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Managing fever of children

Prof Dr M Karim Khan
Fever is the commonest symptom (about 41 percent) for which parents bring their children to the physicians. Fever always brings tension in parents' mind and sometimes they become puzzled if temperature is high (more than 102-104 degree Fahrenheit), especially when fever persists for more then 3-4 days and/or associated with convulsion.
Rectal thermometer reading is the best to assess core temperature of the body; it is 0.5 degree higher than that of oral temperature and 0.8 degree higher than that of axillary temperature.
In most cases, fever indicates presence of some infections somewhere in the body. The cause may be viral, bacterial, protozoal, rickettsial etc. Sometimes a cause may not be identified. Fever with convulsion always creates panic situation which needs to be evaluated.
Managing fever, physicians in private settings tend to adopt strategies involving less diag-
nostic testing or empiric treatment, whereas hospital-based physicians are most likely to test and treat.
The appropriate management of feverish infants has been debated. The fact is that — fever does not necessarily need to be treated. For example, if a child is playful, comfortable, able to sleep and drinking plenty of fluids, then medical treatment is not likely to be needed. On the
other hand, steps should be taken to decrease fever in a child who is uncomfortable, dehydrated, vomiting, having difficulty sleeping. All febrile children less than 36 months of age and toxic appearing should be hospitalised for evaluation and treatment of possible sepsis or meningitis.
Control of fever is a major issue for physicians caring for children. The World Health
Organisation (WHO) recommends in the guidelines for standard acute fever management that treatment with Paracetamol in children 2 months up to 5 years of age should be limited to those with high fever (rectal temperature 39° C or above). Supportive care with additional fluids, appropriate clothing and environmental conditions should be emphasised.
We advise mothers to remove clothing of the children having high temperature; tap water sponging is the best way to reduce increased body temperature. If it fails after sponging, administration of syrup Paracetamol is recommended consulting a paediatrician.
Sometimes at the peak of temperature, children vomit or refuses to take any oral medication. In those cases Paracetamol suppository can be used. If fever does not subsides with in 3-4 days, evaluation of the cause of fever need to be done. Travel history is important. Then physical examination and occasionally laboratory examination are needed.
So when your child is having fever, do not get scared and do not promptly go for medicine. Take time and observe carefully at home. Follow the recommendations to reduce temperature. Take care of your baby.
The writer is a Professor, Department of Paediatrics, Community Based Medical College (CBMC), Mymensingh.
E-mail: mmukkhan@gmail.com