Is it really a fever?

So your little one has a fever! And you are mighty worried! Well, there is no need to panic. Fever in children is bound to occur at least a few times throughout childhood.  In most cases, fever is the body’s natural response to many insults, and it helps the body most of the time. However, there are times when the fever can harm the child, and therein lies the rub. Hopefully, by the time you read this article, you will be able to tell the difference.

How do we maintain body temperature in day-to-day life?

A region in the brain called the hypothalamus regulates average body temperature very tightly. The average body temperature is 37° C or 98.4° F. Please note that this is the average temperature and body temperature may fluctuate slightly even at different times of the day (classically, the body may feel warmer when one has just indulged in significant exercise).

Methods to confirm fever in children

What should I do when I feel that my child has a fever or that his body is warm?

The first thing that you should do is to confirm that your child has a fever. The tactile method (touch) is unreliable and depends as much on the temperature of the observer’s hands as the child’s temperature. You must keep a thermometer at home and use it. There are different types of thermometers available, and a digital thermometer is best for many reasons:

• You need to keep it in contact with the child’s body for a shorter time than glass thermometers. Many of them are now available as contactless. They are invaluable in checking an irritable, cranky child’s temperature.
• There is a lesser chance of breakage since you don’t have to shake down the thermometer every time you use it.
• There are environmental issues, too. Glass thermometers contain mercury, a heavy metal that can contaminate groundwater. Spillage of mercury from the thermometer, when it breaks, is very harmful to the environment, and you can read more about this here.

There are many sites to check a child’s temperature, but the most comfortable for parents is the axillary or oral temperature (in older children). In contactless thermometers, you point the thermometer towards your child’s forehead, and bingo! You have a reading!

AXILLARY TEMPERATURE MEASUREMENT (SCREENING AT ANY AGE):

• Clean the thermometer with lukewarm, soapy water or rubbing alcohol. Rinse with cool water.
• Dry the armpit.
• Keep the arm pressed against the chest for a full 4-5 minutes with a glass thermometer and two minutes using a digital thermometer.

ORAL TEMPERATURE MEASUREMENT (4-5 YEARS & OLDER):

• Wait for at least 30 minutes if the child has had something to eat or drink.
• Clean the thermometer with cool water and soap.
• Place the thermometer with its tip under the tongue and ask him to hold the thermometer between his lips for one minute, if digital, and three minutes, if it is a glass thermometer.

RECTAL TEMPERATURE(BIRTH TO 3 YEARS)

• Clean the thermometer with cool water and soap.
• Put a small amount of lubricant (jelly or even ghee) at the end to be introduced.
• Position the child on your lap on his belly with your hand on his back or keep her on her back with the legs bent to her chest, resting one hand on the back of her thigh.
• Introduce the thermometer to about 1.5 to 2.5 cm (not more than that) and keep it for one minute till the beep sounds (in models that support it).

The best way to measure temperature is to use a rectal thermometer and any reading from the armpit that is > 37.2° C / 99° F or any oral reading that is > 37.5° C / 99.5° F or rectal temperature > 100.2° F or 38°C is considered as fever. One can also measure the temperature in the ear canal (not suitable for children < 6 months or if there is wax in the ear).

Please do not use plastic strips or pacifier thermometers, as they are unreliable.

I checked, Doctor, my child has a fever. What next?

Do not stop just by noting whether there is a fever. Note down the exact temperature and the time at which you noted the fever, and keep taking the temperature every 15 minutes until the reading comes down to normal or shoots up to alarming levels—more than 105°F or 40.5°C —in which case you must contact your doctor immediately.

What are the causes of fever in children?

There are many causes of fever:

• The most common cause is an infection – whether bacterial, parasitic, viral, or other infections.
• Very commonly, the fever is in response to a vaccination that the child may have received in the past (Different vaccines can cause fever at different times post-vaccination).
• Teething is unlikely to cause fever, especially if the child’s rectal temperature is> 38.5° C. So beware of labeling teething as a cause of your child’s fever!
• Bundling up a child too tightly can cause a fever, though again, it is usually not > 38.9° C / 102° F.

Emergency care or Early visit to the clinic?

Doctor, the thermometer from the armpit shows 38° C! What should I do? Do I need to bring the child to the hospital immediately?

The level of temperature should not be the only guide. It also depends on the symptoms the child is experiencing. If he is otherwise well and can carry on his ordinary activities, it is OK to treat the fever yourself.

You will need to schedule an appointment with your pediatrician if (rectal temperatures – remember that rectal temperature is > axillary temperature by at least 1° F):

1. Your child is less than three months old and has a fever of> 38° C, regardless of whether the child looks well.
2. Your child is more than three months old, has a fever that has been> 38° C for more than three days, or is appearing ill (clinging to you, unusually drowsy, irritable, fussy, and has decreased his intake of oral food/fluids).
3. Children between 3 months and 36 months old who have a fever of> 38.9° C / 102° F.
4. Children of any age whose temperature is > 40° C.
5. If the child develops convulsions along with the fever, get the child to the emergency room immediately. Seizures or convulsions typically occur when the body temperature is > 38° C.
6. Children (of any age) who have fevers repeatedly.
7. Children who have chronic preexisting illnesses like known heart disease, convulsions, nephrotic syndrome, etc., and develop a fever.
8. Febrile children who develop a new rash.
9. Any child with urinary symptoms or other associated symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea.
10. Children who have been in a very hot area, like an overheated car or out in the sun.
11. Children who have immune system problems, such as sickle cell disease or cancer, or are taking steroids
12. Your child still “acts sick” once his fever comes down. A child who is sick between two episodes of fever is the earliest and most important indicator that your child needs early evaluation.
13. Your child seems to be getting worse.
14. The fever persists for more than 24 hours in a child younger than two years.
15. In a child two years of age or older, the fever persists for more than three days (72 hours).

How should I bring down my child’s fever?

The first question is whether you should treat the child’s fever. Many minor viral illnesses can cause a high fever. Remember that fever is one of the body’s defense mechanisms against infections. The germs that cause various infections thrive at 37° C, the average body temperature. By raising the temperature, the body makes the environment unsuitable for the microbes to thrive in. Additionally, many body products and processes are more efficient at higher temperatures.

If the fever is < 38.9° C / 102° F and your child is otherwise looking well, there is no need to treat the fever. Signs that the child is otherwise well:

• In between episodes of fever, if your child is alert and playful, then your child is unlikely to have a severe illness. When the child has a fever, most children will be either listless, cranky, and irritable.
• His appetite has not decreased significantly,, and he he asks for food and water when the fever is down.
• Mothers especially have a great feeling about when their child looks well. So if you feel that the child seems to be well when his fever is down, it is improbable that the child has anything seriousito do the fever is > 38.9° C / 102° F or if your child shows the following signs, do treat his fever:

• The child’sfluid intake has gone down, and he is urinating less frequently.
• He is vomiting – at this point, he is losing extra fluids in the vomitus.
• She is cranky and irritable or unable to sleep even when she does not have a fever.

General measures to bring down the fever in children:

• Let the child rest if he so wishes. He can resume school when he has not had a fever for at least 24 hours.
• Plenty of fluids should preferably be at room temperature so that the child passes an adequate quantity of urine. Giving him more fluids than this is even better if he accepts it.
• The child is unlikely to have a healthy appetite for food. Please do not force-feed him, as he will almost certainly vomit.
• In our country, at least, put only a single layer of clothing on the child, preferably cotton. The body tries to bring down the temperature by dissipating heat to the surroundings. If you bundle up your child, the body heat gets trapped in the heavy clothing.
• If you notice that your child’s clothes are wet with sweat, just change them. Most children sweat when their fever comes down.
• It would be best if you bathed/sponge the child with lukewarm water as this helps to bring the fever down. Remember to dry him up quickly and clothe him so he does not shiver. Do not use alcohol or cold sponging as the child is bound to shiver, and shivering increases heat production in the body. Use sponging only in conjunction with medications unless the child does not tolerate the drugs. Do not wrap up the child or submerge the child in warm water, as sponging brings down the temperature as the water evaporates.

Medications to control the fever in children

• Paracetamol (Calpol, Crocin) is the best. Give Paracetamol as and when the fever neeParacetamolt (in the appropriate dose) up to every 4-6 hours.
• If the fever is still not controlled, substitute the next dose of paracetamol with ibuprofen (Ibugesic,Paracetamolmbiflam) every 6 hours.
• DO NOT USE ASPIRIN as aspirin may rarely cause severe disease if given to individuals less than 18 years of age. Aspirin is OK for treating fever in adults, though.
• Doses of these medicines are to be calculated as per the child’s weight and not as per age, so know your child’s current weight.

If you need any more information, do not hesitate to contact your doctor.