Fever is one of the most common ailments for which parents seek medical advice. Fever has traditionally been defined as a rectal temperature of over 100.4O F or 38O C. Temperatures measured at other sites are usually lower. It is not a very severe problem in majority of the cases. In fact, in children, fever often means that the body is trying to recognise and fight an enormous variety of viruses, bacteria and other microorganisms. However, it can surely make the child feel uncomfortable and, sometimes, even dehydrated. Let us know more about fever in children, how to diagnose it, how to treat it at home, and when to approach a doctor.
Why do we get fever?
Human being is a warm-blooded animal. It means our body temperature is kept constant, irrespective of environmental
temperature. We have a thermostat mechanism in the part of our brain called hypothalamus, which maintains body temperature within normal range. Normal temperature is mandatory for functioning of all our organ systems and cells. This is similar to a thermostat in a refrigerator, which keeps temperature at a set level irrespective of outside conditions. Various conditions can reset this thermostat to higher level resulting in fever.
Fever is a body’s immune response to an intruder, commonly in the form of infection. Entry of bacteria and viruses in the body stimulates the immune system, resulting in production of substances known as pyrogens. These stimulate the brain centre and cause fever. Some non-infective diseases also cause fever through the same mechanism. Heat illness or some
drugs can also cause fever by their direct effect on hypothalamic centre. Thus, fever is a symptom of underlying disease and not a disease in itself.
How to measure temperature
Temperature can be measured at various sites using different types of thermometers.
- Rectal temperature is measured by inserting lubricated rectal thermometer into the anal opening upto one inch. This records actual body temperature. A reading of more than 100.4oF or 38oC is considered as fever.
- Axillary temperature is measured by glass thermometer. Digital thermometers are inexpensive and obtain a reading in seconds. A reading of more than 99o F or 37.2oC is fever.
- Mouth temperature can be taken in older children. It is 0.5oC lower than rectal temperature.
- Aural (ear) temperature is recorded by aural thermometers. The reading is similar to mouth temperature.
For all practical purposes axillary temperature should suffice for home care. It is not mandatory to add one degree to the axillary temperature recorded. Barring extremes (very low in sick child or very high >105oF), what is more important is the
trend of fever, rather than actual reading.
Causes of fever in children
In children, fever is usually due to infection (entry of germs into the body). The infection could be viral, bacterial or parasitic. It is common to have repeated viral respiratory infections in a toddler. These are self-limiting and need no treatment except paracetamol. It does not mean that the child has poor immunity. He does not need any immune boosters or tonics.
Sometimes, a child may get bacterial infections like tonsillitis, urinary tract infections, pneumonia, etc. These diseases need antibiotics. Malaria is a common parasitic infection in some parts of our country. Rarely fever may occur because of allergy, drugs or heat illness.
In exceptional circumstances, prolonged fever may be an indicator of serious or chronic disease, but in this case the child would be very sick and would obviously have other associated complaints apart from fever.
Is fever always harmful?
As mentioned, fever is the body’s response to infection. Therefore, to some extent, it is a protective response by the body, and an attempt to kill germs. While very high fever (106oF) can harm the normal tissues of the body, lesser degree of fever only causes discomfort to the patient (and lots of parental anxiety!) but doesn’t harm by itself. Therefore, in a febrile child, our efforts should not be directed at just suppressing the fever and desperately bringing it down to normal. Instead, we should aim to limit fever to a safely manageable and comfortable level. At the same time, we should attempt to find the cause of fever.
Sometimes, fever can cause febrile convulsions in a child between the age of six months and five years. Though it causes a lot of anxiety in parents, these convulsions are usually benign and cause no long-term damage. Persistent high fever can cause dehydration in small babies and hence we should ensure good fluid intake during fever.
Self-care at home
The three goals of home care for a child with fever are to control the temperature, prevent dehydration, and monitor for serious or life-threatening illness.
Controlling temperature: The first goal is to make the child comfortable by monitoring and reducing the fever below 1020F (38.90C). This is achieved by using medications, dressing the child appropriately and tepid sponging.
Clothing: Children should not be overdressed indoors, even in winter. Overdressing keeps the body warm as it prevents cooling by evaporation, radiation, conduction, or convection. The most practical solution is to dress the child in a single layer of clothing, then cover the child with a sheet or light blanket. If the child is shivering, obviously he/she needs to be covered to stop the shivering. However, shortly afterwards, the fever is bound to shoot up, so he/she needs to be medicated in anticipation of this rise in temperature.
Medications: Mild fever does not need any medicines. In moderate or high fever, paracetamol is the safest antipyretic. Parents often feel that it is too mild and never works. It is important to understand that our aim is to merely lower fever to a level so as to make the child comfortable and not to bring it totally down to normal. In fact, an overdose or a powerful antipyretic may be harmful. Besides, by suppressing fever, it may hide the true clinical picture of a child. Fever is an important symptom of an underlying illness and therefore its trend gives vital information to your doctor, which may be missed if fever is aggressively suppressed. Hence, it is advisable to give medicine only when required and not round the clock.
The dose should be correctly measured by the cap or dropper provided with bottle. Another common error is to get confused between drop and syrup formulation. They contain the same medication in different strengths. Drops contain 100 mg of paracetemol in 1 ml while syrup contains 125 or 250 mg in 5 ml.
Tepid sponging: This is a very simple and effective way to bring down temperature. It reduces fever by dissipating heat from body. Use a wet towel soaked in tap water or lukewarm water and sequentially wipe different parts of the body, so as to cover large areas (including trunk and back). Allow these areas to dry on their own, by evaporation. This should be done for 10 to 15 minutes. This cools down skin and reduces the temperature temporarily.
Sponging should never be done with ice-cold water, nor does one need to add salt or cologne to water. The application of cold water may cause shivering, which may result in generation of heat resulting in rise of temperature and thereby defeating the purpose of sponging. It goes without saying that a child who is already shivering should not be sponged. It is a myth that sponging leads to cold or pneumonia. If the child does not allow sponging he/she can be given a shower or put in a tub of water.
Prevention of dehydration and feeding during fever
- It is natural for a child not to eat well during fever or illness. Poor appetite is physiological and may be nature’s way to give rest to our system. However, we must continue to offer them their regular food without any restrictions. Forced feeding is going to irritate the child further and has no benefit
- As said earlier, good fluid intake is more important than food to prevent dehydration. Your child should urinate light-coloured urine at least every four hours, if well hydrated.
Monitoring at home: When to seek medical advice
Parents must watch for development of new symptoms. They must contact their doctor or emergency room if the child has ‘danger signs’ or atypical features as listed below.
- Child is younger than six months of age (regardless of prematurity)
- A seizure occurs
- Child has a purple or red rash
- A change in consciousness or behaviour occurs
- Child’s breathing is shallow, rapid, or difficult
- Child has a headache that will not go away
- Parents suspect that child may become dehydrated from diarrhoea, vomiting or not drinking (for example, sunken eyes, dry diapers, tented skin, unarousable, etc.)
- Not passing adequate urine
- Already shown to doctor and child is now getting worse or new symptoms have developed
Prevention of many illnesses that cause fever revolves around personal and household hygiene. Use these strategies to prevent the spread of viruses and bacteria:
- Wash your hands with soap and water
- Cover your mouth and nose when sneezing and coughing
- Handle food with clean hands
- Properly immunise your child
- Eat a healthy diet including fruits and vegetables
- Get proper amount of sleep
Fever is an important indicator of underlying illness, usually infection. Fever per se does not harm the child and may be beneficial to some extent. Hence, our approach to fever management should be gentle and directed mainly towards monitoring and adequately hydrating the child.