Hi doctor,My 10-months-old daughter got a fever. I have been rotating between Tylenol and Motrin every 3 hours or as I feel necessary based on her temperature. Yesterday I did not give her anything for a couple of hours, and the fever spiked to 103.6. I gave her Motrin, and it went back down to 100.7. But I could not seem to get it to go away completely. She also has been having mild diarrhea (2-3 wet watery diapers a day). She also got her first tooth this last weekend and is getting another one. Could this be due to teething? At what point do I need to take her to the ER? How long can I keep up the Motrin and Tylenol?
Hi. Many thanks for your query. Very often we put down these symptoms to teething, but this usually is a viral illness - a viral upper respiratory tract infection URTI. Teething by itself does not cause these symptoms, it is just that it is the same age that they start teething that they get the more viral illness as mother's antibody in the child's blood die down and the child has not yet grown her own antibodies. So it is a coincidence, rather than a cause. Viral illnesses as a general rule start getting better 3-5 days after the onset, though on rare occasions it may take up to 7 days. But we advise seeing the child in the ER/GP Surgery if there is no sign of improvement after three days, so if the child is not better by today, I would probably get her examined by a doctor. Diarrhea may have been caused by the same virus that has caused the URTI; viruses like Adenovirus can often affect the gut and the respiratory tract at the same time. You need to make sure that you give her plenty of fluids and watch her urine output. For viral fever, there is very little to do other than using Tylenol (Paracetamol) and Motrin (Ibuprofen). You cannot use Tylenol more frequently than 6 hourly, but it is very usual for viral temperatures to return before the next Tylenol is due, so we advise to use Motrin at that time. Motrin, however, cannot be repeated before 6-8 hours. Making sure that the doses are right is essential. For an 8.62 kg child, Tylenol should be 120 mg per dose, and Motrin should be 50 mg per dose. Virus. FBC (full blood count), U&Es (urea and electrolytes) and CRP (C-reactive protein). Bacterial illness. Viral URTI. 1. Tylenol 120 mg if the temperature is above 100 F (maximum 6 hourly). 2. Motrin 50 mg if the temperature returns before the next dose of Tylenol is due (maximum 6-8 hourly). 3. Plenty of fluid by mouth. 4. Watch urine output. 5. Attend ER/GP Surgery if no signs of improvement.