Persistant low grade fever in 21 month-old.

  1. Hi!

    I'm a future nursing student starting a BSN program this Fall (yeah)!

    My daughter (21 months) has been running fever now (intermittant, as I think it goes down while she's sleeping) for 12 days. Highest it's been though is 100.7 rectal. Had her urine checked b/c she recently had a kidney infection but it was clear (this was on Sat.). I normally would maybe assume she just runs a higher temp since it's on the cusp of normal, but she normally runs a much lower temperature, in fact it's quite low when she's asleep or just woken up. It's been as low as 96.6 when I've taken it during the night (again, rectal). Her normal daytime temp runs around 98.9 (rectal). And with the UTI she ran around the same temps (highest 100.4) for the previous 5 days before it spiked and I took her to the ER at 105. So, as of late, 100.2-100.4 means something is going on, not that that can change and be "normal" for a kid, but it was about a month ago that she had the kidney infection and the 100.2-100.4 did mean her body was fighting something. She has no other symptoms but last night she slept for 16 hours straight and then today, after only being awake for 2.5 hours took a nap for another 2 hours. Both times I had to go in and wake her up. When she's awake she acts completely normal, eating, drinking, and playing fine. Oh...I have also noticed maybe 3 small bruises on her trunk in the last week. This is the first time I have noticed bruises on her trunk. They have now all faded and there are no new ones. She may be bruising more easily but I can't be for sure. She takes flovent 44 twice a day (for RAD) and Keflex once a day until we get her renal US and VCUG results back (tests were done on Mon.). Other history is a vascular ring repair (double aortic arch, a congenital heart defect) in Dec. (she is not at a higher risk for endocarditis than the gen. population, however). Her CBC a month ago showed eleveated WBCs 22,000 and an elevated CRP so I assume that since her WBCs weren't like "leukemia" high then that they wouldn't be now, so am I right to not be worried about that....

    I just took her temp again and it was 100.9 so it seems to be going up just a bit.

    Any ideas???

    Any help would be much appreciated!

    Carrie and Madeleine (21 months)
    Last edit by Atlnurstudt on Apr 28, '05
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  2. 29 Comments

  3. by   jeepgirl
    That's very low grade. At my facility, we don't even consider treating a temp (rectal) that is above 100.5 unless the kid is uncomfortable.
    However, we always encourage moms that if they are worried to go see their PCP. Tell your doc / NP what you've noticed and how it has continued... and go from there!!
    Last edit by jeepgirl on Apr 28, '05
  4. by   Mimi2RN
    Sounds like something is not quite right. Kids don't run fevers, even low grade ones, for nothing. Hope you soon get it figured out, I don't have any other ideas for you, as you seem to be having appropriate testing done. If it continues, and you don't find out, get back to her pediatrician, for a thorough check-up.

    Keep in touch, I'd like to know what you find out.
  5. by   Jolie
    You have noted 2 symptoms, persistent low grade fever, and fatigue that are concerning to me. I don't pretend to know why they are occuring, but I do think that a return visit to the pediatrician is in order.

    You mention that your daughter had a vascular ring repair. Did that involve any type of synthetic graft or patch? If so, I wonder if that could be the source of an inflammation/infection?

    Please let us know how she is doing!
  6. by   Jenneu
    keep up at it until you get some answers. Since her CBC showed an elevated white count, I'd want a repeat if it were my child (with differential).

    Hope she feels better soon!

    J
  7. by   jeepgirl
    Quote from Jenneu
    keep up at it until you get some answers. Since her CBC showed an elevated white count, I'd want a repeat if it were my child (with differential).

    Hope she feels better soon!

    J
    a manual diff!
  8. by   LaShell
    22,000 WBC is pretty high, and too long to be running a fever imho, even though it is low grade. Also the bruising.... How are her platelets, how about a blood culture, liver tests? Have you had those done? Good luck to you!
  9. by   Atlnurstudt
    Hi,

    I haven't taken her to the doc. yet (I feel really guilty about that but I have a Micro Lab final in about an hour; I can only handle so much in one day ) The CBC she had done a month ago was in the ER and WBCs were high b/c she had a rather bad kidney infection. I tried to make a sick appt. for tomorrow but they wouldn't let me until tomorrow, how stupid is that! Argh, this is our second pediatric practice (we changed after the heart defect (oh, no grafts btw) was repaired for a lot of reasons). So...I'm going to take her in tomorrow and demand a CBC with manual differential, LOL! I dread it b/c her kidney infection only got so bad b/c when I took her in last time with fever (6 days duration mind you) they told me it was a virus and did NOTHING, they didn't even get a urine sample...stupid when I look back on it, I knew at the time that they should look at her urine but I'm just a lowley nursing student, what do I know, right...?). Well after this last episode (and the Doc. did appologize to his credit) I am going to go in there and be assertive, I know my little girl better than they do, plus she likes to be a "zebra" for whatever reason. It's never been the "usual" when it comes to her. Gotta love her for that though, she does everything in style, especially when comes to getting sick (already got a trip to the Children's hosp. in a helicopter! ) I'm alway on the brink of a nervous breakdown however... :chuckle

    Thanks for your replys and any future thoughts!

    Blessings,
    Carrie
    Last edit by Atlnurstudt on Apr 28, '05
  10. by   Atlnurstudt
    Hey,

    With the exception of Mon. and Tues. this week, my daughter has continued to have a fever, highest 101.5 rectal, usually under 101, between 100.4 and 101 rectal. She did have a CBC and sed rate, both normal. Ummm, this Mon. and Wends. she also slept for 15-16 hours overnight, long for an almost 2 year old I thought. She's fine when she's awake, happy, eating, drinking. Was cranky tonight and last night but hard to say why, LOL! What do you think I should do at this point? I was SO excited yesterday when she hadn't had a fever for 2 days, I thought it was over. Now I'm worried again. I even bought a new digital thermometer to be sure. It's BD and just a traditional 1 min. one. My other is BD too, but takes temp. in 10 sec. I thought this new one would be more reliable and it's actually reading .3 degrees higher than the other. Soooo, any ideas? I'm at a loss and don't want to make a mistake. Her heart defect went undiagnosed for 13.5 months b/c my ped. wouldn't listen to me (I trusted her a bit too much instead of being assertive) so I've already had a bad experience b/c of this sort of thing. I'm with a new pediatric group but really it's been awful there b/c I can never see the same doc. for a sick appt. and I have to beg them to listen to me, they ALWAYS say "well...she looks good." 10 MDs and 2 PNP in the group. Could go back to her old ped. where I might feel more comfortable. She didn't catch the heart thing but she knows my daughter really well and tends to err on the side of caution. I trust her more than the people in this group, anyway. I have learned that it's more about having a doctor who will trust you and work with you, that doctors make a lot of mistakes, little ones mind you, because it's not an exact science and they're human. Well...sorry I'm rambling. Please let me know if you have any ideas? Should I ask to be referred to a specialist? What kind?

    Thanks!

    Carrie
    Last edit by Atlnurstudt on May 5, '05
  11. by   VickyRN
    Just a thought... the persistent low grade temps and fatigue are suggestive of endocarditis. I know you stated she is not at any greater risk than the general population, but with her history of heart surgery, I would question that. Have they done any blood cultures on her? Also, an echocardiogram would be a good idea.
  12. by   Jolie
    Generally speaking, I am not in favor of using the ER for this type of problem, but since you have been thru 2 pediatric offices with little consistency or satisfaction, I think it may be time to call in the big guns.

    I would seriously consider going to the ER of a reputable Children's Hospital. Write up a thorough history of her heart problem, surgery and current illness, including lab results, and bring it along. Insist on seeing an attending physician.

    Good luck!
  13. by   Atlnurstudt
    Thanks for all of the advice so far, I didn't even think of going to the ER. I did look up some info on endocarditis and that definitely seems possible. Would I be able to hear some sort of murmur if I listened to her?? Just wondering? They haven't done any cultures yet either...I'm going to take her temp again tonight (it was just 100 rectal this afternoon, is that still considered fever?). I will need to figure out a good time to go to the ER so that I don't have to wait forever. (I've never been coded a "green" before, and have waited up to 8 hours as a "yellow", heck when she came in on a helicopter, I'm assuming she was a "red" at that point, I still waited around 30 min. before I saw the surgeon). We do have an excellent children's hospital here in Atlanta and I LOVED my last doc. there, Dr. Judy Mills, the woman is a MD who treated us like a wonderful nurse would have, can't beat that!!!!

    Blessings,

    Carrie
    Last edit by Atlnurstudt on May 5, '05
  14. by   jeepgirl
    Quote from Atlnurstudt
    Thanks for all of the advice so far, I didn't even think of going to the ER. I did look up some info on endocarditis and that definitely seems possible. Would I be able to hear some sort of murmur if I listened to her?? Just wondering? They haven't done any cultures yet either...I'm going to take her temp again tonight (it was just 100 rectal this afternoon, is that still considered fever?). I will need to figure out a good time to go to the ER so that I don't have to wait forever. (I've never been coded a "green" before, and have waited up to 8 hours as a "yellow", heck when she came in on a helicopter, I'm assuming she was a "red" at that point, I still waited around 30 min. before I saw the surgeon). We do have an excellent children's hospital here in Atlanta and I LOVED my last doc. there, Dr. Judy Mills, the woman is a MD who treated us like a wonderful nurse would have, can't beat that!!!!

    Blessings,

    Carrie
    100 rectal is a normal temp.

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