Fever In Children: Dont Treat the Thermometer, Treat the Child
Mar 26, 2013
By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy
This winter just does not want to end, and neither does our cold and flu season. No parent wants to see their baby or child sick, so when they see a high temperature on their thermometer, panic usually sets in. They rush to medicine cabinet, looking from something to bring that high number down, and if they dont have anything, its off to the pharmacy. A fever is the bodys response, in which it attempts to find a new body temperature, called a set point temperature. Normally the bodys temperature is around 38C. Any temperature consistently higher than 38C is a fever.
Fever itself is not usually harmful and it may actually help activate the bodys immune system to fight the disease. When treating fever we aim to provide patient comfort and avoid further effects from the fever. It is important to remember fever is a symptom of a disease, not an actual diagnosis. Most commonly fever develops in response to an infection. High fevers with temperatures over 41.1C may indicate a more serious infection and medication attention is advised.
Touching your childs forehead is not the proper way to determine if they have a fever. Temperature measurements can be taken using a variety of thermometers, which are available at the pharmacy. Measurements can be taken in the rectum, mouth or ear as long as you are using the proper type of thermometer. Axillary temperature or measurements taken from the arm-pit region are not recommended as they are often difficult to measure and are inaccurate.
Acetaminophen and ibuprofen are the fever treatments of choice. Acetaminophen is marketed as Tylenol and Tempra and ibuprofen is sold as Advil or Motrin. Both are available without a prescription. They have been well studied and are considered safe if given at the proper dose.
Acetaminophen is recommended as first line therapy because of its long term use in paediatrics and its very good safety profile. Acetaminophen should be given in doses of 10-15 mg/kg every four to six hours. Side effects are extremely uncommon if given at the proper dose. It is the only medication recommended for a baby under 6 months old.
Ibuprofen is considered 2nd line therapy and can be given at doses of 5-10 mg/kg every 6-8 hours. Side effects are also uncommon if given at the proper dose; however, some GI or stomach upset can occur. Acetylsalicylic acid or Aspirin is not recommended in children under 15 years of age.
One of the biggest questions I get asked in the pharmacy is whether Acetaminophen and Ibuprofen can be given together or alternated. The answer I provide is yes, in certain situations when absolutely necessary. However, parents must follow label instructions closely and be sure to monitor their children for any possible side effects. Also if one medication seems to lower the fever effectively, only use one!
Other methods have limited value but they can be tried to lower core body temperature. Sponging with cool water can dissipate body heat. Alcohol is never recommended is it can be absorbed through the skin or ingested by the child. When sponging, always remember colder water is more uncomfortable to the child. Ice Pack or cooling blankets can lower the body temperature by a process called conduction. However it can lead to rebound hyperthermia and you must be very cautious not to freeze sensitive skin. Circulating fans directed over ice may transfer heat away from the childs skin surface.
Another common question how long parents should wait until taking their feverish child in to see a physician. The answer depends on the age of the child. If the child is under three months old, consult a doctor immediately. If the child is between three months and two years old consult a physician if the fever lasts more than three days or if it their temperature is 40 degrees Celsius or higher. Children who are greater than two years old and are feverish more than three days, should see a physician.
My advice today is when your child develops a fever, always question why the fever is happening. Sometimes we try to focus on eliminating the fever and forget to investigate the reason behind it. There may be an underlying illness. There is a saying Dont treat the thermometer, treat the child.
As always if you have any questions or concerns about these products, ask your pharmacist.
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.
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