Dr. Lynn Cates
Specializing in pediatric infectious diseases and childhood immunizations.
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 Ask Dr. Cates
Three-Year-Old with a Fever for Five Days | | | QUESTION | | | Dear Dr. Cates,
Our three-year-old daughter has had a fever of 103 for five days, throwing-up a couple of times, liquid mostly. Our pediatrician requested blood and urine samples. Blood work came back clear with signs of a viral count. Preliminary urine came back positive for UTI. We've alternated Tylenol and Motrin to control her fever, but it still remains and spikes one hour before it's time to provide another dose (three hours Tylenol/five hours Motrin). We can't keep the fever down with ice, tepid baths, etc. On day three she also had congestion with clear discharge from her nose. Her pediatrician prescribed Zithromax. She took two doses (1st day 1 tsp, 2nd day 1/2 tsp). He called (on day four) for her update and we replied "doing the same." He then prescribed Omnicef. She?s taken two doses. She continues to digest jello, toast, and fluids. What should look for? How long can I safely give her Tylenol/Motrin to control the fever? Should I consider an ER opinion? Please help.— Browneyegirl in La Verne, CA | | | ANSWER |
February 14, 2002 | | | Dear Browneyegirl,
I'm sorry to hear that your daughter has been sick for so long. It's hard to know what is going on without seeing her, and maybe doing more lab work or other tests like, perhaps, a chest x-ray. Even then, we often aren't able to pin down a diagnosis before the symptoms go away if it is a viral infection. Although it certainly is possible to have a fever this long with a virus (especially influenza), this many days of high fever are usually more suggestive of a bacterial infection. Some of the more common ones include urinary tract infections (UTIs), ear infections, or pneumonia.
It sounds as if your pediatrician has done appropriate studies, but it also sounds like it is time for him to examine her again to be sure that she hasn't developed new findings that would help guide him in selecting appropriate treatment. When he sees her again, he also may feel it is time to repeat some lab tests, or perform some new ones. It is particularly important for you to take her back now if in addition to her fever, vomiting, and nasal discharge she also looks sick to you (although many people assume that with all of these symptoms a child would have to look sick, sometimes children can have all these things going on, but go about their business acting pretty normal).
Your question about how long you can safely give her Tylenol/Motrin to control her fever is a good one. Generally, it is okay to give this combination for the course of a routine childhood illness (that is, a few days), but you will want to remind your pediatrician that you have been giving her these medicines for several days now when you see him.
If she continues to be sick and your pediatrician can’t find an answer, you can request that he refer you to a specialist in children's infectious diseases for another opinion.
— by Lynn Cates, M.D., F.A.A.P. |
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