What temperature is considered a fever in children. How to accurately measure a child’s temperature. When should you call a pediatrician for a child’s fever. What are the signs of a serious fever in children. How can you treat a child’s fever at home.

What Constitutes a Fever in Children?

A fever is generally defined as a body temperature above 100.4°F (38°C). However, the threshold for concern varies depending on the child’s age. For infants under 3 months, any temperature above 100.4°F is considered significant and warrants immediate medical attention. For older children, higher temperatures may be tolerated for short periods without cause for alarm.

Age-Based Fever Guidelines

• 0-3 months: Above 100.4°F (38°C)
• 3 months – 3 years: Above 102°F (38.9°C)
• 3 years and older: Above 103°F (39.4°C)

It’s important to note that these are general guidelines. The overall health and symptoms of the child should always be taken into consideration when assessing the severity of a fever.

Accurate Temperature Measurement Techniques

Obtaining an accurate temperature reading is crucial for proper assessment and treatment of a fever. The most reliable method depends on the child’s age and cooperation level.

For Infants Under 3 Months

Rectal temperature measurement using a digital thermometer is the gold standard for infants. This method provides the most accurate core body temperature reading.

For Children 3 Months to 4 Years

Axillary (armpit) temperature measurement is a convenient and less invasive option. While slightly less accurate than rectal readings, it can provide a good indication of whether a fever is present.

For Children 4 Years and Older

Oral temperature measurement using a digital thermometer placed under the tongue is the preferred method. It’s important to wait at least 15 minutes after eating or drinking to ensure an accurate reading.

When to Seek Medical Attention for a Child’s Fever

While most fevers are not inherently dangerous, certain situations require prompt medical evaluation.

• Any fever in an infant under 3 months old
• Fever above 102°F (38.9°C) in a child 3 months to 3 years old
• Fever above 103°F (39.4°C) in a child 3 years or older
• Fever lasting more than 2 days, regardless of age
• Fever accompanied by severe symptoms such as difficulty breathing, extreme lethargy, or signs of dehydration

Always trust your instincts as a parent. If you’re concerned about your child’s condition, don’t hesitate to contact your pediatrician for advice.

Understanding the Purpose of Fever

A fever is the body’s natural defense mechanism against infections. When the immune system detects a threat, it raises the body temperature to create an inhospitable environment for pathogens and to boost immune function.

Benefits of Fever

• Slows down bacterial and viral replication
• Enhances white blood cell activity
• Stimulates the production of antibodies
• Increases metabolism to support immune function

While fevers can be uncomfortable, they play a crucial role in fighting off infections. In most cases, allowing a mild to moderate fever to run its course can help the body recover more quickly.

Home Care Strategies for Managing Fevers

When a child has a fever that doesn’t require immediate medical attention, there are several ways to provide comfort and support the healing process at home.

Hydration

Ensuring adequate fluid intake is crucial during a fever. Offer water, clear broths, or electrolyte solutions frequently. For infants, continue breastfeeding or formula feeding as usual.

Rest

Encourage your child to get plenty of rest. Sleep allows the body to focus its energy on fighting the infection.

Comfortable Environment

Keep the room temperature comfortable, typically around 70-72°F (21-22°C). Dress your child in light, breathable clothing to prevent overheating.

Fever-Reducing Medications

Over-the-counter medications such as acetaminophen or ibuprofen can help reduce fever and alleviate discomfort. Always follow the dosage instructions based on your child’s age and weight.

Common Myths About Childhood Fevers

There are several misconceptions about fevers in children that can lead to unnecessary worry or inappropriate treatment.

Myth: All fevers are dangerous and must be treated aggressively

Reality: Most fevers are beneficial and help the body fight infections. Mild to moderate fevers typically don’t require treatment unless the child is uncomfortable.

Myth: Fevers can cause brain damage

Reality: Typical fevers (under 105°F or 40.5°C) do not cause brain damage. Very high fevers, usually associated with heat stroke or certain medical conditions, can be dangerous.

Myth: The height of the fever indicates the severity of the illness

Reality: The degree of fever doesn’t necessarily correlate with the seriousness of the underlying condition. A child’s overall symptoms and behavior are more important indicators.

Recognizing Signs of Serious Illness Beyond Fever

While fever is often a primary concern, it’s crucial to be aware of other symptoms that may indicate a more serious condition requiring immediate medical attention.

• Difficulty breathing or rapid breathing
• Severe headache or neck stiffness
• Persistent vomiting or diarrhea
• Unusual rashes, especially those that don’t blanch when pressed
• Extreme lethargy or difficulty waking
• Signs of dehydration (dry mouth, sunken eyes, decreased urination)
• Seizures or convulsions

If your child exhibits any of these symptoms alongside a fever, seek medical care promptly.

The Role of Vaccinations in Preventing Febrile Illnesses

Vaccinations play a crucial role in protecting children from many serious illnesses that can cause high fevers and other complications.

Common Vaccine-Preventable Diseases

• Measles
• Mumps
• Rubella
• Influenza
• Pneumococcal disease
• Meningococcal disease

Keeping your child up-to-date on recommended vaccinations can significantly reduce their risk of developing these potentially serious infections and associated fevers.

Fever as a Normal Vaccine Response

It’s important to note that mild fevers can occur as a normal immune response following vaccination. This is typically not a cause for concern and usually resolves within a day or two.

When Fevers Become Chronic: Exploring Underlying Causes

While most childhood fevers are acute and resolve within a few days, persistent or recurrent fevers may indicate an underlying medical condition that requires further investigation.

Potential Causes of Chronic Fevers

• Autoimmune disorders (e.g., juvenile rheumatoid arthritis)
• Certain cancers (e.g., leukemia, lymphoma)
• Chronic infections (e.g., tuberculosis, HIV)
• Periodic fever syndromes (e.g., PFAPA syndrome)

If your child experiences recurrent fevers without an apparent cause, it’s important to consult with a pediatrician for a thorough evaluation and potential referral to a specialist.

The Impact of Fever on Child Development and Learning

While short-term fevers are generally not harmful, prolonged or frequent fevers can potentially impact a child’s development and academic performance.

Short-Term Effects

• Decreased concentration and attention span
• Fatigue and reduced physical activity
• Temporary loss of appetite

Long-Term Considerations

Chronic or recurrent fevers may lead to:

• Increased school absences
• Delays in social skill development
• Potential impacts on academic performance

Addressing the underlying cause of persistent fevers and providing appropriate support can help minimize these potential impacts on a child’s overall development and educational progress.

Fever Management in Special Populations

Certain groups of children may require special considerations when it comes to fever management and evaluation.

Children with Compromised Immune Systems

Children undergoing chemotherapy, those with HIV/AIDS, or those taking immunosuppressive medications may be at higher risk for serious infections. Even low-grade fevers in these children should be evaluated promptly by a healthcare provider.

Children with Chronic Medical Conditions

Children with conditions such as heart disease, lung disease, or sickle cell anemia may be more vulnerable to the effects of fever. These children may require more aggressive management and closer monitoring during febrile illnesses.

Premature Infants

Premature babies, especially those born before 37 weeks gestation, may have an immature immune system and temperature regulation. They may require more frequent monitoring and lower thresholds for medical evaluation when fevers occur.

The Future of Fever Management: Emerging Technologies and Research

As medical technology advances, new tools and approaches are being developed to improve fever detection, monitoring, and management in children.

Wearable Temperature Sensors

Continuous temperature monitoring devices that can be worn comfortably by children are being developed. These devices can provide real-time temperature data and alerts to parents and healthcare providers.

Improved Diagnostic Tools

Rapid point-of-care tests are being developed to quickly identify the cause of fevers, allowing for more targeted and timely treatment.

Personalized Medicine Approaches

Research into genetic factors that influence fever response and susceptibility to infections may lead to more individualized approaches to fever management in the future.

As our understanding of fever and its role in the immune response continues to evolve, so too will our strategies for managing and treating fevers in children. Staying informed about these advancements can help parents and healthcare providers make the best decisions for children’s health and well-being.

How High is Too High? A Guide to Kids’ Fevers (2021 Update)

Throughout your child’s life, one of the most common and worrisome issues that can come up is a fever. You know how the signs begin: chills, a warmer body, and flushed cheeks; but what does your child’s fever mean?

No matter how well or badly your child is feeling, a fever can be a sign that something isn’t quite right. When a fever comes around, that means your child’s body is reacting to an infection or virus; a fever is a sign that your child’s body is fighting back! Even though fevers are a sign of healthy bodies reacting to illness, they definitely can make your child feel lousy.

READ MORE: Guide to Setting Sleep Schedules for Kids

Especially for our youngest patients, who can’t easily say what hurts or that they feel sick, a fever is a clear indicator that they are experiencing sickness or pain. Even as children age, fevers, combined with other symptoms, can be dangerous and must be met with quick medical attention.

But the question remains: what do I do about my child’s fever? With our easy guide below, we help you navigate the highs and lows of fevers, and how to react along the way. As always, contact your pediatrician for specific medical advice for your child. For a general guide to cold and flu season, follow along below:

Best Way to Check a Child’s Temperature

Depending on your child’s age, their temperature can be taken differently, using different thermometers. The fastest and most accurate of all the different kinds of thermometers is the digital thermometer. Most doctors recommend using digital thermometers versus other kinds.

For infants under 3 months of age, the most effective and accurate way to check temperature is rectally, using a digital thermometer. There are two ways to easily take a rectal temperature. With the face down method, place a blanket on your lap, and then lay your baby across your lap, facing downwards. Take your baby’s temperature by using petroleum jelly to insert the thermometer; hold it for 3 minutes to allow the temperature to register. You can also take your baby’s temperature by laying them face up on a firm surface and holding their legs up, with their knees towards their chest. Then proceed to insert the thermometer and get a reading.

You can also take your baby’s temperature under the armpit with a digital thermometer. While not as accurate, this will allow you to get a general idea of if your child has a fever or not. Most daycares and schools will use this method as a general guide if your child has symptoms of being sick.

Fever strips and pacifier thermometers are not usually recommended, as they tend to not be as accurate. We also discourage parents from using glass thermometers, as the mercury inside can poison your child if they are exposed to it.

READ MORE: Guide to Cough Season – What Kind of Cough Does My Child Have?

For older children, you can use a variety of thermometers. The most popular is the digital thermometer, but there are also ones that get a reading by being inserted into the ear or pressed against the forehead. The most accurate way of taking the temperature of an older child is by using a digital thermometer under the tongue. This should be used after your child is 4 years old.

Be aware of what your child has just eaten or had a warm or cold drink when you take their temperature. For example, if your child has a sore throat and just had some soup to ease the pain, wait about 20 minutes for your child to reach his or her resting temperature for the most accurate temperature reading.

Have a Fever? When to Call Your Pediatrician

Depending on your child’s age, there can be different degrees of worry when it comes to fevers. Here is a quick guide for when it is time to call Pediatrics East:

• If your child is under three months old, any fever should be addressed. If his or her temperature is above 100.4 degrees, it is time to call us.
• For children ages three months to three years, call us if there is a fever of 102 degrees or higher.
• For all kids three years and older, a fever of 103 degrees or higher means it is time to call Pediatrics East.
• If a fever of 102 degrees or higher lasts for more than two days, please give us a call, too.

Along with these guidelines, it is important to call Pediatrics East if your baby has not received immunizations and has a fever. Also, please call your pediatrician if your child experiences excessive vomiting or diarrhea, if your child seems dehydrated, or if a serious rash is present with the fever.

READ MORE: Does My Child Have Allergies or a Cold?

If your child is experiencing more severe symptoms with their fever, it does make sense to skip calling Pediatrics East and head to the emergency room. Go to the emergency room in the following circumstances:

• Your child is not breathing or has trouble breathing
• Severe abdominal pain
• Your child has a seizure
• Your child has any other apparent problems, such as swelling or trouble swallowing

Low-grade Fever? What to Do Now

If your child (age six months and older) has a fever that registers above 100.4 degrees and below 102 degrees, you are in a bit of an in-between zone for the first couple of days. While it isn’t necessary to bring your child to Pediatrics East, you will need to keep your child home from daycare or school.

If there are other symptoms in addition to their fever, such as a sore throat, bad cough, or other issues, be sure to monitor the temperature every few hours. If his or her fever begins to rise, it can be a sign of an infection or virus that might need immediate attention. As mentioned above, if a fever persists for several days, give us a call.

Here are the steps you can take to help lower a fever:

• Give Tylenol (infant or kid variety, depending on their age).
• Take a lukewarm bath (not a cold or ice water bath) or a sponge bath.
• Give plenty of fluids, such as water and juices.
• Make sure your child gets plenty of rest.

No Fever, but Still Sick?

Does your child not have a fever, but still appears sick? Monitor his or her symptoms and temperature to determine whether the sickness is getting worse. The best thing you can do for your child is to keep fluids going, feed comforting foods, give lots of love, and call us if symptoms persist or worsen. To get a better idea of what may be bothering your child, check our Child Illnesses pages to learn more about what your child could be experiencing. Of course, you can always call our office to talk through any concerns or worries you have. 

More Resources

• Guide to Cough Season
• Guide to Ear Infections and Ear Aches
• Tips for Soothing a Fussy Baby
• Bath Time Safety for Kids
• Flu vs. COVID-19

Kids’ Fevers: How High is Too High?

Fevers often get a bad rap, particularly when it comes to children. Although they leave many parents worried, in most people, a fever is rarely dangerous. In fact, they are actually a good thing. Fevers are a natural way that our bodies fight off infections by increasing the body’s temperature in order to make it more difficult for germs to live and multiply.  When it comes to kids’ fevers, here is some helpful information to help you determine how high is too high:

When to Check for a Fever

A child’s temperature can change slightly during the day, depending on the time of day and how active your child is. The normal range for body temperature taken orally (by mouth) ranges from 97.7°F to 99.5°F. Parents should take their child’s temperature if they notice any of the following symptoms:

• Excessive sweating
• Dry, hot skin
• A rash
• Very pale or very red face
• Changes in breathing such as unusually fast, slow, noisy or strained
• Cold symptoms such as runny nose, cough, sneezing, sore throat or hoarseness
• Mood changes such as irritability, crankiness, fatigue
• Vomiting
• Diarrhea
• Pain in any part of your child’s body
• Your child says, “I feel sick”

How to Take Your Child’s Temperature

Your first inclination may be to feel your child’s forehead to determine if he or she has a fever. But, a digital thermometer is the best method to take both oral and rectal temperatures quickly and accurately. Despite their appeal, tympanic (ear) and temporal artery (forehead) thermometers that are available for home use often aren’t as high quality or accurate as those used in physician’s offices.

There are three ways to check your child’s temperature:

• Oral: Suitable for children age 5 and older. Be sure your child has not had anything to drink in the 10 minutes prior to taking their temperature.
• Rectal: The most accurate method to take a temperature for children under the age of 5.
• Axillary (Armpit): Not quite as reliable, armpit temperatures are generally used for infants. This method is also used when older children aren’t cooperative or can’t close their mouth due to congestion.

How High is Too High?

Whether or not a visit to your child’s physician for a fever is necessary depends on a variety of factors, including age. Call your pediatrician if:

• Your child is under 3 months old with a fever of 100.4 °F or higher
• Your child is 3 to 6 months old with a fever of 101.0 °F or higher
• Your child is 6 months or older with a fever of 103. 0 °F or higher
• Your child has a fever 104.0 °F or higher regardless of age

You should see a physician for any fever under the following circumstances:

• Lethargy that persists after taking fever-reducing medication
• Lasting more than 3 consecutive days with or without an obvious source of infection, such as cold symptoms
• In conjunction with severe pain
• In conjunction with sore throat lasting more than 24-48 hours
• Accompanied by pain when urinating
• Accompanied by headache, stiff neck or red or purple-colored patches on the skin
• In a child with compromised immunity
• Occurrence following a trip overseas

Caring for a Child with a Fever

Children with fevers who aren’t uncomfortable typically don’t need treatment, and for fevers under 102°F medicine is usually not necessary.

Ways you can care for a child with fever include:

• Keeping them home from daycare, school or extracurricular activities until he or she has had no fever or symptoms for 24 hours without the use of fever-reducing medications.
• Avoiding clothing that’s too warm. You should also refrain from covering your child with extra blankets, as they stop the heat of the fever from escaping.
• Keeping your child hydrated by giving them plenty of cool, clear liquids. Pedialyte and water are preferable, but if it encourages your child to drink more you can also offer fruit juices, popsicles or sports drinks like Gatorade.
• Checking for early signs of dehydration such as dry mouth, lack of tears when crying, decreased urine output or decreased frequency of urination. If you have an infant younger than 6 months old with less than 6 to 8 wet diapers per day or an older child that urinates fewer than three times a day or once every 8 hours, call your child’s doctor immediately.
• Helping reduce discomfort with acetaminophen (Tylenol) or ibuprofen for children 6 months and older. Infants age 2 to 6 months may be given Tylenol, but you should consult with you his or her doctor prior to use. Our dosage calculator can be used for guidance here as well.
• Lowering the fever with lukewarm baths. You should never use cold baths.

Schedule an Appointment

HealthPark Pediatrics offers sick visits by appointment Monday through Friday from 8:30 a.m. to 5:20 p.m. and Saturday and Sunday from 9 a.m. to noon. Urgent visits may be scheduled after hours on weekdays between 5:30-6:30 p.m. To schedule an appointment, call 919-896-7066. This number can also be used after hours to reach our dedicated nurse triage line.

Fever – Humanitas

Fever is usually a signal that something is wrong in the body. In an adult, fever is accompanied by malaise, however, as a rule, a temperature increase of no more than 103 F (39.4 C) is considered harmless. In children of the first days of life and infants, even a slight increase in temperature may indicate the presence of a serious infection.

However, the severity of the fever does not always indicate the severity of the underlying condition. A mild illness may cause a fever with a significant increase in temperature, and a severe illness may be accompanied by a slight increase in temperature.

The fever usually resolves within a few days. A number of over-the-counter drugs can lower a fever, but in some cases it is better not to lower it. An increase in body temperature greatly contributes to the body’s fight against a number of infectious diseases.

Symptoms

Fever is an increase in temperature above normal values. The temperature normal for an individual may be slightly above or below the average normal temperature 98.6 F (37 C).

Fever, depending on the cause, may be accompanied by signs and symptoms such as:

• Sweating
• Trembling
• Headache
• Muscle pain
• Loss of appetite
• Dehydration
• General weakness

Fever 103 F (39.4 C) to 106 F (41.1 C) may cause:

• Hallucinations
• Confusion
• Irritability
• Convulsions
• Dehydration

Conditions requiring medical attention

Fever in itself is not a cause for concern and a reason to seek medical attention. However, there are times when, if you have a fever, you need to see a doctor yourself or take your child to the doctor.

Temperature measurement

Several types of thermometers are suitable for taking your own and your baby’s temperature, including oral, rectal, and ear (tympanic) thermometers.

Although not the most accurate method, an oral thermometer can be used to measure armpit temperature (axillary temperature).

• Place the thermometer in the armpit and cross your arms over your chest.
• Wait four or five minutes. Axillary temperature is slightly lower than oral.
• The doctor who came on call must be informed of the actual readings of the thermometer and name the place where the temperature was taken.

A rectal thermometer is suitable for measuring temperature in young children:

• To do this, grease the bulb of the thermometer with petroleum jelly.
• Place the baby on the stomach.
• Carefully insert the bulb of the thermometer half a centimeter into the child’s rectum.
• Hold the thermometer and child still for three minutes.
• Never let go of the thermometer while it is in the child’s body. If the child wriggles, the thermometer may go deeper and cause damage.

Infants

Unlike adults, unexplained fever in children is a serious cause for concern. If your child’s temperature rises to 101 F (38.3 C) or more, contact your pediatrician. You should also call a doctor in the following cases:

• Fever in a child under 3 months old.
• Refusal of the child to eat and drink.
• Fever and unexplained irritability: the child cries a lot, for example when changing a diaper or at the slightest movement.
• Lethargy and lack of reaction in a child with fever. In infants and children under 2 years of age, these signs may be signs of meningitis, an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord. If meningitis is suspected, the child should be seen by a doctor immediately.
• The body temperature of the newborn is below normal – below 97 F (36.1 C). In the youngest children, during illness, body temperature is difficult to regulate: it may fall rather than rise.

Children

If a child has a fever, but still reacts to others: makes eye contact, responds to facial expressions and voice, then there is probably nothing to worry about.

In the following cases, the child should be taken to the doctor:

• Lethargy or irritability, frequent vomiting, severe headaches or abdominal pain, or any other symptoms that cause severe discomfort.
• Fever after being in a hot car. Seek immediate medical attention if:
• Fever persists for more than one day (in children under 2 years of age) or more than three days (in children 2 years of age and older)

In special cases, for example, if the child has diseases associated with disorders of the immune system or any pre-existing diseases. Doctors also advise caution if a child has recently been prescribed a new drug.

Adults

Seek medical attention if:

• Temperature rises above 103 F (39.4 C)
• Persistence of fever for more than three days

In addition, seek immediate medical attention if any of the following signs or symptoms accompany a fever:

• Severe headache
• Severe swelling of the throat
• Unusual skin rash, especially if it progresses rapidly
• Unusual sensitivity to bright light
• Stiff neck and pain when bending head forward
• Confusion
• Prolonged vomiting
• Labored breathing or chest pain
• Extreme lethargy or excitability
• Abdominal pain or pain when urinating
• Other unexplained signs and symptoms

Complications

Fever may be accompanied by the following complications:

• Severe dehydration
• Hallucinations
• Fever-induced convulsions (febrile convulsions) in a small number of children aged 6 months to 5 years
• Febrile convulsions

Febrile seizures are usually accompanied by loss of consciousness and convulsions of the limbs, involving muscle groups on both sides of the body. Although febrile seizures are a cause of concern for parents, in most cases they do not have any long-term consequences.

If ​​a febrile seizure occurs:

• Place the child on its side or stomach on the floor or other flat surface
• Remove all sharp objects within reach of the child
• Rid the child of tight clothing
• Hold the child to avoid injury.

Do not put anything in the child’s mouth or try to stop seizures
In most cases, seizures go away on their own. After the seizures stop, it is necessary to show the child to the doctor as soon as possible to determine the cause of the fever.

If convulsions persist for more than 10 minutes, seek emergency medical attention.

Omphalitis in newborns. First symptoms and treatment

This disease is typical for the neonatal period. Infectious inflammation of the navel is extremely rare in older children and adults.

The prevalence of pathology in developed countries is extremely low – it occurs in about 0. 7% of newborns, and in developing countries – in 8%. If childbirth occurs at home, the risk of developing omphalitis is highest – 22%. This is a very dangerous condition that can lead to severe, life-threatening complications and requires immediate treatment. In full-term infants, its symptoms most often occur at 5–9day of life, and in premature babies – by 3-5.

Causes

During pregnancy, the circulatory systems of the fetus and mother are connected through the umbilical cord – a “string” of connective tissue through which blood vessels pass. After childbirth, the umbilical cord is cut. The child has an umbilical wound (umbilical stump). Gradually, its tissues die and become a favorable environment for the reproduction of pathogenic microorganisms.

Gram-positive cocci colonize the umbilical wound within the first few hours. Soon a lot of intestinal bacteria appear. The causes of omphalitis are the result of the vigorous activity of these microorganisms and the development of the inflammatory process in the tissues.

Omphalitis in newborns is a polymicrobial infection, that is, many bacteria take part in its development – both aerobic (which require oxygen to live) and anaerobic (living in oxygen-free conditions). Most often, such microorganisms as Staphylococcus aureus, streptococci, Escherichia coli, Klebsiella, Proteus, Bacteroides, Clostridia (including tetanus pathogens) are found. The most common causative agent is Staphylococcus aureus, including its methicillin-resistant (antibiotic-resistant) strains.

Some factors contribute to the development of omphalitis:

• congenital immunodeficiency conditions eg leukocyte adhesion deficiency
• neutrophil disorders , in particular congenital neutropenia and neonatal alloimmune neutropenia
• congenital malformations : open urachus – a duct that connects the umbilical cord to the top of the bladder during fetal development (normally closes after birth), urachus cyst, open omphalomesenteric duct – communication between the umbilicus and the intestinal tube
• childbirth in unsanitary conditions , at home
• chorioamnionitis in a woman during pregnancy – inflammation of the germinal membranes with infection of the amniotic fluid
• rupture of membranes persistent for a long time
• low birth weight at birth
• catheterization umbilical vessels

Classification

Depending on the clinical form of the disease, the following types of omphalitis are distinguished:

• Purulent (plain). The umbilical wound does not heal for a long time, periodically covered with a crust, from under which fluid and pus are released. In the area of ​​the umbilical ring, redness and swelling occur. Sometimes a mushroom-like growth is formed – fungus. It occurs due to the fact that granulation tissue grows in the navel.
• Phlegmonous (diffuse-purulent). The infectious process spreads to the surrounding tissues. In the navel area there is redness, swelling of the tissues. The umbilical wound ulcerates, pus is released from it. Phlegmon develops (inflammation of the subcutaneous fatty tissue) of the anterior abdominal wall. At the same time, the general condition of the child worsens: he becomes lethargic, refuses to feed, fever appears.
• Necrotic . With this form of the disease, necrosis (death) of tissues occurs – the umbilical stump, skin, subcutaneous tissue. The rest of the umbilical cord acquires a dirty brown hue, an unpleasant odor. Necrosis can spread through all layers of the abdominal wall and lead to peritonitis – inflammation in the abdominal cavity. This form of the disease is caused by anaerobic microorganisms.

There are also several degrees of omphalitis, depending on the severity of the infectious process:

• I degree. Inflammation develops in the vessels of the umbilical cord, pus is released, an unpleasant odor appears.
• II degree. The phlegmon of the anterior abdominal wall joins in the area around the navel.
• III degree. The process is generalized. Such severe complications develop as sepsis (in this case it is called umbilical sepsis), disseminated intravascular coagulation, shock, and the work of all organs is disrupted.
• IV degree. An extensive lesion of the anterior abdominal wall and severe complications, described in the previous paragraph, develop.

Symptoms

It is important to recognize the first signs of omphalitis as early as possible – and immediately begin treatment. The main manifestations of the disease:

• umbilical wound does not heal for a long time
• redness and swelling appeared in the area of ​​the umbilical wound
• the umbilical wound is covered with a crust, fluid and pus periodically exude from it
• an unpleasant smell emanates from the umbilical wound
• in the area of ​​the umbilical wound a characteristic mushroom-like growth appeared
• bleeding from the umbilical wound
• lethargy, loss of appetite, fever – formidable signs that indicate a generalization of the process

With purulent omphalitis, treatment is indicated in a hospital, in the department of pediatric surgery.

Diagnostic methods

If omphalitis is suspected, the doctor carefully examines the child. He not only assesses the condition of the umbilical wound, but also examines the mucous membranes, skin, listens to the lungs and heart, measures body temperature, and checks the functions of the nervous system.

Survey includes:

• Complete blood count with determination of the level of C-reactive protein. The study is repeated after a course of antibiotic therapy or after 72 hours if it does not get better while taking antibiotics.
• Microbiological examination of pus from the umbilical wound helps to determine which bacteria caused omphalitis and evaluate their sensitivity to antibacterial drugs.
• Ultrasound of the abdominal organs helps to identify the inflammatory process in it.

With omphalitis in children, in some cases it is necessary to carry out differential diagnostics, most often with diseases such as:

• Open urachus – communication between the bladder and the navel. At the same time, discharge is noted from the navel, which can be taken as a sign of an infectious process.
• Umbilical granulomas usually appear a week after birth, are pink in color and have a soft, velvety texture. Of these, a clear liquid is often released, blood when damaged, since their tissue is very delicate.
• Umbilical polyps are solid growths. They usually do not lead to infection. They are treated by surgical excision.
• Funisitis – inflammation of the umbilical cord. At the same time, it looks wet and has an unpleasant odor. This condition differs from omphalitis in that the inflammation develops only in the outer layers of the umbilical cord and does not extend to its vessels.

Methods of treatment

The main treatment for omphalitis in children is antibiotic therapy. Broad-spectrum antibiotics from the group of penicillins and aminoglycosides are used in combination with clavulanic acid. With simple omphalitis, drugs are used orally – in the form of dosage forms for swallowing. In some cases, it is more appropriate to use antibacterial drugs in injectable forms (in the form of injections):

• in case of a severe course of the disease, when it is necessary to provide emergency medical care and quickly reach the required concentration of the antibiotic in the body
• in premature babies, especially those with critically low birth weight
• if the child is in critical condition and cannot eat
• for other contraindications to oral medications

During antibiotic treatment, the child’s condition is monitored for three days – it should improve. A complete blood count is repeated with the determination of the level of C-reactive protein in order to track how the dynamics of the inflammatory process in the body changes. If first-line antibiotics help, then the course of treatment is carried out for 5-7 days, and if they are ineffective, they are changed to other antibacterial drugs, usually second-generation cephalosporins.

In parallel with antibiotic therapy, it is necessary to treat the umbilical wound. Usually use a 4% solution of chlorhexidine, 1% aqueous solution of methylene blue, brilliant green, fukortsin. Before using antibiotics, you need to remove the umbilical stump.

If the infection has spread to the anterior abdominal wall, and omphalitis is complicated by necrotizing fasciitis (infectious inflammation and tissue death under the skin, deep fascia) or myonecrosis (infectious inflammation and death of the muscles of the abdominal wall), then an urgent consultation of a pediatric surgeon is required. It is necessary to excise the dead tissue to prevent the spread of the infectious process.

Possible complications

The most frequent and formidable complication of omphalitis is umbilical sepsis, a condition when a generalized (systemic) inflammatory reaction develops in the body. It can lead to septic shock and death. It is because of this that omphalitis needs to be diagnosed and treated as soon as possible. According to some reports, bacteremia (the presence of bacteria in the blood) is detected in 13% of children with omphalitis.

Other possible complications:

• Peritonitis – inflammation in the abdominal cavity
• Gangrene of the intestine
• Evisceration of the small intestine – its protrusion outside the abdominal cavity
• Liver abscess
• Septic umbilical arteritis – inflammation of the walls of the umbilical arteries, which become a focus giving rise to sepsis
• Portal vein thrombosis .
• Necrotizing fasciitis is an infection of the soft tissues under the skin and deep fascia. This is a rare complication, but it progresses rapidly and leads to death in 60-85% of cases.

Prophylaxis

Prevention of omphalitis in newborns consists of two points:

• Delivery under aseptic and antiseptic conditions . That is, in the maternity hospital. Medical professionals will properly treat the stump of the umbilical cord and take all measures to prevent infection from getting into it.

• Proper care of the cord remnant . It usually mummifies and falls off within two weeks. The umbilical wound heals completely within 3-4 weeks. There is no need to create sterile conditions and apply antiseptics, specifically remove the stump. It is enough just to keep it clean, to look so that it does not become contaminated with urine and feces, and is not injured.

Forecast

Mortality in all forms of omphalitis is 7–15%. In uncomplicated disease, the prognosis is usually favorable – timely antibiotic treatment helps to destroy the source of infection. If complications join, then the frequency of adverse outcomes greatly increases.

Main

• Omphalitis is an infectious inflammation of the umbilical wound and surrounding tissues in newborns.
• In modern developed countries, where women give birth in appropriately equipped maternity hospitals, this pathology is very rare.
• The cause of omphalitis is bacteria. The disease can lead to severe complications and death, so it needs to be diagnosed and treated as soon as possible.
• Most often, the doctor makes a diagnosis based on the results of the examination. A standard examination includes a complete blood count, microbiological examination of the detachable umbilical wound (with the determination of sensitivity to antibiotics), ultrasound of the abdominal organs.
• The main methods of treating omphalitis are antibiotic therapy and treatment of the umbilical wound with antiseptics.
• The most formidable complication of omphalitis in newborns is umbilical sepsis.
• If the disease proceeds without complications, then the prognosis in most cases is favorable – with the timely initiation of antibiotic therapy.

Sources:

1. Golovanov V.