ASK THE EXPERT
Dr Bijal Shrivastava answers all your childcare queries
Fever as a symptom is an important clue to reach to a diagnoses in any illness. A five-year-old girl suffering from a seven-day fever, who was under a course of different feverreducing drugs at the regular six-hour interval but without measuring it, came in for a check-up. The medications served to reduce the fever and this led her parents to think that she was alright, as there was no fever, further delaying their visit to the clinic. When she finally came to us after a week, the infection had increased and she was diagnosed with pneumonia. Needless to say, she required to be hospitalised. I want to stress on the importance of measuring the fever and maintaining a fever chart. You’ll know when your child has a fever if the temperature reads above 100.4 degree F in rectal area; above 99 degrees F when measured in the armpit; and above 100 degree F when measured orally. However, body temperature should not be measured orally in young children. Children do have frequent viral infections and fever is a very important symptom. Fever is also a common indicator of certain chronic diseases. With infections, a fever can guide us as to when we have to visit doctor, when we may need antibiotics or when any further intervention is needed. Certain dos and don’ts: 1. Always measure fever before giving
your child any fever-reducing drugs. 2. In the case of a fever between 101 to 102 degrees that lasts for more than 48 hours, or if the initial temperature is between the 103 to 104 degree F-range, then your child may need medical attention. 3. Do not over cover the child as it may increase the fever. In high grade fevers, start cooling the body with either sponging or by reducing the environment temperature. 4. Drugs such as paracetamol or acetaminophen are very safe and should be the first line of fever reducing drugs. However, these can be repeated to maximum six times in a 24-hour period. In case of high fever, one can use ibuprofen (not ibugesic plus or Combiflam), but given a be maximum of four times, and can also be alternated with paracetamol. The third option is mefenamic acid which can be given a maximum of three times in 24 hours. Except for paracetamol, other medications have a side effect of acidity, rarely gastrointestinal bleeding, and chance of renal failure. Barring paracetamol, other NSAIDs are to be avoided if the child has low platelets count or has bronchial spasm, or any underlying kidney issue. 5. Always maintain hydration by
increased fluids and be sure of urine output. Do not stop any food or milk from the child if they are willingly having it. Keep the skin clean by bathing the child daily. In this manner, by measuring fever and controlling it, you can avoid frequent visits to the doctor for normal viral infections and, in addition, a doctor will not be late in diagnosing certain serious infections or other conditions.
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Dr Bijal Shrivastava, MBBS and MD (Paediatrics), is a neotologist at Dr LH Hiranandani Hospital. She works full-time as a pediatric consultant and has been a pediatric practitioner for the last 12 years.