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Fever (Children)

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Fever in children is a temporary elevation of body temperature, often in response to an infection or illness. 
&nbsp;

A fever is an increase in the body temperature, typically around 100.4&deg;F (38&deg;C).<a href="#accordion">[5]</a> All children get a fever occasionally and usually recover within a few days. In fact, it is one of the most common causes of 15-25% of consultations in emergency and primary care departments.<a href="#accordion">[6]</a>

Enteric fever, caused by Salmonella typhi and Paratyphi, is a significant concern in South Asia, particularly among children. Studies have highlighted the predominance of typhoid fever in school-going children in Nepal.<a href="#accordion">[2]</a> 
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Complications from <a href="https://merisehat.pk/disease/typhoid-fever">typhoid fever</a> have been found to occur in 10&ndash;15% of hospitalized patients, with evidence of a higher risk in children under 5, especially when effective antimicrobial treatment is delayed.<a href="#accordion">[3][4]</a>

Another common bacterial infection in infants, UTI, has a prevalence of 7% among children under 24 months old with fever without a source.<a href="#accordion">[1]</a> 
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Fevers can be categorized as:<a href="#accordion">[7][8]</a>

<ul>
	<li>Low-Grade Fever &ndash; The body temperature elevates slightly; lies between 98.8&deg;F (37.1&deg;C) and 100.3&deg;F (38&deg;C)</li>
	<li>High-Grade Fever &ndash; The rectal temperature exceeds 100.4&deg;F (38&deg;C) for babies under 3 months old and 102&deg;F (38.9&deg;C) for kids over 3 months old</li>
	<li>Acute Fever &ndash; It is caused by an infection (e.g., cold, flu, an infection of the digestive tract, pneumonia, UTI, and otitis media)</li>
	<li>Chronic Fever &ndash; It is caused by prolonged or recurring viral illnesses (e.g., hepatitis, TB, sinusitis, juvenile idiopathic arthritis, and leukemia) 
	&nbsp;</li>
</ul>

Sign and Symptoms

Fever is generally accompanied by chills, headaches, a lack of appetite, aches, sweating, dehydration, and a lack of energy.

Other signs observed with specific causes of fever include:

<ul>
	<li>Rashes and vomiting in dengue</li>
	<li>Fever lasting 5 days or more in typhoid</li>
	<li>Seasonal peaks, with the highest incidence occurring from March to June and a lower peak from November to January, in scarlet fever</li>
	<li>Age and geographical location in fever of unknown origin 
	&nbsp;</li>
</ul>

Causes

These include viral and bacterial vectors mainly. For instance, Aedes mosquitoes, Salmonella typhi, E. coli, and group A Strep.

Newborns and infants are more likely to develop serious infections, given that their immune systems are not fully developed. These infections may be acquired prenatally or during birth.

Other less common causes include side effects of certain medicines, vaccinations, and heatstroke. 
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Diagnosis

Doctors will begin by checking the child&rsquo;s breathing, pulse rate, and blood pressure and taking note of their health history. The healthcare professional will also check to see if they are dehydrated.

Often, no tests are advised if the child does not present with any worrying symptoms. For instance, fever may be a natural response to coughs and colds, some common childhood illnesses like <a href="https://merisehat.pk/disease/tonsillitis">tonsillitis</a> or chickenpox, or vaccination. 
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However, occasionally, a diagnosis may require the following tests to help doctors identify underlying infections or other illnesses causing the fever:

<ul>
	<li>Urinalysis and culture</li>
	<li>Complete blood cell count</li>
	<li>ESR</li>
	<li>CRP</li>
	<li>Stool tests</li>
	<li>Antibody levels</li>
	<li>Chest x-rays</li>
	<li>Bone scans</li>
	<li>CT of the sinuses 
	&nbsp;</li>
</ul>

Treatment

The following measures are usually recommended for fever in children:

<ul>
	<li>Over-the-counter medications, such as Tylenol or Advil, to reduce temperature and relieve body aches.</li>
	<li>Antibiotics are prescribed for bacterial infections.</li>
	<li>Home care measures, such as adequate hydration, light clothing, and rest, are also crucial. However, methods like undressing and taking cold baths that may cause shivering in some instances should be avoided. 
	&nbsp;</li>
</ul>

<h5>Important!</h5>

<ul>
	<li>IV medications and continuous monitoring may be necessary if the baby has a rectal temperature of 100.4&deg;F (38&deg;C) or higher.</li>
	<li>Always check with your doctor before giving any medicine to your child.</li>
	<li>Never give aspirin to a child unless your doctor prescribes it. Aspirin is linked to Reye syndrome, which can be fatal. 
	&nbsp;</li>
</ul>

A high fever may lead to febrile seizures.1 in 30 children aged 6 months to 6 years have febrile convulsions. Most children have it only once during their lifetime, typically with no long-term consequences.

However, get medical help immediately if the seizure lasts for more than 5 minutes, if the child looks unwell after a seizure, or if the child doesn&rsquo;t wake up after the seizure ends.<a href="#accordion">[9]</a> 
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<ul>
	<li style="list-style-type: none;">Preventing mosquito bites through insect repellents or mosquito nets can help avoid dengue fever.</li>
	<li>Ensuring proper hygiene and safe food and water practices can reduce the risk of typhoid fever and other illnesses.</li>
	<li>Vaccination against specific pathogens, such as Streptococcus bacteria, can help prevent scarlet fever. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li style="list-style-type: none;">Various infectious and non-infectious conditions cause fever in children, which requires thorough evaluation and management.</li>
	<li>Specific diagnostic tests and screening methods are essential for identifying the underlying cause of fever in children.</li>
	<li>Preventive measures, including vaccination and hygiene practices, play an important role in reducing the risk of fever in children.</li>
</ul>

[1] Barbi, E., Marzuillo, P., Neri, E., Naviglio, S., & Krauss, B. (2017). Fever in children: pearls and pitfalls. Children, 4(9), 81

[2] Singh, S., Shrestha, S., Shrestha, N., & Manandhar, S. (2013). Enteric fever in children at dhulikhel hospital. Journal of Nepal Paediatric Society, 32(3), 216-220.

[3] Espinoza, L., McCreedy, E., Holm, M., Im, J., Mogeni, O., Parajulee, P., … & Marks, F. (2019). Occurrence of typhoid fever complications and their relation to duration of illness preceding hospitalization: a systematic literature review and meta-analysis. Clinical Infectious Diseases, 69(Supplement_6), S435-S448.

[4] Khatun, H., Islam, S., Naila, N., Islam, S., Nahar, B., Alam, N., … & Ahmed, T. (2018). Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture‐proven typhoid patients admitted to an urban hospital in bangladesh. Tropical Medicine & International Health, 23(4), 359-366.