The commonest symptom in children which promptly sends the parents running to a paediatrician is fever. The most over-rated and over-treated symptom in childhood is fever. The most mistreated symptom in childhood is fever. So here is an effort to clear the myths and misconceptions regarding it. What is fever?
In human beings the body temperature usually remains around 37*C (98.6*F) with a normal variation of 1-1.5*C above or below. Even normally the body temperature is low early in the mornings and goes up slightly late in afternoons. A core temperature of 38.5*C (101*F) or more usually is considered as ‘Fever’. FEVER BY ITSELF IS NOT A DISEASE. It is just a reaction to an underlying illness. How does it occur?
Hypothalamus – a small part in the brain- acts like a thermostat in maintaining the body temperature within the normal range. All the illnesses causing fever do so by prompting release of ‘pyrogens’ from various cells in the body. These ‘pyrogens’ are the fever-producing chemicals which reach the hypothalamus through blood stream and raise its set-point leading to fever. Why does the patient feel cold shivers just before the appearance of fever?
It is because the hypothalamus thermostat set-point is already set higher and the rest of the body which is still at a lower temperature feels cold compared to the higher set-point. What are the causes of fever?
Though theoretically there are several causes of fever, the most important group in the paediatric age is infections. The common cases of fever in daily life are as a result of infections which are mostly either viral or bacterial or sometimes due to other infective agents.Inflammatory disorders, immunologic problems, malignancies, drugs and malingering (Factitious fever) are some other important causes to be considered in specific situations. Remember – always think about the common things first! Don’t panic by assuming the worst possible cause.
How to check the temperature?
The mercury thermometer is more accurate but needs a little practice to get used to. The electronic thermometers are simple to use. The aural (ear) thermometers – the ones to be inserted in the ear canal – though touted as easy and quick, are sometimes difficult to use correctly in the smaller children and could give false readings. Arm-pit (Axilla), mouth and rectum are the usual places to check the temperature. Axillary temperature is around 1*C lower and the oral temperature is around 0.5*C lower than the rectally measured one which is closest to the core temperature. The ideal time to keep the thermometer is around 1 minute for rectal, 2 minutes for oral and 4 minutes for axillary temperature. But practically a 1-1.5 minute-recording gives a fair idea of the fever. Is fever risky?
In most commonly encountered situations, fever is not risky and indeed might be considered beneficial to aid the body defense mechanisms to get rid of the germs. If the child remains active, smiling and playful in spite of fever, then the outcome is most likely to be normal. Sick look, lethargy, severe associated symptoms, hyper-pyrexia (>41*C), fever with chills and rigors, continuous fever, rapidly swinging fever with wide temperature fluctuations, prolonged fever and presence of serious pre-existing disease (cardiac, pulmonary, neurological or metabolic) are the situations which warrant special attention. What about febrile fits?
Febrile fits usually occur at the beginning of fever during the sudden rise of temperature so there is no sense in worrying about them when the fever has already been there for some time. Moreover these fits are practically harmless and insignificant in the long run despite their frightful appearance. They can occur in almost 4-5% of normal children. How do we treat fever?
Paracetamol (Acetaminophen) is the safest medicine for fever and in proper dose can be used four to six hourly. Contrary to popular belief where suppositories are supposed to be the 'stronger medicine', suppositories and syrup form of paracetamol have the same efficacy in bringing down fever. Stronger anti-inflammatory medicines like Ibuprofen, Nimesulide and Mefenamic acid should be used only sparingly and under doctor’s supervision. They can have drawbacks like damaging stomach mucosa and triggering asthma attacks. Aspirin is one medicine you should avoid in children as an anti-pyretic, especially in presence of viral illnesses like influenza or chicken-pox, as it can cause Reye’s syndrome – a serious liver affection. Bath or sponging with lukewarm water is another method to bring down the temperature especially when the temperature is very high or is not coming down with medicine. Don’t ever use cold water for sponging. It is not the temperature of the water that is going to bring the body temperature down. It is the heat of the body used to evaporate the water from its surface which will finally bring the core temperature down. And believe me, a cold water bath isn't such a pleasant experience especially if you are having fever! Why do we treat fever?
It is only to prevent the associated aches, pains and misery. Some authorities do believe in not treating a well looking child without a risk factor up to temperatures as high as 40*C. Aren’t antibiotics necessary to treat fever?
If the cause of the fever is not a bacterial infection, antibiotics will not help one bit in treating fever. Almost 90% of common infections are viral. The common wisdom of not starting any specific treatment for first three days of fever is that most of the simple, common viral illnesses causing fever start subsiding by that time. Does the height of fever give any indication of the severity of the underlying illness?
It’s very difficult to differentiate a relatively benign viral illness from a severe bacterial illness just from the height of the fever. In the earlier years of life even common cold can give rise to high-grade fever. So rather than just looking at the temperature value displayed on the thermometer, we should look at the patient as a whole. Unfortunately this is the thing most of us forget to do and often end up making a mountain out of a molehill!
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Fever - A hot topic!
