On day 4 of 2 year old's 40 degree fever

[AlexaStop]

Hi, my poor DS has had tonsillitis and a fever of 40 degrees since Wednesday. It comes down to about 38 with calpol and ibuprofen so I've been alternating these but like clockwork once it wears off it's straight back up. GP diagnosed bacterial tonsillitis on Thursday and he's been on antibiotics since then. Took him to A&E paeds ward last night after he started having some convulsions who also confirmed nasty tonsillitis case and said convulsions are due to very high temp. They said we can come straight back to the ward if he gets worse.
Do we just ride it out? I'm concerned it's not getting much better and also worried about the constant stream of paracetamol and ibuprofen he's been having - I've stayed to the time limits but this will be the fourth day in a row of it.

Hasn't eaten since Wednesday but is managing to drink some things (water, milk), nappies wet and few cases of diarrhoea yesterday. We have a difflam spray but it makes him vomit every time. Poor thing feels so miserable and just wants cuddles but I also have a 10mo to see to. Any advice is welcome!

www.royalberkshire.nhs.uk/Downloads/GPs/GP%20protocols%20and%20guidelines/Children%20and%20adolescents/PaedsTraffic_light_system.pdf

Link too incase easier

Thanks that's really helpful I'll hopefully speak to doctor soon

You poor thing and your poor baby. What a time you are having. I really hope you get answers today and he starts to improve.

With ibuprofen it’s really important to keep hydrated as otherwise it can impact renal function. Is he drinking ok whilst you’re waiting to see the Dr? Diluted apple juice is good for rehydrating children when they can’t immediately access iv.

Bless him, and you. I’m so glad you’re being seen again. Keep us posted x

Saw the doctor, it was the same one he saw yesterday actually. They are reluctant to give him a blood test because it won't tell us anything new as they will already expect his CRP to be high as it is, and he's on a very strong antibiotic already to tackle that. The most telling thing will be the swab to see the cultures grown but it's not ready yet. He doesn't think it is sepsis or pneumonia because his observations are otherwise fine (temp settled at 37, heart rate slightly high due to his crying, and oxygen 97). His chest is clear but he can hear the obstruction at his throat due to the enlarged tonsils. They will continue frequent observations.

They want to keep him in until he's had a sleep so they can monitor his oxygen levels while he has an apnoea.

He managed to eat a bit of bread off a sandwich and has had a small drink of juice which is a big improvement.

Hope your little one feels better soon! Poor thing 😪

That's promising Alexa! Maybe he's turned a corner now with his temp settling too.

Is the dr you are talking to an SHO or a registrar?
Don't be afraid to ask for a more senior opinion.

Your poor little boy. It sounds horrendous.

The tiny bit of bread and juice is a really promising sign. Glad they’re observing him for a bit though x

Do they keep referring to penicillin as a strong antibiotic? It’s an odd choice of phrase- as it’s not really, it’s just a bog standard first line choice for tonsillitis (I’m a pharmacist).

That’s not to say it won’t be effective necessarily. The cultures will help hugely in getting the right treatment. I’d understand them saying he’s on a strong choice if it were an iv broad spectrum or something but less so an oral abx pre-cultures.

I guess they’re saying ‘strong’ to reassure you it should work should the culture show the right specificity.

I do understand why they’re saying no to doing CRPs I suppose. Blood tests are traumatic and harder to perform when kids are dehydrated and cold due to illness. Since they have a focus it’s of less diagnosis value. It’s more helpful to check recovery- so a CRP of 50 coming down to 20 or something. If he doesn’t improve soon I think it’d be worth doing.

I’d want them to be constantly reviewing the swelling/restricted airway and ensuring no further obstruction with the swelling.

Since it’s day 5 of a very high temp I’m really surprised at no ivs yet for antibiotics or fluids.

@shenanigans5 this is the one he has been put on. 2.5ml 4x a day for 10 days.

His obs were good again and temp is staying down so I think we will be heading home soon. He is not settling for a sleep at all and seems very agitated being here. They have still given us open access to come back if anything changes.

@Antiqueanniesmagiclanternshow it was the registrar.

Good. Fingers crossed that things will turn around soon.

[quote AlexaStop]@shenanigans5 this is the one he has been put on. 2.5ml 4x a day for 10 days.

His obs were good again and temp is staying down so I think we will be heading home soon. He is not settling for a sleep at all and seems very agitated being here. They have still given us open access to come back if anything changes. [/quote]
Yes that’s just the basic stuff at the basic strength and dose. No reason to say it won’t work though.

The number of frazzled parents I’ve talked to about doses of pink pen v being spat in every direction with none swallowed.

Hope he’s much better soon and can have a good sleep at home.

It could be that he’s in the process of turning the corner and that by tomorrow you will see real progress. I hope so.

I agree with @shenanigans5 that it’s a fairly standard option for tonsillitis. For a child that poorly though I might have expected co-amoxiclav for two reasons, first it’s broader spectrum so would zap anything that’s there (including if he did have a pneumonia), and second it’s just waaay more palatable so would be much easier to get him to take. Pen V is the correct antibiotic for tonsillitis generally but it not always the best option for kids. It is truly revolting in liquid form.

@Springchickpea

It could be that he’s in the process of turning the corner and that by tomorrow you will see real progress. I hope so.

I agree with @shenanigans5 that it’s a fairly standard option for tonsillitis. For a child that poorly though I might have expected co-amoxiclav for two reasons, first it’s broader spectrum so would zap anything that’s there (including if he did have a pneumonia), and second it’s just waaay more palatable so would be much easier to get him to take. Pen V is the correct antibiotic for tonsillitis generally but it not always the best option for kids. It is truly revolting in liquid form.

Yep- totally agree with the above. I know they really hate deviating from prescribing guidelines. My GP friend has had a few scraps with her own GP over pen v versus co-amox for her children and they always stand firm with pen v.

4 x daily on an empty stomach is also pretty impossible with kids. Particularly when they’re also given ibuprofen which needs to be taken with food.

🤞 your DS feels much more himself soon OP.
Pen v works by breaking bacterial cell walls down so all the toxins released can make them feel worse for a day or so before feeling better. Hopefully he’s coming out of the other side of that process.

He’s also just a little bit too young to reason with about the taste. Because mine was mostly 4 when he was unwell and because he had experienced IV abx I always had the fall back of being able to reason with him that it was better than a cannula, and I could bribe him too. Maybe chat with your own GP in the morning? I would definitely be trying to touch base with them tomorrow

You're doing a great job, op. Your children are very lucky.
I hope he gets better soon. He should be turning a corner soon, hopefully.

Thank you all.

He's had his 4th dose of new antibiotics and temp has been down since this morning. Going to try him with some food shortly.

I was changing his nappy and his little body feels so skinny compared to usual. Poor thing hasn't eaten much since Tuesday evening.

Very positive update. He will catch up when he feels better. C

Glad he's perked up slightly, I'm sure once he's better he will eat you out of house and home to make up for this week

Shocking how much care varies around the country. I don't know where you are based but I am 100% sure if you'd presented at Harrogate they would have kept you on the ward until an improvement was seen. Mine have both been kept in for much less than this

Poor wee soul. I hope he starts to improve soon.

Once he starts eating properly he’ll fill out. The main thing is to keep him hydrated for now