In my last article,
I discussed a fever case of one of my patients Priya. Just a few days ago Priya revisited my clinic for a follow-up of her 2 year old daughter. On
her last visit I had explained her why fever is a friend, not foe. Moreover, I had given her some handy tips to take care of her daughter. Priya
affirmed that the advices I suggested helped her great deal. It’s not always that you don’t need heavy medications from your doctor. Small easy
tips work wonders sometimes, just like with Priya’s daughter.
Here are a few things you should know about fever.
Know what is fever
Because of the normal variation in body temperature, there is no single value that is defined as fever. However, the following are generally accepted
Rectal temperature above 100.4ºF (38ºC)
Oral temperature above 100ºF (37.8ºC)
Axillary (armpit) temperature above 99ºF (37.2ºC)
Ear (tympanic membrane) temperature above 100.4ºF (38ºC) in rectal mode or 99.5ºF (37.5ºC) in oral mode
Forehead (temporal artery) temperature above 100.4ºF (38ºC)
Axillary, ear, and forehead temperature measurements are easier to obtain than rectal or oral temperatures, but they are less accurate and may need to be
confirmed rectally or orally in certain children.
Which drugs to use?
The role of fever lowering agents is very clear, to make the child comfortable. So, the end point is not a number to which the temperature should
be brought down. It means that if the child is sleeping comfortably there is no great merit in waking up the child to administer drugs. These drugs reset
the thermostat to lower levels.
Parents get panicky if the temperature does not touch the base line after giving medicines. Paracetamol is the most commonly used and safe drug. It lowers the temperature by 1-2ºC, not necessarily bringing it back to normal. Paracetamol is very effective in alleviating pain as well.
The other drug favored by parents is Ibuprofen, which is equally effective. It can be particularly useful where swelling (inflammation) is associated, like
joint swelling with fever.
Sponging with lukewarm or tap water is better than immersing body in cold water. The water should take heat from the body and evaporate, making use of
latent heat to effect heat loss. Hydrotherapy is very useful in patients where the thermostat is normal as in heat stroke.
If we decide to sponge the patient, we should use paracetamol about 30 minutes before sponging. If we do not use medicine, anything that attempts to
increase heat loss will cause the body to produce more heat thus offsetting the advantage.
Next time around when your kid gets fever, do not stay awake whole night with a thermometer in hand, waking up a comfortably sleeping child to look at the
number! The goal of treating fever is to make the child comfortable and not "do whatever one can" to bring it back to normal. Fever is a common symptom,
mostly of self limited trivial illnesses.
It is reassuring to learn that fever more often than not is not in itself a damaging factor, the underlying cause is always important. Fever may not after
all always be a foe that we think it is!
Dr. Sanwar Agrawal is the Director of Ekta Institute of Child Health and a renowned pediatrician of the city. After completing his post graduation from PGIMER Chandigarh, one of the best institutions in the country, he contributed remarkably in the field of health. Dr. Sanwar travels across the country for his expert talks on pediatric health. In his artcles he gives us an understanding of the most common health problems in children.
Connect to your hero Dr. Sanwar at firstname.lastname@example.org