How to Care for a Sick Child

Your child is fussy. She won't eat. Her temperature is rising. This is a scary time for any parent. Not knowing what's wrong and not knowing what to do make it scarier. You want to be prepared for times when your child is sick or feverish, so that you will remain calm and know when and how to involve your doctor. This article will help you understand what's ailing your child, what to do about it and what to tell the doctor. Here's a preview:

Diagnosing a Childhood Illness Talk to your doctor beforehand about what medicines to keep in the house, when it's appropriate to call the doctor, and what to do in an emergency. This page will tell you what to ask your doctor so that you'll know what's going on when your child starts displaying symptoms.

How To Treat a Child's Fever Fever is the body's normal response to infection. Many illnesses can cause a child to have a fever, and there is usually little you can do other than to treat the symptoms and try to make your child more comfortable. This page will explain how to read a child's temperature, which types of thermometers to use, how to treat a fever and when to get a doctor involved.

Diagnosing a Childhood Illness

No situation is more frightening for a new parent than a sick baby. Your infant fusses, does not eat well, and has a fever. Should you take her to the hospital? Should you call your doctor? Or are you overreacting? As a well-informed parent, you want to know what you should do -- when to be concerned and when not to worry. You want to know when to call the doctor and how to describe your child's illness. That's what this section is all about.

What You Need to Know

All parents need to learn to tell when their child is sick, when to seek professional help, what to do in emergencies, and how to give medicines. Once you know these facts, you can make the best decisions about your child's health care.

One of the best ways to deal with illness is to be prepared. This includes knowing about common childhood illnesses and emergency measures, as well as having and knowing how to give the appropriate medicines. Some general steps you should take to prepare yourself for illness or accident follow:

Write down the telephone numbers of your child's doctor, including the number for after-hours services, the hospital, the local poison control center, the fire department, and the ambulance service. Post these numbers near every telephone and in a central location, such as on the refrigerator, and include the numbers in your cell phone directory and personal digital assistant. Make sure your babysitters know where these numbers are located and how to dial 911 in an emergency. When dialing 911, stay on the phone line even if you are unable to tell the operator where you are; the operator can track the phone number to the location.
Ask your doctor what you should have on hand for emergencies and treatment of common ailments. Some doctors suggest keeping certain commonly used medicines on hand for late-night illnesses.
Discuss with your doctor what you should do in an emergency. If your child eats a bottle of pills or drinks a poison, should you call your doctor, the local emergency room, or the poison control center? (Most doctors recommend that you call the poison control center first.) If your child is injured, should you call your doctor first or take your child to the emergency room? Asking these questions before an accident actually occurs helps you and your doctor know what to expect.
Learn about childhood illnesses and accidents. Articles such as this one help prepare you for the inevitable illnesses and injuries that befall all children. Other sources of information include your child's doctor and the American Academy of Pediatrics (www.aap.org).
Take a first-aid course and learn CPR (cardiopulmonary resuscitation) and the Heimlich maneuver (for choking). Be sure the instruction pertains to both children and adults (many courses deal only with adults). In the classes you have the opportunity to practice these skills on specially constructed models that are very lifelike.
Most important, in an emergency, don't panic! You must remain calm to react properly to the situation and get your child the appropriate care. Panicking will only slow you down and interfere with your ability to think clearly. Calming techniques, such as taking two or three slow, deep breaths or talking out loud to yourself in a reassuring voice, may help you deal with the panic; you can practice these techniques before a real emergency arises.

Before You Call the Doctor

Before your child ever gets sick, talk with the doctor about the types of symptoms or illnesses which would warrant an after-hours call and which could wait to be evaluated during regular office hours. Keep the doctor's guidelines in mind when you think about calling him or her in the middle of the night.

If you are very worried about your child's health and well-being, do not hesitate to call after-hours; however, refrain from doing so in nonemergency situations. Your doctor can give you advice over the phone to handle most childhood illnesses during the night -- until you can see the doctor in the morning.

Before you call your doctor, you need to have some information ready to respond to your doctor's questions, and you need to know what information you want to get from the call. For example, if you feel your child needs medicine, don't wait to call until all the local drugstores are closed. In some communities, it's next to impossible to get any medicines after the pharmacies are closed. It's better to call your doctor earlier rather than later.

Also, almost all illnesses seem to get worse as the night progresses, so if your child isn't well at 7:00 P.M., there's little chance he'll be a lot better by 10:00 P.M. If you are concerned, call at 7:00 P.M. instead of waiting until 10:00 P.M.

If you really want the doctor to see your child, tell him or her right at the outset of the call. Your doctor will then know that all the reassurances over the phone won't help if you really want to have your child examined. However, if you just want some advice over the phone, let your doctor know that also.

Once you decide to make the call to your doctor, you should have some important information on hand so you can more efficiently let your doctor know exactly what's going on. First, the doctor needs some basic data. Give the doctor your child's name and age to help your doctor place your child. Be prepared to tell the doctor your child's weight, what medicines he's taking, what illnesses he's had, and the date of his last visit to a doctor. Then be ready to answer these questions about the current situation:

What's wrong with your child? This may sound like a silly question to prepare for, but all too often a parent can't answer it concisely. Think about your child's problem and be prepared to describe exactly what's going on. Think about the following: What is your child eating (solids, liquids, nothing)? Is he urinating a normal amount? Does he have diarrhea? If he's not acting himself, what's abnormal about his actions? Does he have a fever? If so, how high is his temperature and what method did you use to take it?
What's happened to make you decide to call the doctor now? This is an important question for you to think about. For example, your child's temperature may have gone up a lot, or he may have suddenly begun to cry and pull at his ear, or he may have just begun to vomit violently. Or perhaps you are concerned because your child's high fever has not broken after a few hours. If you are worried because your child's condition has worsened or because it hasn't gotten better, contact your child's doctor for advice. Ask the doctor for specific directions to alleviate your child's symptoms.
What do you think is ailing your child? Often, parents know what's wrong. This is particularly true if their child has had many episodes of the same illness. For example, many parents know when their child is getting another ear infection. Or if other members of the family have had a similar illness, there's a good chance your child is getting it. Or perhaps you're concerned because your child's symptoms are similar to those attributed to a particular disease you've heard about. Let the doctor know what you suspect, even if it seems far-fetched or silly.
Where do you want a prescription filled? Know which drugstore you want to use and make sure it's open and has a pharmacist on duty before you call. Have the phone number of the drugstore ready to give to your doctor.

Doctors who take care of children expect interruptions and emergencies -- these go with the age group. Most have no problems with appropriate phone calls at any hour.

Signs and Symptoms

Whenever your child is ill, your observations of her condition are very important. When you assess your child's illness, you're really looking at two different aspects: signs and symptoms. These terms have specific meanings to your doctor.

A symptom is something a patient complains about. A sign is something the doctor (or you) can see, measure, feel, hear, taste, or smell. If your child complains that her ear hurts, this is a symptom; if she keeps pulling on her ear, that is a sign.

Signs and symptoms are indicators of illness, but they are not illnesses themselves. When your doctor treats your child, he or she may treat the signs and symptoms of the illness, the illness itself, or both.

For example, acetaminophen is frequently given to a child with a fever; it may reduce the fever, but it doesn't affect the underlying illness causing the fever. However, an antibiotic given to your child when he has an ear infection actually helps the body fight off the infection, so it treats the illness. The earache (a symptom) and the fever (a sign) go away because you are treating the infection (the illness). For a list of precautions to take when using over-the-counter analgesics, click here.

Most of the medicines you can buy in the drugstore without a prescription treat symptoms but don't treat the illness itself. In other words, over-the-counter cold medicines you may buy for your child don't make her cold go away any more quickly, but they may make her feel a little better.

There's an ongoing debate about treating signs and symptoms of common illnesses. Some doctors believe, unless the signs and symptoms are severe, you're better off not treating them. Some of the symptoms of an illness may actually be beneficial and speed recovery. Every medicine has side effects, and sometimes these are worse than the illness itself.

One of the signs that may speed recovery is fever. On the next page you'll learn about this special condition and what's going on in your child's body.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Treat a Child's Fever

Fever in a child strikes fear in the hearts of many parents. If a fever seems high, they may wonder if their child will have a seizure or the temperature will "cook" their child's brain and cause permanent damage. Fever is perhaps the most misunderstood sign in all of medicine. But you should know the proper way to treat your child's fever and when you should call your doctor.

Fever is the body's normal response to infection. Everyone has an internal thermostat that controls body temperature. When an infection is present, certain chemicals are released in the body that, in effect, reset the thermostat to a higher setting.

This helps to explain the chills your child may experience when his temperature is going up. He feels cold because his body wants to be at a higher temperature. Once his fever breaks, he is hot because his body wants to be at a lower temperature. The breaking of the fever means his internal thermostat has been turned down to normal.

Understanding how a fever occurs helps you know how to treat the chills and sweats that often accompany an illness. When your child has the chills, add some blankets until he feels comfortable. Similarly, when he begins to sweat and feels warm, you should take off clothes or blankets. Bundling him up when he feels warm defeats what his body is trying to accomplish.

Taking a Temperature

A normal oral temperature is 98.6 degrees Fahrenheit. A normal rectal temperature is one degree higher; an axillary (armpit) temperature is one degree lower. "Normal" means average -- some people run a slightly higher or lower temperature, and that is normal for them. Temperature also varies throughout the day; a person's temperature is usually a little higher in the afternoon and evening. It's a good idea to know your child's normal temperature in case it is slightly above or below average.

The most accurate way to take the temperature of a young child is rectally. Any thermometer will do, although one designed for rectal use is shaped a little differently so it goes in more easily. If your child can't keep a thermometer under her tongue and can't keep her mouth closed for three minutes, use a rectal thermometer.

Inexpensive electronic thermometers (for oral or rectal use) are more accurate, quicker and easier to read, and safer than glass thermometers, which can break. They signal you when they have reached their final reading by sounding a tone. If you use an electronic thermometer, however, keep fresh batteries on hand.

To take your child's temperature with a rectal thermometer, lay your child on her stomach. (If you are using a glass thermometer, shake down the thermometer to 96 degrees or lower and lubricate it with some petroleum jelly first.) After separating her buttocks with the thumb and first finger of one hand, gently insert the thermometer to a depth of about one inch. Then pinch her buttocks closed. Hold a glass thermometer in place for three minutes to be sure you get an accurate reading or wait for the tone to sound in an electronic thermometer before withdrawing it.

Be sure to shake down a glass thermometer before each use. Separate the baby's buttocks and gently insert the thermometer. Thoroughly wash (with cool water) and dry the thermometer after each use.

Put the thermometer under her tongue (if you use a glass thermometer, be sure to shake it down first). She should close her mouth around the thermometer (without biting down) and keep her mouth shut for three minutes or until the tone sounds. Be sure she hasn't drunk anything cold or hot within the 15 to 30 minutes before you take her temperature (if she has, the reading will be artificially low or high, respectively).

Axillary temperatures are not very accurate. The same applies to temperatures taken with strips held against a child's forehead.

How Important Is a Fever?

Many childhood illnesses cause a fever; most of these illnesses are caused by viruses. Unfortunately, viruses don't respond to antibiotics. There's nothing medicine has to offer to treat the vast majority of viral illnesses except symptomatic relief (known as supportive therapy).

Young children are smarter than adults in many ways. One is the way they respond to illness. When they are sick, they look and act sick. They don't try to hide their illness. The way your child looks and acts is a much more accurate reflection of the seriousness of his illness than his temperature.

Don't panic just because your child has a fever -- watch how he acts. You should call the doctor if a child younger than six months old has a temperature over 101 degrees. For an older child, call the doctor if the temperature is over 103 degrees or if he has a temperature of 101 degrees or greater for 48 hours. Remember that a fever is a sign the body is fighting off the illness.

Treating a Fever

If your child's temperature is high enough, or if the fever makes him very uncomfortable, you should go ahead and treat it. Acetaminophen is the drug to use. Do not give a child aspirin. The use of aspirin in a child with a viral disease has been associated with a very serious illness called Reye syndrome.

Acetaminophen is available under many different names. Acetaminophen products designed for use in children also come in different forms -- liquid, syrup, and chewable tablets. Most drug doses, including acetaminophen, are calculated according to the weight of the child. Read the package directions carefully, and be sure you understand them before giving your child a dose. Check with your doctor or a pharmacist if you have any questions about the correct dose.

Parents wonder whether they should bathe their child to bring down his temperature. Many doctors now believe this treatment is never needed. Others may advise sponge baths if your child's fever is very high. Check with your child's doctor. If you do sponge bathe your child, be sure to use tepid water (about 96 degrees Fahrenheit). Bathe him for no longer than 15 to 20 minutes and no more frequently than every two hours. Stop bathing him if he shivers or gets goosebumps.

Cooling by bathing lasts only for a short time. If you do not give acetaminophen in conjunction with bathing, your child's temperature bounces right back up once he dries off. Do not use rubbing alcohol -- inhaled fumes may cause some damage. Never use ice water to bathe your child.

A sick or feverish child is worrisome to a parent. Knowing what to do to relieve your child's suffering and treat the illness will alleviate much of your worry. Similarly, you don't want to become the kind of hysterical parent that is constantly calling the doctor. Following the tips and suggestions in this article should help you stay calm the next time your child is sick.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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ABOUT THE AUTHORS

Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.

Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.