My 4 year old has had a fever for 6 days. Day 3, he peaked at 104 so we took him to the ER and they said he has a virus and brochitis. Prescribed albuterol and directed to keep using Tylenol and to go back to the doc if fever persists for 2 more days. Day 5, took him to the pediatrician and she said he has a virus and laryngitis and to stop the albuterol. It is now day 6 and as of this morning, he had a 102.5 temperature. He has no appetite, no energy, no diarrhea, no voice, no sleep and complains of his throat and his head hurting.
Tylenol every 4 hours around the clock for 6 days. Albuterol for 2 days until instructed to stop. Over the counter Robitussin to help his cough.
Hello from JustAnswer!
You have given the Tylenol at most 4 or 5 times per day?
His fever has persisted beyond 72 hours -- has any clinician done tests to rule out non-viral concerns, such as cultures of throat, blood, and urine or chest x-ray?
Does he have any chronic health conditions or long-term medications?
We started him with Advil every 4 hours until we were instructed at the ER to switch to Tylenol, and we have been giving him 1.5 teaspoon every 4 hours around the clock since then. The fever would subside for an hour or two then spike back up again.
No tests have been done.
He was diagnosed last year with "asthmatic tendencies" so he's had wheezing, and we usually use a nebulizer to help. But no long-term medications.
Thank you for the information.
OK, no formal diagnosis of asthma or any other chronic condition.
An important point to prevent overdose: I'll assume that the doses of Advil (ibuprofen) and Tylenol (acetaminophen) are appropriate for his weight/age, but ibuprofen is meant to be dosed at most every 6 hours up to 4 times per day while acetaminophen may be given at most every 4 hours up to 5 times per day. One option to prevent overdose of either (with possible kidney or liver damage) is to ALTERNATE between ibuprofen and acetaminophen doses every 3-4 hours as needed for ache or fever.
The points that the fever has persisted beyond 72 hours (the usual maximum duration for a minor viral fever) and that the fever does not respond for very long to fever medication raises clinical concern for a bacterial infection that may require antibiotic treatment. In this case, I would strongly advise pediatrician reevaluation with consideration of appropriate tests or imaging studies to rule out bacterial infection (such as strep throat, urinary tract infection, blood infection, or pneumonia).
Sorry, my husband just reminded me they did a strep test done on day 3 and it was negative. So they ruled out bacteria then.
My son's pediatrician yesterday did not feel it was necessary for any blood tests and told us it was just a virus that will take its course.
Is it possible to be a virus and take this long to leave his system?
What test should be specifically ask for when we take him back to his pediatrician?
What would warrant a trip to urgent care?
If they only did a rapid strep test, then be aware that this test misses up to 20% of infections. A 2-day throat culture is much more accurate at detecting strep throat.
Was your pediatrician made aware of the (at that time) 5-day history of fever? Again, the fever due to most viral infections will subside within 72 hours (3 days); beyond 3 days, the clinical concern grows for bacterial infection.
It is possible that this is just a fever due to viral infection, but the risk of bacterial infection should not just be overlooked. I would at least call his pediatrician and mention the two points from my prior post: (1) the fever has lasted more than 72 hours; (2) the fever does not respond to fever medication for more than 1 or 2 hours. Then ask, based on these two points, if they would consider repeat exam and possible tests to rule out bacterial infection (e.g., throat culture, urine culture, blood culture, chest x-ray, etc., if indicated).
A persistent, medication-unresponsive fever is one guideline for ER or urgent care evaluation. Other urgent concerns include: fever approaching 107-108 degrees Fahrenheit; abnormal mental interaction/consciousness; marked neck stiffness or oversensitivity to light; bluish discoloration to lips/face or nails; markedly decreased urine volume or less than one good void every 6-8 hours; breathing difficulty or wheeze.
This list is by no means all-inclusive -- if ever your parent's instincts tell you that something is seriously wrong, do not hesitate to seek prompt medical evaluation.
In practice since 2000.