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Many Parents are Afraid of Fever. Don’t Be.

Written by: Kerry Frommer Fierstein, MD, FAAP

In a recent article the American Academy of Pediatrics reviews the facts and fiction that surround fever in children and reminds nurses and pediatricians to better educate parents about fever.

Important fever facts:

The following information does not apply to infants under three months of age for whom you should contact your pediatrician urgently for any temperature of 100.4oF (38oC) or higher.

  • There is no “normal” temperature. 98.6 is an average and many children will normally run a little higher or a little lower. In addition, throughout the day, a given child’s temperature will vary by as much as a full degree.
  • Fever can be helpful in fighting infections. Fever slows down the growth of viruses and bacteria while activating our immune system.
  • Higher fever does not necessarily mean a more seriously ill child. Most fevers, no matter how high, are brief and not dangerous. However, if your child has a fever greater than 101 degrees Fahrenheit for more than 48 hours you should see the doctor to discover the cause of the fever.

Fevers do not cause brain damage or death. Children with fevers above 104 degrees are not at increased risk of problems because of their temperature (the one exception is heat stroke, which usually occurs from over activity in warm weather.) Fevers can cause “febrile seizures” but these types of seizures, though scary to watch, do not cause any permanent effects. Furthermore, there is no evidence that Tylenol (acetaminophen) or Motrin (ibuprofen) use will reduce the risk of fever seizures.

Parents should remember:

  • The #1 reason to bring down your child’s fever is to make him/her more comfortable.
  • It is not necessary to wake your child to give him/her fever medicine.
  • Look at your child, not the thermometer. If your child is drinking, quietly playing, or sleeping, do not worry about fever. If your child looks poorly and is too weak to drink, he/she should be seen by the doctor regardless of the temperature.

Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens, Dr. Kerry Frommer Fierstein is a New Yorker all the way. She works atPediatric Health Associates, PC, a division of Allied Pediatrics of New York.

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What can I do to help my child’s allergies?

Written by: Kerry Frommer Fierstein, MD, FAAP

Pollen counts are high and allergies are bad. Phone calls and office visits regarding allergy have risen sharply in the last week or so. There are many steps you can take to help your child with allergies this time of year. We hope these suggestions will help, but if they don’t, please make an appointment with your pediatrician to learn about further treatment options.

What can I do to help my child’s allergies?

The best way to decrease allergy symptoms is to avoid the things to which you are allergic.

  • Wash hands when coming indoors – at school and at home.
  • Change clothes upon entering the house and do not keep the laundry hamper in the child’s room.
  • Shower nightly and as soon as possible when finished playing outside.
  • Keep plenty of tissues around and teach your child not to use a tissue to rub his eyes, especially outdoors, because this brings the pollen right to his eyes.
  • A cool compress will also help reduce swelling and itchiness.
  • If the allergy is to pollen, keep the windows closed and the air-conditioner on. (Clean filters regularly.)

What over-the-counter (OTC) medicines can I use?

Allergies are caused by the body’s release of histamines. Anti-histamines are a mainstay of allergy treatment. They treat the general symptoms of runny nose and itchiness.

 Benadryl is the most widely known anti-histamine, however, it is not the best choice for allergy sufferers, because its effects only last a few hours, and it often causes sleepiness. It can be useful at bedtime when symptoms are interfering with sleep.

Claritin (Loratadine is the generic name) is the most commonly used OTC allergy medication. It is dosed once a day, usually in the morning. The dose for ages 6 and up is 10mg – given either as a pill or a dissolvable tablet. A liquid form is available. It comes as 5mg per teaspoon. Children over 6yrs get 2 tsp. Children 4-6yrs get 1 tsp. Children 2-4yrs. get ½ tsp.

Zyrtec, generically known as cetrizine, is another commonly used allergy medicine available over-the-counter. Often providing more effective relief than Claritin, Zyrtec is also slightly more likely to cause sleepiness, so most physicians recommend using this once daily medication at night. The dose for ages 6 and up is 10mg – given either as a pill or a chewable tablet. A 5 mg chewable is available for children 4-6 years old. A liquid form is available as well. It comes as 5mg per teaspoon. Children over 6yrs get 2 tsp. Children 4-6yrs get 1 tsp. Chlidren 2-4 yrs get ½ tsp. Zyrtec brand liquid was taken off the market last year (along with Tylenol) and has not come back yet. Store brands of Cetrizine will work as well.

Allegra (fenofexadine) just became available over-the-counter in March 2011. If you have noticed that claritin or zyrtec are not working as well for your child, you should try Allegra. Dosing for those 12 years and older is 60 mg twice a day or 180 mg once a day. Dosing for children 6-12 years is 30 mg twice a day. For children under 6 years, check with your pediatrician. Allegra comes as liquid -30 mg per teaspoon and as 30 mg ODTs (orally disintegrating tablets.) It also comes as 60 mg and 180 mg tablets.

Decongestants, like Sudafed, can be added to antihistamines when congestion is the major problem, but this is not typically needed for Spring-time allergies.

If OTC antihistamines are not working make an appointment to discuss a prescription strength anti-histamine.

Will eye drops help?

Yes, if eye itchiness is a major symptom, then allergy eye drops will help. Zaditor is a medicated eye drop that is now available over-the-counter. It can be used in children as young as 3 yrs. It can be used on an as needed basis but will be more effective if used every day. If your child’s eye allergies are very bad this year, next year we would recommend starting eye drops in April, just before the season hits.

What can I do if over-the-counter medicines don’t work?

There are lots of prescription medicines for allergies. There are antihistamines such as Clarinex and Xyzal. Also, there are anti-inflammatories such as Singulair and there are eye drops such as Pataday, Elestat and Optivair. Lastly, pediatricians often recommend nose sprays  such as Nasonex, Flonase, Veramyst and Rhinocort.

As always, we recommend to make an appointment with the pediatrician to help you map out a plan for your child.

My child is on prescription medicines but is still having symptoms.

Often, when one medicine doesn’t work, another medicine in the same class will be more helpful. Or, it is possible to combine several different medicines. Make an appointment to see us and discuss the situation.

How can I tell an allergy from a cold?

  • Allergies don’t cause fevers.
  • Allergies often cause itchy eyes and noses, along with the clear runny nose.
  • Allergies cause sneezing “fits” as opposed to the occasional “achoo” of a cold.
  • Allergies can linger for weeks to months; colds are usually done within 2 weeks.

Do I need to see an allergist?

Allergists can be helpful when your child has not found relief from OTC meds or the prescriptions we have given you. Allergists can be helpful in many ways – identifying the cause of allergies, helping to adjust or minimize medications in chronic sufferers, and as a last resort, the formulation and treatment with allergy shots (immunotherapy).

Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens, Dr. Kerry Frommer Fierstein is a New Yorker all the way. She works atPediatric Health Associates, PC, a division of Allied Pediatrics of New York.

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Why Do We Need A Doctor’s Note to Apply Sunscreen?

Written by: Kerry Frommer Fierstein, MD, FAAP

Parents make decisions for their children all the time. It is part of the job. Breast or bottle? Cloth or plastic? And that is just the beginning. By the time a child enters school the decisions a parent has made number well into the thousands.

Medical decisions are just part of the job description as well. Is my child sick? Does she need to go to the doctor? Should I put ointment on his cut?

Yet as soon as that child walks into a New York school, that same parent can’t approve the use of sunscreen on a school trip unless a physician signs off on it.

This upsets me on so many levels.

As a parent, I don’t understand why I can’t ask the school nurse to give my child a simple over-the-counter medication – the same medication I bought without a prescription and gave my daughter before she got on the school bus.

As a pediatrician, I can’t imagine a circumstance where sunscreen or bacitracin would be bad for a child, unless there is an allergy, which I depend on the parent to give me this kind of history anyway.

In my busy home life, I don’t need the unnecessary procedures involved with getting the doctor to sign off on over-the-counter medications.

In my busy practice life, I don’t need yet one more unnecessary piece of paper demanding my attention.

As a parent and a physician, I would like the schools and the government to remember that parents make health decisions every day, decisions much more important than sunscreen, bug spray and Tylenol.

Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens, Dr. Kerry Frommer Fierstein is a New Yorker all the way. She works at Pediatric Health Associates, PC, a division of Allied Pediatrics of New York.