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Child has fever, loss of appetite. All test normal with low haemoglobin. Underlying cause?

Feb 2013
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Practicing since : 2002
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Hello doctor,
I am a member of the elite panel of Health Care Magic,
My grand son, aged 1 yr and 2 months old, is having a temperature varying between 99.6 to 100.4 F for the last one month. He is not picking up weight, still having 7.5 for the last 3 months. But active, cheerful, and not at all sick looking. He is not taking food properly, having an aversion for food. He was given routine vaccinations, and antibiotics on 3 or 4 occasions for fever of higher temperature earlier. His urine routine was normal and culture sterile. His Kidney and bladder scanned by USG Abdomen and nothing abnormal detected. His PA chest Xray and mantaux normal. Blood culture also is sterile. Blood : Hb= 8.5 gms %, MCV=60.6Cu microns, MCH= 16.5 , MCHC= 27.2%, Platelet count= 4.6 Lakh. Total WBC was 0000 cell/ cu mm on 4th May and 11,800 on 8th May. (after Homoeopathic medicine) DC= Neutrophil=28%, Eosino= 6%, Baso= 0%, Lympho= 65%, Mono=1%, ESR= 5mm at 1 hr. SGOT= 57 IU/L, SGPT= 49 IU/L, Malarial parasite Nil, Serum Ca= 9.1 mgs%, Serum Phos= 3.6 mgs%, Serum urea= 16mgs%, serum creatinine= 0.5 mgs%. His serum Alkaline phosphatase was 1347 U/L on 4th XXXXXXX and 1855 U/L on 8th XXXXXXX (after homoeopathic medicine). He is having radiological findings of rickets, with widened physis with fraying and cupping of mataphysis on Xray wrist and fraying of the lower ribs at the costochondral junction at the right costal margin on Xray chest.
Kindly advise: What can be the cause of running temperature and loss of appetite? What can be the cause of Anaemia? What can be the cause of increased Serum Alkaline Phosphatase? What are the steps to be taken further? Can the present temperature be taken as normal or pathological ? Baby is not sick looking. Mother is emaciated and now worried over her baby's condition.
Kindly advise me doctor
Thanking you in anticipation,
+91 0000
Posted Fri, 5 Jul 2013 in Child Health
Answered by Dr. E Venkata Ramana 1 hour later
Hi Sir,

Thank you for your query on Healthcare Magic.

Low grade fever of last one month duration needs further investigations.

Is there any organomegaly like liver or spleen?

Is there any lymphadenopathy?

The cause of anemia in your grandson is mostly due to nutritional cause.

Worm infestation like with hook worm also a reason for iron deficiency in children.

The loss of appetite in your grandson may be due to two reasons:

1. This is seen in almost all children after the age of 1 year. There is decreased
appetite because of decreased growth rate from the age of 1 year. Because of
increased growth rate before the age of 1 year, infants have good appetite.

After 1 year, the growth rate decreases, hence there will be a proportionate decrease in appetite.

2. Anemia, as the child is having low hemoglobin, it is another cause of decreased

The cause of increased serum alkaline phosphatase is rickets. In rickets, the activity of bone resorption increases and this leads to increase in serum alkaline phosphatase.

Temperature of 99.6 to 100.4 degree F is significant and it should be reevaluated with appropriate investigations.

The steps to be take for the child are:

1. Rickets has to be treated by giving the injection of vitamin D in therapeutic
dosage with pediatrician prescription.

2. Anemia has to be treated by giving oral hematinics like iron, vitamin C, and
vitamin B complex like folic acid and vitamin B12.

3. Deworming the child if indicated.

4. Nutritional measures to be taken to improve his weight and nutritional status.

5. Daily temperature chart to know the pattern of temperature and reevaluation
by the pediatrician with repeating investigations if required.

6. To discuss with the pediatrician the need for empirical antimalarial treatment
with Lariago if the fever is persisting.

Hope I have answered your query, if you have any clarification please let me know sir.

Best regards.
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