Fever
Definition
HealthSciences - The human body has the anterior hypothalamus in the brain responsible for the regulation to be stable body temperature (thermostat) which ranges from 37 ℃ +/- 1.
Temperature measurement
Temperatures in the area anal (rectal temperature) closest to the actual body temperature (core body temperature). Temperatures in the area of the mouth or the armpit (axilla) about 0.5 to 0.8 ℃. lower than the temperature rectally, with a note after the measurement for at least 1 minute. Not recommended measure ( "guess") body temperature by touching the hand (without using a thermometer).
Physiology Fever (What Happened Fever)
Fever is usually caused by the body's exposure to infectious microorganisms (viruses, bacteria, parasites). Fever may also be caused by non-infectious factors such as immune complexes, or inflammation more. When a virus or bacteria enters the body, the various types of white blood cells or leukocytes release "fever-causing substances (endogenous pyrogen)" which in turn triggers the production of prostaglandin E2 in the anterior hypothalamus, which then increases the value of the threshold temperature and there was fever. During fever, the hypothalamus carefully controlling the temperature rise so that the body rarely exceeds 41 ℃.
Fever impact
Beneficial Impact on Body Immune Function
Some research evidence 'in-vitro' (not done directly on the human body) showed the defense function of the human body works well at temperatures fever, compared to a normal temperature. IL-1 and other endogenous pyrogens will "invite" more leukocytes and increase their activity in inhibiting the growth of microorganisms. Fever is also triggered in the number of leukocytes and increases the production / function of interferon (a substance that helps leukocytes combat microorganisms).
Negative impact
First, the possibility of dehydration (lack of body fluids). When experiencing fever, increased evaporation of body fluids so that children can dehydrate.
Second, the lack of oxygen. When the fever, the child with lung disease or heart disease blood vessel may suffer a lack of oxygen, so that the lung disease or heart abnormalities acute respiratory infections felt heavier.
Third, fever above 42℃ can cause neurological damage (nerve) , although very rare. There is no research evidence that indicates the occurrence of neurological damage when the fever below 42℃.
Lastly, children under the age of 5 years (toddlers), mainly at the age between 6 months and 3 years old, at risk of febrile seizures (febrile convulsions), particularly in rectal temperature above 40 ℃. Febrile seizures usually goes away by itself, and does not cause neurological disorders (nerve damage).
Fever is often accompanied by other symptoms such as headache, decreased appetite (anorexia), weakness, and muscle pain. Most of them are associated with fever-causing substances before.
Fever Virus Infection
Fever in infants and children are usually caused by a viral infection. In a fever accompanied by canker sores, chicken pox rash, or other rashes are easily recognizable, as the virus that can cause fever soon be concluded without the need for special examination. Mild fever can also be found in children with cough, runny nose (common colds), with rinovirus one of the most frequent causes. Other causes of fever in children is enteritis (inflammation of the gastrointestinal tract) caused mainly by rotavirus.
Viral diseases are self-limiting disease (will end and heal by itself).
Fever Bacterial Infections
Among the fever caused by bacterial infections in children, one of the most common are urinary tract infection (UTI). Generally not accompanied by other symptoms. Most at risk have a baby younger than 6 months.
More serious bacterial infections such as pneumonia or meningitis (infection of the lining of the brain) can also cause symptoms of fever. However, the percentage is not great. From infants> 3 months and children 1-3 years old with fever> 39 ℃. only 2% (1-3.6%) are bacteria have entered the bloodstream (bacteremia).
In this age group, Hib immunization program succeeded in reducing the risk of bacterial meningitis are very significant.
pneumoniae (a major cause of bacterial infections are serious enough).
Seniors who require high vigilance of parents and doctors are under the age of 3 months. Babies should undergo a more thorough examination because 10% of it can have serious bacterial infection, and one of which is meningitis. To facilitate the risk assessment, Rochester assign some points to identify low risk of serious bacterial infections in infants with fevers.
Rochester criteria are :
Baby looks fine.
The previously healthy baby:
Born at term (≥ 37 weeks of gestation).
There is no history of treatment for hyperbilirubinemia (jaundice) for no apparent reason.
There is no history of treatment with antibiotics.
There is no history of hospitalization. There is no chronic disease or other underlying diseases fever.
Discharged from a maternity joint / before Mother.
No signs of skin infection, soft tissue, bones, joints, or ears.
Laboratory values as follows :
Leukocytes 5000-15000 / ml
Neutrophil counts rod 1500 / mL. ≤10 leukocytes in urine
≤ 5 erythrocytes (red blood cells).
In infants with diarrhea stool
Although it is known that most of the causes of fever is a viral infection, but the data show that in fact the majority of medical staff diagnosed as bacterial infections. In one study in the United States, this percentage reaches 56%. And in the same study still found their antibiotics at a fever that has not been clearly identified cause (either viral or bacterial).
Drug effects Pereda Fever (Antipyretic)
One study reported that voluntary adult volunteers infected with the virus Rhinovirus and treated with therapeutic doses of aspirin (the usual dose used in the treatment), more likely to become ill than those receiving placebo. Results were similar (although not significant), reported with the use of aspirin and paracetamol. Furthermore, the use of these two drugs, plus ibuprofen, increasing the blockage in the nose (nasal obstruction) and suppress the antibody response. And other studies do not support this finding.
In a survey of 147 children with bacterial infection, there was no difference in length of stay in those given two or more of antipyretics, compared with those receiving one, or were not given an antipyretic.
A randomized study of children who allegedly caused fever virus, showed paracetamol does not reduce the duration of fever and did not eliminate the symptoms associated. However, acetaminophen make children a little more active and fitter.
Treatment with Antipyretic
Work mechanism
Paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are more effective antipyretic. Works by inhibiting the production of prostaglandin E2 in the anterior hypothalamus (which rise in response to the endogenous pyrogen).
Paracetamol.
Paracetamol is the drug of choice in children. The dose of 10-15 mg / kg / times.
Paracetamol is conjugated in the liver to sulfate derivatives and glukoronida, but there is a small part metabolized to form intermediates aryl hepatotoxic (be toxic to the liver) if the amount exceeds capacity hepatotoxic agent for the liver metabolizes with glutathione or other sulfhydryl (more than 150 mg / kg). Then 500 mg tablets should not be given to children (eg the 500 mg tablet three times can be harmful to the baby with a weight under 10 kg). Packaging in the form of syrup 60 ml safer.
Aspirin
An effective antipyretic use in children but can cause serious side effects. Aspirin is irritating to the stomach thereby increasing the risk of gastric ulcers, bleeding, until perforation (leakage due to the formation of a hole in the stomach wall). Aspirin also can inhibit the activity of platelets (clotting function in the blood) that can lead to the risk of bleeding). Giving aspirin to children with a viral infection shown to increase the risk of Reye's syndrome, a rare disease (incidence until 1980 by 1-2 per 100 thousand children per year), which is characterized by liver and kidney damage. Therefore, it is not recommended for children under five.
Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
Type (NSAIDs) are most commonly used in children is ibuprofen. A dose of 5-10 mg / kg / times have antipyretic effectiveness equivalent to aspirin or paracetamol. Similar to aspirin and other NSAIDs, ibuprofen can cause stomach ulcers, bleeding, and perforation, although these complications are rare in children. Ibuprofen is also not recommended for children experiencing fever and diarrhea with or without vomiting.
Other types,
Pyrazolone derivatives such as phenylbutazone and dipiron, effective as antipyretics, but far more toxic (harmful).
Therapy
Supportive therapy
Efforts are Recommended
Increase fluid intake (breast milk, milk, water, soup, or fruit juice). Drinking a lot also capable of being an expectorant (salve airways) by reducing the production of mucus in the airways. Rarely, severe dehydration in the absence of diarrhea and vomiting constantly.
Avoid fatty foods are difficult to digest because of fever lowering activity of the stomach.
Wear light clothing good indoor air vents. Children don't have to continue to lie in bed, but kept to refrain from excessive activity.
Child with warm water compress to do if a child is fussy and felt very uncomfortable, generally at an ambient temperature of 40 ℃. Compress can be done by putting the child in the tub already filled with warm water. Then wash the body, arms and legs of children with the warm water. Generally compress the child will reduce fever within 30-45 minutes. However, if the child feels increasingly uncomfortable with bathing, don't do it !!!
Efforts Supportive Not Recommended
Efforts to 'cool down' the child to undress, bathe or wash with cold water, or compress with alcohol. If the threshold values of the hypothalamus has been debased in advance with the drug, undress the child or compress with cold water will only make him shiver (and uncomfortable), as the body attempts to maintain the temperature of the center is at the threshold value that has been adjusted. Besides alcohol can also be absorbed through the skin into the bloodstream, and certainly there is a risk of toxicity.
Conclusion fever
The views of society will continue to change fever. Now the fever is regarded as a response 'healthy' to disease and considered reasonable. Treatment is 'aggressive' must be proven by scientific evidence. So the rational therapy is reassuring to patients and health workers, and to ensure that they are 'controlling' her disease and not 'controlled' by disease.
Efforts to deal with the fever is not a priority. The first act is there any identifying bacterial infections (pneumonia, otitis media, streptococcal pharyngitis, meningitis, or sepsis) , and if necessary refer to the hospital for further action.
Both parents and health professionals should not automatically give fever relief medication to all children with a fever. “ Take care of her, not the thermometer " . Enterprises relieve fever is intended to overcome the inconvenience of the child (if significant), and is usually obtained through oral administration of paracetamol in children who only have a high fever alone. This would create health care (and families) who efficiently directed solely for the good of children, an emphasis on finding the cause and through efforts to reduce unnecessary polypharmacy, and to prioritize essential treatment alone.
Read also :
⇨How to prevent children from insomnia.
⇨Protect kids from adenovirus Infection.
⇨Chronic and acute respiratory Infections.
Definition
HealthSciences - The human body has the anterior hypothalamus in the brain responsible for the regulation to be stable body temperature (thermostat) which ranges from 37 ℃ +/- 1.
Temperature measurement
Temperatures in the area anal (rectal temperature) closest to the actual body temperature (core body temperature). Temperatures in the area of the mouth or the armpit (axilla) about 0.5 to 0.8 ℃. lower than the temperature rectally, with a note after the measurement for at least 1 minute. Not recommended measure ( "guess") body temperature by touching the hand (without using a thermometer).
Physiology Fever (What Happened Fever)
Fever is usually caused by the body's exposure to infectious microorganisms (viruses, bacteria, parasites). Fever may also be caused by non-infectious factors such as immune complexes, or inflammation more. When a virus or bacteria enters the body, the various types of white blood cells or leukocytes release "fever-causing substances (endogenous pyrogen)" which in turn triggers the production of prostaglandin E2 in the anterior hypothalamus, which then increases the value of the threshold temperature and there was fever. During fever, the hypothalamus carefully controlling the temperature rise so that the body rarely exceeds 41 ℃.
Fever impact
Beneficial Impact on Body Immune Function
Some research evidence 'in-vitro' (not done directly on the human body) showed the defense function of the human body works well at temperatures fever, compared to a normal temperature. IL-1 and other endogenous pyrogens will "invite" more leukocytes and increase their activity in inhibiting the growth of microorganisms. Fever is also triggered in the number of leukocytes and increases the production / function of interferon (a substance that helps leukocytes combat microorganisms).
Negative impact
First, the possibility of dehydration (lack of body fluids). When experiencing fever, increased evaporation of body fluids so that children can dehydrate.
Second, the lack of oxygen. When the fever, the child with lung disease or heart disease blood vessel may suffer a lack of oxygen, so that the lung disease or heart abnormalities acute respiratory infections felt heavier.
Third, fever above 42℃ can cause neurological damage (nerve) , although very rare. There is no research evidence that indicates the occurrence of neurological damage when the fever below 42℃.
Lastly, children under the age of 5 years (toddlers), mainly at the age between 6 months and 3 years old, at risk of febrile seizures (febrile convulsions), particularly in rectal temperature above 40 ℃. Febrile seizures usually goes away by itself, and does not cause neurological disorders (nerve damage).
Fever is often accompanied by other symptoms such as headache, decreased appetite (anorexia), weakness, and muscle pain. Most of them are associated with fever-causing substances before.
Fever Virus Infection
Fever in infants and children are usually caused by a viral infection. In a fever accompanied by canker sores, chicken pox rash, or other rashes are easily recognizable, as the virus that can cause fever soon be concluded without the need for special examination. Mild fever can also be found in children with cough, runny nose (common colds), with rinovirus one of the most frequent causes. Other causes of fever in children is enteritis (inflammation of the gastrointestinal tract) caused mainly by rotavirus.
Viral diseases are self-limiting disease (will end and heal by itself).
Fever Bacterial Infections
Among the fever caused by bacterial infections in children, one of the most common are urinary tract infection (UTI). Generally not accompanied by other symptoms. Most at risk have a baby younger than 6 months.
More serious bacterial infections such as pneumonia or meningitis (infection of the lining of the brain) can also cause symptoms of fever. However, the percentage is not great. From infants> 3 months and children 1-3 years old with fever> 39 ℃. only 2% (1-3.6%) are bacteria have entered the bloodstream (bacteremia).
In this age group, Hib immunization program succeeded in reducing the risk of bacterial meningitis are very significant.
pneumoniae (a major cause of bacterial infections are serious enough).
Seniors who require high vigilance of parents and doctors are under the age of 3 months. Babies should undergo a more thorough examination because 10% of it can have serious bacterial infection, and one of which is meningitis. To facilitate the risk assessment, Rochester assign some points to identify low risk of serious bacterial infections in infants with fevers.
Rochester criteria are :
Baby looks fine.
The previously healthy baby:
Born at term (≥ 37 weeks of gestation).
There is no history of treatment for hyperbilirubinemia (jaundice) for no apparent reason.
There is no history of treatment with antibiotics.
There is no history of hospitalization. There is no chronic disease or other underlying diseases fever.
Discharged from a maternity joint / before Mother.
No signs of skin infection, soft tissue, bones, joints, or ears.
Laboratory values as follows :
Leukocytes 5000-15000 / ml
Neutrophil counts rod 1500 / mL. ≤10 leukocytes in urine
≤ 5 erythrocytes (red blood cells).
In infants with diarrhea stool
Although it is known that most of the causes of fever is a viral infection, but the data show that in fact the majority of medical staff diagnosed as bacterial infections. In one study in the United States, this percentage reaches 56%. And in the same study still found their antibiotics at a fever that has not been clearly identified cause (either viral or bacterial).
Drug effects Pereda Fever (Antipyretic)
One study reported that voluntary adult volunteers infected with the virus Rhinovirus and treated with therapeutic doses of aspirin (the usual dose used in the treatment), more likely to become ill than those receiving placebo. Results were similar (although not significant), reported with the use of aspirin and paracetamol. Furthermore, the use of these two drugs, plus ibuprofen, increasing the blockage in the nose (nasal obstruction) and suppress the antibody response. And other studies do not support this finding.
In a survey of 147 children with bacterial infection, there was no difference in length of stay in those given two or more of antipyretics, compared with those receiving one, or were not given an antipyretic.
A randomized study of children who allegedly caused fever virus, showed paracetamol does not reduce the duration of fever and did not eliminate the symptoms associated. However, acetaminophen make children a little more active and fitter.
Treatment with Antipyretic
Work mechanism
Paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are more effective antipyretic. Works by inhibiting the production of prostaglandin E2 in the anterior hypothalamus (which rise in response to the endogenous pyrogen).
Paracetamol.
Paracetamol is the drug of choice in children. The dose of 10-15 mg / kg / times.
Paracetamol is conjugated in the liver to sulfate derivatives and glukoronida, but there is a small part metabolized to form intermediates aryl hepatotoxic (be toxic to the liver) if the amount exceeds capacity hepatotoxic agent for the liver metabolizes with glutathione or other sulfhydryl (more than 150 mg / kg). Then 500 mg tablets should not be given to children (eg the 500 mg tablet three times can be harmful to the baby with a weight under 10 kg). Packaging in the form of syrup 60 ml safer.
Aspirin
An effective antipyretic use in children but can cause serious side effects. Aspirin is irritating to the stomach thereby increasing the risk of gastric ulcers, bleeding, until perforation (leakage due to the formation of a hole in the stomach wall). Aspirin also can inhibit the activity of platelets (clotting function in the blood) that can lead to the risk of bleeding). Giving aspirin to children with a viral infection shown to increase the risk of Reye's syndrome, a rare disease (incidence until 1980 by 1-2 per 100 thousand children per year), which is characterized by liver and kidney damage. Therefore, it is not recommended for children under five.
Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
Type (NSAIDs) are most commonly used in children is ibuprofen. A dose of 5-10 mg / kg / times have antipyretic effectiveness equivalent to aspirin or paracetamol. Similar to aspirin and other NSAIDs, ibuprofen can cause stomach ulcers, bleeding, and perforation, although these complications are rare in children. Ibuprofen is also not recommended for children experiencing fever and diarrhea with or without vomiting.
Other types,
Pyrazolone derivatives such as phenylbutazone and dipiron, effective as antipyretics, but far more toxic (harmful).
Therapy
Supportive therapy
Efforts are Recommended
Increase fluid intake (breast milk, milk, water, soup, or fruit juice). Drinking a lot also capable of being an expectorant (salve airways) by reducing the production of mucus in the airways. Rarely, severe dehydration in the absence of diarrhea and vomiting constantly.
Avoid fatty foods are difficult to digest because of fever lowering activity of the stomach.
Wear light clothing good indoor air vents. Children don't have to continue to lie in bed, but kept to refrain from excessive activity.
Child with warm water compress to do if a child is fussy and felt very uncomfortable, generally at an ambient temperature of 40 ℃. Compress can be done by putting the child in the tub already filled with warm water. Then wash the body, arms and legs of children with the warm water. Generally compress the child will reduce fever within 30-45 minutes. However, if the child feels increasingly uncomfortable with bathing, don't do it !!!
Efforts Supportive Not Recommended
Efforts to 'cool down' the child to undress, bathe or wash with cold water, or compress with alcohol. If the threshold values of the hypothalamus has been debased in advance with the drug, undress the child or compress with cold water will only make him shiver (and uncomfortable), as the body attempts to maintain the temperature of the center is at the threshold value that has been adjusted. Besides alcohol can also be absorbed through the skin into the bloodstream, and certainly there is a risk of toxicity.
Conclusion fever
The views of society will continue to change fever. Now the fever is regarded as a response 'healthy' to disease and considered reasonable. Treatment is 'aggressive' must be proven by scientific evidence. So the rational therapy is reassuring to patients and health workers, and to ensure that they are 'controlling' her disease and not 'controlled' by disease.
Efforts to deal with the fever is not a priority. The first act is there any identifying bacterial infections (pneumonia, otitis media, streptococcal pharyngitis, meningitis, or sepsis) , and if necessary refer to the hospital for further action.
Both parents and health professionals should not automatically give fever relief medication to all children with a fever. “ Take care of her, not the thermometer " . Enterprises relieve fever is intended to overcome the inconvenience of the child (if significant), and is usually obtained through oral administration of paracetamol in children who only have a high fever alone. This would create health care (and families) who efficiently directed solely for the good of children, an emphasis on finding the cause and through efforts to reduce unnecessary polypharmacy, and to prioritize essential treatment alone.
Read also :
⇨How to prevent children from insomnia.
⇨Protect kids from adenovirus Infection.
⇨Chronic and acute respiratory Infections.
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