Winter is coming: care of the febrile children in the time of COVID-19
- PDF / 367,563 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 39 Downloads / 135 Views
PERSONAL VIEWPOINT
Winter is coming: care of the febrile children in the time of COVID‑19 Nicole Gerber1,2 · Jonathan S. Farkas3 · Adam J. Ratner3 Received: 21 September 2020 / Accepted: 27 October 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
In the pediatric emergency department (PED), winter seems to arrive earlier each year. After the broken bones and lacerations of the summer, the winter season brings fevers and respiratory illnesses. Fever is our bread and butter—it is the most common reason for PED visits [1]. Fever phobia is ingrained in our society [2]. In the pre-vaccine era, a febrile child was cause for concern; those who were ill-appearing had high rates of bacterial meningitis, and even well-appearing children could not be rapidly discharged. Occult bacteremia was a common condition in well-appearing young febrile children and frequently required laboratory evaluation and treatment with empiric antibiotics [3]. With the introduction of the protein–polysaccharide conjugate Haemophilus influenzae type b vaccine in 1987, and the pneumococcal vaccine based on similar technology in 2000 (expanded in 2010), the evaluation of febrile children became a little easier for pediatricians. Rates of invasive bacterial disease declined rapidly, and while we remain vigilant in our evaluation of febrile children, most could be confidently discharged without an extensive workup, with a likely diagnosis of a viral syndrome. These PED visits for well-appearing febrile children were a constant for us. After a thorough history and physical exam, we knew how to counsel parents on the care of their child. Make sure to get plenty of rest. Encourage oral fluids. Use antipyretics for comfort. Make sure everyone at home is washing their hands well. Return to school when 24-hour fever-free. These visits were enjoyable in a way. We reassured worried parents and briefly counseled them on the difference between viral and bacterial illnesses. We comforted parents that their children * Nicole Gerber [email protected] 1
Weill Cornell Medical Center, New York Presbyterian, 525 East 68th Street, M‑131, New York, NY 10021, USA
2
Department of Emergency Medicine, Division of Pediatric Emergency Medicine, 525 East 68th Street, M130, New York, NY 10021, USA
3
New York University Langone Health/Bellevue Hospital Center, 462 First Ave, New York, NY 10016, USA
would likely recover soon, that the best medicine was the tincture of time. We counseled them on reasons to return and advised close follow-up with their pediatricians if not improving. As pediatricians, we knew what to be worried about. This year, winter ushers in a season of uncertainty. The first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection changed the world. The disease (COVID-19) continues to spread globally as the world struggles with viral containment. Quarantine, isolation, and social distancing have become part of our daily vernacular. Much of the world went into lockdown and is only now just sta
Data Loading...
