Fever.. there are many ways and medicines.. but if you donot encourage heat loss.. fever will go off slowly. fever may be beneficial but treatment is comforting. Read basic concept of managing fever.. why not to use cold water.. why no sponging or wet compresses on forehead alone..how change in position can help fever control.. and how to avoid delirium or fits..
fever in children
Any rise in temperature is a discomfort.. and above 101F it becomes intolerable... and hence requires treatment.
'Highest level of tolerable temp' has no clinical significance as some children show symptoms of hyperpyrexia even at 103 F. and it varies from person to person.
The question is whether do we need to treat the fever?
fever upto 101F should be watched.. as it may get cured spontaneusly and it can cure the disease at times.
High fever in children, can at times turn lethal; so observing without treatment is no wise.
How do we manage:
1.Switch on Fan /AC, not directed towards pt, air in room should be free flow.
2.take clothes off.. no blankets... a common question always asked is what to do if child is shivering...? The answer is child may shiver.. we may give blanket for 1o min only.. as shivering doesnt last longer and fever starts rising after shiver if a blanket is given. Also shivering is protective while fever may be harmful. SO do take the vlanket off by 10 min... can repeat same.
3. Give an oral antipyretic. In viral infections and malarial fever , the myalgia plays a significant role... so its better to use a combination with ibuprofen or only ibuprofen.. more symptomatic relief. wait for 10 min.
4. Fever coming down : observe. keep opne, turn to side, increase area of heat loss by radiation. ...Fever not coming down: start sponging. continuous or intermittent.
5. Sponging tricks : Keep fan on. dont get scared of shivering. Dont use ice or cold water (why? : its not required ! and it has a risk of ppting hypothermia in children.. children are scared of cold when febrile) use a wet hanky /turkish towel, make it wet.. remove excess water.. spread it over the trunk and tummy... cover maximum surface area, faster relief; till it dries off or becomes hot.. then change the towel, repeat same till temp comes down. Forehead sponging: Most of the times not reqd.. as it carries undue emphasis from movies.. and covers small area. Please dont restrict sponging only to forehead.
TricK: make scalp wet, let the forehead towel cover eyes.. that avoids pricking sensation in eyes.
6. wait another 10 minutes.. temp same or falling... observer and continue. If temperature rising.. try injectable paracetamol... by this we are just increasing the dose of PCM, changing route is only bcos child wont be in a position to take oral; one may try rectal.. equally effective.
There are different fever medicines tylenol, motrin, combiflam,inbugesic, meftal are few trade names, some are combination medicines. some doctors discourage combination medicines. They are available but should not be taken without a prescription by a doctor as some do have side effects in some individuals.
7. Treat the cause of fever !!
Why prompt relief of fever required?
Annoying symptom, discomfort, feb seizure... hyperpyrexic brain damage.
if the seizure had been with the fever, at the rise of fever and with no more than 1 day fever history; it is more likely to be a febrile seizure. however in developing countries hypocalcemia and tuberculosis is so common that they may get precipitated with fever as convulsions.
treatment remains same even if second opinion is taken. if the seizures are febrile by definition as above; main therapy is to prevent the fever from coming and also from rising it beyond 99 with prompt therapy. regarding how to manage fever, please read details at my blog
if there is associated calcium deficiency or rickets or evidence or suspicion of infection like tuberculosis, it is prudent to evaluate in this direction continuing treatment for fever which may be an added antibiotic after an expert consultation.
Some patients do need neuroimaging like MRI scan or EEG (brain graph), to decide further therapy. repeated febrile seizures may be started on drugs like clobazam for short or long term depending on clinical settings and reports.
what is more important for parents is the precautions one is supposed to take to prevent seizure from complicating at home and also learning to treat the seizure or convulsion at home.
As soon as you notice a seizure, turn the child on one side so that he wont aspirate secretions, loosen the clothes donot hold the patient tight. donot spray water or any other thing on face. keep rectal diazepam suppository handy which your doc may teach you how to use it in an emergency , that can help tackle seizure by introducing the medicine in correct dosage in the child's rectum through anus. This tricks needs to be learnt by parent or care taker. its prudent to give such therapy at home; after medical advice demonstration after a thorough consultation in individual case.
if the seizure is not tackled properly it may cause some permanent damage. seizure in a child whose milestones are delayed, usually is because of some permanent damage at brain. extent of damage decided extent of normalcy.
discuss with your doctor regarding possibility of meningitis,viral fever,malaria,TB,typhoid,drug fever or dengue fever,pneumonia. These may be few of the common amongst 30 common causes of fever.
A doctor surely is not a GOD, to know exactly what is the cause of fever in a given child at a given time. the diagnosis made by doctor is a conclusive speculation of many possibilities in a given situation. Its like in a case of murder if we find a blood stained knife around, we speculate that it must be the killer knife without knowing exact what has happened. Only the eyewitness account knows the truth (the HISTORY) and every one knows how the witnesses turn fragile. So it isn't criminal if a doc tells you the reason is viral in first visit and malaria in second visit or typhoid in third visit for fever in a week. As the disease evolves day by day, a doctor may understand more about it as time passes and hence may suggest respective investigations or change of therapy.
Every fever can be malaria in India. A case of fever visiting a surgeon may get labelled as gall bladder or liver infection, visiting a gynecologist as urinary infection or visiting a physician as hepatitis or viral.. in monsoon season. Occasionally a patient may suffer from more than one of these. Really confusing? Thats why its an "objective art of intuitions" to make a diagnosis.
SO how does a Doctor speculate what a case could probably be?
This way: BUT IN ALL CASES DONOT ATTEMPT YOURSELVES TO DIAGNOSE, AS THIS IS JUST A TIP OF ICEBERG AND A NON MBBS PERSON IS LIKELY TO MAKE A WRONG IMPRESSION. THIS IS ONLY FOR UNDERSTANDING HOW THINGS CAN GET COMPLEX AS ALL CAN BE CHANGING TO OTHER DIAGNOSIS IN SELECT CASE IN CERTAIN INDEFINITE PERCENTAGE OF POPULATION,
If you are in India, have chance of mosquito bites, get fever with chills and shivery rigors with headache; with a symptom free gap of 12 hours or more between two fever episodes without medicines... you may have malaria mand doctor may find liver , spleen growing or painful in tummy and blood may show low platelets that may last 5 days after symptom free phase. Often it takes upto two days to get response with proper medicines .. blood test is must but may not always be positive.
Sounds so simple, but its the commonly underdiagnosed and commonly overdiagnosed disease.
Many people relax when doctors say ;"oh its viral fever" in a casual note.. but not to forget that the dreadful Dengue, Catastrophic Chiken Gunya, flu and hailing HIV,killer hepatitis are all viruses.So its a serious issue too.
Often viral fevers of respiratory system present like 2 day fever, 2 day runny nose, 5 day cough. Such flu like diseases often settle in a week but precautions are needed to prevent spread,eating and drinking healthy and understanding dangers like pneumonia.
PROPER CONSULTATION WITH A DOCTOR AT EARLIEST EVENT MAY HELP YOU BE WISER.
Viral fevers in children with rash.. can be measles, mumps, rubella,dengue,etc many more.
coming up. visit again.