The following post based on my clinical experience and knowledge discusses the topic in broader sense. Consider the clinical situation of your child and advice of your doctor before adhering strictly to any advice below.
Fever is a common symptom in children.It is not a disease on its own. It is a manifestation of an underlying illness. In children, most of the times the underlying illness is an infection. Fever can persist as long as the source of an infection exists.So fever is a response of our body to an infectious process.Does this natural response produce any benefit? The benefits of fever are debatable in deed.
Fever causes considerable anxiety to parents. Children with fever restrict their activity;their intake will become poor;head ache,vomiting and body pain may complicate things depending upon the underlying illness. Finally there is a real concern for developing fits (convulsions).
Bringing down the temperature is the foremost priority for both the physician and parents.But one should keep in mind that resolution of fever is only transient till we completely eliminate the infection.Fever will persist till infection is effectively controlled by antibiotics and other measures.How are we going to bring down the temperature? There are medications and some physical means.
Medications:
The drug Acetaminophen (widely known as Paracetamol in India) is safe and effective drug for controlling fever. It acts on temperature control center in brain and sets thermostat to lower level. The body recognizes this lower temperature as the normal temperature and cuts down production and conservation of heat energy.
Oral formulations are adequate on most occasions. In emergent situations rectal formulations are given for faster relief in sick children. Avoid injections, as oily formulations of paracetamol are very painful.There is also risk of introducing infection at injection site. As the duration of action is usually 4-6 hours,dosage can be repeated as advised by your doctor.
Physical Measures:
The heat loss or gain from one source to another source is by four means.
Fever is a common symptom in children.It is not a disease on its own. It is a manifestation of an underlying illness. In children, most of the times the underlying illness is an infection. Fever can persist as long as the source of an infection exists.So fever is a response of our body to an infectious process.Does this natural response produce any benefit? The benefits of fever are debatable in deed.
Fever causes considerable anxiety to parents. Children with fever restrict their activity;their intake will become poor;head ache,vomiting and body pain may complicate things depending upon the underlying illness. Finally there is a real concern for developing fits (convulsions).
Bringing down the temperature is the foremost priority for both the physician and parents.But one should keep in mind that resolution of fever is only transient till we completely eliminate the infection.Fever will persist till infection is effectively controlled by antibiotics and other measures.How are we going to bring down the temperature? There are medications and some physical means.
Medications:
The drug Acetaminophen (widely known as Paracetamol in India) is safe and effective drug for controlling fever. It acts on temperature control center in brain and sets thermostat to lower level. The body recognizes this lower temperature as the normal temperature and cuts down production and conservation of heat energy.
Oral formulations are adequate on most occasions. In emergent situations rectal formulations are given for faster relief in sick children. Avoid injections, as oily formulations of paracetamol are very painful.There is also risk of introducing infection at injection site. As the duration of action is usually 4-6 hours,dosage can be repeated as advised by your doctor.
Physical Measures:
The heat loss or gain from one source to another source is by four means.
- Evaporation
- Conduction
- Convection
- Radiation
Obviously child with fever is hotter than his/her ambiance(environment).We can facilitate the heat loss from his body to his environment by all the four modalities mentioned above.
Evaporation:
Transformation of a substance from one form to another form needs energy or releases energy.So water from its liquid form transforms into vapor by consuming energy.So one gram of water consumes about 540Cal of energy to get vaporized.The body heat of child is spent to vaporize water on the skin surface.This forms the basis in tepid sponging.- A clean cloth or sponge is soaked in water.
- The water is smeared on the skin of children by gently rubbing over the skin.
- Try to cover as much area as possible(including face and head in small children).
- The wet clothes should not be left on skin as it can prevent convection heat losses.
- Avoid very cold or ice water for sponging. Try to use clean tap water or boiled water cooled to room temperature.Very cold water decrease the size of the blood vessels in the skin and decreases circulation of blood.The skin may be cool, but the temperature inside the body may be high.
Conduction:
This is heat loss or gain through the contiguous surfaces.Conduction is faster on metallic surfaces.Placing the child on metallic cots will promote faster heat loss rather than placing the child on mattress.
Convection:
Heat loss produced by the draught(movement) of air.By opening door and windows and switching on the fan, one can promote the movement of air. When convection is coupled with evaporation, we can induce greater heat loss in children.
Radiation:
One great example is SUN.Every life on earth is thriving by the energy of the SUN.Heat loss occurs from hotter to colder objects by radiation. The amount of heat loss is proportional to the the difference between the temperature of the two objects.The greater the difference, the heavier the heat loss.
In real life situation,we can place the child in cooler environments to produce heat loss. We can place the children in Air-conditioned rooms maintaining temperature around 24 degree Celsius.Extremely low temperature is not advisable.
In india, most of the parents are averse to the practice of tepid sponging. Rather they place their children under blankets and heavier clothes.They are doing this to avoid shivering. Shivering is an indication that the temperature is coming down.The body is generating heat by muscular activity in the form of shivering to offset the drop in temperature. Getting inside the blankets is a behavior response of the child to conserve heat and increase the temperature.Even if they are not practicing tepid sponging ,they should at least remove clothes and blankets till temperature becomes normal.
