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Fever

 

What is fever? Does it have a normal purpose?

Fever is a normal defensive bodily response to an irritating factor. This factor is usually a virus or a germ that enters the blood. The body’s “thermostat” is located in an area of the brain, called the hypothalamus. Fever has a purpose: it provides an alarm signal to all the cells of our immune system, telling them to work more intensively, in an attempt to eliminate the annoying factor. In addition, germs are destroyed more easily in high temperatures. So, to some extent, fever is a useful symptom for the body.

As well as by infection from a virus or a germ, fever in babies can also be caused by a vaccination, medication, strenuous activity (playing), emotional turmoil, or the fact that they are wearing too many clothes.

What is the normal body temperature?

The normal temperature of a child’s body (measured under the arm) is 36.5 to 37.2 degrees Celsius. Normal body temperature is increased by activity, heat, and as the day progresses. 37.3 C to 37.9 C is a low-grade fever, while above 38.0 C the child has a regular fever.

How do we measure body temperature?

Use a non-mercury thermometer. Mercury thermometers are reliable, but it is better not to use them for safety reasons. With electronic thermometers, first heat the thermometer in your hand, then take three consecutive measurements, and consider the last one to be reliable.

Always ­take the child’s temperature from the same position (armpit, rectum etc), and tell the doctor where on the body the temperature was taken.

It is better to take the temperature from body membrane, for example, from the rectum, the mouth, or the ear. When measuring the temperature under the armpit, add 0.4 degrees Celsius to the measurement.

If the child seems very sick, and the armpit temperature is not high, be sure to confirm it with a membrane temperature measurement. This is because sometimes, particularly with severe infections, the temperature of the skin and the limbs does not reflect the temperature of the interior of the body, so the underarm measurement may mislead us, and wrongly reassure us.

Is fever dangerous?

Fever alone is not dangerous, even when it is high; it doesn’t cause brain damage, as parents frequently fear. However, the cause of the fever, which should be diagnosed with the help of the paediatrician, may be dangerous.

Remember that your baby can be equally sick when his body temperature is 38.5C and when it is 40C. A fever of 40C for two days shouldn’t worry you, if it is due to a virus. On the contrary, a fever of 38.5C, which is due to possible meningitis, needs immediate treatment at the hospital.

How should I treat the child’s fever?

Fever doesn’t always need to be treated. As previously mentioned, it is a normal bodily reaction, which should be respected, when it is not severe. Therefore, there is no need to give the child with a temperature of 37.5C or 38.0C medication. However, when fever becomes high or causes crying, restlessness, discomfort, distress or lack of appetite, then it best to treat it.

As a general rule, always consult your paediatrician. Fever is not a disease, but it can be the manifestation of a serious disease. In newborns and infants less than six months old, fever above 38.0C that is not related to a vaccine, needs medical attention, and is treated as a severe symptom until the opposite is proven. If the paediatrician is not concerned, you can lower the fever in the following ways:

· Don’t take the child’s temperature too often, “as a precaution”, for example, every half an hour, or hourly, but only when you feel that the child is warm.

· It is not always necessary to administer medication. Put comfortable clothes on the baby or take them off. If the child is cold or is shivering, cover him for a while.

· Use a fan, on a low setting, and with caution.

· Sponging the baby usually has no effect.

· Give the child a lukewarm bath. Fill the bathtub with 5 centimeters of lukewarm –not hot– water (36-37 degrees C). If the baby starts shivering, take him out of the bath, and wrap him in a dry towel. When the baby stops shivering, warm the water again and continue. 5-10 minutes are usually enough.

· Give the child plenty of fluids in order to prevent dehydration.

· Check regularly if the child is hot during the night.

· If again, you consider it necessary to administer medication (not for a temperature below 38.5), first consult your doctor, who will tell you which medication you should give and how. You can usually give paracetamol (Depon or Panadol) or/and ibuprofen/ mefenamic acid (Algofren/Ponstan). Often, the dose given by parents is not sufficient, so always consult your paediatrician for dosage. If a combination of medications is needed for frequently recurrent fever, we usually alternate the medications every 3-4 hours.

· Measure the temperature more thoroughly, give the antipyretic early if the child has a history of febrile seizures.

· Give the antipyretic with the spoon included in the medication’s packaging, or measure it with a syringe. Avoid using normal spoons, because the quantity of the medicine will differ, and it is difficult to be certain how much medicine was actually given.

· Be careful with antipyretics, that contain the same drug, (e.g. Depon, Panadol, Dolal). If you give them all at once, you may accidentally reach a toxic dose.

· Never give aspirin to a child under 16 years old.

· Keep the child home from school or daycare for at least one more day after the fever subsides.

 

What should I look out for?

Most of the time, fever doesn’t indicate a serious infection.

However, always ask for medical assistance if:

· The baby is under 6 months old

· The child’s mood deteriorates, and he cries all the time, or is lethargic

· The child develops a rash that doesn’t retreat or blanch with pressure

· The child has a seizure

· The child has difficulty breathing or is groaning

· The child doesn’t eat, vomits, and doesn’t want to play, even when the fever drops

· Fever is over 40.5 degrees C.

· Fever doesn’t fall easily, or rises quickly, or intervals of improvement are very short

· Fever continues to be high after the first 24 hours, and without any other accompanying symptom (e.g. runny nose, cough, sore throat)

· Fever lasts for more than 3 days

· You can’t cope for any reason; something doesn’t seem right with your child. Trust your instinct, the paediatrician will respect it and seriously take it into consideration.

 

Stelios Papaventsis MRCPCH DCH IBCLC 2013

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