Dr. Hugh Gilgoff is a seasoned pediatrician relatively new to the Brooklyn community.  He has a balanced approach to medicine, combining a rigorous western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987.
Dr. Gilgoff worked in Manhattan for 11 years, and now practices with the LICH group on 185 Montague Street.  He is an expert diagnostician, and is praised for going the extra mile for his patients in need.  Likewise, he is known for his patience, and never makes a family feel rushed or judged.
In a new monthly column, he’ll be presenting his balanced approach to issues such as newborn care, including rashes, reflux and respiratory illnesses.  He’ll discuss fever, its myriad of causes, and when to call the pediatrician.  And finally, he’ll weigh in on sleep, solids and discipline, in an attempt to answer all those questions that you just didn’t have enough time to ask your doc!

Dr. Gilgoff is available for free prenatal consults, second opinions, and is accepting new patients with all types of insurance plans.  We at A Child Grows in Brooklyn have heard numerous positive reports from our families and recommend him without hesitation.  Please call him at 718.780.2334 to set up an appointment.

In his first column, Dr. Gilgoff discusses fever, and what to look for when your child spikes a high temperature.

FEVER
Fever is a sign – not a disease in of itself.  It’s the body’s reaction to an insult – most often an infection – and some even believe it serves a good purpose.  Why then should we fear a fever – and dread a high fever at that?  Because, as a sign of an infection it could in some cases signal pending danger.

What causes fever?
Except for the rare cases (such as rheumatic diseases or certain cancers), fever indicates an infection.  Infections are usually viral or bacterial (yes, they could be fungal, parasitic, etc. – but let’s stick to the basics here!).  In general, most viruses will run their course and your child’s immune system will eventually deal with and eliminate the germ that caused the fever.  In most cases you’ll see other signs and symptoms that will help you localize where, and therefore what type of virus is causing the illness.

Is there a runny nose, cough, cold and fever?  This is usually an upper respiratory infection.  Is there vomiting and diarrhea, with mild abdominal pain?  In most cases, this signals acute gastroenteritis, or a stomach flu.

When to worry?
If the fever is a natural response of the body, when should we worry?  This often depends on the clinical symptoms and the age of the patient.

A newborn baby just can’t fight off a bacterial infection, and therefore any fever above 100.4, or 38 degrees Celsius is an emergency.  If your baby is less than two or three months, any fever is a serious and urgent concern – so don’t wait for the morning, and don’t just give Tylenol.

If your child complains of localized ear or throat, pain on urination, or right lower abdominal pain (don’t forget about that appendix), this could signal a bacterial infection.  Although we all try to limit our antibiotic use, these are times you may need help to fight off an infection, and you should see your pediatrician within 24 hours.   If there is any fast breathing, or if your child is lethargic, or just not looking right, it’s time to see the doc immediately.  And if there are any mental status changes, or vomiting with neck stiffness, it’s a definite trip to the emergency room, to rule out meningitis.

How do they look?
As your child grows, their immune system matures, and there are more clinical cues to help us assess how sick the child is.  That lack of clinical cues is another reason that we are forced to investigate fevers in newborns with more rigor – they can’t talk, play or even smile when they are first born – so how do we know if they are very sick!

Even an older child can look “out of it” with a high fever, so one of my biggest lessons is that regardless of the number of the fever, the approach is always the same: first bring the fever down and then reassess.   If after Tylenol or Motrin, your child is playful and happy and eating and drinking, it is a great sign, and most likely viral, and can wait a bit more without seeing your pediatrician.  If however, after the fever breaks, your child still just doesn’t look right – they are not interactive and happy – it’s time to get them evaluated.

You know best!
Always remember, that with fever and ALL situations, you know your child best – so if something just doesn’t feel right to you and you are concerned – come see your pediatrician.   That is what we are there for, and there should be a low threshold to making sure your child will be ok!

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