I hope I'm not just preaching to the choir with this post, but I feel like I can't have a blog written from the Pediatrician's perspective and NOT talk about vaccines. It's too big a part of our practice.
Vaccines truly form one of the cornerstones of a pediatric practice. They are among the few interventions that are cost-saving. One of the others is providing clean drinking water. In the US, we have a schedule of vaccines for all children, and will provide them to everyone because they are cost-saving. These include Hepatitis A and B, Diptheria, Tetanus, Pertussis, Measles, Mumps, Rubella, Polio, and Chicken Pox. It is because of these vaccinations that polio no longer exists in the Western Hemisphere (the reason it has not been eradicated in the Eastern Hemisphere is because there is resistance to vaccination efforts), and partly the reason smallpox only exists in labs.
And yet, despite all the data showing that vaccines work, there is a huge anti-vaccine movement in industrialized nations. Organizations such as the Vaccine Liberation and the Think Twice Global Vaccine Institute advocate to parents not to get their children vaccinated.
Don't get me wrong. I'm all about informed consent and vaccine safety. I think all vaccines should be rigorously tested before they are given to millions of children. I think vaccine reactions should continue to be monitored, and that vaccines aren't necessarily a one-size fits all thing. There are some children who can't get vaccines, either because they are allergic to something in the vaccine itself, or because they do not have a strong enough immune system to make the vaccine effective (or worse, they could contract the disease if a live vaccine is used). But, considering that, all children who are able to get vaccines should, in order to protect those who can't. When the healthy population doesn't get vaccinated, they serve as possible source of infection to those children.
Let's look a little more in depth into their arguments.
First, the supposed link with autism. While this could be a blog post in and of itself, let's run through a quick history of this argument. Back in 1998, Andrew Wakefield, a surgeon from the UK, published a paper in Lancet, a well renowned medical journal, claiming that MMR vaccines had a link to autism. Around this same time, the FDA published guidelines requesting the removal of mercury based products from foods. Thiomersal, a mercury-based solvent and preservative, was being used at that time in several vaccines, and the CDC and AAP requested vaccine manufacturers to remove it. Note that these two episodes were linked in time, but not by anything else. In the ensuing decade, thousands of studies have been done. None have been able to replicate Wakefield's results, and none have shown harm to thiomersal, though it is no longer used in vaccines. In 2004, the Lancet partially retracted Wakefield's paper, after Brian Deer (a reporter in London) demonstrated that there were conflicts of interest that were not disclosed. Then in 2009, Deer determined that Wakefield had actually falsified much of his data. In 2010, the Lancet fully retracted the paper, and Wakefield was banned from practicing medicine by the General Medical Council in the UK.
Moral of the story: vaccines do not cause autism. There has not been a single study that shows that it does. The vaccine schedule is set up in a way that children are going to have developmental changes shortly after administration of the vaccines. That's what happens when kids get older.
Vaccine Liberation makes the claim that cleanliness can prevent all diseases, and 'proves' this with graphs showing that the death rate of several vaccine-preventable diseases and several where there is no vaccine available. The primary problem with these graphs is that they only look at death rates. Death isn't what we're concerned about in most cases. Polio, for instance, causes paralysis. We can prevent death through a variety of interventions, including the ventilator. It's the paralysis that we want to prevent. Mumps? It rarely causes a complication resulting in death; we give the vaccine to prevent inflammation of the testicles or ovaries, which can result in infertility. It also just doesn't sound like a fun illness to have. Complications from measles are more common, but it's especially bad to be pregnant and exposed to measles (same with chicken pox; most complications are in pregnant women). The graphs don't take into account any of these complications; they just look at the death rate.
Think Twice claims "Recently vaccinated children do carry the disease germ and are able to spread it to other children. Many so-called epidemics are initiated and spread in this manner, even though the unvaccinated are blamed." It is true that some vaccines are live vaccines, meaning that the virus was altered to cause an immune response, but not disease, and the virus itself is still functional. These vaccines tend to be more effective than other vaccines, because they act more like a disease-causing virus than the segments that are used in the inactivated or subunit vaccines. These include the varicella (chicken pox), oral polio, and MMR vaccines.
However, the idea that children can spread disease after getting these vaccines, especially that this accounts for most of the cases of these diseases, is incorrect. Most measles cases are imported, meaning that they were brought back from people traveling overseas, usually to Asia. These were most commonly unvaccinated people who contracted the illness, though some vaccinated people remain susceptible. Of course, the recent outbreaks of measles may change that assumption in the near future.
This post is already getting long, so I'll end it here, but if you know of any other arguments against vaccines, please feel free to bring them to my attention and I will do my due diligence in examining the data. But in the meantime, please vaccinate your children. For the good of society, and for their own health.
Need more evidence that parents not vaccinating their children is causing harm? Check out this map. It shows the vaccine-preventable diseases Measles, Mumps, Rubella, Polio, and Whooping Cough (Pertussis) on a world map where all the epidemics are occurring, along with how many cases are in each epidemic.
Showing posts with label sick day. Show all posts
Showing posts with label sick day. Show all posts
Sunday, May 11, 2014
Sunday, March 9, 2014
Popping Pills: The Age of Antibiotics
Last week, we discussed how to take care of a sick child. Susie came in with a fever, cough, and runny nose, and we talked about the importance of treating the fever and keeping her hydrated. But gosh darnit, you want her illness to go away, for her to be able to go back to school or daycare, and so on. So, you demand a medication to make things go away. An antibiotic. Your pediatrician refuses, saying that it's not indicated.
Look, I understand why you want your child to feel better. You hate seeing them sick. I get it. Really, I do.
But antibiotic use with diseases like the one above is such an issue that the American Academy of Pediatrics has made it #1 on their list of 5 things pediatricians and parents need to discuss.
Let's take a step back a moment. As a kid, you certainly learned about germs. The germ theory of disease, that is, that germs cause disease, has been around since the mid-1800s. It is the reason that when you go into surgery now, any member of the staff touching your open wound is 'sterile', and the reason we wash our hands when going into and coming out of patient rooms. The reason you probably tell your children to wash their hands before dinner, and Lysol every surface in the house if you have a bad illness spread through.
There are four major types of 'germs': bacteria, viruses, parasites, and fungi. Bacteria causes diseases like strep throat (which is caused by a streptococcal bacteria), some pneumonias (infections of the lung), and some other, rarer infections of the brain, sinuses, and intestines. Parasites include malaria and pin worms. Fungi cause diseases like athlete's foot, yeast infections, and ringworm. Viruses can cause any number of different diseases, so many that we don't always know about them. The common cold is caused by a group of viruses called rhinoviruses. Herpes, chicken pox, the flu, cervical cancer, and any number of other respiratory or stomach bugs are also caused by viruses.
Statistically, you are more likely to come in with a disease caused by a virus than one caused by any of the other groups of germs. Antibiotics are not effective against viruses. We do have some medicines that are effective against some viruses; for instance, cold sores caused by the herpes virus can be treated with acyclovir to shorten the course of disease and the flu can be treated early on with Tamiflu (though it really doesn't help). But amoxicillin won't make your cold go away.
As with fevers, showing up to your doctor within the first few days of an upper respiratory infection (a cold) doesn't tell us a whole lot. It could be bacterial, but it is much more likely to be a virus. And if antibiotics aren't going to help you, then the risk of them doing harm outweighs the benefit. Any antibiotic, but particularly the penicillins, can cause life-threatening allergic reactions, or more mild side effects such as diarrhea and vomiting. Why chance it if you don't need it?
So when should you get antibiotics? The American Academy of Family Practitioners recommends antibiotic use for upper respiratory infections only if the symptoms have lasted 10 days. Viruses generally go away after 5-7 days (though the cough may last up to 2-3 weeks), but if you continue to have fevers, runny nose, etc after that period, or if you start to feel better and suddenly get worse, you're much more likely to have a bacterial infection. Note that the color of the snot or mucus has no bearing on whether or not it is bacterial or viral. Unless it's clear, then it's more likely to be allergic in nature, rather than infectious.
What about other things?
Ear infections should generally be treated, but the physician should see a bulging, red, and pus-filled ear-drum. An ear drum that just has fluid behind it is not a sign of a middle ear infection, and antibiotics should not be given in those cases. You can see some examples of what ear drums look like here.
Bronchitis (chest colds) should probably be evaluated by a physician, but generally follows the same concept as upper respiratory infections: no antibiotics until 10 days into the course, or if you get better and take a turn for the worse. There is one important exception: if a child has coughing spells so severe that he/she vomits at the end, or has a "whoop" trying to breathe during the spell, he or she should be seen, as these are indications of Pertussis, which can be life-threatening in very young children. There is an antibiotic treatment for it, but often once the coughing starts, the antibiotic is no longer effective.
There is some current debate over whether or not strep throat needs to be treated. Antibiotics do not shorten the course of strep throat. The reason we give them is to prevent the development of rheumatic fever, which can lead to permanent heart damage. It's a rare complication of strep throat, and studies have shown that treatment with antibiotics essentially eliminates the risk of rheumatic fever, but there has been some concern that the risk of complication from using antibiotics exceeds the risk of getting rheumatic fever in developed nations (David Newman, who is an awesome speaker, talks about this a bit in his book Hippocrates' Shadow). But, antibiotics should only be given in patients who have a positive strep test, or who have a high suspicion for strep throat, which is not the case in most instances of a sore throat.
Bottom line, those physicians who argue with you about the need for antibiotics are trying to help you. They are not trying to make your life more difficult. Instead, they are trying to eliminate the risk of a complication from taking an unnecessary medication. If they're doing their job right, they should provide you some information about how to treat your symptoms and get you back to your normal self, even without antibiotics.
If they aren't explaining to you why, ask. It's your right as a patient to know what your physician is thinking when deciding on treatment. And if you don't agree, talk about it. Don't get mad and run off to another physician who will just give you what you want--those aren't the type of physicians you want around when things get hairy because they truly don't have your best interests at heart.
Look, I understand why you want your child to feel better. You hate seeing them sick. I get it. Really, I do.
But antibiotic use with diseases like the one above is such an issue that the American Academy of Pediatrics has made it #1 on their list of 5 things pediatricians and parents need to discuss.
Let's take a step back a moment. As a kid, you certainly learned about germs. The germ theory of disease, that is, that germs cause disease, has been around since the mid-1800s. It is the reason that when you go into surgery now, any member of the staff touching your open wound is 'sterile', and the reason we wash our hands when going into and coming out of patient rooms. The reason you probably tell your children to wash their hands before dinner, and Lysol every surface in the house if you have a bad illness spread through.
There are four major types of 'germs': bacteria, viruses, parasites, and fungi. Bacteria causes diseases like strep throat (which is caused by a streptococcal bacteria), some pneumonias (infections of the lung), and some other, rarer infections of the brain, sinuses, and intestines. Parasites include malaria and pin worms. Fungi cause diseases like athlete's foot, yeast infections, and ringworm. Viruses can cause any number of different diseases, so many that we don't always know about them. The common cold is caused by a group of viruses called rhinoviruses. Herpes, chicken pox, the flu, cervical cancer, and any number of other respiratory or stomach bugs are also caused by viruses.
Statistically, you are more likely to come in with a disease caused by a virus than one caused by any of the other groups of germs. Antibiotics are not effective against viruses. We do have some medicines that are effective against some viruses; for instance, cold sores caused by the herpes virus can be treated with acyclovir to shorten the course of disease and the flu can be treated early on with Tamiflu (though it really doesn't help). But amoxicillin won't make your cold go away.
As with fevers, showing up to your doctor within the first few days of an upper respiratory infection (a cold) doesn't tell us a whole lot. It could be bacterial, but it is much more likely to be a virus. And if antibiotics aren't going to help you, then the risk of them doing harm outweighs the benefit. Any antibiotic, but particularly the penicillins, can cause life-threatening allergic reactions, or more mild side effects such as diarrhea and vomiting. Why chance it if you don't need it?
So when should you get antibiotics? The American Academy of Family Practitioners recommends antibiotic use for upper respiratory infections only if the symptoms have lasted 10 days. Viruses generally go away after 5-7 days (though the cough may last up to 2-3 weeks), but if you continue to have fevers, runny nose, etc after that period, or if you start to feel better and suddenly get worse, you're much more likely to have a bacterial infection. Note that the color of the snot or mucus has no bearing on whether or not it is bacterial or viral. Unless it's clear, then it's more likely to be allergic in nature, rather than infectious.
What about other things?
Ear infections should generally be treated, but the physician should see a bulging, red, and pus-filled ear-drum. An ear drum that just has fluid behind it is not a sign of a middle ear infection, and antibiotics should not be given in those cases. You can see some examples of what ear drums look like here.
Bronchitis (chest colds) should probably be evaluated by a physician, but generally follows the same concept as upper respiratory infections: no antibiotics until 10 days into the course, or if you get better and take a turn for the worse. There is one important exception: if a child has coughing spells so severe that he/she vomits at the end, or has a "whoop" trying to breathe during the spell, he or she should be seen, as these are indications of Pertussis, which can be life-threatening in very young children. There is an antibiotic treatment for it, but often once the coughing starts, the antibiotic is no longer effective.
There is some current debate over whether or not strep throat needs to be treated. Antibiotics do not shorten the course of strep throat. The reason we give them is to prevent the development of rheumatic fever, which can lead to permanent heart damage. It's a rare complication of strep throat, and studies have shown that treatment with antibiotics essentially eliminates the risk of rheumatic fever, but there has been some concern that the risk of complication from using antibiotics exceeds the risk of getting rheumatic fever in developed nations (David Newman, who is an awesome speaker, talks about this a bit in his book Hippocrates' Shadow). But, antibiotics should only be given in patients who have a positive strep test, or who have a high suspicion for strep throat, which is not the case in most instances of a sore throat.
Bottom line, those physicians who argue with you about the need for antibiotics are trying to help you. They are not trying to make your life more difficult. Instead, they are trying to eliminate the risk of a complication from taking an unnecessary medication. If they're doing their job right, they should provide you some information about how to treat your symptoms and get you back to your normal self, even without antibiotics.
If they aren't explaining to you why, ask. It's your right as a patient to know what your physician is thinking when deciding on treatment. And if you don't agree, talk about it. Don't get mad and run off to another physician who will just give you what you want--those aren't the type of physicians you want around when things get hairy because they truly don't have your best interests at heart.
Sunday, March 2, 2014
Sick Day: How to Manage Sick Kids
The scenario: Dad brings in little Susie to see the doctor because Susie has a fever, a cough, and a runny nose. She hasn't been acting herself today, not really interacting with people and not wanting to eat. Maybe Mom has a bit of a runny nose too, but she feels fine. Maybe little Susie goes to daycare or school and there are a half dozen other kids sick. She's been sick before, but it's never been quite this bad.
The three things I always want to know in this scenario are: 1) how high was the fever and how was it measured 2) have you given her any medicine for her fever (and if so, how much), and 3) is she still drinking and peeing?
A lot of parents will come in telling me their child just feels hot. And while that is an important measure of fevers, it doesn't really tell us much about the fever itself. And in many cases, there wasn't a fever at all. There really isn't such a thing as a 'low-grade fever'. A fever is defined as a core body temperature of 38.0C - 38.3C (100.4F - 101F), depending on who you ask. Emphasis on the 'core body temperature' part. That means, in really little kids (less than a year or so), you should take their temperature in their rectum (up their bottoms). In older kids, oral is a reasonable way to take a temperature (under the tongue), but can be flawed if they just ate or drank something cold. The thermometers that measure in the ears or across the forehead aren't really good measures of core body temperature.
In general, kids act weird when they have fevers. Sometimes, they'll just be listless and not want to play. Sometimes, it seems more serious, because they start shaking or seeing things that aren't there. One of my mentors has said repeatedly that he doesn't pay attention to anything strange a kid does when he/she has a fever, because fevers do weird things to the mind. And I'm not sure the last time you had a fever, but they aren't comfortable.
Giving medicines, such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen), in appropriate doses, can reduce fevers. I've seen Tylenol be given to a kid who was barely interacting with me in the Emergency Department (ED), and 15 minutes later, they're up and running around the room. Both acetaminophen and ibuprofen should be given in weight-based dosing, and ibuprofen should not be given to kids under 6 months of age. So you should check with your doctor to see how much medicine your kid should be getting. If they aren't getting enough, their fever might not come down and they still may look sick. Despite their best intentions, alternating between acetaminophen and ibuprofen every 4 hours doesn't really seem to help more than just sticking with one medication, and is more prone to errors that could lead to overdose. So, find one you like and stick with it.
At this point, I'd like to point out that fevers themselves do not harm kids. Even if your kid's fever is 104F*, if it comes down to normal with medicine, I'm less likely to be worried about it. Let me repeat that: fevers themselves do not cause harm. However, fevers are signs that something isn't quite right. Usually, in kids, it's a virus that they haven't been exposed to before, and their immune system is doing what it's supposed to and fighting it off. Every so often, though, it's something more insidious. It's that something else that results in fever that actually does the damage, not the fever itself. In fact, some would even suggest to allow a child to be febrile for a period of time to give them a chance of fight off their infection. I do agree that this is safe, so long as the child is comfortable. But if your child isn't comfortable, treat their fever. It'll make things easier for both of you.
When should you be concerned?
1) If you give the medication, and the fever does not come down. Call your pediatrician or go to an Urgent Care or Emergency Department.
2) If the child does not act normal after the medication is given and the fever has come down. As I said, most kids will bounce right back to their normal selves, but kids with bad infections will still look sick.
3) If the fever lasts more than 3-5 days, or if the child starts to get better and suddenly gets worse again. Both are signs of either another infection that is more worrisome, or a variety of disorders that are marked by prolonged fevers.
If you bring your child in to be seen on day 1 of the fever, there isn't going to be a whole lot your doctor can tell you. The illness hasn't had a chance to 'present itself,' and we can't really differentiate between the number of different diseases that cause fever.
And that brings me to the second thing I ask parents. If we've gotten past the fever part, and the child isn't staying hydrated, then we, as physicians, get a little more worried. See, kids become dehydrated much more quickly than adults. A really bad stomach bug that causes vomiting and diarrhea could dehydrate a kid and leave them looking really sickly. Fever itself can also cause dehydration, not only because kids don't feel like eating and drinking during that time, but it also increases how much they sweat, something we refer to as 'insensible losses'.
When kids are sick, they don't feel like eating. That is fine. Our bodies are used to using energy stores during times of infection. But, not drinking, or not having things like popsicles or other high-water 'foods' can quickly lead to dehydration. In little kids, particularly those in diapers, one of the easiest ways to determine whether they are taking enough in is to check how much they're putting out. If an infant goes from wetting a diaper every 2 hours (12 in a day) to wetting one every 12 hours, there's a problem, and they're not taking in enough liquids (or they have a problem with their kidneys, but that's another discussion).
Taking fluids by mouth is the best way to take them. It's non-traumatic, and the best way to prevent complications from a medical intervention. Kids who are throwing up everything they try to drink, or kids who are having difficulty breathing, are the hardest ones to get to drink. We generally recommend small volumes of fluids in those cases, 1-2 oz every half hour or so. Don't give the baby a full 8 oz bottle of milk if she's been vomiting all morning. Even things like popsicles, if given often enough, can keep kids hydrated. So, we do an oral challenge to see if they are willing and able to take the fluids by mouth.
If they aren't able, we consider admitting to the hospital for IV hydration. It's not preferred, because there's always the risk of injury or infection with placing things like IVs (a low risk, but still a risk), but the risk of dehydration is much greater than those risks, so we do it when it's necessary.
Now, if your child has a chronic disease, most especially something like Cystic Fibrosis or Diabetes, you should follow the instructions of the doctor regarding sick day rules.
Otherwise, managing their fever and making sure they stay hydrated are the two things you can do to get your child feeling well once again. And if you aren't sure, call your pediatrician. Most will have overnight people on call specifically to answer these questions for you and determine if your child needs to be seen right away. There's nothing wrong with getting in to see the doctor, but we can be much more helpful if you've tried a few simple things on your own first.
Next week, we'll talk more about the role of antibiotics in treating children.
*Note: Elevated body temperatures can cause damage, but they must be greater than 40-41C (104-105.8F) for a prolonged period of time for this to happen. This generally does not happen with infections, but more often in things like heat stroke or medication overdose resulting in hyperthermia. Note that at these times, it is not referred to as a 'fever', but 'hyperthermia'.
The three things I always want to know in this scenario are: 1) how high was the fever and how was it measured 2) have you given her any medicine for her fever (and if so, how much), and 3) is she still drinking and peeing?
A lot of parents will come in telling me their child just feels hot. And while that is an important measure of fevers, it doesn't really tell us much about the fever itself. And in many cases, there wasn't a fever at all. There really isn't such a thing as a 'low-grade fever'. A fever is defined as a core body temperature of 38.0C - 38.3C (100.4F - 101F), depending on who you ask. Emphasis on the 'core body temperature' part. That means, in really little kids (less than a year or so), you should take their temperature in their rectum (up their bottoms). In older kids, oral is a reasonable way to take a temperature (under the tongue), but can be flawed if they just ate or drank something cold. The thermometers that measure in the ears or across the forehead aren't really good measures of core body temperature.
In general, kids act weird when they have fevers. Sometimes, they'll just be listless and not want to play. Sometimes, it seems more serious, because they start shaking or seeing things that aren't there. One of my mentors has said repeatedly that he doesn't pay attention to anything strange a kid does when he/she has a fever, because fevers do weird things to the mind. And I'm not sure the last time you had a fever, but they aren't comfortable.
Giving medicines, such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen), in appropriate doses, can reduce fevers. I've seen Tylenol be given to a kid who was barely interacting with me in the Emergency Department (ED), and 15 minutes later, they're up and running around the room. Both acetaminophen and ibuprofen should be given in weight-based dosing, and ibuprofen should not be given to kids under 6 months of age. So you should check with your doctor to see how much medicine your kid should be getting. If they aren't getting enough, their fever might not come down and they still may look sick. Despite their best intentions, alternating between acetaminophen and ibuprofen every 4 hours doesn't really seem to help more than just sticking with one medication, and is more prone to errors that could lead to overdose. So, find one you like and stick with it.
At this point, I'd like to point out that fevers themselves do not harm kids. Even if your kid's fever is 104F*, if it comes down to normal with medicine, I'm less likely to be worried about it. Let me repeat that: fevers themselves do not cause harm. However, fevers are signs that something isn't quite right. Usually, in kids, it's a virus that they haven't been exposed to before, and their immune system is doing what it's supposed to and fighting it off. Every so often, though, it's something more insidious. It's that something else that results in fever that actually does the damage, not the fever itself. In fact, some would even suggest to allow a child to be febrile for a period of time to give them a chance of fight off their infection. I do agree that this is safe, so long as the child is comfortable. But if your child isn't comfortable, treat their fever. It'll make things easier for both of you.
When should you be concerned?
1) If you give the medication, and the fever does not come down. Call your pediatrician or go to an Urgent Care or Emergency Department.
2) If the child does not act normal after the medication is given and the fever has come down. As I said, most kids will bounce right back to their normal selves, but kids with bad infections will still look sick.
3) If the fever lasts more than 3-5 days, or if the child starts to get better and suddenly gets worse again. Both are signs of either another infection that is more worrisome, or a variety of disorders that are marked by prolonged fevers.
If you bring your child in to be seen on day 1 of the fever, there isn't going to be a whole lot your doctor can tell you. The illness hasn't had a chance to 'present itself,' and we can't really differentiate between the number of different diseases that cause fever.
And that brings me to the second thing I ask parents. If we've gotten past the fever part, and the child isn't staying hydrated, then we, as physicians, get a little more worried. See, kids become dehydrated much more quickly than adults. A really bad stomach bug that causes vomiting and diarrhea could dehydrate a kid and leave them looking really sickly. Fever itself can also cause dehydration, not only because kids don't feel like eating and drinking during that time, but it also increases how much they sweat, something we refer to as 'insensible losses'.
When kids are sick, they don't feel like eating. That is fine. Our bodies are used to using energy stores during times of infection. But, not drinking, or not having things like popsicles or other high-water 'foods' can quickly lead to dehydration. In little kids, particularly those in diapers, one of the easiest ways to determine whether they are taking enough in is to check how much they're putting out. If an infant goes from wetting a diaper every 2 hours (12 in a day) to wetting one every 12 hours, there's a problem, and they're not taking in enough liquids (or they have a problem with their kidneys, but that's another discussion).
Taking fluids by mouth is the best way to take them. It's non-traumatic, and the best way to prevent complications from a medical intervention. Kids who are throwing up everything they try to drink, or kids who are having difficulty breathing, are the hardest ones to get to drink. We generally recommend small volumes of fluids in those cases, 1-2 oz every half hour or so. Don't give the baby a full 8 oz bottle of milk if she's been vomiting all morning. Even things like popsicles, if given often enough, can keep kids hydrated. So, we do an oral challenge to see if they are willing and able to take the fluids by mouth.
If they aren't able, we consider admitting to the hospital for IV hydration. It's not preferred, because there's always the risk of injury or infection with placing things like IVs (a low risk, but still a risk), but the risk of dehydration is much greater than those risks, so we do it when it's necessary.
Now, if your child has a chronic disease, most especially something like Cystic Fibrosis or Diabetes, you should follow the instructions of the doctor regarding sick day rules.
Otherwise, managing their fever and making sure they stay hydrated are the two things you can do to get your child feeling well once again. And if you aren't sure, call your pediatrician. Most will have overnight people on call specifically to answer these questions for you and determine if your child needs to be seen right away. There's nothing wrong with getting in to see the doctor, but we can be much more helpful if you've tried a few simple things on your own first.
Next week, we'll talk more about the role of antibiotics in treating children.
*Note: Elevated body temperatures can cause damage, but they must be greater than 40-41C (104-105.8F) for a prolonged period of time for this to happen. This generally does not happen with infections, but more often in things like heat stroke or medication overdose resulting in hyperthermia. Note that at these times, it is not referred to as a 'fever', but 'hyperthermia'.
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