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What causes persistent fever, cough, running nose, vomiting and anorexia in an infant?

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Posted on Fri, 20 May 2016
Question: Writing to you from XXXXXXX My son, 2.7 years old, weighs 10.5 Kgs, is having fever since the night of March 11. My paediatrician is not available. I am following the procedure he has recommended in the past, i.e.
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paracetamol every 4 to 6 hrs if fever more than 101. Sponging if fever more than 102. Meftal-P if fever still not coming down. Visit doctor if fever continues for over 4 days.
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Two times in the past he has had viral fever and we have tried the same. It has worked. It's a bit different this time. When he was small we could do sponging easily, but now he has grown up and is not allowing sponging. He becomes restless and cries a lot if we try sponging and while crying he sometimes vomits.

Please find the chart showing fever and medicine given below:
Note: The Crocin we are using contains 120mg paracetamol per 5 mg.

######## Chart #####################
Mar 12, 5:30 AM - 100.5 C

Mar 12, 7:30 AM - 101.6 C

Mar 12, 12:00 Noon - 101.8 C
given 8ml crocin syrup

Mar 12, 4:30 PM - 101.3 C
given 8ml crocin syrup
vomited after 15 mins

Mar 12, 6:15 PM - 101.3 C

Mar 12, 9:20 PM - 102.2 C
given 8 ml crocin

Mar 12, 11:30 PM - 100.6 C

Mar 13, 3:30 AM - 101.8 C
given 8 ml crocon

Mar 13, 9:00 AM - 102 C
given 8 ml crocin

Mar 13, 1:50 PM - 101.8 C

Mar 13, 2:30 PM - 104 C
given 8ml crocin syrup
did sponging forcefully for 10 mins
vomited

Mar 13, 3:30 PM - 100.5 C

As you see above, Crocin is not very effective, temperature mostly remains above 101 after taking crocin. And after 3 hours temperature crosses 102. As you see above, it reached 104 a few hours back.

I have bought meftal-p but not given him yet.

1. Shall we got to a hospital immediately or we can manage the fever at home? If managing at home, what should be the course of medication we should follow now?
Can we give meftal-p with crocin together? How many hours gap between the two? Also suggest the dosage.

2. If fever is very high and he does not allow sponging what to do? Ignore his cries and do it forcefully? Can we use ice water for sponging or tap water?

3. If he vomits within a few minutes of getting medicine, do we need to give medicine again?

4. The crocin bottle says not to give more than four times in 24 hours. But if we give every 4 hours we may end up giving him medicines 5 to 6 times in 24 hours

Please call me anytime if required.
doctor
Answered by Dr. Taher Kagalwala (1 hour later)
Brief Answer:
There is a possibility to use both paracetamol and mefenamic acid, but:

Detailed Answer:
Dear friend,

Thank you for posting a direct question to me. First of all, my appreciation of your detailed documentation of your son's fever. I would like to know what is causing the fever. Perhaps it is a virus. Would you please let me know the following:
a) Has he any other symptoms?
b) How is his appetite and behaviour when he DOES NOT have a temperature?
c) Is there anyone else in the household who is I'll?

If these replies can be sent right away, I could reply pronto.

Coming to your other questions. Firstly, yes, you could give doses of Mefenamic acid in between the Paracetamol doses. Secondly, don't worry about sponging him if he doesn't like it.

Awaiting your further input.

Dr. Taher
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Taher Kagalwala (1 hour later)
Please find the answers below:

a) Has he any other symptoms?
Other symptoms are: cough (not too much though), running nose, sleeping a lot, not taking food, vomits some times. He probably has a bit of pain in stomach. After feeding last night he was very uncomfortable and making faces as he is going to vomit. I kept him in my lap and kept patting gently on his back. He passed gas many times and then slept.

b) How is his appetite and behaviour when he DOES NOT have a temperature?
His appetite is extremley poor. We have to spend at least one hour to feed one roti or a glass of milk. His weight is not increasing. In fact his weight has not increased at all in past four to five months. Our paediatrician suggested cypon syrup. That too didn't work. We tried deworming (albendazole 400 mg single dose). But his appetite is still same. He is very lean and thin. Also he will have a running nose almost 10 to 11 months a year.

c) Is there anyone else in the household who is I'll?
Yes, a visitor (an aunt) came to our house two days before my son started having fever. The visitor reached here after touring the entire South XXXXXXX The visitor is coughing a lot (dry cough) in the night. She also has irritation in the throat. Other than that the she has no symptoms. Unfortunately my son played the whole day with her when she arrived, even slept with her in the night.
doctor
Answered by Dr. Taher Kagalwala (39 minutes later)
Brief Answer:
This is a viral infection.

Detailed Answer:
Thank you so much for your replies, Mr. XXXXXXX

First of all, the replies are clearly indicative of your son catching a virus, most likely from his great aunt. In the event, there should be no further concerns, even if the fever is high at times. I would be more reassured of this if you could open his mouth and see if the back of the throat looks normal or is very red, and if the tonsils (the two reddish small organs behind the tongue on each side of the mouth) are the size they usually are or if they are very large and red and showing yellow spots on them. I know that this is something normally done by doctors, but it is not so difficult to do if you are diligent and gentle with him (as you will be, since you are his dad).

If the throat isn't unduly red and the tonsils look okay, we can carry on with the current regimen of using Crocin primarily, but supplementing it with Meftal P from time to time, giving him liquids and getting him to rehydrate. and making sure he wets his nappy at least 3-4 times in 24 hours.

The appetite issue at present is due to his infection; once he is well, you should be showing him to someone who is not happy giving medicines like Cypon (which is clearly the wrong thing to do for stimulating someone's appetite, since it rarely works and leads to sedation and other side-effects). He might need a little input from a dietician if that is at all possible.

The remaining part of this answer has to do with the logical way of treating a viral infection.

As viruses are self-limiting, there should initially be a worsening of the condition in a child, followed by gradual but spontaneous recovery over a week to ten days. Antibiotics are NOT useful and must NOT be used. Failure of improvement in a few days' time should lead to you visiting a doctor and requesting him/her to run a few tests on your son such as a complete blood count, an ESR and inflammatory markers in the blood (commonly, the C- reactive protein). If these tests are abnormal, antibiotics MAY be needed.

If his intake does not improve, you might want to suggest to the Paediatrician to hospitalise your son for a day and infuse some fluids into his vein. Mostly, though, this is not needed - and definitely not needed if he is drinking fluids and wetting his nappies at least 3-4 times in 24 hours.

I am confident that your son will improve over the next few days. Please write back to me if he doesn't or you have any other concerns.

Dr. Taher

P.S. Sponging is losing in popularity in medical practice as large scale studies have not shown it to be better than using medicines alone.
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Answered by
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Dr. Taher Kagalwala

Pediatrician

Practicing since :1982

Answered : 706 Questions

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What causes persistent fever, cough, running nose, vomiting and anorexia in an infant?

Brief Answer: There is a possibility to use both paracetamol and mefenamic acid, but: Detailed Answer: Dear friend, Thank you for posting a direct question to me. First of all, my appreciation of your detailed documentation of your son's fever. I would like to know what is causing the fever. Perhaps it is a virus. Would you please let me know the following: a) Has he any other symptoms? b) How is his appetite and behaviour when he DOES NOT have a temperature? c) Is there anyone else in the household who is I'll? If these replies can be sent right away, I could reply pronto. Coming to your other questions. Firstly, yes, you could give doses of Mefenamic acid in between the Paracetamol doses. Secondly, don't worry about sponging him if he doesn't like it. Awaiting your further input. Dr. Taher