1-What is the normal temperature of the body, when is fever mentioned?
Fever is defined as body temperature being higher than normal. Hyperthermia is when the body temperature exceeds 41 ºC. Recent studies have shown that normal body temperature in children is 37.9 ºC. Normally, the body temperature of newborns is higher than that of older children. Based on oral skin temperature, the average temperature in the first 6 months of life is 37.5ºC, after the age of 3 it drops below 37.2ºC, and at the age of 11 the average temperature is 36.7ºC. Body temperature during the day shows a circadian rhythm starting from the age of two, with the lowest measured around 06.00 and the highest around 18.00. Diurnal variations within the first two years are not very significant. Body temperature measured in the evening is 0.6°C higher in children aged 6 months to 2 years, and approximately 1°C higher in those over two years of age, compared to that measured in the early morning hours. The temperature measured under the armpit is approximately 1.0ºC lower than the rectal temperature and 0.5ºC lower than the oral temperature. Normal body temperature varies between 36.5ºC and 37.5ºC. In children, there may be a slight increase in body temperature in the afternoon after playing and feeding. In cases such as overdressing, excessive physical activity, hot weather, dehydration, body temperature may rise without illness.
If the temperature measured under the tongue is between 37.4ºC-38ºC, subfebrile fever is between 38ºC-38.4ºC, mild fever is between 38.5ºC- A moderate fever between 39ºC, a high fever between 39ºC and 40ºC, and a very high fever between 41ºC and above. When 0.5ºC is added to these values, rectal fever is obtained, and when 0.5ºC is subtracted, armpit fever values are obtained.
2- What methods should be used to measure fever in children?
Fire It can be measured by different methods.
Underarm
Rectal
Inguinal
Tympanal (measurement from ear)
Orally is measured (intraoral measurement).
Temperature is measured rectally between the ages of 0-4. The child is placed sideways on the examination table or face down on the mother's lap, the degree of mercury is inserted into the anus until the end and held for 3 minutes. It is known that rectal measurement correlates best with body core temperature compared to measurements made by other means. Temperature should not be measured rectally in children with anal lesions, immunocompromised patients and preterms. Measurements made through the axillary and external auditory canal were found to be less sensitive, especially due to reasons such as sweaty skin or improper placement of the thermometer. Oral temperature measurement may be dangerous in children under 6 years of age because the classic thermometer may break. In older children, temperature is taken from the armpit, groin, tympanal, or more accurately under the tongue. Electronic thermometers can also be used. When taking measurements inside the mouth, care should be taken not to consume cold or hot foods and drinks at least 10 minutes before the measurement. The thermometer should be placed under the tongue in the mouth and kept for 2-3 minutes and then read. Measurement should be made under the armpit by keeping the thermometer stationary under the armpit for 3-5 minutes. The child's armpit skin should not be wet and sweaty.
3- What are the main diseases that cause fever in children?
►Infections
Respiratory tract infections (cold, pharyngitis, tonsillitis, otitis, sinusitis, croup, herpangina, bronchitis, bronchiolitis, pneumonia.)
Urinary tract infections
Enteric infections (Acute gastroenteritis)
Central nervous system infections (Meningitis, encephalitis)
Central nervous system infections (Meningitis, encephalitis)
p>Infectious diseases with rash (measles, rubella, chickenpox, scarlet fever) Systemic infections
Localized infections
►Collagen-vascular, connective tissue diseases (Acute rheumatic fever, juvenile, rheumatoid arthritis, systemic lupus erythematosus, Kawasaki disease, Henoch-Schönlein disease)
►Neoplastic diseases (Leukemia, neuroblastoma, lymphoma)
►Dehydration
►Drugs (atropine, salicylate, amphetamine poisoning)
►Vaccines
►Neurological diseases
►Blood diseases
►Bleeding
►Excessively high environmental temperature
Infectious diseases are the most common cause of high fever in childhood. It is possible to identify the microbial agent that often causes fever in children. The increase in body temperature is short-lived and infection can be diagnosed with localized symptoms. In some cases, the infection causing fever cannot be localized; Diagnosis can only be made through laboratory examinations. In pediatric practice, patients with high fever but whose focus cannot be determined constitute the most critical group in terms of follow-up. This group especially includes young children under 3 months and between 3 months and 3 years. During the neonatal period, it may be observed that the baby's fever does not increase during acute infection and may even be hypothermic.
In the first 3 months of life, high fevers are not as common as in older children. Fever due to infections caused by viral pathogens in the respiratory tract and gastrointestinal system is prominent in children between the ages of three and 36 months, especially in the winter months. ) would be It is described as white. In cases of fever whose cause cannot be determined, infections, collagen vascular diseases, and malignancies, especially leukemia and lymphomas, should be distinguished.
4- When does fever cause convulsions in a child? When should families be worried and take the child to the doctor immediately?
Especially in cases of fever above 39 degrees, extreme caution should be exercised in terms of seizures. However, recent studies support that febrile seizures occur during the period when the fever begins to rise (37.5ºC-38ºC). Febrile convulsions are seen in children between 3 months and 5 years of age, especially in children between 2 and 3 years of age. If the fever cannot be reduced and remains above 39ºC, if there is a family history of febrile convulsions, if the child is younger than 2 months, if the baby or child cries and moans constantly, becomes restless when touched, if there is a tendency to sleep, if purple rashes appear on the skin, if breathing is difficult, if there is difficulty in swallowing, if the general appearance is poor. If there is persistent vomiting, diarrhea, or if the child has had a seizure before, the patient should be taken to the hospital.
5- What are the practices to be done at home to reduce the child's fever?
The first precaution to be taken in children with fever is to remove their clothes. Sometimes the child becomes completely undressed, depending on the surrounding temperature. You can also take a warm shower. Towels soaked in warm water are placed on the forehead, groin, arms and legs. With these measures, the fever often goes down. It is also important to adjust the temperature of the feverish child's environment (20ºC -22ºC), give plenty of fluids and provide sufficient calories. Antipyretic drugs and antibiotics should not be used without consulting a doctor.
6- Do you recommend reducing fever with cold water and ice at home?
Warm temperature to reduce fever. Use water (temperature 28ºC -32ºC) should be done. Cold water and ice should not be applied instead of warm water. Dressing with warm water should be applied especially to children whose fever persists after 1 hour even though an antipyretic is given, and especially to babies under 6 months of age, when the fever is to be reduced without medication. In cases where the fever is very high and febrile delirium develops, a warm dressing can be applied to make the child comfortable.
7- Do you recommend antipyretic medication? Which active ingredient drugs are unsafe to give?
The high temperature limit for which antipyretic drug use is recommended is 39-39.5 °C. If the child feels hot and uncomfortable and has symptoms such as tachypnea, antipyretic medication can be given at lower fever levels. When giving antipyretics to babies under 4 months of age, uncontrolled medication should not be used for more than 3 days.
8- What kind of procedure do physicians follow in the treatment of high fever?
Careful history taking, careful observation of the child and physical examination are the basic steps in determining the etiology of fever. In patients where the cause of fever cannot be determined, examinations based on history and physical examination evaluations help make the diagnosis.
9- What is your recommendation if the child has chronic health problems such as tonsils that cause frequent fever?
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It is important to take a throat culture in throat infections. If group A beta hemolytic streptococci are grown in throat cultures 5 or more times a year, if the child has adenoids, if the tonsils are large enough to touch each other in the midline, and if they cause breathing pauses during sleep, the child should be referred to an ENT specialist.
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