Google Search


Monday, January 14, 2008

Managing fever at home


Most parents get alarmed when their precious ones (read kids) are down with a high temperature. Fever is actually a mere symptom of the war between the harmful agent and the human body. In this tussle, which human often wins, fever arises because the immune process which is activated tries to fight back and defeat the insulting/attacking agent.

In pediatric practice, fever is the most common presenting symptom of patients brought to me. While appropriate control of fever is important, it is also imperative to discover the cause of the fever, as it is only then that one can hope to eradicate it before it produces any further symptoms or damage.
The mainstay of treatment is, in brief:tap water or slightly warm water sponging for the entire body; oral medication, mostly in the form of paracetamol; and identification and elimination of the underlying cause. 


Having outlined the essentials of fever management in the previous post, let me go ahead and tell you exactly what needs to be done when your precious child has fever. For the purpose of this discussion, I will exclude babies less than one year of age in whom fever can be an emergency and medical attention by a doctor or a trained nurse or medical assistant is of paramount importance.

First of all, you should know that the normal body temperature varies between 97 and 99 degrees Fahrenheit depending upon the age of the person and the climate and environment in which the person resides. The mean normal body temperature is 98.6 F. A temperature rise of more than 1 degree F from this mean is defined as fever.

Considering this basic point, please remember that a slight body warmth in the middle of the day, or after you have brought the child in from the outside heat, or after the child returns from active play is NOT fever. Neither is the body said to be "febrile" if the child has an ear temperature (taken with the ear-thermometer) of about 99.8 F or less. The internal body temperature is about 1 F higher than the temperature of the arm-pit (axilla), which, in turn, is 1 F higher than the temperature of the skin over the toes or lower legs.

A rise in body temperature in an otherwise well-looking child may or may not mean that worse problems are on their way, and hence, careful monitoring is necessary in every child with fever. Fever is generally due to infections, but may be secondary to other forms of inflammatory diseases, systemic (general) diseases and occasionally, a disturbed central nervous system (read "brain").

The best treatment for fever is SPONGING. To sponge means to continuously wipe the child's torso and upper half of the legs with a hand towel dipped repeatedly in lukewarm or tap water. Sponging is a serious type of treatment that overcomes the disadvantages of giving medicines; however, it can prove to be difficult if the child is restless or refuses to cooperate. Using lukewarm water helps to get him/her to allow you to remove his/her clothes and to mop the torso without the fear of this causing a chill or any other form of discomfort. Try and keep at the sponging for a time that is proportional to the original temperature rise. Approximately, it takes at least half an hour of sponging to reduce the temperature by 1-1.5 degrees F. During this procedure, keep giving sips of water or electrolyte rich fluids to the child as he/she feels more thirsty than usual with fever.

Many care-givers think that a tepid water bath can be used instead of sponging. No, it cannot be an effective substitute since the mechanism of reduction of fever as outlined above requires the water to evaporate off the skin of the child. Hence, there is no substitute to sponging.

Keep monitoring the warmth of the skin by pushing your hand in between the child's back and the mattress; this is one area of skin that is not being sponged and hence reflects the actual fever position. Alternatively, you may check his/her temperature with a thermometer placed in his/her mouth/ear.

If the original temperature is between 99.6 and 102, sponging alone might prove to be effective. If, however, the temperature is higher, you might have to place an ice-bag above his/her head and also administer a fever medicine like paracetamol (Crocin, Adol, Metacin, Calpol) in a dose of 3-6 ml as often as needed (but with an interval of 4-6 hours between successive doses). For older children who are heavier, these brands have adouble strength formulation also available, at least in India, where I live (Crocin DS, Metacin Soorsa, Calpol Plus).

As of 2011, evidence is clear that paracetamol, along with sponging, and treatment of the underlying cause of the fever, is one of the best methods to control fever.

Other effective fever medicines include Mefenamic Acid (Meftal - p, Ponstan), Ibuprofen (Motrin Jr, Ibugesic, Flamar) and Nimesulide (Nise, Nimulid) - the last one being not licensed for use in the U.S.A. and many other developed countries because of the fear of some side-effects. In fact, nimesulide pediatric preparations have now been removed from almost ALL countries including India. However, combinations of nimesulide and paracetamol are available. I strongly discourage the use of this combination. Since the time this entry was made, the use of all these other anti-pyretics has been reduced owing to their propensity to cause many side-effects.

In addition to the foregoing, let the child rest, eat only light and soft food that is easy to digest and allow him/her to do restful activity like reading, viewing television etc.

However, the most important thing to do is to go as early as possible, but definitely not later than 48 hours, to a doctor. He/she will examine the child, perhaps order some tests (investigations) and try and arrive at the cause of the fever. Unless the cause is found and treated appropriately, the fever may not subside in almost 30% of the cases. The other 70% may, if they have a mild problem, resolve on their own without a diagnosis.

A word of caution here: if the child is frankly sick, that is, he/she does not look well, or, if he/she has symptoms like a severe headache, excessive crying, serious coughing, watery loose motions, etc., see that doctor right away. Waiting for 48 hours in such cases can be dangerous.

Before you post your queries here, please read through all the replies to previous comments. Your answer may already be there. Thank you.

Entry updated May 2013

Great Offer

Dr. Fuhrman

Dr. Fuhrman