(MUST READ ) Friend of friend with a child

Dear Amber, 

I need your help on this my best friend has child now. Her: exhausted, busy, no time for self, no time for me, etc. 

Me (no kids): Wow. Sorry. 

What'd you do today? Her: Park, play group. Okay. 

I've done Internet searches, I've talked to parents now I want a child doctor advice now. I don't get it. What do stay-at-home moms do all day? Please no lists of library, grocery store, dry cleaners . . . I do all those things, too, and I don't do them EVERY DAY.

I guess what I'm asking is: What is a typical day and why don't moms have time for a call or e-mail? I work and am away from home nine hours a day (plus a few late work events) and I manage to get it all done. I'm feeling like the kid is an excuse to relax and enjoy -- not a bad thing at all -- but if so, why won't my friend tell me the truth? Is this a peeing contest ("My life is so much harder than yours")? What's the deal? I've got friends with and without kids and all us child-free folks get the same story and have the same questions.

One of your friends/friends 

Okay Friend of Friend "Here Goes"
Remember You Asked For It:

Relax and enjoy. You're funny.

Or you're lying about having friends with kids.

Or you're taking them at their word that they actually have kids, because you haven't personally been in the same room with them.

Internet searches?

I keep wavering between giving you a straight answer and giving my forehead some keyboard. To claim you want to understand, while in the same breath implying that the only logical conclusions are that your mom-friends are either lying or competing with you, is disingenuous indeed.

So, since it's validation you seem to want, the real answer is what you get. In list form. When you have young kids, your typical day is: constant attention, from getting them out of bed, fed, clean, dressed; to keeping them out of harm's way; to answering their coos, cries, questions; to having two arms and carrying one kid, one set of car keys, and supplies for even the quickest trips, including the latest-to-be-declared-essential piece of molded plastic gear; to keeping them from unshelving books at the library; to enforcing rest times; to staying one step ahead of them lest they get too hungry, tired or bored, any one of which produces the kind of checkout-line screaming that gets the checkout line shaking its head.

It's needing 45 minutes to do what takes others 15.

It's constant vigilance, constant touch, constant use of your voice, constant relegation of your needs to the second tier.

It's constant scrutiny and second-guessing from family and friends, well-meaning and otherwise. It's resisting constant temptation to seek short-term relief at everyone's long-term expense.

It's doing all this while concurrently teaching virtually everything -- language, manners, safety, resourcefulness, discipline, curiosity, creativity. Empathy. Everything.

It's also a choice, yes. And a joy. But if you spent all day, every day, with this brand of joy, and then, when you got your first 10 minutes to yourself, wanted to be alone with your thoughts instead of calling a good friend, a good friend wouldn't judge you, complain about you to mutual friends, or marvel how much more productively she uses her time. Either make a sincere effort to understand or keep your snit to yourself.

You have got to be kidding me? I answered this only to stand up for your so called friend with a child. I honestly think she deserves a friend that is not so self absorbed and narcissistic.I do not know who you are or if this is a joke or you just wanted to find a way to talk to me. I do not know if you are male or female, but please refrain from emailing me again.

Fever and the Knowledge There Of:

Fever today is not the same fever of 30 years ago.

What does this mean?

To begin with, one must understand that fever itself (for the most part) is not dangerous. Fever, defined as 100.4 degrees Fahrenheit or higher, is not a disease in and of itself; rather it is a symptom or a sign of an underlying disease. Viewing fever as a disease will lead to accepting common misconceptions and evoke unnecessary anxiety.

Several times a week in my office I see children with a fever reaching 104-105 degrees who recover without incident. Studies have indicated that fever itself is not worrisome until a child reaches 106 or higher. Fortunately, fever greater than 106 will usually occur only in a child with an underlying neurological deficit or, very rarely, an environmental heatstroke (e.g. being locked in a car inadvertently in the middle of summer).

When your child has a fever, his body is telling you that he is sick (or sometimes overheated by external causes). In the majority of cases, a fever indicates that your child has become infected with a germ. There are other causes of fever as well. For example, after your child has received immunizations, he may exhibit a non-worrisome fever for a day or two. In this case the body is reacting to either dead or weakened germs or germ fragments that have been purposefully introduced to create beneficial lasting immunity.

Most parental anxiety with fever revolves around the fear that there may be potential harm to the child as a result of the fever. Specifically, the parent is often worried about damage to the brain.

In truth, fever will rarely damage or hurt the child (as mentioned above), although the underlying germ causing the fever potentially could. Which is why as a pediatrician, I am seldom concerned about the fever itself; I am always far more concerned about the source of the fever. My job as a pediatrician, when presented with a febrile child, is to deduce the source of the fever and then to decide whether the source is of concern or not (and it most often is not).

If the fever is coming from a brain infection, pneumonia or kidney infection, I am very worried about the child because all of these infections are quite serious and potentially life-threatening if not treated properly. However, if the fever is coming from a cold virus or stomach virus (which is far more likely, statistically), I am not worried about the child because most of these infections resolve on their own with time and pose little to no threat to the well-being of a child.

Which brings me back to my opening statement: fever today is not the same fever of 30 years ago.

The reason is simple: vaccines. The current gamut of immunizations, while currently controversial (although the tide is finally shifting - thank goodness), are perhaps the greatest advancement of modern medicine in the past century. The vaccinations we currently administer confer protection against the deadly germs which our parents' generation grew up with. Germs which cause meningitis, diphtheria, tetanus, pneumonia, measles, whooping cough, epiglottitis . . . and the list goes on and on.

In present day, when a child who follows the recommended vaccine schedule presents to me with fever, there are many germs that I can automatically factor out while making my diagnosis. As a result of immunizations, I already know what a child CANNOT possibly have as the source of the fever. As a result, I can focus on a much more narrow list of the usual suspects as I begin my detective work.

Imagine playing the game Clue, knowing that Professor Plum, Colonel Mustard and Mrs. Peacock are already behind bars. It just makes the game that much easier (although not as easy as peeking in the envelope like my brother often did). Likewise, if I can evaluate a fever already knowing that measles, mumps and diphtheria are out of the running, it makes my job a lot easier. Which is why as a pediatrician I have a leg up on my pediatrician as a child , who had to do the same job without the benefits of many of the newer vaccines.

Of course, as antibiotic resistance is on the rise, the landscape of our usual suspects is beginning to change once again, hence the vital need for judicious use of antibiotics (but that is a topic for a separate blog). Nonetheless, fever today represents a far more limited field of possible dangerous causes than the fever of 30 years ago. That is why I sympathize when a grandmother is still apprehensive of her grandchild's fever. She lived through the years of measles, mumps and diphtheria. Many of them remember what a fever could represent in their days and understandably harbor anxiety about their grandchild's temperature.

But as a new generation grows up with a legion of vaccinated and protected children (for the most part), there will hopefully be a societal shift in the right direction concerning the fear of fever.

Let me conclude by noting that fever can still and sometimes does represent meningitis, pneumonia or a dangerous infection. As far as vaccines have advanced, there is still more work to be done. So when a child with a fever is acting sick (i.e. not playing, not eating, appears ill, doesn't smile, lacks energy) he or she must be evaluated by a doctor.

However, over time, with the proper communication between a well-informed pediatrician and an attentive mother, a parent can begin to grasp when to be worried and when not to be worried. This maternal instinct can be honed over time if a mom is equipped with the right information and the proper guidance from her pediatrician.

I am proud to say that in my practice I now have many veteran mothers who don't come in for every fever (although they initially may have), but only when there is an accompanying noticeable change in the activity level of her child. I could write oodles of blogs to delineate this skill, but there is a level of understanding that can only come from repeated communication and hands-on experience.

The end result is a family that has a far lower level of anxiety about fever and a far higher understanding of what fever truly is and represents. It is a benefit to the parent and to the pediatrician alike. It saves the mom unnecessary trips to my office, copay money and frustration while it frees up my appointment slots for the kids who truly need to be seen.

There are many aspects of fever I did not cover in this blog, but hopefully this can serve as a primer in building a firmer knowledge base for the anxious parent who wants to learn more!