Fevers take on a heightened priority in children with cancer and you must react right away—time is of the essence. Caution: This information is NOT meant to supplant the advice of your physcians! Fevers can be an indicator of infection which is especially dangerous to children with weakened immune systems or central lines (port-a-cath or broviac). A fever is defined as 100.5 degrees for three consecutive measurements or 101 degrees once in a 24 hour period and time is the most critical factor in evaluating and treating patients with fevers. What to do if your child has a fever: First and foremost, check with your health care staff for your hospital's specific procedures. Generally speaking, however, these are the steps you will follow: Call the Hem/Onc clinic and talk to the nurse for instructions. Bring your child to the emergency room (be prepared to go to the closest ER if your child's condition worsens). You can be ready for a peripheral blood draw by applying EMLA® before leaving home or otherwise preparing your child for the test if it won't cause them undue anxiety. Once in the ER: Immediately identify your child as a pediatric hem/onc patient to the staff when you check in and make sure the pediatrician on call is notified that a pediatric hem/onc patient with a fever needs to be seen. The recommended evaluation for fever and neutropenia includes complete physical examination, including a minimum of the following tests: CBC with differential Blood cultures from both the central line and peripheral blood (in accordance with POG guidelines). This includes blood from both ports of a double reservoir port-a- cath. The blood drawn peripherally is needed for comparison to blood from the central line--to determine if there is an infection isolated in the central line. Urine test and culture. Chest x-rays (PA and lateral) If neutropenia is confirmed: Antibiotic therapy is started as soon as possible. Child is admitted to the pediatric ward. Antibiotics of choice: Either ... Or: Ceftazidime: 150 mg/kg/day in three divided doses First dose: 50 mg/kg Maximum dose: 6 gm/24 hours One Aminoglicoside (Gentamycin): 7.5 mg/kg/day in three divided doses First dose: 2.5 mg/kg AND One Beta Lactam (Ticarcillin/Clavulanate): 300 mg/kg/day in four divided doses First dose: 75 mg/kg Maximum dose: 18 gm/24 hours When central line infection is strongly suspected, the antibiotic Vancomycin is added. The first dose can be given when the patient is admitted to the ward. Pitfalls to avoid: Don't delay in getting the initial evaluation by the physician. Don't delay in getting blood drawn (if the ER staff is unfamiliar with central line procedures, take your child to the pediatric ward!). Don't delay in starting antibiotics. If your child is admitted to rule out sepsis (infection), the antibiotic is ordered stat and given as soon as possible. This site made me feel so much better, it brought tears to my eyes to see that you all have been through it too. My son is ten and was diagnosed this past July with lymphoblastic lymphoma. He has been admitted five times since October for fevers. None has been blamed on bacteria though. This last time he was in the hospital for seven days. They believe he had severe sinusitis. It so good to have support. Thanks lenore mom The cause of infection in my sons port, was from the same bacteria that causes gingivitus.....check for puffy gums...and keep the mouth as clean as possible!! Despite the warnings and the urging by doctors to call if your child has a fever, some parents still do not realize the importance of IMMEDIATE intervention in a medical facility. I unfortunately witnessed a beautiful little girl with a brain tumor die from sepsis in the clinic, because her mother didn't think the temp of 100.6 was high enough to worry about. The child was acting fine until about 3 hours before coming to clinic. In that time she became septic and was unable to stablize, passing away only 1 hour of arriving in the clinic for a regular check-up. Children with impaired immune systems may not necessarily run a really high temp, just a low grade one, until they have white cells to fight the infection. ANYTHING over 100.5 axillary (under the arm) is grounds to call the doc. Better safe than sorry. Even though it may be a real hassel to go in the hospital after only being home for a day or two. We know—we lived about 10 months as an inpatient during our 2 year old son's treatment for Renee . My daughter had an extremely high fever at diagnosis. Initially the ER treated her for meningoococcaal septicaemia. She was in great pain for a week from what turned out to be streptococcus E. She was lucky to survive. Watch those temperartures! Our daughter, Michelah, has ALL and she started running a fever last week. It ended up that she had a crack in the catheter that was attached to her port and had to have emergency surgery to have it removed. She was a very sick girl--I'm glad we did not delay in taking her to the doctor. Our son, Monte, was diagnosed with osteosarcoma, cancer of the large bone, femur of his left leg. I have talked with many individuals in the medical profession and cancer patients, parents, etc. One must remember to keep a very watchful eye on your child, some children do not show signs of distress by fever. Often when the blood count or ANC is at 0 the body's ability to produce a fever may be limited. Other signs of infection can be tiredness, paleness, irritability, loss of interest in routine activities, chills, lower than normal temps, each body reacts differently. Please observe the routine of your child especially following chemo treatments. We have been very fortunate with a good prognosis and thus far the chemo seems to be working. The tumor is receding and we are now trying to build our sons body to prepare for surgery. And always, keep in mind this is the path not chosen, yet a journey we will survive! Keep up the smiles, tears, positive thinking and prayer! A lot of children spike fevers religously when their counts are down—our son is one of those children. Even if you know that your child always spikes a fever at a specific time, do not delay in bringing your child into the hospital. I have heard of several instances where parents delay (because they knew the fever was due to low counts) and in the end, the children perished because that one time, there really was an infection. We must take every precaution when fighting these battles with our precious children. Our daughter, Brianna, had been acting funny all week and when we had her appointment at the clinic, I told the doctor I was worried. He said because her ANC was only 28 she was going to act a bit tired and all. My husband and I continously took her temperature and on Saturday, it went from 99.6 to 103.9 in 45 minutes. We rushed to the hospital—long story short: we ended up in the PICU for septic shock. If we would not have been paying such close attention to her, we could have lost her. Don't ever think your being too paranoid when it comes to fevers, there is no such thing with our kids.