Tag Archives: fever

Fever: Myths vs Facts

Misconceptions about fever are commonplace. Many parents needlessly worry and lose sleep when their child has a fever. This is called fever phobia. Overall, fevers are harmless. Let the following facts help you put fever into perspective:

Myth: My child feels warm, so she has a fever.

Fact: Children can feel warm for many reasons such as playing hard, crying, getting out of a warm bed, or being outside on a hot day. They are “giving off heat.” Their skin temperature should return to normal in 10 to 20 minutes. Once these causes are excluded, about 80% of children who feel warm and act sick actually have a fever. If you want to be sure, take your child’s temperature. The following are the cutoffs for fever using different types of thermometers:

• Rectal, Ear, or Temporal Artery Thermometers: 100.4°F (38.0°C) or higher

• Oral or Pacifier Thermometers: 100°F (37.8°C) or higher

• Under the Arm (Axillary or Armpit) Thermometers: 99°F (37.2°C) or higher

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Myth: All fevers are bad for children.

Fact: Fevers turn on the body’s immune system and help the body fight infection. Fevers are one of the body’s protective mechanisms. Normal fevers between 100°F and 104°F (37.8°C and 40°C) are actually good for sick children.

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Myth: Fevers above 104°F (40°C) are dangerous and can cause brain damage

Fact: Fevers with infections don’t cause brain damage. Only body temperatures above 108°F (42.3°C) can cause brain damage. The body temperature climbs this high only with extreme environmental temperatures (eg, if a child is confined to a closed car in hot weather).

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Myth: Anyone can have a febrile seizure (seizure triggered by fever).

Fact: Only 4% of children can have a febrile seizure

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Myth: Febrile seizures are harmful

Fact: Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm. Children who have had febrile seizures do not have a greater risk for developmental delays, learning disabilities, or seizures without fever.

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Myth: All fevers need to be treated with fever medicine

Fact: Fevers only need to be treated if they cause discomfort. Usually fevers don’t cause any discomfort until they go above 102°F or 103°F (39°C or 39.5°C).

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Myth: Without treatment, fevers will keep going higher.

Fact: Wrong. Because the brain has a thermostat, fevers from infection usually don’t go above 103°F or 104°F (39.5°C or 40°C). They rarely go to 105°F or 106°F (40.6°C or 41.1°C). While the latter are “high” fevers, they are harmless ones.

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Myth: With treatment, fevers should come down to normal.

Fact: With treatment, fevers usually come down 2°F or 3°F (1°C or 1.5°C)

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Myth: If the fever doesn’t come down (ie, if you can’t “break the fever”), the cause is serious.

Fact: Fevers that don’t respond to fever medicine can be caused by viruses or bacteria. It doesn’t relate to the seriousness of the infection.

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Myth: Once the fever comes down with medicines, it should stay down.

Fact: The fever will normally last for 2 or 3 days with most viral infections. Therefore, when fever medicine wears off, the fever will return and need to be treated again. Fever will go away and not return once your child’s body overpowers the virus (usually by the fourth day).

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Myth: If the fever is high, the cause is serious.

Fact: If the fever is high, the cause may or may not be serious. If your child looks very sick, the cause is more likely to be serious.

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Myth: The exact number of the temperature is very important

Fact: How your child looks is what’s important, not the exact temperature.

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Myth: Oral temperatures between 98.7°F and 100°F (37.1°C and 37.8°C) are low-grade fevers.

Fact: These temperatures are normal variations. The body’s temperature normally changes throughout the day. It peaks in the late afternoon and evening. An actual low-grade fever is 100°F to 102°F (37.8°C to 39°C).

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Summary: Remember that fever is fighting off your child’s infection. Fever is one of the good guys.

Fever

Definition:

Your child has a fever if:

– Rectal, Ear, or Temporal Artery (TA) Temperature: 100.4°F (38.0°C) or higher

– Oral or Pacifier Temperature: 100°F (37.8°C) or higher

– Under the Arm (Axillary or Armpit) Temperature: 99°F (37.2°C) or higher

– Limitation: Ear (tympanic membrane) temperatures are not reliable before 6 months of age

– Temporal artery and skin infrared temperatures may be reliable in young infants

Use this guideline if fever is your child’s only symptom

Causes:

* Main Cause: Colds and other viral infections

* Fever may be the only symptom for the first 24 hours (ie, viral fevers). The onset of symptoms (eg, runny nose, cough, diarrhea) are often delayed. In the case of roseola, fever may be the only symptom for 2 or 3 days.

* The cause of fever usually can’t be determined until other symptoms develop. That may take 24 hours.

* Bacterial infections (eg, strep throat, urinary tract infections) also cause fever

* Teething does not cause fever

Fever and Crying:

* Fever on its own shouldn’t cause much crying

* Frequent crying in a child with fever is caused by pain until proven otherwise

* Possible causes are ear infections, urinary tract infections, and sore throats

Normal Variation of Temperature:

* Rectal: A reading of 98.6°F (37°C) is just the average rectal temperature. It normally can change from 96.8°F (36°C) in the morning to a high of 100.3°F (37.9°C) in the late afternoon

* Oral: A reading of 97.6°F (36.5°C) is just the average oral temperature. It normally can change from a low of 95.8°F (35.5°C) in the morning to a high of 99.9°F (37.7°C) in the late afternoon.

Return to School: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities.

Call 911 Now (Your Child May Need an Ambulance) If:

* Not moving or very weak

* Unresponsive or difficult to awaken

* Difficulty breathing with bluish lips

* Purple or blood-colored spots or dots on skin

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Not alert when awake

* Any difficulty breathing

* Great difficulty swallowing fluids or saliva

* Child is confused (delirious) or has stiff neck or bulging soft spot

* Had a seizure with the fever

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do not give your baby any fever medicine before being seen)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Very irritable (eg, inconsolable crying, cries when touched or moved)

* Won’t move an arm or leg normally

* Signs of dehydration (eg, very dry mouth, no urine in more than 8 hours)

* Burning or pain with urination

* Pain suspected

* Chronic disease (eg, sickle cell disease) or medication (eg, chemotherapy) that causes decreased immunity

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Child 3 to 6 months of age with fever

* Child 6 to 24 months of age with fever present longer than 24 hours but no other symptoms (ie, no cold, cough, diarrhea, etc)

* Fever repeatedly above 104°F (40°C) despite fever medicine

* Fever returns after gone for longer than 24 hours

* Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

Parent Care at Home If:

* Fever with no other symptoms and you don’t think your child needs to be seen

Home Care Advice for Fever:

1. Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for sick children and help the body fight infection. Use the following definitions to help put your child’s level of fever into perspective:

* 100°F to 102°F (37.8°C to 39°C): Low-Grade Fevers: Beneficial, desirable range

* 102°F to 104°F (39°C to 40°C): Average Fever: Beneficial

* Above 104°F (40°C): High Fever: Causes discomfort but harmless

* Above 106°F (41.1°C): Very High Fever: Important to bring it down

* Above 108°F (42.3°C): Dangerous Fever: Fever itself can cause brain damage

2. Treatment for All Fevers: Extra Fluids and Less Clothing:

* Give cold fluids orally in unlimited amounts (Reason: good hydration replaces sweat and improves heat loss from the skin)

* Dress in 1 layer of lightweight clothing and sleep with 1 light blanket (avoid bundling) (CAUTION: Overheated infants can’t undress themselves)

* For fevers 100°F to 102°F (37.8°C to 39°C), this is the only treatment needed (fever medicines are unnecessary)

3. Fever Medicine:

* Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).

* Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

* The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, fever medicine usually lowers the fever by 2°F to 3°F (1°C to 1.5°C)

* Avoid aspirin (Reason: risk of Reye syndrome, a rare but serious brain disease)

4. Sponging:

* Note: sponging is optional for high fevers, not required

* Indication: May sponge if fever above 104°F (40°C) doesn’t come down with acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) (always give fever medicine first)

* How to Sponge: Use lukewarm water (85°F to 90°F) (29.4°C to 32.2°C). Do not use rubbing alcohol. Sponge for 20 to 30 minutes.

* If your child shivers or becomes cold, stop sponging or increase the water temperature.

5. Contagiousness: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities.

6. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101°F and 104°F (38.4°C and 40°C) and last for 2 or 3 days.

7. Call Your Doctor If:

* Fever rises above 104°F (40°C) repeatedly

* Any fever occurs if your child is younger than 12 weeks

* Fever without a cause persists longer than 24 hours (if your child is younger than 2 years)

* Fever persists more than 3 days (72 hours)

*Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Fever: How to take a temperature

Definition:

* Rectal, Ear, or Temporal Artery (TA) Temperature: 100.4°F (38.0°C) or higher

* Oral or Pacifier Temperature: 100°F (37.8°C) or higher

* Under the Arm (Axillary or Armpit) Temperature: 99°F (37.2°C) or higher

* Limitation: Ear (tympanic membrane) temperatures are not reliable before 6 months of age

Where to Take a Temperature:

* Temperatures measured rectally are the most accurate. Temperatures measured orally, by electronic pacifier, or by ear canal or TA are also accurate if done properly. Temperatures measured in the armpit are the least accurate, but they are better than no measurement.

* Child Younger Than 3 Months (90 Days): An armpit temperature is the safest and may be preferred for screening. If the armpit  temperature is above 99°F (37.2°C), check the rectal temperature. The reason you need to take a rectal temperature for young infants  is that if they have a true fever, they need to be evaluated immediately by a doctor.

* Child Younger Than 4 or 5 Years: A rectal or electronic pacifier temperature is reliable. An ear or TA thermometer can be used after 6 months of age. An axillary (armpit) temperature is adequate for screening if it is taken correctly.

* Child Older Than 4 or 5 Years: take the temperature orally  (by mouth), by ear thermometer, or by TA thermometer

How to Take a Rectal Temperature:

* Have your child lie stomach down on your lap

* Put some petroleum jelly on the end of the thermometer and on the opening of the anus

* Slide the thermometer gently into the opening of the anus for about 1 inch. If your child is younger than 6 months, put it in only about ½ inch (inserting until the silver tip disappears is about ½ inch)

* Hold your child still and leave the thermometer in for about 20 seconds with a digital electronic thermometer. (Note: the AAP recommends that older glass thermometers be discarded because they contain mercury. If that’s all you have, however, leave it in for about 2 minutes to get an accurate reading.)

* Your child has a fever if the rectal temperature is above 100.4°F (38°C).

How to Take an Armpit Temperature:

* Put the tip of the thermometer in an armpit. Make sure the armpit is dry.

* Close the armpit by holding the elbow against the chest for 4 or 5 minutes. The tip of the thermometer must be covered by skin.

* Your child has a fever if the armpit temperature is above 99°F (37.2°C). If you have any doubt, take your child’s temperature rectally.

How to Take an Oral Temperature:

• Be sure your child has not had a cold or hot drink in the last 30 minutes

• Put the tip of the thermometer under one side of the tongue and toward the back. It’s important to put it in the right place.

* Have your child hold the thermometer in place with her lips and fingers (not teeth) for about 30 seconds with a digital electronic thermometer. (Note: the AAP recommends that older glass thermometers be discarded because they contain mercury. If that’s all you have, however, leave it in for about 3 minutes to get an accurate reading.) Keep the lips sealed.

* Your child has a fever if the temperature is above 100°F (37.8°C)

How to Take a Digital Electronic Pacifier Temperature:

* Have your child suck on the pacifier until it reaches a steady state and you hear a beep.

* This usually takes 3 to 4 minutes

* Your child has a fever if the pacifier temperature is above 100°F (37.8°C)

How to Take an Ear Temperature:

* This thermometer reads the infrared heat waves released by the eardrum

* An accurate temperature depends on pulling the ear backward to straighten the ear canal (back and up if your child is older than 1 year)

* Then aim the tip of the ear probe midway between the opposite eye and earlobe

* The biggest advantage of this thermometer is that it measures temperatures in less than 2 seconds. It also does not require cooperation by the child and does not cause any discomfort.

* Limitation: If your child has been outdoors on a cold day, he needs to be inside for 15 minutes before taking his temperature. Earwax, ear infections, and ear tubes, however, do not interfere with accurate readings.

How to Take a Temporal Artery (TA) Temperature:

* The thermometer reads the infrared heat waves released by the TA, which runs across the forehead just below the skin.

* Place the sensor head at the center of the forehead midway between the eyebrow and hairline.

* To scan for your child’s temperature, depress the scan button and keep it depressed

* Slowly slide the TA thermometer straight across the forehead toward the top of the ear, keeping in contact with the skin

* Stop when you reach the hairline and release the scan button

* Remove the thermometer from the skin and read your child’s temperature on the display screen

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Diarrhea

Definition:

Diarrhea is the sudden increase in the frequency and looseness of stools

* The main risk of diarrhea is dehydration

* Loose or runny stools do not cause dehydration

* Frequent, watery stools can cause dehydration

Causes:

* Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause

* Bacteria (eg, Salmonella, Shigella) cause some diarrhea. The main food-borne bacteria are Campylobacter, Salmonella, and Escherichia coli.

* Food Poisoning: Rapid onset of vomiting and diarrhea within hours after eating a food contaminated with toxins (eg, cream dishes that are not properly refrigerated). Symptoms usually resolve in fewer than 24 hours without a need for medical care.

* Giardia (a parasite) occasionally, especially in child care centres.

How to Recognize Dehydration:

* Dehydration means that the body has lost excessive fluids, usually from vomiting or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting, or a mild decrease in fluid intake does not cause dehydration.

* Dehydration is the most important complication of diarrhea

* The following are signs of dehydration:

– Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark-yellow, concentrated yellow. If the urine is light straw coloured, your child is not dehydrated.

– Dry tongue and inside of the mouth. Dry lips are not helpful.

– Dry eyes with decreased or absent tears

– In infants, a depressed or sunken soft spot

– Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your child’s doctor to teach you how to do this test.

– Irritable, tired out, or acting ill. If your child is alert, happy, and playful, he is not dehydrated.

– A child with severe dehydration becomes too weak to stand or very dizzy if he tries to stand.

Definition of Diarrhea in Breastfed Infants:

• The stools of a breastfed infant are normal unless they contain mucus or blood, or develop a new bad odor.

* The looseness (normally runny and seedy), color (normally yellow), and frequency of stools (normally more than 6 a day) are not much help. Breastfed babies may normally even pass some green stools surrounded by a water ring (normal bile can come out green if intestinal transit time is rapid enough).

* During the first 1 to 2 months of life, the breastfed baby may normally pass a stool after each feeding. (However, if an infant’s stools abruptly increase in number and looseness and persist for 3 or more stools, the baby probably has diarrhea)

* Other clues to diarrhea are poor eating, acting sick, or fever.

Definition of Diarrhea in Formula-Fed Infants:

* Formula-fed babies pass 1 to 8 stools per day during the first week, then 1 to 4 per day until 2 months of age.

* The stools are yellow in colour and peanut butter in consistency

* Formula-fed newborns have true diarrhea if the stools abruptly increase in number or looseness and persist for 3 or more stools, become watery or very runny, contain mucus or blood, or develop a new bad odour.

* Other clues to diarrhea are poor eating, acting sick, or fever

* After 2 months of age, most infants pass 1 or 2 stools per day (or 1 every other day) and no longer appear to have mild diarrhea.

Return to School: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

Call 911 Now (Your Child May Need an Ambulance) If:

Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Signs of dehydration (eg, no urine longer than 8 hours, no tears with crying, very dry mouth)

* Blood in the stool

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Abdominal pain present longer than 2 hours

* Vomiting clear liquids 3 or more times

* Child is younger than 1 month with 3 or more diarrhea stools (mucus, bad odor, increased looseness)

* Passed more than 8 diarrhea stools in the last 8 hours

* Severe diarrhea while taking a medicine that could cause diarrhea (eg, antibiotics)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Pus in the stool present for more than 2 days

* Loss of bowel control in a toilet-trained child occurs 3 or more times

* Fever present for more than 3 days

* Close contact with person or animal who has bacterial diarrhea

* Contact with reptile (snake, lizard, turtle) in previous 14 days

* Travel to country at risk for bacterial diarrhea within past month

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Diarrhea persists more than 2 weeks

* Loose stools are a chronic problem

Parent Care at Home If:

Mild diarrhea (probably viral gastroenteritis) and you don’t think your child needs to be seen

Home Care Advice for Diarrhea:

1. Reassurance:

* Most diarrhea is caused by a viral infection of the intestines

* Diarrhea is the body’s way of getting rid of the germs

* Here are some tips on how to keep ahead of the fluid losses

2. Mild Diarrhea:

* Continue regular diet

* Eat more starchy foods (eg, cereal, crackers, rice)

* Drink more fluids. Formula or milk are good balanced fluids for diarrhea (EXCEPTION: Avoid all fruit juices and soft drinks because they make diarrhea worse)

3. Formula-Fed Infants With Frequent, Watery Diarrhea: Start Oral Rehydration Solution (ORS)

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* Start ORS for frequent, watery diarrhea (Note: formula is fine for average diarrhea)

* Use ORS alone for 4-6 hours to prevent dehydration. Offer unlimited amounts.

* If ORS is not available, use formula prepared in the usual way (unlimited amounts) until you can get some.

* Avoid Jell-O water, sports drinks, and fruit juice

4. Returning to Formula:

* Go back to formula by 6 hours at the latest (Reason: child needs the calories)

* Use formula prepared in the usual way (Reason: it contains adequate water)

* Offer formula more frequently than you normally do

* Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (soy formula) are only needed for watery diarrhea persisting more than 3 days.

* Extra ORS: Also give 2 to 4 oz (30 to 120 mL) of ORS after every large, watery stool

5. Solids:

Infants Older Than 4 Months: Continue solids (eg, rice cereal, strained bananas, mashed potatoes).

6. Breastfed Infants With Frequent, Watery Diarrhea:

* Continue breastfeeding at more frequent intervals. Continue solids as for formula fed.

* Offer 2 to 4 oz (60 to 120 mL) ORS (eg, Pedialyte) after every large, watery stool (especially if urine is dark) in addition to breastfeeding.

7. Children Older Than 1 Year With Frequent, Watery Diarrhea:

* Fluids: Offer unlimited fluids. If taking solids, give water or half-strength Gatorade. If child refuses solids, give milk or formula.

* Avoid all fruit juices and soft drinks (Reason: make diarrhea worse)

* ORS (eg, Pedialyte) is rarely needed, but for severe diarrhea, also give 4 to 8 oz (120 to 240 mL) of ORS after every large, watery stool.

* Solids: Starchy foods are absorbed best. Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, or rice. Pretzels or salty crackers can help meet sodium needs.

8. Probiotics:

* Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria in the gastrointestinal tract.

* Yogurt is the easiest source of probiotics. If your child is older than 12 months, give 2 to 6 oz (60 to 180 mL) of yogurt twice daily (Note: today, almost all yogurts are “active culture”)

* Probiotic supplements in granules, tablets, or capsules are also available in health food stores.

9. Diaper Rash: Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (eg, petroleum jelly) around the anus to protect the skin.

10. Contagiousness: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

11. Expected Course: Viral diarrhea lasts 5 to 14 days. Severe diarrhea only occurs on the first 1 or 2 days, but loose stools can persist for 1 to 2 weeks.

12. Call Your Doctor If:

* Signs of dehydration occur

* Diarrhea persists more than 2 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Cough

Definition:

* A cough is the sound made when the cough reflex suddenly forces air and secretions from the lungs.

* A coughing spasm is more than 5 minutes of continuous coughing

Causes:

* Most acute coughs are part of a cold, a viral infection of the large airway (viral bronchitis).

* Other Common Causes: Croup, bronchiolitis, asthma, allergic cough, whooping cough.

Sputum or Phlegm:

* Yellow or green phlegm is a normal part of the healing process of viral bronchitis.

* This means the lining of the trachea was damaged by the viral infection and is being coughed up as new mucosa replaces it.

* Bacteria do not cause bronchitis in healthy children. Antibiotics are not indicated for the yellow or green phlegm seen with colds.

* The main treatment of a productive cough is to encourage it with good fluid intake, a humidifier (if the air is dry), and warm chicken broth or apple juice for coughing spasms (if child is older than 1 year).

Return to School: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

Call 911 Now (Your Child May Need an Ambulance) If:

* Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)

* Child has passed out or stopped breathing

* Lips are bluish when not coughing

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK)) If:

* Your child looks or acts very sick

* Choked on a small object that could be caught in the throat

* Difficulty breathing for child younger than 1 year and not relieved by cleaning the nose

* Difficulty breathing present when not coughing

* Lips have turned bluish during coughing

* Ribs are pulling in with each breath (retractions)

* Can’t take a deep breath because of chest pain

* Severe chest pain, coughed up blood, or wheezing

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Continuous (nonstop) coughing

* Child is younger than 3 months

* Earache or sinus pain (not just congestion) is also present

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

* Chest pain present even when not coughing

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Coughing has kept child home from school for 3 or more days

* Symptoms of nasal allergy are also present

* Cough has been present more than 3 weeks

Parent Care at Home If: Cough with no complications and you don’t think your child needs to be seen

Home Care Advice for Cough:

1. Reassurance:

* Coughs are a normal part of a cold

* Coughing up mucus is very important for protecting the lungs from pneumonia

* We want to encourage a productive cough, not turn it off

2. Homemade Cough Medicine:

• Goal: Reduce the irritation or tickle in the throat that triggers a dry cough

* Child Aged 3 Months to 1 Year: Give warm, clear fluids (eg, warm water, apple juice) to treat the cough. Amount: 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. Avoid honey until 1 year of age.

* Child Aged 1 Year and Older: Use HONEY, ½ to 1 teaspoon (2 to 5 mL), as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, you can use corn syrup)

* Child Aged 6 Years and Older: Use COUGH DROPS to coat the irritated throat. (If not available, you can use hard candy)

3. Nonprescription Cough Medicine (Dextromethorphan):

* Nonprescription cough medicines are NOT recommended (Reason: no proven benefit for children and not approved for children younger than 4 years) (Food and Drug Administration, 2008).

* Honey has been shown to work better for coughs

* If you decide to use cough medicine from your drugstore anyway, and your child is older than 4 years, choose one with dextro-methorphan (DM). It’s present in most nonprescription cough syrups.

* Indication: Give only for severe coughs that interfere with sleep, school, or work (every 8 hours)

4. Coughing Spasms:

* Expose to warm mist (eg, foggy bathroom)

* Give warm fluids to drink (eg, warm water, apple juice) if child is older than 3 months

* Amount: If child is 3 months to 1 year of age, give warm fluids in a dosage of 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. If child is older than 1 year, use unlimited amounts as needed.

* Reason: relax the airway and loosen up the phlegm

5. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (eg, in infants, give 2 oz less formula) (Reason: cough-induced vomiting is more common with a full stomach).

6. Fluids: Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out nasal secretions and loosen phlegm in the airway.

7. Humidifier: If the air is dry, use a humidifier (Reason: dry air makes coughs worse)

8. Fever Medicine: For fever above 102°F (39°C), give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

9. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse

10. Contagiousness: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

11. Extra Advice: Antihistamines for Allergic Cough

* Antihistamines can bring an allergic cough and nasal allergy symptoms under control within 1 hour

* Benadryl is very effective and no prescription is needed

• They need to be given every 6 to 8 hours

12. Expected Course:

* Viral bronchitis causes a cough for 2 to 3 weeks

* Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow, or green.

* Antibiotics are not helpful

13. Call Your Doctor If:

* Difficulty breathing occurs

* Wheezing occurs

* Cough lasts more than 3 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt