Fever in Infant and Children

DEFINITION

Fever is usually a sign that something unusual happens in our bodies. For children who are still very small and the baby, a slight increase in body temperature can indicate a serious infection.

However, the degree of fever does not always indicate the severity of the underlying condition. Mild disease may cause a high fever, and more serious disease may only cause a mild fever.

Normal body temperature varies between individuals and throughout the day (usually the highest in the afternoon). Normal body temperature is higher in children of pre-school age and the highest around the age of 18-24 months. However, even so, a child is said to be a fever when body temperature reaches around 38 degree C or higher when measured with a rectal thermometer.

CAUSE

Fever occurs as the body's response to infection, injury, or inflammation, and causes a lot.

Acute fever (lasts for 7 days or less), usually caused by an infection. The most common causes are:

· respiratory tract infections due to viruses, such as colds or flu

· gastrointestinal infections due to virus

· certain bacterial infections, especially ear infections (otitis media), sinus infections, pneumonia, and urinary tract infections

Teething process usually does not cause fever to more than 38.3 degrees C.

Newborns and babies younger have a higher risk for a variety of serious infections because the immune system is not perfect. Some infections can be obtained before or when the child is born, including sepsis, pneumonia, and meningitis (infection of the lining of the brain).

Causes of acute fever are rarer among others:

· side effects of vaccination and the use of certain drugs

· bacterial infections of the skin or joints

· viral or bacterial infection of the brain, membranes of the brain, or both

Fever chronic (lasting for more than 7 days), most often caused by a viral infection that long. Chronic fever can also be caused by:

· Other infectious diseases such as hepatitis, sinusitis, pneumonia, gastrointestinal tract infections due to bacteria or parasites, bone infections, heart infections, and tuberculosis.

· non-infectious causes, such as Kawasaki disease, juvenile idiopathic arthritis, and cancers (such as leukemia and lymphoma).

SYMPTOMS

Babies who have a fever usually be fussy and may not be able to sleep or eat well. Children are more likely to become less active and lose interest in play. Children can have seizures when the body temperature rises or falls rapidly (febrile seizures). In some cases, the fever is very high so that the child becomes lethargic, sleepy and unresponsive.

There are several symptoms that need attention and watch out for, namely:

· fever that occurs in infants aged less than 2 months

· child lethargic or weak

· looks ill

· out of breath

· bleeding in the skin, which appears as spots or patches of reddish purple

· infants or toddlers being kept crying (can not be soothed)

· children are more likely to become a headache, stiff neck, or confused

Children with fever should be immediately taken to the doctor if they have warning signs above, or if the child is younger than 2 months.

Children who do not have warning signs on top and between the ages of 3-36 months should be taken to the doctor if the fever reaches 39oC or more. In addition, children should also be taken to the doctor if the fever has lasted more than 5 days.

DIAGNOSIS

Body temperature can be measured using a digital thermometer or mercury thermometer. Mercury thermometer needs to be shaken before use to ensure that the temperatures appear to be below normal body temperature. Mercury thermometer should be installed for 2-3 minutes. Digital thermometers are easier to use and faster (the thermometer will usually give a sign when finished measuring the temperature). However, the mercury thermometer is no longer recommended because the thermometer is made of glass and fragile, so the risk of giving papaparan against quicksilver (mercury).

There are several ways to measure body temperature:

- Rectal temperature, is the most accurate, because that is closest to the inside of the body temperature. The thermometer should be smeared with grease and then slowly inserted into the anus of about 1.5-2.5 cm child when the child is prone. Children must be maintained so as not to move.

- The temperature of the ear, using a digital ear thermometer which measures the infrared radiation from the eardrum. Ear thermometers are not reliable for infants younger than 3 months.

- Oral temperature, measured with a thermometer placed under the tongue of the child. This method is accurate but difficult to do in children are still small, because they are difficult to keep the mouth closed when the thermometer is installed. Usually this means a new start can be used when a child over the age of 4 years.

- Temperature forehead (temporal artery), measured using a special digital thermometer that measures infrared radiation from an artery in the forehead area (temporal artery). Forehead temperature measurements are not as accurate as a rectal temperature, especially in infants younger than 3 months.

- Armpit temperature, measured by putting a thermometer in the armpit children, directly on the skin. Measurement of body temperature with this method is less accurate than other methods. However, if it is not convenient to perform a rectal temperature measurements and no tools to measure the temperature of the ear or forehead temperature, the axillary temperature measurement can be done, rather than not measure the temperature at all.

Detecting fever is not a difficult thing, rather than determine the cause. To find out the cause, keep in mind a full explanation of the child's illness from their parents. If necessary, it could be done a physical examination and also support, such as:

· chest x-rays, can be useful in ensuring some conditions on the chest (lung or heart)

· complete blood count, electrolytes, and blood culture

· urine examination

· lumbar puncture to take a sample of cerebrospinal fluid covering the brain and spinal cord. This examination can be done if it is suspected meningitis.

TREATMENT

If the fever is caused by a disturbance, then the disorder needs to be treated. Another treatment is done to make the child feel better.

- General handling can be done to help a child who has a fever, among others:

· give the child to drink plenty of fluids to prevent dehydration

· apply warm compresses to the forehead, hands, and feet

Because shivering may increase body temperature of children, the ways that can make kids shiver, for example, to undress the child and gave the cold water, only be used if the child's body temperature is very high (around 41oC) or more.

Do not give alcohol to a child compress because alcohol can be absorbed in through the skin and cause danger.

- Drugs for lowering fever

Drugs known as antipyretics can make the child feel better, namely by lowering body temperature. These medications have no effect on infection or other disorders that cause fever. However, if the child has a disorder of the heart, lungs, brain, or nervous, or history of febrile seizures, it is important to use this medication.

Antipyretic drug that can be used for example ibuprofen. It is important to provide appropriate drug doses and at appropriate time intervals. The drug will not work when given in doses that are too small or too long-term administration. And even though these drugs are relatively safe, but do not prescribe too much or too often, because it can lead to over-dosage.

Aspirin is no longer used to reduce fever in children because these drugs can interact with certain viral infections (such as influenza or chicken pox) and lead to serious disturbances, called Reye syndrome.

REFERENCE

- C, Deborah M. Fever in Infant and Children. Merck Manual Handbook. 2013.

- J, Robert F. Fever in Children. eMedicine Health. 2010.

- Mayo Clinic. Fever. 2011.

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