Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
What to Expect the Toddler Years (203 page)
Has your toddler recently begun taking a new medication?
Has your toddler recently eaten a new or unusual food or a food that might have been spoiled?
If the doctor doesn’t have your child’s chart at hand, this information might slip his or her mind. This information is especially important if the doctor has to prescribe medication. Let the doctor know:
Your child’s age and approximate weight.
If your toddler has a chronic medical condition and/or is presently taking medication.
If there is a family history of drug reactions or allergies.
If your child has had any previous reactions to medications.
The telephone number of your pharmacy (if a prescription is to be called in).
In addition to details of your toddler’s symptoms, it will also help to have ready any questions you have (about diet, keeping your toddler home from day care, calling back if the symptoms continue, etc.) and a pencil and pad (so you can record any instructions). Keeping an illness “diary” in a health history record or notebook or on the computer will give you an important resource for the future when you’re trying to remember information, such as which medicines your toddler won’t tolerate or how many ear infections he or
she had last year; and it may remind you to ask your doctor certain questions.
If the doctor is unavailable when you call, ask when you can expect your call to be returned. Then be sure you’re available at that time; don’t tie up the telephone or run out to the bank while you’re waiting. If you must leave the house, call the doctor’s office back and let them know when you can next be reached. If your call isn’t returned as expected, try again, just in case there has been a slipup—a misplaced message, for instance.
LL ABOUT FEVER
Your toddler’s uncharacteristic morning tantrum over what to wear tells you something isn’t quite right; a little later the glazed eyes and the too-rosy cheeks say the same thing. When your little one listlessly puts down the spoon and falls asleep at the table at noon, there’s further corroboration. A touch to the forehead sends you hunting for the thermometer; within minutes, your suspicions are confirmed: Your toddler is running a fever.
Do you rush to the medicine cabinet to dip into your stash of acetaminophen elixir? To the telephone to call your toddler’s doctor? To the bathroom to run a cool tub? To the bedroom for some extra blankets? To the kitchen to warm up some chicken soup—or to pour a glass of orange juice? Do you do all of the above? Or none of the above? Knowing the answers is important to your toddler’s health and well-being.
Scientists now believe that fever, in most cases, is not an enemy (even fevers as high as 106°F, or 41.1°C, do no permanent damage), but rather the body’s protective response to such invaders as viruses, bacteria, and fungi. When one of these menacing microorganisms makes its way into the body, white blood cells take action and produce a hormone called
interleukin
, which travels to the brain to instruct the hypothalamus, a gland in the brain, to turn up the body’s thermostat. It appears that higher body temperatures help the immune system to fight infection and that some microorganisms
are unable to thrive at these elevated temperatures. Fever may also lower iron levels in the body while increasing the invaders’ need for that mineral—in effect, starving them. When it’s a virus that has launched an attack, fever enhances the production of interferon and other antiviral substances in the body.
KNOW YOUR TODDLER
Toddlers, like the rest of us, vary in their responses to pain. Some can tolerate a great deal (the curious climber who falls off the monkey bars, gets up without so much as an “ouch,” and climbs right back on) and some very little (the fledgling walker who shrieks with every tumble, even when the landing is cushioned by a plush carpet). It’s a good idea to take such differences into account when deciding how sick your toddler is. For example, if a feverish child who is ordinarily a stoic is pulling one or both ears, consider an ear infection—even if he or she doesn’t seem to be very uncomfortable—and call the doctor. On the other hand, if you’ve got a very pain-sensitive child, you might be wise not to fly to the phone at each and every whimper. Be wary, however, of the cry-wolf syndrome; keep in mind that the child who complains a lot will sometimes actually be sick.
The chills and shaking that often occur when body temperature suddenly rises a couple of degrees above normal signal the body to turn the heat up still higher—while encouraging the fever sufferer to take measures that will stoke the fire even more (drink some hot cocoa or tea, pile on another blanket, or cuddle up in a heavy robe).
Normally, body temperature is at its lowest (as low as 96.5°F, or 35.8°C, taken orally) between 2
A.M.
and 4
A.M.
, is still relatively low (as low as 97°F, or 36.1°C) when we get up, then slowly rises over the course of the day until it peaks between 6 and 10 in the evening at about 99°F (37.2°C). Body temperature tends to be slightly higher in hot weather, lower in cold, higher during exercise than at rest. It’s more volatile and subject to greater variation in young children than in adults. A toddler is generally not considered to have a fever until the rectal temperature reaches 100.5° to 101.1°F (38.1°C to 38.4°C).
Fever behaves differently in different illnesses. In some, the body temperature may remain persistently elevated; in others it will be lower in the morning and higher in the evening, or rise, fall, and spike again with no obvious pattern. The way the fever behaves sometimes helps the doctor to make the diagnosis.
When fever is part of the body’s response to illness, temperatures above 106°F (41.1°C) are rare, and those beyond 108°F (42.2°C) unheard of. But when fever results from failure of the body’s heat-regulation mechanism, as in heat illness, temperatures can soar as high as 114°F (45.6°C). Such extremes can occur when the body is producing too much heat or can’t cool itself effectively, either an internal abnormality or—more commonly—because of over-heating caused by an external heat source, such as a sauna or a hot tub, for example, or the inside of a parked car in warm weather (air temperatures inside a closed car can quickly shoot up to 113°F, or 45°C, even with the windows open 2 inches and the temperature outside a moderate 85°F, or 29.4°C). Overheating can also result from strenuous physical activity in hot, humid weather or from being very overdressed in very hot weather. (Though toddlers are less susceptible to heat illness than they were during the first year of life, sensible precautions still need to be taken; see page 499.)
Fever due to the failure of heat regulation is an illness in itself; not only is it not beneficial, it is dangerous and requires immediate treatment. Temperatures over 106°F (41.1°C) that are due to illness also require immediate treatment. It’s believed that fever that high ceases to be helpful and that, at this extreme, the positive effects of fever on the immune response may be reversed.
AKING YOUR TODDLER’S TEMPERATURE
The fastest and easiest way to determine whether your toddler has a fever is to touch your lips or the back of your hand to one side of his or her forehead or the nape of the neck. With a little practice, you will quickly learn to discern the difference between normal and feverish. If your toddler feels warmer than normal, use a thermometer to get a more precise reading. Be aware that the lip-touch system works less reliably if either you or your toddler has
been outside (in the cold or in the hot sun) or in a warm bath, or if you recently sipped a hot or cold drink. A young child’s forehead may also feel toasty when he or she crawls out from under the covers in the morning, whether there’s fever or not.