WWYD, newborn with a high fever? - Mothering Forums

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#1 of 31 Old 03-30-2010, 07:38 AM - Thread Starter
 
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Just for the record, I know what I did, as this happened 2 weeks ago. But I'm curious how others here would have reacted.

Anyway, 2 weeks ago I had an evening meeting. When I finished the meeting, DH handed me DS2, who had been sleeping on his chest. The baby was 6 weeks old. I thought he felt hot, but it had been a warm day and he was in kind of heavy pj's. So I changed his pyjamas and waited for him to cool down. No luck. I started to nurse him and the second he latched on I knew he had a fever. I let him nurse a bit, then took his temperature-- it was 103.6.

What would you have done in this situation?
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#2 of 31 Old 03-30-2010, 09:11 AM
 
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Personally, with a 2 month old, I would have gone straight to the dr. or ER. That would be a fever to high, in a baby too young for me to wait it out at home.

That's just me though - I hope he's feeling better now
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#3 of 31 Old 03-30-2010, 09:37 AM
 
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cool cloths, nursing, nursing, nursing...if it didn't get better, the I would have called the DR.

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I would go straight to the ER.

This happened to us when dd was 6 wks old. Turned out she was septic from a UTI and very VERY ill even though she "looked" ok and was nursing well. We spent over a week in the hospital, but I hate to think of what might have happened if we had tried to wait it out. So yeah, fever in an infant under 3 months old, I would go straight to the ER.
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#5 of 31 Old 03-30-2010, 12:50 PM
 
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cool cloths, nursing, nursing, nursing...if it didn't get better, the I would have called the DR.
This along with a warm bath, skin to skin.

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#6 of 31 Old 03-30-2010, 01:01 PM
 
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This happened to me when DS1 was 5 weeks old- I went right to the doctor.

Kirsten, mama to Monkey since May 2007 and Bean born 11/7/09
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#7 of 31 Old 03-30-2010, 01:03 PM
 
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Straight to the ER. If the child was older, I would of nursed.

So, what did you do?

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#8 of 31 Old 03-30-2010, 01:23 PM - Thread Starter
 
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We went to the pediatric ER nearest us immediately. They took blood, bagged DS for urine and admitted us. It turned out that he had a UTI, which luckily had not reached his kidneys. We were in the hospital for 3 days, then went back for another week for IV antibiotics.

I might have tried to wait it out, but the ped I saw two weeks after DS was born told me that babies his age weren't "allowed" (as she put it) to have fevers. Anyway, I was just wondering if the consensus here was to go to a dr or the ER, or if it was to wait it out...
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#9 of 31 Old 03-30-2010, 08:38 PM
 
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ER

After a friend of mine had a scary experience re. newborn w/fever (didn't take him in right away and by the time she did it was a real life-threatening emergency), I will always err on the side of caution (and beg anyone who asks my advice to err on the side of caution as well)!

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#10 of 31 Old 03-30-2010, 09:08 PM
 
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An older baby/toddler I would nurse, cool cloths, acetaminophen for comfort if necessary...

An infant I would bring in immediately. I work in the ED, and just last week got to bag a newborn flown in by helicopter. He was septic, and admitted to ICN.

The parents were blown away. Baby was 28 days old.

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#11 of 31 Old 03-31-2010, 03:31 AM - Thread Starter
 
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Ceinwen, just out of curiosity, at what point would you consider a baby old enough to wait it out? Three months? Six? I'm also planning to ask the ped at our monthly check-up on Saturday at what point fevers are no longer a serious emergency...
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#12 of 31 Old 03-31-2010, 03:34 AM
 
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So, do newborns not present w/ other symptoms when they have a UTI? How do they get them?

Mama to expecting Babe 2
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#13 of 31 Old 03-31-2010, 03:46 AM - Thread Starter
 
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So, do newborns not present w/ other symptoms when they have a UTI? How do they get them?
In our case there were no other symptoms. Baby was nursing well and sleeping well until he developed the extremely high fever. As for "how", well, bacteria got up his urethra. I was asked how I clean him-- whether I used packaged wipes, which can irritate things. I use warm water and cotton wipes, so was doing everything right. I'm extremely vigilant now about thoroughly drying him off before putting a new dipe on. They also did an ultrasound while we were in the hospital to check for a malformation that can mean greater likelihood of UTIs, but he doesn't have that.

It was one of the scariest experiences of my life so far. They were talking about doing a spinal tap, and about the possibility of an infection he got during birth, even though I tested negative for that test...
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#14 of 31 Old 03-31-2010, 04:26 AM
 
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I work in ED too and I would take a baby that young straight in, especially with a temp that high!

Probably after about 6 months I would try other things *if* they had no other signs/symptoms and were feeding and weeing well but I wouldn't try for very long. Once they were over a year I would probably try for a bit longer. And my first port of call might be the GP rather than ED if it was during office hours which I wouldn't do with a tiny.

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#15 of 31 Old 03-31-2010, 12:06 PM
 
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Originally Posted by Marylizah View Post
Ceinwen, just out of curiosity, at what point would you consider a baby old enough to wait it out? Three months? Six? I'm also planning to ask the ped at our monthly check-up on Saturday at what point fevers are no longer a serious emergency...
Between 6 months and 12 months, I would worry slightly less, but would still seek out care fairly quickly (taking other things into consideration - hydration, behaviour, etc.) After 12 months, I'd worry slightly less.

And it's funny, because I'm an extremely delayed/selective vaxer, lean towards naturopathic medicine, etc. - but most people assume since I work in the ED I'm hardcore into allopathic medicine.

That's why I chose emerg though, I like working on traumas/real emergencies, regular medicine bores me!

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#16 of 31 Old 03-31-2010, 01:51 PM
 
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So, do newborns not present w/ other symptoms when they have a UTI? How do they get them?
Often the only symptom is high fever, sometimes poor eating, lethargy (which is sometimes hard to detect in infants). Some children are just predisposed to UTI, but often in cases of infant UTI, the child has a condition called vesicoureteral reflux (kidney reflux) where the urine moves from the bladder into the kidneys where it can cause serious complications and permanent damage. As for how they get them, no one can really say. It has nothing to do with cleanliness in most cases. DD had 8 before her first birthday despite daily abx and other preventative measures.

OP - I also wanted to add that an ultrasound can't rule out kidney reflux, only a VCUG can do that. An u/s will show most significant abnormalities, but dd has always had normal u/s and still has reflux, high grade as well as other renal abnormalities that did not show up on the u/s. Don't want to worry you, just thought I would mention it so that you know to watch for signs of recurring UTI. fwiw, our doctor says the cut-off age for ER and fever is 3 months, and then straight to the doctor until 6 months.

I'm glad your lo is feeling better. It's a really scary situation to have your babe that sick at such a young age.
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#17 of 31 Old 03-31-2010, 02:20 PM - Thread Starter
 
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Often the only symptom is high fever, sometimes poor eating, lethargy (which is sometimes hard to detect in infants). Some children are just predisposed to UTI, but often in cases of infant UTI, the child has a condition called vesicoureteral reflux (kidney reflux) where the urine moves from the bladder into the kidneys where it can cause serious complications and permanent damage. As for how they get them, no one can really say. It has nothing to do with cleanliness in most cases. DD had 8 before her first birthday despite daily abx and other preventative measures.

OP - I also wanted to add that an ultrasound can't rule out kidney reflux, only a VCUG can do that. An u/s will show most significant abnormalities, but dd has always had normal u/s and still has reflux, high grade as well as other renal abnormalities that did not show up on the u/s. Don't want to worry you, just thought I would mention it so that you know to watch for signs of recurring UTI. fwiw, our doctor says the cut-off age for ER and fever is 3 months, and then straight to the doctor until 6 months.

I'm glad your lo is feeling better. It's a really scary situation to have your babe that sick at such a young age.
Can you tell me what VCUG stands for?

I see the ped on Saturday and I'll ask about this. I'm in France, so I need to find out what this procedure is called here.

ETA: N/m. Google is my friend.

TIA
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#18 of 31 Old 03-31-2010, 02:35 PM - Thread Starter
 
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Sorry to serial post.

workjw, thanks so much for the information. I'm bummed to know that there's a chance we'll be back in the hospital if DS has a reflux problem. I know that the u/s was to check for structural abnormalities and to see how far the infection had progressed. So they never told me they'd be able to totally rule out reflux.

The VCUG sounds pretty horrible, but hey, if we end up having to do it, we'll survive.

Does your daughter still struggle with this issue? Can it be outgrown? Ugh. What a horrible thing.
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#19 of 31 Old 03-31-2010, 02:38 PM
 
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No signs....serious...requires medical attention...sounds like UTIs are the real thing to fear! (Sorry, not trying to debate, just a no vax mama).

Mama to expecting Babe 2
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#20 of 31 Old 03-31-2010, 11:35 PM
 
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No signs....serious...requires medical attention...sounds like UTIs are the real thing to fear! (Sorry, not trying to debate, just a no vax mama).
I'm not sure I understand what you mean? Are you saying UTI's are not something to fear? (also not trying to debate, just don't know what you mean) ftr, we are selectively, delayed vax, but still not sure what that has to do with UTIs
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#21 of 31 Old 04-01-2010, 12:18 AM
 
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Sorry to serial post.

workjw, thanks so much for the information. I'm bummed to know that there's a chance we'll be back in the hospital if DS has a reflux problem. I know that the u/s was to check for structural abnormalities and to see how far the infection had progressed. So they never told me they'd be able to totally rule out reflux.

The VCUG sounds pretty horrible, but hey, if we end up having to do it, we'll survive.

Does your daughter still struggle with this issue? Can it be outgrown? Ugh. What a horrible thing.
I hope I didn't scare you, that certainly wasn't my intention. Reflux is actually pretty common (1-3% of kids have it) and 80% of kids outgrow it by about age 6, depending on the severity. So even if he does have it, odds are that he will outgrow it but yeah, it can be a bummer. Hopefully your guy just happened to get a UTI and doesn't have reflux at all. I just think it's important to be very aware of signs for UTI if there is a past history mostly b/c treating it quickly is really important. For example ds (no reflux) can run a 103 fever for days without me batting an eye. On the other hand, if dd has a 101 fever for more than 24 hours with no visible signs of illness, we have her urine tested just to be sure that it is not a UTI. For a child with reflux, treating the infection before it has a chance to move into the kidneys is the key to keeping them healthy.

The VCUG is definitely not a lot of fun, but it's not as awful as it sounds. DD has had 2, one at 7 wks, and then one at 10 mos and she did really well with both.

We do still deal with reflux, and probably will for years, but dd is an extremely rare case. She has grade 5 reflux in both ureters, and also has 2 extra ureters both with low grade reflux, along with some other unique urinary and renal issues. She's what you might call a one of kind!
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#22 of 31 Old 04-01-2010, 02:48 AM - Thread Starter
 
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Thanks for the additional information. So sorry to hear your daughter has these unique issues! I will be super-vigilant about temperatures with DS2. This is just all so new for me-- DS1 didn't have a fever until he was, I dunno, 23 months old, or something like that! But it is good news that most kids will outgrow the problem.

We're lucky we caught it before the infection had reached the kidneys. And to think, I was half-tempted to let the baby sleep and "see what happened"...
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#23 of 31 Old 04-01-2010, 02:52 AM
 
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I'm not sure I understand what you mean? Are you saying UTI's are not something to fear? (also not trying to debate, just don't know what you mean) ftr, we are selectively, delayed vax, but still not sure what that has to do with UTIs
No, I mean in the context of vaccinating culture...we routinely vaccinate when incidence is low, symptoms are clear and treatments are varied (for most vaccine related illnesses). Meanwhile, a UTI has a quick onset, no other symptoms and is very dangerous and require immediate medical intervention.

I mean, seriously? Why aren't we scared of UTIs? Other than this thread I've never heard of UTIs and newborns and the dangers of them, etc. I don't see it in baby magazines or on TV, or on hospital walls, or in pamphlets from the mayor, etc.

E.g. if I had a newborn with a fever, I would be concerned and ask for advice, but the first thing in my head would never have been "UTI! Hospital!"

Sorry if I was confusing, my short post was just a reference more to our cultural conditioning/focus.

Mama to expecting Babe 2
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#24 of 31 Old 04-01-2010, 08:26 AM
 
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My DD1 has a Neurogenic Bladder. She has had lots of UTI's. Most of the time there is no real symptom except smelly, cloudy or dark pee. She doesn't normal present with a fever. Crabbyness, yes.

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#25 of 31 Old 04-01-2010, 12:38 PM
 
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No, I mean in the context of vaccinating culture...we routinely vaccinate when incidence is low, symptoms are clear and treatments are varied (for most vaccine related illnesses). Meanwhile, a UTI has a quick onset, no other symptoms and is very dangerous and require immediate medical intervention.

I mean, seriously? Why aren't we scared of UTIs? Other than this thread I've never heard of UTIs and newborns and the dangers of them, etc. I don't see it in baby magazines or on TV, or on hospital walls, or in pamphlets from the mayor, etc.

E.g. if I had a newborn with a fever, I would be concerned and ask for advice, but the first thing in my head would never have been "UTI! Hospital!"

Sorry if I was confusing, my short post was just a reference more to our cultural conditioning/focus.
Thanks for clarifying I completely agree with you. I guess the reasoning is that UTIs themselves are not that dangerous except in infants or kids with kidney reflux, so it's not a priority? We had certainly never heard of the dangers of UTI (or fever for that matter) in a newborn when dd got sick. I guess maybe it doesn't happen that often, but I talk to parents all the time that have been through the exact same thing, so it can't be that uncommon either.

fwiw we started a website to raise awareness for kidney reflux and the dangers of UTI, so at least we're doing our part!
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#26 of 31 Old 04-01-2010, 12:49 PM
 
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Thanks for the additional information. So sorry to hear your daughter has these unique issues! I will be super-vigilant about temperatures with DS2. This is just all so new for me-- DS1 didn't have a fever until he was, I dunno, 23 months old, or something like that! But it is good news that most kids will outgrow the problem.

We're lucky we caught it before the infection had reached the kidneys. And to think, I was half-tempted to let the baby sleep and "see what happened"...
Yeah, it doesn't feel "natural" to be worried about a fever, but sometimes it is better to be safe than sorry. Like KatWrangler mentioned, you also want to watch for strange or smelly pee and sometimes ftt can also indicate UTI. Good luck! I hope everything works out well for you and you don't have to deal with this again!
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#27 of 31 Old 04-02-2010, 01:25 AM
 
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Ceinwen, just out of curiosity, at what point would you consider a baby old enough to wait it out? Three months? Six? I'm also planning to ask the ped at our monthly check-up on Saturday at what point fevers are no longer a serious emergency...
I like Dr. Sears' fever guidelines, he also gives age ranges:

http://www.askdrsears.com/html/8/t082100.asp

Glad your LO is better.
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#28 of 31 Old 04-02-2010, 04:16 AM - Thread Starter
 
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Yeah, it doesn't feel "natural" to be worried about a fever, but sometimes it is better to be safe than sorry. Like KatWrangler mentioned, you also want to watch for strange or smelly pee and sometimes ftt can also indicate UTI. Good luck! I hope everything works out well for you and you don't have to deal with this again!
I will keep an eye out for smelly pee. As for FTT, baby is up six pounds since birth (and he was a big baby, at 10 lbs) and is wearing size 6 months already! So no clues there, lol.

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I like Dr. Sears' fever guidelines, he also gives age ranges:

http://www.askdrsears.com/html/8/t082100.asp

Glad your LO is better.
Thanks for the link, that's very helpful.

I feel like a first-time mom with this stuff, since DS1 was such a healthy baby. I think his first real illness was at 17 months, and his first fever wasn't until much later. I just never had to think about this kind of thing!
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#29 of 31 Old 04-06-2010, 12:00 AM
 
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DD1 came down with a sore throat and fever when DD2 was 4 days old. Five days later, DD2 had a fever in the middle of the night. Despite being sure it was the same viral illness, we followed ped's advice and headed for the ER. There, they did blood cultures, urine cultures, and a spinal tap (very hard to watch on a 9-day-old), then started her on IV antibiotics and kept her in the hospital for 2 days. Fortunately, everything came back negative and her fever was down 2 days later, so we could go home. At the time, I regretted taking her to the hospital, because it certainly didn't help our already difficult time BFing, and the abx gave her diarrhea. However, I've thought about it a lot since then, and I would probably do the same thing again in a similar situation. She could just as easily been sick with a serious bacterial infection.

I'm glad everything turned out OK with yours.

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#30 of 31 Old 04-06-2010, 12:23 AM
 
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I've done that, only the newborn was 9 days old. I called the dr and while waiting for the callback, put cool cloths on him. She sent us to the ER, and they did the whole spinal tap thing because the cath was fine, no UTI. Like JensB, it was probably a random virus, DH and DD were sick around the same time. I too would do it again if need be though, although I might not consent to a spinal tap again since they start IV antibiotics anyway. I might wait for a spinal tap with the regular doctor the next day rather than the ER resident with the "I-get-to-practice-spinal-taps!!!" attitude.

The guideline the hospital gave me was that if they're under 2 months old, then definitely bring them in. Between 2-3 months, it can be trickier, because if they've had a very recent vax and the temp isn't super high it might just be a common vax reaction. So at that age, call the dr. and they might say "oh you just got the polio vax, come to my office tomorrow if not sick in any other way").

I've always wondered what that means for newborns who get a Hep B vax at birth, but I delay that one, and my dr. starts the series at 2 months for her regular schedule anyway. It can cause fevers, so how would you know for a newborn?

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