Part Three

The Next Generation

By Eileen Metheny Carlton

Dr. C. Damon Moore, Pediatrician, Pediatric Healthcare

Fever is every parent’s boogeyman. Unlike the fabled monster, it can attack in broad daylight as well as the darkest hours of night. Touching a child’s forehead and discovering that it is radiating an abnormal heat level stops a parent in his or her tracks. When the thermometer confirms the degree of the problem, the next step is to call the doctor and find the cause. Dr. C. Damon Moore of Pediatric Healthcare in Loudoun is no stranger to this scenario. Fever, Moore says, is often just one sign or symptom of a larger problem.

“If your temperature is 100.4 or 100.5 degrees, that is a fever, and if the patient is less than 8 weeks old, it needs to be looked at. But if the patient is 6 years old and has a fever of 105 degrees, it may not be as much of a cause for concern. When I am taking a call, whether from a parent or a patient or the emergency room, I always want to know how old patient is. As soon as I know the age, I can make a differential diagnosis. This is a very common kind of medical speak that refers to the different things that it could be based on,” Moore says.

Moore emphasizes that while any child with a fever should be examined by a doctor, the diagnosis is not often going to be for something that is life-threatening.

“If you took 100 infants with fever as a symptom, maybe 1 to 2 percent might have something serious. But there’s no way to distinguish by looking at them who the 1 to 2 percent would be. You are compelled to do a work up: lumbar puncture, chest X-ray, drawing blood, urine analysis, blood culture, things that are just done along with exam to exclude something bad,” Moore explains.

Moore explains that an infant who gets a fever during the first eight weeks of life is a big concern “because we are still concerned about a child’s immune system not being as competent as it will eventually be. We also worry the environment and things that still may be holdovers from birth. This includes strep infections, herpes infections, things like that. … Overwhelmingly sepsis, neonatal sepsis, is a big concern. It is not always confined to one area, but can spread to the entire body.”

Moore indicates that “naming the top five ailments we treat children for is pretty easy. … They include upper respiratory infection because we see that all year—fall, winter, spring and summer. Then there’s sore throats, whether viral or strep, ear infections and asthma and allergies.”

Communication between parent and pediatrician, he says, is of utmost importance.

Adams Family, Patients of Dr. Damon Moore (Photography by Jonathan Timmes)

One of the parents Moore deals with on a regular basis is Elizabeth Adams, 38, of South Riding. Her three children are 1-year-old Parker, 6-year-old Haley and 9-year-old Meghan. Adams, a stay-at-home mom, began taking her children to Moore nine years ago.

Haley had eight back-to-back ear infections when she was 3 and 4 years old. She eventually took Haley to an ear, nose and throat specialist to see if she needed to have tubes, but by the time they got her there, spring was arriving and the problem left on its own.

Parker has had RSV, or respiratory syncytial virus. The symptoms can range from having a simple clear runny nose and occasional cough that can be treated at home, to severe difficulty breathing that may require hospitalization. Other symptoms might include a low-grade fever, sore throat, headache and irritability. Younger children, especially those under 2 or 3 years old, are most at risk for more severe symptoms, such as high fever, wheezing, difficulty breathing, a persistent cough or apnea.

“You don’t necessarily take medication for it, but he did use a nebulizer. He had this horrible, horrible cough, where he sounded like a seal. The symptoms can vary,” Adams says.

Meghan used to need a nebulizer when she had a bronchial infection, Adams says, but has outgrown it and has not needed one in two years.

Adams stresses the need for an open doctor-patient relationship. “For me, it was actually important to talk to the doctor, just getting to know the pediatrician. And not just the doctors, the nurses as well. … It is so important that you get a good feel from your pediatrician’s office. You’re your children’s advocate, and you’re the only one that can do that for them.”

(February 2010)