|
Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version
Illustration
Fever
DESCRIPTION
A fever means the body temperature is above normal. Your
child has a fever if his:
Tactile (touch) fever is the impression that your child has
a fever because he feels hot to the touch. Checking a fever
this way is more accurate than we used to think. But if
you're going to call the doctor, actually measure the fever.
The body's average temperature when it is measured orally is
98.6ƒF (37ƒC), but it normally fluctuates during the day.
Mildly increased temperature (100.4 to 101.3ƒF, or 38 to
38.5ƒC) can be caused by exercise, excessive clothing, a hot
bath, or hot weather. Warm food or drink can also raise the
oral temperature. If you suspect such an effect on the
temperature of your child, take his temperature again in a
half hour.
CAUSES
Fever is a symptom, not a disease. It is the body's normal
response to infections. Fever helps fight infections by
turning on the body's immune system. The usual fevers (100
to 104ƒF, or 37.8 to 40ƒC), which all children get, are not
harmful. Most are caused by viral illnesses; some are
caused by bacterial illnesses. Teething does not cause
fever.
EXPECTED COURSE
Most fevers with viral illnesses range from 101 to 104ƒF
(38.3 to 40ƒC) and last for 2 to 3 days. In general, the
height of the fever doesn't relate to the seriousness of the
illness. How sick your child acts is what counts. Fever
causes no permanent harm until it reaches 107ƒF (41.7ƒC).
Fortunately, the brain's thermostat keeps untreated fevers
below this level.
While all children get fevers, only 4% develop a brief
convulsion from the fever. Since this type of seizure is
generally harmless, it is not worth worrying about
excessively. If your child has had high fevers without
seizures, your child is probably safe.
HOME CARE
- Extra fluids and less clothing
Encourage your child to drink extra fluids, but do not
force him to drink. Popsicles and iced drinks are
helpful. Body fluids are lost during fevers because of
sweating.
Bundling can be dangerous. Clothing should be kept to a
minimum because most heat is lost through the skin. Do
not bundle up your child; it will cause a higher fever.
During the time your child feels cold or is shivering
(the chills), give him a light blanket.
- Acetaminophen products
Children older than 2 months of age can be given any one
of the acetaminophen products. Tylenol, Anacin-3,
Liquiprin, Panadol, and Tempra all have the same dosage.
Remember that fever is helping your child fight the
infection. Use drugs only if the fever is over 102ƒF
(39ƒC) and preferably only if your child is also
uncomfortable. Give the correct dosage for your child's
weight every 4 to 6 hours, but no more often.
Two hours after they are given, these drugs will reduce
the fever 2 to 3ƒF (1 to 2ƒC). Medicines do not bring
the temperature down to normal unless the temperature
was not very elevated before the medicine was given.
Repeated dosages of the drugs will be necessary because
the fever will go up and down until the illness runs its
course. If your child is sleeping, don't awaken him for
medicines.
CAUTION: The dropper that comes with one product should
not be used with other brands.
- Dosages of acetaminophen
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than acetaminophen drops 1/2 dropper
7 pounds (80 mg/0.8 ml)
More than acetaminophen drops 1 dropper
14 pounds (80 mg/0.8 ml)
acetaminophen syrup 1/2 tsp
(160 mg/5 ml)
More than acetaminophen drops 1+1/2 dropper
21 pounds (80 mg/0.8 ml)
acetaminophen syrup 3/4 tsp
(160 mg/5 ml)
chewable acetaminophen 1+1/2 tablets
(80-mg tablets)
More than acetaminophen drops 2 droppers
28 pounds (80 mg/0.8 ml)
acetaminophen syrup 1 tsp
(160 mg/5 ml)
chewable acetaminophen 2 tablets
(80-mg tablets)
chewable acetaminophen 1 tablet
(160-mg tablets)
More than acetaminophen drops 3 droppers
42 pounds (80 mg/0.8 ml)
acetaminophen syrup 1+1/2 tsp
(160 mg/5 ml)
chewable acetaminophen 3 tablets
(80-mg tablets)
chewable acetaminophen 1+1/2 tablets
(160-mg tablets)
More than acetaminophen syrup 2 tsp
56 pounds (160 mg/5 ml)
chewable acetaminophen 4 tablets
(80-mg tablets)
chewable acetaminophen 2 tablets
(160-mg tablets)
adult acetaminophen 1 tablet
(325-mg tablets)
More than acetaminophen syrup 2+1/2 tsp
84 pounds (160 mg/5 ml)
chewable acetaminophen 5 to 6 tablets
(80-mg tablets)
chewable acetaminophen 3 tablets
(160-mg tablets)
adult acetaminophen 1 to 1+1/2 tablets
(325-mg tablets)
More than acetaminophen syrup 4 tsp
112 pounds (160 mg/5 ml)
chewable acetaminophen 8 tablets
(80-mg tablets)
chewable acetaminophen 4 tablets
(160-mg tablets)
adult acetaminophen 2 tablets
(325-mg tablets)
-----------------------------------------------------------
Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
As the above table shows, acetaminophen is available in
several oral forms. It is also available as a rectal
suppository in 120-mg, 325-mg, and 650-mg dosages.
Suppositories are useful if a child with a fever is
vomiting often or having seizures caused by the fever.
Use the same dose (that is, the same amount of
milligrams) in the suppository form that you would use
for oral acetaminophen. Most suppositories can be cut
(for example, cut in half) to supply the right dose for
your child's age.
If your infant is under 12 weeks of age, call your
doctor and don't give acetaminophen.
- Ibuprofen
Ibuprofen is similar to acetaminophen in its ability to
lower fever. Its safety record is also similar. One
advantage ibuprofen has over acetaminophen is a longer
lasting effect (6 to 8 hours instead of 4 to 6 hours).
Children with special problems requiring a longer period
of fever control may do better with ibuprofen. Give the
correct dosage for your child's weight every 6 to
8 hours.
Type
Weight of Child (Dosage Form) Dose
-----------------------------------------------------------
More than ibuprofen liquid 1/2 tsp
12 pounds (100 mg/5 ml)
More than ibuprofen liquid 3/4 tsp
18 pounds (100 mg/5 ml)
More than ibuprofen liquid 1 tsp
24 pounds (100 mg/5 ml)
More than ibuprofen liquid 1+1/2 tsp
36 pounds (100 mg/5 ml)
More than ibuprofen liquid 2 tsp
48 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 2+1/2 tsp
60 pounds (100 mg/5 ml)
ibuprofen tablets 1 tablet
(200 mg)
More than ibuprofen liquid 3 tsp
72 pounds (100 mg/5 ml)
ibuprofen tablets 1+1/2 tablets
(200 mg)
More than ibuprofen liquid 4 tsp
96 pounds (100 mg/5 ml)
ibuprofen tablets 2 tablets
(200 mg)
-----------------------------------------------------------
Abbreviations: mg = milligrams
ml = milliliter
tsp = teaspoon
- Combining or alternating acetaminophen and ibuprofen
We don't recommend combining acetaminophen and
ibuprofen for the following reasons:
- There is no added benefit in reducing fever compared
to either product used alone.
- Combining can cause confusion, dosage errors, and
poisoning.
- You don't need to control the fever this closely.
- If instructed by your physician to alternate both
products, do it as follows:
- Use both if the fever is over 104ƒF and does not
go down using only one medicine.
- Give a fever medicine every 4 hours (acetaminophen
every 8 hours and ibuprofen every 8 hours).
- Alternate medicines for only 24 hours or less,
then return to a single product.
- Avoid aspirin
The American Academy of Pediatrics recommends that
children (through age 21 years) not take aspirin if they
have chickenpox or influenza (any cold, cough, or sore
throat symptoms). This recommendation is based on
several studies that have linked aspirin to Reye's
syndrome, a severe encephalitislike illness. Most
pediatricians have stopped using aspirin for fevers
associated with any illness.
- Sponging
Sponging is usually not necessary to reduce fever.
Never sponge your child without giving him acetaminophen
first. Sponge immediately only in emergencies such as
heatstroke, delirium, a seizure from fever, or any fever
over 106ƒF (41.1ƒC). In other cases sponge your child
only if the fever is over 104ƒF (40ƒC), the fever stays
that high when you take the temperature again 30 minutes
after your child has taken acetaminophen or ibuprofen,
and your child is uncomfortable. Until acetaminophen or
ibuprofen has taken effect (by resetting the body's
thermostat to a lower level), sponging will just cause
shivering which is the body's way of trying to raise the
temperature.
If you do sponge your child, sponge him in lukewarm
water (85 to 90ƒF, or 29 to 32ƒC). Use slightly cooler
water for emergencies. Sponging works much faster than
immersion, so sit your child in 2 inches of water and
keep wetting the skin surface. Cooling comes from
evaporation of water. If your child shivers, raise the
water temperature or stop sponging until the
acetaminophen or ibuprofen takes effect. Don't expect
to get the temperature down below 101ƒF (38.3ƒC). Don't
add rubbing alcohol to the water; it can be breathed in
and cause a coma.
CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:
- Your child is less than 3 months old.
- The fever is over 105ƒF (40.6ƒC).
- Your child looks or acts very sick.
CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:
- Your child is 3 to 6 months old (unless the fever is due
to a DTP shot).
- The fever is between 104 and 105ƒF (40 and 40.6ƒC).
- Your child has had a fever more than 24 hours without an
obvious cause or location of infection.
- Your child has had a fever for more than 3 days.
- The fever went away for over 24 hours and then returned.
- You have other concerns or questions.
|
