The days and nights are long. You watch the clock, thermometer in hand or every now and then touch the forehead of your son or daughter.
Life at home comes to a standstill, for your child is running a temperature and that terrifies you.
Bringing down the fever becomes your sole goal and you will do anything and everything to do just that.
You will dose the child with paracetamol, sponge him over and over again, bathe him with eau de cologne or plead with the family doctor to give medicine to bring the fever down.
Knowing the fears of parents, especially these days when dengue is on the prowl, MediScene spoke to three Consultant Paediatricians at the premier children's hospital in Sri Lanka, the Lady Ridgeway Hospital, to find out what should be done about a fever and when to worry.
Here is what Consultant Paediatricians Dr. Kalyani Guruge, Dr. Samantha Waidyanatha and Dr. Padmakanthi Wijesuriya have to say.
Parents are very fearful that a fever may do some harm to the child, says Dr. Guruge, explaining that bringing down the fever, however, is not the answer. "The most important thing is to find the underlying cause to which the body has responded with the fever."
Fever by itself will not harm the child, stresses Dr. Waidyanatha, while Dr. Wijesuriya adds that fever is a symptom, it's only part of the disease.
A fever indicates that the body is, in fact, reacting to something happening in there.
Even a febrile convulsion or fit will not harm a child, explains Dr. Waidyanatha, adding that there are no reports of such incidents.
According to Dr. Wijesuriya febrile convulsions usually occur within the first 48 hours and in children younger than five years old.
"But parents are worried about such convulsions when the child is even 10 years old," she says.
All three doctors urge parents not to keep dosing their child with paracetamol or any other drug.
For, according to them, medications can veil the underlying cause of the fever. "Various drugs can actually do more harm than good," they warn.
Beware of giving your child ibuprofen, diclofenac sodium (mostly used in suppository form) and mefenamic acid, MediScene understands.
These have an effect on the functioning of platelets as well as the platelet count and can lead to an increased bleeding tendency in a child who has dengue fever, explains Dr. Guruge, with the other two Paediatricians in vigorous agreement. (Platelets are irregular-shaped cell fragments which are part of the components that make up blood and assist in the clotting process when there is an injury to prevent a person haemorrhaging.)
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| Dr. Kalyani |
Dr. Samantha |
Dr. Padmakanthi |
These medications should be strictly avoided, particularly when dengue is around, MediScene learns, because these too can cause bleeding on their own, especially in the gut.
The bleeding tendency is known to occur in Dengue Haemorrhagic Fever (DHF) and these medications can aggravate this tendency, says Dr. Wijesuriya.
Another thing to avoid is red or brown food and liquids, advises Dr. Waidyanatha, because once again if the child has contracted DHF, doctors will not be able to find out whether the stains in the child's vomit or stools are due to DHF or the coloured food or drink that has been given.
So what should parents do when a child is having fever?
Firstly watch the child carefully, reiterate these Paediatricians. Is the child behaving normally? Is the child looking unwell?
If, and the if is of vital importance, MediScene understands, the child has no other symptoms (see box) but the fever, give the correct dose of paracetamol to control the temperature.
If it does not settle with the paracetamol don't worry, says the doctors, adding that parents should not overdose the child just to bring the fever down. Paracetamol should be administered only four times a day and the dose would depend on the weight of the child.
Read the pack carefully or get medical advice before administering paracetamol, say these doctors. "It is not a cure, it is given to comfort the child. What is important is to look for the illness."
If the child vomits after a dose of paracetamol, don't give another one again, but follow the four-dose routine for 24 hours, they explain, adding that it is essential to give a lot of fluids to the child as well, along with the normal diet.
"Don't forget to check whether the child is passing urine as usual," says Dr. Wijesuriya.
The other vital necessity is rest.
Sponging may not be very useful, especially if the child is screaming and kicking and averse to it, says Dr. Waidyanatha, but if possible keep the child sans heavy clothes, and only lightly dressed.
Usually, the fever goes away on its own but if there are no other symptoms and the fever has not settled within three days, see a doctor, reiterate these Paediatricians, while stressing that fever accompanied by any other symptom would require that the child be taken without delay on the very first day itself.
Do not relax even after the fever is down, particularly if dengue is suspected and certainly don't send the child to school or for extra-curricular activities.
"Watch the child for 48 hours even after the fever is gone," says Dr. Guruge, while the others add that if the child looks unwell or has a rash or is not eating, don't take a chance. Take the child to a doctor.
For, it is better to be safe than sorry later.
Parents keep an eye
Be vigilant and watch your child. If a fever is accompanied by ONE or MORE of the symptoms given below, rush the child to the doctor immediately.
- Vomiting
- Headache
- Any abdominal (stomach) pain, especially on the right side
- Pain in the limbs or joints
- Cold hands and cold feet
- A rash on any part of the body
- Refusing to take food - eat or drink
- Lethargy and refusing to get out of bed
- Feeling sleepy and not being his normal self in between fever episodes
- Looking unwell
Checking the temperature
Usually, a child is considered to be running a temperature if he has more than 100 0F or 38 0C, MediScene learns.
Although the "normal" temperature is supposed to be 98.4 0F and 37 0C, it varies in each individual, the time of the day etc.
How do you check the temperature of a child?
Infants and very small children – insert the thermometer in the armpit. There are also thermometer bands which can be pasted on the forehead.
Bigger children (over eight years of age) – the thermometer can be inserted under the tongue. Ensure that the child has not been given anything hot to drink before doing so.
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