Fever in Children

How to define fever?

Fever is defined as a rectal temperature ≥100.4°F or axillary temperature >99°F. Value >104° per rectal is called hyperpyrexia and need to be seen by a clinician urgently. Body temperature fluctuates in a defined normal range (97.88°f-100.2°f rectally) the highest being in the evening and the lowest point is reached in the morning. So very often sometimes a child may feel a bit warm in the evening when compared to the morning.

What is the mechanism behind fever?

Fever is caused by certain substances produced by your body known as pyrogens which includes various chemicals like Interleukin 1 , Interleukin 6, Tumour necrosis factor etc. These are produced in response to infection, Inflammation, certain types of cancers, and few rare conditions.

What causes of fever?

In majority of cases fever is caused by infection which could be viral or bacterial. Most of the viral infections are self limiting and they usually resolve by itself in 3-5 days and sometimes upto a week. Usually they respond to antipyretic medications and the child will be well inbetween with near normal activity. Bacterial infections usually will need treatment depending on the clinical condition of the child. Bacterial infections can be preceded by a viral infection. Other uncommon causes of fever are inflammatory conditions, few types of cancers and others.

How and when to treat?

It is important to look into the pattern and severity of fever, clinical condition of the child, listen to the parent and make a decision regarding how to treat. Fever in newborns and infant less than 3 months must be monitored closely as there is a high chance of bacterial infection with potential involvement of the membranes around the brain called meningitis. It is important to look for the focus of infection and the common sites are throat, ears, urinary systems, and the gut. Blood and urine investigations may be needed. A period of observation in the hospital may be needed in certain situations

Is it necessary to treat all types of fever with antibiotics?

No. Viral infections resolve with supportive care in the form of antipyretics, maintaining hydration and rest.

When would you consider condition slike dengue, typhoid, malaria?

Compared to the western countries we have a higher incidence of the above mentioned diseases. A high index of suspicion is needed.

Can we prevent fever?

The answer is yes and no. We are colonized by different types of bacterias and viruses and there are different type of bugs in the environment around us. They spread from one person to other by means of contact/touch and in the form of droplets. This spread can be minimized by proper handwashing before touching your child(Particularly newborn infant).

With the advent of vaccines severe and fatal conditions like diphtheria, tetanus, measles, H Influenza etc are rarely seen in Vaccinated children nowadays

Author: Dr. S. Boopathi


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