When To See A Doctor For A Child's Cold And Fever

            When babysitting for a niece recently, Grandma and I were told, “If he gets a fever of over 100.3, take him into the Emergency Room”. Her toddler son is perfectly healthy and has no medical problems, but our niece had been told by a medical person that “any fever over 100.3 was dangerous.”

            Toddlers, especially toddlers in day care, seem to catch a new virus about every two weeks. In this era of poor insurance and high co-pays, it is important that young parents know how to tell if a child needs to examined in a medical facility or if observation at home is appropriate.

            Most viral infections start with an evening fever. The child is crabby, tired and has a poor appetite at the end of the day and then develops a fever. The height of the fever is unimportant – fever that comes with a viral infection is never dangerous. If, after an age-appropriate dose of a fever/pain reliever is given, the child seems to feel better, the parents should just watch to see if the child acts any sicker.

            Within the next twelve hours, the virus will declare itself – the child will develop runny nose and congestion or perhaps vomiting and diarrhea if it is a gastrointestinal virus.

            With an upper respiratory virus (a “cold”), the child can feel pressure and fluid build-up in the middle ear because the swelling in the nose causes blockage of the drainage tube out of the ear. The child complains of mild ear pain and pulls on the ear. The child’s eye can develop some crusting mattering from a similar blockage of the tear duct. The ear pain can be treated with a dose of fever/pain reliever and the mattering in the eye treated with cleansing with a warm washcloth. The nose drainage can be thick or thin and can be about any color. The fever will be up and down for three days. The child will be coughing and feel bad, but will not be severely lethargic or ill-appearing. No cold medications or antibiotics are necessary. The symptoms improve over three days, even though the cough can last for two weeks.

            A complication of a cold is that bacteria can infect the blocked fluid in the ear or the eye. These infections usually develop later in the course of a cold. Daytime fever with a common cold should be gone by the third day. If the daytime fever lasts longer than three days, or if the fever goes away and then returns, it could be a sign of bacterial infection. If a prolonged or late fever is accompanied by more severe or continuous ear pain, the ear may need antibiotic treatment. If the mattering in the eye is persistent or becomes pus-like, it also could be a bacterial infection. If the fever returns on the fourth or fifth day and the cough is getting worse, pneumonia could be developing.

            But, if the child continues to act only mildly ill, the fever goes away in three days and the symptoms slowly get better, the child is probably going to be fine and the parents have made it through one more viral infection.