Transcription:

Scott Webb: Fevers in our kids can be alarming. But my guest today, emergency department physician, Dr. Misty Navarro, wants us to know that fevers tell us that our bodies are fighting intruders, and we may not need to rush to the ED every time our kids have fevers.

This is Ask The Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Navarro, thanks so much for your time today. I was mentioning to you that I have a couple of kids, they're older now, 14 and 19, but certainly dealt with fevers as I'm sure many parents have and may still be doing, as we speak perhaps. So let's start here. Just sort of lay the groundwork, maybe you can define what a fever is. What are fevers?

Dr. Misty Navarro: So a fever is defined as being greater than a 100.4 degrees Fahrenheit or 38 degrees Celsius. So normal temperatures can fluctuate throughout the day, kind of based on hormonal changes and your temperature can go up one to two degrees just normally. So, you know, a lot of people think that maybe a low-grade fever would be 98.7 to 100, but that's really just normal fluctuations in body temperature. So the definition is over 100.4 degrees Fahrenheit or 38 degrees Celsius.

Scott Webb: So it seems to me that the sort of standards have changed, right? When I was a kid, I think it was always like 98.6, but it seems like a little bit lower than that is normal and perhaps a little higher than that is normal. And it's an important part of our defense, right? So our bodies are trying to fight things off. It's our body's way of defending itself or telling us that something's going on. So maybe you can discuss that a little bit, like when and why, you know, our fevers might spike and what it's really telling us.

Dr. Misty Navarro: A fever in itself is not dangerous. It's just a body's way of defending itself from intruders, so viruses, bacteria, what have you. The body releases chemicals that are called cytokines or mediators and produces natural antibodies in response. So this is just normal processes evolved over time for the body to be able to defend itself. And then, the next time that it encounters that invader, it's swifter at going after and attacking the virus or the bacteria.

And kids develop higher fevers in response to these invaders because their immune systems aren't fully mature and fine tuned, so they go at the invader with full force. So they can often have, you know, high temperatures, 103, 104, rarely above 105. But it doesn't necessarily mean that it's any more serious of infection. It just means that they have a very robust immune system.

Scott Webb: Well, first of all, you're speaking my language. And I'm certain that it plays well with kids. We talked about intruders and invaders, right? So what are the most common causes of fever?

Dr. Misty Navarro: So the common causes of fever that I see are usually what's called the common cold or a viral upper respiratory infection. Nowadays, where, you know, COVID is included in that basket, as is flu, RSV. We see gastroenteritis, which causes vomiting and diarrhea, otitis media or ear infections; croupe, which is that stridor, barky cough that you get. Bronchiolitis is really common. In fact, our bronchiolitis season started earlier this year. And it's very classic. Once you hear it, you know what bronchiolitis is. It's that noisy, kind of raspy breathing that almost sounds a little wheezy. Urinary tract infections are a common cause of fever, especially in female patients less than 12 months old and some uncircumcised boys. And that's really the most common serious bacterial illness that we see in the under two age group. There's some less common causes of, you know, sepsis or bacteremia where you have bacteria in your bloodstream, appendicitis, cancers, but those are far less common than all of the other things that I mentioned.

Scott Webb: Yeah, a lot of that stuff does seem like it's on the greatest hits list, if you will. And wondering as a parent, I'm sure parents would benefit from this answer, you know, a lot, when should we be concerned about fever? When should we bring our children to the ED or, you know, possibly urgent care? Basically, when should we seek medical attention?

Dr. Misty Navarro: If the infant or the child is under three months old or premature, maybe up to four or five, even six months, depending on how premature, those are children that we worry about serious bacterial illness. They're more likely to have reasons to be admitted to the hospital, need for antibiotics. If you're in that three months to three-year age group and you're ill-appearing, and I'll discuss that in a second, those are children that should come in or if you have any signs of, you know, respiratory distress, any febrile seizure should probably be evaluated, I'll talk about that later. And then, if your child has a complex medical history or special medical considerations, those are children that should come in for evaluation and, hopefully, you have a plan with your pediatrician ahead of time if you do fall into that age group.

What should you be looking for to indicate that your child might be seriously ill? If they have poor feeding, excessive vomiting or diarrhea, they're lethargic or not making eye contact, they have an abnormal cry, they have any signs of respiratory distress, so increased work of breathing, poor color, apnea or they stop breathing, any signs of dehydration, like they're not making wet diapers, their lips and their tongue are dry or cracked, sunken eyes, and that can just look like dark circles around their eyes where they're kind of like just almost collapsed in, those are signs of pretty profound dehydration. Any abnormal skin color, and like I said, febrile seizure.

Scott Webb: Yeah. So let's assume that our child has a fever, elevated fever and one or more of, you know, the appearances or the things going on that you mentioned there. So we bring them in to the ED for evaluation. What are you looking for?

Dr. Misty Navarro: Our goal is to rule out serious bacterial illness or any sort of life-threatening conditions. So you should expect that you're going to get a full history and physical, looking at their, you know, medical history, birth history, looking for any abnormal physical exam findings and sort of looking for the source of the fever, if you will. And it'll depend on the patient. If you're coming in with respiratory symptoms, we might go down that pathway. If you're having diarrhea, we'll go down a different pathway. Rashes. So it really depends on the symptoms that your child's having. So if your child is less than 28 days and you come to the emergency department with a fever, you can expect a full septic workup.

Twenty-nine to 60 days, it's a little bit more nebulous. They'll get blood, urine, maybe a lumbar puncture depending on lab results and how the child looks. They may get a chest x-ray if they're getting respiratory symptoms. Viral testing, COVID, flu, RSV, a cath urine specimen and plus or minus admission, depending on the results, how the kid looks and the ability for close followup.

So once you get past 60 to 90 days up to three years and the child's fully vaccinated, rarely are you going to need blood work because now your risk of having a serious bacterial illness is less than a percent. The most common causes are going to be some of those viral things that we mentioned earlier.

Flu, I think we're going to have a really tough flu season just based on data in the southern hemisphere. And so that and RSV, those are kind of the things that we're looking at. Stool studies, sometimes if they're having a lot of diarrhea. Close followup. These kids rarely need to be admitted to the hospital.

Now, that being said, if you're child's unvaccinated with, you know, their primary pediatric vaccinations, that's a completely different child. And that's a child you're going to do a more extensive workup on because they're at higher risk because they don't have the protection of vaccines.

Scott Webb: Yeah, I see what you mean. And we covered some ground earlier. You were mentioning that folks, maybe naturally as the fever goes up for a child, you think, well, they must be getting even sicker. The illness must be worse because their temperature is higher. So that's maybe one of the myths. Are there any others that you can dispel for us?

Dr. Misty Navarro: Another myth is, you know, that fevers are bad and can cause brain damage. As I said, you know, the fever is an important defense mechanism for the body. Fevers are good. That being said, why do we treat fever? Well, we treat it because it makes the kid uncomfortable. You're not sleeping, you don't want to eat or drink. They're not able to stay hydrated. So We treat the fever less because the fever is bad in and of itself, but it makes you feel uncomfortable.

Another fever myth is that all fevers need to be treated, and we really only treat the fever if the child's looking uncomfortable, not sleeping, not eating, not drinking. You know, there's a lot of times I hear about parents waking their children up from dead sleep in the middle of the night to medicate them for a fever. It's really unnecessary.

Another myth is that if the fever doesn't go down, it means it's more serious. I usually tell parents that Tylenol, ibuprofen, acetaminophen, and what have you, they're not curing a fever, they're just hiding it for a little while. And when the medications wear off, the fever is going to come back. Usually, the body will resolve fevers within two to five days. If it's lasting beyond that, that's probably a child that needs to come in for further testing to make sure they don't have something else going on.

Scott Webb: Well, doctor, this has been really educational today. I'm sure parents agree. You know, those of us who are parents, we have kids, as you say, there's things that we can do at home. We can reach out to providers we can go to the ED. So lots of options, which we want with kids. So thank you so much, doctor. You stay well.

Dr. Misty Navarro: All right. Thank you so much.

Scott Webb: And for a complete list of all of our podcasts, please visit svmh.com. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.