Modern approaches to the treatment of fever in children with infectious pathology

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Kurilova Alina Petrovna

Pediatrician

14.05.2019

Before you start taking antipyretics, you need to answer a few questions:

what age is the child?
How does a child tolerate an increase in temperature?
Is there a family or child history of febrile seizures?
Are there any other symptoms of the disease besides fever?

Increased temperature or fever

is a protective-adaptive reaction of the body in response to the influence of pathogenic stimuli, as a result of which a restructuring of thermoregulation processes occurs, leading to an increase in body temperature, which stimulates the natural resistance of the body.

An increase in temperature affects the child’s body both positively and negatively.

Positive influence

is that when the temperature rises in the child’s body, the immune system is activated, phagocytosis increases, the production of antibodies increases and the level of interferon increases, which helps to stop the proliferation of pathogenic microorganisms and overcome infection.

Bad influence

high temperature on a child manifests itself in the occurrence of convulsions (febrile), increased load on the baby’s cardiopulmonary system (heart rate and breathing rate increase). Therefore, fever is dangerous for children with developmental defects of the heart and bronchopulmonary system, and heart rhythm disturbances. Also, when the temperature rises, the functioning of the brain, liver, stomach, kidneys and other internal organs suffers, which is dangerous for children with chronic pathologies of internal organs, symptoms of dehydration, developmental disorders and diseases of the nervous system.

Why is fever dangerous in children, and how to deal with it?

advises a medical pediatrician. Fever is the most common sign of the development of infectious and some other diseases in children.
Many things can cause a child to have a fever, from common childhood illnesses such as chicken pox and tonsillitis to reactions to vaccinations. An increase in body temperature is an innate protective mechanism by which the body stimulates the functioning of the protective factors of the immune system. Also, the increased temperature of the internal environment of the body itself can lead to inactivation or death of pathogens of many diseases. Remember that everyone's body temperature normally fluctuates 1-2 degrees throughout the day and may vary depending on age, activity level and other factors.

So rising temperatures are not a “problem.” This is an indicator that some kind of attack by microbes, viruses or other factors has occurred on the body, and the body reacts to it, gives a “response”. It is much worse when bacteria or viruses attack, but the temperature does not rise (i.e. there is no immune response, or it is insufficient).

On the other hand, the approach to each child should be individual.

If the child

restless or feeling weak
cannot tolerate muscle pain, headaches,
there is nausea,
no appetite,

then you must first use physical methods to improve the child’s well-being

put to bed - this way the body will retain strength to fight infection and calm the child;
drink fractionally with water or sweetened warm herbal tea with chamomile, linden, cranberry juice;
provide access to fresh air;
If there is an appetite, feed small portions of warm food (for example, soup, thin porridge with water, a light breakfast).

Also, according to the clinical course of the fever, apply additional cooling measures.

For “red” or “pink” fever

the baby's body feels hot to the touch,
skin is red or pink, moist,
The child himself does not complain about his health, is active, and does not lose his appetite.

In this case, the child must

undress,
wipe with a towel soaked in water at room temperature,
apply a cool compress to your forehead,
drink water at room temperature
and be sure to call a doctor.

For "white or pale" fever

the child’s limbs and body feel cold to the touch,
lips and nail beds take on a bluish tint,
skin is pale and dry,
There is a disturbance in well-being: the child is lethargic, delirium is possible.

In this case, the child must

warm by rubbing the limbs with your hands or using warm water (other means are prohibited!),
put on socks
cover with a blanket
and drink warm tea or water.

The use of antipyretics for such symptoms is ineffective - you need to urgently call a doctor!

The exception is children at risk, whose temperature is reduced above 37.1 degrees. These are kids,

having diseases of the nervous system,
experiencing convulsions due to a rise in temperature,
those suffering from chronic diseases of the circulatory system, respiratory system or hereditary metabolic diseases and other risks (overheating, symptoms of dehydration, etc.).

Febrile seizures are diagnosed more often in children under 6 years of age with temperatures above +38 degrees, as well as in children with pathologies of the nervous system at any temperature. It is recommended for such children to reduce their temperature to febrile levels (not higher than +38.0) or to those values recommended by a neurologist.

Usually, against the background of an increase in temperature, the child’s heartbeat and breathing rate increase: the respiratory rate increases by 4 respiratory movements for every degree above +37.0 degrees, and the pulse rate increases by 20 beats per minute for every degree. However, against the background of diseases of the cardiovascular system and respiratory organs, such as developmental defects or heart rhythm disturbances, inappropriate increases or decreases in pulse and breathing are possible. Such children, on the recommendation of a cardiologist and pulmonologist, are prescribed antipyretics up to febrile levels (i.e., not higher than +38.0 degrees).

Children with hereditary metabolic diseases (diseases of the thyroid gland, kidneys, liver, disorders of the immune system and others) and children with imperfect compensatory mechanisms of thermoregulation during fever (these are some children from birth to 2 months) are also prescribed antipyretics on the recommendation of related specialists funds up to febrile numbers.

Overheating - an increase in body temperature due to additional exposure to heat

prolonged exposure to the sun,
wearing too much clothing
excessively wrapping children).

The risk of overheating is associated with the risk of heat stroke. It manifests itself

not only at elevated temperatures,
but also in impaired consciousness, convulsions,
disorders of the heart and breathing.

First aid is to call the ambulance team “112”.

Before the doctor arrives

undress the child
move to a cool place or shade,
provide access to fresh air or blowing with a fan (but not cooled air!),
apply a cold compress to your forehead,
wipe the body with cool water or wrap it in a sheet moistened with cool water.

Antipyretic therapy for children should be prescribed strictly individually, taking into account clinical and anamnestic data.

What is a fever?

The normal temperature for babies and children is around 36.4°C, but this may vary slightly from child to child.

Low-grade fever is an increase in temperature from 36.7 to 38 degrees.
Fever is a high temperature of 38 C or more.

The following symptoms appear when you have a fever:

Your baby's forehead, back, or stomach feels hotter than usual.
The surface of the skin becomes sweaty (moist) and sticky.
The baby's cheeks and sometimes forehead turn red.

To measure temperature, it is best to use a safe digital thermometer without mercury filling.

Prevention and treatment of coronavirus in children

Treatment of Covid in children is no different from symptomatic treatment of other acute respiratory viral infections. There are currently no specific medications for the treatment of COVID-19 in children. Therapy is usually aimed at alleviating the symptoms of the disease and preventing the development of a bacterial infection.

Typically, for mild to moderate forms of COVID-19, the pediatrician gives the child the following prescription:

bed rest, maximum limitation of contacts;
moist cool indoor air;
drinking plenty of water;
washing the nasal mucosa with saline solutions;
gargling with antiseptics;
antipyretics for high temperatures (above 38.5 °C);
enterosorbents for digestive problems;
antitussives and vasoconstrictors;
antihistamines.

In case of a complicated course of the disease, antibacterial drugs and drugs that normalize respiratory function are prescribed.

If it is necessary to undergo routine vaccination, a child can be vaccinated after Covid two weeks after complete recovery.

To minimize the likelihood of a child becoming infected with coronavirus, it is necessary to maintain personal hygiene : wash your hands more often (at least 20 seconds), use antibacterial wipes. As often as possible, treat gadgets, toys, door handles, and work surfaces with antiseptics.

It is necessary to ensure that children do not touch their face or eyes with their hands. Maintain water and drinking regime. Pediatricians recommend irrigating the nasal cavity with saline solutions after visiting public places. You should also spend more time in the fresh air and regularly ventilate the room.

Children are tested for coronavirus, including when the child comes into contact with a person confirmed to have COVID-19.

If a mask regime is in place, all children over 12 years of age must wear a mask with the same requirements as adults. For children from 6 to 11 years old, wearing a mask is recommended if adults can monitor its correct use, including timely replacement of the mask.

How to measure a child's temperature:

The child's armpit should be clean and dry! If it is wet, the thermometer will show an inflated result!
Move your child's arm to the side and place the thermometer in the upper armpit.
Gently place your hand against your body and keep it pressed while taking the temperature.
Leave the thermometer in place for as long as indicated in the instructions. Some digital thermometers beep when the temperature measurement is complete.
Take out the thermometer. The display will show the baby's body temperature.
If your child has just had a bath or has been wrapped tightly in a blanket, wait 10 minutes before taking their temperature.
Professional infrared thermometers allow you to instantly measure body temperature. If there is a need to measure the temperature as accurately as possible, but there is no professional thermometer at hand, the most accurate results are obtained by measuring the temperature rectally.

What to do if your child has a high temperature

The child must be kept at home and supervised. The temperature should drop within 3 or 4 days.

After vaccination, the temperature can remain normal for up to 48 hours.

What do we have to do:

if the child is less than 6 months old, call a doctor immediately
Give your baby plenty of fluids to drink (or continue breastfeeding)
monitor signs of dehydration
feed if the baby wants to eat
Regularly monitor your child's condition at night
give the child antipyretics prescribed by the doctor

Medium form

Moderate severity of COVID-19 is characterized by a significant deterioration in well-being. In this case, pneumonia always develops, so hospitalization is indicated. After the first symptoms associated with fever and severe weakness appear, shortness of breath develops and pain in the muscle joints appears.

In the days following coronavirus infection, the following manifestations are observed:

1 day. Body temperature rises to 37.5°C. Headaches and discomfort in joints and muscles occur. There is nasal congestion.
2-4 days. The general condition worsens significantly, dyspeptic disorders and dizziness occur. Body temperature can rise to 38.5°C, so you need to lower it with special medications. There is a constant sore throat and bouts of prolonged non-productive cough, which indicates the spread of infection to the lungs. Almost always, a sick person ceases to smell.
5-6 day. The patient's condition worsens. Additionally, compressive pain appears in the chest. The body temperature does not fall below 38°C and must be constantly brought down with antipyretic drugs. These symptoms are evidence of the development of viral pneumonia, which requires a full examination and appropriate treatment.
7-14 days. With the correct course of treatment, the patient's condition improves. Cough and nasal congestion disappear, body temperature normalizes.

After the condition has stabilized, testing is carried out. If the result is negative, the person is considered recovered. But it may take another couple of weeks for complete recovery.

What not to do when the temperature rises

Do not undress your child or cool him or her with blows or rubs; fever is a natural and healthy response to infection. Hypothermia can lead to complications from the infection.
Do not cover your baby with a warm blanket or wrap him up, as this may cause heat stroke. Just cover your baby with a sheet or light blanket.
Do not give aspirin to children under 16 years of age. Absolutely never! This may be due to a rare but dangerous disease called Reye's syndrome.
In children under one year of age, medications available in the form of rectal suppositories are recommended to reduce fever.
Do not self-medicate. For young children, the dose of drugs and the frequency of their use should be calculated individually; the prescription can only be made by a doctor after diagnosis.

Stopping blood circulation and breathing

Call an ambulance (resuscitation) immediately!

Ensuring airway patency:

if a cervical spine injury is suspected, the neck is immobilized
clean the oropharynx (pear, finger)
eliminate obstruction caused by retraction of the tongue or compression by soft tissues of the neck, push the lower jaw forward or raise the chin.
improving airway patency. The head is positioned along the midline. Children, unlike adults, should not throw their heads back too much, because in children this can lead to airway obstruction. A towel folded several times is placed under the back of the head (for adults, a cushion under the shoulders).

Ventilation is started using the mouth-to-mouth method (mouth to mouth and nose) and indirect chest massage. The effectiveness of ventilation is assessed by chest excursion.

Ventilation is performed so that each breath lasts 1.0-1.5 s. The frequency of compressions on the chest of a newborn is at least 120 per minute, the ratio of the frequency of insufflations and compressions is 1:3. In older children, the frequency of pressure is at least 100 per minute. The child is placed on a hard surface and chest compressions are immediately started. The ratio of the frequency of inflation to the frequency of chest compressions is 1:5.

In infants, indirect massage is carried out in two ways: pressing on the chest with the middle and index fingers of one hand, or clasping the child with both hands so that the thumbs are located on the middle third of the sternum, and the rest support the back.

In both cases, pressure is applied to the lower third of the sternum (about a finger's width below the nipples). In children 1-2 years old, I press on the sternum with the protrusion of the palm of one hand. Older children and adults use two hands. In both cases, pressure is applied to the lower third of the sternum (approximately two finger widths above the xiphoid process). Depth of descent of the sternum: children under one year old: 1.5-2.5 cm, up to 7-8 years old - 3-5 cm, older - 4-6 cm. The effectiveness of indirect massage is assessed by the pulse in the carotid and femoral arteries. Resuscitation measures must be continued until doctors arrive!

When should you seek emergency medical help?

It is necessary to call a doctor or ambulance in the following cases:

The child is less than 3 months old and has a temperature of 38°C or higher
The baby is between 3 and 6 months old and has a temperature of 39°C or higher
Against the background of fever, rash, vomiting, and diarrhea appeared
Fever lasts for 5 days or more
The child refuses the breast, does not eat, behaves unnaturally
The child has signs of dehydration: dry diapers, sunken eyes, crying without tears.

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Diagnosis of coronavirus in children

When the first signs characteristic of COVID-19 appear and/or when a child comes into contact with a person with confirmed coronavirus, you must call a pediatrician . He will examine the child, prescribe a PCR smear for coronavirus and a general blood test. Based on the test result, the pediatrician will give recommendations for caring for the child, prescribe treatment, and, if necessary, refer for consultation to other specialists (pulmonologist, otolaryngologist, ophthalmologist, etc.). If pneumonia is suspected, an X-ray or computed tomography scan of the lungs is performed.

To detect respiratory failure, you can use a pulse oximeter, a device that helps measure the concentration of oxygen in arterial blood. Pulse oximeter readings should not be lower than 96 units.

Signs of particularly dangerous diseases accompanied by fever

Fever can be a sign of serious illnesses such as meningitis, urinary tract infection and sepsis. It is necessary to urgently call an ambulance or take the child to the hospital emergency room if he has:

There is tension and stiffness in the neck muscles,
A rash has appeared that does not go away when you press on it with a finger
The child is very irritated by light,
The attack of fever does not go away, the child “shakes” with chills
The child has unusually cold hands and feet
Your baby has pale, mottled, blue, or gray skin
The baby's crying has become weak, moaning, and does not look like usual
The baby is sleepy, lethargic, and difficult to wake up
The child has difficulty breathing, the stomach is pulled in under the ribs when breathing
In a newborn baby, the fontanel on the top of the head has become bulging

What should you do if your child has a seizure? Seizures are a very serious side effect of fever in some children. Febrile seizures occur in 2–4% of all children under 5 years of age. Not all seizures cause sudden muscle twitching. Some seizures look like “fainting.” If your child develops a seizure, do the following:

Place your baby on his side.
Do not put anything in your child’s mouth, even if “experienced” grandmothers recommend doing so.
Call an ambulance immediately if the attack lasts more than five minutes.
If the attack lasts less than five minutes, call your doctor or make an emergency visit to your doctor.