Monthly Archives: August 2009

A Sentence on Sunday

Dear Carter,
You’ve been lying to me lately.  It’s frustrating because I know when you’re telling a lie, and yet you always say “I’m the truth, Mommy”.  Truth or no truth, you’re stinkin’ adorable.  I can’t wait until you’re old enough to watch Finding Neverland.  You are Peter.

Dear Lydia,
YOU’RE POTTY TRAINED!!!!! Three days now without an accident! And just in time for school to start. I’m so proud of you. And I’m so glad I can stop buying pull-ups(those suckers ain’t cheap)!

Dear Asa,
I love how you are constantly moving.  I’m a little worried about what will happen once you start walking.  If you are awake, you’re a ball of energy.  You have this thing were you put your arms out and open and close your hands when you get excited-kinda like a puppy wagging its tail…so, so adorable.

You’re all my favorites!
Love, Mommy

The Doctor is In: Fever in Kids

So, I’m giving in and giving my husband a space to talk about what he knows best: pediatric medicine.

Everyone?  This is Marshall.  Say hi(and ignore his visually maddening Twitter background). Today he’ll be talking about fever in kids.  But if there’s something else you’d like to see him write about, email me at queenofhaddock(at)gmail(dot)com and we’ll see what we can do.

***Disclaimer – this is my personal statement regarding fever and includes things that I tell my own patients/parents in visits to my office.  This is not meant to be a substitute for a visit to or discussion with your pediatrician.  For any questions regarding your child’s health you should of course discuss them with your pediatrician.  This is meant only to provide information, which I hope you find helpful.***

So as far as fever goes, it certainly carries a lot of parental anxiety with it, and often a lot of caregiver anxiety as well.  Fever has been recognized for centuries as part of the body’s mechanism for fighting infection.  Many species of animal have been able to survive because of their ability to mount a febrile response to invading pathogens, be they virus, bacteria, or other.  Certainly fever should be considered in the context of the individual patient’s presenting signs and symptoms (i.e. a child with a fever of 104 who is bouncing all over the exam room warrants a different response than a child with a temperature of 104 who is lethargic and unresponsive).  There are always exceptions to every rule or statement, so for the purposes of this discussion we’re talking about “normal” kids – those with normal immune systems, no complex medical history, etc.

To talk about fever we should also consider what’s normal.  Most people consider a temperature of 98.6 a normal temp, and start worrying as soon as you hit 99.  The 98.6 is often not where someone’s temperature is found to be even when well, just as most women don’t actually deliver on their “due date.”  The number considered by many to be “normal”  came about when a physician by the name of Carl Wunderlich conducted one million measurements of temperature on 25,000 adults using a 12 inch thermometer and obtaining readings from under the arm.  He then obtained the average of those readings to be 98.6, with ranges from 97.2 to 99.5.  An individual’s body temperature varies throughout the day and can change by more than a degree, with the normal low for the day being in the early morning and the normal high occurring in the early evening.  The definition of a true fever begins at 100.5 – so when the daycare calls you and says “your child has a temp of 99.5, come get them,” you can educate them on what defines fever.

The first thing I tell all my patients/parents is that fever is not harmful in and of itself. It certainly makes a child uncomfortable, and brings with it an increase in heart rate and breathing rate.  Most healthy children can handle these things well (again, those with chronic illness, heart or lung disease, immune system problems, or other abnormalities may not be as straightforward).  I’m often asked how high a fever can go before a parent should worry, and my answer is that there is no magic number at which I hit the panic button.  Certainly, if a patient has a 106, I’m going to want to examine them to see what’s going on, but the height of the fever is not nearly as reliable a predictor of serious illness – rather, the child’s clinical appearance is a much more reliable tool for assessing them.  One common concern is brain damage with high fevers.  Brain damage has never been shown to be caused by high fever, even in children with temperatures as high as 107.6 (although if my patient has a 107.6, I’m sure going to figure out why!).  In other words, a 104 is not “worse” than a 101, per se, just makes you feel really crummy.  Fever can easily be 104, 105 with common viruses as with bacterial infection.

Another common concern is seizures due to fever.  Certainly they can occur, and although scary for all involved, a single simple febrile seizure won’t cause any long-term ill effects (certainly still talk to your pediatrician, and if a child has more than one they may warrant further evaluation).  For info from the AAP(American Academy of Pediatrics) website regarding febrile seizures, go here.   Simple febrile seizures often occur with the initial temperature elevation at the beginning of the illness.  Often the seizure occurs first and fever is only discovered later.  As far as febrile seizures go, even though higher temperature has been shown in some studies to be an independent risk factor, the most aggressive fever treatment with Tylenol/Motrin won’t reduce the risk of a febrile seizure – so basically if a young child is going to have one, it’s going to happen.  When they do, they don’t cause any long term ill effects (although they’re quite scary at the time).  Any seizure activity, associated with fever or not, should of course be discussed with/evaluated by your child’s pediatrician.

As far as the fever response in the body, it has several potential benefits.  First, it elicits several inflammatory mediators which activate/enhance certain components of the immune system so the body can more efficiently fight off whatever bug (virus, bacteria, etc.) that’s causing infection.  It also makes it harder for the invading bug to do its thing (I like to compare it to yard work – it’s a lot easier to pull weeds when it’s 75 degrees outside than when 95 degrees. Likewise, it’s harder for invading bugs to work efficiently when body temp is higher).  So fever does provide some measure of protection.

Fever management is also a common point of inquiry.  Fever does bring with it an increased metabolism, so replacing the nutrients and water lost as a result will be crucial to good fever management.  Pushing fluids (Pedialyte is best) and making the child comfortable will help a great deal in accomplishing this.  Lukewarm bathing/sponging provides only a marginal improvement in temperature, and can make a child uncomfortable, so should largely be avoided.  Cold water or rubbing alcohol can constrict the surface blood vessels that help the child to dissipate heat, and therefore should absolutely be avoided.  A common misconception is that it’s more successfully managed with alternating Tylenol and Motrin every 3 hours or so.  (Interesting side note, AAP did a survey of pediatricians regarding that, and about 1/3 of those surveyed thought that AAP recommended alternating.  There is in fact no AAP stance/statement stating that one should alternate the two).  Alternating Tylenol and Motrin carries several risks. First, dose confusion is common, especially when it’s 2:00 in the morning and you can’t remember what you last gave your child.  Motrin and Tylenol are both metabolized in the liver, and Motrin can inhibit production of a protein (glutathione) that assists in the metabolism of Tylenol.  So, alternating the two over time can lead to increased Tylenol levels in the blood.  (**Any child with liver disease should not be dosed prior to discussion with a physician!!).  Dosing of either Tylenol or Motrin is based on weight, so especially for young children talk to your pediatrician about the best dose for your child’s weight (all 8 month olds are not created equal – my 8 month old weighs as much as some kids twice his age!).

Several studies have shown that Tylenol and Motrin are about equally effective in temperature reduction.  One thing to realize with treatment is that at proper weight-based dosing, the average response to treatment is a drop in 2 degrees that lasts for 2 hours.  So if you were to treat a 103.8 and it only went down to 101.8 that would not be a failure of treatment; rather, that would be a reasonable response.  The only reason to treat fever is for comfort – other than discomfort there are no generalized ill effects from fever.  Certainly I’m happy if a 103 goes to 98 with treatment, as that makes the child feel better, but we don’t always get that.  As far as which one to use, my office recommends Tylenol rather than Motrin for several reasons: First, Motrin can be irritating to the stomach, especially in a child who isn’t eating/drinking well and has a largely empty stomach.  Second, Motrin can inhibit some of the types of white blood cells that fight infection – there are some white blood cells whose job is to find the invading bug and eat it.  Motrin inhibits them in their activity (can provide you a link to the study from 1997 if interested), and therefore can slow the body’s ability to eliminate infection, especially if bacterial.  Third, Motrin has a slightly increased risk of decreasing blood flow to the kidneys if a child is already a little bit dehydrated.  (In fact every pediatric nephrologist I’ve spoken to is adamant that if a child has fever along with vomiting/diarrhea that they absolutely should not get Motrin).  Some may disagree with me on that last point, but if Tylenol and Motrin are fairly similar in effectiveness, and Motrin has potential for a short-term hit to the kidneys if the kiddo has a decreased circulating blood volume, (which is possible with fever) I say why chance it (could write several paragraphs on that, but I’ll spare you that one…).  Tylenol is effective, and carries none of those risks.

Those are the main points I usually cover.  Take home message is that fever does tell us there’s something going on (virus, bacteria, etc.), but is not harmful in and of itself, and can help the body do its job.  Keep in mind that if a cause for the fever is found (i.e. ear infection) and treatment is initiated, fever can persist for 24-48 hours after starting treatment, and even with good old fashioned cold viruses we expect fever to last 3-5 days.  Persistence of fever beyond that would warrant another look by your pediatrician to make sure nothing else is going on.  Certainly any concerns regarding fever and associated symptoms should be directed to your pediatrician.

Sources cited in this article:

  2. Avner, Jeffrey R. “Acute Fever.” Pediatrics in Review 30 (2009): 5-13.
  3. Hirtz, Deborah G. Pediatrics in Review 18 (1997): 5-9.
  4. Zielinska, Malgorzata, and Wladyslaw Fenrych. “The application of a flow cytometric assay for evaluation of phagocytosis of Neutrophils.” Acta Biochimica Polonica 44.1 (1997): 121-26.

DL05 Dr. Marshall Ivey, M.D.  joined Milledgeville Pediatrics in July of 2008.  He is  originally from Athens, Georgia.  He obtained an undergraduate degree in Microbiology from the University of Georgia.  He then attended medical school at the Medical College of Georgia in Augusta, Georgia.  He remained in Augusta after graduation from medical school to complete his training in Pediatrics at the Children’s Medical Center, completing both an internship and residency in Pediatrics.  Upon completion of residency he sat for the American Board of Pediatrics certifying examination and is currently board certified in Pediatrics.  He is married with three children, ages 4, 3, and 8 months.

The Doctor Is In

So, for a while now I’ve been considering something but not acting on it: letting my husband post on my blog.  This is, after all, my space.  It’s where I talk about…well…the stuff he’s tired of hearing me talk about.  So, we made a deal.  I’ll let him post every now and then as long as he promises not to blog about sports.

See, my husband is a pediatrician(a very good one, I might add).  And he has a lot of soap boxes that I’m tired of hearing about really good information to share with parents everywhere.

BUT…here’s the deal: main concern with medical blogging is the whole liability thing.  It wasn’t until the Healthcare by Committee session at BlogHer this year that I realized that there are physicians who do blog(like Dr. Gwenn and Dr. Jennifer Shu).   And as long as he doesn’t violate any HIPAA regulations, and as long as everyone remembers that what he writes here is for informational purpose only, we’ll be fine.  You can’t sue him because this is not a doctor-patient relationship.  And if you have a specific problem, an usual situation or just think that what he says doesn’t sound right…then call your child’s actual physician, and talk to him or her.

Also, he’s a pediatrician, not a god.  (We don’t do the god complex thing around here.  And along those same lines, I hate being referred to as “a doctor’s wife”.)  And although he’s pretty awesome, he’s a real person with real feelings.  So if you disagree with him, be nice about it.  Or I will block you.  ‘Cause it’s my blog and I’m the queen of The Ivey League, and I can do what I want here.

Check back later today for his first post: Fever in Kids.

Wordless Wednesday: I ♥ man boobs! Edition


A Sentence on Sunday

When Carter and even Lydia were little, I wrote lots of long letters to them.  I’d write about what they were doing at that stage in life.  I’d tell funny little stories about them.  I still have a book where I jot down things as they come to me, but the days of long letters is long gone.  Unfortunately, there’s just not enough time in my day.  Poor Asa is almost 8 months old(on Saturday! Where did the last month go??) and has maybe 3 letters.  More than average, I would guess, for a lot of folks…but a lot less than average for me.  So I decided that if I wrote a sentence(or two or three) to each of my kids every Sunday, it would add up over time.  So…I guess I’m starting my own meme.  But it’ll be fun(I hope) to look back at the end of the year and see what each week held.

Dear Carter,
You are quite possibly the smartest 4 year old I’ve ever met.  I know you’re my kid and all, but seriously?  You actually say things like, “Lydia, that’s not the proper way to assemble to train track” and “I would actually prefer if you didn’t yell at me” .  I kid you not…these are the kinds of things you come up with.  I never cease to be amazed. (Oh, and by the way…I would actually prefer if you didn’t do things that cause me to yell at you.  Just sayin’.)

Dear Lydia,
It’s like you turned three and the magic diction fairy came and tapped her wand on your head, and just like *that*…your “r”s started sound like “r”s.  No more ‘hee’ and ‘they’, but ‘here’ and ‘there’.  It’s no longer ‘doyk’ outside, and we no longer get in the ‘coy’ to drive.  And I miss it.  I liked the non-existent “r”s.  The only thing I don’t miss is you saying “Tuckey” .  I think we’re all glad to get that behind us.  Especially Carter!

Dear Asa,
In the past month you’ve learned to roll from back to front and back again.  You’ve learned to eat baby food, and now table food.  Drink out of a sippy cup.  Pinch like nobody’s business.  Babble like a crazy man.  And you’re beginning to figure out how to pull up on things.  I think you’re the happiest baby we’ve had so far.  You smile a lot.  You love to bounce in your “johnny jumper”, although you’re about to outgrow the weight limit!  Slow down, little one…you’re getting too big too fast.

It's just gross…

Let me begin by saying that I love my husband and I love my children.

But I HATE fingernails.  And I HATE cutting them.

It’s just gross.  Have you seen what lives up in there?

It is so disgusting that I really believe that Mike Rowe could add “nail guy” to his list of dirty jobs.  Seriously…what you can’t see is often more disgusting that what you can see.

Anyway, my husband(who is wonderful in many, many ways) doesn’t trim the kids’ nails.  Might I remind you that he’s a stinkin’ pediatrician, and he won’t cut his own kid’s nails.  This is something he should be able to handle, but it somehow always ends up on the mommy to do list.  I’ve tried to out-wait him several times.  Surely, I thought, he’ll eventually pull out the clippers.  Oh, but no…I wait and wait, and after getting a scratch on my face or on the baby’s face or after someone stabs someone else, I break down and trim them myself.

And I say, “This is the last time I’m doing this.  He can do it next time!”

But month after month, I find myself searching for clippers and wrestling the kids until we’re all hot and covered in sweat and tiny, disgusting miniature nail bits.  (You’re welcome for that mental picture.)

Oh…and you silly people who think you can trim a baby’s nails when they’re asleep?  I’ve tried that multiple times with all three of my kids.  It doesn’t work.  Did you drug them before the nap?  Is that the critical step I kept missing???

Our Little Diva

When I really want something I say to stick with the kids, I make them shake on it.  I say it, and then they repeat it while we’re shaking hands.  It isn’t fail-proof, but it helps.

So my mom just came to pick the “big kids” up for a sleepover at her house tonight.  As they were getting ready to go I reminded Lydia, who is just barely potty trained, that she needed to use the potty if she had to go pee.

Me: Shake on it?

Lydia, while shaking my hand: I pwomise not to pee orr poop on de floy at Gramama’s house.

And then…she takes a bow as if she’s just completed a stunning performance on Broadway.

Oh, how I love that child!

Right Now

It’s quiet.


It’s quiet now.

Not often,

But it is right now.

And I can hear my own heart beating.

My breath.






I close my eyes.


“Be still and know that I am God.”

That’s easy to do right now.

In the quiet, the dark.

And even though I’m tired.

I stay awake.

To feel the quiet.

To hear nothing and everything.

And to be still.

Mann Fann

**Updated – Winner posted at the bottom!**

A few months ago, I shared a secret with you: I (heart) Chris Mann.

And three things have happened since that post was first published that have exponentially increased my Mann crush:

  1. Chris put mah picture in his “Heartless” video.  (Twice!)
  2. I met the gorgeous Chris Mann in the flesh and heard him sing IRL(which was even more amazing than you can imagine).
  3. Chris debuted his EP on iTunes and amazon, and the ratings and reviews have been unbelievable.

You can go to iTunes or amazon and purchase the EP ooooooooorrrrr you can try to win a FREE SIGNED EP here!

Each of you can enter to win THREE ways before Wednesday night at midnight:

  1. Go here (scroll down and look on the right) and listen to his music. Pick your fave, come back here and put the title of your pick in the comments.  (Side note:  See the “6,000+ plays” of “On a Night Like This”?  Yeah…I’m responsible for about 5,999 of those. Love that song!)
  2. Go here (scroll down and look on the left) and sign up for his mailing list.  Come back here and comment, letting me know that you added yourself to his email list.
  3. Tweet about this giveaway and leave the specific link to your actual tweet in the comment section below.

*This is not a sponsored post, although Chris is donating the signed EP.  I heard his music and immediately fell in love with his warm, smooth sound and undeniable talent.

**Using, the winner of the signed Chris Man EP is Lauren! Congrats, girl! You’re gonna love this EP!**

Three years, eleven days…

Ok, so almost two weeks ago, I promised a post about Lydia.  I could write about her…or I could just show you how cute she is.  Fair enough?


Ok…maybe just one story.

The other day my mom and I took Asa and Lydia shopping with us while Marshall and Carter went to the movies.  After we’d shopped for a few hours, we decided to get a snack for the road.  Lydia asked for “candy”, and I picked out a Kit-Kat for her.  I don’t think that she’d ever had one before…but I can guarantee that it won’t be the last one she ever has!  I broke it into the four pieces, and started to drive.  She was quiet for about 15 and then this…

Lydia:  I’m sorry I ate Carter’s snack.
Me:  What are you talking about?  We didn’t get Carter a snack?
Lydia: Yes, we did.  But I ate it.
Me: Babe, that was your snack.  I’m sure Carter will have a snack with Daddy.
Lydia: Well, I really wanted to save it for him…but I started eating and I just forgot about him.

It’s the thought that counts, right?