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Monday, January 26, 2015

Fever in Children

Fever is an extremely common 'problem' that brings parents to the doctors.

A few things to demystify:

1) Fever is a sign; not a problem. It indicates that the child has an infection. Our role is to find the source of the infection, assess the severity of it and determine the type of treatment.

2) Fever is a natural reaction to an infection. If a child has an infection, they will have a fever. And children normally have fever for a longer period of time than adults. This is because the child may be fighting the virus (bugs/ germs) for the first time. Hence as long as the infection is ongoing, the fever will come and go. Its the natural, expected course.

ANALOGY:  Our immune system fighting the virus or bacteria are like the soldiers fighting their enemies. When the soldiers use the guns and grenades to fight, there will be blasts and open fire, which is analogous to the fever. And if they are fighting new enemies, the fight will be longer. But once they recognise the enemy, they are able to eliminate them much faster. Hence fever lasts longer in children than adults.

3) Fever itself doesn't damage the brain nor kill. It is the underlying infection that causes the damage. However many of the elderly folks believe that fever damages the brain. Many parents have visited the doctor saying that the grandparents insisted they brought the child to the doctor as the fever is too high. This made me think- where did this myth come from?

It might be an association issue: For example, meningitis (infection of the lining of the brain) is serious and can kill if not treated early. Its signs are subtle, with fever, headache, and sometimes a rash. It can cause high and prolong fevers. If untreated, it can cause brain damage, hearing loss and even death. Perhaps our ancestors associated the fevers with such horrible outcomes and concluded that fever damages the brain.

4) There is no such thing as high or low fever. Above 38-38.5 is a fever.....and 41 degrees celsius and above is abnormal. Damage is NOT proportional to the number. It mainly means the child will feel more uncomfortable.

5) Fever can cause fits in children and it is known as febrile seizures.  3% of children between the age of 6 months to 5 years will have it. It usually doesn't cause any long term damage nor does it result in epilepsy. (yes.. it is different from epilepsy).
Answers to common questions: http://www.patient.co.uk/health/febrile-seizure-febrile-convulsion

Another website which helps clarify these myths:
http://thesgem.com/2014/11/sgem95-paediatric-fever/


SO WHAT TO DO WITH A FEVER????
1) Bring the fever down with medications so that the child will be comfortable
2) Ensure that the child is playing, feeding and behaving normally, especially when the fever comes down. If not, medical attention is required.

Hope this is useful!!!

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