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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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6yo with recurrent fever, headache, sore throat

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My 6yo has had recurrent fevers with sore throat and headache for the past 6 months or so. About once a month he starts with complaining of a headache then the fever and sore throat follows. Never any exudative pharyngitis seen. Mild cervical lymphadenopathy palpated. Usually more pronounced on one side than the other. Strep always negative. The last time, he had a full meningitis workup with normal chem panel, normal CBC, normal UA, and negative strep. It's always chalked up to a virus. He doesn't have any coexisting diagnoses except taking Claritin for allergy symptoms he developed since we moved to Seoul and it's poor air quality. When he was a baby, he had a full cardiac workup for benign PACs that disappeared by his 1yo appt. And once when he was 21days old, he was admitted for triple antibiotics for fever of unknown origin - also chalked up to a virus. Other than that, he's healthy with a great diet, excellent hand washing habits, very active, normal kid. Up to date on all his vaccines. But our other son who's 9yo never gets sick like this - and he's the one with mild RAD, eczema, and vitiligo. All the health care providers he sees here are really great but they're fresh out of residency and remote from any more experienced English-speaking providers to consult with. I just want to be sure it's normal for this to recur as often as it has, and that we shouldn't be worried about a specialty workup for something more serious.  By the way, our time zone is 14hr ahead of EST.  The phone number the website required is a US number to my Korean cell phone, but I wanted you to be aware that we are not in the US.  We're military living abroad.  Thanks for your help. 


Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

Hi. Are you able to chat?

Dr. A. Clark :

I'll watch for your return to chat and am happy to visit with you.

Customer:

I'm here.

Customer:

Am I too late?

Customer:

I forgot to mention that his fevers last about 2-3 days and go away. While he has them, he is glued to the couch. Twice when I took him to the office for a strep test, he had to stop "for a break" halfway through the building to lie down and rest. Only one of those times, he complained of nausea but never vomited. When not sick, he is a voracious eater (with a normal BMI), but when he has the fevers, he hardly eats at all, and we have to remind him to stay hydrated with his favorite fluids - usually water or diet Ginger Ale.

Dr. A. Clark :

Hi. I'm seeing patients but will continue to watch chat.

Dr. A. Clark :

I am concerned that he has so many infections too and even if they are not strep they are still affecting his health. Has he any problem with his sleep: snoring, restless, mouth-breathing, tired when he gets up?

Customer:

None of the above. His BMI is normal. No sleep apnea or snoring. He still occasionally migrates to our bed in the middle of the night, so I'd know if that were the case. He's usually self-regulated in getting himself up between 0630 and 0730. Doesn't complain of tiredness or act tired once up, unless he's got a fever.

Dr. A. Clark :

Then I don't think there is anything to worry about as strep is the only bacterial infection that affects the tonsils but it might still be worthwhile having an ENT surgeon take a look at him

Customer:

Sounds good. I just wanted to be sure I didn't need to worry about something more serious with his immune system or brain. A good friend of mine is the ENT here, and he's out of the country for about a month or two. I assume you think I can wait that long. In the mean time, do I need to swab his throat every time?

Dr. A. Clark :

Not much chance of that as it sounds like, other than the sore throats, he's very healthy. I think you can wait to see your ENT friend when he returns. I would have them do both a strep rapid test AND and culture each time if the rapid test is negative.

Customer:

Ok. Will do. I just hate going through the ER since it's a weekend. Again. That's how he got the meningitis workup last time. It was a Sunday and he told the nurse his neck hurt. There's no such thing as urgent care or acute care clinics on the military base in Korea. And the rapid streps always reflex a culture if negative.

Dr. A. Clark :

If he can bend his chin down to his chest then meningitis, which is rare these days, is unlikely. There is a huge difference between a stiff neck and a sore neck due to a sore throat. The rapid strep test is only about 70% accurate so a culture following a negative rapid test is a good idea.

Dr. A. Clark :

Please let me know if you have any further questions.

Customer:

Thanks for the reassurance.

Dr. A. Clark :

Happy to able able to assist you.

Dr. A. Clark :
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Dr. A. Clark and other Pediatrics Specialists are ready to help you
I hope your child is doing well but if you ever have any other problems for which you'd like my advice please feel free to reply here or with a new question, asking for me by name. Have a great day and my best to your family.