Fever is the most frequent sign of a child’s illness. This situation is experienced by parents with particular anxiety and apprehension, in most cases without reason

Fever must be considered a defence mechanism of the child and not an illness, in fact it is very useful in overcoming the illness

First of all let us define the normal values of the child’s body temperature, these values oscillate between 36.5°C and 37.5°C, following a circadian rhythm.

The body temperature reaches its lowest values in the early hours of dawn and then gradually rises during the day.

Higher values, always remaining in the normal range, occur during digestion and in the early afternoon.

How to control fever

In principle, it should not be detected after physical activity. The detection sites can be: axillary or inguinal, possibly avoiding anal, so as not to create further discomfort for the child.

Remember to scale down half a degree in the case of anal detection.

The most commonly used thermometers are skin thermometers, electronic thermometers and infrared thermometers; the latter, if used correctly, give reliable measurements and are faster.

Physio-pathological aspects of fever

A rise in body temperature can occur through endogenous or exogenous mechanisms.

In the first case through substances in the body itself that activate so-called endogenous pyrogens. In the second case, the rise occurs as a result of external conditioning, often caused by high temperatures in the environment in which one is staying and by altered thermodispersion mechanisms.

In the second case, one therefore speaks more correctly of hyperpyrexia.

A typical example of this is the characteristic ‘heat stroke’, due to living in hot, humid and poorly ventilated environments.

Heatstroke makes use of remedies other than antipyretics: transport in a cool and ventilated environment, in the shade, the child must be hydrated and cooled by physical means.

The endogenous mechanism occurs by viruses, bacteria, fungi or protozoa invading the body.

These pathogens activate particular cells in the blood: monocytes and macrophages that produce the characteristic endogenous pyrogens, represented by interferon, interleukin 6 and especially interleukin 1.

These substances in turn reach a particular area of the brain called the hypothalamus, differentiated into two zones, the anterior and posterior, via the blood stream.

The anterior zone is responsible for thermoregulation and causes the release of prostaglandins through the enzymatic action of cyclooxygenases.

The posterior zone of the hypothalamus is deputed to the action of constriction of the arteries with reduction of thermodispersion and therefore accumulation of heat in the body.

As we can see, therefore, it is a combined action of the hypothalamus that eventually leads to the onset of fever.

In this complicated mechanism there is the co-participation of the voluntary muscles with the onset of shivering: the contraction of muscle fibres leads to the production of heat, the latter also produced by the hyperactivity of the liver.

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Fever therefore serves the defence of the child’s organism, following two paths

• inhibition of the replication of virulent agents, especially viruses and bacteria
• stimulation of the immune system with activation of T and B lymphocytes. These represent the ‘soldiers’ engaged in fighting the ‘enemies’: viruses, bacteria and other pathogens.

In the defence system, the whole organism is involved, activating particular metabolic functions, including

• increased synthesis of protein substances: immunoglobulins, complement factors, C-reactive protein, haptoglobin, ceruloplasmin.
• increased blood glucose by breaking down hepatic and muscle glycogen, which is important for an increased supply of energy substances.
• mobilisation of fats directly from the adipose tissue, releasing the characteristic ketone bodies which, in excess, spill over into the urine, resulting in the typical ketonuria, the reason for so much unwarranted anxiety in parents. In fact, this condition is not to be treated except by an increased intake of glucose or fructose, the latter being quicker in restoring low blood sugar values that have been consumed in excess by the body. Excess sugar consumption is also due to the insulin-boosting action.
• Release of hormones including ACTH (adreno-corticotropic hormone), which stimulates the adrenal glands, which in turn produce more cortisol, which is used to cope with the stressful state caused by fever. It also releases GH (growth hormone), which is also involved in this combined action with an energising effect. The production of growth hormone explains the increased growth, especially in stature during the fever period.
• hypertrophy of the lymphatic system and especially the lymph glands, which become enlarged and increase their immune function.
• alterations in the sleep-wake relationship with sleep prevailing over wakefulness. This alteration is explained by the direct action of interleukin 1 on the nervous system, a sort of sleeping pill which, by decreasing the child’s activity, encourages greater recovery of energy and facilitates the action of the immune system.

This sleepiness of the feverish child is another reason for parents’ anxiety. It is preferable, however, to carry out a medical check-up to rule out a pathological involvement of the nervous system.

Reduced function of the gastro-intestinal system, which in turn explains the lack of appetite and frequent vomiting with the emission of undigested food.

Active drugs against fever

• acetylsalicylic acid has been abandoned, due to the possible occurrence of Reye’s syndrome, especially in patients suffering from chickenpox and influenza syndromes. There is also the non-negligible risk of gastric bleeding and/or alteration of the coagulation mechanism.
• the use of corticosteroids is not recommended mainly because they may mask important symptoms that are useful for diagnostic purposes
• the use of paracetamol and ibuprofen is certainly the most indicated. These drugs exert their action by inhibiting cyclooxygenase, which, as we have seen above, favours the activation of endogenous pyrogens. However, these two drugs should not be used alternately, as they favour the onset of toxic effects if combined.

Complementary methods to antipyretic drugs

Undress the child, instead of covering him or her as parents are often inclined to do, give plenty of water to drink and lower the room temperature.

Sponging with water and alcohol should be avoided: it causes the skin to cool down, stimulating the thermoregulatory centre, resulting in shivering and trembling, which further raises the body temperature.

Recommendations in the case of a child’s fever

Use antipyretic drugs only when the temperature is above 38° C.

In children who have suffered febrile convulsions, anti-pyretics should be given with a fever of 37.5°C; this is important as it has been documented that convulsive seizures are favoured by the rising phase of the fever.

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Source

Medicitalia