Tuesday, June 4, 2013

When is Fever in Children a True Emergency?

Data from the CDC confirms what every pediatrician already knows: the most common reason for ER visits for both boys and girls is fever.  Fever continues to be a symptom that strikes fear in the hearts of parents though, thanks in large part to vaccines, most childhood illnesses that cause temperature elevation are either self-resolving viral syndromes or minor ailments that respond promptly to treatment.
In most instances, a fever does not warrant a trip to the emergency room – the child can be provided comfort with an over-the-counter antipyretic medicine and safely be seen in their doctor’s office the next day.  There are some exceptions to this.  The following is a list of situations in which fever is a true medical emergency.
1.      The child is less than 6 weeks old.
Newborn babies are more susceptible to serious infections and are less able to fight them off.  A febrile infant under 6 weeks of age requires immediate medical attention and in many cases will require hospital admission.
2.      The child has an underlying illness.
Some chronic conditions predispose to serious infections or thwart the body’s ability to fight mild infections.  Among these are genetic diseases such as Sickle Cell Disease and Cystic Fibrosis; acquired diseases including leukemia and other forms of cancer; and all diseases that affect the immune system, from inherited immune-deficiencies to HIV infection/AIDS.

3.      Children who take immunosuppressive medications.
Some medications, such as steroids and drugs that alter the immune system, place children at risk for serious infection.  These medications are often used to treat chronic conditions including juvenile arthritis.
4.      Recent travel to foreign countries.
We sometimes take for granted the fact that many infectious diseases are extremely rare or virtually inexistent within the borders of our country.  Travel to some parts of the world may put children at risk for malaria, yellow fever, typhus and other “exotic” diseases.
5.       Children who are not vaccinated.
The incidence of blood infections, bacterial meningitis and measles has plummeted in the last twenty years due to safe and effective vaccines. One benefit of widespread vaccination efforts is herd immunity, which to some extent protects individuals who are not vaccinated by virtue of the fact that these diseases are much rarer.  Nonetheless, outbreaks of preventable infectious diseases happen with regularity among unvaccinated children.

Finally, children who appear ill.
I’m often asked by parents at what temperature they should start to worry.  The actual reading on the thermometer is just one piece of information that should be considered in the context of the overall picture of how the child acts and feels.  Any child with the worst headache of his life, especially in conjunction with a stiff neck or vomiting should be seen immediately.  So should ill appearing children with a rash, particularly if the rash doesn’t blanch when pressure is applied to the skin. I do ask that children with a temperature of 105 degrees Fahrenheit or higher receive rapid evaluation, and any child who has had a febrile seizure needs to be seen the same day.  Finally, I ask parents to trust their gut feeling.  Pay attention to that little voice tells you something is just not right.  Your subconscious may be picking up on something you just can’t put into words.  This is sometimes referred to as “tacit knowledge”.

Though most childhood fevers are not true emergencies, some situations do require immediate evaluation.  This article is not intended to discourage parents from seeking appropriate medical care for their children but to empower them with knowledge.  As always, questions and concerns should be addressed to your child’s pediatrician.

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