Mysterious fever

Kelsie kept a fever all night despite me alternating Tylenol and Ibuprofen every 3 hours. They gave her a high dose of Ibuprofen at the ER which broke the fever (it got down to 98.5) but when she woke up from her nap it went right back up again. She had Ibuprofen at 11:30am at the ER, I gave her Tylenol at 4:30 but at 6:00p, her fever was up to 104.1 again. She was still acting ok, trying to play and acting herself for the most part, but the acetaminophen was doing nothing to bring down her temp. So I gave her another dose of Ibuprofen at 5:30pm and around 8:30 it was 99.5. But by 10:00, it was back up to 101 and stayed between 100.5-102.5 all night. As a PNP who sees kids with fever all the time, I usually don't get too excited about fever. I usually don't even treat Kelsie's fevers unless they get above 102 or she is acting sick. But after what happened yesterday, I was a little more on alert last night. I actually set my alarm so I could make sure her fever wasn't getting too high.  She still ate a good dinner last night, and slept well (except for me waking her up to give her medicine). But this morning, she is still sleeping as of 9:10am and that is not like her. She is due for more medicine but I checked her temperature and it was 100.0, so I'm just going to let her sleep it off.

As to what is causing this, we're still not sure. She still doesn't really have any symptoms. She coughed 3 times since being home from the ER but that could just be her typical occasional reflux cough. A UTI is still a possibility because they didn't check her urine at the ER. Since it was just day one of the fever, they didn't want to traumatize her with a catherization and I didn't disagree. However, since it has been almost 24 hours since this started and we still don't really have any symptoms to clue us in to the cause of this fever, I still want to rule out a UTI. So I went by her doctor's office last night to pick up a urine specimen cup and I am going to try to get her to pee in the potty for me when she wakes up (they gave me a hat for the toilet too so I can catch it). The other possibility is an ear infection. The resident looked in her ear yesterday and thought it looked a little red but when I looked, I thought it looked ok and I definitely wouldn't have treated that as an ear infection. (They didn't think it was bad enough to treat yesterday either). But I saw her sticking her finger in her ear last night and checked again and it definitely looked worse in the left ear. I will check again this morning and may have her doctor take a look when I go to drop off her urine. She definitely isn't acting like a kid with an ear infection (still eating well, not fussy, not complaining of pain, not waking up crying, no cold symptoms etc), so even if it still looks worse this morning, I'm not so sure that I would even treat it with an antibiotic yet as it could still just be viral.

They gave me Tamiflu and wanted me to start that even though her flu test was negative. If by some slim chance this was actually a false negative and she did have the flu, it could be more serious for her because she has CF. But I just really don't think that is what this is. She doesn't look or act like all the other kids I've seen with flu this year. And Tamiflu can cause a lot of abdominal discomfort and GI upset, so it could make her feel worse. I have actually taken it before and it made me throw up after the first couple of doses. So I didn't give it to her last night. I didn't know how it would affect her and I didn't want to risk her having a tummy ache and vomiting during sleep. I still haven't decided if I am going to give it to her this morning or not. Ahhh its both a blessing and a curse to be both a pediatric health care provider and a mother! My mind teeter totters all the time on how to care for my child's many healthcare needs!