[mercyteapot]

Do you ever run across parents that tell you this story? "She has a fever of 103, but I didn't treat it because I wanted the doctor to see". Uh, sweetie, the doctor has seen a fever before. Considering that you've been waiting all bloody day for this appointment, don't you think it would have been a good idea to give your kiddo some Tylenol and a tepid bath to make her a little more comfortable?

I used to work for a busy peds practice and we heard this story a couple times a week. A story a co-worker told recently reminded me of it. Whyohwhy do parents think that this is necessary? Do they think the doctor won't believe them unless the kid is actually febrile at the exam, or what?

[LPN1974]

It would be nice if babies came with an instruction booklet, but since they don't, you'd think mother's instinct would manage to take care of some of it.

[SusanJean]

I think this is part of our role to educate parents. Think about it. This has happened to me - the nurse has said "Well, his temp is normal now." (Referring to my child.)
Granted, I knew he had a fever, I know the doctor knows what a fever is, but an off hand comment like that can make you feel as tho you need to actually present with the fever in the office.
And, we are also told that a fever can be good, it can help combat the infection, so when do we treat the fever?

My questions are rhetorical (at this point) as I've "been there, done that" - but even if you know about medicine, when you are a new parent, all knowledge seems to go out the window. A little compassion and patience and willingness to educate parents, make them partners in the care of their children is what is called for.

[Spidey's mom]

Originally Posted by SusanJean

I think this is part of our role to educate parents. Think about it. This has happened to me - the nurse has said "Well, his temp is normal now." (Referring to my child.)
Granted, I knew he had a fever, I know the doctor knows what a fever is, but an off hand comment like that can make you feel as tho you need to actually present with the fever in the office.
And, we are also told that a fever can be good, it can help combat the infection, so when do we treat the fever?

My questions are rhetorical (at this point) as I've "been there, done that" - but even if you know about medicine, when you are a new parent, all knowledge seems to go out the window. A little compassion and patience and willingness to educate parents, make them partners in the care of their children is what is called for.

This is so true - I've felt that way also. "Well, his fever is normal now" . . . .like I'm lying about him actually having a fever and I'm wasting the nurse's and doctor's time.

I've never not medicated my child though . . . but I can sorta understand why some folks don't.

steph

[humglum]

I think this is part of the parent teaching that we should be doing as pedi nurses. Granted, as a nurse for adults I've let fevers go until they reach a certain point (38.5 or so) before I'd medicate for them, because fevers are generally beneficial. However, parents need to know the risks of febrile seizures in kids. I *always* emphasize how important it is to treat a fever so something like that doesn't happen.
I'd hate to think that nurses/docs act like that if a kid in the office is afebrile when he or she is examined. That creates a culture of the parent feeling they have to 'prove' that the kid is febrile and then, of course, they wouldn't treat at home. Very dangerous, in my opinion.
This whole discussion reminds me of the mechanic phenomenon... as soon as I take my car into a garage... poof! that weird sound is gone.

[NoCrumping]

Originally Posted by LPN1974

It would be nice if babies came with an instruction booklet, but since they don't, you'd think mother's instinct would manage to take care of some of it.

When I was a younger mother, way before nursing school... my daughter had a fever.... it was over 100... I didnt treat it, she was vomiting, alot, so I took her to the doctors, not thinking to give the tylenol first..... then I got a good talking to from the nurse, saying she could have had a seizure, why didnt I give the tylenol, etc..... Now I always give it!!!! She was so mean.....

[humglum]

I'm sure she wasn't trying to be mean. I've had that very same conversation with young mothers. I've seen way too many febrile seizures and they're traumatizing and largely unnecessary.

[mercyteapot]

I should have emphasized that I wasn't talking about new parents, although when I was a new parent, I erred on the side of caution and was on the phone to the doctor's office all the time. You can have alll the knowledge in the world, but when its your kid, you still need all that reassurance. It would have been nice if we had had the staff to have nurses answering the phones and booking appts, so that they could have told the parents to go ahead and give the child Tylenol before the appt. I just hated to think of these poor little kids, waiting all day to see the doctor without any pain relief. I think it is important that parents be told about febrile seizures- I know that when I had my son, I got loads of reading material from the OB, hospital, and the ped we chose, but I guess it is different in every setting.

[atlkidrn]

There is a lot of new evidence-based information regarding fever and antipyretics. Knowing nurses are generally short on time, I am still posting a link to a really good article on fever in the journal "Contemporary Pediatrics": http://www.contemporarypediatrics.co....jsp?id=143315

To summarize: Like another poster mentioned, fever can be therapeutic. If a child is running around, able to play, and has a fever, there is not an automatic need to give an antipyretic. Fever will actually enhance the body's ability to fight the infection (viral or bacterial) and hasten the recovery time. An antipyretic can make the uncomfortable child feel better, and that is a good reason to give one. In a child who is has diarrhea, vomiting, or isn't drinking, bringing the fever down can also lessen their dehydration. Interestingly, evidence shows that a child prone to febrile seizures is not less likely to have one just because they received an antipyretic at home.

As a PNP, I think pediatricians/PNP's are more likely to take seriously a report of a fever measured by a thermometer prior to the office visit - treated or not - than a report of "he felt hot."

Other comments or experiences?

[UnewmeB4]

Originally Posted by atlkidrn

There is a lot of new evidence-based information regarding fever and antipyretics. Knowing nurses are generally short on time, I am still posting a link to a really good article on fever in the journal "Contemporary Pediatrics": http://www.contemporarypediatrics.co....jsp?id=143315

To summarize: Like another poster mentioned, fever can be therapeutic. If a child is running around, able to play, and has a fever, there is not an automatic need to give an antipyretic. Fever will actually enhance the body's ability to fight the infection (viral or bacterial) and hasten the recovery time. An antipyretic can make the uncomfortable child feel better, and that is a good reason to give one. In a child who is has diarrhea, vomiting, or isn't drinking, bringing the fever down can also lessen their dehydration. Interestingly, evidence shows that a child prone to febrile seizures is not less likely to have one just because they received an antipyretic at home.

As a PNP, I think pediatricians/PNP's are more likely to take seriously a report of a fever measured by a thermometer prior to the office visit - treated or not - than a report of "he felt hot."

Other comments or experiences?

Thanks for the article!

I rarely gave my children Tylenol, and do not rush to give it to my adult pts in the hospital. Our bodies were designed magnificently, and we, in a "hurry and fix it culture" rush to treat so many times, when the body is doing what it was designed to do. That is how we ended up with the horrendous resistant bacteria we now have. People were always at the DRs, getting antibiotics , so they can keep on going. Take the drugs and run...right back to the rat race...spreading your germs to those around you...and the cycle continues...