Being board certified in Internal Medicine and Pediatrics and working in a full spectrum primary care practice I get to see all types of people every day. Yesterday, for instance, I took care of a two week old and then went across the hall to care for a 99 year old. I absolutely love that part of my job.
That age difference also allows for me to gain a unique perspective on the choices we all have to make. I literally will walk out of one room having told a middle aged woman she has lung cancer to the next room only to find out a teenage girl had her first cigarette recently. I’ll counsel a diabetic on starting insulin then go meet a sixth grader who is 85lbs overweight.
When you can see the end of every new beginning it impresses upon me the urgent need to change our destiny. We must learn to choose differently and to choose wiser.
Watch this video and see what I mean. I warn you though it doesn’t pull any punches. I have seen a patient at every stage portrayed in that man’s life even the last one. At each stage we can choose differently and avoid the ending.
Come see us and learn about our wellness program and our nutritional counseling. This doesn’t have to be your destiny or the destiny of your child.
How does this happen?
I was recently asked by Maralee Bradley, host of a great blog on adopting, parenting, and fostering children entitled A Musing Maralee, to answer some of her reader generated questions on fevers, the common cold, and influenza. I’ve had the privilege to do this before for her on a series of questions regarding vaccinations. It was a great experience for me and her audience asked some really fantastic questions. You can find those posts starting here. Years ago I had the opportunity to work with Maralee and her husband, Brian, in caring for their son. They have since moved, grown their household with more wonderful children, and continue to ask challenging questions of me.
The original post from her website is at Ask the Pediatrician: What should I know about fevers? I’ll repost the future Q&A’s as they get posted on her site.
What is a fever? When does it become a problem? How should I treat it?
We use body temperature as one of many tools to help understand how sick a person is. Any number on a thermometer, in and of itself, doesn’t provoke a certain diagnosis or a specific set of therapies. It only tells us information we then use to help decide why the person has an atypical body temperature and if anything needs to be done.
Core body temperatures fluctuate during the day and often reach their peak in the late afternoon. A healthy adult might reasonably be measured at 99-100°F between 4-5pm. Women attempting to time ovulation know their body temperatures change over the course of their menstrual cycle. It all has to do with what temperature is appropriate for the situation. One of the most critically ill children I ever cared for in the emergency room had a core body temperature of 94°F. He had a brain infection that was so severe he couldn’t even maintain a normal body temperature. While people are individual in what their body temperature normally runs this doesn’t change how we define a fever. People who really are sick enough to manifest a fever still get about 100.4°F.
So when do we worry about a rising body temperature? In infants we have to be more diligent because they lack many of the other signs and abilities we rely on in older children and adults to help point out the cause. An infant may be cranky or sleepy as a sign of their infection but lots of infants are occasionally extra fussy or take long naps. Unusual body temperatures help us tell the difference.
An infant less than 3 months old who develops a body temperature above 100.4°F should be evaluated by a physician in a matter of hours. They are at much higher risk of serious infections such as meningitis, urinary tract infections, and bacterial infections of the blood stream. As such, we must be all the more diligent to prove their fever isn’t of great concern. Hours matter in these situations so I often advise my patients who call in the middle of the night to seek emergency care if their infant has a fever. We must prove their health as the risk of fatal infection is so great.
In older children we move the ‘worry point’ to 102°F. When children under three years of age but older than three months develop a fever they often display more evidence of why the fever occurs and if we need to try and fix it. They can report ear pain or sore throat. They may be potty trained and then suddenly develop accidents because of an urinary tract infection. They stop eating and complain of belly pain with appendicitis. In these situations we are able to focus in on the cause of their over all problem of which fever is simply one manifestation. I typically recommend to parents that children under three years of age be evaluated by a physician as soon as possible. Often the next day in the office is just fine as long as there are no other red flag symptoms like shortness of breath or uncontrolled abdominal pain. Emergency care may still be necessary. When in doubt contact your physician for advice on what to do for your particular situation.
As to everyone older than three years of age, it all depends on the circumstances. For instance, we are currently in the mini-epidemic of our seasonal influenza infections. In this case, anyone with a fever and symptoms at all suggestive of influenza ought to be evaluated. Early diagnosis and therapy can make a big difference in influenza outcomes. However, most of the year when otherwise healthy people have a modest fever such as 101 F, I recommend a watchful waiting approach. Respiratory tract infections typically are self-cured in seven days or so and other more serious infections will manifest with other symptoms that will help guide our diagnosis and therapy options.
A word on how to take an accurate temperature. What we want to know is what the temperature inside the body is. Rectal temperatures are by far the most accurate and it is what I recommend to parents caring for infants. As children age, oral temperatures are very good as children can hold the thermometer under their tongue consistently. Remember not to eat or drink anything for about 5-10mins prior as that can alter the result. If your kids are asleep it doesn’t matter what their temperature is really. I certainly wouldn’t wake them up to test it. Under arm or axillary temperatures are pretty good also. Lots of people suggest adding a degree to those readings. I’ve never seen good data to show that should be done so I always just ask parents how they took the temperature.
Ear thermometers and forehead thermometers seem like a great idea but I’ve seen many inaccurate readings. I once saw a healthy, playful 5 year old boy with ear pain who was reported to have a temperature of 108°F! Turns out the ear they checked the temperature in was infected. His body didn’t have a fever but his ear sure did.
So once you’ve found a fever and appropriate therapy is underway, whether that’s letting to body do its thing or using proper medication to kill off an invading pathogen, the question becomes “Should we reduce the fever?” I think the answer really depends on the person. Many kids can run around and play normally with all manner of fevers while others of us tend to feel really run down. I would say treat a fever when, after you know what’s causing it, you need it to go away. I don’t know of any real advantage to leaving the fever just for the fever’s sake. Sure many bacteria grow best in normal body temperatures so changing that might slow them down. In my experience though the body is so fantastic at doing what it needs to do that the body temperature doesn’t play the deciding factor.
If you are a patient at Trinity then feel free to drop us an email or call us. Together we can decide how and when to treat a fever.
Worldwide, infectious diseases are still the number one cause of death in young children. But deaths from infectious diseases declined markedly in the United States during the 20th century and have long ago fallen out of the number one position. It is remarkable that in the U.S. in 1900, over 30% of all deaths occurred in children aged less than 5 years. Now that percentage is about 1%. The top causes of death in 1900 were pneumonia, tuberculosis (TB), diarrhea and diphtheria. Immunizations, antibiotics, and better nutrition and sanitation have been major contributors to the huge drop in these infectious diseases.
Today our kids have different battles. Yes, infectious diseases still lurk and can be serious threats. One concern in that regard is that we have been so successful that we are getting complacent about immunizations, beginning to re-open the door to diseases like whooping cough that had been nearly stamped out – but that’s for another article. In our day, one of the biggest battles involves the tsunami of media inputs washing and crashing over our kids, and us. That tsunami suddenly kills a few, shortens the life span of many more, and cripples the quality of life of countless others.
Because of all this, the discussion in my well-child visits is different from when I started practice over 20 years ago. There is more discussion about the media diet of the children I’m seeing. How many hours a day do they spend in front of a screen (television, computer, DVD, video game, smart phone, etc.)? What kind of games, shows and music are they taking in? This is not in the form of an interrogation or guilt-trip, but more to just highlight this area as a key factor in the health of the child. For example, children ages 11-14 average over five hours of screen time daily. It is no surprise that any activity that pipes content into your brain for that much time daily will have a powerful impact physically, emotionally and relationally.
For starters, a child’s (and this still applies to adults as well) media diet impacts their health physically. In the U.S., obesity has more than doubled in children and tripled in adolescents since 1980. As obesity has increased, so has diabetes. Some of this is tied into the increased time spent sitting and watching a screen rather than engaging in various types of physical exertion.
But beyond this purely physical impact, increased television viewing is also associated with a number of other negative outcomes for children. Children watching high levels of television are less likely to experience feelings of contentment, to participate in after-school activities,to engage actively in other intellectually stimulating activities,to have mostly “A” or “B” grades,and to do well on math achievement tests. Excessive television viewing at very young ages (one to three) is linked to a decreased attention span later in life and to sleep problems.
Research has also found that viewing television violence is associated with children’s aggression – no surprise. Young adults who routinely watch violent television programs as children (six- to ten-year-olds) exhibit more aggressive behaviors as young adults than their peers who watch little or no violent television. Another study finds a link between viewing violent television in adolescence, and drug dependence in later years. Still another found a 30% increased risk for adult criminal behavior for every additional hour of screen viewing on weekdays from ages 5 to 15. Those viewing more socially positive content and less violence demonstrated more socially positive characteristics over time.
Like our food diet, our media diet hugely affects our overall health and that of our children, physically, emotionally, relationally and even spiritually. Both the quantity and quality of what we view is impactful. As a physician, as well as the dad of seven kids, I’ve seen that played out over and over. It’s a tough challenge to help keep kids screen time appropriately limited and positive. And setting the right example personally is key as well. But it’s worth the effort. Just like you want your kids to have the healthiest food and to avoid toxins, help them take the best nutrients into the vital realm of their minds.
Andrew Smith, MD is board-certified in Family Medicine and practices at Trinity Medical’s Maryville office located at 1503 East Lamar Alexander Parkway. Contact him at 982-0835