I've read over a few of your previous answers, but am still concerned. I have a 6 yr. old son who has a temperature. When it started it reached up to 104.4. It's highest point now is about 103 to 102.5. It's been 6 days and I'm really starting to worry. I took him in on day 3 and they said he had no strep but was sick. Dr. advised should last 3-5 days. He's got a stuffy nose, cough and mild nausea. Won't eat, and drinks very little. He doesn't act sick most of the time, wants to play and such. I can't afford to take him back to the dr. and am unsure of what to do next.
Dear “Concerned Mother”,
Taking care of a child with a fever is probably one of the hardest things that a mother has to do. Watching your child experience such discomfort, not knowing the cause and worrying about complications is very stressful. I know, because I have been in the same situation with my own child. Luckily, the majority of fevers in children are caused by a virus, which means; fluids, rest, time and loving care is all that is needed for a child to get better. In time the child’s body fights the infection and the fever goes away.
There are some situations and signs that should cause a parent to be concerned and seek medical attention. Any child under 3 months old with a fever of 100.4 rectally or higher needs to be evaluated by a Physician. Children at this age are more susceptible to serious infections such as Meningitis or Bacteremia. In addition, fever many times is the only indicator that an infant has a serious infection.(1)
A fever accompanied by a stiff neck, headache, sore throat, rash, painful urination, inability to eat, joint pain, problems breathing or abdominal pain should also be evaluated. (1) Children with a chronic medical conditions such as Diabetes, Sickle Cell Anemia, Immune Deficiency or Asthma need to be seen by a Physician because an illness can cause complications and worsening of the their underlying condition.(1) An evaluation by a health care professional is also indicated in a child with a fever that persists beyond a 5 day period. Even if a child was seen early in the course of his illness, as in the case of your son, a re-evaluation is necessary.
One of the reasons a re-evaluation is necessary is because a child with a virus may develop a secondary bacterial infection. When a child develops a virus his body mounts an immune response and works hard to fight the infection. It is during this time of stress that a child is more susceptible to developing a bacterial infection. That is why it is common for infections such as Sinusitis and Pneumonia to occur after a child is diagnosed with a cold or a virus.
A persistent fever is one of the signs of a bacterial infection.(1) A bacterial infection can settle anywhere in the body, including the respiratory tract, sinuses, urinary tract, skin, blood or the bones. Without the benefit of an evaluation by a health care professional, there is no way for a parent to know if their child has a bacterial infection. In some cases a fever may be the only sign that a bacterial infection is present.
Surely, there are some viruses such as the Influenza Virus or Epstein-Barr Virus (Mononucleosis) that can cause a fever to last beyond 5 days.(2,3) Only a thorough history and physical examination performed by a Physician or Nurse Practitioner can determine if a bacterial infection exists. Therefore the only way to find out if further intervention is neeeded is to bring a child back to the Doctor’s office for an evaluation.
During a follow up examination further testing may be performed in order to determine the cause of a persistent fever. The specific type of testing ordered depends upon the age of the child, his immunization status, social situation, contact with sick people and the findings on his Physical Examination. Bloodwork, urine testing and a chest x-ray are tests that may be performed.
Each Physician has his or her own opinion regarding when a follow up is necessary and which testing needs to be performed on a child with a persistent fever. Since your son has a fever for 6 days now, I suggest that you telephone your Physician and let him know that you cannot afford to return to the office but are concerned about his persistent fever. Your physician should be able to guide you regarding the next step. He is the one that examined your son and is familiar with his condition. He also is aware of the viruses and infections that are prevalent in your community at this time. He may be able to tell you that “Influenza” for example is going around your community and causing a prolonged fever in children.
It is important to stress your financial situation to your Physician because he may be able to offer you options that could help. Some Physicians may be willing to set up a payment plan or defer payments when a parent financially cannot afford healthcare. Your physician can also help you cut down on the cost of health care by offering free medication samples when they are necessary or recommending generic prescription medications instead of brand for a less expensive price.
You may also want to consider calling your insurance broker, Personnel Department that handles your health insurance or Health Department in your town in order to get information about lowering your health care costs. Your local Health Department should be able to give you information about free health clinics in your area.
The US Department of Health and Human Services can provide you with information about low cost health coverage for your family. This agency can give you information about state run programs that provide health insurance to children who do not have insurance. There are financial requirements for the programs offered, but you may still qualify even if you work.
It is also important that you address your child’s fever because the longer he is sick the more days he will miss from school. A longer illness also puts him at risk for complications such as dehydration and also gives him more opportunities to spread the infection to others. Worrying about his fever is also not good for your health, therefore I suggest addressing the situation for both of your sakes.
For Information about Low Cost Health Insurance for Children:
U.S. Department of Health and Human Services Website
NJ FamilyCare Insurance
If you are interested in reading other Pediatric Advice Stories covering this topic:
Fever, Rash & Joint Pain
Fever and Vomiting
Tracking Flu Activity
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 429-434.
(2)Nield L, Kamat D. “Flu” Season: Here We Go Again.. Consultant for Pediatricians. 2005. Oct:411-416.
(3)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1688-1689.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Parents with Sick Children