Pose your questions on Ask, Answer, Learn to Dr. Greene and the DrGreene.com community.
Ask DrGreene
Dr. Greene will be chatting live for one hour on Tuesday February 16th at 10:00 a.m. PT (Noon CT) (1:00 p.m. ET). Click Here to chat with Dr. Greene
Fast Fact
Most bacteria and viruses that cause infections in humans thrive best at 98.6 degrees F (37C). Raising the temperature a few degrees can give the body the winning edge. In addition, a fever activates the body's immune system, accelerating the production of white blood cells, antibodies, and many other infection-fighting agents.
Brain damage from a fever will not occur unless the fever is over 107.6 degrees F (42C) for an extended period of time.
Untreated fevers caused by infection will seldom go over 105 degrees unless the child is overdressed or trapped in a hot place. In a neurologically normal child, the brain's thermostat will stop the fever from climbing above 106 degrees F.
· About 4% of children will sometimes have seizures with fever. These febrile seizures are caused by rapid increase in temperature, not by the height of the temperature. Once a child already has a high fever and a febrile seizure, a febrile seizure is unlikely to reoccur with the current illness. In any event, typical febrile seizures are over in moments with no lasting consequences.
While 98.6 degrees F is considered the normal core body temperature, this value varies between individuals and throughout the day. The daily variation is minimal in children less than six months of age, about 1 degree in children 6 months to 2 years old, and gradually increases to 2 degrees per day by age six. A person's baseline temperature is usually highest in the evening. Body temperature, especially in children, is normally raised by physical activity, strong emotion, eating, heavy clothing, elevated room temperature, and elevated humidity. Rectal temperatures below 100.4 degrees F (38C) may be entirely normal (no fever). A rectal temperature of 100.4 or above should be considered a fever. Lower values might be a fever, depending on the child.
A fever does not necessarily need to be treated. If a child is playful and comfortable, drinking plenty of fluids, and able to sleep, fever treatment is not likely to be helpful.
Steps should be taken to lower a fever if the child is uncomfortable, vomiting, dehydrated, or having difficulty sleeping. The goal is to bring the temperature between about 100 and 102 degrees F -- not to eliminate the fever.
When trying to reduce a fever, first remove excess clothing or blankets. The environment should be comfortably cool (one layer of light weight clothing, and one lightweight blanket to sleep).
Two medicines are useful for reducing fever in children: acetaminophen (Tylenol) and ibuprofen (Children's Advil or Motrin). Acetaminophen is given every 4-6 hours, and works by turning down the brain's thermostat. Don't use under three months of age without first having the child examined by a physician. Ibuprofen is given every 6-8 hours, and helps fight the inflammation at the source of the fever. It is not approved for children under 6 months. Both medicines may be given for stubborn fevers, but be very careful about using the correct dose of each.
A lukewarm bath or sponge bath may help cool a febrile child (after medication is given -- otherwise the temperature bounces right back up). Cold baths or alcohol rubs cool the skin, but often make the situation worse by causing shivering, which raises the core body temperature.
Fever is a signal that something is going on in your child. Usually this is a minor illness, but it can be a serious infection, such as meningitis. Any child less than 90 days old with a fever should be examined by a physician right away, to rule out a serious infection (unless there was a DPT shot in the previous 24 hours). Children of any age who have a fever 104 degrees or more should also be seen, unless the fever comes down readily with treatment and the child is comfortable. Any child who has a fever and is very irritable, ill appearing, confused, has difficulty breathing, has a stiff neck, won't move an arm or leg, or who has a seizure should also be seen right away.
Even without the above symptoms, children under 6 months of age with a fever should be examined by a physician within 24 hours (again unless they just had a DPT), since they may have some infection that needs to be treated. Older children with a fever (6 to 24 months old) who are acting well and have no other symptoms should be seen if the fever lasts >48 hours (or >72 hours if they do have minor cold or flu symptoms).
You may or may not have seen the injury, but now your young child won’t use the arm. Is it broken? Nursemaid’s elbow can be quite painful, but it can also be fixed in moments with dramatic relief.
What is elbow subluxation?
In children under about 4 years old, the head of the radius bone (a bone in the forearm) is not as big proportionately as it will be later. When the arm is straightened and pulled, the elbow joint is loose enough to separate for a moment while a bit of ligament slips between the bones before they snap back together. Ouch!
Who gets elbow subluxation?
Elbow subluxation is a common injury in toddlers and preschool children. It is most common when children are swung, pulled, or lifted with the arm at full length. It is especially common if kids are yanking their arms against the pull. The injury also happens sometimes with falls.
What are the symptoms of elbow subluxation?
The main symptom of elbow subluxation is refusal to use the affected arm. Kids will usually hold the arm close to the body, with the elbow bent. The hand is usually turned down or toward the body.
Kids may scream if you attempt to turn the hand or move the elbow, but there is unlikely to be swelling or bruising.
Is elbow subluxation contagious?
No.
How long does elbow subluxation last?
Nursemaid’s elbow usually lasts until someone manipulates the joint to free the trapped ligament.
How is elbow subluxation diagnosed?
The diagnosis is usually made based on the history and physical exam. If there is a question that there is a fracture, X-rays may be needed.
How is elbow subluxation treated?
If there is clearly no fracture of the bones around the elbow, elbow subluxation is treated by manipulating the head of the radial bone to allow the trapped ligament to spring free. This is done by turning the hand upward and bending the elbow while holding pressure over the head of the radius. Some doctors use a different technique, where they turn the hand downward until the palm is facing out (called hyperpronation).
A click is often felt as the joint springs back to normal position.
This causes a moment of increased pain before dramatically increasing the child’s comfort. Moments later, you will often see the child running and playing as though nothing had happened.
How can elbow subluxation be prevented?
Avoiding pulling on the outstretched forearm of young children can prevent some cases of this common injury. Special care should be taken when lifting or swinging children.
Thanks for this. This happened to my son last night and it is so true that one minute, he was screaming and crying while the doctor was putting the ligament back, and the next minute he literally was running around the hospital as if nothing happened!
You may not see an immediate improvement, but if you are going to successfully treat eczema, it is important to break the cycle! Click here to find out how.
Comments
like night and day!
Thanks for this. This happened to my son last night and it is so true that one minute, he was screaming and crying while the doctor was putting the ligament back, and the next minute he literally was running around the hospital as if nothing happened!