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Fever Overview

Fever Overview

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Published by: ronan_2905 on Feb 18, 2010
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01/20/2013

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FEVER OVERVIEWFever is a normal response to a variety of conditions, the most common of which is infection. Fever occurs when the body's temperature iselevated as a result of the body's thermostat being reset to a higher than usual temperature.Nearly every child will develop a fever at some point. The challenge for parents is to know when to be concerned. This topic review will discussthe definition of a fever, how to accurately measure a child's temperature, how and when to treat fever, and signs and symptoms that requirefurther evaluation.TEMPERATURE CONTROLThe body's temperature is controlled by a part of the brain (the hypothalamus). Body temperature varies over the course of the day, although thehypothalamus usually is able to maintain it within a relatively narrow range. The hypothalamus regulates temperature by balancing heatproduction in the muscles and the liver with heat loss from the skin and lungs.Fever occurs when the hypothalamus increases the body's temperature. This may be in response to the immune system detecting an infectiousagent, such as a bacterium or virus.FEVER DEFINITIONBecause of the normal variation in body temperature, there is no single value that is defined as fever. However, the following are generallyaccepted values:
Rectal temperature above 100.4ºF (38ºC)
Oral temperature above 99.5ºF (37.5ºC)
Axillary (armpit) temperature above 99ºF (37.2ºC)
Digital pacifier temperature above 100ºF (37.8ºC)
Ear temperature above 100.4º (38ºC) in rectal mode or 99.5ºF (37.5ºC) in oral modeFEVER CAUSESInfection is the most common cause of fever in children. Common viral and bacterial illnesses like colds, gastroenteritis, ear infections, croup,and bronchiolitis are the most likely illnesses to cause fever Teething probably does not cause fever. In particular, studies have shown that temperatures of 101.3ºF (38.5ºC) or greater are unlikely to berelated to teething.Some childhood immunizations can cause fever. The timing of the fever varies, depending upon which vaccination was given.HOW DO I MEASURE MY CHILD'S TEMPERATURE?The best way to measure a child's temperature depends upon several factors. In all children, a rectal temperature is the most accurate.However, it is possible to accurately measure the temperature in the mouth (for children older than four or five years) or ear (for children older than six months) when the proper technique is used.Temperatures measured in the armpit are the least accurate, but may be useful as a first test in an infant who is younger than three months. If the armpit temperature is over 99ºF (37.2ºC), the rectal temperature should be measured.It is not accurate to measure a child's temperature by feeling the child's skin. This is called a tactile temperature, and it is highly dependent uponthe temperature of the person who is feeling the child's skin.SHOULD I TREAT MY CHILD'S FEVER?There are pros and cons of treating fever. Fever may play a role in fighting infection, although it can make a child uncomfortable.The height of a child's fever is not always the best indicator of whether the child needs to be treated and/or evaluated. Instead, it is important tonote how a child behaves and appears. Fever is usually accompanied by other symptoms. Some of these symptoms require evaluation by ahealth care provider, even if there is no fever. The table provides a list of these symptoms
 
In most cases, a child with a fever can be observed and/or treated at home. However, it is important for parents to know when a child with afever needs to be evaluated by a healthcare provider, when fever should be treated, and when it is reasonable to observe the child withouttreating the fever.These are general guidelines that do not necessarily apply to every situation; parents who have questions or are concerned about their childshould contact their child's healthcare provider for advice.Evaluation recommended — A healthcare provider should be consulted in the following situations:
Infants who are less than three months of age who have a temperature of 100.4ºF (38ºC) or greater, regardless of how the infantappears (eg, even well-appearing young infants should be evaluated)
Children who are older than three months who have a temperature of 100.4ºF (38ºC) or greater for more than three days or who appear ill (eg, fussy, clingy, refusing to drink fluids)
Children who are three to 36 months who have a temperature of 102ºF (38.9ºC) or greater 
Children of any age whose temperature is 104ºF (40ºC) or greater 
Children of any age who have a febrile seizure. Febrile seizures are convulsions that occur when a child (between six months and sixyears of age) has a temperature greater than 100.4º F (38º C).
Children of any age who have recurrent fevers, even if the fevers only last a few hours
Children of any age who have a fever and have a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia
Children who have a fever as well as a new skin rashTreatment recommended — Treatment of fever is recommended if a child has an underlying medical problem, including diseases of the heart,lung, brain, or nervous system, or if the child has had febrile seizures in the past.Treatment is helpful if the child is uncomfortable, although it is not necessary.Treatment not required — In some cases, it is not necessary to treat a child's fever. A child older than three months who has a temperature lessthan 102ºF (38.9ºC), who is otherwise healthy and acting normally, does not require treatment. However, parents who are unsure if their child'sfever needs treatment should contact the child's healthcare provider.Fever is a commonsymptomof many medical conditions:
e.g.
Various skininflammations,
e.g.
Immunological diseases,
e.g.
Reaction to incompatible blood products
e.g.
Thrombo-embolic processes,
e.g.
Intermittent fever: Elevated temperature is present only for some hours of the day and becomes normal for remaining hours,
e.g.
 malaria, kala-azar ,pyaemia, or septicemia. In malaria, there may be a fever with a periodicity of 24 hours (quotidian), 48 hours (tertian fever), or 72 hours (quartan fever, indicating
). These patterns may be less clear in travelers.
Continuous fever: Temperature remains above normal throughout the day and does not fluctuate more than 1 °C in 24 hours,
e.g.
lobar pneumonia,typhoid,urinary tract infection,brucellosis, or typhus.Typhoid fever may show a specific fever pattern, with a slow stepwise increase and a high plateau.
Remittant fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours,
e.g.
 infectiveendocarditis.UsefulnessTheoretically, fever can aid in host defense.There are certainly some important immunological reactions that are sped up by temperature, andsomepathogenswith strict temperature preferences could be hindered. Fevers may be useful to some extent since they allow the body to reachhigh temperatures, causing an unbearable environment for some pathogens. White blood cells also rapidly proliferate due to the suitableenvironment and can also help fight off the harmful pathogens and microbes that invaded the body.

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