Medication

“Accidental” Psychotherapy (Pedcast)

Today, I am going to tell you about an amazing experience I had last week. A longtime patient of mine, a 12 year old boy who I have known for a decade, came in for his checkup. I had reviewed his chart before walking in the room, an noticed that the last time I had seen him, he came in with classic anxiety symptoms of difficulty sleeping and concentrating, feeling anxious, and having headaches, and stomachaches. When I asked him why he felt so anxious, he said that the social aspects of middle school were overwhelming for him. The academics were easy but the fitting in with his peers…that was a whole nother matter as they say down in the South. After we talked all this over,  it was so clear to me and his Mom that he was exhibiting the somatic symptoms of anxiety. I suggested that they go and try a therapy called “Cognitive Behavioral Therapy” or CBT as it is known in the business. Yes there are medicines for this but CBT is at least as effective. Continue reading

Rethinking Antibiotics (Pedcast)

 

Fascinating new study in Pediatrics April 2015 that raises new questions about a medical tool that has been around for almost 100 year, antibiotics. First discovered in the 1930s, antibiotics have undoubtedly saved millions of lives and have been a great tool for medical science. Until recently, doctors and scientists thought of antibiotics as targeted weapons that are able to selectively destroy germs that our bodies were fighting, invasive germs, and leave the host, your child, with a balance of  healthy bacteria, so called normal flora. Continue reading

How Long is Too Long for a Cold? (Pedcast)

 

I was browsing some articles the other day and came across a gem that I thought changed my understanding of disease and one that you might be interested in. The topic was a scientific estimates of the length, in time, of respiratory symptoms in children.

Why is this important you ask?  Well, doctors use these estimates to guide treatment… we are taught that if a cold last more than 10 days that means the child likely has a bacterial Continue reading

Grandma’s Fever Control (Pedcast)

Welcome to another edition of DocSmo.com, the pediatric blog dedicated to the well being of children and families. I’m your host, Dr. Paul Smolen, a board certified pediatrician with 32 years of practice… and counting. Today we are going to take on a topic that every parent unfortunately encounters needs to master, that of understanding and managing fever.

First, let me remind my new listeners about something we have talked a lot about on this blog, the fact that fever is not a disease, but rather a symptom, a sign that your child’s bodily defense has been turned on, most often because of a new infection.  Fever certainly is an important thing for parents to recognize and pay attention to but it, in itself, is not a disease…just a sign of a problem, a symptom that usually signals the onset of an infectious disease.  If you need to learn how to take a rectal temperature, check out my video on the subject, currently #1 on You tube for this subject.  My mother is so proud.  Anyway, back to fever. In the era of immunized children, a fever in your child is most likely being caused by a virally caused infectious disease, a disease that usually needs no treatment other than time and loving symptomatic care.   Starting to relax a little about fever… I hope so.

I think it will be useful for you to learn some of the science behind temperature control? Just how does your child’s body control his or her temperature? For the answer to that we need to take a little detour down what I call, Science Lane.  It goes without saying that having a normal body temperature is extremely important to the good health of your child.  There is a very narrow range of temperature that your child’s body will function properly at…too cold, and the child’s metabolism slows down with terrible consequences.  Too hot, and their brain malfunctions, again sometimes causing terrible problems.   Your child’s body temperature is controlled by a part of the brain called the hypothalamus; the thermostat of your child’s body so to speak. For various reasons, this thermostat works on a day/night rhythm called a circadian rhythm, body temperature being slightly higher at night than during the day.  Sickness alters this set point and exaggerates this day/night rhythm.  A group of substances called pyrogens, released from white blood cells when a child is sick, can turn up a child’s body temperature in an instant, just like adrenaline that can raise their heart rate or insulin that can lower their blood sugar, almost instantly.  Raising your child’s body temperature a little is useful when they are sick, speeding up their immune response.  Raising their body temperature VERY quickly is a big stress on a child’s body as any parent with a child with febrile convulsions can attest.

How and when do you as a parent need to get your child’s temperature down?  Well, actually the same ways you cool your house down…  by either turning down the thermostat or by opening the windows and letting the heat out.   Let me explain. When confronted with your feverish child, you can do the same things.  Acetaminophen, ibuprofen, and similar medicines literally turn down the thermostat in your child’s brain.   Their bodies temperature “set point” is lowered by these medicines just as you would do by lowering the thermostat program.  Similarly, a tepid bath, cool drinks, and wet clothes transfers heat transfer from your feverish, hot child and thereby lowers you’re their body temp, just like opening the windows of your hot stuffy house.  Grandma’s have known forever, that putting a feverish child in a bathtub of lukewarm water gets their temp down quickly. Think about it, when your child’s temp is 102 F and you put them in a bathtub of 75F water, heat is literally sucked out of them by the cooler bath water.  The water will continue to cool the child until the bath water reaches their body temperature, 102F.  You don’t have to use cold water simply any water temperature that is lower than your child’s high body temperature. This is a very quick and very effective way of lowering a child’s body temperature, just like Grandma told you.   The only negative side effect of the bathtub method is you might need to get into the tub with them… that’s not so bad, is it.

-So, let’s summarize today’s pedcast and review the wisdom that Grandma has given us.   Fever is not a disease, just a defense mechanism your child’s body uses to speed up recovery from an infection.

-Most childhood illness today, in immunized children, are viral illness and self -limiting thank goodness. This is why you put your children through the pain of getting shots. The serious, life threatening bacterial infections of the past have been mostly eliminated by routine childhood vaccines. What a blessing.

-There are two main reasons to lower a child’s temperature, to make them more comfortable and to try and distinguish serious from non-serious illness. If your child is hot but not uncomfortable, I prefer not to lower their bodies temperature because this may slow their recovery from the infection.

-Parents have two choices when they have decided to lower a child’s body temperature, pharmacologically turning down the thermostat with ibuprofen or acetaminophen or physically removing heat, usually with water baths.

You need to remember that fever can signal serious trouble such as when your child has the combination of fever and rash, or an extremely high fever (105 or greater), or when your very young infant has fever, especially those under 3 months of age, or when a child has fever for more than 3 days, or when fever occurs in combination with any localized symptoms such as chest pain, a swollen joint, a stiff neck etc. etc..  These are a few situations where fever can mean serious trouble and should not be ignored. for more advice about your child’s fever, call or visit that wonderful person you call your child’s pediatrician.

I hope this pedcast continues your pediatric education and makes you a little more confident the next time your little ones have an elevated body temperature. If you want to learn more on the topic of fever and children, take a few moments to read or listen to other pedcasts on the subject.:

1.https://www.docsmo.com/fever-friend-or-foe-pedcast/,

2. https://www.docsmo.com/fever-facts-pedcast/,

3.https://www.docsmo.com/medicines-help-or-harm-pedcast/.

As always, your comments are welcome at my blog, www.docsmo.com and on iTunes. This is Dr. Paul Smolen, recording in studio 1E, hoping you don’t go wild, the next time you have a sick child.