Hey, fellow parents. First and foremost, I want to say that I get it. You’re bringing your little one into the ER because you are just that concerned about them. But here’s something that needs to end: Not treating your child at home for a basic fever. (I’m talking about a fever with no other life-threatening symptoms.)
All you have to do is give acetaminophen (Tylenol). That’s it. If you’d like, you can also (as long as the child is no longer an infant) give ibuprofen (Motrin). Then, if you feel it’s necessary, bring your child to the ER.
Too often, we get a child who is under five who is having a fever and nothing more. One of the first things we ask in the ER is “When was the last dose of Tylenol?” For far too many parents, the answer is, “I didn’t give any.”
To this, I have to hold my tongue from spitting out, “Why in the hell not?” I don’t have to say anything at all, though, as most parents will beat me to the punch by hastily excusing themselves from treating their child at home for all sorts of various reasons.
The most common reason is, when you think about it, terrible: You wanted us to see how high the child’s fever is and/or…and this is the WORST…you didn’t think we’d believe you.
Why…in the HELL…would you put the life of your child in the hands of people who wouldn’t believe you?
Let’s make it all clear: WE WILL BELIEVE YOU. If you say your child had a 105.9 fever at home, you gave Tylenol, and now the child’s fever is 99.1, we will still document that and treat the child as though they spiked a high fever. It’s not like we’ll see your child as Tylenol-seeking. Don’t be silly. Treat your child at home. Because if you don’t give your child Tylenol and then bring them in to see us, do you know what we will do for that fever?
That’s right. We will give your child Tylenol.
And this is extra silly for two reasons:
1) I guarantee that your Tylenol at home is cheaper than the Tylenol we will bill you for.
2) Now you’ve just extended your child’s stay in the ER.
It’s the second reason that’s more important, of course. If you bring your child in for a fever and we already see that it’s controlled with Tylenol/Motrin, then we already feel confident that we can get your child diagnosed and discharged. But, if your child starts out with that 105.9 fever with us, we have to wait to see if the fever comes down before letting you and your little one go home.
Take also into account the psychology of it all. Children are usually fearful of ER’s, and rightfully so. If you’re not doing your part to reduce their time of stay, then you are inadvertently extending their amount of time experiencing fear and anxiety. Most of the time, a simple strep or flu test, and/or a look in your child’s ears or throat will give us a diagnosis, and those examinations take less than twenty minutes. Reducing a fever can take hours. Essentially, if you give your child Tylenol for a fever, bring them in, let us assess and diagnose them, you could possibly be discharged home within an hour of getting a room in the ER (I can’t account for waiting room time, which could be extra long if all your child has is a fever—and another reason to treat them before bringing them in, as a reduced fever will make their wait in the waiting room all the more comfortable). But, if your child has been brought in without being medicated, not only could you be waiting in the waiting room for hours while your child’s fever is not changing, you could wait hours longer once your child is seen, just so we can be sure the fever is manageable with over-the-counter medications.
Sure, in certain respects, fevers are good. They are one of your body’s ways of kicking off the immune response party. If your child is comfortable and you feel like holding off on that dose of Tylenol, that’s absolutely fine—ride it out. But if your child is comfortable and you don’t want to give them Tylenol, then why come to a busy ER where they will potentially be exposed to more illnesses to catch? But if the fever is making your child uncomfortable, it’s better to try and reduce the fever with Tylenol to help them rest. Sleep and rest are also important to fighting illness. Dragging your child out to an ER at 2am for a fever of 102 and no other symptoms is not all that great of an option.
While we’re on the subject of sleep, I also want to put out a suggestion here. Too often I see parents come into the ER with their young child in the middle of the night with very basic symptoms of illness. Mild things like coughs, sore throats, and fevers. The child isn’t having any difficulty breathing or anything—I’m talking about basic illnesses that are treatable by family physicians or Urgent Cares. These parents hear their child coughing and then check on them and find they have a fever of 101 Fahrenheit or something not terrible, but they still bring their toddler in at two in the morning.
By bringing your child in, you are keeping both you and your child from resting. Rest is important for children. If you can give Tylenol and/or Motrin and let the child sleep, it’s truly better for the child if you take them to the doctor after a good night’s sleep. Now, don’t hear me wrong—if you have true concerns for your child’s health, of course bring them in—but please give them some Tylenol first.
I’d also like to cover an enormous worry I keep hearing about since the gift of the Internet: Febrile Seizures. Yes, they happen, but not often. And they don’t occur when the fever is controlled. So the best thing a parent can do to prevent these is—you got it—give Tylenol at home. That being said, febrile seizures are rare, and they seem to be caused by a dramatic increase or decrease in fever in most cases. But parents end up yelling at us upon occasion because we “aren’t doing anything to prevent a febrile seizure.” Well, I’ll tell you now, febrile seizures are low on our list of concerns about your child, even if their fever is 105-plus. It’s likely they won’t have one, the primary treatment is usually Tylenol and/or Motrin, and, even if they have one, they aren’t harmful in the long run. There’s no evidence of any long-term effects from febrile seizures. For those few children who have experienced them, there is no evidence of any brain damage, seizure disorders, or any other neurological problems resulting from them. In other words, we aren’t scared of them, and we aren’t focused on them. Now help me get this Tylenol down your kid’s gullet or else I’ll have to push a suppository up their butt.
While we’re on the subject of butts, there’s also some strange fears going around about rectal temperatures. For whatever reason, there’s an odd increase in parents refusing to let me take a rectal temperature on their child, claiming they heard through some source saying that placing a thermometer probe in a child’s butt will cause harm.
Um, no. There is no evidence that a small probe in a child’s rectum will cause harm. For young children, this is one of the most accurate ways to get a temperature. It’s their core temperature, after all. It’s far more accurate than under the armpit, and for tiny children, getting an oral temperature is laughable. Temporal thermometers are okay, but they are often inaccurately used, as they need to run along the temporal artery. The ear thermometers are alright, but we generally don’t use them in ER’s. The easiest, most accurate temperature is taken rectally for most children two and under. The only reason to be afraid of a rectal temperature is because you think it’s sexual, and I ASSURE YOU IT’S NOT. Dear lord is it ever NOT. Get your mind out of the gutter. And if you’re saying that you aren’t afraid about it being sexual—that you truly believe the probe can cause harm—then let me offer you the clear evidence of the last poop your child took. Now think of the biggest poop they ever took. There’s a lot of room for expansion back there, right? A small thermometer probe isn’t going to hurt your child, okay?
So, in summary, if you bring your child into an ER in the middle of the night with a 105 fever and you haven’t given any Tylenol and are refusing a rectal temperature, then yes, you can safely assume we are not offering you a “Parent of the Year” award at the nurses’ station.
Medicate your kids, folks. There is NEVER going to be a time when you bring your child into the ER and say, “I gave him Tylenol right before we came, but I wanted to make sure he was okay,” and we judge you. It will be the opposite. We will applaud your ability to act and take care of your child.
As a final note, I’m not going to cover when to bring your child into the ER (if you want to know more about fevers, read this bit from the Mayo Clinic). Use your intuition or the myriad internet advice resources. Of course, there’s not a bad reason to bring your baby in to see us. If you think something is up and you need a physician to tell you everything is going to be alright, that’s absolutely fine, of course. We will never turn you away. I’d rather children be brought in for something minor that didn’t need to come to the ER than parents holding their children at home until they require resuscitation. Hell, I’ll treat kids with minor illnesses all day long. I love kids. Especially when they’re all cute in the middle of the night giving me the “why the heck am I here?” look.
But dammit, at least try the Tylenol first.
So who am I to give advice? Your answer is here.
Have a question? Ask here.
And, of course, feel free to leave a comment. I’m okay with being corrected or engaging in conversation.
Seattle Children’s Hospital: Fever—Myths Versus Facts: https://www.seattlechildrens.org/conditions/a-z/fever-myths-versus-facts/
Science Daily: How Sleep Can Fight Infection: https://www.sciencedaily.com/releases/2019/02/190212094839.htm
Good information about fevers that I didn’t want to cover because the Mayo Clinic (and a million other sources) already did a good job: https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759
Dr. Gupta from the Cleveland Clinic offering information on febrile seizures: https://health.clevelandclinic.org/when-your-childs-fever-leads-to-a-seizure-8-things-to-do-when-to-call-9-1-1/