Tuesday Tips- Kids and Fever

Fever is so misunderstood in general.
I answer many calls about fevers every day, mostly from worried parents. When I worked in the pediatric emergency room, many patients visited with fever everyday.
Fever scares parents. It's easy to understand why, since some very serious illnesses present with fever as one of the symptoms; such as influenza, pneumonia, and meningitis. The truth is that most childhood fevers are due to mild viral illnesses which require nothing more than home treatment, and will last for less than 3-4 days. Fever is the body's natural way of resisting infections. Fever all by itself is not dangerous in any way and is part of the body's defense system. It is normal for a fever to fluctuate over the course of the day.
You might wonder why doctors and nurses advise giving medication to reduce fever, since most fevers are helpful. Well, if you've ever had a fever yourself you know how it makes you feel: shivery and uncomfortable, achy and tired. Taking fever medications like Tylenol (acetaminophen) or Advil (Ibuprophen) can bring the fever down temporarily to give comfort and allow the patient to rest.
It's important to realize that these medications don't affect the underlying cause of the fever and have only a short term affect. They also need to be given carefully according to your child's age and weight. If you're unsure, always check with a pharmacist to clarify the safe dosage to give.


Myth #1: Fever causes brain damage and seizures

The truth is, a normal childhood fever won't cause brain damage. The brain controls how high a person's temperature can go. Occasionally, a young child can have what is called a febrile seizure, meaning a seizure caused by fever. It is believed that these seizures are caused by the body's temperature rising rapidly. A seizure like this may look very frightening, but is not dangerous or damaging. It usually lasts less than a few minutes and the child recovers quickly. It is always a good idea to seek medical attention for a seizure, especially if it lasts longer than a few minutes or it is the first one your child has had, just in case the fever is not the only cause.

Myth #2 : High fever = more serious illness than a low-grade fever

This is not always true. Children and babies often have more frequent and higher fevers than adults. Rather than focusing on how high the fever gets, it is more important to notice whether or not the fever responds to home treatment (does the fever come down at least 1 degree celsius an hour after giving fever medicine and other cooling measures? does the child 'perk up' after the fever comes down?) and to notice what other symptoms the child might have:

Things to check for:
Breathing: Is your child breathing rapidly and shallow? Is she wheezing or having other noisy sounds with breathing? Is her colour pale? Is she having a hard time nursing from the breast or bottle because she has to break suction to breathe? Does he have a persistent cough?
Hydration: Is your child still drinking fluids well? Having wet diapers or urinating at least once every 6-8 hours? Is the urine pale or dark? Is your child having vomiting or diarrhea?
Level of Alertness: Is your child alert when awake? Confused or very irritable? (It's fairly normal for a child to be a bit clingy and tired when the fever is high, but he should perk up somewhat when the fever comes down) Does your child respond to you normally?
Any other symptoms: Complaints of pain, excessive crying that is hard to comfort, pink/cloudy or foul-smelling urine. A new rash or bruising. Neck stiffness or pain and headache. In babies- is there a bulging or sunken area over the soft spot on the scalp?
Prior Medical history: Any prior medical conditions, such as being born prematurely or having a congential heart condition, diabetes or asthma can make your child at higher risk in cases of milder illnesses.

Myth #3 : It Is Urgent to Bring a Child's Fever Down to Normal

As mentioned, since fever is not dangerous, it's not urgent to bring it down. If your child is sleeping comfortably there is no need to wake him to give medication for fever. Simply remove any extra layers of blankets and keep the house at a comfortable temperature. A hot environment and too much clothing will make it difficult for your child's body to let off the extra heat to cool itself. If he becomes too hot and uncomfortable, he will wake up to let you know.
Cold or even cool baths are not necessary and are actually very uncomfortable when a child has fever. They will usually cry and resist, get goose bumps all over and start shivering. Shivering is actually the body's way of trying to warm the skin, so this will work against trying to bring the fever down. If your child wants a bath, make sure the water is warm enough that it doesn't cause shivering.
Dress your child lightly in enough clothing to cover and prevent shivering. Give fever medicine if the child is uncomfortable and re-check the temperature after an hour.
Sometimes older children with a fever will find it soothing to have a cool cloth on their forehead, but just for comfort, not to try to cool their body down.

IMPORTANT note about babies under 3 months of age:

ANY fever (37.6 C or higher, measured under the armpit) in a baby under 3 months of age should be evaluated by a doctor immediately, even in the absence of other symptoms. Very young babies don't have a well-developed immune system and are at higher risk for serious illness.

Here is a really helpful website to refer to if you'd like to use an online tool to go through a symptom checklist to decide if your child needs medical attention for any symptom. Just type the symptom into the 'enter health topic' field and click on the GO button.

For example:
If I type in "fever" the first 2 results are:

'fever, ages 3 and under' and 'fever, ages 4 and older'

Choose the appropriate topic, then click on "check your symptoms" in the right hand list. This will guide you through a list of yes/no questions which will help you decide if your child needs more than just home treatment. It's very easy to navigate.

There are over 3000 topics to choose from with lots of detail and resources listed, and all the information is updated regularly to keep it current. It's a fantastic resource for any parent to have in their bookmarks.

* As always, the information I share here is general and comes from reliable sources, as well as my pediatric nursing experience. It doesn't replace a doctor's advice and is not meant to diagnose. If you are concerned about your child's symptoms, you should always contact your doctor for specific advice *

Green Thursday- for Swingers!

As you can probably tell by the crafts I make- I'm into re-use and recycling. I've decided to start a regular Thursday posting dedicated to earth-friendly topics. Could be a product review, giveaway, advice on being green, websites of interest on the topic or anything else I can think of:-)
If you are making or selling something 'green' and you'd like me to blog about it, please contact me. helen@juicybags.ca
I chose Thursdays because it's our garbage and recycling pick-up day. Maybe it will help me remember to get the bins out to the curb on time...yeah right! Let's see, I need a title for it, maybe 'Green Thursdays', or perhaps 'Oh-Crap-I-Forgot-Again'

Today, I'm going to show you something TOTALLY cool, made out of recycled tires. I remember seeing something similar to this quite a few years ago when my kids were small. I wanted to buy one, but at the time we didn't have our own yard, so I had nowhere to hang it. I just surfed around this morning, trying to find it online and I found this:

Close The Loop is a company in Kunkletown, PA (love the name) that makes the most incredible kids' swings out of recycled tires. I'm not just talking your normal run-of-the-mill tire swings here- not even CLOSE. Check these out:


Yes! A motorcycle!


...and a dragon!
Not to mention all the others they have pictured on their site, including a kangaroo, an airplane, a shark (so cool!), an elephant, a T-Rex and many more.

They're priced from around $90 to $120, depending on the design, which I think is very fair, considering they are handcrafted and so creative.

Looks like the only deliver inside the USA *pout*, not that I have anyone to buy one of these for at the moment...but Canada isn't like overseas or anything, sheesh.
Anyway, all you lucky American parents and kids can go and check them out or buy one of these swings here

Tuesday Tips

As you know by my little bio up there in the corner, I'm an RN. I have 15 years experience in Pediatrics, mostly from the emergency department in a children's hospital. For the past 5 years I've been working as a telephone advice nurse. As you can probably guess, I get many calls from parents about everything from A to Z, including growth and development and symptoms of illness.
There are many subjects that come up over and over again. I thought I would address one question here each week to try to shed some light on some of the common concerns. I would love it if readers added their comments. If you have a question you'd like me to cover here, please send it to RN411@juicybags.ca

**This information is not a replacement for your doctor's advice and I don't diagnose. All the information I share is from reliable sources and my nursing experience and is general in nature. For advice on a specific child's situation, please consult your Health Care Provider**

Today's Question: Why won't my toddler eat?

This is a very common issue and there are many things that contribute to feeding problems in this age group. I get so many calls about this and the problems that it causes. First, it's important to remember that a toddler's stomach is very small and their appetite is easily satisfied with small amounts of food.

Bottles and Sippys
Keeping their stomach size in mind, if they are drinking milk or juice (anything other than plain water) from a bottle and/or sippy cup throughout the day or night, their appetite will be low for other foods. Excessive milk or juice consumption is a big problem for toddlers. It can cause tooth decay when bottles and sippy cups are used as pacifiers. It can also cause constipation and iron deficiency anemia.

Too Much Cow's Milk or Juice
Did you know that a toddler's daily milk intake should be limited to 16 ounces per day? That's 2 cups over 24 hours. Juice should be limited to 4 ounces per day. It can be offered in small servings at meals. Milk or juice is not a good snack if it exceeds their daily requirements. Teaching your child to use an open cup early on (while seated to prevent spilling and choking) rather than carrying a bottle or sippy is preferable. Other dairy products like yogurt or cheeses should be given in moderation as well. Remember that servings for toddlers should be smaller. Drinking too much milk can also contribute to iron deficiency anemia, because milk is very low in iron. Anemia makes kids sluggish and tired and can interfere with brain development. I once cared for a child who was 3 years old and drank ONLY cow's milk and drank it constantly from a bottle. She ate no solid foods other than pancakes. Her anemia was so severe that she didn't even have the energy to play. Of course, this is a very extreme example!

When I child drinks milk or juice at night, the natural sugars in milk or juice pool around the emerging teeth and erode the enamel. There is even a name for it: Nursing Bottle Caries. Many parents don't even know their children have this problem until it causes them pain and needs surgical intervention. The cavities (or caries) begin behind the upper and lower front teeth so they often aren't noticed until they spread around the teeth or cause pain. As you can imagine, damaged teeth can affect the child's desire to eat solid foods. The teeth often require extraction or crowns. It's heartbreaking to see a young child with rotted or missing front teeth from such a preventable problem!
Too much milk and dairy products can also cause constipation. Constipation can be very painful and can become worse once toilet teaching begins. If milk or dairy products replace fruits, vegetables and whole grains in your child's diet, bowel problems are very likely at some point. If your child starts to resist toileting due to fear of pain, the constipation will become worse and then the cycle begins. Once constipation becomes a long-term pattern, it takes a long period of treatment with diet and sometimes stool softeners or other treatments to get it under control.

So, you might be wondering if that's enough fluid for a child to drink in a day. Well, water is the best thing for thirst and will also help to prevent constipation. Plain water should be available to your child throughout the day to quench thirst. It won't satisfy hunger the way milk or juice does, so your child will be more likely to try new foods and eat more solid foods. If you are trying to transition away from a night-time bottle or sippy cup, try offering water only in the bottle, although it is obviously much better to avoid starting the bottle-in-bed habit than to try to change it later on! Get your own water bottle and model water-drinking to your child.

Variety and Autonomy
It's important to offer your child a choice of a few different foods at each meal and serve them food when other family members are eating. Make mealtime enjoyable but not distracting. No TV, video games or toys at the table. Let them feed themselves (I know it's messy, but it's all part of the learning) and offer milk or juice after the meal instead of alongside. Meals and snacks should only be served with the child safely seated to reduce the risk of choking. A suggestion for breakfast might be: a small bowl of hot whole-grain cereal, a few pieces of cut-up fruit and 1/2 a scrambled egg, with 2-4 ounces of milk offered in a cup after he's finished eating. He may not eat it all, but he will likely eat more than if you offer only one food. Allow your child to decide when he is full. Don't force him to eat more than he wants. It's important for him to learn to eat to satisfy hunger, not to please Mom! Focus on offering whole grains breads and cereals, fruits and vegetables at each meal. Since toddlers' stomachs are tiny (and their attention spans are short!) 3 small meals and 2-3 snacks per day are recommended.
If you are breastfeeding, nursing after meals is preferable at the toddler stage, to encourage the child to try new foods. Breastfeeding doesn't cause the same problems as cow's milk, but limiting night-feedings can help to encourage a more varied and complete diet.

Remember to offer foods again and again periodically, even if your child rejects them the first few times. Children's tastes change, and they will often accept foods they previously refused (or threw across the room!) This is even true in my house where the kids are teenagers now, although they don't throw food (when I'm around anyway:-)
Try to offer your child similiar foods to what other family members are eating. Toddlers like to copy what older siblings and parents do. Mealtimes are excellent opportunities to model healthy eating habits.

Here is a good, general online resource for Toddler Feeding advice in PDF format.
From "Toddler's First Steps"

This is a big topic. I tried to keep it concise, but there's a lot to be discussed and I'm sure other parents have great tips to share. Feel free to comment!