Top 10 Confessions of a Pediatrician

What she really thinks about the Internet, 3 a.m. calls, and other tricky issues.

The Truth About Colds and Fever

doctor holding newborn baby

We want to tell you, off the record, that cake for breakfast is not always a bad thing.

I live a double life. Three days a week I wear the hat of a pediatrician in a busy practice, providing medical care and advice on parenting issues ranging from potty training to puberty. The rest of the week, I'm a stay-at-home mother of a 2-year-old, attending play dates and music classes, and blending in with the rest of the world in my minivan and workout clothes. In my Mommy world, I'm sometimes drawn into friendly conversations filled with medical misinformation, which leaves me in an awkward position: Do I slip off my sweatjacket right there on the playground and don my white coat? Or do I keep my opinions to myself? Here's how I solved my dilemma: I've put it in writing -- and have come up with my top 10 points. Below is a glimpse into the life of Dr. Mom. I hope the information will help you and your pediatrician communicate better.

1. We know that colds are frustrating and miserable. We in the medical profession have found lots of fancy-sounding terms to describe colds, from "viral upper-respiratory infection" to "purulent rhinitis." But what we're really telling you is that your child's illness, uncomfortable as it is, is just a cold. Symptoms are wide and varied and often include a runny nose (clear, yellow, or green -- the color doesn't matter), fever, cough, sore throat, congestion, and fussiness, for up to two weeks. The old "colds only last 7 to 10 days" rule is really misunderstood. By the 7- to 10-day mark, a cold should be showing signs of improvement, but it may not be completely gone.

So why do we persist in describing this type of illness as "viral rhinosinusitis" instead of a plain old cold? Oftentimes we're afraid parents will think we're downplaying their concerns. Somehow, giving an illness a more elaborate term seems to validate those concerns. So are you wrong for bringing your child to the doctor when it's "just" a cold? Absolutely not! Colds are very real, miserable, frustrating illnesses; as doctors, we're equally frustrated that there's little we can do to make them disappear. Next time your pediatrician diagnoses your child with a "viral syndrome," catch her off-guard and say, "Oh, you mean a cold." You'll make her squirm, but better yet, show her you're no dummy!

2. Fever isn't dangerous. When parents frantically alternate fever-reducing medicines every three hours, put children in tepid bathwater, or sponge with cold washcloths to try to lower temperatures, pediatricians want to cry "fever phobia!" The truth is, there is no magic number at which a temperature becomes dangerously high. Even temperatures of 105? won't cause brain damage. (The one exception is a fever in a newborn. If your baby is 3 months or younger, any fever above 100.4? could be serious and warrants an immediate call to your doctor.)

We advocate treating fever to decrease the chances of dehydration and to make a child feel better, but a temperature that doesn't lower to normal range with the administration of antifever medications is no more dangerous than one that does. Alternating different antifever medicines -- ibuprofen and acetaminophen, for example -- is a widely accepted practice, but it's never been proven to have any added benefit over using one medicine alone. Whatever fever remedy you use, make sure you administer the recommended dosage for your child's weight and age.

The bottom line? It's not the fever that concerns pediatricians, it's the associated symptoms. Lethargy, inconsolable crying, rash, or respiratory distress accompanying a fever are indications that your child should be evaluated by a physician to determine the cause of her underlying illness.

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