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!

He's had a few sips here and there, and he's been taking his antibiotic in disguise of 2 - 3oz baby milk in bottle. Still not eating although he nibbled a prawn cracker. Temp still low, but he's still mouth breathing because his tonsils are so large.

Will be keeping him off nursery tomorrow. He just started a few weeks ago so I'm guessing he must have caught something from there.

Fingers crossed for a more settled night for all of you

Hope he's on the mend

Thank you. This is the first night he's not had his raging fever - hoping it continues. He's in our bed again tonight and still clingy and saying it's sore so I'm keeping on top of the calpol and ibuprofen stream.

Hope you all get a more restful night 💐

@shenanigans5

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.

Same thoughts- fellow HCP

Will be keeping him off nursery tomorrow
Well that's a no-brainer

I would keep him off a few days as he needs to rest, plus he needs to eat!

@picturesandpickles

I would keep him off a few days as he needs to rest, plus he needs to eat!

Indeed. I doubt any nursery would accept him in his current state tbh. Are you working?

I would keep off nursery for the whole week.

He'll be wiped out even when he recovers from the tonsillitis.

Yeah- you can’t really be considering nursery when he’s not eaten/drank for several days and still has an active infection. Keep him off for the week to recover.

Nurseries are absolutely germ riddled. If you send him in at a low ebb he’ll be brewing another nasty illness by the end of the week.

How is he this morning @AlexaStop? How are you? Have you had some rest?

Definitely keep him off all week - absolutely shouldn't be in when he's been that poorly x

@LapinR0se

I live in Switzerland. Here the child would be admitted for rehydration and observation as well as IV antibiotics if needed. I find the NHS really lax.

I must admit, I've been reading this thinking "why on earth will they not admit this child, he's clearly very poorly."

OP, I have no advice and zero medical credentials, I just wanted to offer some virtual support to you and some sympathy for your wee lad. Hope he starts to feel a lot better very soon and you both get a chance to rest.

He'll be off all week, I'm still on maternity leave so that's not a problem.

I can't really compare the care he received as it's the first time we've really used the service for kids apart from when my daughter was in special care at birth, but he was seen by one doctor every day at least. We are in the west of Scotland.

Thankfully his temperature stayed down all night. He was however up every few hours with pain and his snoring was very loud. Even when he's awake he still sounds like he's snoring a bit. I might give the GP a ring when they open soon and have a chat to see if there's anything to make him more comfortable, and to query the route to possibly removing the tonsils in the future. If it was simply the infection it wouldn't worry me as much, but it's the size of them obstructing his airway that is concerning.

Hmmm, so, there are two main routes to tonsillectomy. I have sort of covered infectious earlier, but there are strict criteria based on the number and frequency of infections. This may never come back; you may never be looking at tonsillectomy for these reasons. But if he were my child I would be doing a quick scan of his tonsils every fever from now on.

The second is for apnoea/sleep disturbance. Is he generally a snorer? My child was terrible, and did have apnoea events. Although also for some reason the night he did a home sleep study was inexplicably the only night he actually slept through ever, and it was inconclusive 🤷‍♀️ - it’s worth asking for a referral based on snoring (when not unwell) if you want to look at this route.

Spring my DD10 is a really heavy snorer after some nasty bouts of tonsillitis up to the age of about 6. We've never been offered sleep study but I guarantee if we did it would be one of the nights where she doesn't make a peep!

Alexa I'm glad to hear his temp is staying down! Fingers crossed for a better day today.

Just thought I'd give a positive update. After almost a week he is finally starting to get back to his old self. Still not eating much, but no fever and his pain seems to be subsiding. He had a good stretch of sleep last night too.

Thank you all for the support and encouragement to push and get his antibiotic changed at the hospital, the first one was clearly not working for him and it could have been a much different situation if I'd waited another day or so. His swab confirmed a bacterial infection.

A great update to read hope he is back to full power soon

Thanks for updating! I'm so glad the second antibiotic did the trick and he is on the mend

PS Hope you are getting a bit more rest now!!

That's the update we've been waiting for Alexa! He's on the mend

Great news! I was a little worried for you over the weekend. Glad things have made a turn for the better.

That’s a brilliant update, thank you. So glad x

Hooray! Glad he's feeling better.