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fever

FEVER

Definition

What body temperature is considered Fever?

Temperature taken from patient’s ear drum which is above 37.5 degrees Celsius is considered fever. But, be cautious, if temperature taken from armpit need to be added 0.5 degrees Celsius.

 

 

Cause

What cause Fever?

Generally fever indicates there is condition called inflammation process going on somewhere in our body. If this condition happens in the upper airway, the child would have fever, cough, flu and sore throat. During this process of combating against the germs, our body white blood cells produce inflammatory chemicals which causing fever. In another word, fever is a ‘good’ sign to tell you that, your kid is having strong immunity.

 

Investigations

Any investigation to be done?

No need. Unless we suspect dengue fever, or fever lasting for more than 5 days, blood and urine tests are indicated. Depends on clinical examination, other relevant investigation, like chest x-ray, may be needed to get the diagnosis correct.

 

Treatment

What medicine needs to be given to a feverish patient?

A medicine called paracetamol. It carries different name in the market, for example, Panadol, Uphamol, Progesic etc. Besides this, a medicine called Ibuprofen, which is anti-inflammatory drug, also can reduce fever indirectly.

what is the dosage of paracetamol for kids?

NORMAL OF AVERAGE BUILD ARE: 15mg / kg four to six hourly a day.

The dosage of paracetamol is calculated base on patient’s body weight. It is 15mg/kg/dose and to be give 4-6 hourly a day. If the patient’s weight is 10kg and the paracetamol that you use is 250mg/5ml (50mg per every 1ml). You need to give the paracetamol of 15mgx10kg, which is 150mg, or 3ml for every dose. You need to be cautious; some paracetamol has lower concentration, like 120mg/5ml. 

What about Fever medicine that made for buttock insertion?

The medicine that designed for buttock insertion is called suppository. There are 2 types in the market, which are paracetamol and ibuprofen suppositories. This medicine is highly effective to bring down fever fast and recommended for high fever like temperature above 39 degrees Celsius. Parents must follow the instruction given by doctor about the dosage and frequency of insertion. Generally, we advice to insert the suppository 4 hours after taking oral paracetamol if fever still persistent high.

Any side effect caused by suppository?

It is safe. Occasionally it may cause loose stool if given too frequent.


Others

Can the feverish kid takes bath?

If he is still feverish, use towel soaked with pipe water (do not use ice) to do tepid sponging on his body, especially on his forehead, neck, armpit and inner thighs. If the kid dislikes the wet towel, you may just spray water film on his forehead frequently. Water vaporization from skin surface will absorb body heat. If his body temperature is normal, you may bath him.

Can he take solid food, like rice?

Yes, he can. No correlation between fever and rice. Just bear in mind that feverish kid tends to vomit as the tummy usually bloated during the illness. Therefore, if he has no appetite to eat, just give plenty of fluid to rehydrate his body. This is very important especially the kid has been given suppository and sweat profusely, or the kid is suffering from diarrhea. Parents don't worry if the kid does not feel hungry for food and skip a meal. If the kid does not like plain water, try to give fruit juice, glucolin, ribenna, honey (honey only for those above one year) etc. Never give carbonated drink!

Parents can assess the hydration status of the kid by checking few things.

  1. Mouth is moist
  2. Urine color is clear, not concentrated yellow
  3. Skin when pinched up and let go, it goes back to normal complexity and not wringkled

Feverish kid must take antibiotic?

No, absolutely no indication. 90% of upper airway infection with symptoms of fever, cough and flu is caused by virus. This illness is self-limiting and will be fought by the patient body’s immune system. Antibiotic is only indicated if there is bacterial infection, ie acute tonsillitis. If we over use antibiotic without control, there will be more bacteria develop resistance towards this antibiotic in near future. Besides this, the antibiotic may cause tummy upset as it kills good germ (probiotic) in the guts. Therefore, don’t take antibiotic unnecessary!

Will high fever ‘burn’ and cause brain damage?

No. As long as the fever is not caused by the inflammation that occurs at the brain itself, (encephalitis) or brain’s shields (meningitis), there is no risk for brain damage.

What is febrile fit?

When body temperature shoots up above 39 degree Celsius, the child with the age from 6 month to 6 years old may suddenly experience convulsion. During the attack, the child loses his consciousness (not respond to call) and may suddenly fall down. There is uprolling of eyeballs, biting tongue, drooling of saliva and jerky movement of the limbs. This attack may last few seconds to few minutes. After the attack, the child usually becomes drowsy and will not respond to call ( parents don’t worry). There may be urine and fecal incontinence, too. The risk of a child to have febrile fit is 5%, but it would be higher if there is family history of similar problem. 

What to do if a child has febrile fit?

Parents should not panic. Try to hold the child if he is dropping down to prevent injury. Make sure he is lying on his body side to prevent suffocation if so happen there is vomiting occurs. Open the tight button at his neck and push away surrounding harmful sharp objects if any. Never try to put any object into child’s mouth as what old people thought to prevent tongue biting. You can insert medicine suppository to bring down the fever fast while tepid sponging his body. Once the fit stops, bring the drowsy child to nearest clinic for examination.

 

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