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2. Fever in children Mostafavi SN, MD
Pediatric infectious disease department
Isfahan University of Medical Sciences
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3. 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.
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4. 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
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5. Normal body temperature
Axillary( 1-5 yr.) T< 36.8⁰C in morning
0.5 ⁰C higher in oral( >5 yr.)
1 ⁰C higher in rectal(<1-3 yr.)
0.5 ⁰C higher at other times( circadian rhythm)
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6. Types of thermometer
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7. Elevated body temperature
Fever: change in hypothalamic set 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
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9. Mechanism of producing fever
Heat production:
Increased metabolism of body ( ↑T4, ↑cortisol, …)
Increased muscle tone and activity
Heat conservation:
Peripheral vasoconstriction
Behavioral changes
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11. 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
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12. Benefits and harms of fever
Uncomfortable for patients in fever> 39ºC
Exacerbate chronic disorders( cardiac, pulmonary, metabolic, seizure)
Benefits:
Decrease microbial replication
Enhanced immunologic function
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13. 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
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14. Indications of antipyretic therapy
High fever (ie, ≥40ºC )
Discomfort
Chronic cardiopulmonary, metabolic, renal, neurologic disorders
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15. 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
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16. 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
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17. 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
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18. 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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