By Peggy O'Farrell
The Cincinnati Enquirer

Worries about fevers and influenza in babies and young children are making pediatricians' phones ring persistently and crowding emergency rooms with panicky parents.

The viral infections can be especially hard on infants and young children. Since a tot can't tell you what's ailing him or her, it's up to parents to recognize the signs.

Dr. Steve Muething, director of clinical services at Cincinnati Children's Hospital Medical Center, says they look for signs of disorientation and dehydration, along with fever and flu symptoms, when trying to determine how serious their child's illness is. Children 6-to-23-months old are in a high-risk group to develop complications from the flu.

Flu symptoms include fever, muscle aches, fatigue, headache and congestion. Young children may also suffer nausea and vomiting.

When is a baby's fever considered dangerously high?

Everyone wants to know what the number is. The height of the fever doesn't tell you when to worry. It's how the child's acting. Danger signs are when the child's acting very unusual, with profuse vomiting and difficulty breathing along with the fever. Those are the main alarm signs. If the baby's under 2 months old and has a fever, call the doctor. And we consider a fever to be a temperature above 100.4.

The Enquirer newsroom has had a baby boom of sorts in the last year, so we corraled four of the tots for a photo: (from left) Eli Caudill, 9 months, son of Dave Caudill, features copy desk chief and Nicole Kingery, assistant news editor; Mateo Gutierrez, 10 months, son of reporter Karen Gutierrez; Taye Fuqua, 8 months, son of features news aide Mona Fuqua and photographer Joseph Fuqua II, and Sonnie Simons, 10 months, daughter of photographer Brandi Stafford. (Brandi Stafford photo)

What's the best way to take a baby's temperature?

The most accurate way is rectal. The underarm temperature is pretty good, as long as you leave the thermometer in place two or three minutes. The ear thermometers, if the child's under 3, are not accurate.

Interestingly, experienced moms' hands on their children have been tested and shown to be accurate in telling when there's a fever. They're not accurate in knowing the number.

What's the best way to bring the fever down?

FEVER BREAK

Innovative products now on the market could help the next time your little one has a fever: • BeKoool soft gel sheets are the newest form of cold compresses. The promise to stay cool for up to six hours and to lower skin temperature, soothing fevers, migraines, sinus headaches and other ailments. Cost is $3.73 for four online. • TraxIt Children's Wearable Underarm Thermometers are $3.49 for eight thermometers online. • Unisar's Remote Fever Monitor beeps to alert parents when their baby's temperature reaches a certain level. They're available online for $56.95.

WHO'S AT RISK

The following groups are most at risk for complications from the flu: • Adults 65 and older • Children 6 months to 23 months • Anyone with a chronic medical condition such as heart disease or diabetes • Pregnant women

WHEN TO GET HELP

Take your child to the pediatrician or emergency room if he or she shows any of the following symptoms: • Rapid or labored breathing, bluish skin tone • Not drinking enough to prevent dehydration • Changes in mental or emotional status: not waking up; not interacting • So irritable that he or she doesn't want to be held • Flu symptoms improve, but the child becomes ill again with fever, cough worsens • Worsening of underlying medical conditions (heart or lung disease, diabetes, etc.) Source: The American Academy of Pediatrics

The standards are acetaminophen and ibuprofen. (Giving children aspirin for fevers puts them at risk for Reyes syndrome.) Those usually work in about an hour. If the child's feeling better, that's a good sign. And focus more on the symptoms than the number.

Things that don't work are alcohol baths, cold baths and cold wash cloths. They actually make the child much more uncomfortable and don't bring the temperature down.

When is it time to get medical help?

The time to talk to your doc is when the child gets sick. They can give you more precise advice.

The time to go to the ER is if the child has the fever and difficulty breathing, is not alert and not aware of the surroundings and the medicine's not improving their symptoms.

People seem pretty aware of when to come in, really.

Parents are warned that their children might suffer fever-induced seizures. What's a seizure look like?

The most common form is sudden shaking all over the body, including arms and legs and head. Usually they'll grit their teeth and be totally unaware of their surroundings.

The most common form lasts less than two minutes and then they're out of it and slowly come around within about 15 minutes.

Parents are really, really worried about seizures. From a physician's point of view, it's scary, but the kids come through it and they're fine. There's no brain damage from a regular fever seizure. The first time it happens, you should call your pediatrician or come in.

They're recurrent in some children, and some families get used to them. But it is very appropriate the first time a baby or toddler has a fever seizure to come into the ER and make sure everything's OK.

How can you reduce your child's risk of getting the flu?

The two big things we talk about are avoiding crowded areas where people will want to hold and kiss and touch the baby, and the other thing is hand washing, hand washing, hand washing.

It's hard when we tell people to say no to people, because everyone wants to show off the baby, but that's really the best thing.

Dehydration is a big worry when little ones are sick. How can you tell when your child is dehydrated?

They'll look dry to a parent: sunken eyes, dry mouth, a decrease or stopping in the number of wet diapers. And they become very lethargic. They lose interest in play or even looking around or drinking. That's a definite time to call the doctor or go to the emergency room, and that's with or without fever.

What's the best way for first-time parents to know what to expect when their baby is sick?

It's really appropriate for families and moms during a normal checkup to go over a plan with their doctor so they feel more in control and less frightened when it happens. It just helps to ask: What should I do the first time my baby has a fever? Ask about medications, and make sure you have all the correct phone numbers.