GENERAL GUIDELINES ABOUT FEVER IN CHILDREN

GENERAL GUIDELINES ABOUT FEVER IN CHILDREN

Fever is one of the most common symptoms of underlying disease in children, whenever the child develops fever the various question which comes to parents mind are:

  1. What is fever? Whether it’s a friend or enemy?
  2. Baby’s head most of the time feels warm on touch. Is it because of fever?
  3. Why child develops fever?
  4. What should parents do when the child develops fever?
  5. Whether to send a child to school or not when a child is having a fever.
  6. Weather antibiotics are required when the child develops a fever.
  7. Appetite decreases when the child develops a fever. What Parents should do?
  8. Various Red Flag signs or Danger signs which Parents should know.
  9. Can High fever lead to Seizures and brain damage in children?
  10. Which all medicines can be used safely in children at home?

What is fever?

The normal temperature of the body is around 37°C (98.6°F), plus or minus about 0.6°F. Whenever there is an infection or inflammation in the body, the brain responds by raising the body temperature to help fight conditions, so it is the body’s protective mechanism against various types of insult. Rectal temperature above 38°C (100.4°F) is considered as fever. Fever is important to sign which tells us that “all is not well” in the body hence to look for the underlying cause and elevated body temperature helps in controlling the disease process. Fever makes the child uncomfortable and increases the metabolic needs of the body. Fever itself is neither a friend nor an enemy; rather, it is a messenger that brings to your notification whenever your body is responding to an insult.

The Baby’s head is always warm to the touch. Is it fever?

Touching is an unreliable method to check the temperature. A digital thermometer is the best way to check the temperature. Avoid mercury thermometer, as it is toxic and could break. An accurate way to check temperature s through the rectum but it is cumbersome and uncomfortable for the child.  The axillary method is fairly precise and most commonly used in children. There is some difference in body temperature checked at various sites like the Axillary temperature is around  0.5–1.0°F lower than oral temperature while the rectal temperature is 0.5–1.0°F higher than the oral temperature.

Age Recommended site
Birth to 6months
  1. Rectal (Definitive)
  2. Axillary(Screening)
6 months to 5 years
  1. Rectal (Definitive)
  2. Axillary, tympanic,or temporal artery (Screening)
>5years
  1. Oral (Definitive)
  2. Axillary, tympanic or temporal artery (Screening)

Digital thermometers:

Used for measuring Rectal, Axillary (Arm Pit), or Oral temperature. Clean the thermometer with a sterile cloth before use.

Electronic ear (tympanic) thermometer:

The tympanic thermometer measures heat waves from the eardrum and it can be used in infants 6 months or older. Crying, otitis media, and wax in the ear do not have much effect on tympanic readings.

Temporal artery thermometers:

These thermometers measure heat waves on side of the forehead and can be used in infants 3 months or older. It is good for screening children but not recommended when definitive measurements are required.

Infrared thermometers:

Noncontact infrared thermometers can be used to measure temperature rapidly and noninvasively but they have poor accuracy. Their use is currently not recommended either at home or in the hospital. The prime utility of such devices is in the mass screening of a large population.

Various types of thermometers have been shown below.

As discussed above, fever is the body’s protective mechanism and can occur because of various reasons: 

  • Infections (viral, bacterial, protozoal, and fungal)
  • Dehydration
  • Autoimmune diseases
  • Drugs
  • Postvaccination
  • Malignancy

Most causes of fever in children are benign and self-limiting. Viral infections are by far the most common cause of fever in children. Sometimes few investigations are required to look for the cause of fever.

Fever is only a symptom, and the focus should be to find out the cause. The main objective of treating fever is to reduce the discomfort to the child, rather than to just reduce the temperature.

Do the following to make the child comfortable:

  • Do not overdress the child. Wear the child loose clothes, as per season.
  • Keep the child well hydrated. More fluid is lost during fever.
  • Medications (Paracetamol, Ibuprofen) can be given in doses as recommended by a doctor.
  • Tepid sponging with water at Temp 28–30°C can be done to reduce the temperature after the medication is administered. Use of ice-cold water for sponging is not recommended in fever.

Sponging should be done by continuous wiping off the body with tepid water from head to toe for 15–20 minutes, along with antipyretics. 

A child can also be given a bath with tepid water during fever.

 Bathing can actually help bring down your fever. 

Young infants (<3 months old) should not be kept exposed for long due to the risk of hypothermia and sponging may be preferred in this age group.

A child can be sent to school when having mild fever with no other symptoms. But most schools and child care centers do not allow children to come to school until the child is febrile for 24 hours. It is preferred to not send a child to school during febrile illness for the following reasons:

  • Child may feel weak, uncomfortable, and dehydrated during a fever episode making it difficult to sit in school.
  • Child may have some contagious underlying infection (most viral infections are highly contagious), which may spread to other children.
  • The commonest cause of fever in children is viral infections. Antibiotics are used only for bacterial. Their injudicious use in every febrile illness is not recommended. Let Your Paediatrician decide about the need for an antibiotic, depending on if he/she is suspecting a bacterial infection.

Childs Appetite during Febrile Illness.

Discomfort and Body-aches associated with a fever make a child fussy and dull. It is important to keep the child well hydrated during fever, and the child should be encouraged to take small sips of water and light meal during illness. Complete inability to take anything (even fluids and breast milk) from the mouth is an indication to visit your doctor.

Red Flag Signs

Most febrile illnesses are not serious. However, you should visit the paediatrician immediately

If a child is younger than 3 months old or has any of the following:

  • Extreme lethargy, drowsiness, excessive cry or irritability
  • Vomiting everything and/or not able to accept feeds orally
  • Headache, neck stiffness or breathing difficulty
  • Abnormal body movements or abnormal behaviour
  • Temperature above104°F
  • Fever persists for more than 2-3 days

Similarly, in a febrile child following signs should make you relaxed:

  • Playful and active during interfebrile period
  • Acts like himself/herself during most of the day
  • Feeding well
  • Passing urine normally

Is it true that high fever can lead to seizures and brain damage in children?

Febrile seizures are convulsions that can occur in a child with fever. These seizures usually occur in kids 6 months to 5 years old. Children are more likely to have a febrile seizure if they have a family history of the same, or if they have already had one in the past. Most children outgrow having febrile seizures by the time; they are 5 years old. There is no evidence that the intensity of fever is linked to the probability of having febrile seizures or brain damage in children. Also, these seizures do not increase the risk of further epilepsy.

Medicines to Bring Down Fever

Drugs in children are administered according to their body weight. The wrong dosage may lead to toxicity and unwanted side effects. Always consult your paediatrician before administering any drug to your child. Different brands may have different formulation and strength of the medicine. This should be confirmed with the pharmacist before buying the drug.

Common medicines can be used safely at home to bring down a fever.

Paracetamol is the safest drug to bring down the temperature in children. If given in proper dose (15 mg/kg body weight), it brings symptomatic relief. Remember, the purpose of fever medicine is not to bring down the temperature to a normal level, but to provide symptomatic relief to the child by reducing pain and discomfort. If the initial fever was high, say 104°F, administration of paracetamol may bring it down to 101°F and not make the child afebrile. If a child is not taking Medicine by oral route, paracetamol suppository through rectal route can be given.

The next dose can be repeated after 4–6 hours if required. Other medicines (ibuprofen, mefenamic acid) are also available and should be used only in consultation with your doctor. Do not use aspirin or nimesulide for the relief of fever in children.

Important Message 

  • Do not over the cover the child. Keep him/her in a cool airy environment.
  • Do not sponge the child with ice-cold water. Always use tepid water (28–30°C) when doing sponging.
  • Paracetamol is the safest medicine to control fever. Avoid Aspirin and Nimesulide.
  • Do not keep treating the child at home on its own. Consult Paediatrician at the earliest.

By Dr. Vivek Walia

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