Fever: When to Worry & When Not to Worry

Fever is good and bad. It’s good because it warns you that something is going on in the body, and since most viruses don’t fare well in heat, it helps purge the illness. It’s bad, obviously, because your kid is sick and uncomfortable. But as serious as a febrile illness may be, a fever in and of itself is not dangerous for the body and won’t damage the brain, even in the rare event that it causes convulsions.

A normal temperature is between 97°F and 99°F, a low-grade fever is around 100.5°F, a moderate fever is around 101.5°F, and a high fever is over 103°F. The margin of error is about half a degree, depending on how you take the temperature and the type of thermometer you use. There is also a wide variation in the presentation of fever for a child. The same illness will make some kids boiling hot, while it leaves other kids cold, so to speak. Below are a few points on what to look out for when your child has a fever. As always, we are here for you. If you have any questions, give us a call. You can also reference the Wizard of Dose, pediatric dosing calculator.

When to Worry
– If your child is very sleepy or sluggish and remains that way when the fever drops after anti-fever medication.
– If they have other symptoms, like respiratory difficulty or repetitive vomiting.
– If their fever persists over several days, or subsides and returns.
– If they drinks little fluid, which could lead to dehydration.

When Not to Worry
– If your child is lucid and aware, even in discomfort.
– Even if you can’t bring the fever down, you shouldn’t necessarily worry; some flus and viruses produce fevers that medications can barely touch. This is not a reliable sign of an illness’s severity.
– If the fever disappears after a few days.

What To Do
– Lower your child’s temperature with either acetaminophen or ibuprofen or even both. This is more to alleviate discomfort than to get a better reading on the thermometer. If their discomfort is pronounced, don’t be stingy; use the highest recommended dose for their age, and repeat as often as needed.
– If you have any doubt as to the origin of the fever or the need for treatment, address the issue with your doctor.

What Not To Do
– Don’t take your child’s temperature over and over again. You know they have a fever. It will go up and down until the illness resolves.
– Don’t use cool baths or an alcohol rub. These strategies date from prehistory, and they just create chills and discomfort. Medications are much more effective.

Measles Update

In light of the current measles outbreak in the US, we would like to address some basic facts about the disease. Measles had been eradicated in the US back in 2000, but since then, there have been occasional outbreaks as vaccination is not universal.

Measles is an acute viral illness that is characterized by a very high fever, cough, runny nose and red eyes followed by a specific rash; symptoms can last 5 to 7 days. Just like the flu, this virus is very contagious and can sometimes have rare but serious complications, especially among immunocompromised individuals.

Who is at risk?

– Unvaccinated children
– Children under one year. (The MMR vaccine is routinely given at age 12 months or older with a second dose after age 3 years. Before age 1, the vaccine is not as effective. Infants under 3 months carry some passive maternal immunity; most mothers have been vaccinated.)

Transmission:

Measles spreads via coughing and sneezing. It is a highly contagious virus that can linger on surfaces and in the air for up to 2 hours after an infected person has left.

Prevention:

– Vaccination of course.
– In the event of an outbreak, the recommendation is to avoid crowded places (not very realistic in NYC), especially if you are not immunized.
– After administration of the MMR vaccine, it takes the body 2-4 weeks to make immunity.

At this time, the New York City Health Commissioner has issued an Order for children residing or attending daycare within the following zip codes (11205,11206,11221,11249) who are between 6 months and a year should receive an early dose of the MMR vaccine. Anyone over 12 months who lives, works or attends school in the listed zip codes, who has not received any dose of MMR, must also receive an initial dose.

What We’re Doing:

Our staff has been properly instructed to screen for kids at risk prior to their office visit. If we identify concerning symptoms, we ensure appropriate infection control to prevent contact between patients. We have stocked additional MMR inventory and are actively scheduling patients eligible for early doses. Our practice will continue to educate and provide vaccinations for all New York City families.

Your Child’s Persistent Cough

The mechanism of a persistent cough is twofold. Either they have a strain of a virus that induces a long-lasting cough (several weeks, in some cases), or they have suffered from a string of recurrent colds, each of them with a new onset. In either case, the cough, which becomes dry with time, gains momentum at night when the mucus drips down the airway. To make matters worse, the constant forceful expulsion of air (the cough) becomes an irritant itself, which triggers additional coughing. The cycle becomes self-perpetuating.

Three or four days into a viral illness, the cough is no longer contagious, but you may have a hard time convincing the parents of your child’s classmates of this fact.

Dr. Michel Cohen, explains in The New Basics, what to look out for. Read more here.

Camp Brooklyn Fund Honors Dr. Michel Cohen

Camp Brooklyn Fund’s organization creates sleep-away camp scholarships for Brooklyn kids who would otherwise not have the opportunity to attend. When they chose Tribeca Pediatrics’ founder, Dr. Michel Cohen as their honoree for their annual Community Service Award Gala, he was touched.

1 in 3 kids in Brooklyn are living under poverty. For people working to better the living conditions of children in New York, places and opportunities like this one, matter a lot. When asked about his thoughts on the mission of Camp Brooklyn Fund, Dr. Cohen said, “Expanding horizons that otherwise may be limited is important. Camp is somewhere kids get to see outside of their regular routine.” He went on to recall his camp experience of getting separated from his group and spending hours lost in the woods. “They had to look for me, after I got really lost in the night…” he laughed. “I guess camp is about teaching survival.”

Every kid deserves to get a bit lost in the forest, as well as build fires and roast marshmallows, regardless of where you’re from. This fund is dedicated to making sure the future of Brooklyn gets to enjoy learning these skills, and find recreation.

Learn Hot to Get Involved

You can donate or attend the gala honoring Dr. Cohen here. This event will be held on November 15th at Giando on the Water in Brooklyn, NY.

There is a special discount for Tribeca Pediatrics parents. First enter the promotional code ‘CAMP’ on top, and then a limited ‘LEADER IN TRAINING’ ticket type will be revealed. This ticket grants entry from 9pm to 11pm and gets you access to the silent auction (ends 9:30pm), open bar, and dancing!

Coxsackie

Don’t panic when your child’s school posts a Coxsackie alert; the name is the scariest thing about this virus. Coxsackie (named after a town in New York State) is exceedingly common and responsible for many different illnesses. Most of them are mild, while others are severe but rare. Indeed, many nonspecific flus are caused by one of the Coxsackie species. Symptoms include moderate fever, scratchy throat, loss of appetite, and sometimes pinkeye. The treatment is the same as for all common viral illnesses: Ride it out.

Coxsackie is also responsible for two common mild conditions with equally scary names: herpangina and hand-foot-mouth disease.

Herpangina
Herpangina, a result of the Coxsackie virus that primarily affects young children, causes painful lesions in the mouth. In general, it starts with a moderate to high fever and decreased appetite, followed by the appearance of small sores in the mouth and the back of the throat.

Herpangina runs its course in a few miserable days. Treatment centers on managing the pain. You may have to resort to painkiller suppositories if Jimmy clamps his mouth shut because of the painful sores. Oral soothing lotions and mild topical anesthetics aren’t very helpful. As far as eating goes, a few days of decreased appetite don’t pose a big problem, as long as Jimmy manages to sip fluid so he doesn’t become dehydrated. Herpangina is sometimes confused with another equally painful febrile illness, herpes of the mouth. The confusion is not important, because both ailments call for the same treatment. The only noteworthy distinction is the fact that oral herpes can reappear in the form of a fever blister many years later.

Coxsackie is quite contagious and usually appears as an epidemic in the summer and in the fall. Prevention is unrealistic, since, like almost every other viral illness, contagion is at its peak in the early phase of the illness, when symptoms are minimal.

Hand-Foot-Mouth Disease
Another short-lived and relatively mild Coxsackie virus, this disease primarily affects young children but can be caught at any age. Sufferers find their hands, feet, and mouth covered with raised lesions that can occasionally blister and become painful. The rash can also show up on the buttocks (where it won’t blister). This condition usually disappears spontaneously within a week. As with herpangina, contagion is hard to control, and pain management is key. Note that it has nothing to do with foot-and-mouth disease, which afflicts livestock.

School Anxiety; An Excerpt from Dr. Cohen’s “The New Basics”

I vividly remember bringing my daughter to nursery school for the first time. Her mother and I were so apprehensive at the idea of leaving this little thing by herself for a whole two and a half hours. That morning, the family walked to the school with great ceremony, our daughter in her crisp new floral dress. When we arrived, there were already a dozen kids there, half of them screaming and hanging on to their parents’ jackets. After we spent an hour playing with all the toys available, we reached the fateful moment of separation. We kissed her good-bye and snuck out, but we didn’t get very far: We looked back to see our little girl’s blond curly head banging on the window. We ended up going back in and joining a happy group of kids and parents singing “The Wheels on the Bus.” We wanted to show her how much fun she could have, so much fun that we ended up staying there all morning and the next morning too.   

Separation Anxiety

The first day of school can generate a later but lesser form of separation anxiety. Some kids will have it the first time you leave them at school; others may take a few sessions.

How to Deal

The best way to drop your kid off at school is to stay a few minutes and then leave. The message you send when you leave confidently is that you approve of the place, and you approve of leaving them there, no matter how heartbroken you are. If you try to avoid the unease by prolonging your stay or over-explaining the process, you’ll only arouse their suspicion and anxiety. When you come back a few hours later, they’ll begin to understand that every departure is followed by a return. Not to mention that they’ll start to have a great time.

Flying with Your Baby

Whether you’re in desperate need of a vacation or it’s time to visit family afar, you may wonder if you can even bring your baby on board. Do not let your fears of flying with your little one hold you back from enjoying your next trip. Here are some tips to read before take off!  

When Can Babies Fly?

There is no minimum age limit. As soon as you think you and your child can tolerate the duration of the flight, go ahead and book your tickets. Does your baby need all their vaccination boarding the plane? Contrary to popular belief, babies do not need all their immunizations before their first flight. Airplanes, like any other crowded place, may be a haven of germs, however, kisses from grandma or snuggles from their sibling who just got out of daycare, are not any less of a risk for your baby.

Crying While Flying

Your baby crying during the flight is something you can’t avoid. There is nothing special you need to do that would be any different from soothing your baby at home or any other public place. Overfeeding or extensive rocking may only worsen the crying.

Ear Pressure

Thank goodness for modern technology and systems that have improved air cabin pressure control. There is no need to get caught up in figuring out all the ways to avoid baby’s ears from “popping”. If little pressure does built up, babies will swallow their saliva and even crying will help alleviate their ears. So take the pressure off yourself in figuring out how to “depressurize” your baby’s ears.

Read Dr. Michel Cohen’s air travel tips here.

Q & A with Dr. Cohen on Temper Tantrums

A parent’s nightmare: You are trying to enjoy a wonderful dinner with the family and your toddler is lying facedown on the floor, with their legs kicking in the air as they project the loudest screams possible.

Here are some answers from Dr. Michel Cohen, to help you make this nightmare go away.

1. My child was always so happy and easy as a baby, where is this coming from?

Temper tantrums are actually an important developmental milestone as your child is learning to process situations and express their frustrations. It is often triggered by a sense of being overwhelmed with too many choices, stimulation and a combination of feeling overtired. The case of kicking and screaming typically starts around fifteen months of age, especially if they cannot fully verbalize.

2. What is the best way to calm them down?

I have an easy solution for you – do nothing! No bribing, no hugging, no yelling: simply ignore them. The worst thing to do is to reinforce the outbursts by giving your child extra attention. Give them the opportunity to evolve their own coping mechanism and learn how to manage their own frustrations. And be consistent. Don’t ignore them sometimes, but punish or reward them other times. The unpredictable responses will disrupt the child’s expectations and approach to deal with their emotions. This can lead to extended and more frequents tantrums long term.

3. Other people are staring, what do I do?

I repeat, ignore the tantrum. Yes, it feels mortifying and embarrassing, but trust me, you are not the first person with a toddler who throws a temper tantrum in public. In fact, I am sure most of the parents staring understand how you feel. If it gets out of hand, restrain them to the stroller without explanation or leave where you are. There is no need to try to reason or have a rational discussion with your screaming child.

4. Will these tantrums ever end?

With a lot of patience and persistence in this routine, your child should no longer be throwing tantrums by age two. Start early in encouraging your toddler to establish a way to stay calm and cope with their frustrations. The longer you wait, the harder it will be for you and your child to overcome these temper tantrums.

Read more on temper tantrums here.

Six Things to Know About the Stomach Bug

Stomach bugs are nasty viruses that can easily make their way into your household, especially during the winter. With stomach bugs—viral infections of the intestine—unfortunately, comes diarrhea, vomiting, dehydration, and possible fevers. In case your kid comes down with one, here are 6 precautions, tips, and measures you can take to help them heal. Most importantly, vigilance is key.   

1. How it Gets Around

The poetic name for how this virus gets around is feco-oral or oro-fecal transmission. That means your child probably picked it up in the bathroom at school.

2. Vomiting Is Going to Last at Least 24 hours

The vomiting spells that come with stomach bugs can be violent, food-heavy, or after a while, as is common, come out as bile. Be aware that vomiting will last at least 24 hours, and if the fits stay past a few days, call your pediatrician.

3. For Sick Infants Under 6 months

Stomach viruses are rare in infants, however if they suddenly vomit more than once, it is important to work hard on preventing dehydration. Be sure to continue feeding them breast milk or formula in really small amounts and call your pediatrician for more guidance.

4. Don’t be Too Quick to Reintroduce Normal Foods

A child’s stomach is still sensitive for a good length of time after healing from a stomach bug. Any foods that might challenge the stomach should be avoided for a bit.

5. Rehydration Doesn’t Only Mean Water

It’s good for your child to intake a lot of liquids while their body is going through a stomach bug. They’re losing a ton of minerals, salts, and sugars that need to be replaced, so consider that for their beverage options. You can give them any soft or sports drink (though better if diluted with water) at room temperature, and make sure they drink it slowly.

6. Diarrhea is Normal, Mostly

Diarrhea following a stomach virus is messy, takes a while to heal, and is normal, unless you’re seeing blood or mucus in the stool. In this case, you know what to do: call your pediatrician. Also, be cautious of a diaper rash, as it is a common side effect of diarrhea.

Dr. Jason Perlman on Flu Testing and Treatment

Every parent, old or new, knows that the winter season is flu season. While the virus is common, the symptoms can be quite uncomfortable for kids, so we get a lot of parents in with questions, especially regarding flu testing and treatment. This month, Dr. Jason Perlman, our resident ID specialist, weighs in what to know for healing from the flu in 2018.



Jason, you are an ID doctor, what does that mean?

It means that in addition to my pediatric training, I spent 3 years studying infectious diseases (i.e.; bacteria, viruses, funghi, and parasites) and how they interact with children when they cause illness.

Does Tribeca Pediatrics test for flu?

We do not test for flu because by the time symptoms of the virus show up, treatment or management of the illness wouldn’t change. Basically, when you’re sick with the flu, and showing symptoms your doctor will be able to start a treatment plan without waiting for any type of test results.

What is Tamiflu? Does Tribeca Pediatrics administer this treatment for illnesses?

Tamiflu is the standard anti-flu medication. However, we do not treat the flu with this medication. Tamiflu is only effective within 48 hours of a flu diagnosis (when symptoms show up), and is said to shorten the time spent sick by 2 days, if you’re lucky. And the treatment is not without side effects. These include abdominal pain, vomiting and diarrhea, and delirium. Especially since Tamiflu is only a therapy, not a cure, our doctors haven’t found that the benefits outweigh the side effects.

Does Tribeca Pediatrics test for RSV?

We do not test for RSV. RSV, Respiratory Syncytial Virus, is a seasonal infection, and is the most common cause of Bronchiolitis. Bronchiolitis presents itself as a bad cold, wet cough, fever, and wheezing, especially in children younger than 2 years old. Many viruses can cause Bronchiolitis. Ultimately, treating the condition is what benefits the child, not identifying those symptoms specifically caused by RSV.