© IE Online Media Services Pvt Ltd
Tags:
Journalism of Courage
Most children have had at least one episode of fever before they turn one. Fever on its own usually does not give rise to any problem. In fact, it is a good thing as it is a sign that the body is fighting an infection. But in situations when your baby wakes up in the middle of the night burning up, it might be difficult for you to know what to do next.
Fever is essentially the body’s internal “thermostat” raising the body’s temperature above its normal level as it fights off the infection. The hypothalamus in the brain is responsible for this. The hypothalamus manages to keep the temperature around 98.4F but when there is an infection, it resets the thermostat. Our body temperature is not constant, it varies from 96.5 to even 99.5 through out the day, the lowest is mainly in the morning and a little higher in the evening and can vary in children when they run around and play.
The hypothalamus can reset the body temperature to a higher set in response to an infection, illness or some other cause. Doctors believe that it helps the body fight the infection better, with our white blood cells working more efficiently then. In general, a fever means a temperature above 100.4 F.
Digital thermometers are inexpensive and the most accurate way to measure temperature in children. Don’t use glass thermometers that contain mercury as exposure to it can be a potential risk to mercury poisoning.
Children over 5 can have their temperature checked by placing the thermometer under the tongue . Younger children can get it checked from the axilla. Rectal temperatures are usually done in children under three months, especially in hospitals.
You my get slightly different numbers depending on where you took the temperature — oral, axillary, rectal, ear or forehead. Oral or rectal measurements are more accurate than the other measurements.
Causes of Fever
Parents need to remember that fever is only a sign of an illness and not the illness itself. It is merely a symptom.
Infection: Most fevers are caused by a bacterial or viral illness. These include colds, gastroenteritis or stomach infections, ear infection, croup, bronchiolitis and urinary tract infection, to name a few. Currently, a spate of viral infections like dengue and influenza can also give rise to high fever.
Over dressing: This is the commonest reason in newborns or infants as they are unable to regulate their body temperature well when they are over clothed or if the room is too hot. As infections in babies can be serious, it is important to get the baby examined by a doctor if your baby is presenting with fever under three months of age.
Post immunisation: Many babies get fever after vaccinations but usually it’s is low grade and does not last more than 24 hours.
Teething can cause the baby to feel warm but if fever is more than 100F then it’s unlikely to be the cause.
In otherwise healthy children, not all fevers need medicine. High fever (over 102F) can make the child uncomfortable and. hence, may need treatment.
Doctors decide to treat fever on looking at the overall condition of the baby. The height of a child’s fever is not always the best indicator of whether the child needs to be treated and /or evaluated.
Alarm Bells
Children with fever and any of the below symptoms need to seen as soon as possible”
— does not respond to you or has trouble waking up.
— has blue lips, tongue or nails
— the soft spot in the head of the infant is bulging
— has a stiff neck
— has severe stomach ache
— has a rash or purple spots that look like bruises
— refuses to drink
-is very irritable and cranky
Also speak to your doctor if your child has numerous loose stools lasting more than three days, burning when passing urine, ear pain or pain in the throat.
You need to consult your doctor
– When infants below three months have fever more than 100.4F
– Children from three months to one year who have a temperature of more than 100.4F for more than three days
– Children of three months to three years of age who have a temperature of more than 102F
– Children of any age who have a temperature of more than 104F.
– Children who have a febrile seizure
Febrile Seizure
Febrile Seizures are convulsions that occur in a child between six months and five years of age and has a temperature more than 100.4 F. Majority occur between the age of 12 months and 18 months.
It can be frightening to watch. However, they do not cause any harm and intelligence and other aspects of brain development are not affected by the seizure. They can occur with infections and also immunisations that cause fever.
They usually occur in the first day of illness and, in many cases, the seizure is the first clue to the illness. Most seizures happen when the fever is over 102F.
They usually last less than a minute and involves usually arms legs and face.
Once they stop, they need to be assessed to see that they are not because of a serious infection of the brain like meningitis. These children can get a recurrence, and this happens usually within the first year of the illness.
Treatment of fever
In most cases it is not necessary to treat a child’s fever. A child who is over three months and has a temperature of 102F or less and is otherwise healthy and acting normally does not require treatment.
Medication
The most effective way of treating a fever is by giving paracetamol or ibuprofen. They reduce the fever and the discomfort accompanying the fever.
Aspirin is not recommended in children as it can cause a rare and serious illness called Reye’s syndrome.
Paracetamol can be given 4 to 6 hourly but not more than five doses in 24 hours.
Under three months, you should consult a doctor before giving paracetamol. Ibuprofen should not be given under six months of age. Giving combinations of paracetamol and ibuprofen or even alternating then is usually not recommended as it increases the chances of getting the dose wrong. Fever reducing medicines should only be given as needed.
Having a fever can increase the risk of the child getting dehydrated. Children who have fever may be reluctant to eat, so it’s important that you encourage them to drink fluids. If the child is unwilling to drink, its important to speak to the doctor. Rest is important but children don’t need to be forced to rest. When they feel tired and achy, parents can encourage them to rest. Once temperature has been normal for more than 24 hours they can resume their normal activities.
I am not in favour of sponging, especially cold baths and ice packs, it can actually increase the temperature by shivering and have the opposite effect. All in all, fever alone is no cause for worry. Just keep a careful watch on the temperature and how long your child has had one.
Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight
For all the latest Parenting News, download Indian Express App.
