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Managing your Sick Child

Managing Fevers

Use this chart to help you decide which method to use.

AgeRecommended technique
Birth to 2 years1st choice: Rectum (for an accurate reading)
2nd choice: Armpit
Between 2 and 5 years1st choice: Rectum (for an accurate reading)
2nd choice: Ear, armpit
Older than 5 years1st choice: Mouth (for an accurate reading)
2nd choice: Ear, armpit
  • What is a normal temperature? Babies younger than 6 months old should see a doctor when they have a fever.
  • Older children can be treated at home, as long as they get enough liquids and seem well otherwise.
  • However, they should also see a doctor if their fever lasts for more than 72 hours.
  • The degree of a fever does not tell you how serious your child’s illness is. How a child acts is usually a better sign.
  • Medication is not always needed to reduce a child’s temperature.
MethodNormal temperature range
Rectum36.6°C to 38°C (97.9°F to 100.4°F)
Mouth35.5°C to 37.5°C (95.9°F to 99.5°F)
Armpit34.7°C to 37.3°C (94.5°F to 99.1°F)
Ear35.8°C to 38°C (96.4°F to 100.4°F)

Treatment: You do not need to treat a fever.  In fact, the best reason for giving your child medicine is not to reduce the fever but to relieve any aches and pains.

Acetaminophen Dose (Tylenol):  Best to dose based on weight 15 mg/kg/dose every 4-6 hours, no more than 5 times/day.

Ibuprofen Dose (Advil or Motrin): 10 mg/kg/dose every 6-8 hours

  • For very high or stubborn fevers, alternate between Acetaminophen and Ibuprofen every three hours (i.e., give a dose of Acetaminophen then three hours later give Ibuprofen then three hours later Acetaminophen, etc.) These two medications are safe to use together like this.
  • Compared with Acetaminophen (Tylenol), lasts a little longer, and seems to bring a fever down farther.
  • Always use an oral syringe to measure.

 

Cold Symptoms

Cold medications are not recommended for children under the age of 6!

  • Use single entity products and just treat the symptoms your child has (i.e. cough or runny nose etc) Talk to your pharmacist when choosing cold medications as using more than one product could result in accidental overdosing.
  • Many cold medications also contain acetaminophen (Tylenol) or ibuprofen (Advil)
  • Use cold water humidifiers in room to help with stuffiness
  • Saline nasal sprays can help (if you child will let you!)

 

What is the “FLU” or influenza?

The flu is a respiratory virus not a “stomach bug” as commonly believed.  It can, however does not generally cause vomiting and diarrhea.

Symptoms are similar to however, generally much worse than a cold.

SymptomColdInfluenza
FeverRareUsual; high fever (102 ° F/39 ° C - 104 ° F, 40 ° C), sudden onset, lasts 3 to 4 days.
HeadacheRareUsual; can be severe
Muscle aches and painsSometimes, generally mildUsual; often severe
Tiredness and weaknessSometimes, generally mildUsual; severe, may last up to 2 to 3 weeks
Extreme tirednessUnusualUsual; early onset, can be severe
Runny, stuffy noseCommonCommon
SneezingCommonSometimes
Sore throatCommonCommon
Chest discomfort, coughingSometimes, mild to moderateUsual, can become severe.
ComplicationsCan lead to sinus congestion or infection, and ear aches.*Can lead to pneumonia and respiratory failure, and become life-threatening. Can worsen a chronic condition.
PreventionFrequent hand washingAnnual immunization for children > 6 months and frequent hand washing


Should children get the Flu Shot?

  • 15% to 42% of healthy preschool and school-age children are infected annually with influenza
  • Healthy children younger than five years of age are hospitalized as often as patients 50 to 64 years of age.
  • Infants younger than six months of age have the highest hospitalization rates.
  • Canadian pediatric surveillance indicated that of childhood admissions to hospital for seasonal influenza, more than one-half were younger than two years of age.
  • Most children and youth admitted to hospital for influenza are healthy, but the risk of hospitalization and severe disease is increased in children with
    • neurodevelopmental delay or neurological disease,
    • cardiac or pulmonary disease,
    • cystic fibrosis,
    • diabetes and obesity, or
    • defects of the immune system.

The risk of hospitalization and severe disease is also increased in pregnant women.

 

Other Common Childhood Illnesses:

  1. RSV (Respiratory syncytial virus): More common than the flu.  Most are exposed before age 2. Symptoms look like flu or cold i.e. runny nose, fever, cough.  In babies it can lead to bronchiolitis or pneumonia.  Only 20-40% of kids will have wheezing, 2% will need to be hospitalized.
  1. Fifth’s Disease (parvovirus B19): sometimes called “slapped cheek” disease because of a characteristic red rash on face. Child may be fine or have cold-like symptoms before the rash appears. 20% percent will get before age 5 and 60% before 19. Pretty benign.
  1. Hand Food Mouth (and sometimes bum) disease (coxackievirus A16): Usually causes a fever. Occurs in summer or fall.  Blisters on hands feet and inside and/or around the mouth and buttocks.  Uncomfortable but usually resolves in 10 days.
  1. Croup (caused by a group of viruses called human parainfluenza viruses—same as the common cold viruses): The main symptom of the croup is the “barking” cough.  Up to 6% of children with croup are hospitalized, however it is rarely fatal.  Puffers may be required to help with breathing until the virus passes.  6/100 children get croup every year.  More common in children < 6 and most frequent in < 2 years of age.
  1. Scarlet Fever (bacteria Group A Streptococcus) A rash that sometimes occurs with strep throat. Kids with strep throat will often have a very sore throat and high fever with or without rash.  The scarlet fever rash starts on the chest and is bright red like a sunburn and feels rough like sandpaper.  Child’s tongue may have a whitish appearance except for the taste buds which might be red (strawberry tongue).  Requires antibiotics.  Can be dangerous if left untreated. 
  1. Impetigo (Bacterial skin infection caused by staphylococcus or streptococcus). Very contagious and easily spread to other parts of the body if the sores are touched.  Appears on the skin as cluster of itchy bumps or sores that appear fluid filled.  They will crust over.  Requires antibiotics
  1. Rotovirus: Rotavirus infection causes gastroenteritis resulting in diarrhea, vomiting, and mild fever. (This is what we sometimes call the “stomach flu—a real misnomer)  Nearly all children have at least one bout by the age of three. Approximately 0.3-1.3% of children < 5 years of age will require hospitalization for rotavirus. Rotavirus vaccines (2-3 doses) are recommended for infants. The first dose must be between 6 weeks and 15 weeks and all doses are completed by 8 months.  Live vaccine.

 

 Managing Vomiting and Diarrhea

Most often vomiting and diarrhea are caused by a germ called a virus. Vomiting and diarrhea are the body’s way of getting rid of an infection or telling us that something is wrong. Infection by a virus is usually mild and does not last longer than 1 week.

  • Use an oral rehydration solution. Unless your doctor advises otherwise, use an oral rehydration solution such as Pedialyte for infants and children who have diarrhea, vomiting or fever. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They’re also designed for easier digestion. Oral rehydration products are readily available in most drugstores, and many pharmacies carry their own brands. Begin giving fluids early in the course of an illness instead of waiting until the situation becomes urgent.
  • Be sure to give enough solution. Your doctor may suggest specific amounts, depending on your child’s age and degree of dehydration, but a general rule of thumb is to keep giving liquids slowly until your child’s urine becomes clear in color. When your child is vomiting, try giving small amounts of solution at frequent intervals — try a spoonful or so every few minutes, for instance. If your child can’t keep this down, wait 30 to 60 minutes and try again. Room temperature fluids are best.
  • Continue to breast-feed. Don’t stop breast-feeding when your baby is sick, but offer your baby an oral rehydration solution in a bottle as well. If you give your baby formula, try switching to one that’s lactose-free until diarrhea improves — lactose can be difficult to digest during diarrhea, making diarrhea worse. Never dilute formula more than the instructions advise. Your doctor also may suggest substituting an oral rehydration solution for the formula for 12 to 24 hours.
  • Avoid certain foods and drinks. The best liquid for a sick child is an oral re-hydration solution — plain water doesn’t provide essential electrolytes, and although sports drinks replenish electrolytes, they replace those lost through sweating, not through diarrhea or vomiting. Avoid giving your child milk, sodas, caffeinated beverages, fruit juices or gelatins, which don’t relieve dehydration and which may make symptoms worse. Try small amounts of simple foods such as bananas, rice, apples, toast (BRAT), pasta, other fruits and vegetables.  Avoid dairy and fatty foods.

Your child should see a doctor if he or she has any of the warning signs for serious vomiting or diarrhea. The warning signs can be different for each child. Watch your child closely. Pay attention to things that you think are different about your child’s behaviour.

See a doctor if your child has any of these warning signs:

  • not willing to drink
  • vomiting often for more than 4 to 6 hours
  • more than 6 large, watery diarrheas in 1 day
  • stomach pain that is severe and does not stop
  • fast breathing
  • very sleepy or very fussy
  • severe head or neck pain
  • green vomit
  • blood in the vomit or diarrhea
  • fever over 39°C or 102.2°F for longer than 12 hours
  • sunken fontanelle (the soft spot on your child’s head if he or she is less than 18 months old)

 

In General:  When to go to Emergency Room

Call a doctor right away if your child shows any of the following signs. If you can’t reach a doctor take your child to the emergency department of your local hospital right away.

  • When the child has diarrhea and vomiting AND has no tears, dry mouth or is not urinating.
  • When a baby under three months of age has a fever over 38.5 C or 101 F.
  • When your child has difficulty breathing.
  • When your child develops a rash that does not turn white when you push on it.
  • When your child has a fever and is difficult to wake up or is very sleepy.

 

Recommended On-line Resources

The availability of on-line information is endless.  It is hard to distinguish between reliable sources and sources that represent opinion or corporate interests.  These websites are reliable and served as the references for what we have provided.

Health on the Net (HON) Foundation: is a Swiss not-for profit organization that helps Internet users find useful and reliable online medical information.  It has a search engine that you can use.  If a site is reliable it will often have a note stating it is HON certified.  If in doubt you can put the website into the HON search engine to check.

 

Here are some of our favorites:

 

 

dr-jennifer-ryan

Dr. Jennifer Ryan, BSc. Pharm, Pharm D, ACPR, FCSHP

Jennifer received her Bachelor of Pharmacy in 1999 from Dalhousie University, Halifax, Nova Scotia and completed the Canadian Hospital Pharmacy Residency Program at the Hospital for Sick Children in Toronto, Ontario in 2000. She received her Doctor of Pharmacy in 2006 from the University of Florida.

From 2001-2014 held several positions as a hospital pharmacist including: Pharmacy Research and Education Coordinator, Clinical Manager, Pharmacy Residency Coordinator and Pharmacy Practice Leader in Nephrology. She has held an adjunct faculty position with Dalhousie University since 2005. Jennifer’s research interests have included areas of disease prevention, medication adherence and pharmacy education. Jennifer has presented nationally and internationally.

Jennifer and husband Cory now own and operate the Medicine Shoppe Pharmacy, in Grand Bay-Westfield where they live and raise their three children. They have a strong sense of community responsibility and are committed to improving healthcare access for their clients and neighbors.

You can find more valuable information at  www.facebook.com/themedicineshoppepharmacygrandbaywestfield

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