Top 10 Confessions of a Pediatrician
The Truth About Colds and Fever
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.
3. We hate the Internet. Okay, so that's not a completely fair statement. There are certainly a number of very helpful, informative, easy-to-use Web sites out there. As with anything else, however, there are a large number of sensationalizing, nonscientific sites that contain misinformation and provoke unnecessary fear and apprehension in well-intentioned parents.
Your pediatrician should be open to discussing any information you come across on the Internet and, at the same time, be able to provide you with a few reputable and reliable child-health Web sites that you might use. (For suggestions, see "Worthy Web Sites," on page three.)
4. We really try not to run late, and we don't think your time is any less valuable than ours. Trust me, as a mother, I've been there. You've left the house without a spare diaper or a sippy cup because you've rushed to make it to the doctor's office on time, only to sit for 30 minutes in the waiting room and another 30 minutes in the exam room before she makes an appearance. All the while, your under-the-weather toddler is becoming more and more unmanageable. To be certain, running behind is not something that is just built into the system. Doctors hate it as much as you do! We try hard to stay on schedule, but we hope parents will understand if we've chosen to take extra time to care for another child because she needs it, as opposed to speeding through each visit. We think your children's health and everyone's time is more valuable than that.
5. We really don't mind being woken up at 3 a.m. We may not verbalize that to parents, but that's the truth. Not only do we not hate it, as is commonly feared, but we expect it! We weren't drafted into medicine, we chose it as our life's work; and part of that means being available at all hours, no matter how big or small the problem. I joke with most of the parents in my practice that nothing is certain in life except that fevers and vomiting always start in the middle of the night, and not during office hours. We know that's true, and we'd be surprised if we didn't hear from you from time to time.
6. When it comes to your baby's health, don't listen to your mother -- unless she's a practicing pediatrician. This one might truly get me in trouble, but what I'm referring to is the perpetuation of medical old wives' tales from generation to generation. What exactly do I mean, you ask? Let me offer up a few examples: Constipation causes fever and ear tugging is a reliable sign of ear infections. These notions are often widely held beliefs, but have no physiological basis. So while Grandma is well intentioned, think twice next time she recommends an enema to help pass the "toxins" causing Emma's fever.
More Truths Exposed
7. We don't always have an answer. Here's a truly tough one for most physicians -- admitting when we don't know something. News flash: We're not perfect. With many cases of fever, rash, and other common childhood conditions, we're not able to pinpoint an exact cause. But based on an exam and the features of your child's symptoms, your pediatrician should at least be able to rule out those conditions that would require immediate treatment or further testing, and should also be able to discuss the possible underlying causes and potential courses of action.
8. We hate to examine ears. Ask any parent to name the most stressful part of their child's doctor visit, and aside from shots, she'll probably say the ear exam. Now, ask any pediatrician what the most stressful part of the physical exam is, and she'll probably shout, "the ear exam!" Yes, it's true. To the casual observer, it may seem that holding a child down, cleaning out her ears, and looking through a tiny, lighted pinpoint instrument at her eardrums is about as medically ho-hum as it gets. But it's a painstaking, awful business that makes us want to scream like a toddler. On the other hand, on those rare occasions when we're able to successfully make a game of "looking for puppy dogs in your ears" without making a child cry, it feels as if we have just reached the peak of Mount Everest. "I did it!" we're screaming in our heads, as the crowds go wild with applause and cheers. It's the little things in a pediatrician's life that bring us the most joy!
9. We love your kids. Ask any pediatrician why she went into pediatrics, and her first 20 reasons will be a resounding "because I love kids." We try to win their hearts with stickers or impromptu games of peekaboo, and we secretly hope the parents are paying attention. While we may not come right out and say it, your child (yes, even when he refuses to stand on the scale, screams and kicks at the sight of the otoscope, or suddenly develops steel-trap jaws at the mention of a tongue depressor) is a special part of why we love what we do.
10. We'd like you to give yourself a break. This is good advice that I not only offer up professionally but also try to adhere to personally. Believe me, when it comes to rattling off their latest feat as Supermom or opining on the latest sleep-training strategy, parents can be vicious. While the force behind these words is an honorable one (the love of our children), listening to them can be overwhelming and guilt-inducing. Even pediatricians have been on the receiving end of those evil stares you get from having your 10-month-old out at the grocery store after (gasp) 8 p.m. What we want to tell you, off the record, is that chocolate cake for breakfast is not always a bad thing, inadvertent sunburns at the beach don't make you a horrible mother, a pacifier dropped on the ground still tastes good to a toddler, and bedtimes are made to be missed. The list could go on and on, and while we may come across as sticklers on some things, we acknowledge that the reality of life is a far cry from what you might find in any parenting book. So the next time you pull up next to a frazzled-looking mother in her minivan at a stoplight, and watch as she shoves french fries and animal crackers into the backseat toward her screaming toddler, remember she might just be someone's pediatrician! Give her a wink and a nod, and let her know you're in on her secrets.
Worthy Web Sites
Dr. DuMond's recommendations for accurate, reliable health information:
- The American Academy of Pediatrics: aap.org
- The Centers for Disease Control: www.cdc.gov
- The Nemours Foundation for Children's Health: kidshealth.org
Sara DuMond, MD, is a pediatrician in Mooresville, North Carolina.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.