Childhood Leukemia, Circumcision, Fever – PediaCast 104

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  • Childhood Leukemia
  • Circumcision
  • Shopping Cart Head Injuries
  • Growth Slumps And Food Allergies
  • Fever



Caller 1: Hi, Dr. Mike. This is Kristin from Manic Mommies, and I'm just calling to congratulate you on 100th  
episode. Keep up the great work. Bye!

Announcer 1: Bandwidth for Pediacast is provided by Nationwide Children's Hospital, for every child, for every  


Announcer 2: Welcome to Pediacast, a pediatric podcast for parents. And now, direct from Birdhouse studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome to Pediacast.


This is Dr. Mike, coming to you from Birdhouse studio. It is episode 104, hundred and four, for Tuesday, January  
29th, 2008. We're calling this one, "Leukemia, Shopping Carts, and Fever."

You know, you've heard the old saying, when it rains it pours. And I know it's true in a lot of people's work place. And I just want to let you know, it's also true for doctors as well. And I talked about, you know, when there's a full moon, emergency rooms are more crowded or hospitals are more crowded. You've probably heard that before. And I know in your job, whether you are a stay-at-home mom, or whether you're working in the workplace, or wherever that may be, I know when it rains, it pours for you as well.

Now, many times in pediatrics, and I hate to admit it, but sometimes things can be repetitive and even a little boring. I mean, we do the same well checkups.


You know, the 2-month visits are all the same; the 4-month visits are all the same; what we talk about, you know,  
over and over and over again; we see a lot of kids with colds and sore throats and ear aches, but sometimes  
there's a much bigger challenge. And sometimes, those big challenges come in bunches, all at the same time. And at the end of the day, so take like last Friday, I had one of those days. You know, toward the end of the day, like all within the last 30 minutes of my office hours, we have a baby come in with RSV who had some apnea with it, so they stopped breathing and you got to get them on oxygen, you're stimulating them doing breathing treatments; we  
had to have the squad come to the office to take the child to an emergency room that's right across the parking lot  
from our office, so that then the children's hospital transport team could come and get the child.

So that's all going on, at the same time that a grandma brings a toddler in who's been abandoned by the mom and grandma doesn't really know what to do with this toddler.


Doesn't know what medications the toddler's on. She know there's something, but basically mom dropped the  
toddler off and left the state. You know, they got to get the children's services involved and all that and then, at the  
exact same time, we had a kid with a really bad belly ache, and a possible appendicitis. Okay now this is all at the  
same time and 30 minutes before I'm supposed to go home. So, some days, repetitive and boring is just fine. You  
know what I mean. It's true in my job, and I know it's true in your job, too.

Okay, so what are we going to talk about today? Childhood leukemia and circumcision. That's in the news  
department. So we're going to talk a little bit about those things. And then we're going to answer your questions. It's a Skype day. So, all of the questions that we're going to deal with today are Skype messages. So people, rather than using the contact link at the website or emailing, these are folks who used the Skypeline.


And if you like to use the Skype line to ask your questions, it is really easy to do. Just go to, or just dial on your  
phone 347-404-KIDS, that's 3-4-7-4-0-4-K-I-D-S.

And so what did you ask about when you used the Skype line? Well, shopping cart, head injuries, growth slumps  
and food allergies and then we have a question about fever. So that's all coming up.

The information presented in Pediacast is for general educational purposes only. We do not diagnose medical  
conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call  
your doctor and arrange a face-to-face interview and hands on physical examination.

Also your use of this audio program is subject to the Pediacast Terms of Use Agreement which you can find at, and with that in mind, we will be back with News Parents Can Use, right after this.




Our News Parents Can Use is brought to you in conjunction with news partner, Medical News Today, the largest  
independent health and medical news website, and you can visit them online at

A breakthrough study of identical twins has for the first time confirmed the existence of cancer stem cells that cause  
the most common form of childhood cancer, acute lymphoblastic leukemia (or ALL) — backing evidence that this  
childhood cancer starts in the womb. The research should lead to less aggressive treatment for childhood ALL and  
provides the hope of new, more effective drugs. The research should lead to less aggressive treatment for  
childhood ALL and provides the hope of new, more effective drugs.

Scientists from The Institute of Cancer Research together with colleagues at The University of Oxford and Great  
Ormond Street Hospital, funded by Leukemic Research and the Medical Research Council (MRC), have  
compared cells in the blood of 3-year-old identical twins Olivia, who is being treated for leukemia, and Isabella who is healthy. They found that both twins had the same genetically abnormal primitive cells in their blood. These "pre-leukemic" stem cells reside in the bone marrow and either "lay dormant" or go on to develop into full-blown  
leukemia stem cells.


The new research, published in the Journal of Science, shows that pre-cancerous stem cells arise from an  
abnormal fusion of two genes during the mother's pregnancy to create a hybrid protein called "TEL-AML1." This  
genetic mistake can set in motion a series of events that cause the cells to become leukemic. The authors  
confirmed their findings in the twins, Olivia and Isabella, by putting the TEL-AML1 gene into human cord blood cells, which were then transplanted into mice that had no immune system. They found that the pre-leukemic stem cells found in both twins also became established in the bone marrow of the mice, which proved the "self renewing" nature of the cells and confirmed a direct link between the specific genetic malfunction and leukemia


Professor Tariq Enver, who led the research at the MRC Molecular Hematology Unit, says: "This research means  
that we can now test whether the treatment of acute lymphoblastic leukemia in children can be correlated with either the disappearance or persistence of the leukemia stem cell. Our next goal is to target both the pre-leukemic stem cell and the cancer stem cell itself with new or existing drugs to cure leukemia while avoiding the debilitating and often harmful side effects of current treatment."

The seriousness of these side effects is all too clear for Olivia herself — she became blind in one eye as a result of  
an infection that her body was unable to fight due to the chemotherapy treatment.

Professor Mel Greaves of The Institute of Cancer Research and co-author of the paper added: "This study of a twin pair discordant for leukemia has identified the critical stem cells that initiate the disease and maintain it in a covert state for several years. We suspect that these cells can escape conventional chemotherapy and cause relapse during or after treatment. These are the cells that dictate disease course and provide the bull's eye to target with new therapies."


So this is a wow, folks. Remember, this is just one pair of twins that the researchers examined and if this turns out to be true and there is indeed this precursor cell for ALL, and if you can screen kids for these stem cells and find a way to selectively destroy them before they cause full-blown leukemia, well the implication of that is nothing short of amazing.

Alright, moving on, rates of circumcision vary widely across the nation, a phenomenon likely linked to regional  
variations in racial, ethnic and immigrant populations, as well as insurance coverage, according to the latest News  
and Numbers from the Agency for Healthcare Research and Quality (AHRQ).


Circumcision is the surgical removal of foreskin from the penis of an infant boy. The operation is usually performed  
for cultural, religious, or cosmetic reasons rather than for medical reasons. Some organizations, including the  
American Academy of Pediatrics, maintain there is insufficient evidence that routine circumcision is medically  
necessary. However, there is research suggesting that some health benefits may be gained, including a slightly  
decreased risk of developing penile cancer, a lower chance of urinary tract infection in newborns, and a potentially  
lessened risk of HIV transmission.

The new report is an analysis of hospital-based circumcisions in 2005. Among its findings:
   – In the Western US, only 31 percent of newborn boys were circumcised in hospitals in 2005. That compares with  
75 percent in the Midwest, 65 percent in the Northeast, and 56 percent in the South. Factors influencing  
circumcision rates may include insurance coverage and immigration from Latin America and other areas where  
circumcision is less common and may also include the presence or absence of medical insurance coverage.


    -Nationwide, about 56 percent of newborn boys — or 1.2 million infants — were circumcised. The national rate has  
remained steady for a decade. It peaked at 65 percent in 1980.

    -About 60 percent of circumcisions were billed to private insurance, 31 percent were billed to Medicaid, nearly 3  
percent were charged to other public programs, and about 4 percent were uninsured.

So these are interesting numbers and it does illustrate the regional differences in the United States in terms of our  
cultural expectations and whether babies should circumcised or not.

So again, in the Western US, 31% of baby boys are circumcised, 75% are circumcised. So, you know, I think it's  
helpful to know what parents think in parts of the country that are different from our own. And it adds a little  
perspective to the parenting life.


Alright, that concludes our News Parents Can Use. We're going to take a quick break, and we'll be back to answer  
your questions right after this.



Caller 2: Hey, Dr. Mike. This is Sean from Michigan. I know you had an episode a while back and I haven't had a  
chance to go back and look at it, but children falling. We've got a 13-month-old, went shopping, and made a  
mistake putting him in the large part of the shopping basket. When I turned my back to do something and my wife  
was paying, he all of the sudden took a tumble out of the shopping cart and hit the floor, but from what I can  
understand, he did a complete somersault, so he landed on his back. We called our pediatrician, and they said to  
watch him overnight and went in the next day, did a complete physical and said we should be fine, but my wife still  
has concerns of after effects and long lasting effects and now, every time that he tries to take step down, she gets  
very cautious, which I can understand but, just wondering what your opinion is for long lasting effects and anything  
like that or just which episode it was. Thank you very much for all you do and one of these days I will remember to  
log on and give you a review. Thanks, Dr. Mike.


Dr. Mike Patrick: Well, thank you, Sean for calling in on the Skypeline. So, basically kids should not be in the basket part of shopping carts. Now, I know, Sean, you're thinking, yes I know that now. But terrible head injuries can and do result, and I've seen it happen–

You know, I've seen it happen on the receiving end in the emergency department. Kids come in with bad head  
trauma because of this. And I've seen it at the grocery store. It's just–oh boy. It's just a terrible noise when a kid's  
head hits the floor. Just terrible noise!


So, really, your child's lucky that they landed on their back and kind of did that flip rather than landing on their head,  
because landing on the head can result in a skull fracture or even worse, a bleed, you know, where you have blood  
that impinges on the brain and increases the pressure inside the skull and that can lead to very bad things.

So let's talk a little bit about head injuries in kids whether it be because they fell out of a shopping cart or whatever  
reason. First, let me say, if your child has a head injury and they hit their head hard, it never hurts to see your doctor.  
I mean, always call. Even if they seem to be doing okay, there's nothing wrong with wanting your child checked out.

Now, what are some of the things that I think about when I see a kid with a history of a head injury. First, did they get knocked out? That's something that I consider as a doctor. It is important. Did they get knocked out or not? Were they stunned? Were they crying right away? Or were they quiet? Did they vomit? Have they vomited since it  


Of course, if they've had a seizure, we'd want to know that. If it's an older kid, are they complaining of a severe  
headache? If it's a younger baby, they may not be able to tell you they have a bad headache but if they are very  
irritable or difficult to console, much more fussy, you can assume, well maybe they have some pain somewhere so  
maybe they have a headache. Or are they acting normal, whether they are a baby or an older child. And how's their  

So really, you know, you want to get a good history about exactly what happened? Did they get knocked out? Have they had vomiting? Do they have a headache? You know, all these things come in to play and are important. If you  
have a kid who really has none of those things, so they did not get knocked out, maybe they cried right away but  
then got over it. They have not had any vomiting. Certainly no seizure. They have been acting normal since it  
happened. Not complaining of a headache, or they are not really irritable and fussy or inconsolable. They are eating  


You know then, for those kids, they're probably doing well. And you know, observation very closely is really most  
likely all you're going to need to do. Now again, for liability purposes, call your doctor. Let them be the one to tell you  
what I'm telling you. And then you watch them over the next couple of days, and then if any of those sort of warning  
signs start to happen, you know if they start to have vomiting, they start to have a severe headache, or inconsolable,  
very fussy, not interested in things they used to be interested in, you know, if they look at you funny, then you want to  
call your doctor and let them know.

Now we talked about not letting them sleep. It's really not that sleep is dangerous or a problem, it's just that, while  
they are asleep, they start to have any of these warning signs going on, you are not going to know about it because  
they're sleeping. So, kids that have a significant head injury, we'll say, wake them up a couple of times during the  
night, look for these symptoms, make sure that they are not complaining of a bad headache, or when you wake  
them up, they are not suddenly screaming and inconsolable.


You want to make sure that they know who you are and where they are if they are of age to be able to do that. And  
it's going to be normal for them to be sleepy, like middle-of-the-night sleepy, they should recognize who you are and know who they are and where they are and that sort of thing and that's really the reason that you wake them up in the middle of the night just so you can judge if their brain is working properly or if there's an issue there.

Now, if any of these things are occurring even if it's a few days later, and even if your child had previously been okay, you still need to let your doctor know. And usually at that point, if any of those warning signs are going on, usually we'll get a CT scan of their head and even if you have a normal CT scan, and then start to have a few days into it these kind of symptoms: vomiting, severe headache, they're not acting right, then sometimes we even scan them again because there are certain bleeds that may not show up right away. And the things you are looking for, skull fracture, epidural bleeds and subdural bleeds, these are just where blood vessels get stretched and torn a little bit, and you have bleeding in the brain.


But that extra volume of blood as it seeps out of the blood vessels, you know it takes up space and that increases  
pressure which can be bad for the brain.

Now, let's say that the CT scan's normal, there's not skull fracture, there's no bleeding, but they still have some signs and symptoms — they may have headache, they might have some vomiting, complaining of dizziness, this still can be a concussion and even babies can get concussions. Now what's a concussion? It's basically a brain injury that does not show up on a CT scan. So, the brain's going to look normal when you scan but it definitely got jarred.

And this can result in chronic headaches, dizziness, loss of balance, nausea and vomiting. They can have eating  
disturbances, sleep problems, altered mood states, you can see anxiety, depression, irritability and they can have  
learning issues with school as well.


And babies and toddlers, they may lack interest in their favorite toys, they can become irritable and they can also  
have sleep and eating issues as well with concussions. So how long does that last? Well, that's hard to say. It can  
last weeks, it can last months, and sometimes you can have intermittent problems for years after concussion,  
depending on the severity of the concussion and whether there have been recurrence of concussions. So the more concussions you have, the more significant the illness of the concussion is or the signs and symptoms that you see.

So how do you treat a concussion? Well, there's really not a lot you can do. You got to protect against further head  
injury and that's why now we know it's important, kids in sports and school, if they have a certain number of concussions, we take them out of sports because the more you have the worse it is on your brain. But otherwise,  
there's really no treatment for concussions other than to treat the chronic symptoms that they are having and to  
follow up real closely with your doctor.


So there's no question, concussions stink and even if baby who falls out of a car under their head can get one. So  
those are kind of the things that you look for both in the acute phase to know whether you need to get a CT scan or  
not, and then also, a lot later on, and can last for weeks to months what the signs of a concussion would be.

So, again, thanks for your question, Sean. I hope I helped you out. If you'd like to know a lot more about concussions, there's a good information sheet from the Mayo Clinic and if you check out the show notes, we'll put a link to that in there so just go to, look in the show notes and there'll be a link to the concussion page from the Mayo Clinic. And for the rest of you out there, please keep your kids out of those shopping cart baskets. You know, concussions stink, but there's much worse that can and does happen — traumatic head injury with bleeds and lifelong neurological devastation can result.


I've seen it happen. It's not one of those things you just read about, so definitely keep your kids out of the shopping  
carts. Okay we have another Skype question, this one from Liz in North Carolina. And let's get right to it.

Caller 3: Hi, Dr. Mike. This is Liz from Cary, North Carolina. My daughter is 10 months old and on her 9-month  
wellness visit. Everything was fine. Her weight didn't increase as much as it had on previous visits, but doctor  
attributed that to her being more mobile and active and not just playing around anymore. She's been on … since the beginning due to a sensitive stomach; everything else just made her spit up constantly. At day care she's eating stage 2 baby foods twice a day, two containers per meal in addition, she'll have about 33 ounces of formula a day. So she's eating pretty well. The more I read on what other kids her age are eating or are supposed to be eating, the more it concerned me. It seems that other kids, they are eating actual foods — yolks, eggs, noodles, actual vegetables that don't come in jars.


We introduce new food on the weekend since we have to be … to it. But if I only do a new food on  
weekends, she'll never be eating regular food, or at least will be eating out of jars for a whole lot longer. We've had  
some foods that have made her vomit such as oatmeal, spinach and lentils, so I don't want to give her a bunch of  
new foods a day, and this weekend we gave her yogurt made from whole milk and she broke out in hives. Could  
she be allergic to milk? When can we get her tested? And is it worthwhile to get her tested? And when do they grow out of this sensitivity? And at what point can I stop being the overprotective first-time mom and risk for a regular food without having to worry about how she's going to react to it? Thanks for your help and keep up the great podcast. Thanks.

Dr. Mike Patrick: Alright, Liz. Boy, you sound frustrated. [Laughs] You know when I get the emails, I can't really get a sense  
of your tone so this Skype messages are kind of interesting and it's more like being in the office because you get a real good sense of where parents are with their questions.  Let's take this one thing at a time.


First off, a growth slump is normal at about 9 months of age, and when you look at a growth chart, you'll see that the curve kind of flattens a bit between 9 and 15 months, and this is just a normal growth pattern. Kids slow their growth down as they get to be around a year old. And how do they slow their growths down?

Well, one way is by a change in their metabolism and by appetites. So kids are going to have a decreased appetite around the year of age and a few months before that and a few months after that. And that's normal. And that's one of the ways they slow their growth down which is supposed to happen around that time is by decreasing their appetite. Now grandparents, you know, always get upset about that. "Oh, they're not growing as fast as they were.  
They're not eating what they should." But if you force more food on them than what they need, then overweight  
issues are going to pop up.


So I think it's best to let your child dictate how much food they're going to eat or maybe even when they eat and as  
parents it's our jobs to dictate what they're going to eat. And it's best for kids, I think, to learn to eat when they are  
hungry and stop eating when they are full right from infancy. You know, I think that you are probably giving the right  
amount of food with the description, Liz, that you gave. So it sounds like the right amount. I wouldn't look at what  
others are eating. You want to look at your child's diet, their growth. Think about it in the context of the family growth  
pattern. We've talked about that many times before. And I'd listen to your doctor. I mean your doctor sees many,  
many, many, many more kids than the grandmas or the aunts or the neighbors who think they know everything,  

So if your doctor isn't worried, especially if your doctor sees lots of kids and if it's a pediatrician, you know they do,  
then I wouldn't be worried either. Ask your doctor to show you the growth chart, explain the curve and tell you and  
explain to you exactly why he or she is not worried.


If they can't do that, if they can't take the time — you know it takes three minutes to show you the growth chart, show  
you where they are and explain to you why they are not worried, then you probably want to find a doctor who can do  
that, right? Because I mean, you know, it doesn't take that much time and it's important that parents understand  
exactly what's going on but in general, it sounds to me like your child's growing just fine, and I wouldn't really change  
anything with the diet.

Now in terms of milk allergy, it sounds like your child probably does have one. There is a blood test that you can do to check for milk allergies. They are not 100%. The older the infant is, the more reliable it's going to be. In terms of  
how long milk allergies last, yes they can last anywhere from a few months and sometimes a few years and  
sometimes a lifetime. I would definitely avoid milk or dairy until you know for sure, and you can talk to your doctor  
about testing usually somewhere between 9 and 12 months.


Most doctors check some blood work anyway to check a lead level and to check to make sure that kids are not  
anemic and that may be a good opportunity to check a blood test for a milk allergy. And then, in terms of introducing new foods, that was the next thing that you brought up.

You know, once every weekend is pretty darn slow. Giving them something new every couple of days. Like you said, you don't want to do a whole bunch of new things on the same day especially if they are prone to having some reactions to different foods but once every weekend is pretty slow too. So yes, a new thing every couple of days is probably going to be fine. Reactions usually, if they are going to occur, it's going to be within a day or two anyway. You can have delayed sensitivity or reactions that occur a little bit longer afterward but those are rare for food allergies.

And also keep in mind, food sensitivities or food allergies can pop up anytime. Now, they're going to be more  
common in the first couple of years of life as new things are introduced but older kids can have them too.


And then, to add more confusion to the mix, you know, a lot of times it's not even the first time that a child has a food that they have a reaction to it. We've talked about this before too. But the way the immune system works, the first few times your body is exposed to something, it's fine with it and then suddenly it decides "Oh I don't like this. I'm going to make antibodies against it." So then the reaction occurs with the next exposure when the body then uses those antibodies and the reaction that you see in the skin is a side effect [coughs] of the– Oh my goodness! Excuse me, my cough is still there. It's much better though, you have to admit. It's much better. But it's still there a little bit.

Okay so the first few exposures may not result in sensitivity right away, so even by doing something new every two  
or three days, you still may not protect yourself from confusion but I think the bottom line, Liz, you just got to relax a  
little bit here. Okay?


It sounds like your child's growing fine. I wouldn't compare the growth with other kids. Remember, too, we have an  
obesity problem in the United States and it often starts in the infancy in toddlerhood so if you are comparing your  
child to all the other ones, yours may look small even though they're normal because all the other kids are too big.  
And then again, I think it's also okay to spit up your new food introduction a little bit, you know, to add variety but you don't have to. I mean, you know, even if you go slow with it though, there's not guarantee that a confusing reaction will occur down the line. But you know, have some Benadryl handy and your doctor's phone number. If there's a history food reaction in other kids in the family or in the family or in that specific kid, you can always take a bottle of Benadryl to the day care so if they start to have a reaction, they can give it. And you just get a note from the doctor telling the day care under what circumstances to give the Benadryl and how much to give, that sort of thing. And then the day care will be all set in case a reaction does occur.


And then if you can't tell exactly what food it was, don't panic. You'll figure it out in the end. For more information on  
food allergies, I have a link in the show notes to They have a nice write up on food allergies in kids  
and of course we'll have a link to that for you in the show notes.

Okay we have one more question through the Skypeline. This one is Troy.

Caller 4: Hey, this is Troy from Illinois, and I just listened to your Podcast number 24. First time I called in and I think  
your show is great. You talked about temperature and we've just been having a battle with, not only the doctors, but  
with day care and things like that with temperature and having a degree, not having a degree, and here recently we  
had our daughter who is 3 months old and she had– Oh, well at that time 3 months old; I guess she's 4 months old  
now but at that time, she had a temperature of a 100.4°F and she got sent home from day care.

   Took her to the doctor, the doctor put her on an IV almost immediately and then sent us up to the hospital to get a  
spinal tap and all kinds of stuff. So it ended up being that they didn't do a spinal tap and that he was concerned  
about meningitis and all this stuff. Well, here recently, a couple of weekends ago she had another fever, but this time it got up to 101°F. We called the doctor, and the doctor said, "Oh does she have any other symptoms?" Well, no. The last time you said it was 100.4°F and we went through all this stuff. And he said, "Well if she doesn't have any other symptoms or anything like that, she can get up to 102°F and even at 102°F just give us a call back, we'll kind of monitor her but if she gets up to 104°F to 105°F…" and it just went on and on.


And I'm just really confused about fevers in infants and when do you need to take them in to the emergency room,  
when do you not take them to the emergency room, why did we have to spend two days in the hospital for 100.4°F  
temperature. Anyway, I'd appreciate your thoughts and concerns and if you got another episode that you can turn  
me to, I'd listen to that. I appreciate it. Thanks. Bye.

Dr. Mike Patrick: Okay Troy, well thanks for your question. Boy, it sounds like it was a whole confusing series of events and I cannot really speak to why your doctor did the things that he did but I can tell you sort of what my take on fever and where I go with this.

First let me say, fever by definition is a rectal temperature that is 100.5°F or greater. I'm going to use Fahrenheit  
since that's the measurement that I'm used to using but certainly, Celsius or centigrade is another way that they can look at it and normal with that's going to be around 37°C.


So that's all I'm going to mention with that. So a rectal temperature of 100.5°F or greater would be considered a  
fever. Now, if you take the temperature some other way, whether it's axillar or under the arm, oral, in the ear,  
their skin, they have this temporal artery scanners that you scan across the forehead, are those always going to be  
exactly equal to the rectal temperature? No.

Now if you add a degree to those, is it going to equal to rectal temperature? No. Probably not. You know, try it some time. Take your kid's temperature under the arm and then do the rectal and see if they're 1° apart. It's really unlikely that they're going to be 1° apart. The gold standard is rectal. You know, take it how you want.


But when you call your doctor, tell them the number you get and how you took it, and then let the doctor decide what to do with that information. So don't add a degree or don't subtract a degree. Just take the temperature, tell us how you took it, what number you got, and we'll go from there.

Now the rules regarding fever — pretty straightforward — in infants, I want to know what the rectal temperature is. It's as simple as that. I don't what the axillary, I don't want oral, I don't want in the ear, I want a rectal temperature in an  
infant because I'm going to base my decision on what to do on what that rectal temperature is and that's the gold  
standard. That's the number that we want, is then one that you obtain with a rectal temperature.

If the child is less than one month of age and their rectal temperature is 100.5°F or greater, the standard of care in  
most communities is going to be to admit the child to the hospital, do a full septic workup, that means you want to  
get urine with a catheter and get a culture of the urine. You want blood. You want a blood culture.


And you want to do a spinal tap, so that you can get a cerebral spinal fluid and do a culture on that. And you're going  
to do IV antibiotics — two different kinds of IV antibiotics. Why so aggressive? Well, sepsis can be overwhelming  
very quickly in young infants and can lead to death in a matter of hours. So it's really important that you get right on it and if it turns out that they are not septic, or they just have a virus, you would rather overdo it and have a baby who's fine than two underdo it and have a baby that's dead.

So generally, the standard of care is going to be, if they are not less than a month old, and their rectal temperature  
is 100.5°F or greater, you're going to do the whole she-bang which is in the hospital.

Now what about if the temperature is100.5°F rectally at home and 100.4°F at the doctor's office. What if you go to  
the doctor's office and they take the temperature rectally and it's 100.6°F but then you undressed the infant and take it again 5 minutes later, and now it's 100.2°F? What do you do then?


Well, this is where the art of medicine comes into play. And it's going to be a judgment call that your doctor's going  
to make based on their training, their experience, the prevailing community standards, what your baby looks like,  
other symptoms that may be going on. So, they can say exactly what you're going to do and with those kind of  
exceptions, other than to trust the doctor that you are trusting to take care of your child.

Now between one and two months of age. This is a gray area. Some doctors are going to follow the same rules as  
you do with kids that are less than a month old. But there is more leeway here for using individual judgment and sort of looking at how the kid looks.

I mean if you have a kid who is between one and two months, and their temperature is 100.7°F and they're eating  
fine, they're smiling at you, you know, you might get the urine, you might get a blood culture. Are you going to put  
them to a spinal tap? Maybe not.


On the other hand, if they are between one and two months of age and their temperature is 100.4°F and they're  
really irritable, I think most people would still do the full blown septic workup with the spinal tap and everything else.  
So, again, it's a judgment call between one and two months. Over two months of age, we worry about fever a lot  
less. I mean, we still do worry some, you know, and especially depending on what the kid looks like, whether their  
symptoms are going on, but there are certainly over two months of age, you worry a lot less about quickly  
developing overwhelming sepsis that can kill a baby in a matter of hours.

So I do understand your confusion with this, Troy, and only your doctor can answer why they gave this specific  
advice that they gave. What I outlined here is what I do and what the doctors that I know in practice with also do. But of course, your mileage may vary, so hopefully that helped you out a little bit. We're going to go and take a quick break and we'll be back to wrap up the show right after this.




Alright, thanks go out to Nationwide Children's Hospital for providing the bandwidth for this podcast, also to Medical News Today, which you can find at, for helping us out with the news department, and Vlad over at for helping us out with the artwork, both at the website and on the feed and of course, thanks to all of you for participating in the program with your comments and questions. Again, if you'd like to send us some, just go to the website, click on the contact link — you can reach me that way — or just email or call the Skypeline like the folks today did at 347-404-KIDS.

Also, Pediascribe, that's the blogging arm of Pediacast. It's a mom blog done by my wife Karen and I usually  
highlight one of her posts at this point during the show and what I'm going to highlight today is "Why my house  
smells like fish" and I'm just going to let that speak for itself, folks. Okay [Laughs].


So if you want to check that out, just go to or go to, click on the link in the show notes, it will take you right to that post.

Alright, we should have one more show this week, and you'll notice the show are getting a little longer and getting a little more windy, aren't I? I'm sorry about that. I'll try to get a little more concise here for you.

And this really busy time of the year, because the flus are starting to rear its ugly head at the office, and RSV is  
really kicking up, so we've been really, really busy at the office so I'm doing well to get two shows out each week. My goal is three but this week, I think I'm only going to be able to get one more done. We'll see how it goes. So anyway, there should be one more, probably on Thursday, and until then this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody!



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