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Fever in children

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DR SANJAY BAFNA MD
( Pediatrics )

Consultant Pediatrician, Jehangir Apollo hospital, Pune

Fever is one of the most common ailments for which parents seek medical advice. Fever has traditionally been defined as a rectal temperature over 100.4O F or 38O C. Temperatures measured at other sites are usually lower. It is not a very severe problem in majority of the cases. In fact, in children, fever often means that the body is trying to recognize and fight an enormous variety of viruses, bacteria and other microorganisms. However, it can surely make the child feel uncomfortable and, sometimes, even dehydrated. Let us know more about fever in children, how to diagnose it, how to treat it at home and when to approach a doctor.

WHY DO WE GET FEVER?

Fever In Children

Human beings are warm-blooded. It means our body temperature is kept constant irrespective of environmental temperature. We have a thermostat mechanism in the part of our brain called hypothalamus which maintains body temperature within normal range. Normal temperature is mandatory for functioning of all our organ system & cells. This is similar to a thermostat in a refrigerator which keeps temperature at set level irrespective of outside conditions. Various conditions can reset this thermostat to higher level resulting in fever.

Fever is a body’s immune response to an intruder; commonly in the form of infection. Entry of bacteria & viruses in the body stimulate our immune system resulting in production of substances known as pyrogens. These stimulate the brain centre & cause fever. Some non-infective diseases also cause fever by same mechanism. Heat illness or some drugs can also cause fever by their direct effect on hypothalamic centre.

Thus fever is a symptom of underlying disease & not a disease in itself.

HOW TO MEASURE TEMPERATURE

Temperature can be measured at various sites using different types of thermometers.

Rectal temperature is measured by inserting lubricated rectal thermometer into anal opening upto one inch. This records actual body temperature. Reading more than 100.4oF or 38oC is considered as fever. Axillary temp. is measured by glass thermometer. Digital thermometers are inexpensive and obtain a reading in seconds. Reading more than 99.o F or 37.2oC is fever

Mouth temp. can be taken in older children. It is 0.5oC lower than rectal temperature.

Aural( ear ) temp. is recorded by aural thermometers. The reading is similar to mouth temperature.

For all practical purposes axillary temperature should suffice for home care .It is not mandatory to add one degree to the axillary temperature recorded. Barring extremes ( very low in sick child or very high >105oF ) what is more important is trend of fever ,rather than actual reading.

CAUSES OF FEVER IN CHILDREN—

In children fever is usually due to infection ( entry of germs in our body ). The infection could be viral, bacterial or parasitic. It is common to have repeated viral respiratory infections in a toddler. These are self limiting & need no treatment except paracetamol. It does not mean that child has poor immunity. He does not need any immune boosters or tonics.

Sometimes child may get bacterial infections like tonsillitis , urinary tract infections, pneumonia etc. These diseases need antibiotics.

Malaria is common parasitic infection in some part of our country.

Rarely fever may occur because of allergy , drugs or heat illness.

In exceptional circumstances prolong fever may be an indicator of serious or chronic disease but this child would be very sick & would obviously have other associated complaints apart from fever.

IS FEVER ALWAYS HARMFUL ?

As mentioned above fever is body’s response to infection. Therefore to some extent it is protective response by the body-an attempt to kill germs. While very high fever (106oF) can harm the normal tissues of the body, lesser degree of fever only causes discomfort to the patient (and lot of parental anxiety! ) but doesn’t harm by itself. Therefore, in a febrile child our efforts should not be directed at just suppressing the fever & desperately bringing it down to normal . Instead we should aim to limit fever to safely manageable & comfortable level. At the same time we should attempt to find the cause of fever.

Sometimes fever can cause febrile convulsions in a child between the age of 6 months and 5 years. Though it causes lot of anxiety in parents these convulsions are usually benign & cause no long term damage.

Persistent high fever can cause dehydration in small babies & hence we should ensure good fluid intake during fever.

SELF-CARE AT HOME

The three goals of home care for a child with fever are to control the temperature, prevent dehydration, and monitor for serious or life-threatening illness.

Controling temperature

The first goal is to make the child comfortable by monitoring and reducing the fever below 102 F (38.9 C). This is achieved by using medications , dressing the child appropriately.& tepid sponging.

Clothing-

Children should not be overdressed indoors, even in the winter. Overdressing keeps the body warm as it prevents cooling by evaporation, radiation, conduction, or convection. The most practical solution is to dress the child in a single layer of clothing, then cover the child with a sheet or light blanket.

If the child is shivering , obviously he needs to be covered to stop the shivering. However ,shortly afterwards, the fever is bound to shoot up, so he needs to be medicated in anticipation of this rise in temperature.

Medications-

Mild fever does not need any medicines. In moderate or high fever, paracetamol is a safest antipyretic. Parents often feel that it is too mild & never works. It is important to understand that our aim is to merely lower fever to a level so as make child comfortable & not to bring it totally down to normal. In fact an overdose or a powerful antipyretic may be harmful. Besides by suppressing fever it may hide the true clinical picture of a child. Fever is an important symptom of an underlying illness & therefore its trend gives vital information to your doctor which may be missed if fever is aggressively suppressed. Hence it ts advisable to give medicine only when required & not round the clock

The dose should be correctly measured by the cap or dropper provided with bottle.

Another common error is to get confused between drop & syrup formulation. They contain same medication in different strengths. Drops contain 100mg of paracetemol in 1ml while syp contain 125 or 250mg in 5ml.

Tepid sponging

This is very simple & effective way to bring down temperature. It reduces fever by dissipating heat from body. Use a wet towel soaked in tap water or lukewarm water & sequentially wipe different parts of the body, so as to cover large areas ( including trunk & back ) .Allow these areas to dry on their own, by evaporation. This should be done for 10-15minutes. This cools down skin & reduces the temperature temporarily.

Sponging should never be done with ice cold water, nor does one need to add salt or cologne to the water. The application of cold water may cause shivering, which may result in generation of heat resulting in rise of temperature & thereby defeating the purpose of sponging. It goes without saying that a child who is already shivering should not be sponged. It is a myth that sponging leads to cold or pneumonia. If child does not allow sponging he can be given shower or put in tub of water.

PREVENTION OF DEHYDRATION & FEEDING DURING FEVER-

  • It is natural for a child not to eat well during fever or illness. Poor appetite is physiological & may be nature’s way to give rest to our GI system. However we must continue to offer them their regular food without any restrictions. Forced feeding is going to irritate child further & has no benefit
  • As said earlier good fluid intake is more important than food to prevent dehydration. Your child should urinate light-colored urine at least every four hours if well hydrated.

MONITORING AT HOME- WHEN TO SEEK MEDICAL ADVICE

Parent must watch for development of new symptoms .They must contact their doctor or emergency room if child has “ DANGER SIGNS “ or atypical features as listed below

Child is younger than 6 months of age (regardless of prematurity).

  • A seizure occurs.
  • Child has a purple or red rash.
  • A change in consciousness or behavior occurs.
  • Child's breathing is shallow, rapid, or difficult.
  • Child has a headache that will not go away.

Parents suspect that child may become dehydrated from vomiting, diarrhea, or not drinking (for example, sunken eyes, dry diapers, tented skin, unarousable, etc.).

Not passing adequate urine

Already shown to doctor and child is now getting worse or new symptoms have developed.

Prevention

Prevention of many illnesses that cause fever revolves around personal and household hygiene. Use these strategies to prevent the spread of viruses and bacteria:

  • Wash your hands with soap and water.
  • Cover your mouth and nose when sneezing and coughing.
  • Handle food with clean hands.
  • Properly immunize your child Eat a healthy diet including fruits and vegetables.
  • Get the proper amount of sleep.

Multi-Specialty Jehangir Hospital is the best hospital in Pune providing health care services related to heart, kidney, joints, critical care and more.

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