• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    What are the Top Three Questions Raised at Advanced Pediatrics Now – May/June 2019?

    By Dr. Arthur Lavin

    People sometimes wonder, what are most people calling us about these days?

    Well, here are the top three reasons people are calling Advanced Pediatrics right now:

    #3  Fever

    Fever is a constant companion here at the office.  There has never been a week in practice in which we have not had a call about fever or seen a child with fever.

    There are two reasons fever tops the charts.

    First, everyone gets fevers.  There are very, very few, if any, humans alive who have never had a fever.   That’s worth thinking about for a moment.  Everyone.  Not many, not lots, but everyone.  That makes fever a universal experience.  And this is a very good reason we see it frequently.

    Second, fevers raise worries.  Everyone knows that if your child has a fever, something is wrong.  No one has a fever every day, so when it appears, it clearly indicates a problem has arrived.  Now the question is what is wrong, and more importantly, how wrong is the wrong?   The answer usually falls into one of two places, either nothing serious is wrong, or something serious is indeed wrong.

    Fortunately, the vast, vast majority of fevers fall squarely in the category of harmless illnesses, harmless in the sense that once the illness is gone no harm remains.  And the vast, vast majority of these mild illnesses are caused by viruses, and a couple of minor bacterial conditions- strep throat and ear infections.

    Fevers can indicate that something serious is wrong, but fever almost never tells us which it is- harmless or harmful.  If not the fever then what?  Other symptoms.  Trouble breathing, severe pain, stiff neck are examples of symptoms that tell us if a fever indicates something harmful may be going on.

    So it is very good that so many fevers indicate harmless problems, and we remain very glad to help answer all questions about them.

    #2  Rashes

    Rashes, like fever, are a constant companion at the office as well.  We see or talk about rashes every day too.   There are three reasons for why rashes are of concern so often.

    First, everyone gets rashes.  The skin is a boundary organ, meaning it is an organ that faces the inside and the outside of the body.  Breaks in the skin open pathways for dangerous chemicals and germs to cause harm to the inside of the body.  As a result, the skin must prepared, in every square inch, to mount a defense of the body should a crack or opening appear.  Most people aren’t aware that the skin is also the largest, that is heaviest, of all the organs of the body, outweighing the heart, brain, all.  Putting this all together, the skin is a very major organ of the immune system, loaded with cells to defend, and so large that there are many, many immune system cells across the skin.  Rashes are nothing but collections of the immune system cells reacting to something that has raised its alarms.

    Second, rashes are visible.  There may be all sorts of immune system activity inside the body, but we cannot see that activity.  When the immune system cells gather in the skin, however, the redness and swelling are visible for all to see.

    Third, like fever, the appearance of a rash establishes something is wrong, and now the question raised is whether it is serious.  Again, like fever, the vast majority of rashes indicated problems that go away without causing any lasting harm.

    But, rashes can indicate problems worth dealing with.  Perhaps most frequently, skin infections, and allergies.

    So while it is very good that so many rashes are not worrisome, we remain very glad to help answer all questions about rashes.

    And, right now, the #1 reason people are calling Advanced Pediatrics is:

    This is a real surprise, or should be, measles was on its way out, we have never seen a case of measles at Advanced Pediatrics, there are no cases yet reported in the state of Ohio, yet calls about measles are a most frequent topic, at least for now.

    The reason is clear, the United States is experiencing the largest measles epidemic the nation has seen in over 20 years.  But it goes beyond that.  We also happen to live in an era of tremendous energy when it comes to the topic of immunization.  The energy is very intense on both sides of the issue.  People who are opposed to immunizations come to the topic with very intense feelings.  And, people who are in favor of immunizations come to the topic with very intense feelings.

    Intense feelings have a tendency to  bend perspectives, and harden positions.  And so it is with immunizations.  Those in favor see their perspectives influenced by the rise in feelings towards people who do not immunize.  Not that long ago, perhaps people disagreed about immunizing, but those in favor did not harbor intense anger about other positions.  But many do now.  And on the other side, those opposed to immunizations feel very strongly about their set of facts, and get upset at facts that challenge that position.

    And so it is depth and intensity of the fixed positions large numbers of people are taking around the issue of immunizations that informs so many calls about measles.  The 2019 US measles epidemic confirms everyone in their position and only fans the flames of intense feeling on the subject.  For those in favor of immunizations, the epidemic is proof that not immunizing opens the door to once vanquished diseases, a position which does by the way have a lot of reason behind it.  For those opposed to immunizations, the epidemic leads to a scramble to try to characterize measles as a harmless disease and the epidemic as much smaller than people think.  On that point, the facts are pretty clear, about 1 in 1000 healthy people die if they get measles, and the number on the US epidemic is also very clear, about 800-900 at last count.

    Perhaps the #1 reason we get called on the measles issue, though, is from parents whose children are not yet immunized, either because they are too young for the vaccine (< 1 year old), or have not received it yet even though old enough too.  We recommend all children get the MMR on or soon after their first birthday, and a second, final dose anytime 1-3 months after the first.


    1. Advanced Pediatrics is happy to help families with any questions about their children, so we receive a lot of questions.
    2. Right now fevers, rashes , and measles are our most commonly asked questions.
    3. Fevers and rashes are in the vast majority of cases indicators of mild conditions that cause no harm over time, but it is good to be sure.  And we are happy to let you know if they do indicate anything worrisome.
    4. The measles concerns are emblematic of a deeply intense moment of passionate feelings about immunizations in our nation at this time.

    Here is to your health, and a happy and healthy Summer!!

    Dr. Arthur Lavin


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