Fever in Children

Apr 26, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

I for one welcome our robot overlords. I hope they find my radio voice can sooth the masses during their conquest of Earth. Emily and I were listening to a documentary saying the next group of jobs that would be taken over by computers would be professional jobs like pharmacists, accountants, lawyers and doctors. Emily was terrified that meant when she got out of school there wouldn't be any jobs left for her. I think of the up coming robo-pocalypse as more of an opportunity. I think I'd be good at saying, "Don't worry. SkyNet means you no harm. Go back to watching Netflix and we'll take it from here."

Until I get the chance to sell out the human race and become a lap dog to SkyNet from the documentary series The Terminator, I guess I'll just have to be a pharmacist for a while. As a pharmacist we get questions about sick kids a lot. Last week, I had a grandmother call. She was looking after her 5 year old grandson for a week. He had a temperature of 38 C. Did he have a fever? What should she do?

Fevers in children are quite common, but very rarely are they dangerous. Normal temperature is about 37 C. A fever is when the body temperature is above 38 C as measured by a rectal thermometer. And that is the first fever problem in kids. How do we measure their temperature?

For better or worse, rectal temperature measurement is still considered the gold standard. If the child is under the age of 2, a rectal temperature is the best option and under the armpit the second best option. Between the ages of 2 and 5 rectal is still recommended, but both ear and armpit thermometers can be used. And as a parent, I found ear thermometers to be awesome. They are so much easier to use and there is so much less parent and child trauma. Over the age of 5, an oral thermometer is recommended and ear and armpit are the alternatives.

The most frequent reason for a fever in children is an infection. It is actually a useful response by the body to an infection and helps the body fight and kill the invaders. Fevers in children usually go away on their own and usually don't cause any problems for the child.

When treating a fever, we are aiming to keep the child comfortable, not necessarily to keep their temperature down. Start with making sure the child is drinking plenty of fluids to prevent dehydration. Have the child wear light clothing, don't put them under blankets and try to limit their physical activity. Some red flags that the child should be taken to the doctor or emergency room are if the child is under 6 months old, if the fever has lasted longer than 72 hours, if the child has a rash and fever together, if the child is difficult to arouse, the child has a history of seizures, or if the child is very, very sick.

When my children had fevers over 40 C, I put them in a luke warm bath. This is now considered less useful, unless it makes the child more comfortable. Sponge or regular baths cool the skin through evaporation. However, this induces the body to shiver and vasoconstrict as the body tries to get its temperature back up to it high set point. It is like a furnace trying to get back to a higher thermostat setting.

It works better if we can reset the thermostat to a lower temperature. That is what medications like acetaminophen (tylenol) or ibuprofen (advil) do. Both acetaminophen and ibuprofen should be dosed based on the child's weight, not the child's age. Acetaminophen is usually dosed at 10-15 mg/kg/dose every 4-6 hours up to 5 doses in 24 hours. Ibuprofen is usually dosed at 5-10 mg/kg/dose every 6 to 8 hours up to 4 doses in 24 hours. Most medication boxes will have nice simple weight/dose charts on their side. However, if you are at all confused or concerned by what dose to give your child, phone the pharmacy. We can help.

There are a few medication things not to do when your child has a fever. Don't give them ASA. We worry about that leading to a condition called Reye's Syndrome. Don't give them naproxen sodium or alleve. That hasn't be studied in fevers in children.

In 1997, Deep Blue from IBM beat Garry Kasperov at Chess. The world was stunned. In 2011 Watson from IBM beats Brad Rutter and Ken Jennings at Jeopard. The world is amazed. In October 2015 AlphaGo by Google beat a human Go champion 4 games to 1 and the world seemed to barely notice. Maybe since Go is not a game we in the west are familiar with, it didn't make an impact. But Go has more potential moves than there are atoms in the universe. AlphaGo didn't win because of raw computing power and memory. It is smart. And, you know whose putting out the welcome mat.

Canadian Paediatric Society - Temperature Measurements in Paediatrics www.cps.ca/en/documents/position/temperature-measurement

As always if you have any questions or concerns about these products, ask your pharmacist.

 


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