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What Causes Persistent Fever, Nose Congestion And Trouble Breathing In Children?

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Posted on Tue, 14 Jul 2015
Question: My daughter will be 3 in July and started preschool last week. On Saturday evening, we noticed she was slightly lethargic. We took her temp and it was 101.9 rectal. She only had a temp so we gave her children's Motrin so she could sleep. Throughout the night she sounded like
she was having trouble breathing, snoring like sounds. Her nose seemed stuffy, not running. We gave her Motrin again at 0350 am the next morning but we didn't write down her temp. At 6:47 am, Sunday morning her temp was 100.5 rectal. At 7:15, after she ate we gave her Motrin.

We had not given her any children's Motrin until 7:15 Sunday morming. Her rectal temp was 101.8 at 11:20am, 102 at 5:38pm, and 102.7 rectal just at 7:30 Sunday evening. She doesn't seem to have much energy, and has just wanted to stay in bed or on the couch.

She's threw up Saturday night but just once, and now her nose has been running off and on but nothing concerning, very light.

Today is Monday, 9:00 pm, and the first time we noticed she had a temp was Saturday at appx 9:00 pm. We were hoping the fever would have broken by now but here we are on day 3 and her temp is 100.7

She doesnt have any symptoms other than slight lethargy and she been consistently running this fever. When should we take her to the doctor?
doctor
Answered by Dr. Archana Verma (58 minutes later)
Brief Answer:
No need for investigations at present

Detailed Answer:
Hi
Welcome to the HCM

I completely understand your concerns but don't worry. Most likely your child is suffering from a self limiting viral illness. If your child has temperature less than 102 degrees Fahrenheit and is not showing any other symptoms such as rashes, bad throat, cough and breathing problems, bowel or bladder disturbances etc. then you may just follow the following measures to help her:

1. Give her acetaminophen syrup at 15mg/kg/dose instead of Motrin. It is more helpful to relieve the fever. Repeat the dose of acetaminophen after 6-8 hours interval if fever persists.

2. Cold sponging will be helpful in early relief.

3. If she has running nose or mild cough, then use Syp. Benadryl or Chlorpheniramine.

4. Keep her well hydrated by regular feeds and oral fluids such as lemonade, soups, juices etc.

There is no need for antibiotics at present.

In case she develops any other symptoms or the fever shoots up above 102 degrees Fahrenheit even after next 2 days, then do inform me, I will be happy to help you out.

Hopefully this will help you.
Take care
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Archana Verma (3 days later)
We've been monitoring our saughters fever. Its stayed below 100 without medicine. However, her flem has increases and she's coughing a lot at night.

My apologies but I am uploading a picture. She just coughed this flem and it looks yellow. Could it be turning into bronchitis? Considering her fever went up to 102.7, it appears to be bacterial. Shouldn she be starting antibiotics?t
doctor
Answered by Dr. Archana Verma (43 minutes later)
Brief Answer:
Investigate her first by chest X ray and blood and sputum test

Detailed Answer:
I have gone through your question and the picture attached. There is a possibility of chest infection.
I would recommend you to go for the following laboratory work up before you start her on antibiotics:
1. Chest X Ray ( PA) View
2. Sputum gram stain and culture
3. Complete blood count with differential.

Start her on Syp. Augmentin 5 ml thrice daily. It's an antibiotic.

Kindly upload the reports for my reference, so that I can suggest you the further plan of management.
Hopefully this will help you.
Take care
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Archana Verma (1 hour later)
What would the CBC be looking for? Do you think its prudent to radiate a toddler for a chest cold? Wouldn't the sputum culture identify infection without the addition of needles and X-rays?

Doctors here in the states seldom test for anything. They'd rather you fight it off on your own and will only dose you with antibiotics if it doesn't go away.
doctor
Answered by Dr. Archana Verma (18 minutes later)
Brief Answer:
You may give antibiotics emperically

Detailed Answer:
I see such cases many a times in my clinical practice. Most of the times they do respond to a course of antibiotics for 7-10 days. But sometimes they don't. So it's always better to establish a proper diagnosis and treat accordingly rather than emperically.
Sputum gram stain and culture doesn't always show the offending organism but if it's positive then it will be useful.
Chest X Ray does expose the child to mild radiation but it's indicated in the case to rule out any pneumonia. If present, also it helps to check for the type of pneumonia ( like streptococcal, staphylococcal, atypical etc).
Complete blood count( CBC) will help to check for any infection in body. In case both the above tests look fine, then CBC will guide us to the need for antibiotics.

Hopefully this will help you.
Take care
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Archana Verma (1 hour later)
She had a CBC in the past with aytipcal lymphocytes and a follow up blood smear. The results were frightening. She was diagnosed at 2 with absolute lymphcytosis. The pathology report recommended virology to rule out infection and if persistent, flow cytometry. We went to see a pediatric HEMA/ONC who said children have juicy lymphcytes and sent us on our way. Since then, we've had two addtional CBC's and blood,smears. I will upload those on another thread. The results are always varying but for the life of me, not a single bit of labwork ha ever been performed. We call it surface medicine, they never look to see what is actually causing the problem. The doctor said she would be fine but if shes coughing the same stuff tomorrow, i will persue testing.

Thank yous
doctor
Answered by Dr. Archana Verma (5 hours later)
Brief Answer:
Upload the reports for my review

Detailed Answer:
I completely understand your concerns but don't worry. In case you go for the laboratory work up, please upload the reports for my review. I would be happy to help you out.
If I have answered your question then you may close this discussion, rate it and write a review.
Take care
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. Shanthi.E
doctor
Answered by
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Dr. Archana Verma

Pediatrician

Practicing since :2006

Answered : 1129 Questions

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What Causes Persistent Fever, Nose Congestion And Trouble Breathing In Children?

Brief Answer: No need for investigations at present Detailed Answer: Hi Welcome to the HCM I completely understand your concerns but don't worry. Most likely your child is suffering from a self limiting viral illness. If your child has temperature less than 102 degrees Fahrenheit and is not showing any other symptoms such as rashes, bad throat, cough and breathing problems, bowel or bladder disturbances etc. then you may just follow the following measures to help her: 1. Give her acetaminophen syrup at 15mg/kg/dose instead of Motrin. It is more helpful to relieve the fever. Repeat the dose of acetaminophen after 6-8 hours interval if fever persists. 2. Cold sponging will be helpful in early relief. 3. If she has running nose or mild cough, then use Syp. Benadryl or Chlorpheniramine. 4. Keep her well hydrated by regular feeds and oral fluids such as lemonade, soups, juices etc. There is no need for antibiotics at present. In case she develops any other symptoms or the fever shoots up above 102 degrees Fahrenheit even after next 2 days, then do inform me, I will be happy to help you out. Hopefully this will help you. Take care