? What's going on?

Dr. Miller: Usually, not. There's two points. One, could it be serious? Is this something that you need to worry about? And again, you go back to worrisome signs and symptoms. So if you have fever, if you either have a measurable fever and you're continuing to cough or you feel like you have a fever or you have night sweats, then that's something you need to get checked out. If you're coughing up a lot of sputum, you know, thick, gunky, smelly sputum, that's something you need to get checked out. If you have rib pain, if you're short of breath, that's something you need to get checked out.

Most of the time with a viral infection, an upper respiratory tract infection, you're sick for anywhere from three to seven days, and you get over it. I mean, you cough a little bit and you're hoarse, and then it goes away.

Interviewer: Are we talking about a cold when you say . . .

Dr. Miller: We're talking about a cold, an upper respiratory viral infection. I mean, everybody gets those in the winter and sometimes in the summer and spring, but mostly in the winter.

So what do you do? You have this cough. It's called a post-viral cough. It's not productive. It's annoying. It's probably due to the fact that the virus, which is gone after seven days, has irritated the bronchial lining and the cough receptors in your airways, and they continue to produce this cough reflex and you continue to cough. And it can go on for eight weeks, sometimes ten weeks.

Interviewer: What?

Dr. Miller: A long time. I know patients who have had chronic cough that's not productive after a viral illness, after a cold that goes on a couple of three months, and there really is no good treatment for it. A lot of those antitussives, those cough medicines you can buy at the store, they really don't work. And so it's nagging.

And sometimes though, patients who do have chronic cough might have asthma or might have asthma triggered by the cough, and so it doesn't hurt if you're really struggling with that cough to go see a physician to see if there could be something else causing it. You know that you haven't had any worrisome signs, you're not worried that you've got pneumonia or some other bad thing going on, but the cough is just driving you nuts, go see a physician about it. You might have an asthma variant of the cough, which could respond to treatment, inhaler or something like that. But a lot of times, you're just kind of stuck with it until it goes away, which is really bothersome, but we don't have great treatment for that.

Interviewer: And most of the time, that's what the case is after a cold and I continue to have a cough for two or three weeks afterwards.

Dr. Miller: Correct. Now again, the vast majority of patients that get colds, they get better, and only it's a small percentage with this chronic cough.

Announcer: Have a question? Ask it. Send your Listener Question to hello@thescoperadio.com.

Dr. Gellner: Parents are often concerned by some scary symptoms their child has that aren't necessarily scary to your pediatrician. We'll discuss a few common scary concerns today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kid Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Kids can do some pretty scary-looking things. They get weird rashes, they stop breathing when they cry and they bang their head against the wall. Those are the top three concerns I hear that freak parents out. One scary rash we see a lot in toddlers and elementary school kids happens after another scary symptom: a high fever for several days. The fever goes away and this red rash appears on their back and chest. That's roseola and it's caused by a virus. It's pretty harmless but contagious until the rash goes away. Nothing you do will make it go away faster and most kids get it at some point.

Another rash that looks scary but isn't to most is caused by a virus called parvovirus. No, not the kind your dog gets vaccinated for, that's a different strain. This one causes their cheeks to turn bright red like someone slapped them. That is why it is also called slap cheek syndrome. They will also get a lacy appearing rash on their arms and legs. Once your child gets the rash, they're not contagious anymore. But this is a rash you need to let any pregnant woman around your child know about. It can hurt unborn babies so pregnant women need to let their OB know so they can get testing right away.

Next are breath-holding spells. I know how scary these can be because my boys had these too. My little guy would hold his breath until he had a seizure sometimes. Kids get so upset, either a big temper tantrum or they got hurt, and then they cry and then they hold their breath, and then their lips turn blue, and sometimes they pass out. Then they start breathing on their own again and wake up as if nothing happened. About 5% of kids under 8 have these. The good news is that, by age five, 80% of that 5% would have stopped this behavior.

Sometimes, if a child is anemic, taking iron supplements will help this. If your child is not anemic, do not just give them extra iron. Too much iron isn't a good thing. Now, if your child is not having a breath-holding spell and stops breathing or is having a seizure, that's time to call 911.

Last is head banging or hitting, in older infants and toddlers. I frequently get asked by parents if this will cause their child to have brain damage, if they need to wear a helmet, or if their child has some sort of mental illness. The good news is the answer to all of these is no. It may seem odd, but this is actually a self-calming behavior their child is doing. Kids usually stop doing this by age two but can continue until age four. Trying to figure out ways to get your toddler to calm down before they get to the head banging part helps.

Head banging is only worrisome, when a child has other concerning behaviors, such as not making eye contact, speech delay, or rocking themselves repeatedly when stressed. That could be autism and most of us pediatricians screen for that at 18 and 24 months as part of their well visits.

Pediatricians hear a lot of scary symptoms. It's good to ask if you have any questions about your child's symptoms to make sure it's not anything that needs further investigation.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: When is a fever bad enough that you should go to the ER? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician Dr. Troy Madsen, on The Scope. On The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. When is a fever bad enough to go to the ER? Dr. Madsen, shed some light on that for us.

Dr. Madsen: Yeah. You know, it's interesting you bring that question up because I've had people ask me even recently. They've said, "At what point is the fever just going to cook my brain and how high does it have to be to cook my brain"?

Interviewer: That can't happen. Right?

Dr. Madsen: I can't say I've ever seen it happen and I told them that.

Interviewer: Okay.

Dr. Madsen: And it's something that's out there. I remember hearing that too, like people saying, "Wow, you got to keep your fever down, or you're just going to fry your brain." I can't say I've seen that. So when I think of fever I don't think of the absolute number with the fever. We define a fever as being 100.5 degrees Fahrenheit or greater. So I think of fever more in terms of what are the symptoms that you're having or what kind of medical problems do you have.

This is a child, a young infant, less than, say, 12 weeks old, and they have a fever of 100.5 or greater, you got to go to the ER because there, we get concerned about a serious infection. If this is someone who has an immune system problem, who's on chemotherapy, or maybe has HIV, or something that's affecting their immune system, again, another reason to go to the ER. I'm not concerned about is it 105, is it 100.5, if they have a fever, they need to have testing done.

Interviewer: If they are in that particular group?

Dr. Madsen: Exactly.

Interviewer: Okay.

Dr. Madsen: If they have immune system problems, if they're very young, and then, of course, if they're very old, people who are very old also. It's interesting because very old people really don't get high fevers like someone in their 20s might. So in them, a fever or a temperature of 100.5, that's pretty significant. And again, potentially a sign of something going on that's very serious. Whereas the average person walking along, who's healthy, who has really no medical issues, maybe they have a cough, maybe they have a fever up to 102, even 103, in my mind, that's not so concerning.

So when I think of fever, I think of more the whole person, what kind of medical problems do they have. And then, beyond that, I think of "Okay, what else is going on?" If it's someone who has a fever, who says the light bothers my eyes, my neck is stiff, I'm confused, or someone is reporting to me that they're confused, then I think of meningitis. Fever with a really severe cough, or a cough that has been going on for a week, and won't go away, I think of pneumonia or a sinus infection. Certainly, fever is with your unary symptoms, back pain, we think about kidney infections and issues there.

So again, you're taking that whole picture. So I think the big take home point would be that I don't even own a thermometer at home. I don't check my own temperature. I know if I'm hot, or I'm cold, or family member is hot or cold. I've heard some pediatricians say, "Get rid of your thermometer. Just don't use it on your kids unless they're the very young kids less than 12 weeks old," Because there, you are again looking at the whole picture. It's not just the fever.

Is the child lethargic? Are they feeding well? Are they eating? Are they still urinating, meaning that they're still having adequate fluids in their body? You're looking at everything there in addition to the fever.

Interviewer: That's kind of a tough paradigm for me to wrap my head around because I think a lot of people are just driven by "Oh, 103 fever. That's burning up. That's a major problem." But it sounds like you're saying to take that as an indicator to maybe assess, are there some other issues going on and those other issues are actually the reasons why you'd probably go to the ER?

Dr. Madsen: That's exactly it. You could have 103 fever with kind of a run of the mill cold, and you could feel absolutely miserable, but it doesn't mean you have to rush to the ER.

Interviewer: Okay.

Dr. Madsen: And you can. If you're at all concerned, never hesitate to call your doctor. Never hesitate to go to an urgent care or an ER. But in your mind, I want to think of it as like, "Okay. This absolute temperature means you're sick or something less than temperature means you're not." Like I said, some people with 100.5-degree temperatures who have other problems, that's really serious. Whereas another person on 103-degree temperature, probably very well, just could be a viral infection, and it isn't that big a deal.

Interviewer: So this could be probably tough information for somebody to hear because I'm imagining if they're listening to this, they're concerned about somebody in their life with a fever. If they don't fall in one of those two groups, the very young, the very old, they're going to want to do something. But it sounds like what you're saying is a fever should only indicate that maybe you should look and see if there are other symptoms?

Dr. Madsen: That's exactly it.

Interviewer: Yeah.

Dr. Madsen: Yeah. I won't rush to get into the hospital based on a fever alone. Look at the whole picture. Look at all the symptoms. Look at how the person is acting. If they're acting fine, and they're eating well, and drinking well, and they're alert, and they're not confused, and they've got a temperature of 102, they're probably okay. You can give it some time. You can take some Tylenol, some ibuprofen, to bring the fever down and see how they're doing.

Announcer: We're your daily dose of health, sciences, conversation. This is The Scope, University of Utah Health Sciences Radio.