1. Acute fever: The majority of acute fevers in children are caused by respiratory problems, of which viral colds are the most common. Theoretically, viral colds do not require antibiotics, however, because the air quality in China is so different from that in developed countries, it is easy to combine bacterial infections in the late stages of the cold, especially in children under 5 years old, when antibiotics are needed. If the child has a fever, also pay attention to whether it is accompanied by other symptoms, if at the same time there is a runny nose, sneezing, conjunctival congestion, etc., then generally speaking it is a cold, if accompanied by a cough, in the early stage most of them are also symptoms of a cold, the majority of children with a cold fever in 3-5 days, a few special viral infections, fever can be up to 5 The majority of children with cold and fever are in the range of 3-5 days, with a few specific viral infections, the fever can be up to 5-7 days (such as herpes pharyngitis, etc.), and in extreme cases up to 10 days, the first 3 days of cold and fever, do not pay much attention to it, just pay attention to control the high fever, personal experience does not require antibiotics, fever more than 5 days, should be further diagnostic tests to exclude other problems. Many pediatric diseases are not diagnosed in the early stages of fever, and the course of the disease itself is a very important diagnostic basis (e.g. Kawasaki disease), so it is useless to be anxious in the early stages of the disease. Antibiotics should be added if the cough worsens in the later stages of the fever. When a fever is first seen, doctors usually prescribe antibiotics, but in fact the vast majority do not need to be used immediately and can make their own judgments based on the doctor’s diagnosis of the condition. Many doctors now tell parents that their child’s throat is a little red or that the breath sounds in the lungs are a little coarse after a physical exam. There are no specific criteria for the coarse breath sounds, so it doesn’t mean anything), but it’s just the doctor’s way of saying that he wants to save himself some time. If only these descriptions alone, you can do without antibiotics and pay attention to the condition. 2, the treatment of acute fever: infants and young children due to the imperfect development of the thermoregulatory center, body temperature fluctuations, many times, high fever is not parallel to the condition, that is, high fever does not indicate a serious condition, many children’s body temperature is very high, but the spirit is good. Therefore, there is no need to be too anxious about high fever, and fever itself is the body’s protective response. The basal body temperature of children is higher than that of adults, so the standard for fever is also higher than that of adults, the specific standard is still different from family to family, the most scientific is to compare with the child’s usual body temperature, but it is difficult to do. Generally speaking the axillary table is higher than 37.4 degrees and the anal table is higher than 37.8 degrees, which can be considered feverish. In addition, because the human body temperature is low in the morning and high in the evening, it should also be analyzed specifically. For fever below 39 degrees (anal gauge), it can be left untreated (some books may have a higher standard), watch for other symptoms and drink plenty of fluids. For children with a history of convulsions, antipyretics need to be used early, along with anticonvulsants to prevent high fever convulsions. The treatment of fever mainly includes medication and physical cooling. At present, the main antipyretics for families are oral and anal suppositories, and the oral ones are mainly acetaminophen and ibuprofen, with many trade names. “Some doctors will say that if the temperature is not very high, use acetaminophen, and if it is very high, use ibuprofen. But if you want to use it, the amount must be sufficient, the safety range of these two drugs is very large, more than 10 times the normal dosage also did not see obvious side effects. “The dosage of acetaminophen is at least 10 mg/kg. In clinical practice, we often see parents worrying about the side effects, so they try to give their children a little less, sometimes the amount is a little bit different, and the effect is not there. “The dose of ibuprofen is 8-10 mg/kg, and there are many compound preparations or syrups, so parents need to study the specific content and concentration carefully, and convert it to weight, not age. If the child has been insensitive to antipyretics, the dose can be increased by another 1/4. Antipyretic drugs will sweat a lot after use, so be sure to add more water. Antipyretic drugs are also more likely to cause drug allergies (the other 2 types are antibacterial and antiepileptic drugs), so be very alert and careful if a rash appears on the body, and serious drug reactions can be very serious and even life-threatening. Physical cooling: you can use an old hot water bag (filled with cold water, a little more than half), freeze it in the refrigerator, do not freeze, lay a thin towel on top, put it under the neck (not under the head), let the hot water bag bend over and wrap both sides of the neck, because the neck blood vessels on both sides, so the effect is good. The groin, elbow fossa and behind the knee joint can also be covered with ice water bags, that is, must be in the blood vessels through the body surface cold compress to have effect. Off-topic: infants and children’s venipuncture is more difficult, many parents are very worried about the infusion will be played a lot of needles, will stare at the injection nurse, in fact, this is counterproductive, anyone is in a relaxed state to better play their level of a particular, when faced with stress, the general level will be discounted. Surgeons are generally reluctant to operate on family members for this reason, and internal medicine doctors will not do risky operations on their own family members. Parents staring at the nurse, will undoubtedly give the nurse pressure, but easy to play into, playing intravenous injection is very often based on the feeling, a nervous, easy to make mistakes, especially the inexperienced nurses. So it is recommended that you do not stare at the nurse when your child is getting a shot, it is best to let the nurse hold the child in another place to play, and if you want the parents to cooperate, do not go to see the shot. The doctor’s own child shot will not go to see the nurse shot. To tell a true story: a male colleague’s own 2-year-old son was hospitalized and needed a jugular vein to draw blood, several nurses in the ward to grab the crying child operation, the doctor outside the ward heartbroken tears, but he would not go in to see his son, because the nurse a nervous, operation failure, or the child suffering. 3, about blood tests and films: Among the common acute respiratory diseases in children, only otitis media and purulent tonsillitis will have obvious blood changes of bacterial infection, other diseases rarely see obvious blood changes. In children, even in bronchitis and bronchiectasis, significant blood changes are rare, even in bronchopneumonia, and the vast majority do not have significantly elevated white blood cells. Therefore, for the first visit, blood tests are not very meaningful, but doctors usually request them (including screening), mainly for the protection of the doctors themselves, and if an experienced doctor does not request blood tests, there is no need to request them yourself. In fact, most of them are not too problematic, mainly for the sake of the doctor’s treatment, and if they are shown to other pediatricians, many of them are fine, so don’t worry too much. However, there are very few very severe pneumonia, sometimes only a symptom of high fever, nothing else, physical examination also can not hear the wet rosacea, chest X-ray can be clearly diagnosed. Therefore, if the child has only a high fever and the physical examination does not reveal anything, it is still necessary to take a radiograph. Ancillary examinations can only be used as a reference for the doctor’s visit, and finding a doctor who is only trusted is the key. 4. Observation and treatment of cough and sputum: Most coughs and sputum start from a cold, and most of them are viral in the early stage, so there is no special medicine, so don’t pay too much attention to them. The frequency is better understood, but the degree is more difficult to explain: generally speaking, a continuous cough (each cough is several times in a row) is more serious than a single cough. As the disease worsens, you can feel that the cough is coming from the trachea or deeper, and the sound will be muffled, which often indicates that the lesion has reached the trachea. The main observation of coughing sputum is the stickiness of the sputum. Young children do not spit out sputum, and the sputum they cough into their mouths is swallowed into their stomachs, so parents cannot see the sputum. coughed out. On the contrary, if the phlegm is still in the trachea after coughing 5-6 times, it means that the phlegm is sticky. When the condition is not very serious, the doctor’s physical examination will not be able to find out anything. At most, the breath sounds will be a little coarse, and a little phlegm sound will be heard if the parents can give more detailed information, which can be used as a reference for the doctor’s treatment. At least I pay attention to the parents’ accounts. The recovery of cough and sputum in young children is generally slow, especially in children with allergies, so parents should not be too anxious and focus on observing the changes in the condition, as the disease is always a dynamic process that either gets better slowly or gets worse slowly. The cough syrup and cough syrup for children are very different from those for adults, with very few coughing ingredients and mainly phlegm-suppressing and anti-inflammatory, and the lung power cough combination is a safe Chinese medicine. The purpose is to make the phlegm diluted and easy to cough out. Generally, after using it for about 5 days, it will be obvious that the phlegm is “loosened” when coughing (refer to the previous expressions), and a few will also feel that there is more phlegm at the same time. The main purpose of this stage is to promote the discharge of phlegm or to reduce the amount of phlegm. Infants have poor coughing ability and phlegm is not easily eliminated, so you can use back patting to promote the flow of phlegm, the specific method: put your fingers together and bend your palms together slightly to form a slight depression in the palm part, gently pat your back so that there is a resonance effect, you need to pat in different positions, upright, lying down, lying on your side, 5-10 minutes each time. The main reason is that the airway is prone to allergic inflammation (antimicrobial agents are ineffective), plus the small caliber of the airway and the incomplete development of the cartilage around the airway in young children, which can easily lead to airway spasm and mucus production. It is necessary to add some anti-allergic drugs and bronchodilators. The use of antimicrobial agents: If it comes to tracheitis, bronchitis, antimicrobial agents should still be used, often seen in the clinical treatment of untimely development process pneumonia. The best purulent tonsillitis is given intravenously, and the course of treatment should be sufficient, usually with penicillin treatment for 2 days, the temperature will be normal, many parents are only willing to infusion 3 days, in fact, this treatment is not complete, easy to form recurrent tonsillitis, such a number of children, the body a tired fever, certainly the tonsils of the problem, infusion 3 days temperature normal, recurrent episodes. So especially for children who have purulent tonsils for the first time, it is recommended that the infusion be given for at least 5 days, preferably 7 days. Sometimes, when a child goes to the clinic today, the doctor says, “It’s not a big problem, it’s a bit of bronchitis, just take some medicine, but 2 days later the cough is significantly worse, and then go to the clinic, the doctor says there is a lung rhythm, pneumonia. Parents this is often will front a doctor’s poor level of responsibility, not convinced. In fact, a large part of these cases is because the first visit, the condition has not yet developed to pneumonia, not that the doctor is not responsible, the condition of young children change quickly, school-age children generally do not do so. 5, about diarrhea and vomiting: diarrhea and vomiting are the most common gastrointestinal symptoms in pediatrics, the main causes are bacterial infections, viral diarrhea, food indigestion, drug side effects, etc., viral colds sometimes combined with diarrhea, the diagnosis of diarrhea is relatively simple, stool tests are very important, very often more important than the child’s physical examination, it is best to have stool specimens at the clinic, the majority of normal blood count, only The majority of blood tests are normal, but only bacillary diarrhea and a few other bacterial diarrheas may have elevated white blood cells. If bacterial diarrhea is ruled out, antibacterial agents can be used, but many viral diarrhea stools also have a small number of white blood cells, which makes it difficult to rule out bacterial infections, so doctors usually suggest using some antibacterial agents. The sensitivity is mainly related to the body (of course, the incidence is very small) and has nothing to do with the dose. Previously, it was thought that oral gentamicin drops would not be absorbed into the bloodstream and were safe. However, recently, some scholars also believe that gentamicin drops may be absorbed into the blood when the intestinal mucosa is damaged, so I personally think that it is better not to use gentamicin, but to consider it only when the effect is not good. Cephalosporin II is effective for most bacterial diarrhea, but a few are not effective. Cephalosporin III is much more effective for diarrhea, with fewer side effects, and currently there are cefetamet, cefixime, cefdinir, and the fourth generation cephalosporins are more effective, such as: cefepime, cefpodoxime. The most dangerous thing about diarrhea is dehydration and electrolyte disturbance (very serious), so it is most important to replenish water (better add some salt), water refuses to drink, some carbonated drinks are also very good, the application of oral and abdominal rehydration salts (ORS) need to pay attention to: the amount of water must be increased by half than the requirements of adults in the instructions, for example: adults require 500 ml of water, infants must add 750 ml of water. To determine whether there is dehydration, parents most If the urine is basically normal, there is definitely no dehydration, but if there is no urine for half a day, you should consider going to the hospital. The most commonly used antidiarrheal medicine now is montelukast (Similac, etc.), which is not absorbed in the intestinal tract, so it is very safe, and mild diarrhea may cause mild constipation after use. However, we often encounter children with severe diarrhea with very poor results, personal experience can increase the dose, beyond the instructions double also no problem. Children who can swallow the medicine a bit of Huang Lian Su is also very effective, both antibacterial and anti-diarrheal. The diet of children with diarrhea should avoid greasy, but for children who eat milk, do not stop milk. Many parents will find it particularly difficult to feed the medicine, often vomited by the child, you can try to prepare a 10, 20 ml syringe, the medicine pumped into it, slowly playing into the child’s mouth, I have not tried it myself, some parents say the effect is good. Another thing to note about vomiting is that it may be a sign of other diseases, such as encephalitis and meningitis, so pay attention to the mental state. In addition, blood tests within a short period of time after vomiting can result in high white blood cells, which can be clinically meaningless. It is better to check blood after 4-6 hours after vomiting.