Alex Tang
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Books Recommendation
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Medical Students /Paediatric notes
Help, my child is having a fever!
by Dr. Alex Tang
Fever is the commonest cause of anxiety among parents especially fever in children. Few parents will ever forget the shock of discovering a very hot child in the middle of the night. What is fever? Fever is when the body temperature is at or above 38° C. This definition is the same for a newborn baby, a toddler, an adolescent or an adult. The normal body temperature is between 36.5°C and 37.4°C. Contrary to popular belief; fever is a good sign because it shows that the body is fighting against an infection. In fighting an infection, the body produces a pyogenic agent, which causes fever and helps defeat these invaders.
Causes of fever
The commonest cause of fever in children is an infection. These infections are due to either a virus or bacteria. The commonest site of infection in children is the throat, ears, nose, lungs and the urinary bladder. Hence fever may often be accompanied by other symptoms such as cough, watery nose, earache, vomiting and diarrhea. Of the viruses, the commonest are the common cold and influenza viruses. However in our country, we must also be aware of dengue fever. The common bacteria causing infection in children are streptococcus, staphylococcus and haemophilus influenza. Antibiotics are useful against bacteria but not against viral infections.
What to do with a febrile child
The first step is to remove most of the clothing from the child. The idea is that clothing tend to trap heat and make the child hotter. Hence it is not advisable to wrap a febrile child with more clothes. The next step is to ‘tepid sponge’ the child. Use two or three small towers and soak them in tap water. Then wring them until they are almost dry. Wipe the forehead, the neck, the armpits and the chest and stomach of the child. After wiping, the child should be moist and not wet. The principle is that when the water evaporate, it takes the heat along with it. It is not advisable to use ice water because it will cause the blood vessels to constrict and trap the heat inside the body. Cool pack may be used but is not as effective as tepid sponging. The next step is to give the child fever-reducing medications. The commonest is paracetamol (panadol) although brufen (oral or suppository) may be used. The medications must be given in the appropriate dosage at the appropriate interval. The child must also be given a lot of fluid to drink. Most fever will subside with the above mentioned measures.
When to see a doctor
Fever caused by viruses is more common than bacterial fever and should subside in two to three days. Adequate fluids, appropriate fever medication and food intake should be enough. However, a child should be brought to see a doctor if the fever persists for more than three days or has vomiting, diarrhea and difficulty in breathing. If the child is very lethargic, drowsy or the fever persisted in spite of appropriate fever reducing measures, then the child should be brought to see a doctor immediately.
What if my child has a fit and what to do then
Children below 6 years of age have a tendency to throw a fit (seizure) if the fever is too high. A seizure occurs when the child loses consciousness, with eyeballs staring upward and involuntary jerking of the arms and legs. This is due to overheating of an immature brain and is called a febrile fit. It rarely occurs in children above 6 years of age. When a fit occurs, the first thing to do is to turn the child onto his or her stomach. Remove any food items in the mouth and make sure the mouth is not blocked. Most death due to febrile fit is not due to the fit itself but due to suffocation. Suffocation occurs if something in the child’s mouth or even the tongue obstruct the airway. If the child is biting his or her teeth, gently insert a piece of cloth for the child to bite on. Do not use a metal spoon or your finger! Then tepid sponge the child. When the fever comes down, the child will wake up. It is not necessary to inflict pain on the child to wake the child up. All children with fits must be brought to see a doctor but bring down the temperature first.
Prevention of fever
It is not possible to prevent fever as infection can occur anytime. But it is possible to reduce the incidence of fever episodes. A sensible healthy lifestyle will help; the child must be given a balanced diet, enough exercise and a loving home environment. Personal and family hygiene is important. Fever is a necessary evil because every time your child gets an infection, his or her immune system gets a boost. And in time as they grow up, you will notice that they tend to get fever less frequently
