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Fever in children

Fever in children. Mostafavi SN, MD Pediatric infectious disease department Isfahan University of Medical Sciences. At the end of class you would be able to:. Definition of fever. Measurement of fever by all types of thermometer. Definition and types of hyperthermia. Mechanism of fever.

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Fever in children

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  1. Fever in children Mostafavi SN, MD Pediatric infectious disease department Isfahan University of Medical Sciences

  2. At the end of class you would be able to: • Definition of fever. • Measurement of fever by all types of thermometer. • Definition and types of hyperthermia. • Mechanism of fever. • Indications of antipyretic therapy • Ways for control of fever.

  3. Hypothalamic set point • Perception of body temperature from: • Blood temperature • Cold and warm receptors of skin and muscles • Regulation by: • Peripheral vasodilation/ vasoconstriction • Sweeting • Heat production in muscle and liver • Behavioral response by seeking a cooler or warmer environment

  4. Normal body temperature • Axillary( 1-5 yr.) T< 36.8⁰C in morning • 0.5 ⁰C higherin oral( >5 yr.) • 1 ⁰C higherin rectal(<1-3 yr.) • 0.5 ⁰C higher at other times( circadian rhythm)

  5. Types of thermometer

  6. Elevated body temperature • Fever:change in hypothalamicset point( till 41ºC) • Hyperthermia: • Environmental heat: heat stroke • Excessive heat production: malignant hyperthermia (anesthetic drugs) or Neuroleptic malignant syndrome (antipsychotic drugs), thyroid storm • Defective heat loss: dehydration+ over clothing, anti-cholinergic drugs, Ectodermal dysplasia, familial dyautonomia

  7. Mechanism of producing fever • Heat production: • Increased metabolism of body ( ↑T4, ↑cortisol, …) • Increased muscle tone and activity • Heat conservation: • Peripheral vasoconstriction • Behavioral changes

  8. Other effects of fever • Shivering chills • Constitutional symptoms: headache, anorexia, nausea, vomiting, myalgia, arthralgia • Somnolence • Decrease serum iron and zinc levels • Increased heart rate and respiratory rate

  9. Benefits and harms of fever • Benefits: • Decrease microbial replication • Enhanced immunologic function • Harms: • Uncomfortable for patients in fever> 39ºC • Exacerbate chronic disorders( cardiac, pulmonary, metabolic, seizure)

  10. Management of fever phobia • Fever is a physiologic response not an illness • Most fevers are benign • Fever not make the illness worse • The height of the fever is less important than other signs of serious illness • Febrile convulsion is age dependent, and often a familial benign disorder • Antipyretic therapy not decreases the recurrence of FC • Initial measures is extra fluids and reduced activity • Antipyretics if the child is uncomfortable (decreased activity or fluid intake, etc) • No need to measure the fever after antipyretics • No need to awaken the children for antipyretics

  11. Indications of antipyretic therapy • High fever (ie, ≥40ºC ) • Discomfort • Chronic cardiopulmonary, metabolic, renal, neurologic disorders

  12. Control of fever • Acetaminophen • Ibuprofen • No aspirin , diclofenac Na and other NSAIDS • No corticosteroid • No complementary and alternative therapy remedies • External cooling : in hyperthermia, very young infants, severe liver disease

  13. Acetaminophen • Choice of antipyretic therapy due to long-lasting safety • Peak effect in 3-4 hr. • The duration of action: 4-6 hr. • Usually safe with no adverse effects

  14. Iboprufen • Slightly more effective and longer-lasting than acetaminophen • Duration of action: 6-8 hrs • Not recommended in < six mo. • Adverse effects: gastritis, gastrointestinal bleeding, acute kidney injury • With appropriate doses and if taken with food usually is safe

  15. External cooling • If more rapid and greater reduction of temperature is necessary • At least 30 minutes after antipyretics • Comfortably warm or tepid water (generally around 30ºC ) • Alcohol should not be used

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