Prolonged fever in child: What to Know and When to Worry

20.06.202311.06.2023 by alexxlab

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What to Know and When to Worry

A pediatric infectious diseases expert explains how parents can best treat a fever in young kids and when it’s time to seek care.

With many different viruses circulating this winter, parents and caregivers may begin to worry as soon as they see the first sign of a runny nose or sore throat in their children. Is it RSV? COVID-19? The flu? But the symptom that usually makes parents most concerned is fever.

“Fever is one of the most common reasons parents call the pediatrician, and when we see an increase in infections, we see more fevers,” said Dr. Karen Acker, a pediatric infectious diseases specialist and hospital epidemiologist at NewYork-Presbyterian Komansky Children’s Hospital and assistant professor of clinical pediatrics at Weill Cornell Medicine.

According to Dr. Acker, a fever, which is defined as a body temperature of more than 100. 4° F, is a body’s normal response to fighting an illness. It means the immune system is doing its job, and in most circumstances there is no need to be worried.

Health Matters spoke to Dr. Acker to learn more about fevers, including how long they last, ways to treat them, and when parents need to seek medical care for their children.

Health Matters: What are important things a parent should know when their child has a fever?
Dr. Acker: Typically, a fever due to a run-of-the-mill virus can last from 24 hours to three to four days. Sometimes, fevers can last longer — even over a week — and it’s not necessarily a reason to be alarmed, as long as the child is not struggling with other symptoms, such as dehydration, shortness of breath, or severe lethargy or irritability. But if your child has prolonged fever for seven days or more, it is a good idea to bring your child to your pediatrician for evaluation.

It’s a myth that these typical fevers can cause brain damage.

If a child has symptoms such as shortness of breath, fast breathing, poor oral intake of fluids, fever of more than 104° F, then it’s important to see a pediatrician. When babies have difficulty breathing, it’s harder for them to breastfeed or drink from a bottle, and that puts them at risk for becoming dehydrated.

How do you know the fever is due to a common cold, RSV, the flu, or COVID-19?
These viruses can often look alike, and while there are some general differences, the only way to know for sure is to bring your child to the pediatrician to get tested. Influenza is typically accompanied by high fever (103° or 104° F), body aches, fatigue, and upper respiratory symptoms, including cough. RSV usually causes runny nose and cough, but children can get a fever, and 20% to 30% of children have faster breathing due to infection of the lower airways (known as bronchiolitis). COVID-19 can cause runny nose, cough, and fever, but it appears to be a less common cause of more severe disease and hospitalization in children compared to RSV and influenza. (For more, see symptoms chart below.)

When is it time to take your child to the emergency department?
That’s always the big question.

For infants less than 6 weeks old, a fever always warrants a visit to the emergency department, because young babies are at higher risk for infection. You can call your pediatrician and they will recommend going to the emergency room.

For older infants, you should discuss with your pediatrician. The pediatrician should always have an on-call service.

If your child is unable to drink, is dehydrated (has less than five wet diapers in 24 hours), has difficulty breathing, or if your baby is inconsolable, it is recommended to go to the emergency department.

How can parents treat fevers at home?
Treating a fever is more about treating the symptoms rather than trying to bring down the temperature.

If a child has a fever and is still playing, drinking fluid, eating, and running around, there is no need to treat it with medication.

However, it’s normal for children to feel really uncomfortable when they have a fever. Typical symptoms include feeling achy, having chills, or a headache. Over-the-counter fever reducers, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), can reduce a child’s temperature and help them feel better.

Remember, babies under 6 months cannot take ibuprofen – only acetaminophen.

You don’t need to give your child a cold bath (unless it makes your child feel better).

Many people believe an ice-cold bath is the answer to a fever. The truth is, that will only make your child really upset, and after the bath, the fever will go right back up again. If your child wants to take a bath, lukewarm water does gently reduce the body heat.

Can you explain what causes a febrile seizure?
We are still learning why a fever can trigger seizure activity in the brain and why certain children have febrile seizures, although it is likely due to a mix of genetic and environmental factors. For parents, it is really scary to witness, but fortunately febrile seizures are almost always benign. If your child has a seizure at the same time as a fever, you should go to the emergency room for evaluation to make sure it is a simple febrile seizure. If it is just one isolated seizure that lasts less than 15 minutes (simple febrile seizure), it will likely have no lasting effects on the brain, and it will not increase the risk for epilepsy. If there is more than one seizure in a 24-hour period or a prolonged seizure, your child may be observed for longer and be evaluated by a neurologist.

Does a fever mean a child is contagious?
Usually children with viral infections are the most contagious when they have a fever. That’s why schools have specific guidelines about kids needing to be fever-free, without medication, for a full 24 hours before returning to the classroom.

What foods or drinks are recommended when a child has a virus?
The main priority is good hydration, so make sure your child is drinking plenty of fluids. When children have a fever, they usually don’t hydrate as well. I tell parents to monitor how much the child is urinating. It’s easy with a baby because you can check the diapers, and you want at least five wet diapers in a 24-hour period. For older kids, urinating every six hours is normal.

They are probably not going to have a big appetite, and that’s OK. If your child has vomiting and diarrhea, it’s best to choose foods that are not too hard on the stomach, such as applesauce, rice, and toast. And, of course, chicken soup, which has the added benefit of helping with hydration. Parents also ask about vitamin C or zinc to fight infection. If your child has a balanced diet, they are getting the appropriate amounts of vitamin C and zinc, so supplementation is not generally recommended or thought to have any impact.

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PEM Pearls: Prolonged Fever in Pediatric Patients

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Febrile pediatric patients are ubiquitous in emergency departments (ED) around the country. Parents agonize over the presence, height, and persistence of fever, despite the energy we invest in attempting to reassure them and minimize ‘fever phobia’. But when should we, as providers, also be worried? Very often in pediatric patients we are trying to distinguish self-limited viral infections from potentially harmful bacterial ones. In ill-appearing patients, it’s easy. We treat the patient aggressively as if their symptoms were attributable to a bacterial infection. The proper approach is more opaque with the relatively well-appearing febrile child. How do we pick out the bacterial infections in these cases?

Part of the answer to this question is determined by the patient’s age.

The evaluation of a neonate with fever is straightforward, in some ways the simplest. We assume the patient has a bacterial infection until proven otherwise. We routinely obtain blood, urine, and spinal fluid for analysis and culture, consider chest X-ray and stool cultures, and treat empirically with antibiotics until the cultures are negative. Neonates can certainly be ill and at times represent challenging resuscitation scenarios, but the evaluation and management of a febrile-but-otherwise-well-appearing neonate is not, cognitively speaking, a particularly complex enterprise.

These infants are only slightly more complicated. There exists some institutional variability, but in most settings, all patients will have urine and blood obtained to risk stratify. The practitioner should strongly consider a lumbar puncture given the limitations of the physical exam (this latter point is the subject of much debate). Depending on the patient’s risk category, the care team may admit and/or treat with antibiotics or discharge home with close follow-up.

Due to the successes of widespread immunization in this country, particularly Haemophilus influenza type B and Streptococcus pneumoniae, febrile children older than 3 months are often considered to be low risk for serious bacterial infection and are given a summary treatment in many fever reviews. We are frequently reminded that the rates of occult bacteremia in the post-PCV7 and Hib era have dropped dramatically, from 5% in highly febrile children to <1-2% in the modern era.^1–4 We are therefore implored not to routinely obtain blood cultures and complete blood counts on otherwise healthy, generally well-appearing febrile children. These tests are not usually helpful and frequently lead to false positives that magnify patient and parental anxiety, and burden the health system in the form of repeat visits and additional costs. It is easy enough to abstain from ordering blood cultures and CBCs. But who, among these well appearing patients, should we worry about? Certainly a few among these well appearing patients will have serious pathology. How do we pick them out? That is why, in my opinion, these patients constitute perhaps the most challenging age group in determining appropriate diagnostic work-up and management.

How aggressively should I work-up a child with 5 days of fever, rhinorrhea, and congestion? What if that patient had a cough but their lungs were clear? What if they were wheezing? What if their rapid flu was positive? Let’s consider a few cases that you almost certainly have seen in your ED.

A 4-year-old boy presents with 5 days of fever, congestion, occasional non-bloody, non-bilious emesis, and some loose stools. His 16 month-old sister starting getting sick yesterday with similar symptoms. His vital signs are: T 39.5C, HR 125, RR 22, BP 98/67. His oxygen saturation is 100% on room air. He is tired-appearing but non-toxic. Tympanic membranes look normal and his oropharynx is only mildly erythematous. His lungs are clear to auscultation bilaterally. Abdomen is soft, non-tender, and there is no rash. It’s February, and you think he might have the flu. So you order a rapid flu. Eureka! It’s positive. You inform the family and neatly invoke this as the explanation for their child’s fever. The mother, however, is not reassured. She says “I’m worried about this fever. Are you sure it’s just the flu? How long is the fever going to last?”

How long

does the fever from common viral illnesses last?

The answer is, not surprisingly, dependent on the virus. An old, but very informative study published in the American Journal of Disease of Children studied children aged 3 months to 15 years diagnosed with influenza A and B, parainfluenza 1, 2, and 3, RSV, and adenovirus, evaluating both duration and height of fever.⁵ The following table summarizes their findings.

	Before Admission		In the Hospital		Total Duration
	n	Days	n	Days	n	Days
Adenovirus	24	3.2±2.5	25	1.7±1.1	25	4.8±2.2
Influenza A	47	2.1±2.2	47	2.9±1.7	47	5.1±2.8
Influenza B	27	2.6±2.2	18	2.9±2.2	27	5.2±2.0
Parainfluenza 1	25	2.0±2.0	25	2.0±1.4	25	4.0±2. 0
Parainfluenza 2	21	0.8±0.8	21	1.6±1.6	21	2.5±1.9
Parainfluenza 3	53	1.1±1.3	53	2.0±1.7	53	3.1±2.1
Respiratory Syncytial Virus	60	1.7±1.7	60	1.8±1.3	60	3.5±2.3
Table 4. Duration of Fever Before Admission, During Hospitalization, and Total Duration of Fever in Respiratory Virus Infections (mean±SD)

Can a bacterial co-infection exist with influenza?

In a study of patients hospitalized with influenza from 2003-10, 2% were found to have culture-positive bacterial infections, most commonly Streptococcus pneumoniae and Staphylococcus aureus. Of note, this almost certainly underestimates the true incidence of bacterial coinfection, given that bacterial cultures were collected at the discretion of treating physicians rather than in a systematic fashion. Additionally, pneumonia complicated influenza in 25% of these patients, many of which likely represented bacterial-viral coinfection not detected by blood or sputum culture.⁶ Additionally, influenza alone can be serious business, with complications including encephalopathy, rhabdomyolysis, acute kidney injury, and myocarditis. So viral respiratory infections can have serious sequelae. However, in the relatively well appearing child with fever of 5 days duration, we needn’t necessarily invoke an alternative explanation for fever. Influenza can certainly cause fever of this duration, and in fact typically does.

Case 1 Answer

So yes, concerned parent, the virus can certainly cause fever of this duration. Continue to use antipyretics as needed to keep your child comfortable, watch for worsening symptoms, and follow-up closely with your primary care doctor.

Speaking of lower respiratory tract infections, what about pneumonia? How reliable is my exam for picking it out, and do I need to worry about “occult pneumonia”?

You are seeing a 3-year-old girl with runny nose, cough, and fever up to 39. 0C at home, for about 5 days. The patient has been seen by her primary care physician and was diagnosed with a viral upper respiratory infection (URI). With persistent symptoms, her parents bring to the ED. She is comfortable, but apprehensive to exam. Vital signs are temp 38.4C, HR 116, RR 24 (99% on room air), and BP 92/66. She has no evidence of acute otitis media, her lungs are clear, and she has easy work of breathing. You obtain a rapid flu, and it’s negative. Her parents say, “Geez doc, she sure is coughing a lot, especially at night. Could she have pneumonia?” As illustrated by the previous study, this may simply be a respiratory virus. But are you sure this child does NOT have pneumonia? And if you’re not, should you get a chest X-ray?

When should you get a chest X-ray for pneumonia?

In a febrile child with respiratory distress or adventitious sounds to auscultation of the chest, the decision to obtain a chest X-ray is somewhat straightforward (a caveat, of course, for young infants who have clinical bronchiolitis, in which case a radiograph is NOT routinely warranted). In children with a fever, cough, and clear lungs, the decision is much less clear. Multiple studies have demonstrated that some percentage of febrile pediatric patients without respiratory distress or abnormal auscultatory findings will have radiographic pneumonia. In the pre-heptavalent pneumococcal vaccine (PCV-7) era, the incidence of so-called “occult pneumonia” was estimated to be from 15-25%.^7,8 Recent studies in the post-pneumococcal vaccine era suggest that occult pneumonia is present in 5-9% of febrile pediatric patients without clinical findings of pneumonia.^8,9

Here is the diagnostic challenge: If these patients have no clinical findings of pneumonia, how do we pick them out? A 2010 study attempted to answer this question.¹⁰ Of 308 eligible patients, 21 (6.8%) had occult pneumonia (i.e. no signs of respiratory distress and no lower respiratory tract findings on exam). The authors considered a variety of potential predictive factors to identify occult pneumonia, including duration of fever, presence and duration of cough, height of temperature, oxygen saturation, and serum WBC count, among others. Unfortunately, the authors could find no strong predictors for the presence of occult pneumonia. They did find that fevers >1 day and worsening cough were moderately predictive.

Figure 1. Decision tree for the identification of patients with occult pneumonia; for this analysis, patients with equivocal chest radiographs are considered to have pneumonia¹⁰

What about the 2-year-old child with truly prolonged fever?

What about the patient chart with a chief complaint of “fever, congestion x 2 months”? Often, a careful history will elucidate a more multiphasic illness course that constitutes consecutive viral or minor bacterial infections. As Dr. Gary Marshall succinctly puts it, “Kids get sick all the time.”¹¹ In fact, an old but excellent study examining children attending daycare found that the average child aged 6 weeks to 5 years suffered 6.5 respiratory illnesses per year, with a peak rate of 10.4 illnesses per year at age 6 months to 1 year. Sick all the time indeed. I’ve found that normalizing the frequency of respiratory illnesses in young children can to some degree assuage parental anxiety about recurrent URIs and fevers. But what about situations where an illness seems to be legitimately prolonged and discrete?

You are seeing a 2-year-old boy with congestion, cough, and fever, up to 102F at home, for 10 days. His parents state that they have been seen 3 times by their primary care physician and have been reassured that this is a “common cold”. Parents report his symptoms are getting worse. The patient is non-toxic on exam, but clings to his mother. Vital signs are temp 39.1C, HR 122, RR 24 (100% room air), and BP 91/66. He has no evidence of acute otitis media but has copious mucopurulent nasal discharge. His lungs are clear, and he has easy work of breathing. A chest X-ray is normal. His parents say, “He’s never been sick this long, doc; he can’t breathe out of his nose and he is coughing a lot. Is there anything we can do to make him get better faster?” You try to remember, do little kids get sinusitis?

Sinusitis in kids

According to the Infectious Disease Society of America (IDSA) and the American Academy of Pediatrics (AAP), they can indeed get sinusitis. Though the frontal and sphenoid sinuses pneumatize over a period of years, the ethmoid and maxillary sinuses are present at birth, with the latter rapidly expanding by 4 years of age. Though acute bacterial rhinosinusitis (ABRS) is less common in children <2 years old, it occurs frequently in pediatric patients aged 4-7 years and is observed even in infants. One 2010 study using strict inclusion criteria found that compared to those receiving placebo, children aged 1-10 years who received amoxicillin/clavulanic acid were more likely to be ‘cured’ (50% vs 14%) and less likely to have treatment failure (14% vs 68%).¹² So appropriate antibiotic therapy can expedite recovery and mitigate symptoms in children with ABRS.

The operative phrase here, however, is “strict inclusion criteria”. Every child who presents with mucoid rhinorrhea and a tactile fever does NOT need antibiotics, and in fact will not benefit from antimicrobial treatment. Also consider the side effects of antibiotic therapy (diarrhea, rash, antibiotic resistant microbes). The presumptive diagnosis of ABRS should be made when a child with URI symptoms meets 1 of the following 3 conditions:¹³

Persistent illness (nasal discharge or daytime cough or both lasting >10 days without improvement)
Worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement)
Severe onset (concurrent fever with temperature ≥39°C/102.2°F and purulent nasal discharge for ≥3 consecutive days)

If the child does not meet these criteria, antibiotics should not be prescribed. If they meet criteria for worsening or severe symptoms, antibiotics should likely be employed, and if symptoms are persistent, they should at least be considered. So for the child in our case, with 10 days of worsening symptoms, fevers, and purulent nasal discharge, in discussion with parents, I would likely treat with antimicrobials.

Prolonged Fever in Pediatric Patients: Final Points

None of the patients described above were exceptionally ill. Likely these will represent a large portion of the pediatric patients you will see in daily practice. Fever is very often a manifestation of a self-limited viral illness in the otherwise healthy pediatric patient: the hard part is deciding when it is not. Though this discussion has only scratched the surface, hopefully it serves to highlight some of the nuanced decisions that must be made when approaching the febrile pediatric patient.

Teele D, Pelton S, Grant M, et al. Bacteremia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a “walk-in” clinic. J Pediatr. 1975;87(2):227-230. [PubMed]

McGowan J, Bratton L, Klein J, Finland M. Bacteremia in febrile children seen in a “walk-in” pediatric clinic. N Engl J Med. 1973;288(25):1309-1312. [PubMed]

Herz A, Greenhow T, Alcantara J, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-month-old children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J. 2006;25(4):293-300. [PubMed]

Carstairs K, Tanen D, Johnson A, Kailes S, Riffenburgh R. Pneumococcal bacteremia in febrile infants presenting to the emergency department before and after the introduction of the heptavalent pneumococcal vaccine. Ann Emerg Med. 2007;49(6):772-777. [PubMed]

Putto A, Ruuskanen O, Meurman O. Fever in respiratory virus infections. Am J Dis Child. 1986;140(11):1159-1163. [PubMed]

Dawood F, Chaves S, Pérez A, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis. 2014;209(5):686-694. [PubMed]

Bachur R, Perry H, Harper M. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999;33(2):166-173. [PubMed]

Murphy C, van de, Harper M, Bachur R. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007;14(3):243-249. [PubMed]

Rutman M, Bachur R, Harper M. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009;25(1):1-7. [PubMed]

10.

Shah S, Mathews B, Neuman M, Bachur R. Detection of occult pneumonia in a pediatric emergency department. Pediatr Emerg Care. 2010;26(9):615-621. [PubMed]

11.

Marshall G. Prolonged and recurrent fevers in children. J Infect. 2014;68 Suppl 1:S83-93. [PubMed]

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Chow A, Benninger M, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. [PubMed]

13.

Denny F, Collier A, Henderson F. Acute respiratory infections in day care. Rev Infect Dis. 1986;8(4):527-532. [PubMed]

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According to experts from the All-Russian Health Organization, cancer is detected in about 300 thousand children aged from birth to 19 years. We asked Valentina Timofeeva, Chief Freelance Pediatric Oncologist, several questions about the origin of cancer in children, their treatment and rehabilitation of oncological patients.

How common is cancer in children?

Most often, in the practice of pediatric oncologists, malignant brain tumors, leukemias, lymphomas, as well as neuroblastomas and nephroblastomas, are encountered. The approximate incidence of oncological diseases in children in all countries of the world is approximately the same. It is 14-15 cases per 100 thousand children. For example, the incidence of children in the Ulyanovsk region in 2021 was 15 per 100 thousand of the child population.

Why do children get cancer? How to identify an existing cancer?

Up to 90% of detected cases of cancer in children of the first year of life are congenital. In most cases, this is an embryonic tumor caused by a malformation of the fetus. Since it is very important to detect a tumor in the first six months of a child’s life, parents of newborns must observe the frequency of in-depth examinations as part of a pediatric medical examination. Cancer alertness of doctors and parents is the main condition for timely detection and treatment of oncological diseases. In both adults and children, malignant tumors are most often detected by screening. In the first years of life, a pediatrician directs to narrow specialists. Since juvenile tumors occur mainly in adolescence due to malignant transformation in cells and adult-type tumors, at an older age, in addition to the medical examination that children undergo before being sent to kindergarten and school, it is necessary to undergo an annual preventive examination with the child at the local clinic. residence.

What signs of cancer should alert parents?

A significant difference between pediatric oncology is the complexity of early diagnosis. In addition, some features of the child’s body (which is in the stage of active growth) and the absence of specific subjective complaints make it difficult to diagnose. Children most often cannot clearly articulate what worries them. However, adults may suspect cancer in a child for a number of reasons: pale skin, refusal to eat, cessation of weight gain, behavioral changes, lack of activity, indifference to what is happening. A cancerous tumor can be determined by touch as a volume dense subcutaneous formation, for example, in the abdominal cavity, while the child complains of abdominal pain. You need to immediately consult a doctor, postponing all other matters! Remember that neither studies, nor competitions, nor trips – nothing can be more important than the health of the child. A palpable swelling on the leg or arm may be a sarcoma. A brain tumor manifests itself as hydrocephalus – an abnormal increase in the size of the head. The child complains of nausea and vomiting, especially in the morning.

What should parents do if these signs appear?

If parents think that the child’s behavior has become unusual, you should consult a doctor. With leukemia in children, there is a prolonged fever, the cause of which is not obvious to parents, bruises and a rash on the skin, small subcutaneous hemorrhages. Reliable information about the presence of signs of the disease will give a blood test. It will show anemia, low platelet count, changes in white blood cells. Be sure to tell the doctor about the suspicion of an oncological disease, if the child does not stop coughing for a long time and the fever persists, the temperature stays at high levels for 10 days or more, antibiotic therapy does not help.

What medical institutions in our region provide care for children with cancer?

Medical hospital care for children with oncohematological diseases is provided on the basis of the children’s specialized oncology department of the Ulyanovsk Regional Children’s Clinical Hospital named after Yu. F. Goryachev. Children under the age of 18 are admitted to the department. Every year, more than 500 patients with oncological and severe hematological diseases receive help: hemoblastoses, solid tumors, and tumors of the central nervous system. Out-of-hospital care is provided on the basis of the consultative and diagnostic center of the hospital, where hematologists and oncologists conduct appointments, carrying out continuity between the doctors of the hospital and the polyclinic.

What changes have occurred in the organization of care for children with oncopathology in recent years?

Since 1999, pediatric oncohematology of the Ulyanovsk region has been working as part of a cooperative multicenter group for the treatment of oncopathology in children with the National Medical Research Center for Pediatric Hematology, Oncology and Immunology named after D. Rogachev. Thanks to established cooperation, we have gained access to all the information about modern technologies for treating cancer in children: we have the opportunity to meet and exchange experience with leading pediatric oncohematologists from the federal center and other cities of Russia. In recent years, in our practice, we have widely used telemedicine consultations with federal clinics to discuss the treatment of seriously ill patients. This interaction allowed everyone to improve the results of treatment by an order of magnitude.

Can patients receive high-tech medical care without leaving the region?

Therapy of malignant diseases in the Ulyanovsk region is carried out using unified treatment protocols based on high-dose chemotherapy and adequate accompanying therapy in accordance with international programs that have proven their effectiveness. Organized continuous monitoring of cancer incidence in the Ulyanovsk region. Oncology department nurses perform infusion treatment – transfusion, chemotherapy using special equipment, are able to work with central and peripheral catheters, have the skills to care for patients with fungal, viral and bacterial infections, hemorrhagic complications, including under sterile conditions.

What is being done for a comfortable stay of a profile patient in the oncology department of the hospital?

Taking into account the duration of treatment, the department has created the necessary conditions for a long stay of children with their parents, providing full-fledged care and organizing leisure activities for children. The educator of the department helps the child to adapt in the hospital, get used to the rules of the hospital regime. Much attention is paid to psychological assistance to young patients; a psychologist works in the department. The methods of various creative processes are widely used, the methods of art therapy are successfully applied.

Are there rehabilitation programs in our region? What can a profile patient expect after discharge from the hospital?

Rehabilitation of children is carried out on the basis of the Russkoye Pole sanatorium in the Moscow Region and the Zvyozdochka Rehabilitation Department of the Ulyanovsk Regional Children’s Clinical Hospital. Passing a rehabilitation course is important to prevent relapse and social adaptation of children after struggling with a serious illness. The staff of the department fruitfully cooperates with the Simbirsk Diocese of the Russian Orthodox Church, the department has a prayer room in honor of the icon of the Mother of God “ALL Tsaritsa”, which can be visited at any time by both children with their parents who are undergoing treatment, and employees of the department. The work of the department is assisted by a number of regional public organizations: the Rotary Club, the Give Good Charitable Foundation, Gulliver JSC, Rostelecom JSC, Life Insurance Insurance Company.

Oncology Department of the Ulyanovsk Regional Children’s Clinical Hospital named after public and political figure Yu.F. Goryacheva in our region is the flagship of hospital care for children with the introduction of new methods of diagnosis, treatment and rehabilitation.

With the assistance of the Center for Public Health and Medical Prevention of the Ulyanovsk Region

types, symptoms, diagnosis, treatment, clinical guidelines

Fever is insidious: it may not threaten the child’s health at all, or it may be a symptom of a transient dangerous infection. When the temperature rises, you should understand the situation, find the cause and constantly monitor the changes.

Heat exchange in children is somewhat different than in adults. At birth, all babies have a special brown fat, which is quickly replaced by ordinary white fatty tissue. Brown fat contains many mitochondria. They interact with fatty acids and release heat when needed. Since babies are very vulnerable in the first days of life, this mechanism protects them from hypothermia.

In the process of life, the mechanisms of heat transfer in children continue to change, they become more and more similar to the thermoregulation of adults. In fact, the final development of the system ends only by 8 years. Until this age, children lose heat worse and at the same time produce it better. Because of this feature, overheating is more dangerous for the baby, and the entire thermoregulation system is much less stable. Temperature jumps in children happen often, and the reasons can be very different.

What is fever

Body temperature above 37°C is considered hyperthermia, ie fever. When measuring temperature in the rectum, fever is considered to be above 38°C.

The mechanism of fever is as follows: pyrogens, substances that stimulate fever, provoke the release of anti-inflammatory substances. Pyrogens are most often of an infectious nature. They act on the thermoregulatory center, which becomes less sensitive to thermal impulses. The whole system is rebuilt to work at a higher level: heat production increases and heat transfer decreases, which leads to a general increase in body temperature.

At the same time, many viruses and bacteria in such a “heat” reduce the rate of reproduction, and the immune system increases the synthesis of antibodies. The activity of leukocytes, inflammatory cells, also increases. At its core, an increase in temperature is a protective reaction of the body, which allows you to quickly defeat the infection and activate the immune system.

Symptoms of fever in children

An increase in body temperature immediately affects the well-being of the child. The skin becomes hot, wet, the baby has weakness, chills, headache, he cries. If the fever is severe, then delirium, confusion and convulsions are possible.

Clinically, fever in children is divided into “pink” and “pale”.

The first is the most common and relatively harmless. It is provoked mainly as a reaction to an infection, despite the high numbers on the thermometer, the child usually feels fine. At the same time, the baby’s skin is red, hot, moist, legs and arms remain warm. The higher the temperature, the more often the child begins to breathe, the pulse quickens.

Pale fever is much more dangerous. Due to vasospasm, the skin turns white, may be covered with “marble” cyanotic spots. The skin is hot, but dry, the child hardly sweats. Hands and feet are cold, shortness of breath may begin. There are problems with pressure: it rises sharply, and then can drop almost to a state of shock. At the same time, the child is excessively lethargic, it is impossible to wake him up. Or, on the contrary, overexcited, he is disturbed by hallucinations and delirium.

Pale fever is characteristic of severe bacterial infections. It requires special attention, as it can cause serious complications.

Causes of fever in children

The body temperature of young children is unstable. It can fluctuate from emotional overexcitation, fatigue. At an older age, hormonal failure during puberty can also cause fever.

But the main causes are various infections. Injuries, internal hemorrhages, burns and bruises, overheating in the sun and dehydration can also cause fever. The reasons can be very serious: tumors, genetic diseases, hormonal disorders.

Fever is usually accompanied by a sudden rise in temperature, which is stopped by drugs, but can last for several hours. There are long-term conditions, while the temperature rises slightly, but often. One such example is thermoneurosis. To determine the exact cause, you need to call a pediatrician (1).

Treatment of fever in children

Almost always, body temperature rises as a reaction to infection: bacteria, viruses. In some cases, there are few specific symptoms at the very beginning of the disease (for example, with meningococcal infection). At the same time, the disease develops rapidly and in some cases can even lead to death, so you should always pay increased attention to fever.

Treatment will be specific, aimed at eliminating the source of infection. For this, depending on the cause, antibiotics, antiviral drugs, as well as their own immune forces can be used. To reduce the temperature with threatening numbers, antipyretics are used in various forms. Dosage and choice of drug depend on the age of the child.

A slight and short-term increase in temperature may be associated with nervous tension, overheating, teething. It is important to know that the very fact of teething cannot cause a significant jump in temperature – normally this process is quite natural and does not cause fever. If you are teething and have a high fever, it is almost certainly not your teeth that are causing you to relax (2). You need to establish the cause, remember what happened before the rise in temperature, which could cause a fever. If it is overheating, the child should be moved to a cool place, give water, cool the head, wipe the body with water. Do not wipe the skin with alcohol, vodka or too cold water and ice. Severe cold constricts blood vessels and heat transfer is still reduced, the body cannot cool. And alcohol can be partially absorbed through the skin, its vapors adversely affect the baby.

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The temperature can drop badly from dehydration, so sometimes you even have to force a sick child to drink. There is a special formula, according to which, with each degree of excess temperature, the volume of liquid that needs to be taken increases. For every degree of elevated temperature, 10 ml of water per kilogram of the child’s weight is added.

Diagnostics

Various thermometers, including mercury and electronic, are used to measure temperature. The latter are not very accurate, the error in degrees in individual models can be large. Mercury thermometers must be used very carefully so as not to break.

Temperature in children is taken under the armpit, in the groin or in the rectum. Shake the thermometer to 35°C, wipe it with a disinfectant and insert it under the arm or into the skin fold (it must first be wiped) in the groin. You need to hold the thermometer by pressing the bent arm or leg of the child for about 10 minutes.

The most accurate way is to measure the temperature in the rectum. In children under 2 years old, this is the main method. Rectal temperature is always higher than on the surface of the body. Normal rectal temperature is considered to be 37. 3-37.7. Before the measurement, it will not be superfluous to do a cleansing enema, but you can do without it. The thermometer must first be disinfected, the tip should be lubricated with petroleum jelly and inserted into the rectum to a depth of no more than 5 cm. Then squeeze the child’s buttocks with your hands and hold for about 5 minutes.

Modern methods of treatment

The most reliable way to quickly reduce the temperature is to take antipyretic drugs. They are also called antipyretics.

Do not give such medicines at every temperature jump, and even more so as a preventive measure – it will not work. Usually, antipyretics are used after 38-39 ° C, before this threshold the child feels quite well, and a slight fever helps to cope with the disease.

When convulsions appear, under the age of 2 months, with very poor health, you need to focus on the child’s feelings, and not on a thermometer. Sometimes antipyretics are required for mild fever, and sometimes a temperature of 39°C the child tolerates normally.

Fever should subside within about half an hour after taking the drug. If the antipyretic in the form of tablets, gels and syrups was ineffective, intramuscular or intravenous injections are usually administered. Persistent fever, which is not stopped for a long time by drugs, is the reason for calling an ambulance. Hospitalization may be required (3).

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Prevention of fever in children at home

Fever is possible with any infectious disease (4). It’s impossible to avoid it. It is only necessary to monitor the condition of the child, do not wrap him in blankets, give a sufficient amount of liquid.

When the fever subsides, there will be active sweating, all clothes and bedding may become wet. To make the child more comfortable and not get sick even more, change clothes more often.