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Friday, January 26, 2007

Fever –- From Zero to Three Years

Not every child who feels warm has a fever?

Babies under four months of age don't control their body temperatures very well. Becoming too warm is often related to how warmly they are dressed or bundled. If your infant feels warm to the touch but cools down quickly when unbundled, and is otherwise acting well, chances are it isn't a true fever or cause for concern. It have also found that skin-to-skin contact, such as when breastfeeding, can also cause babies to feel warm temporarily.

For babies at 4-9 months age don't control their body temperatures as well as older children. Becoming too warm is often related to how warmly they are dressed. If your baby feels warm to the touch but cools down quickly when unbundled, and is otherwise acting well, chances are it isn't a true fever or cause for concern.

Healthy babies and toddlers, 9 months to 3 years, have normal changes in their body temperature over the course of a day. They can feel warm to the touch after a lot of crawling or running around, or if they are dressed particularly warmly.

What is a normal temperature?

A normal temperature depend on the ways are taken. There were any ways to take body’s temperature orally or by mouth, rectally or by rectum, axillary or by placing the bulb of the thermometer under the arm, or using an ear thermometer.

When taken orally, it‘s about 37oC or 98oF. Temperatures taken rectally usually run 0.5oC higher than those taken orally. So, a normal temperature is about 37.5oC or 99.5oF when taken rectally. But temperatures may vary during the day, even in healthy children. Many doctors define a fever as an oral temperature above 37.8oC or 100oF or a rectal temperature above 38.0oC or 101oF or an axillary (by ear) temperature above 37.2oC or 99oF. But, ear temperatures are not accurate in children under 6 months of age and often not recommended in children less than 1 to 2 years of age.

When to take fever seriously?
Fever in a newborn or infant younger than three or four months of age requires more attention than in older infants and children. At this age, the immune system is not fully developed and infants are not as well-equipped to fight infections as an older child or adult. In addition, there are certain serious infections that are more likely to appear in the newborn period.

Fever often serves a useful purpose in helping your child's body fight an infection. After nine months of age, babies and toddlers generally fight infections pretty well. Somewhere around six months of age, your baby's immune system becomes more fully developed, and she will start to fight infections more effectively.

Four to nine months a transitional period when fevers in otherwise healthy babies (they're eating well and not acting sick) don't automatically require a phone call to the doctor. However, most healthcare professionals will still use a little extra caution when evaluating babies this age.

This would include the evaluation of any baby with a high fever (e.g., higher than 102 degrees F, 38.8 degrees C), or any baby who isn't eating well or looks sick. Providers' definitions of "fever" and "high fever" may vary a bit, so be sure you clarify when your baby's provider wants to be called about your baby's fever. Of course, you should always call if you are concerned.

Rather than just paying attention to whether your child has a fever, it's more important to assess how long the fever lasts, how high it goes, and, most importantly, how sick your child seems.

How high a fever goes doesn't necessarily predict how serious your child's illness will be. When in doubt, ask your child's healthcare provider: "At what point should I call again?"

How can I tell if my child has a fever?
Kiss or touch your child's forehead. If you think he feels hot, you're probably right. A fever is usually a sign that the body is waging a war against infection. An exact temperature reading will confirm your suspicions and help you and your child's doctor figure out the best way to get your toddler back on the road to health.

Most doctors — and the American Academy of Pediatrics (AAP) — agree that a normal body temperature for a healthy child is between 97 and 100.4 degrees Fahrenheit (36 to 38 degrees Celsius). A toddler is considered feverish if his temperature is over 101 degrees F (38.3 degrees C). If you are unable to get the fever down with medication, or if your child still appears to be very ill, seek medical attention.

Fevers often help to follow the course of an infection, so many health professionals want to be informed if fevers continue more than a certain number of days without resolving. (I generally use five days as a rough rule of thumb.)

Don't depend on fever as your only sign of infection. If your child is irritable, lethargic, not feeding well, or just looks sick to you, whether or not she has a fever, you should suspect an infection. Don't assume that a fever has to be present before seeking medical attention if you have concerns about your child's health.

Common causes
The most common causes of fever in a child this age are generally the same as adult, viral infections. If your child has symptoms of a viral infection (such as the common cold or diarrhea), especially if she has been exposed to others with the same symptoms, she may well have the same infection.

Infants may become much sicker than older children and adults with the same infection. The same cold that causes a simple runny nose in an eight-year-old can cause fever, congestion, poor sleep, poor feeding, and even vomiting in a baby.

The best approach is to limit your child's exposure to people who are sick, especially people with fevers. Keep in mind, however, that babies at this age benefit greatly from being around other kids, and it's not practical to avoid every child with a runny nose for fear of a fever or cold.

How to prevent infection?
The best approach you can take with your infant is to ask all who hold her to wash their hands first, and to limit her exposure to people who are sick, especially people with fevers. By using these simple measures, you can decrease (but not eliminate) your infant's chances of getting a viral infection and therefore, fever.

If fever is a defense against infection, is it really a good idea to try to bring it down?
Since fever is part of the body's defense against bacteria and viruses, some researchers have suggested that the body may fight infections more effectively when its temperature is elevated. On the other hand, if your toddler's temperature is too high, he'll be too uncomfortable to eat, drink, or sleep, and that makes it harder for him to get better.

If your toddler's fever isn't affecting his behavior, you don't need to give him anything to lower it. Offer him plenty of liquids to prevent dehydration, and don't overdress him. If his body temperature is higher than normal because of extra clothes, a scorching day, or a lot of active play, help him cool down by taking off a few of his layers, and encourage him to rest or play quietly in a cool spot

When should I call the doctor?
You're the best judge of whether your child is really ill, so call if you're worried, no matter what his temperature is. Besides, a temperature reading isn't the only indication of whether a fever is serious. Your toddler's behavior is a factor, too, since a high fever that doesn't stop him from playing and eating normally may not be cause for alarm. Keep in mind that your child will be hotter if he's been running around than if he's waking up from a nap.

Something else to remember: Your child's temperature — as well as your own — rises in the late afternoon and early evening and falls between midnight and early morning. The natural cycle of our internal thermostat explains why doctors get most of their phone calls about fever in the late afternoon and early evening.

You can follow the guidelines below to help decide when to call your doctor, but it's important to call your doctor whenever you feel that your child needs help or if you have any questions.

  • Under one month old. Call your family doctor right away if your baby's temperature goes over 38.5oC (101.3oF) rectally, even if he or she doesn't seem sick. Your doctor may want to see your baby and may want to put him or her in the hospital to find out what's causing the fever. Babies this young can get very sick, very quickly. Also call your doctor if your baby has any of the warning signs listed below, even if he or she isn't running a fever.
  • One to three months old. Call your doctor if your baby has a temperature of 38.5oC (101.4oF) even if your baby doesn't seem sick, or a temperature of 38oC (100.4oF) that has lasted more than 24 hours. Also, call if your baby has any of the warning signs listed below.
  • Three months to two years. If your child has a fever of 38.6oC (101.4oF), watch how he or she acts. Call the doctor if the fever rises or lasts for more than three days, or if your child has any of the warning signs listed below. If the temperature is 39oC (103oF), call your doctor even if your child seems to feel fine.
  • Over two years old. If your child has a fever of 38.6oC (101.4oF), watch how he or she acts. Call the doctor if the fever rises or lasts more than three days, or if your child has any of the warning signs listed below.
  • Be sure to mention symptoms such as a cough and ear pain (if you suspect it) or vomiting and diarrhea — these can help the doctor make a diagnosis. She will then give you instructions on how to care for your toddler and whether you need to come into the office.

Be on the lookout for any of the following symptoms, which could indicate a more serious problem when coupled with a fever:

  • Purple-red spots on his skin that don't turn white or paler when you press on them, or he has large purple blotches. Both of these can signal a very serious bacterial infection.
  • Difficulty breathing (he's working harder to breathe or is breathing faster than usual) even after you clear his nose with a bulb syringe. This could mean pneumonia or asthma.
  • Changes in behaviour
  • Severe headache
  • Constant vomiting or diarrhea
  • Skin rashvDry mouth
  • Sore throat that doesn't improve
  • Earache that doesn't improve
  • Stiff neck
  • Fever comes and goes over several days
  • Stomach pain
  • High-pitched crying
  • Swelling on the soft spot on the head
  • Irritable
  • Unresponsive or limp
  • Not hungry
  • Pale
  • Whimperi

How fever affects your child's eating?
Babies under 4 months

Babies under 4 months having a fever may not affect fluid intake, and this is very reassuring. If your baby does seem to be drinking less, pay attention to how much and how often, as well as whether she is having fewer wet diapers. Fever, as well as vomiting and diarrhea, are all potential causes of dehydration. Even if they don't have vomiting and diarrhea, infants can become dehydrated more quickly than larger children and adults. Also, poor feeding can be a sign of a more serious infection, so be sure to discuss any concerns you have with your baby's healthcare provider.

Babies 4-9 months

Many babies start eating baby cereal and foods by around six months of age. For some babies, having a fever may not affect their fluid or food intake, and this is very reassuring. It is very common, however, for babies who develop fevers with viral infections at this age to lose interest in solid foods until they feel better. There's no need to focus on how much solid food your baby eats while she has a fever and cold. You may find that your child is more interested in eating when the fever has come down. If she does not show any interest in food, don't worry. During a normal cold or fever, it does not matter if your child does not eat as long as she continues to get enough to drink. Offer more frequent breast- or bottle-feedings and pay close attention to whether your baby starts to urinate less often, as this can be a sign of dehydration. Be sure to discuss with your baby's healthcare provider any concerns you may have.

Toddler 9 months - 3 years

Instead of focusing on food, direct your attention toward making sure that she gets enough to drink and doesn't become dehydrated. Offer more frequent breast- or bottle-feedings and pay close attention to whether your baby starts to urinate less often, as this can be a sign of dehydration. Be sure to discuss with your baby's healthcare provider any concerns you may have. Even if they don't have vomiting or diarrhea, smaller children can become dehydrated more quickly than larger children and adults, but not as quickly as when they were infants. Offer small amounts of fluids more frequently. For toddlers who are not drinking well, you can be a little more creative in your attempts by offering items such as popsicles, ice cream, and Jell-O. Discuss with your child's healthcare provider any concerns you may have.

Can a high fever cause brain damage?
This is a common concern for parents, but brain damage from a fever is extremely unlikely. It's not unusual for a sick toddler to run a temperature of 104 or even 105 degrees Fahrenheit. Although fevers over 106 degrees are very unusual, most children can tolerate a temperature of slightly greater than 107 degrees without long-term effects from the fever itself. Of course, when your toddler starts to get a high fever, you'll want to take steps to bring it down.

There are times, too, when you should contact your doctor if your toddler runs a fever. Ask your doctor what her guidelines are for phoning. She may suggest you call if your toddler's fever reaches 103 degrees F (39.4 degrees C) or higher. The most important thing is how ill your child looks and acts. The doctor will probably ask you about other symptoms when you call, and give you instructions on how to care for your toddler and whether you need to come into the office.

By the way, some children between 6 months and 5 years of age have brief seizures when they're running a high fever, but even these febrile seizures don't cause brain damage.

Should I give my child a sponge bath or a drawn bath to lower his fever?
Many times when a child's temperature climbs, especially over 103°F, parents become concerned that the child is in danger due to the fever. But remember — a fever helps your toddler fight an infection. If your child has a high fever, his doctor may suggest giving him the proper dose of acetaminophen or ibuprofen, to reduce his temperature. It can be a slow process, though, and parents always want to do more. A bath is often suggested by well-meaning advisors. If you do give your toddler a bath, make sure the water is lukewarm to warm, not too cool, because shivering can actually increase his temperature rather than help reduce it. Alcohol baths are no longer recommended, because they can cool your child too quickly, which can be dangerous. You might also simply try a cool cloth on your toddler's forehead and not over-dressing him to help cool him down.

Why does my toddler's fever keep coming back?
Fever-reducing medicines bring down body temperature temporarily. They don't affect the bug that's producing the infection, so your child may run a fever until his body is clear of the infection. This can take at least two or three days. Some infections, such as influenza (the flu), can last from five to seven days. If your toddler has been treated with antibiotics to fight a bacterial infection, it may take 48 hours for his temperature to fall.

My toddler has a fever and no other symptoms. What's wrong?
When a child has a high fever that isn't accompanied by a runny nose, a cough, vomiting, or diarrhea, figuring out what's wrong can be difficult. There are many viral infections that can cause a fever and no other symptoms. Some viral infections, such as roseola, cause three days of very high fever followed by a light pink rash on the trunk. More serious infections, such as meningitis, urinary tract infections, or bacteremia (bacteria in the bloodstream), may also trigger a high fever without any other specific symptoms. If your toddler has a high fever and no other symptoms, call the doctor.

See another article, Fever medication.


1 comment:

Ian Balin said...

Thank you, this was very informative!