Ask A Pediatrician: The Truth About Fevers, Antibiotics & Vaccines - Dr. Diane Arnaout

0:00Hi, it's Hunter Clark Fields, author of Raising Good Humans. If you've ever thought, I wish I could help other parents the way I've been helped, this is for you. The Mindful Parenting Teacher Certification Program is now open for enrollment. You'll deepen your mindfulness, learn to lead powerful parenting groups, and join a supportive, heart-centered community. Are you ready to make a difference? I only take a very limited number of people into this program, so apply now. Visit mindfulparentingcourse.com slash teach.

0:28Dr. Diane Arnaout:You're listening to the Mindful Mama podcast. Today, we are talking about all the things you can ask a pediatrician. We're going to talk about the truth about fevers, antibiotics, and vaccines with Dr. Diane Arnault.

0:43Welcome to the Mindful Mama podcast. Here, it's about becoming a less irritable, more joyful parent. At Mindful Mama, we know that you cannot give what you do not have, and when you have calm and peace within, then you can give it to your children. I'm your host, Hunter Clark-Fields. I help smart, thoughtful parents stay calm so they can have strong, connected relationships with their children. I've been practicing mindfulness for over 25 years. I'm the creator of the Mindful Parenting course and teacher training, and I'm the author of the international bestseller, Raising Good Humans, Raising Good Humans Every Day, and the Raising Good Humans Guided Journal.

1:22Welcome back to the Mindful Mama podcast. Hi, I'm so glad you're here. Welcome if you're new. So glad you are here too. This is a good episode to join if you have questions about your child's health, all kinds of different things, because we are going to talk to Dr. Diane Arnault, a board-certified pediatrician, fellow of the American Academy of Pediatrics, a mother of two. She practices in Fort Worth, Texas and provides general pediatric care from birth to age 18 and the author of Hiccups, a pediatrician mom's guide to surviving your first year of parenthood. I love this conversation so much because we get to talk to Dr.

2:07Diane about what parents really need to know. We're going to talk about everything from fevers and to antibiotics. We're going to talk about the things that are weird but normal and the things that are kind of normal but a little concerning. So you're going to find out what you can stop worrying about and what to actually pay attention to. So this is really, really, really helpful episode. So join me at the table as I talk to Dr. Diane Arnau.

2:38Dr. Diane, thank you so much for coming on the Mindful Mama podcast. Thank you for having me. I'm so happy to be here today. Good. um i'm excited to talk to you you're a pediatrician you're a mom so what are some of the things that you see parents worrying about that are actually really benign that they don't need to worry about let's get that right out there oh okay yeah no we're diving right in huh there are you know what i would say if there was one thing if i could have a little you know megaphone and have a room full of parents with me and announce something that would just help everybody sleep better at night, it would be fever.

3:22It would be talking about fever. I think parents worry a lot about fever, understandably. It is a change. It is abrupt, usually. It is scary. My own child once woke up with a 105 point something fever one day. I was terrified. I'm a parent too, so I get it. But I think if parents understood the biological reason for fever, why we have fever and how fever works in our body, like, I think they would feel so much better. In fact, I wrote about it one day. I was, you know, eating some cereal on a Saturday morning. It was like, let me write out like the scientific process behind fever because let's nerd out about it.

4:08Fever does not fry a child's brain. Fever does not harm a child. They look really tired. They look miserable. Fever makes us feel achy. It cooks off the bad stuff, right? Isn't that the point of fever? Yes. So germs hate heat. And so when you get a germ in your body, when a child gets a germ in their body, there's a little part of our brain that like flips the switch and is like, all right, it's time to send out the army. It's time to get things hot. It's time to get some chemicals talking to each other. the best way to do it is to reset the thermostat. So just like when you go to your wall and change your AC thermostat, your body does the same thing and says, nope, let's go to 102.

4:49To get to 102, your child has to shiver and shake and kind of feel cold and want to be under blankets. That rises the body temperature. And when you raise the body temperature, even a degree or two, it starts to... Can I interrupt you this? Because shivering is an action that a reaction that to cold to keep you warm. So when it's raising the temperature, you're shivering to to keep the temperature inside. That's how that's working? Yes. Isn't that fascinating? That's so fascinating. Yeah. There's a word also called rigors. It's really common with flu. If you get the flu, you'll see your kids shake a little bit.

5:29But isn't that brilliant? It just gets the blood flowing into your muscles. It gets heat to rise. Suddenly all these special immune system cells start running around. Your heart rate goes up. Isn't that important to get blood flowing faster? Yeah, yeah. That makes sense. The way I, you know, when I was in the grocery store with my children and they were acting up and I was like, are you getting sick? You kind of feel warm. The way I knew if they were going to spike a fever is by feeling their pulse and by feeling how cold their hands were because your body sends all the blood centrally so that it circulates in your central body.

6:02All this has purpose. The chemicals between cells start rapid firing and talking to each other so that it can find these germs, identify it, and attack it. But that's the whole point. That's why we have fever. Why haven't we, you know, there's been documented fever for thousands of years in human history. Why haven't we kind of evolved out of it? That's because we need it. And so this is a long answer to your question, but I think if there's one, probably one of the top things I wish parents would realize is, for the most part, pretty benign, is fever. It's so important. It's interesting because I felt like I'm kind of like on the crunchy spectrum, you might say.

6:44And, you know, I totally actually do make my own granola. and but um but um love it but and so I I felt like okay yeah like the I know fever is good but then I would think then my worry was like okay well is it bad to give my kid Tylenol for a fever like am I stopping a process that's actually helpful so is it can is that something that we need to worry about? So there are, if you want to look at data, there is some, there are small and interesting studies out there. I remember reading one about lizards, of course, like, you know, we would always prefer studies done in humans. But I remember reading one study about lizards, that when lizards, these lizards, these animals became ill, if you suppress the fever, it actually took slightly longer for them to feel better, for them to get better or recover from their illness.

7:40I want to say that there is a lot of theory and studies that suppressing fever makes you more contagious to other people around you over time. It's interesting. I always tell parents the same thing. Treat your child, not the number. Parents really come to me and they'll say, Well, first I gave Tylenol and then I gave ibuprofen and it really, the number only came down to 100.8 and it wasn't normal again. And I'm like, hey, you don't have to get it back to normal. What we're trying to do is make your kid comfortable. If your child's sitting there at 101 eating some goldfish and watching some TV and seems comfortable, then that's okay.

8:25You don't even have to, I've done, there's several times my children have been sick and I look at them and I say, how do you feel? And they're like tired, but I'm okay. And they lay on the couch and watch a show. and I don't give them medicine. I wait till they say, you know, mommy, can I have some medicine? Or I wait till they ache or moan. Then I treat that. I treat that discomfort. I think that's, you know, I want my kid to be comfortable. But I tell parents, you treat the kid, not the number. And you don't have to chase it. And you don't have to like, people will alternate meds every three hours.

8:53Like none of that's actually been proven to be necessary or helpful. So I generally tell parents, pick a medicine like Tylenol or ibuprofen. Give it every six hours or so. Watch to make sure your child is drinking well and breathing comfortably. And let fever do its thing. It has a job. Now, I think where the fear comes is that there is a condition called febrile seizures where some children genetically are prone to have a seizure when they have a fever, when the fever number is going up. And this is not a dangerous seizure. it does not cause brain damage, but it sure as heck is scary to see as a parent.

9:35So I think that's kind of where the folklore about fever frying your brain and hurting your kid's brain kind of came from. But in general, fever is benign and helpful, not just benign, very, very helpful in the sickness process. This is so great. I'm so glad we talked about this in like the first five minutes of talking to you because people need to hear this and some people drop up sometimes. So you got it. Fevers are benign and they're helpful. I mean, I guess, yeah, then you want to treat the child. So you see a point where it's like your child's really suffering or you see a point where, and then you might want to take sips beyond that.

10:17Right. Yes. And you know, there's all this talk about putting your kid in a cold, I always feel for these children, their parents put them in a cold bathtub to bring the fever down. And I just think to myself, think about the last time you had fever, how you shivered under your blankets. And then to be plunged in cold water or warmish water, like that just seems like it would feel terrible. And you don't even – Keep that heat under the blanket. Yeah. You don't want to get rid of the fever. Yeah. Okay. A warm bath is fine. Warm baths make me feel better when I'm sick. But yeah, no, there's no need to be so aggressive in treating fever.

10:51and we want our kids to feel okay and feel good enough to drink and good enough to talk and good enough to be comfortable, but no need to chase the number. It's there for a reason. We worry about fever in children under three months old and we tend to definitely approach that kind of fever differently because newborn babies have a very new immune system that's still learning. And after five days of fever, in older kids, I like to see the child after five days of fever, just to see them in the office and make sure that everything's okay, that something doesn't need treatment in my office. But I'm kind of like you.

11:30I actually am, quote unquote, crunchy. As crunchy as a pediatrician can get, I spend a good majority of my day talking people out of medication with a few exceptions, of course. Children need meds sometimes, and it's important sometimes, but our bodies are amazing. That's a huge part of what I do every day is to educate in person and online about why our bodies do what they do and the importance of getting sick sometimes, the importance of things like fever.

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13:29What sets the D8 apart from anything else in the market are the Target Wash, which blasts water directly into those nightmare blind spots like straws and nipples, and Pump 360, which rotates the water streams to completely clean the tricky curves of breast pump flanges. You have so much to do. You need to stop spending your nights hovering over the sink. Instead, you can let the Mom Cozy d8 handle it all if you're in the infant stage or know someone who is you have to check these out the mom cozy night pro bottle warmer or the deep clean bottle washer d8 they're offering 20 off if you go to mom cozy.com and use code mindful mama for 20 off that's mom cozy.com and use the code mindful mama yeah i mean i think then uh perfect this is a perfect segue to talking about antibiotics in my family my husband had um he had appendus he had a appendicitis like a acute appendicitis and he had to be given iv antibiotics for like three days something to help him to and it was this say you know appendicitis is very serious and it saved you know it was really important but that iv antibiotics messed him up royally for he has messed him up royally for years after that just completely debilitating his gut health and his ability to digest things and all kinds of things like that so we were aware of oh okay we want to there it's important right to not it's interesting because i feel like we're still kind of in a a time where like antibiotics are amazing let's give kids are sick let's see if they need to go get some antibiotics and we give them antibiotics to fix everything.

15:20Like we are kind of in that phase maybe a generation ago. And so some of us, I think, are sort of still keeping that. And I guess we were in this place of like, oh no, maybe we need to hold off on the antibiotics. So where do you see the evidence showing on that front? I agree with you. I think the tide is turning. The more parents are on social media, the more parents are learning. You know, social media has its downfalls, but I think one thing that is great about it is that physicians, medical professionals can get on here and really help people with these decisions. Now, antibiotics, there are studies that have shown that if you give a baby antibiotics before six months old, that they have, I want to say it was a threefold higher chance of food allergies and a double chance for asthma later in life.

16:20It doesn't mean your baby's going to have these problems if they've gotten antibiotics in the first six months of life. But I think it illustrates a really important point. Antibiotics are not to be taken lightly. You need to, can they save someone's life? Absolutely, of course. They are a huge advancement in medicine and they have saved millions of lives, but we need to use them responsibly. and so you know I spend a lot of my day talking folks out of it and my patients know me so well now that they know I'm gonna give them and you know we're gonna sit down we're gonna if we need an antibiotic we're gonna sit down we're gonna talk about why we're gonna talk about hey could we wait a few days and see how it goes absolutely I think what a lot of parents don't realize is that a majority of ear infections for example are viral and don't need antibiotics and it's actually okay to wait it out.

17:12We used to treat ear infections with 10 days of amoxicillin. Now it's recommended that we start treating, you know, in the older kids with five to seven days. We're really trying our hardest in the medical world to adhere to something called antibiotic stewardship. That's the word we're using to say we need to be responsible. We need to understand long-term effects of antibiotics, and we need to use them only in situations where the benefits far outweigh the risks.

17:46I'm sorry that your husband has been through what he's been through, but I'm kind of not surprised because the stuff they put in those IV antibiotics is really potent, life-saving, broad spectrum, going to kill a lot of different things. But sometimes when we're killing the bad guys, we're also killing the good guys too. Yeah, and I guess they're just learning more and more and more how, and that science is really new about how these good you know good creatures in our body are doing so many good things and there are so many more you know biotics that are doing good things I don't know what you call them they got bacteria and things like that that are doing helpful things and there are doing bad things and it's it's interesting you know they're even doing these sort of like transplants of gut bacteria and things like that it's it's um yeah I mean it's all sort of new science, I guess.

18:39So it takes some time. If you think about a brand new baby in the world, immediately when they're born, bacteria from their mother covers their body, gets into their system, gets into their gut. I really think the gut biome helps us learn friend from foe. It helps us learn when they start putting everything in their mouth and they start mouthing and putting toys in their mouth and putting their hands in their mouth. That introduces the world to their insides, to their gut. And when you put a child in antibiotics and it kills those bacteria lining our gut, I think it hinders their ability to understand friend from foe and thus become more reactive to the environment, right?

19:25So what does that lead to? That leads to things like food allergies. That leads to things like seasonal pollen allergies, asthma, things like eczema. We're seeing huge jumps in the amounts of eczema that we see in children and food allergy. And what's the cause of that? There's a lot of theories. But I think part of it is that we're becoming so hygienic and using so many antibiotics, especially in the perinatal period, like when we go have our babies in the hospital or, you know, in the first few days of life if a child struggles in any way. Obviously, we do antibiotics to make sure they're not getting an infection.

20:00But what are we doing in the long term? That's something that we need to keep an eye on. And I think most medical professionals are, for the most part, very aware of this. We really are. we really do try very hard to only use antibiotics in the most dire of circumstances. Okay. Sorry if that was long-winded. No, no, that takeaway. Please don't apologize. You're fine. That's what we're here to do is to talk about things. But yeah, I mean, I'm just thinking about for the listener, it's like, okay, we want to just really make sure it's really, really needed before we're giving these antibiotics. Okay, so on the flip side, maybe we need to hold off a little, right?

20:41Maybe we need to stay home and maybe wait things out before we worry and go to the doctor's office. That's not necessarily what is required of us to be a good parent is to be worried and jumping to the doctors every time there's a fever or something. On the flip side, are there things, are there subtle signs that parents sometimes miss that actually deserve a closer look that they should be paying more attention to? That is a great question. I will say as a physician, just speaking broadly and generally of a kid's doctor, I worry about things like, there's subtle signs like limping. it's generally said in pediatrics that if a child is limping that's always a reason to visit a pediatrician a doctor um i i certainly want parents to come see me if their child if their child's breathing is different in any way sounds different the the uh work they put into breathing is kind of that seems to be increased um like i was saying before any you know baby under three months who has a fever, I want to see them or a child who's had fever more than four or five days.

22:02And then things like hydration status, I'm always looking to make sure I want children to make urine every six to eight hours. Children are tough sometimes. People compare us to veterinarians all the time because our patients can't talk to us often and tell us what's wrong. It's one of the hardest parts of my job is that we're just guessing on the outside, trying to figure out what's going on. But these are sort of some outside signs that I'm never going to shame a parent for coming to see me. I mean, I have worried parents come in on the first day of a very minor cold or, you know, maybe a diarrhea blowout or two.

22:44Most, you know, of us seasoned parents would know it's okay to wait at home to see how that goes. But no pediatrician is going to judge you for coming in if you're worried. If anything, I love to take it as an opportunity to teach so that the next time it happens, it won't be as scary. But the scary stuff would be like the limping and the breathing issues and just hydration is something we really watch for in kids. Okay. All right. Good to know. Let's talk about vaccines. Oh, my gosh, what a big issue this has been. We're all, we're above a little, oh my gosh, we're going to talk about this. But it's so important and it's so emotionally charged and it can be really scary for a new parent.

23:26You, you know, you have the perspective of both a doctor and a mom. So what do you wish parents understood about vaccines? Oh, that's a loaded question. I have a lot of answers for that. I think, and this has been said often, I think vaccines are a victim of their own success. I think if I could walk every parent through a pediatric ICU to show them what the diseases we vaccinate against, what they're capable of, I think those people I walk through the ICU would probably spend the rest of their days trying to talk others into vaccinating. I think that's what's forgotten here. This fear seems to have shifted, right?

24:20The fear has shifted from not wanting our kids to get these awful diseases to not wanting our kids to get these, quote unquote, unnatural, scary shots, right, that cause pain and distress in your day. I wish that fear could, I don't want parents to be fearful of anything, but I often sometimes wish parents knew more about what these diseases can do. So I spend a lot of time, not just shouting from the rooftops, like vaccines save lives, but also like, hey, let's talk about haemophilus influenza. Hey, let's talk about whooping cough and how I watched a child die of it in the ICU when I was in residency.

25:02Let's remind ourselves how tetanus is absolutely everywhere in our environment and how these are things you never hear about on Facebook or TikTok or Instagram because thankfully the majority of kids and adults in America are vaccinated against them. But what's going to happen when they start creeping back in? That's what I worry about. And I think our children are going to be the victims of this shift of fear. And so I spend a lot of time and a lot of energy telling people as much as I can about what I know about those diseases and what I've seen. And I think every decision we make for our kids, even the silliest things like butt cream or, you know, like what brand of diaper we're going to use, or I think every decision we make as parents, we should weigh benefits versus risks.

25:54And when it comes to vaccination and when it came to vaccinating my own kids, the benefit so far outweighs any risk that for me, it was a no-brainer. I vaccinated my children on time. My kids get a flu vaccine every year. I do not think twice about it because, again, probably my perspective, the things I've seen and the things I want to prevent in other children. And in Dr. Diane's book, Hiccups, you talk about the different things you vaccinate for and what it does to children. So I think it's really important to read. But you also give more information, which I think is really helpful. people worry about the ingredients in vaccines and you you break down each of the different ingredients and vaccines and what they do do do you think we could go through that a little bit here because I think this is so helpful to understand I think absolutely again in the in the in the spirit of wanting to be natural and I can see how you know things like preservatives and adjuvants, these words are big and the word preservative definitely has a negative connotation with it, especially in the food world, the nutrition world.

27:12I think it's been a while since I read that chapter, but in the book, I really broke down, why is it there? What's the point? If the people who make vaccines didn't put preservatives in the vaccination, then the vaccine would essentially die or become inert before it made it to the truck, the truck to get to the warehouse. You know, it wouldn't survive long term. And so very safe, very low dose ingredients were used to help these vaccines survive to make it to the fridge in my office. We have very special things called vaccine fridges. You can't just, you know, use the frigid air. You got to spend a lot of money on a vaccine fridge that will keep them at the perfect temperature so that the antigen inside, and that's a big word for piece of a virus or bacteria, so that that thing in there stays viable so that when we inject it into the muscle, and this is how vaccines work, we inject this little piece of a dead germ into the muscle as a blueprint, as a way of waking up the immune system and saying, hey, this is important.

28:23You've never seen it before. This is important. Come look at it and start making some army cells against it. And the trick to getting that to happen is called an adjuvant. That's something that we put in the vaccine to wake up the immune system, to say, hey, you guys need to come over here. You know how your arm gets swollen a few hours after you get your shot? That's a fantastic process where your body has localized and has found it and is sending a lot of white blood cells to the area to say, hey, what is this? This is not cool. This is not me. What is this thing? And then we make an army. And the better you can wake up the immune system, the better the response to the vaccine and the more long-lasting that vaccine is.

29:09Vaccines are not perfect. A lot of times, they'll work for a few years and then it kind of fizzles out. There's a few vaccines where we can't just get it to stick long-term. For example, tetanus. If you step on a nail and you go to the ER, they say, hey, bud, you need a tetanus vaccine. It's been more than five years, more than 10 years. That one, we just can't get to last a very long time. So that's why we do things called boosters. That's why your kid, everyone's like, oh, my kid gets so many shots, same shot over and over. Why is that? Well, those are reminders. Those are reminders so that you make that long lasting till the day you die.

29:46We want protection against these horrible things. And so I understand absolutely, and again, sorry to be long-winded, I understand why parents fear vaccination. I understand the graphics that people put up with little pictures of babies and a thousand little needles around them saying, look how many, look how many vaccines we give our kids now. I only needed 10. You know, my kid gets 25 now. There's reasons for that. And if you understand the science, I really think it makes a lot of sense. And so I hope with the book, it really just spells it out easily so parents understand it. Yeah, I think you do a good, really good job of translating it.