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Having paleness tremors in hands, pain in groin and fever. Suggest

Feb 2013
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Practicing since : 2002
Answered : 3176 Questions
Hi I've taken my son in today too see his NP his normal DR is out of office his sx are paleness tremors in hands times sev years his pcp didn't seem concerned abd pain groin pain on and off since April and fevers every other day for sev months I'm extremly worried as I am a nurse x 15 years and I know something is wrong very wrong to be sure I cannot sleep as his currently up again with a fever his np has ordered CBC with diff , sed rate, CRP serum, TSH, UA, electrolyte panel , vit D 25 -HYDROXY and H pylori he has norm bowels norm appetite normal weight a little under weight takes no reg scheduled meds his abd as well as groin area were all normal upon his examination today any info would be greatly appreciated
Posted Thu, 11 Jul 2013 in Child Health
Answered by Dr. E Venkata Ramana 42 minutes later

Thank you for your query on Healthcare Magic.

I can understand your concerns and worry towards your child health problems.

With your description of your child seems having the following health problems.

1. Paleness.

2.Tremors of hands since several years.

3.Abdominal and groin pain, on and off since April.

4.Fever on every other day for several months.

What about the reports of the investigations done? Are they normal?

What about the ultrasound abdomen report if it is done?

What is the level of hemoglobin and WBC count in CBC?

Paleness may be due to anemia with low hemoglobin.

Tremors in hands usually in children in uncommon but they are seen in conditions like hyperthyroidism, anxiety, low blood glucose, essential tremor, and some underlying neurological problems.

Some children may have physiological tremors, which usually aggravated by fatigue and weakness.

So tremors needs evaluation with history and investigations for the above conditions.

Nothing to worry as his abdomen and pelvis examination is normal

But the causes of on and off fever for several months has to be evaluated further with relevant investigations after consulting the pediatrician like smear for malarial parasite, widal test, peripheral smear for any abnormal cells, complete urine examination, and culture of urine and blood, and mantoux test if it is required.

Therefore I advise you to consult his pediatrician for physical examination, followed by appropriate investigations to look for the causes of on and off fever.

Hope I have answered your query, if you have any clarification please let me know along with the information I have asked.

Above answer was peer-reviewed by
Follow-up: Having paleness tremors in hands, pain in groin and fever. Suggest 12 minutes later
His CBC is not back yet we had that drawn at 6pm his sed rate and UA are completely normal the test you recommended smear for abnormal cells is to rule out what ? Thank you for your timely reply really what concerns me the most is the on and off fevers and now that I think about it he has had fevers a lot in his life I always take him in and they say just a virus I assumed that this too shall pass and concerned about being pale

They did not order an ultrasound or any radiology for that matter nor did they order urine or blood cultures

He also has been saying his forehead hurts I assume it's from fever his hard to read as he never ever complains even with severe pain he says nothing and I fear this has gone on sev months
Answered by Dr. E Venkata Ramana 1 hour later

Thank you for getting back.

In children, on and off fevers are common and they are mostly due to different viral illnesses, upper respiratory tract infections with bacteria.

Most of these fevers will respond to simple Tylenol or some times with a short course of antibiotic for bacterial infections.

This type of fevers will subside within 3 to 5 days.

But if the fever is continuous together for weeks to months, then it is a problem of concern.

The peripheral smear for abnormal cells is to rule out some atypical white cells, blast cells to rule out any underlying hematological malignancies. This is just to rule out any concerns of an underlying problem and to reassure you about your child.

They didn't ordered ultrasound mostly because the examination of abdomen and pelvis was normal.

There may be headache in children with fevers.

Nothing to worry and consult again the doctor with the reports.

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

Above answer was peer-reviewed by
Follow-up: Having paleness tremors in hands, pain in groin and fever. Suggest 23 minutes later
Thank you I guess my last question would be if ALL the blood tests are normal should I push for the tests you recommended ? I don't want to over worry and the blood draw in itself was traumatic for him enough he does has a hx if OCD and anxiety so that may explain the hand tremors . I just know something is very wrong and obviously with me being in med field so long I know and have seen too much and these thoughts are now creeping in about pediatric cancer etc I don't know how far to push this I'f all blood tests are normal but he still continues to have fevers I do not want to put him through any unnecessary tests or anguish but I feel like I need an answer from his dr about unexplained fevers on and off thank you for your feedback much appreciated god bless you and yours
Answered by Dr. E Venkata Ramana 32 minutes later

Thank you for getting back.

If all the tests are normal, there is no need to go for all the tests I have recommended.

Complete review of child complaints of on and off fevers, and a complete general and systematic physical examination of the child by the pediatrician will give an idea to plan for relevant tests if they are required depending on the doctor conclusion.

Yes, I agree with you that it is common in medical people to think about many health related conditions if one of family member suffers even a small medical issue.

Nothing to worry and you can discuss with your concerns, whatever you are having with his pediatrician.

After examination, if the doctor suggest you any investigations depending on his clinical findings, then you can think for further testing.

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

If you don't have any doubt, you can close the session and I request you to kindly rate and review my answer.

Wish your child speedy recovery.

And thank you very much for wishes.

Best regards.
Above answer was peer-reviewed by
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