It is a blessing in disguise, says Jnanendra N Sharma, head of the Department of Pediatrics. NEIGRIHMS
FEVER IN children frightens grownups. It is the most common complaint for which a child is brought for consultation to a doctor. It needs emphasis that fever is not a disease but rather a symptom of an illness.
What is fever?
THE NORMAL oral temperature in children is 36-36.8ºC (97.7-99.1ºF). Diurnal variation is more in young children because they are more active and may go up to 1000 F towards the later part of the day.
Therefore in children below 5 years age, a body temperature 1000 F (37.80 C) or higher and in children above 5 years, 99.30 F (37.40 C) or higher is considered as fever.
Good effects of fever
HUMAN BLOOD has two types of cells; red blood cells and white blood cells. The white blood cells are an important component of the body defense system. A mild fever increases the white blood cells. They kill the body cells infected with organisms invading the body. Fever also improves the ability of certain white blood cells to destroy the bacteria and infected cells. Fever, by itself, create extra heat in the body and impair the replication of many bacteria and viruses so that the organisms cannot survive.
Fever, one due to minor bacterial or viral illness, therefore, can be an expression of the body defense mechanism working at its best.
Can fever do any harm?
Any time the body temperature increases, salt and water are lost via sweating. The body stores of energy and vitamins are burnt up. The body also makes some minerals unavailable because the bacteria need them to thrive.
Besides minerals, the favorite meal of bacteria is glucose. Hence the body switches to burning of glucose rather than burning protein and fat for energy depriving the bacteria its food for survival and multiplication.
It needs emphasis that poor appetite/refusal of food by the ill child is probably an adaptive mechanism of the body during febrile illness. Mothers should not try to force feed children during fever if they don’t feel hungry because the child will regain appetite and the lost weight quickly after the illness ends. However, there is a need to encourage fluids, because dehydration alone can drive up fever.
It needs mention that very high fevers, those above 106°F (41°C) can harm the heart and brain. However, fever is unlikely to cause brain damage because during most infections, the body temperature is maintained at or below 104°F (40°C) as the thermostat in the brain is normally set at this temperature. The thermostat however, may fail to work when a febrile child is overwrapped with warm clothes and exposed to high environmental temperature raising the temperature to an alarmingly high level.
How harmful is a febrile convulsion?
SOME CHILDREN can have a convulsion with fever. Febrile convulsions have been described as a condition without any evidence of brain damage even with repeated episodes. The child continues to develop normally. It is a benign condition.
Does fever need treatment with drugs?
THE RESPONSE of the body to illness in the form of fever is adaptive. It seems reasonable to assume that interfering with the process may do more harm than good. The reason for treating the fever is primarily an issue of comfort for the child. No drug approaches can go a long way toward helping the child feel better. The child should
- Be kept in a cool room, the coolest room in the household or in an AC room.
- Wear light clothing. Over wrapping can increase fever. Child may complain of chill at the onset of fever. Even with chills no wrapping with clothes is necessary. The chill subsides as the body temperature rises. Chills cannot be relieved by wrapping the child with clothes.
- Drink plenty of liquids orally. Fever causes dehydration. Correction can help bring down the fever.
- Eat small frequent meals to compensate the endogenous breakdown due to increased metabolism.
Drugs to bring down fever should be used sparingly when the child is in pain or suffers discomfort from a fever over 102°F (38.8°C). Paracetamol is a safe and effective fever lowering drug. However, it should be given in the proper dose and interval. The preparations containing a combination of two fever lowering drugs should not be used. They are more harmful than useful because their use results in more side effects without additional beneficial effects.
Fever is maligned and misunderstood. A rational approach is most desirable. Priority should be treatment of cause, not the fever.