Tag Archives: ibuprofen

Fever- Friend or Foe? (Pedcast)

Good day and welcome to the DocSmo blog.  I am your host and the creator of this blog, dedicated to parents and children.  I am Dr. Paul Smolen, a board certified pediatrician with 32 years of experience in private practice and 36 years if you include residency and fellowship. All those years in practice has given me an interesting perspective on today’s children and families, and I hope to bring some of my insights to you today, in what I call a pedcast… that’s a podcast about pediatric subjects.  Today we are going to talk about bread and butter pediatrics, a subject that gives both pediatricians and parents many sleepless worried nights; FEVER.  A febrile child is what occupies more of a pediatrician’s life than anything else so  I am about to  share some of the things I have learned over the years about fever.  Here we go.

 

I have spent my adult life with children who have fevers.  Sweating through a high fever illness of a child with his or her parents is the essence of what pediatricians do.  As I like to tell my patients, I am a professional worrier… worry is in my DNA.  When a young child has a fever, it is my job to worry about everything.  Does that rash part of this illness?, is that lack of response to Tylenol a meaningful sign of something bad?, or does fever on day 5 of a sickness really spell trouble?  Fever is probably the number one symptom that brings parents to a pediatric visit.  Parents fear fever… we were taught to fear fever by our mothers and grandmothers because in the pre-vaccine era, fever often meant something terrible was about to happen; meningitis leading to seizure and death, pneumonia leading to a child not being able to breath and dying, or a urinary tract infection with sepsis, shock, and death.  Fortunately, in todays world where most children are immunized, these are much rarer events, but pediatricians and parents still fear fever!

 

It is important to highlight that a fever in and of itself is not usually a danger to an overall healthy child.  Most fevers only last a few days and help to protect your child.  Its your bodies way of making things happen faster, shortening an illness.  Here is a DocSmo pearl A fever is not an illness, usually just a shortcut to wellness.”  It is a physiologic mechanism that fights infection by speeding up a child’s own natural defenses to bacteria and viruses.  Therefore, the main objective of treating your fevered child is to improve his or her overall comfort, not to focus on normalizing his or her body temperature.

 

Many parents and doctors don’t like fever hence their obsession with lowering a febrile child’s temperature.  Fever phobia only makes sense since children who are well don’t have fever, therefore, artificially lowering the temperature of a child with fever must make them well, right?   NO, NO, NO.  In most cases, it simply makes them more comfortable but can actually slow down the sick child’s recovery by a few hours.  Yes, you heard me right…treating fever in most virally caused illnesses actually prolongs the illness.  According to many pediatricians including this one, fever reducers, such as acetaminophen (Tylenol) and ibuprofen (Advil), should only be used for temperatures high enough to make your child uncomfortable, probably the 102 or higher range, especially at night when they need to get comfortable to sleep.     Additionally, unless your child has some special health problem, you should not wake your sleeping ill child only to give him or her antipyretics.  And remember, be aware that cough-and-cold medications may also contain acetaminophen and ibuprofen so be careful not to give your child a double dose of fever reducing medicine… that can be dangerous, especially when they are sick and dehydrated.

 

 

 

The take home message here is that fever is not the primary illness, and doesn’t have to be treated.  A fever is a physiologic mechanism that helps your child’s body fight infection… it accelerates healing by enhancing their natural germ killing ability.  This is not to say, however, that all fevers are harmless.  Parents should be extra mindful of fever if:

  • The fever is in a very young infant, especially in children less than 3 months of age.
  • Or if the fever is 104°F or greater
  • Or if the fever is accompanied by a rash
  • Or if the child is acting particularly ill
  • Or if the fever is accompanied by any localized pain, such as neck pain

A fever certainly can be a sign of a serious infection, but… it is usually not, especially if they have had all their shots.   Your child’s fever may actually be of benefit to him or her, thus the goal of fever reducing medicine use is to improve your child’s comfort not to cure any disease.

 

I hope you found some practical advice in today’s pedcast.  I thank you for joining us.  If you think a friend or relative would benefit from this or any of my podcasts, just hit the send button at my website. Its easy. And, I would love to hear your comments and stories on iTunes, Facebook, or my blog docsmo.com.  Go ahead, express yourself. Connect with the blogging community or simply ask a question. This is Doc Smo, broadcasting from my cutting edge studio 1E, hoping that the next time your little tot is hot, you hit the treatment, right on the dot.  Until next time.

 

 

 

Sources:

 

 

Does a Failure to Respond to Antipyretics Predict Serious Illness in Children With a Fever?
Arch Dis Child. 2013;98(8):644-646. © 2013 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health

://pediatrics.aappublications.org/content/127/3/580.full

 

http://emedicine.medscape.com/article/801598-overview#aw2aab6b5

 

http://www.aafp.org/afp/2001/1001/p1219.html

 

Migraine, what a pain! (Pedcast)

Welcome to the pediatric blog I call DocSmo.com.  I am Dr. Paul Smolen, founder and curator of this blog dedicated to parents and children.  We go beyond the office and give parents a little more depth in their understanding of pediatric health topics.  From diapers to the degree, we talk about it here.  Thank you for joining me today. The only thing better than the kids in pediatrics, are their parents.  I love bringing information to help parents. Today we are going to talk about a topic that is very close to my life experience, since I am a sufferer, of migraines… an incredibly common pediatric disorder. Believe it or not, most parents don’t recognize this headache in their children when they first begin. Well, we don’t want that to happen to informed, sophisticated DocSmo listeners so here we go.   Lets start with what is migraine?  It is a syndrome meaning a constellation of symptoms that follow a typical pattern.  Usually, a migrainer as they are called will first start feeling weak and very tired, possibly preceded by vision changes called a “visual aura”.  If you have never had one of these think of this as what the world looks like if you were looking through the air coming off a very hot road in the summer… it scintillates, it dances and distorts everything. That’s what an aura typically looks like but they can vary from person to person.  Next usually comes a throbbing headache, often focused around the eye or neck which steadily increases in intensity, a crescendo so to speak for you music lovers.  Often this head pain is more intense on one side of the head. Many migrainers get associated symptoms such as sweating, nausea, light and noise sensitivity, and vomiting as part of the mix. These headaches can be brief or last for days.  In between these “spells”, the child is completely normal.  So remember, fatigue with or without an aura followed by a crescendo type headache, often more intense on one side of the head and not responsive to rest or common pain meds is probably a migraine if the child is perfectly normal in between these spells.  If rest and mild analgesics help, this was probably just “I’m tired” headache.   So what causes migraine?  No one really knows but usually close relatives will have similar headaches so there is certainly genetics to this.  They might not call it migraine but maybe “sick headaches”, “menstrual headaches” or “sinus attacks”, but if they follow this pattern, they are likely migraine.  Estrogen and testosterone have a lot to do with these headaches so for children who have this tendency, that means onset most often in middle school.  Migrainers usually have triggers, whether that be stress, noise, bad smells, dehydration, missing a meal, certain foods, or in my case, calculus class in college.  If you are a sufferer, you often think you have a brain tumor.  I did.  What actually happens in the brain is not definitely known but the large nerve in a child’s face called the trigeminal nerve seems to be involved and cause real physical swelling and inflammation around the brain. That’s why the earlier the treatment is started, the better it works.  Stop the swelling and inflammation and the headache subsides. That also explains why acetaminophen usually doesn’t work… it doesn’t reduce inflammation like aspirins.   If your child has been examined and diagnosed with migraine, here is a useful approach I have learned and used over the years. I think it is vital to HAVE A PLAN LAID OUT BEFOREHAND, before the headache comes.  Here is what I recommend if your child starts to get sick at school with a headache you think is migraine:   -Should a headache start at school, have your child go to the school office and ask to take a usual headache reliever that reduces inflammation like Ibuprofen or Naproxen.  Make sure you supply the school with whichever you want. -Have your child be allowed to be in a quite place for 30 minutes after taking their medicine.  Make sure your they rate their pain on a 1-10 scale before they lay down.… if the headache starts getting better…muscle tension and fatigue was likely the culprit.  Time to go back to class.   -If things don’t get better and they are rating their headache as the same or worse, time for stronger medicine.  I go right to what is called the triptans… these are specifically designed meds for migraine. You can also leave a few of these in the nurses station for use because time is of the essence… the sooner the better. Two that are approved by the FDA for children, Axert or almotriptan and Maxalt or rizatriptan.  Maxalt tablets are available in a generic tablet and are very cheap… this is what I start Maxalt.  If a child cannot swallow a tablet or has a lot of nausea with their headaches, I go for the Maxalt melting tabs  (ODT’s)( currently much more expensive).  If a child gets to this stage, time to call Mom or Dad and go home.   -Pay attention to what triggered the migraine and file that information away for future use.  I have found personally, that ibuprofen, naproxen, or Motrin migraine, taken at times when I think I might be migraine prone, can prevent migrainous headaches.  I think this is only for frequent migraine suffers which hopefully no one in your family will ever be.   So remember, that migraine is episodic, escalating, severe, often localized pain in the head and associated with other symptoms like nausea, vomiting, noise and light sensitivity.  Most often they are incapacitating. If you think your child suffers from these, provide your child’s school with a written plan, some ibuprofen or naproxen, and a few triptan tabs.  See if that strategy doesn’t can’t work for you.  I hope it does.   As always, thanks for making me one of your trusted healthcare sources of information.  I will always try and bring you relevant, practical information that you can use with your children.  Your comments are welcome at my blog, or on facebook or itunes.   www.docsmo.com https://www.docsmo.com/docsmo-videos/     This is Doc Smo, hoping every parent has an advanced degree, in how to keep their children pain free.  Until next time.

Fever Facts (Pedcast)

Fever is a problem that every parent is likely to encounter.  Understanding why children get fevers, what they mean, how to accurately measure them, and whether treatment is necessary are the subjects of this podcast.  Listen to Dr Smolen give practical advice to parents about fever in children of all ages.

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