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Suggest Treatment For Elevated ESR Levels In Children Suffering From Fever

Posted on Wed, 8 Apr 2015

Question: My child 3 years 3 months old has suffering Sever cough & Fever 20 days i was consult our regular pediatrician ( D C H) give medicines 24/2/2015 the following:-
1)OTRINOZ PEDIATRIC NASAL DROPS,2) DOLO,3)K-ZINE SYP,4)PROWEL DRY SYP,5)LEVOLIN SYP,6)COOL TOUCH GELPAD-CHILD,7)ASTYMIN LIQID,8)NEMOCID SUSP
again consult 06-03-2015 the following medicine given:-
1) Refzil 0 125mg syp 5 ml BD (9 days), 2) Asthakind Exp 3.5ml TDS(9days),3) Bifilac dry syp 5 Bd(9days), 4) Dolo 5ml (sos)
but the cough is still & fever every day evenging 3 days there then doctor suggest take Blood test, CBC,ESR,CRP,MX and result shows follows:-
HB 11.6GM, HAEMATOCRIT 33.5%, TOTAL RBC COUNT 4.43 millions, MCV -76 gl, MCH - 26.2 pg, MCHC - 34.7% Total WBC count 12200 cells, Platelet count 299000, Neutrophils - 53%,Lymphocytes 34%, Monocytes 4%, Eosinophils - 8%, Basophils 1% ESR(1hr) 90mm, CRP(C-Reactive protein) 5 mg, Mantoux test - Negative
Again he prescribe the following medicine:-
Singulair 4 mg Tab evening 30days
TECZINE syp 2.5ml bd
Hetrazan 100 mg tab 1/2 tds
vomikind sys (sos)
zenflox Eye drops
Now my question is my childs cough reduced but not completely fever also reduced some times it comes he was going play school 2 hours daily last 5 days what i can do now? how do reduce my childs ESR 90 mm

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
This looks like viral illness do not worry.

Detailed Answer:
Hi....This looks like viral illness - do not worry.

Fever of few days without any localizing signs could as well a viral illness. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If the kid is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active.

I have a few suggestions for you -

1. Eosinophils of 8 does not warrant Hetrazon - please stop it.
2. Nemocid (Nimesulide) should not be used in kids - please do nto use it.
3. In a short period antibiotics have been used - viral illness does not warrant antibiotics. Stop - Refzil 0 125mg syp, zenflox Eye drops.

Most importantly - ESR of 90mm is nothing when there is fever. That test doesn't mean anything because any fever will elevate the ESR like that. Most important thing is the well being of the kid. If the kid's temperature is normal and he is feeding normally, you need not worry about ESR. It will automatically come down in a week or 2. You need not do anything for it. Please do not worry about ESR.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (46 minutes later)

Thanks for your reply respected sir, I want some clarification in your answer
Kindly tell me what are the medicine to be continue?

My boy weight is 11 kgs is it ok for his age
His age is 3 years 3 months
He is not feeding properly and sleeping also less because cough
In X-ray - doctor says some allergy reactions (3 times past in last one and half years)

If he sneezing 3 to 4 times he suffer fever for the next day what is the reason behind it? and if he goes to any crowed place also it was happened?

Our Pediatrician threatened otherwise neutralizer or Puff you have to use!

Currently Today we are given the following medicine.
1) Singulair 4 mg Tab evening 30days
2) Hetrazan 100 mg tab 1/2 tds
3) Asthakind Exp 3.5ml TDS

kindly recommend the medicine & foods, pre-caution measures, to continue

Answered by Dr. Sumanth Amperayani (9 minutes later)

Brief Answer:
Please answer the questions below

Detailed Answer:
Hi...Coming to your queries -

1. Right now as there is no fever - no fever medicine is required. If there is fever - Paracetamol can be given in the dose of 15mg/kg/dose (Maximum ceiling dose 500mg per dose) every 4-6th hourly that too only if fever is more than 100F. I suggest not using combination medicines for fever, especially with Paracetamol.

2. No specific foods to avoid.

By what you quote I feel what your kid could be having viral associated wheeze or multi triggered wheeze. I have a few questions for you -
Questions:
1. How many days per month does she cough or feel breathless?
2. How many nights per month does her sleep get disturbed due to above symptoms?
3. Does she feel breathless when she runs around or plays with other kids?
4. Are the symptoms when there are seasonal changes?
5. Is there any family history of asthma or any other sort of allergies like skin allergy etc.?
6. Is the cough always associated with fever?

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (16 minutes later)

Thank you very much respected sir for your reply
Male baby
The following answer as you asked:-
1)     He suffered cough & breathless 2 times in a month now past 20days
2)     Only Last 20 days well known
3)     Yes occasionally Past 20 days well known
4)      May be a chance of Change seasonal XXX
5)     My mother has always suffered cough past 7 years take cough medicine with antibiotic every 15 days
6)     Yes some times (Now 100%)

Currently Today we are given the following medicine.
1) Singulair 4 mg Tab evening 30days
2) Hetrazan 100 mg tab 1/2 tds
3) Asthakind Exp 3.5ml TDS

kindly recommend the medicine & pre-caution measures, to continue
I have 2nd Male baby 6 months 20 days he also suffered sever cough

Answered by Dr. Sumanth Amperayani (18 minutes later)

Brief Answer:
This looks like a wheezing problem

Detailed Answer:
Hi...This looks like a wheezing problem. My suggestions for you -

Suggestions:

1. There are certainly alternative management therapies in allopathy now-a-days. Medicine has advanced a lot and not asthma is 100% controllable.

2. Inhalers are the newest management strategies for this. If I were your paediatrician I would have suggested the use of Budecort metered dose inhaler (100mcg) 2 puffs twice a day through a spacer and this is for regular use for 8 weeks. Another metered dose inhaler is Levolin and this can used as rescue therapy whenever the kid is having severe cough in spite of regular usage of Budecort.

3. The technique is very important and very crucial for the drug to be delivered correctly to the lungs. Regularity of medicine usage also matters a lot. So do not discontinue abruptly after you notice some improvement. The technique of administering an inhaler using a spacer has to be taught to you by your doctor and these are prescription medicines. So I suggest you consult your paediatrician for this.

4. Triggers can be environmental changes/ dust/ talcum powder/ seasonal changes/ un-cleaned a/c vents/ cold weather etc....we can specifically say this is the cause - unless we observe the kid closely - best person is the parent.

Coming to your queries -

1. Precautions include - using the inhaler regularly.
2. Avoid exposure to cold climate and weather changes.
3. This is not related to food - so you can give all foods to your kid.
4. Avoid exposure to dust and old books.
5. Keep the bed covers and pillow covers free from dust with regular washing and drying in hot sun.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. In this way even in health care magic you can follow up always with a single doctor who knows the history of your kid completely. Please find the link below -
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (3 days later)

Sir my wife, child XXXXXXX XXXXX was visited child trust hospital on 10.03.2015 morning but you does not respond then my wife consult Dr.Balasubramaniam. He said wait 3 days stop all medicine. According to that we stopped all medicine but fever medicine will give if 100 F above four times. He is active when there is no fever cough also reduced, feeding is less. What i can do now sir? breathing problem also reduced only salain drops used 2 times as per insturction given by doctor

Now shall i take any medicine,test?

Answered by Dr. Sumanth Amperayani (24 minutes later)

Brief Answer:
Suggestions on medicines

Detailed Answer:
Hi....as the kid doesn't have any fever and breathing problem also reduced now, you need not use any more medicines and no more tests are needed.

Regarding the kid not feeding well....any kid while recovering from any illness is said to be in convalescence period. During this period the kid will feed less. The most important thing rather than food intake is activity of the kid. If the kid is active do not worry at all.

I didn't understand what you meant by I didn't respond and so saw Dr. Balasubramanian. I am here with providing my number and hence forth if you want to see me in XXXXXXX you can call and come - 0000

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sumanth Amperayani (44 hours later)

Thanks for your reply sir

I stopped all medicine now child is active

1) His weight is 11.2 Kgs less for his age how to improve his weight gain?
2) Syp Zincovit or syp astyanin can be given (muti vitamin)
3) pyrantel pamoate oral supension 2.5 ml (nemocid) shall we give now or when did we give (Last dose given in 12th Dec'14)
4) Food intake marginally increase now!
5) Now my second child 7 months boy was also suffered cough but he is active every time snzee in nose large amount sptum comes what i can do? till birth he take more than 4 times antibiotic sir

Kindly advice sir

Answered by Dr. Sumanth Amperayani (5 minutes later)

Brief Answer:
Suggestions

Detailed Answer:
Hi...coming to your queries directly -

1. At his age interest in play increases and interest in food decreases. This is quite natural. If he is active and playing around you need not worry. This age rather than the quantity of the food I suggest you concentrate more on the number of times you feed him and also make whatever you feed him calorie dense by adding good amount of ghee to it.
PLEASE DO NOT GIVE ANY SO CALLED APPETITE STIMULANTS AS THEY ARE NOT VERY SCIENTIFICALLY PROVEN AND THEY HAVE THE SIDE EFFECT OF EXCESSIVE DROWSINESS.

2. You can give Zincovit syrup 5ml once daily for 1 month.

3. Rather than Nemocid I suggest you give Syrup Bandy 10 ml today and another 10 ml after 10 days.

4. Good that food intake has increased.

5. Unless the kid is breathless and has fever more than 103-104 consistently - no need for antibiotics. These may be simple viral illnesses.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. In this way even in health care magic you can follow up always with a single doctor who knows the history of your kid completely. Please find the link below -
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (31 hours later)

Thank you very much sir, now My son XXXXXXX XXXXXX is better and very active

1) Shall child take head bath more than 40 days over because after head bath the child get fever,cough it will happen more than 1 years

2)Kindly give any medicine in Summer season, Foods, in school, outside the house

3) My second child is also better now but some dry cough is there, Sptum comes nose in every sneeze sir but no medicine given to him till now (7 days)

4) Syrup Bandy 10 ml will give tomarrow now my self also caught sever cough,dry cough, Errosive gastrics whether it will affect my childrens?

5) Give General practice to child health

Thank you very much once again kindly reply

Answered by Dr. Sumanth Amperayani (20 hours later)

Brief Answer:
Suggestions

Detailed Answer:
Hi...
1. You can give him head bath. NO problem.

2. Nothing specific - avoid outside foods.

3. He will get better

4. Your condition will not affect kids.

5. I didn't understand what you meant by - Give General practice to child health.

Regards - Dr. Sumanth

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar