What is good to know when children have a fever… Assoc. Prof. Valeri Velev, a specialist in infectious diseases and parasitology, speaks to FACT.
- Assoc. Prof. Velev, let's talk about body temperature in children. What is good for parents to know so that they don't fall into serious anxiety when their child has a fever?
- To begin with, parents should be aware that an elevated temperature is an external expression of a working immune system. That is, it is something normal and expected in an inflammatory process in children. This elevated temperature is a protective function of the body, which tries to create an unfavorable environment for the reproduction and life of the microorganisms that have infected the child. Viral infections are most common in children, so when a fever is high, one should not rush to give antibiotics. In general, a high temperature, up to 38 - 38.5 ℃, is not a dangerous condition. If a child is under 2 years old and the temperature rises to around 39 ℃, it is appropriate to seek medical attention relatively quickly.
- Does giving children medication to lower the temperature give parents a sense of control over the situation?
- Of course. One does not even need to have read many scientific articles on the subject. Every parent has exactly this feeling. It is most often observed at home, when the parent feels more helpless, but I have often observed this in the hospital. Sometimes children should be left to maintain a temperature in order to fight the infection faster, but it is not uncommon for parents to pressure the hospital staff to give a fever reducer despite their advice. In most cases, the fear in a hospital environment is less and parents tend to trust the doctor when to give medication and when not.
- Body temperature in healthy individuals varies throughout the day, because...
- Because many environmental factors change - both external and internal, and the body must balance the release and absorption of heat. The mechanisms for maintaining body temperature are very complex and are influenced by many factors - what is the ambient temperature, what is our current physical activity, whether we have eaten or not, do we have any hormonal imbalance within the physiological range. It is like blood pressure in a healthy person. If you measure it three times in a row, say every hour, you will get three different but close results.
- Is it true that body temperature is normally higher during the first two years of life!
- It is both higher and more variable. This part of the brain, which is responsible for thermoregulation, is more immature. It "learns" the balance that we talked about above. On the other hand, the metabolism of these children is faster and they spend more energy, i.e. give off more heat. Therefore, they are an easy "victim" of infections if they get colder. And last but not least, heat exchange is much larger, because we have a smaller body mass, distributed over a larger body surface. To combat all this, the small organism tries to maintain a higher temperature than normal for our understanding.
- Normal body temperature for children is...
- Within the range of 36.0-37.2 ℃, with the lowest usually being in the morning around 04.00, while in the evening it can even exceed the notorious 37 ℃. For a pathologically elevated body temperature, the so-called fever, which indicates illness, it is necessary to have a temperature above 38 ℃, and there are often other symptoms.
- Why is it important to monitor the general condition of children, even if they have a fever?
- As we have already said, fever is a useful reaction of the body to infections. That is why we should leave the child with a fever for longer.
But, we are still aware that he is a sick child. The temperature is not his only symptom.
The most important thing is for the child to feel comfortable. And if he shows this, through normal activity and at a higher temperature, we can be calmer. If other symptoms of the disease begin to prevail – fatigue, nausea, refusal to eat, sometimes even vomiting or diarrhea, it is obvious that the thermoregulatory center has crossed a threshold at which it is appropriate for us to help and give the necessary medication in a sufficiently adequate dose.
Often parents give a lower dose of a fever reducer and panic that “it does not fall“.
In fact, it falls more slowly. It is important to know that the maximum dose is given for the child's weight and our goal is not necessarily for the temperature to fall below 37 ℃, but to lower it to acceptable values - below 38 ℃.
- When is it necessary to lower the temperature with medication?
- Exactly in the conditions I described. When the child is visibly uncomfortable, when the temperature goes above 38.5 ℃ and if we are talking about a small child up to 2 years old.
Parents whose children have had febrile seizures are terrified of them and give medicine much earlier.
Even before the child has a fever. I will not tell them not to do it, because they will not listen to me. I will only tell them that preventive medication does not protect against febrile seizures. If one of the parents had one as a child, it is very likely that the child has inherited it. In most cases, these seizures are short-lived, under 5 minutes, and completely safe. It is important to keep the child from getting hurt and to tilt their head to the side so that they do not choke if they vomit. In many countries, a cream-like rectal diazepam is sold, but, unfortunately, it is not available in our country.
- Does the rule of drinking more fluids when you have a fever also apply to children?
- Of course. Even more so. The high temperature makes us sweat, we dehydrate, there are toxins in our body – water saves us from all this. It is appropriate to give it more often and less so that the child does not vomit. Usually, nausea occurs with a high fever. We should put food aside, but be persistent with water.
- When does the grandmother's recipe with a wet cloth dipped in vinegar on the forehead work...
- It does not work. This vinegar thing has historical significance and modern medicine completely denies it. Vinegar evaporates faster than water, it is this phenomenon that creates a feeling of cooling, but it is not real. And specifically for the forehead - there are no large blood vessels there and it is pointless to cool it. When we cannot cope with the high temperature, it is quite natural to switch to the so-called physical means, although this is quite unpleasant for the child. This physical cooling is sometimes done in the hospital. But it must have medical logic. When you have a small child, it is good to have a bag of ice, a plastic bottle of frozen water in the refrigerator. In the hospital we keep 2-3 banks of frozen saline. When they need to be used, they are wrapped in a towel and placed where large, main blood vessels pass. Under the armpits and in the inguinal folds. When a person has a high temperature, their limbs are icy anyway. The body tries to centralize blood circulation and directs it to the internal organs and the brain. Hence the paradox - the thermometer shows high values, but the palms and soles are icy. That's why we measure the temperature under the armpit.
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Assoc. Prof. Valeri Velev is a specialist infectious disease specialist and parasitologist in Sofia with over 21 years of medical experience. His interests are in the areas of childhood infectious and parasitic diseases, zoonoses and intestinal infections. In his practice, he performs diagnostics and treatment of parasitic diseases and childhood infectious diseases. He graduated from the Medical University of Sofia in 2003. He has acquired specialties in Medical Biology, Medical Parasitology and Infectious Diseases. In 2017, he acquired the scientific and educational degree "doctor". He is currently part of the specialist teams of DCC 11 Sofia and the Heart Diagnostic Center.