Fever and Vomiting

Lisa,

My one year old is in daycare. He has had every illness in the book... and now is vomiting and running another fever (102.6). I am beginning to feel ridiculous at the Dr.’s office, because he is such a frequent flyer... at what point do I contact the Dr. again... he is keeping nothing down....

“Worried about my little man…”

Dear “Worried about my little man…”

Unfortunately, children in daycare develop a lot of infections because they are exposed to a greater number of children with infections. Even though it feels like you are constantly at the doctor’s office now, that should change when he is older. Doctors are aware that children in daycare become ill more frequently and expect to see them more often for doctor’s visits.

Children with vomiting and fever should be seen by their doctor if they have a headache, a stiff neck, neck pain, irritability, rash, lethargy, signs of dehydration, inability to keep down fluids, if the vomiting persist for 8 hours or longer or if they have any underlying medical conditions that could potentially worsen with an illness. For example, a child with Asthma who is vomiting mucus should to be evaluated for worsening of his Asthma.

Children with Strep infections can develop a fever and vomiting too. Therefore if a child complains of a sore throat and has fever and vomiting, he should also be seen by a doctor. Strep throat is more prevalent in older children, but infants develop it too, especially if they have been exposed to someone with Strep. Infants and young children can’t tell you that their throat hurts. Instead they tend to refuse their bottle, cry when drinking from the bottle or put their hands in their mouth.

Signs of dehydration include decreased urine output, lack of tears, sunken eyeballs, sunken fontanel (soft spot), dry mucosa (inside of the mouth), non-elastic skin, increased heart rate, weight loss, muscle weakness, lethargy or irritability. (1) A child is expected to urinate six times in a 24 hour period. If your child goes 8 hours without urinating or if he does not urinate 6 times in a 24 hour period he should be seen by his doctor. Your child does not need to have all of these symptoms to be dehydrated, but may only have one or two. I have taken care of infants that were moderately dehydrated who still had tears, but instead they presented with a dry mucosa and decreased urine output.

Most children with a fever and vomiting develop the symptoms due to a virus. Typically with viral gastroenteritis, the vomiting comes first and diarrhea follows. Therefore if your child continues to vomit and doesn’t develop diarrhea it would be a good idea to have him checked. In addition, any child with a persistent fever needs to be seen in order to ascertain the source of the fever. Each doctor has his own guidelines regarding when a febrile child at a specific age needs to be seen. Some doctors ask the parent to bring a one year old child in if the fever lasts 24 hours, other doctors may ask the child to come in after the child has a fever for three days. This is assuming that there are no other alarming signs that would warrant a visit sooner. You should ask your doctor what his recommendations are.

The recommended fluid for a child with Gastroenteritis or one at risk for dehydration is Pedialyte in small amounts. (2) If you can’t get your baby to drink Pedialyte, try giving him licks of an ice pop or some bites of sherbert. If he still vomits everything you can use a medicine dropper or syringe and instill one dopperful of Pedialyte between his cheek and gums every 10 minutes to keep him from becoming dehydrated. Another option for a one year old is to wet a clean baby washcloth with Pediatlyte and let him suck on it until he is ready to drink. If nothing works contact your doctor.

It is important to not let a child with a temperature exercise in the heat because this may put him at risk for Heat Exhaustion. A child with a temperature shouldn’t go outside in the extreme heat either, because this may also lead to heat exhaustion. (3) You can control your son’s temperature by using an antipyretic, such as Tylenol. You should try to avoid ibuprofen if you can when a child has gastrointestinal symptoms because it can be irritating to the stomach. Another option is to wipe him down with a tepid (not too cold) sponge or put him in a tepid bath. The bath water should not be too cold because this may cause him to shiver which will only increase his core body temperature and worsen the situation. (4)

I hope he’s feeling better soon.

(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. W.B. 2nd ed. Philadelphia, PA:Saunders Company. 1994:930-932.
(2)The American Academy of Pediatrics. Practice Parameter: The management of acute gastroenteritis in young children. Pediatrics. 1996;97:424-435.
(3)Dawson G. Unusual case of heat stroke in a young boy. The Clinical Advisor. 2006;March:50-58.
(4)Betz C, Hunsberger M, Wright S. Family Centered Nursing Care of Children,2nd ed.1994; Philadelphia: W.B. Saunders Company:315.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily