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Dr. Anu and Children

Managing Fever

Fever is the elevation of the body temperature as a result of release of certain mediators in response to an infection/injury/insult. In children, fever is often presented with sweating, a feeling of being sick, lack of interest in play and loss of appetite. As fever is a natural process due to body's fight against an 'enemy,' fevers under 101 degrees Fahrenheit (38.3 degrees Celsius) generally do not need to be treated unless a child is uncomfortable, has nausea and vomiting or has a history of febrile convulsions. Even higher temperatures are not in themselves dangerous or significant unless a child has a history of convulsions or a chronic disease. It is more important to watch how a child is behaving. If he is eating and sleeping well, and has periods of playfulness, he probably doesn't need any management. If he seems to be bothered by the fever; however, management can be started by a variety of ways, including medication and sponging.

What Causes Fever?
It's important to remember that by itself fever is not an illness - it's usually a symptom of an underlying problem. In children, fever has several potential causes:

Infection: Most fevers are caused by infection or other illness. Fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing: Infants, especially newborns, may get fevers if they're overbundled or in a hot environment because they can't regulate their body temperature.

Immunizations: Babies and children sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it's probably not the cause if your baby's or toddler's temperature is higher than 100 degrees Fahrenheit (37.8 degrees Celsius).

Recording Temperature

As any parent knows, taking a squirming child's temperature can be challenging. But it's one of the most important tools doctors have to figure out if your child has an illness or infection. The method you choose to take your child's temperature will depend on his or her age and how cooperative your child is.

If your child is younger than 3 months, you'll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small.

If your child is between 3 months to 4 years old, you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

If your child is 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, children who have frequent coughs or are breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the tympanic method (with an electronic ear thermometer) or axillary method (with a digital thermometer).

How Do I Use a Digital Thermometer?
A digital thermometer offers the quickest, most accurate way to take your child's temperature and can be used in the mouth, armpit, or rectum. Before you use this device, read the directions thoroughly. You need to know how the thermometer signals that the reading is complete (usually, it's a beep or a series of beeps or the temperature flashes in the digital window on the front side of the thermometer). Then, turn on the thermometer and make sure the screen is clear of any old readings. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer's instructions. Remember to discard the sleeve after each use and to clean the thermometer according to the manufacturer's instructions before putting it back in its case.

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don't worry - it's a simple process:

  1. Lubricate the tip of the thermometer with a water-soluble lubricating jelly (talk with your pharmacist or child's doctor). 
  2. Place your child face down across your lap while supporting the head, or lay the child down on a firm, flat surface, such as a changing table.
  3. Place one hand firmly on your child's lower back to hold him or her still.
  4. With your other hand, insert the lubricated thermometer through the anal opening, about half an inch to 1 inch (about 1.25 to 2.5 centimeters) into the rectum. Stop if you feel any resistance.
  5. Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. Soothe your child and speak quietly as you hold the thermometer in place.
  6. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. If you'd like to keep a record, write down the temperature, noting the time of day.

To take an oral temperature: This process is easy in an older (4 years or older), cooperative child.

  1. Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there's no gum or candy in your child's mouth.
  2. Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk and ask him or her to relax and breathe normally through the nose.
  3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and write down the number on the screen, noting the time of day that you took the reading.

To take an axillary temperature: This is a convenient way to take your child's temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents may prefer to take an axillary temperature, especially if your child can't hold a thermometer in his or her mouth.

  1. Remove your child's shirt and undershirt, and place the thermometer under your child's armpit (it must be touching skin only, not clothing).
  2. Fold your child's arm across his or her chest to hold the thermometer in place.
  3. Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and write down the number on the screen, noting the time of day that you took the reading.

Whatever method you choose, here are some additional tips to keep in mind:

  • Never take your child's temperature right after a bath or if he or she has been bundled tightly for a while - this can affect the temperature reading.
  • Never leave a child unattended while taking a temperature.


Fever Medication

There are several medications that can reduce body temperature by blocking the mechanisms that cause a fever. Safest of all antipyretic agents include Acetaminophen (Paracetamol) and Ibuprofen.  Both of these drugs appear to be equally effective at reducing fever. Never give aspirin to a child under 12 as it may cause stomach upset, intestinal bleeding and Reye syndrome, a rare but potentially fatal disease. Ibuprofen may be given to children 6 months of age and older; however, ibuprofen should never be given to children who are dehydrated or vomiting continuously.

The dose of acetaminophen and ibuprofen or the combination should be based on a child's weight, baseline temperature and not his age. Therefore please consult Kopila before starting any antipyretic agents.

Sponging to Ease Fever

Generally using oral acetaminophen or ibuprofen is the most convenient way to make your feverish child more comfortable. However, in some cases you might want to combine this with lukewarm sponging or just use sponging alone.

It is advisable to combine sponging with acetaminophen or ibuprofen if:

  • Fever is making your child uncomfortable.
  • He has a temperature over 104 degrees Fahrenheit (40 degrees Celsius).
  • He has a history of febrile convulsions or someone else in your immediate family has had them.
  • He is vomiting and may not be able to retain the medication.

How to Sponge Your Child for Fever

Tepid (warm) sponging is a time honored and well known method of reducing the high temperature. Tepid sponging is useful as an immediate but transient measure in bringing down the temperature and it should always be supplemented with antipyretic drugs like paracetamol for a longer antipyretic effect. Never use cold water or ice water for sponging since that will cause constriction of the cutaneous blood vessels and prevent heat loss from the body.  Cold water will be uncomfortable, cause shivering and may even increase the core body temperature.

To sponge your child, place him in his regular bath (tub, or baby bath), but put only 1 to 2 inches of tepid water (85 to 90 degrees Fahrenheit or 29.4 to 32.2 degrees Celsius) in the basin. If you do not have a bath thermometer, test the water with the back of your hand or wrist. It should feel just slightly warm. Seat your child in the water, it is more comfortable than lying down. Then, using a clean washcloth or sponge, spread a film of water over his trunk, arms and legs. The water will evaporate and cool the body. Keep the room at about 75 degrees Fahrenheit (23.9 degrees Celsius), and continue sponging him until his temperature has reached an acceptable level. Never put alcohol in the water; it can be absorbed into the skin or inhaled, which can cause serious problems, such as coma.

Usually, sponging will bring down the fever in thirty to forty-five minutes. If high fever still persists (more than 104 degrees Fahrenheit), you might like to give him a regular bath with luke warm water.  Bathing with luke warm water need not be discouraged in febrile children as it will certainly lower the body temperature, reduces the stink of sweat and also gives some freshness. However, if your child is resisting actively, stop and let him just sit and play in the water. If being in the tub makes him more upset and uncomfortable, it is best to take him out even if his fever is unchanged. Remember, fever in the moderate range (less than 102 degrees Fahrenheit [38.9 degrees Celsius]) is in itself not harmful.

Few useful tips:

·         Make sure your child's room is a comfortably cool temperature - not too hot or too cold.

·         Dress your child in lightweight clothing and cover him or her with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise.

·         Place a fan nearby to keep the cool air moving.

·         Encourage him to drink plenty of fluids to avoid dehydration - a fever will cause a child to lose fluids more rapidly. Water, soup, diluted fruit juices and flavored gelatin (Jello) are all good choices. Avoid drinks containing caffeine, including colas and tea, and Glucose Water.

·         Avoid giving extremely fatty foods or others that are difficult to digest, as fever decreases the activity of the stomach, and foods are digested more slowly. There is no reason to discontinue giving your child the milk he normally drinks. In general, let your child eat what he or she wants (in reasonable amounts) but don't force eating if your child doesn't feel like it.

·         Your child does not have to stay in his room or in bed when he has fever. He can be up and about the house, but he should not run around and overexert himself.

·         If the fever is a symptom of a highly contagious disease (e.g., chickenpox, measles), keep your child away from other youngsters and elderly people.



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