Fever a common illness in kids

By Donya Betancourt

The Jakarta Post considers youngsters' health to be of the utmost importance. After all, the future rests with our children. Today, we start Kids' Health Corner, an interactive weekly column to which readers can e-mail questions, comments and concerns to features@thejakartapost.com or to the writer's e-mail address.

This column starts with one of most common illnesses in children: fever.

SANUR, Bali (JP): Fever is one of the most common reasons for a visit to the doctor. It may be a sign of a viral illness, a minor bacterial infection or a life-threatening bacterial process. While fever most typically indicates the presence of an infection, on rare occasions it may be the presenting sign of poisoning (aspirin) or a malignancy.

Question: What body temperature indicates a fever?

Answer: Normal body temperature is 37.0 C or 98.6 F. A fever is more than 37.5 C (99.5 F) by oral thermometer, 37.0 C (98.6 F) by axilla thermometer (placed in the armpit), 38.0 C (100.4 F) by rectal thermometer.

Please remember to shake your thermometer to force the reading down before taking your child's temperature. It is normal for children to get hot after exercise but they should cool down within 30 minutes. Remember it is not how high the fever is but how rapidly the temperature goes up that causes a febrile convulsion.

Fever in young infants (eight weeks or older) may be caused by severe infection without many clinical findings. There may be a history of excessive crying, irritability, lethargy or poor appetite.

With an older child, clinical impression is more accurate.

There are many ways to take a temperature, which is the best?

For an infant or young child, it is best to take your child's temperature with a rectal thermometer. For an older child or teenager, an oral thermometer is the one to choose.

You may have heard of the new ear thermometers and the skin thermometers. An ear thermometer is good for a child aged one year or older because the ear canal is big enough and you can get a proper reading from the ear.

Taking the temperature reading directly off the skin is unreliable, especially if the skin is warm for other reasons (e.g. sunburn). The temperature reading should give you a good idea about the fever but it is not necessary to know if the fever is exactly 100.8 F or 101.4 F.

What is a febrile convulsion?

A febrile convulsion is a seizure that happens when the fever climbs too quickly. The symptoms are: * sudden rise in temperature. * listless and a vacant look, may be jittery. * could be blue in the face. * body may stiffen. * limbs twitch. * loss of consciousness.

Febrile seizures occur in 2 percent to 5 percent of children from three months to six years of age during a febrile illness that does not involve a central nervous system (CNS) infection.

The risk of seizure is greatest on the first day of illness, and the convulsion often occurs before a fever is noticed.

Typically, a simple febrile seizure is generalized and brief (about 15 minutes), and is almost always over before arrival at the hospital.

The treatment is similar to that of fever. Lay the child down with his face to the side and his/her head lower than the body. Go to a doctor.

One-third of children who have a febrile seizure have at least one recurrence, and one-half of these have a third convulsion.

Nearly one-half of recurrences happen within six months and 85 percent within one year of the initial seizure.

However, recurrence of febrile seizures does not increase the risk of epilepsy.

How do I treat a fever?

1. Call a doctor immediately if the child has a febrile convulsion and if the fever is accompanied by stiff neck, rash, vomiting or diarrhea.

2. Reduce the temperature by:

* sponge bath with lukewarm water especially neck, armpits and groin area because they have big blood vessels.

* do not use cold water as it constricts the blood vessels and causes the body to retain heat.

* do not use alcohol because the fumes can lower the blood sugar.

3. Medication:

* A 10 mg dose of Acetaminophen for every one kilogram of the child's weight every four to six hours.

* In the case of fever exceeding 39.5 C (102.6 F) or not responding to Acetaminophen, give one teaspoon of Ibuprofen for every 10 kilograms of body weight every six hours.

* Acetaminophen suppositories are available in the case of vomiting. However, I suggest a doctor is consulted concerning the dosage suitable for your child.

* Give the child plenty of fluid. Never give Aspirin, as this drug can trigger Reye's syndrome.

Remember a doctor should be contacted if the child is less than eight weeks old, fever persists for more than two days in other age groups, toxicity occurs regardless of age or degree of fever, febrile convulsion develops or if the patient has a weak immune system.

The writer, (drdonya@hotmail.com), is a pediatrician based in Bali,