When Little Miss was about two or three months old, I noticed a weird (i.e. reddish and rough) patch of skin on the back of her arm and that weird patch got progressively worse over the next few weeks. I suspected (and her pediatrician confirmed) it was a mild case of eczema. It is common for babies to develop eczema and, luckily, it often fades by their second birthday. But, in the meantime, it is a bit of a battle to keep it under control. (Why battle you ask? Eczema = itchy spots = baby scratching = open sores = possible infections. You can see the problem. In fact, look there it is.)
When I was thinking about starting this blog one of my biggest hesitations was the “immunization issue.” So in classic awkward Emily style I will bring it up as soon as possible. As a working member of “the establishment” you can probably guess that I believe in immunizations. In fact, I feel they are one of the true gifts of modern medicine and my daughter has received all of her immunizations. (Proud mother moment—she’s getting ready for her 4 month shots here and totally being a champ about it.) However, I know many people have strong concerns about immunizations. I have nothing but respect for parents who are honestly trying to do the best thing for their children. I have read up on the topic from sources I trust to use uncompromising investigatory skills and put the health of my child first. I have made a decision that has a risk/benefit balance I am comfortable with. I would encourage every other parent to do the same. I recommend the American Academy of Pediatrics’ review of the issue as a great place to start. The Institute of Medicine also has a thorough review but it is a much harder read. (Hardly any pictures.)
Enough seriousness. I decided to bring this up today because Mr. Goldman and I got our flu shots! Of course we got them at our neighborhood pharmacy because pharmacists are awesome. I had a major attack of nostalgia. Weirdly enough, giving flu shots is one of the parts of working that I really miss and not because I love to stab people. At least I don’t think that is why. I imagine it was because it was one of the few chances I got to pop out from behind the counter and talk to people. I got so nostalgic I seriously considered asking if I could give Mr. Goldman his shot but I held myself back. I am regretting that. How often do you get to legally stab your husband? Not only that, but men in his particular age range are, by far, the most fun to give shots to. Skinny arms are for chumps. Look at this beautiful bicep—it has “poke me” written all over it. By all over it I mean under that Band-Aid®.
**I found an amazingly detailed and informative blog post on this topic at Married to Medicine. Written by a lawyer married to a doctor, it is the ultimate in vaccination information. I am in awe of its awesomeness.
I will be the first to admit I have developed an excessive and somewhat irrational concern for my daughter’s brain cells. I waste loads of time imagining how the most recent coffee-table-meets-head incident will affect her college placement scores. When she had her first real fever (which, of course, meant she needed to be held all night in order to sleep) I spent the extra waking hours picturing all those precious brain cells being cooked from the inside out. Time for some deep breathing and a little fever reliever. I love a good rhyme.
As a rule of thumb, a child has a fever if their temperature is over 100°F. I highly recommend using digital thermometers as they are much faster and easier to read. In fact, I would be surprised if anywhere even sells the old mercury thermometers anymore. Something about heavy metal poisoning, go figure. I love our ear thermometer—we can always get Little Miss to tolerate it and I feel like the results are more reliable than either an oral or underarm measurement. Technically a rectal temperature is the “gold standard” but…good luck with that.
Fever is not dangerous. It is a natural body process and the body will keep the fever under control. No treatment is necessary unless the child is uncomfortable (i.e. unable to sleep, eat, drink or play normally).
One of the biggest fears I have seen with fevers is febrile seizures. Febrile seizures are rare and do not cause any long-term harm. Giving anti-pyretics (the fancy word for medications that bring down fevers) does not prevent febrile seizures. If your child experiences a febrile seizure you will want to have their pediatrician check it out but you shouldn’t be too concerned. Febrile seizures do tend to run in families.
Who should see a doctor?
-Any child less than 3 months old with a fever
-Any child less than 2 years of age with a fever for 24 hours
-Any child older than 2 years with a fever for 3 days
-Children showing signs of dehydration or any other signs of serious illness (trust your gut!)
-Anyone with a temperature above 105°F
What are the treatment options? (**As always this is general information and is no substitute for the opinion of your primary care physician.)
The non-medication options are the oldies but goodies. Dress the child in light layers if they are hot but grab a blanket if they are getting the chills. Keep them hydrated as much as possible and, if they are really uncomfortable, you can use a damp washcloth or sponge to help cool them off.
The medication options are either acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). Ibuprofen should not be used in infants under 6 months old but, other than that, which one you use is personal preference. I prefer to use acetaminophen at our house because it is easier to find a dye-free version (Little Miss tends to projectile vomit her medicine) in a flavor she liked. These medicines should always be dosed based on the child’s weight and using the measuring tool provided by the manufacturer. If the package doesn’t give a dose for your child’s weight call your pharmacist or pediatrician’s office and they will be glad to help you figure it out. Sidenote: this is a good reason to know the number of a local 24-hour pharmacy. Unless, of course, your baby is perfect and only gets sick during normal business hours.
Speaking of perfect children—I have never been able to get our sweet Little Miss to swallow plain acetaminophen. I have tried lots of tricks and had lots of fun cleaning up gag-reflex vomit. I have resorted to “magic applesauce.” We mix her dose of medicine with a small amount of applesauce and she slurps it right up. A couple of precautions here: only use a small amount of applesauce so you know the whole dose got in there and don’t save any “magic applesauce” for later.
I have heard lots of people recommend alternating acetaminophen and ibuprofen but there is NO benefit to this treatment and it increases the risk of medication error. Your best bet is to pick one and stick with it.
If you have a child who is vomiting (lucky you!) and can’t keep any medicine in their stomach, acetaminophen is available in a suppository (lucky you again!). These have been located behind the pharmacy counter in all the pharmacies I have been in so if you can’t find them in the aisles just ask someone behind the counter.
NEVER give a child aspirin. I know they call it baby aspirin and that is super misleading but aspirin is not for babies.
If you want more information on fevers, and especially for some good basic information on febrile seizure, look no further than healthychildren.org (run by the American Academy of Pediatrics).