What is fever?
An increase in body temperature above normal is defined as fever. In general, a rectal temperature of 38 0C (10.4 0F) is considered fever.
Where can body temperature be measured?
Body temperature can be measured anus, mouth, ear, armpit or forehead. Oral and rectal measurements reflect actual body temperature better. However, due to risks, both methods are not often preferred in practice.
Eating cold or hot food and breathing rate may affect the oral measurement. In addition, oral measurement carries a risk of trauma, especially in children who cannot adapt. Anal measurements carry the risk of trauma and bowel injury, similar to oral measurements. Except for special cases, rectal body temperature measurement in children is not recommended.
In daily practice, the most common body temperature measurement sites in children are the ear, forehead and armpit.
What should be the normal body temperature?
Body temperature depends on the child's age, the body part being measured, and the time of day the measurement is taken. It varies depending on. Therefore, it is difficult to give standard values valid for all children. In general:
-
Body temperature is higher in children than in adults, especially in the first two years of life. As age increases, body temperature decreases towards adult levels.
-
Body temperature fluctuates during the day. Under normal conditions, the highest body temperature values are measured between 17-19 hours and the lowest body temperature values are measured between 24-06 hours. The difference between the highest and lowest body temperatures during the day can be up to 1.1 0C.
-
In general, the temperature measured from the anus (rectal) is approximately 0.5 0C higher than the temperature measured from the mouth (oral), which is approximately 0.5 0C higher than the temperature measured from the armpit (axillary).
-
Values accepted as fever in measurements taken from different body parts in childhood are shown in the table.
Why does body temperature increase?
Under normal conditions The temperature control center in our brain is programmed to keep the internal body temperature constant at 36.50C. Microorganisms such as bacteria and viruses that enter our body, chemical, metabolic and toxic substances stimulate the release of substances called endogenous pyrogens (fever-forming) in our body. These substances affect the region of the brain called the hypothalamus and increase the preset body temperature thermostat level. This results in an increase in body temperature.
Body temperature may increase without changing the body temperature setting due to factors such as tight dressing, environmental temperature, sunstroke, medication and toxins. In this case, called hyperthermia, diagnosis and treatment approaches are different from those of a febrile child.
Is fire always harmful?
Body temperature often rises as a useful defense mechanism. Substances that change body temperature regulation are called endogenous pyrogens. While these substances cause fever to rise, they also have a stimulating effect on immune cells against microorganisms. In addition, microorganisms multiply most easily at the natural body temperature of 36.5–37.5 °C. High body temperature limits the proliferation and harmful effects of harmful microorganisms. In this respect, an increase in body temperature up to a certain level has a positive effect on controlling infections. Fever can be considered harmless as long as it does not reduce the child's activity and appetite or disturb his comfort. However, fever, which negatively affects nutrition and activity and affects the child's comfort, requires intervention.
Is the level of fever an indicator of the severity of the disease?
The severity of fever may not always be an indicator of the severity of the disease. In general, refractory and high fever are more likely to be associated with a serious infection. However, this is not a rule. While some viral infections that are not serious in childhood may have a very high fever, more serious infections may have a milder fever.
What changes occur during periods of rise and fall in body temperature?
During the rise in body temperature, feeling cold, shivering, Coldness, pallor and bruising of the fingertips and lips may occur due to temporary narrowing of the superficial veins. Due to the increase in body temperature and metabolic rate, heart rate, respiratory rate, fluid and calorie needs increase. Depending on the degree of fever, restlessness, weakness, loss of appetite, delirium and hallucinations may occur. Especially in children between the ages of 6 months and 6 years, febrile seizures may occur.
When body temperature reaches its highest level, the skin often appears pink or red. Sweating is an indication that body temperature has decreased.
In what situations should fever be considered normal? Which feverish children can be monitored at home?
Body temperature may increase when the environmental temperature is high or the child is dressed tightly in a way that is not compatible with the ambient temperature. In this case, adjusting the environmental temperature or the child's clothing is sufficient for the body temperature to return to normal.
There may be temporary increases in body temperature in situations such as excessive movement, crying, fear, excitement.
During teething periods, there may be slight and temporary increases in body temperature.
Children with fever that does not increase to very high temperatures, returns to normal with environmental regulation or antipyretics, does not cause any deterioration in the child's activity or nutrition, is short-term and is not accompanied by other findings such as diarrhea, vomiting, rash, cough and shortness of breath, should be kept at home. They can be tracked.
What can be done at home to lower body temperature?
Fever is a defense mechanism of the body. Fever up to 38.5-39 0C may not be intervened unless it causes significant deterioration in the child's activity, nutrition and comfort.
The definitive treatment of fever is to eliminate the condition that causes an increase in body temperature. Until this is achieved, various practices can be performed to control body temperature. These include adjusting the ambient temperature and clothing, taking a warm shower, applying cold and using antipyretic drugs. During these applications, the aim should never be to return the body temperature to normal levels. Weakness, restlessness, malnutrition due to fever The main goal should be to eliminate such situations and increase the comfort of the child.
In mild fever, removing the child's thick clothing, reducing his/her activities (resting), increasing fluid intake and lowering the ambient temperature are usually sufficient. Young children are stripped of their clothes, leaving their undershirts and panties/diapers on. A thin cloth can be covered over them. Older children can be dressed in full-length clothing. Ambient temperature can be reduced to 18 0C.
In a child with fever, fluid loss from the body increases due to sweating or evaporation from the lungs due to frequent breathing. Fever also increases the tendency to vomit. For this reason, liquid foods should be given to children with fever frequently and little by little. Babies who are breastfed should be breastfed at frequent intervals.
In case of high body temperatures, antipyretic drugs can be used. The child should be monitored for signs that indicate a significant health problem.
When should warm application be done and what should be taken into consideration?
Warm application can be applied to children over 3 months of age whose fever does not subside within 30 minutes despite being given antipyretic medication. It is an effective method to reduce body temperature, especially in young children, since their body surface area is large compared to their body weight. For this purpose, cloths or cotton balls moistened with warm water between 29-32 C are placed in areas where large vessels are closer to the body surface, such as the neck, belly, armpit and groin. Wet cloth and cotton should be changed frequently. The procedure can be continued until the body temperature drops by 1 0C. This application can also be done as a warm shower. Nowadays, there are also pads developed for physical cooling for both children and adults.
Points to consider in warm application:
-
Warm application does not cause any change in the thermostat setting in the heat control center. Warm application does not cause any change in the thermostat setting in the heat control center. Even if the skin temperature drops when the application is made, it will rise again in a short time. Therefore, warm application should be considered in children whose fever does not subside within 30 minutes despite antipyretic medication.
-
Warm application can be started earlier in case of excessive increases in body temperature due to external factors such as very high environmental temperature, sunstroke, drug poisoning, and in case of febrile seizure.
-
Sudden and rapid drops in body temperature, as well as high fever, can also cause negative consequences. For this reason, antipyretic medication and warm application should not be done at the same time.
-
Cold application disrupts the comfort of the sick child, increases his/her restlessness and causes sudden drops in body temperature. For this reason, cold water and ice should not be used in the application, and vinegar should not be added to the water.
-
Alcohol or cologne should not be applied to the bodies of children with high fever as they cause serious poisoning.
-
If excessive shivering occurs during warm application, the water temperature can be increased slightly.
In what situation might fever be important? Should a healthcare provider be consulted for further examination?
In the presence of at least one of the following conditions, fever may be a sign of a significant health problem.
-
Generally, it is less than 3 months old. Fever over 38 0C in children and over 39 0C in older children.
-
The baby is less than three months old, especially newborn or premature,
-
Chronic diseases, especially heart, lung, liver and kidney diseases Presence of disease,
-
Fever lasting more than 72 hours, especially more than 5 days, despite treatment,
-
Fever accompanied by bloody and/or mucus-filled diarrhea accompanying,
-
The presence of a congenital or acquired disease that suppresses the immune system or the use of immunosuppressive drugs,
-
Fever accompanied by a rash to do.
-
Unusually weak, high-pitched or persistent crying, inconsolable.
In what cases does fever require urgent diagnosis and treatment?
