Fevers in children

BSNtobe2009 · Oct 3, 2006

Ok, I am new to this site but have searched it out because of the following.
I am a school nurse, who's background is in long term care. I have children of my own, so dealing with children is not of anything new.
I have a fourth grader is my school who has had a low grade fever for the past three weeks of 99 to 100.4 and has occassionally reached 101.0. He has compalints of stomach pain, and has just about had every test immaginable to determine what is going on with him. All of his blood work is within normal limits, not to mention his scans, xrays etc. The doctors are unable to find anything. I am treating him at school for a fever of unknown origin. He has some social issues as well. Has anyone ever heard of developing a fever related to psychosocial problems in pediatrics. I realize the mind is a powerful thing and can trick the body to do just about anything. Irealize this is not a dangerous temperature however, I am concerned because I know he truely thinks he doesn't feel good, Mom is upset and the Dr's are at their whits end knowing what to do for him. Not to mention, I have to send him home with an elevated fever and he can't afford to miss to much school.
Does anyone have any experience with this or know where else I can look?
Thanks so much
Mary

When I was in my last semester of college of my Senior year (yup, great timing)....I got a cold, fever, ran through antibiotics..no biggie right? A day later the fever was back...it went down after Tylonal, but right on the 4 hour mark, like clockwork, the fever was back.

Guess how long the fever lasted? Almost 7 weeks...I am not kidding.

I wasted away to 84 lbs (at the time I was normally 105)...doctors had no explanation for it...he told my mother that if I wasn't running a fever he would suspect I had anorexia.

The fever slowly went away, and it took about another 4 months before I felt like myself. To this day, I have no idea what I had.

My father, who is a physician, also had no clue...but he thinks I had a very stubborn strain of the flu that lingered. The only other symptom that I had was just the regular, hurt all over feeling...it wasn't centralized to any particular area, and I felt like I could sleep forever...strangely...after I had had the fever about 3 weeks...I couldn't feel the heat anymore.

It was the only time in my life that I really and truly thought I was going to die.

ItsyBitsySpider, BSN, RN · Oct 4, 2006

Hey Mary,

Strange situation going on there. I don't know if this helps, but I can tell you that my brother had low-grade fever when he was really tired for many years. This went on until he was in 7th or 8th grade. I don't know if this may be the case with this child but you never know. I would assume that the doctors have ruled out mono, TB, and other easily diagnosed illnesses. I think even lymphoma can cause chronic, low-grade fever but I would hope his MD has already looked into this. Is it possible for you to get mom's permission to speak to the student's MD to see what he thinks is going on? Seems kind of ridiculous that he has to miss so much school if his doctor does not believe he is contagious. I'm not a school nurse so I don't know how that all works. Update us if you find something out, I'd be interested to see what's going on with this little guy.

NRSNFL · Oct 6, 2006

Plus if it were lymphoma, I'd be hard pressed to believe his labs would be "normal". We have a ton of kids come in for FUO. If the labs are all normal, I would be surprised if it is a long running virus...but has he gone to a children's specialty hospital or just his local community hospital. Being that I work for a childrens hospital, we get kiddos from the local community hospitals all the time and they just have no clue.....

tjb6929 · Oct 6, 2006

Hi, this is very strange for a fever to last that long with no known origin. i am just wondering when his fever would reach 101 were there ever blood cultures drawn on him? because this would help to figure out the type of bacteria that is causes the fever/infection. what kind of stomach pain was he having? nausea? or just pain? i am sure they long since ruled out appendicitis.well if he is having a lot of emotional stress, stomach issues woud not be surprising. hmmm...interesting. let me know about those blood cultures. :nurse:

txspadequeenRN, BSN, RN · Oct 6, 2006

Well let me add a situation here... My daughter is 3 years old all of a sudden started spiking temps ..actual temps 106 no adding or subtracting a point. Called the doc's office after a couple of days , well it's probably just a virus ..gave me all the instructions for fever and told me to watch it . Now I realize that this is not all that uncommon and decided to watch it and see if the fever deceased. She also told me that as a pedi nurse they see this all the time and it's really not all that high..... HUMMMM. Anyway we did this for an additional week and a half .. the fever went away for about a day and a half. Then HELLO.... here we go again 106, I pulled back the covers and BAM.. no way to deny, this three year old has a rip roaring UTI. I called the office and told them she was coming in that day. Got her in and I was right .. no virus and so she had to Rocephin and now is on 10 days of ABT's... Whats even better than that is because her sister had reoccurant UTI's she had to have her ureters reimplanted and has a grade 5 scarring on each kidney.. my 3 year old will probably need to go through the same testing to see if she has the same thing.....

ljgrn · Oct 6, 2006

Did they do a urine culture?

tjb6929 · Oct 7, 2006

txspadequeen921, this is not normal for a child to have 106 temps. i ahve been a pediatric nurse for only 4 years in a hospital and i know that temps over 101 consistently are not "normal" and do have cause for concern. as a matter of fact in the hospital we can not discharge a pediatric patient that is consistently running high fevers, low grad maybe..but not higher or equal to 101. blood cultures and urine cultures would have been one of the first things that would have been done on your daughter. especially with her sister having a history of chronic UTI's leading to needing a ureters implant! as a parent myself this situation upsets me, because there is no reason to allow high fevers to continue on with out proper treatment and care. low grade temps are helpful and should not be treated, because it is a sign that there is an infection that the body is trying to fight off..however very high temps over 104 are dangerous and should be taken seriously. just thought i would share my knowledge. i am PALS certified and have attended many seminars and training events in which top pediatris doctors in our hospital host and fevers are one of the topics discussed. hope your daughter is doing better! :nurse:

scribblerpnp · Oct 9, 2006

What labs have been done? Everyone has mentioned blood cx and urine cx. What about Mono? The upset stomach and fever scream out Mono to me (without being able to SEE the pt anyway.)

I wouldn't be as worried of the 99-100.4 temps. The 101 is odd. I know that when I was a kid and even now, when I'm upset or stressed, I can get my temp to go up to about 100.2. When I was little I was especially good at this and was able to talk myself into being sick and the school nurse would send me home b/c I had an increased temp. The real reason I wanted to go home was because I didn't like my school teacher. I managed to do this about 3-4x/month until my mom figured out what was going on and threatened me within an inch of my life (she was a nurse too).

Please keep us updated at to the dx. I'm interested as to what happens!

Pedi-ER-RN, RN · Oct 9, 2006

I was thinking of MONO too.

txspadequeenRN, BSN, RN · Oct 9, 2006

You see this is what I was thinking. I complained to the Doc about this because even though I am not a Pedi nurse I am also not dumb.. I do have 5 children that are alive..lol anyway she is doing better and we are waiting on the C&S to come back. But next time the wont pull that crap on me...

txspadequeen921, this is not normal for a child to have 106 temps. i ahve been a pediatric nurse for only 4 years in a hospital and i know that temps over 101 consistently are not "normal" and do have cause for concern. as a matter of fact in the hospital we can not discharge a pediatric patient that is consistently running high fevers, low grad maybe..but not higher or equal to 101. blood cultures and urine cultures would have been one of the first things that would have been done on your daughter. especially with her sister having a history of chronic UTI's leading to needing a ureters implant! as a parent myself this situation upsets me, because there is no reason to allow high fevers to continue on with out proper treatment and care. low grade temps are helpful and should not be treated, because it is a sign that there is an infection that the body is trying to fight off..however very high temps over 104 are dangerous and should be taken seriously. just thought i would share my knowledge. i am PALS certified and have attended many seminars and training events in which top pediatris doctors in our hospital host and fevers are one of the topics discussed. hope your daughter is doing better!

**canoehead, BSN, RN** · Oct 9, 2006

I worked in peds 6 years and the ER for two, and for a fever of 106 I would be going straight to the ER, and it's an even bet as to whether I'd stop long enough to give Tylenol- let alone see if it worked. The nurse you talked to was dangerous and crazy. She might do that to her kid, but not me- no way. I wouldn't talk to her for advice again.

It's like your kid's arm was cut off and she told you to apply pressure and wait and see if the bleeding stopped. The bleeding might stop (it all stops eventually) but you need to deal with the cause of the problem!