Here we look at fever and the treatment of fever in children, caused by viral infections found in the temperate climate of Great Britain. This advice does not necessarily apply to tropical or sub-tropical infections. Furthermore, children younger than 6 months with a fever need to be discussed with a doctor.
A common misunderstanding is that fevers can get too high and as a result a child may die of a fever.
Another area of concern is febrile convulsions. Febrile convulsions only happen when the temperature rises rapidly in a young child. They usually come out of the blue: first the convulsion occurs and it is only then that the parent realises the child has a fever. When the parent actually notices a fever in the child, the period in which body temperature rises rapidly has already passed and therefore a febrile convulsion is unlikely. Febrile convulsions do not have negative implications for later life. They do not cause brain damage or epilepsy.
As for the concern that the fever and body temperature might rise too high, you can be reassured by knowing that a fever can not go beyond a certain plateau phase. In previous centuries this fact was not understood, and when people died from meningitis, for example, it was claimed they had died of a fever. That is also why there are rhymes warning against fever and ending in predictions of death!
You cannot die of a fever, but you may possibly die of an illness underlying the fever, such as meningitis or malaria. Any serious underlying illness like meningitis, malaria or pneumonia needs to be excluded, of course.
A test to exclude meningitis is to sit the child upright with his or her legs stretched out on the bed, and ask the child to look at their belly button (or keep a toy there to try and make the child look down without forcing). In meningitis this is likely to cause distress because this stretches the meninges. These are the sheath of the brain, enveloping the brain from the forehead, over the top of the head and down the spinal cord, right down to the tailbone.
When this sheath of the brain is inflamed, (i.e. in meningitis), this ‘neck-down’ position can cause a pain in the head and/or neck. (Mind you, flu will cause a pain in the neck area when the person looks down but this pain comes from the neck muscles rather than from the meninges.) A headache, lethargy, and being irritated by light can be indicators of meningitis.
Sometimes these meningitis bacteria circulate in the bloodstream and do not cause a pain in the neck or headache, this is called septiacaemia. In a typical case, this infection can show up as small bruises. So you need to look for a rash as well — it usually looks like little bruises which do not fade when the spots are pressed. Meningitis and septicemia can develop in a matter of hours.
Management of fever
When a serious underlying illness is excluded, you can help the child with tender loving care. During a fever the body wants to heat itself up completely, that is, right up to the hands and feet. Therefore, what you need to do is to check whether the hands and feet are warm. When these are still cold, then it is best to keep the child warm. Once the hands and feet are warm, you can take off the blanket or warm clothes. Just imagine yourself when you have a flu-like illness. At first you tuck yourself under the covers because you are feeling cold. Actually, the body temperature is rising when you feel cold and shivery. Once you are hot all over you get bothered, and throw away the blankets to make yourself comfortable. Don't strip the child off completely or have them shiver from the cold and have goose pimples. Sponging the body might seem kind and loving, but it is uncomfortable for a feverish child.
Some children are prone to febrile hallucinations. This is always very distressing for the child, and also for the parent. Afterwards the child has little recollection but the parents remember everything! Try and stay calm yourself. It helps to cool the child, to take him or her out of bed. Usually the episode recedes in a matter of minutes.
Overall it is not about ‘controlling’ the temperature or ‘managing’ the temperature but about supporting the fever process. You will notice that running a temperature is like running a distance. The child will breathe faster and the heart rate is up and the child will be listless. But once the body has managed to heat itself up into the hands and into the feet, the child will start to perk up again. Therefore it is important to support the fever process and help the body to heat itself into the hands and feet. You would do the same for yourself when you feel cold and shivery despite already having a high fever, you would keep yourself under the duvet until the body has managed to warm up the hands and feet as well. If carers start to try and get the temperature down, then the body has to put extra effort in and this will exhaust and distress the child. Therefore it is about supporting the fever process in order that the body doesn’t need to put ever more effort in to heat every part of the body.
Paracetamol (acetaminophen) are analgesics (painkillers) and can be given if the child has pain or muscle ache or is you think it is distressed by the fever, but often the temperature will go up again anyway and that is due to the above described fever process. The fever is a healing mechanism and you do not need to worry that ‘the temperature can get too high’ – is has never been in the newspapers that again another child has boiled – and febrile convulsions, in general, only happen when there is a sudden rise in temperature, in other words, usually a convulsion comes out of the blue and not when the fever is noticed.
Expect the child to perk up a few times over 24 hours, and often it is noticed that the temperature goes up at night time, this fits with bio-rhythms (circadian rhythms). However, if the child is constantly lethargic then it needs to be seen by a doctor because in that case it might have a serious bacterial infection or Kawasaki disease.
A feverish child will not have any appetite and eat poorly, which is perfectly all right for a few days. Fluids should be offered, of course, to prevent dehydration. Clear liquids like fruit juice or squash (but no fizzy drinks) are best. Actually, often the child seems basically content despite a raging temperature, but it is the parents who are worried!
It is impressive to realise that we constantly maintain a body temperature of 37 degrees Celsius, but even more impressive that we can produce the great heat of a fever. Fever is largely a childhood condition. Children seem to have the ability to produce fevers easily and can tolerate them better than adults. (High fevers are less common in adults and are more often a symptom of a serious illness.) Fevers should be viewed with reverence, particularly when we consider that this heat originates from the Sun! As discussed in a previous chapter , plants bind the warmth of the Sun into their substance. When humans absorb food, this warmth is released into our bodies when it is broken down by oxygen, like the heat from a burning log fire. The following can give a sense of reverence for fever.
The body of the newly born baby is completely built up from substances delivered through the mother. From the moment of birth, with the first breath of oxygen, the baby will start to break down and reorganise these motherly substances. Through the breathing process and feeding, the baby starts to rearrange and transform his or her little body to correspond to its own individuality. During a fever, a dramatic transformation is taking place in the body. The body might need the fever in order to leap hurdles in this process of maturing. We could say that, on the one hand we come into the world with inherited substances and forces, linking us with our past; but on the other hand we go through a process of personal development, drawing us into the future.
To summarize: Fever is alright as long as you remain vigilant for a dangerous underlying infection. Children younger than 6 months with a fever need to see a doctor. The advice is to keep checking every few hours for a rash than does not fade when pressed as in septicaemia (when the bacteria circulate in the blood). Usually people only lift up the tummy shirt but you need to check every part of the body! Secondly check at the same time for meningitis (when the bacteria have infected the sheaths of the brain). See the drawings and text above. If the temperature is above 39C, try and catch a urine sample which the doctor can check for infection. The National Institute for Clinical Excellence - NICE - has also written information for parents, the link for this you can find in the references below.
As such we do better by supporting the fever process so that a new beneficial balance can develop.
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