1. Fever Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

2. What is Fever?  A raise in body temperature above 37.5 o C (IMCI 2002)  During infections, the body is able to raise its temperature which helps to fight germs  So fever is one of the most common signs of infection in ALL children

3. Children with HIV More infections than most children More fevers than most children Fever may be a sign of:  Chest infections  Ear infections  Skin infections  Diarrhoea  Meningitis  Oral infections  HIV Infection ©TALC

4. Fever in Children  Fevers may cause discomfort to the child  Fevers increases loss of water through the skin  This increases the chance of dehydration in children  High fevers may lead to febrile convulsion (seizures or ‘fits’) ©TALC

5. Signs and Symptoms How would you know whether Sofiso has a fever? ©TALC

6. Has Sofiso got a fever? Touch the Child  Forehead, stomach or other parts of body may feel hot to the touch  He may or may not be sweating  Is his heart rate (pulse) fast? ©TALC

7. Has Sofiso got a fever? Look at the Child  Is he withdrawn and/or reluctant to move?  Is he irritable?  Is he breathing fast? ©TALC

8. Has Sofiso got a fever? Take the temperature Our eyes and hands are very helpful in assessing fever But, thermometers are more accurate and may be used to answer:  How high is the child’s temperature?  Has the treatment effectively lowered the temperature?  Has the fever risen? ©TALC

9. Using Thermometers  Try to keep the child calm before taking temperature  Wash thermometer with cold soapy water and/or alcohol  Shake thermometer hard until reading is below 36 degrees  Place bulb end of thermometer well up in to armpit, holding arm down over it and elbow in to baby’s side  Hold position for 4-5 minutes, whilst singing songs/telling story  NEVER leave the child with the thermometer – he WILL move!

10. Remember!!  Mercury is poisonous  If a thermometer is broken, this is extremely dangerous  ALWAYS store a thermometer in a safe place where it will not be broken

11. Reading Thermometers  Hold thermometer in a good light  Rotate until you see a silver line of mercury  Line up mercury with numbers, marked in full degrees (36,37,38) and every two- tenths degree (.1,.2,.3,.4)  Point where mercury ends indicates the temperature  Write it down straight away with time taken 34 35 36 37 38 39 40 5 5 5 5 5 5

12. What to Do? Fever is usually a sign of infection in the child So you need to:  Manage the fever  Identify what may be causing the fever Any underlying infections can then be treated and managed appropriately

13. Does the Child have Fever? If carer reports history of fever or temperature is 37.5 o C or above: Ask:  For how long?  If more than 7 days, has fever been present every day? ©TALC

14. Risk of Meningitis Look and Feel for:  Stiff neck  Bulging fontanelle Suspected Meningitis if:  Any general danger sign OR  Stiff neck OR  Bulging Fontanelle (IMCI, 2002)

15. Suspected Meningitis Home Based Carers  Administer one dose of paracetamol (Panado) for fever 38 o C or above  Refer urgently! Professional Nurses  Child needs dose of IM Ceftriaxone  Test blood sugar  Give one dose of paracetamol (Panado) for fever 38 o C or above (IMCI, 2002)

16. If No Suspected Meningitis Assess the child - Look, Listen, Feel for the following:  Sore Throat  Ear ache, pus from ear  Difficulty breathing, noisy breathing  Cough (+/- sputum)  Diarrhoea  Pain on passing urine  Severe headache, neck stiffness, bulging fontanelle  Skin Inflammation, sores, rashes  Pain in joints Then give Paracetamol (Panado) and discuss with Professional Nurse

17. Managing Fevers Regular administration of medication to:  bring temperature down  keep temperature down  reduce discomfort  encourage drinking and eating

18. Giving Paracetamol for Fever Age or WeightSyrup (120mg/5ml) Tablet (500mg) 2 months up to 1 Year 2.5 - 5 ml- 1 Year up to 5Years 5 – 10 ml- 6-12 Years10 – 20 mlHalf to 1 tablet Every 4-6 Hours AND No more than 4 Times a Day!

19. Managing Fevers  NEVER wrap up a child with fever  Undressing the child allows heat to escape  Ensure cool, fresh air or fan the child  Apply cloths soaked in tepid water to the child  Do NOT let the child start shivering ©TALC

20. Managing Fevers  Encourage the child to keep drinking to prevent dehydration  If breast fed, continue breastfeeding  For non-breast fed children, encourage drinks or small, frequent sips ©TALC

21. Has it helped? Using these interventions can help to reduce a fever But, you need to be sure they have!  Keep checking the child (touch, looking, thermometer)  Continue regular fluids  Continue Paracetamol (Panado) until you are sure the fever is over

22. Febrile Convulsions Children adjust less quickly to high body temperatures Temperature above 38.5 0 C or a rapid change in temperature may lead to febrile convulsion Most common in children 6 months to 5 years Usually only last 1-2 minutes Signs and Symptoms:  Collapse  Eyes rolling upward  Foaming at mouth  Stiffening of the body  Uncontrolled jerking movements  Breathing difficulty in severe cases

23. Handling Febrile Convulsions  Keep calm  Reassure care giver  Ensure area around child is clear and safe  Never restrain the child or place anything in mouth  Loosen clothing around neck and body  Position child with head lower than body if possible  Child may lose consciousness but will usually ‘come round’ without help  If the convulsion lasts longer than 5 minutes, the child needs emergency help

24. After a Febrile Convulsion  The child may sleep  Ensure child is on his side  Give Paracetamol (Panado) if the child is conscious/ able to swallow  Apply cool cloths to body  NEVER put child in a bath  Take child to a clinic for further investigation and treatment of cause

25. Note! If a child has a seizure and is not between 6 months and 5 years, this is likely to be caused by something other than fever

26. Education Care Givers need to be taught how to recognise and manage temperatures in order to:  Alleviate the child’s discomfort  Prevent dangerously high temperatures  Ensure infections are treated as early as possible ©TALC

27. Remember!! Fever is a very useful sign of infection Fevers must be managed properly to prevent distress and complications BUT, the child’s behaviour is the best sign of how sick a child is :- A child may have: NO fever with infection e.g. pneumonia, meningitis (especially in malnutrition) HIGH fever with a mild cold ©TALC