Birth, Baby!

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Thank Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

All right, y'all, today we are here with Dr.

Whitaker.

He is a board certified pediatrician and fellow of the American Academy of Pediatrics.

He completed his Ph.D.

in biochemistry at Rice University, medical degree at the University of Texas Health Science Center at San Antonio, and pediatric residency at Cincinnati Children's Medical Center.

He has over 20 years of experience in a variety of settings, including newborn hospital, emergency, and urgent care facilities, outpatient clinic for children with complex health needs, and mental health difficulties.

Y'all, the fact that he even wants to be here and talk to us is such an honor, and he is gonna talk to us today about fevers and newborns, which we know a lot of parents freak out about.

So, thank you so much for being here today, Dr.

Whitaker.

Well, thank you, Ciarra, and thank you for having me on today.

I really appreciate it, and I appreciate what you do to empower beginnings, too, with the families.

Thank you so much.

We're so excited to have you here.

So, to start us off, can you tell us a little bit about how you decided to become a pediatrician?

Yeah, you know, it's, I think being a pediatrician is a little bit of a calling.

You know, I can't imagine anybody not wanting to work with kids.

They're so genuine and real, and parents are more likely to follow through on plans of action, whereas adults are harder.

You can tell them what to do, but, you know, you know how that goes.

But kids are wonderful.

I remember as a kid always being like, what the doctor said, like when you're a kid, it's like, that's the be all end all.

It's like the police, they said.

Yeah, I know the relationships are great, and to watch them and talk to them and listen to what they have to say is always, especially like three-year-olds who tell you about their day, it's awesome.

Yeah, and it's always so fun.

Samantha's kids were just heckling her the other day for eating sugar while she was sick.

Her kids were talking about her, not to her, in the same room as her, being like, mom's not gonna be healthy if she's already sick and she's eating sugar, it's just bad for her body.

And she was like, why, they listen?

Like, so do they listen?

Yeah, but it's true.

Yeah, they listen, it works.

Yeah, but you should have sugar when you're sick.

That's the one time you should, right?

Oh, thank you.

Thank you, all I ever want is just a cookie, and then my kids are over there, she's gonna be sick forever.

Rude.

That's so funny.

So as a parent of newborns, we get questions a lot about this stuff, and we always have to say, not a doctor, we're not a doctor.

But what signs should parents look for in their babies that go, you know what, maybe I should take their temperature.

Yeah, that's a hard one, you know.

So when I see my newborns, one of the first things I always mention to them is if your baby has a fever, you need to call me, you need to contact me.

But we don't really go into big discussions about why.

But it's really important.

And Sam, I want to focus on fevers in babies that otherwise don't look too sick, because it's very different than a baby who looks sick because fever or no fever, that baby needs to be evaluated, persistent crying, irritability, sleeping too much, not being able to wake them up, breathing funny, too fast, too slow, or grunting, any changes in their skin color, like appearing pale or bluish, diarrhea, vomiting, those are all concerns.

And of course, lethargy or unusual rashes.

And then if they're not drinking and they're signed to dehydration.

So those things with fever or no fever need to be evaluated.

So when we talk about fever, newborns a lot of time, the newborn's that first 28 days of life.

And it's also called the neonatal period.

A fever in that age, most of those kids don't have a lot of severe symptoms.

They have fever and maybe not quite acting themselves, maybe not quite feeding so well, but they don't appear very sick.

And so you said those first 28 days.

So what, you know, that's qualifying as a newborn.

And what is a fever like considered?

Cause I know it's different for different ages, right?

Yeah.

And a fever is a hundred point four.

A lot of times people will talk about low grade fevers.

Oh, my baby had a low grade fever of 99 or a hundred, but those are still considered normal.

Any temperature, a hundred point four or more is a fever.

And, you know, I often wonder who chose that number.

It must've been a committee of people sitting around.

Why not a hundred point three?

Why not a hundred point four?

A hundred point four, you know, and I guess they looked at temperatures across many, many, many people and babies, and they came to this conclusion, but still I think it's funny.

Yeah, that makes sense.

And what about like measuring a newborn's temperature?

Are the like forehead thermometers sufficient?

Or do we need to like be taking the rectal temperatures?

What, how can we do that accurately?

Yeah, I wanted to make one other point is we worry about fever, 100.4 more, but we also worry about low temperature in babies.

So usually 97.7 or below, because babies can kind of have the opposite reaction whether fevers go lower than normal or higher than normal.

You know what's funny?

I mean, I was sick last week or two weeks ago now, and I had a, like I knew, I woke up in the middle of the night and I just knew I had a fever based on how I felt.

But I took it and when I first took it, it was like 99.7.

And for me, I was like, I don't even care.

I don't even care that it's not above a certain level.

I know it's going higher and I feel like crap.

But it's funny how much more, like I feel like little kids tolerate it a little bit better.

Here I am, a big old fat wimp at 38 years old going, I'm 99.7.

So, and I just take it with my forehead thermometer, but we do see in kids, people kind of argue about like, well, if you take it with the forehead thermometer at a degree or whatever, so kind of what is your opinion on that?

Only rectal temperatures are accurate.

That measures the core body temperature the most accurately.

The problem with forehead ones, axillary ones, the armpit ones, babies don't regulate their temperature very well.

So different parts of their body can feel very warm as they're trying to lose heat or gain heat, they can feel too cold.

And so the temperatures usually aren't accurate.

And then like what you were talking about, sometimes when you just know you have a fever, but the thermometer's not measuring it, sometimes you could be on the upswing heading towards fever or you could be coming down from a fever.

So sometimes we're catching it at the wrong moment.

But with babies, medically, what we decide to do is definitely dependent on that number of 100.4 rectally.

And a lot of times, I have a lot of parents who really are hesitant to do rectal temperatures, they're uncomfortable with it for some reason.

You know, for me, I would think...

I was fine with it.

My husband was like, absolutely not.

Like, you're in charge of that.

Yeah, I don't get it.

I don't understand what the uncomfortableness is, you know, but yeah, a lot of families, yeah, just uncomfortable.

But it's the only way.

And it's super easy.

You know, you just take your little digital thermometer, wipe it with some alcohol.

And we use petroleum jelly, like water-based, not petroleum, I'm sorry, water-based lubricating jelly.

But you can use Vaseline or Aquaphor or something.

And you only put it in like a half inch.

It's not that far to get the temperature.

And it's easy if you just kind of grab their feet and bend their knees into their belly and just insert it just a little bit.

But it's the only way to take a temperature.

The other thing I wonder about, yeah, another thing I wonder about is like, especially in the emergency department, people would come in and my baby has a temperature fever.

And I always wonder why they checked it.

If a baby is pure sick, that's obvious.

But a lot of times it's because the heads feel warm.

But like I said, because of thermal regulation, not being able to regulate the heat very well, their heads can a lot of times feel very hot even though their temperature is normal.

Yeah.

So what would be like the signs that a fever might be serious?

And when should someone call the doctor for a fever with a newborn?

Well, number one, you always have to call a doctor if you're newborn in that first 28 period.

I mean, we could talk about older than that.

The algorithms change a little bit.

But I want to focus on that newborn period.

Any fever's got to be, you have to call a doctor, or go to the emergency room, et cetera, et cetera, because it's potentially a medical emergency.

Like I said, a lot of babies don't have any other signs of infection, or they're like mildly acting, not quite themselves.

And everybody's going to take their baby in if they're really appearing sick, for those reasons we talked about before.

It can be hard to tell with a newborn, for sure.

It is, yeah.

And we always say that skin to skin, doing that skin to skin, we always say, at least for the first 40 days, as much skin to skin as you can get, because babies have a harder time, like you were saying, regulating their body temperature and keeping it.

And it's just a little bit more difficult for their little systems to do.

But, you know, some parents that are like, you know, all ends of the spectrum, right?

Well, we've had parents who literally take their baby's temperature every day, because they're just so worried about a fever and a newborn.

Or actually, I find that parents worry more about worrying that their baby's too cold.

Yes.

So, but it's just as important if your baby has a fever.

If you have a six year old and, you know, their fever is breaking, you're like, oh, well, great.

Fever's breaking.

Don't have to do anything about it.

Sounds good.

But for a newborn, somebody under 28 days, if they have that happen, even if they're breaking the fever on their own, we still need to do a little bit more digging, right?

To kind of figure out what's going on.

Yes.

Fever needs to be evaluated.

If I can emphasize that any stronger.

The problem is that babies' immune system is really young.

They have a hard time recognizing illness and they have a hard time responding to the illness.

So especially something like a bacterial infection can take hold very quickly.

And a child who may appear okay with a fever now can very quickly become very, very sick.

Yeah.

Yeah.

I think that a lot of people get nervous to call the doctor because they don't want to be the mom that cried wolf or something like that.

We don't want to be taking the baby in all the time.

Or the other end of it is ERs are gross and they have a lot of stuff going on.

And it's really scary to take your itty bitty fresh newborn into an ER even for something like a fever.

So I think that's where providers like you come in really handy.

And you can say, you know, let's address this and see what's going on.

And then we can decide if you need to go into the ER or if you can come into the office and different things like that, I would imagine.

Yeah, no, I agree with that 100%.

Now, if working in the emergency room for a number of years, we see a lot of babies come in for fever.

One of the things that parents should understand is that when a baby comes, especially in that newborn period, if they show up with a fever or parents even said they have a fever at home, they go back to a room immediately.

They don't wait in the waiting room of a bunch of sick kids, not being exposed, they're taken immediately to a room, no matter how busy it is.

And that's purely because, yeah, it's purely because kids can get sick very quickly.

They can just progress very quickly.

I didn't want to take my kid in further, I didn't want to go to the doctor for the well kid visits, because I was like, there are kids in here that are sick, I don't care if they're on the other side.

I don't care if, it's just the same room guys, you know, I was so freaked out about that.

So I know when you're at home and your baby has a fever and you know you're going to have to bring them in, but like you're like, oh my gosh, I want to fix it, you know, parents want to fix it.

Is there anything that they can be doing when they're at home to keep their baby more comfortable when they have a fever?

Yeah, I think about this, too.

So you cannot give Tylenol, their livers aren't mature enough to be able to break it down.

You can't give ibuprofen because their kidneys aren't mature enough to break it down.

So no, no Tylenol, no ibuprofen in that first, it's two months for Tylenol and it's six months for ibuprofen, but in that newborn period, absolutely not.

The other thing is, a lot of people say, oh, give them a cool bath or something like that.

But again, babies lose heat very quickly and they gain heat very quickly.

So putting them in a cool bath to try to cool them down can lower their temperature too much.

And the other thing is we don't really want to mask a fever in a baby.

If they have a fever, we want to know because that's going to dictate what we do from there on.

And would skin-to-skin be good for that then, the lowering the fever?

Exactly.

And I think what's important is to comfort your child as much as possible.

I think skin-to-skin is a large part of that.

And like you said, our body temperatures help to regulate their body temperature.

So yeah, I think it's a wonderful idea.

So let's just say…

Oh, sorry, go ahead.

Yeah, no, you go ahead.

So let's just say that as a parent, you know, I have this baby, and I think that she's running a fever.

So I've decided that I'm going to take her in to have this fever addressed.

What could I expect when I bring in my newborn?

Yeah, the most common infections that babies have in newborns, let's say in those first few days of life, when you're still in the hospital, it's a little bit different.

You know, parents get, mothers get tested for group B strep.

They may hear that word a lot.

That's a really common cause of bacterial infection in those first few days of life.

And that's because that bacteria has got an amygdala, it's sticky, it's hard for the immune system to recognize.

Other things are prolonged fever in the newborn, if mom has prolonged rupture of membranes more than 24 hours, that increases the risk.

Or if mom has a fever during delivery, that increases the risk for bacterial infection too.

So there's that.

And then let's say you're a home and it's a week or two later.

Most common causes, urinary tract infection, pneumonia, bacteria in the blood, and of course, bacteria around the brain or meningitis.

So when you go to get evaluated, they're going to check the baby's blood, they're going to check the baby's urine, and oftentimes they'll check the fluid that goes around the brain for sites of infection.

We have had so few moms, luckily, knock on all the wood, to have to ever go to the ER.

Hey, people on YouTube, you get to see it.

I always knock on all the wood around my head.

Look at me.

So when people, we've had a few moms, have to take their babies to their parents, I should say.

You know, one time it was very low fever or very low temperature, like super low.

Another time it was an eye infection and she just didn't feel comfortable waiting for the pediatrician's office to open again.

She wanted to go straight to the ER, you know.

But it is very rare.

So I want parents to hear this knowing that it's not super common.

And for those of you that have babies in a hospital setting, you know, they're being monitored for some of these things before you go home.

For those of you that are having home births or birth centers, you do have midwives that are still taking care of you guys afterward and checking in on you.

And so a lot of times these things are getting caught early on and we're being able to help we, as in your team.

And, you know, if you do have to go, as scary as that might seem, it doesn't have to be so awful, right?

It's so wonderful that we do have the doctors and the nurses and all of these people that are able to help us recognize these things and take care of it before it gets too off the rails.

Yeah, you've made a really good point because a lot of the things I talk about are very scary, but like you say, they're not common.

Yeah, and the staff, the pediatricians, the nurses, all the staff have been used to working with these kids for a long time and make things as comfortable as possible.

I don't know, there's something about people who work in the pediatric world where we're just kind and nice.

It's very different than working in adult medicine world where people are a little bit more, I don't know what you would call it, but yeah, all the people that work in pediatrics tend to be a really compassionate and kind group, I think, and funny.

I think they're pretty funny, too.

Yeah, I would agree, too.

The people that are dealing with the babies always seem to be the happiest because, gosh, you're looking at a baby for a reason that they're not healthy.

I know this isn't what we're technically here to talk about, but it relates.

I have a lot of parents who have, you know, we have a lot of parents who are second time or third time or fourth time parents and have these older kids at home and they're just panicking that their older kid is going to get their younger kid sick, you know.

That happens all the time.

Yeah, and we talk about how, you know, especially if you're breastfeeding, you're being exposed to that bacteria and then or virus or whatever, and your breast milk is creating antibodies to help your baby fight whatever thing they may be exposed to.

But those things that you just listed are not typical, you know, four-year-old bringing home from preschool illnesses.

Those are things that are more internal.

And so would you say that it's usually something like that?

Because I think that that's what you just said, but I'm clarifying.

Or would you say that it's, you know, older people getting these babies sick?

Yeah, I think it's a good point.

You know, when babies come home, you know, it's obvious.

Good hand washing.

You don't want a whole lot of people coming over.

Especially during this winter season.

You want people that do come over wearing masks, no kissing on the babies, that type of stuff.

But we tend to hold babies very close to our face.

And that viruses and things like that are transmitted mostly through respiratory.

That being said, most babies, most kids who get fevers, most times it's viral, just like you said.

And especially if you have little olders or preschoolers who are bringing stuff home, you're exactly correct.

Those babies get sick more often sooner than the first baby.

However, the only way to say that it's a virus in a baby is to exclude worse case situations.

Most times they evaluate those things and the baby's doing fine.

They watch them in the hospital for a night.

If they're doing well, all the blood work and all that looks great.

Yeah, then they say, yeah, it's probably a virus.

But you can't ever assume that's a virus.

And even like you can't let let's say baby comes and they have a good ear infection.

Well, number one, it's weird that a two year old or two week old would have an ear infection.

But even that doesn't exclude a further workup because why does a newborn have an ear infection?

Could they have infection other in another place also?

So yeah, so so you're right.

Most of its virus, most of babies are OK.

But we have to make sure because you don't want to miss that one.

It's not right.

So I guess we didn't have this on our list.

I'm just going to throw it at you.

But yeah, when would it like how would a parent decide if they should take their baby into the pediatrician?

Versus like an urgent care or their local hospital or even going, you know, like here in Austin, we have Dell Children's and the Texas Children's Hospital.

So how would they decide which place to take their baby to?

Yeah, that's our question.

You know, in our practice, we're on 24-7.

So we're always available for a parent to call and ask for advice on what they should do or not do.

And even if they have to go to the emergency room, we'll call them first, let them know that they're coming and what they're coming for.

The best place to take a child, a baby especially, would be an emergency room for children.

And our options here are Dell Children's Main Campus, Dell Children's North, St.

David's Children's Hospital, and soon there's going to be Texas Children's Emergency Room.

So there's a lot of options, but not a freestanding urgent care, especially one that deals primarily with adults.

But even when I worked in an urgent care outside of the emergency room environment, if I had a newborn come with a fever, I immediately would send them to the children's emergency room because we're just not equipped to do all the testing that needs to be done.

Because in those emergency cases where it is something bigger, you would want them to be in the place they can get all the help, even if it's a cold or something, you'd rather be safe and have them in that place that has all the tools.

Yeah.

I wanted to emphasize too, so if fever is 100.4, what the heck do you do with 100.2 or 100.3?

You're at home, what do you do?

Because the emergency room isn't going to work up 100.3.

And like I was talking about, the poor babies, it's that number, it's that magic number who knows where it came from.

But since babies don't regulate heat and cold very well, the first thing we do is remove a layer and check that baby's temperature in a half hour again.

If you come into the emergency room with 100.3, what they'll do is they'll keep you for three hours and they'll measure that temperature every half hour.

And if within three hours the baby has no fever and is looking great, they'll send you home.

So that's a good time to call the pediatrician because you can do this at home.

Now, if a baby is seriously sick in that three hour period, they're going to get worse.

They're not going to have an eight hour period where they don't have fever and then it comes back like we do.

I love that.

I love that guidance.

That's so helpful for parents that are listening to this at home and being like, OK, now I kind of have a game plan of what to do.

So you mentioned in your practice that you're 24-7.

I know that this isn't what we're on here for, but I do think it's important to talk about how is that, what is that, and how can people find someone like you or someone like you and are you taking new patients at the time of this recording, which is in February of 2024.

Yeah, we're a different model.

We're a direct primary care model.

So we're membership based and we're not limited by insurance.

And since we don't have to spend a lot of money on ancillary stuff like billing departments and this type of thing, we can keep our patient panels a lot lower and we keep our patient panel low so we're available for same day visits, for calls, for texts, for virtual visits that same day.

And then since we're not restricted by insurance requirements, too, a lot of things can be dealt with over the phone, over text and over virtual.

We are accepting new patients.

You have access to us directly.

There's no nurse line in between us or nurse practitioner in between us.

It's just me and Dr.

G.

So, yeah, it's and since our patient panels are low, it's not like we're getting inundated with calls 24-7.

And I'll tell you, we have had families use y'all and it's just different.

It's just different to be able to text your pediatrician a picture of your baby's random rash on their face and have your pediatrician go totally normal.

Or, you know what, try this cream and if it doesn't clear up in three days, you don't have to go into the doctor.

And just like we said before, you don't want to expose your kid to the germs of a doctor's office if you don't have to.

Another beautiful thing about it is that you guys do home visits.

I think it's a little bit of a small additional charge, but that is such huge piece of mind, especially for someone who is the third kiddo and there's a 10-year-old and a four-year-old at home or whatever, and you don't have to drag everybody around.

Yeah, or just bringing, I just can't imagine bringing a three-day-old in a car out to an office, being exposed to whatever, you know, it makes no sense for me.

You know, I was in the emergency room for a number of years and it was really difficult.

I wanted to do general pediatrics again, really wanted to be a pediatrician again.

I couldn't find a practice that I could join with a clear conscience.

I can't push kids, 30 kids, 15-minute visits, go, go, go, and not be there available for them, not be able to pull and consolidate all the consultants and all the other things.

There wasn't the time, I couldn't do it until I found Dr.

G.

We get to be pediatricians the way I think it should be done.

Well, you didn't name drop, but I'm going to.

They're Blue Monarch Pediatrics in Austin, Texas area.

We are going to put the information on how to find you guys in the show notes.

Since you are taking new clients at this time, that's awesome.

If you guys are listening from other states, the direct care, you said it's called a direct care model?

Direct primary care.

Direct primary care.

So, you know, I know that there are places like this everywhere, but they are smaller.

And I will tell you, I just think you are such an incredible addition to Dr.

G's team.

I'm so thankful that she had you and that you guys found each other.

Yeah, we're going to have you back on again.

Yes, absolutely.

And I think for those of you that aren't in the Austin area, I think it's important to know this is like this is a growing model.

I'm hearing more and more about this.

So these options are available outside of Austin and in other places as well.

So definitely if that's something you're interested in, do some searches, ask around.

It's out there and it's cool.

We like it.

Yeah, thank you.

Well, thank you so much for being here today, Dr.

Whitaker.

And we really just appreciate your knowledge and that you're willing to give this information to parents.

Thank you.

Thank you for joining us on Birth, Baby!

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