Fever is defined as a temperature above 38 ° C.
A rise in temperature may occur after heavy physical activity after a hot bath in the summer, or when the child is covered too. This rise in temperature is the result of an accumulation of heat that exceeds the possibilities of regulating body temperature and it is not a fever.
In the brain, the body temperature is determined by the thermoregulatory center; fever is related to a displacement of the point of thermal equilibrium upwards. Fever is defined as an elevation in core body temperature above 38 ° C in a child who has not been in intense physical activity, which is normally covered and is located in a temperate environment.
To measure the body temperature, the best method is the electronic thermometer rectally. However, we can use other methods less stressful for the child (but less accurate) as the liquid crystal headband placed on the forehead, electronic thermometer for oral or axillary (which requires a longer curing time and under often underestimates the temperature) and the infrared thermometer ear through which the advantage of allowing an outlet temperature very fast (one second).
The most accurate method is still the rectal thermometer (soft tip to avoid injury to the rectum) before the age of two years. Infrared ear thermometer can be used reliably after this age.
Hand on the forehead is not absolutely reliable to indicate the presence of fever in children and even less to assess the level.
Fever is a way of the body’s response to infection and may also exist in inflammatory diseases, but they are rare in children.
Fever is a reflection of the activation of the body’s natural defenses against invasion by infectious agents. It is not dangerous in itself. According to some studies, mortality is even increased in severe bacterial infections without fever, other studies have shown that drugs that lower fever (antipyretics) may delay healing of certain viral infections. There is not enough evidence to support that the fever must be respected. But we now know that it should not be treated systematically.
During infection, the immune cells involved in the fight against infection secrete proteins, cytokines, which are released into the circulation. It is they who will modulate the body’s reaction to infection. For example, some cytokines increase the temperature, others decrease. To increase the temperature, cytokines induce the secretion of a mediator, a prostaglandin, which excites the center of thermoregulation.
There seems to be no correlation between the fever and the severity of the infection that is responsible except in young infants. The risk of severe illness is thus important to 38 ° in an infant less than three months and from 39 ° in an infant aged three to six months.
Moreover, fever is not directly responsible for seizures. We often speak of febrile convulsions. It would be better to use the term convulsions with fever. A part from some neurological diseases (meningitis encephalitis …) which may be complicated by convulsions and require emergency treatment, seizures occur during fever in 2-5% of children under the age of 5 years, usually when between 18 and 24 months.
Seizures are a consequence of the disease in a child is often genetically predisposed. Frequently found, in fact, the notion of convulsions during fever episodes in the family. These convulsions which always cause great concern among parents are in fact harmless. Children who presented seizures during episodes of fever then develop quite normally, without sequelae. Finally, we know that drugs that reduce fever do not prevent the occurrence of seizures.
In some cases the fever warrants emergency consultation: if the temperature exceeds 38 ° in a child less than three months or more than 39 ° in a child aged three to six months. After this age, a consultation is required when the child does not have the same behavior as usual, when there are other symptoms or if fever persists. In all cases, call your doctor or emergency services can judge the need to consult in a timely manner or the opportunity to defer the consultation.
Fever is a symptom, it is safe by it self. Thus, it is not absolutely necessary to bring the temperature to a normal level. The treatment of fever should not be systematic. Fever is a sign of disease, a viral infection most often. It is not removing the fever is cured the child. In contrast, the fever may accompany various disorders related to the illness, loss of appetite, decreased activity, etc.. This discomfort may be some important and should then relieve the child. In addition, any fever requires to find the cause and it may require a specific treatment.
Children who have seizures during fever have a high risk to repeat other during a new episode of fever during the two following years, especially if the first seizure occurred before the age two years. However, no study medication (paracetamol, ibuprofen, diazepam) compared with placebo has demonstrated its ability to prevent seizures when administered at the time of fevers. There is therefore no preventive treatment of these convulsions with fever.
It is, however, advisable to have home valium intrarectal to be administered if a seizure occurs during fever later.
The goal of treatment of fever in children is to relieve the discomfort that can cause fever. This is done using physical means and medicines.
Called physical methods (undressing the child, taking cold drinks, cool bath, wetting, mist …) aim to reproduce the exchanges that the body is naturally involved with the external environment to ensure its thermal regulation. It has long been advised to give the child a bath at a temperature below 2 ° C in rectal temperature of febrile children undress, apply cool packs. But we now know that these methods have modest efficacy (only wetting seems to have some antipyretic effect) in addition, the effect of these cooling methods always very rapidly as soon as interrupts, finally, and most They constantly causes discomfort sometimes important because everything tends to reduce the temperature determined by the agency at the central level is perceived as unpleasant. So give a cool bath, undress a child shivering, applying ice packs and other means of refrigeration processes are inefficient and unpleasant to relegate to oblivion. Conversely, excess clothing, so that “it does not catch cold” can be dangerous.
The combination of a high fever and external conditions favoring hyperthermia (excess buildup, overheated room) may lead to fever-hyperthermia syndrome characterized by fever above 41 ° C and failure of vital functions. This syndrome is fortunately exceptional today (two cases during the 2003 heatwave) but is subject to a high risk of mortality and severe neurological sequelae.
Current recommendations for physical measures are proposing to drink frequently the child to be well hydrated by choosing a drink he readily accepted and not very fresh drink that will not cause a decrease in the best limited temperature, to find the child, without undress completely (especially if shivering is unpleasant) and do not overheat the room but keep the temperature usually recommended (19 °).
Medicines that lower fever (antipyretics) are especially useful for improving the child’s comfort and relieve any pain. The antipyretic drugs currently used in most fevers in children are paracetamol and ibuprofen. Paracetamol has analgesic and antipyretic effects and is used today in France in children.
Ibuprofen has antipyretic, analgesic and anti-inflammatory anti-inflammatory effect that is however minimal at doses antipyretic and analgesic and has no proven benefit for the treatment of fever in children. Ibuprofen should not be used in children less than three months.
Finally, acetylsalicylic acid (aspirin) which was used in children there twenty years is practically not today because of its adverse effects, including the risk of Reye’s syndrome, a syndrome characterized by brain damage and liver, often fatal, can occur when taking aspirin during a viral infection, mainly of chickenpox. Acetylsalicylic acid has also many other side effects that make it today is no longer recommended in children fever.
The goal of drug therapy is not to lower the fever is not dangerous but improve the comfort of the child. Febrile child may feel in good shape. A systematic treatment of fever is not necessarily justified. If medication is required, preferably use paracetamol by offering every six hours as a child in need. It is not justified to give two alternating antipyretic drugs. However, if the child is grumpy 20 to 30 minutes after the first dose of paracetamol (time required for the drug to take effect) is that the treatment is not enough. In this case, we can add another antipyretic and analgesic drug (ibuprofen)
If febrile child is well, it seems to bear his illness, it is unnecessary to give any medication you offer only drinks for hydration is correct and ensure that it does not surcouvrir.
In summary, fever (temperature greater than 38 °) is a symptom, a sign that the child reacts to an illness, infection most often. A fever higher than 38 ° in a child less than three months and a fever higher than 39 ° in an infant aged 3 to 6 months require an emergency appointment. After this age, a consultation is required when the child’s behavior is modified when additional symptoms, when the fever is prolonged, to determine the cause and initiate treatment if disease-specific involved. The goal of treatment for fever is to improve the comfort of the child and not to bring the temperature to a normal level. Treatment, when necessary, based on physical measurements (to drink, do not surcouvrir) associated with medication (paracetamol first line).