Persistent Fever in Hospitalized Child: Seeking Answers and Next Steps

The child has been hospitalized for 8 days and is still experiencing a persistent fever?

Dear Director,
My younger sister is 4 years old.
On the afternoon of August 30, she had a fever of 38.3°C, so we took her to Clinic A for treatment, where she was diagnosed with a common cold.
Later, on September 4, since we ran out of medication, we returned to Clinic A.
This time, the doctor informed us that she had otitis media in one ear and prescribed medication for her treatment.
By September 6, her condition had not improved; she still had a fever, sneezing, and a runny nose.
Therefore, we switched to Clinic B, where an ENT specialist examined her and diagnosed her with otitis media in both ears.
Again, she was prescribed medication for home treatment.
On September 8, concerned that my sister might run out of medication due to the holiday, we returned to Clinic B to get more medicine.
The doctor informed us that the otitis media in one ear had improved slightly and mentioned that the treatment course would take 7 to 14 days.
On September 9, at 2 AM, my sister vomited twice at home, so we took her directly to the emergency department at Weigong Hospital.
The pediatric emergency physician performed an X-ray and found that her abdomen was filled with stool.
They administered an enema for a stool sample test.
After the enema, the stool was dark green and of normal shape.
Following IV fluids and blood tests, the doctor said the blood results were normal, the stool was normal, there were no viruses, but there was a slight elevation in white blood cells indicating some inflammation.
While receiving IV fluids, my sister continued to vomit and have diarrhea, approximately 10 times, eventually vomiting bile.
We informed the doctor about her diarrhea, and he diagnosed her with gastroenteritis along with otitis media, recommending hospitalization.
During the emergency visit, she had a fever of 38.5°C, and the doctor prescribed a suppository to reduce the fever.
Once admitted to the ward, the doctor started antibiotic treatment and arranged for a consultation with the ENT specialist, confirming the presence of otitis media.
On September 11, my sister had a fever of 38.5°C again and received a suppository for fever reduction.
During this time, I experienced vomiting and diarrhea, feeling very uncomfortable in my stomach, while my wife also felt unwell and chose to fast.
On September 12, my son vomited and required an emergency visit, and he was subsequently hospitalized.
The doctor mentioned that this was a case of gastroenteritis being transmitted among family members.
From September 9 to September 12, my sister had a fever twice a day, and by September 13, she only had a fever once in the afternoon, maintaining a temperature around 38°C.
On the morning of September 14, during the doctor's rounds, it was noted that she did not have a fever that day, and she could be discharged the next day.
However, by the evening, her temperature rose to 38.3°C, and the nurse administered an oral fever reducer.
On September 15, during the doctor's consultation, it was suggested that an ENT specialist should check if the otitis media had resolved.
The ENT doctor indicated that her condition had improved significantly and that her fever did not seem to be related to otitis media.
On the morning of September 16, the doctor ordered a urinalysis, which returned normal results.
Today, her temperature has been consistently between 37.5°C and 38.1°C.
Tomorrow, we will receive a blood test report for bacterial culture.
I would like to ask you, Director, if the report shows no abnormalities, should I transfer her to a larger hospital for more detailed examinations? Or do you have any suggestions? We are really anxious as she has had a fever for so many days.
P.S.
My sister's spirits and appetite are normal now.

Mr. Chen, 30~39 year old female. Ask Date: 2018/09/16

Dr. Xiao Kaiwen reply Pediatrics

I have not personally examined the patient, so it is difficult to provide specific recommendations.
However, there are many causes of fever in children, with the vast majority being due to infections.
If possible, I recommend consulting a pediatric infectious disease specialist at a hospital.
Most importantly, it is essential to discuss this with your daughter's primary care physician.

Reply Date: 2018/09/16

More Info

When dealing with a child who has a persistent fever, especially after a series of medical evaluations and treatments, it can be a challenging and concerning situation for any parent. In your case, your 4-year-old daughter has experienced a prolonged fever, which has led to multiple visits to different clinics and eventually hospitalization. Here’s a comprehensive approach to understanding her situation and the next steps you might consider.

Understanding Persistent Fever
A persistent fever in children can be caused by a variety of factors, including infections (viral or bacterial), inflammatory conditions, or even less common causes such as autoimmune diseases or malignancies. In your daughter’s case, the initial diagnosis of ear infections (otitis media) and subsequent gastrointestinal symptoms suggest a possible viral infection, which is common in children and can lead to fever.

Hospitalization and Treatment
During her hospitalization, it appears that the medical team has taken appropriate steps by administering antibiotics for the ear infections and managing her symptoms. The fact that her blood tests showed elevated white blood cells indicates some level of inflammation or infection, but the absence of specific pathogens in cultures is reassuring.

Monitoring Symptoms
You mentioned that your daughter’s fever fluctuates between 37.5°C and 38.1°C, and she is otherwise active and has a good appetite. This is a positive sign, as it suggests that she is not severely ill. However, persistent low-grade fever can be concerning, especially if it lasts beyond a week or two.

Next Steps
1. Await Test Results: It’s crucial to wait for the results of the blood cultures and any other tests that have been ordered. If these tests return normal, it may indicate that there is no serious underlying infection.

2. Consult with Specialists: If the fever persists despite normal test results, it may be beneficial to consult with a pediatric infectious disease specialist. They can provide insights into less common causes of fever and may recommend further testing, such as imaging studies or additional blood tests.

3. Consider a Referral: If your daughter continues to have unexplained fever after all tests are completed and she remains stable, discussing a referral to a larger hospital or a specialized pediatric center may be warranted. These facilities often have more resources and specialists who can investigate complex cases.

4. Home Care and Monitoring: Continue to monitor her temperature at home and keep track of any other symptoms that may arise. Ensure she stays hydrated and comfortable. If her fever spikes again or if she shows any signs of distress (such as difficulty breathing, persistent vomiting, or lethargy), seek medical attention immediately.

5. Emotional Support: It’s also important to take care of your own emotional well-being during this stressful time. Persistent illness in a child can be very taxing, and seeking support from family, friends, or even professional counseling can be beneficial.

Conclusion
In summary, while it’s understandable to feel anxious about your daughter’s persistent fever, the current medical management seems appropriate given her symptoms and test results. Awaiting further test results and considering specialist consultations will be key in determining the next steps. Always trust your instincts as a parent; if you feel something is not right, don’t hesitate to seek further medical advice. Your daughter’s health and well-being are the top priority, and with careful monitoring and appropriate medical care, you can navigate this challenging situation.

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