HEALTH: Managing a fever

Fever in infants is probably one of the more common worries among parents.

Worried about your child’s fever? Here’s a guide for parents

FEVER in infants is probably one of the more common worries among parents. It is also normal for fever to occur in the wee hours of the day, which means consultation from doctors during that time is generally not possible unless the patient is taken to the emergency section at a hospital.
The usual questions that crop up in a concerned parent’s mind are:
* Is my baby’s temperature low or high?
* Should I wake my child up for fever medication?
* Will my baby’s high temperature cause injuries to the growing brain?

HOW HOT IS HOT?
A fever is usually a sign that something out of the ordinary is going on in your body.
“It is our body’s reaction to an inflammation or infection. The release of inflammatory mediators as a result of our body’s response towards infection or inflammation contributes to fever,” says Dr Khoo Boo Aik, paediatrican and neonatologist at Sunway Medical Centre.
Normal body temperature is around 37ºC. Dr Khoo explains that low grade fever is in the range of 37.1 to 37.9ºC, while moderate fever is 38 to 38.9ºC.
A body temperature of above 39ºC is considered high fever.

MANAGE WHILE IT’S HOT
“Not all fevers are bad. It is a good indicator, telling us that our body immune system or defence mechanism is working hard in trying to control infection and inflammation,” says Dr Khoo.
However, fever may be absent in newborn or very young infants or children who are immuno-compromised, even though they may have an underlying infection or inflammation.
Therefore, it is important to examine these groups of infants or children thoroughly. Doctors may need to carry out urine or blood investigations in order not to miss the underlying infection, even in the absence of fever.
Medication is recommended to suppress fever that causes discomfort or to control the fever from spiking high enough to cause seizures, especially in childrens with history of recurrent febrile fit or underlying epilepsy.


ROOT CAUSE
The goal is to find the source of fever, instead of treating just the fever. “Fevers are usually triggered by a viral or bacterial infection,” says Dr Khoo.
Patients with fever are assessed based on the associated symptoms they present, such as cough and flu indicating upper respiratory tract infection, or diarrhoea and vomiting, indicating gastrointestinal infection.
There are instances when the fever does not subside even with medication. This is when the infant will go through a battery of tests, especially if the source cannot be pinpointed.
“In patients with pyrexia (fever) of unknown origin, we need to rule out certain diseases or conditions, which include autoimmune diseases, Kawasaki disease, haematological disorder or malignancy such as leukaemia or lymphoma, and infectious diseases such as tuberculosis, malaria and typhoid,” he says.

BEST TREATMENT
“If a patient has moderate to high grade fever and shows signs of discomfort, uneasiness, or has a history of febrile fits, we will prescribe fever medication,”
says Dr Khoo.
“Treatment, however, also depends on the cause. Once the source of fever, for example a throat infection, is identified, treating it with antibiotics will usually bring the temperature down naturally.”
Some illnesses may need to be treated with antibiotics, depending on whether it is caused by a viral or bacterial infection.
Fever is normally treated with either paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen. Both have antipyretic (fever medicine) and analgesic (pain relief) properties.
Paracetamol is the most common antipyretic used for children with fever that’s ranging from mild to moderate in nature. In patients with high grade fever at more frequent intervals, a combination of anti-pyretic such as paracetamol alternating with ibuprofen every 4-6 hourly or when necessary, is recommended to avoid the risk of overdosing and at the same time, control the fever more effectively.
It is very important not to give the same fever medicine at a very frequent interval, such as every four hours. In addition, parents should be vigilant in following the prescription dosage correctly, which is another important measure to avoid the risk of overdosing your child.

Read more: Managing a fever - Health - New Straits Times http://www.nst.com.my/life-times/health/managing-a-fever-1.461563#ixzz2qSWXYCbD