Most childhood illnesses are accompanied by high body temperature. Often, inexperienced parents fall into a state of panic and resort to self-medication. Uncontrolled use of antipyretic drugs can worsen the child’s well-being and delay the healing process. Therefore, it is necessary to understand what fever in children is, learn to distinguish between its types and be able to provide timely assistance.

Fever is a protective reaction of the body, characterized by an increase in temperature. It occurs as a result of the action of foreign stimuli on thermoregulation centers.

At high temperatures, the natural production of your own interferons increases. They stimulate the immune system, reduce the viability and suppress the proliferation of many pathogenic microorganisms.

Before determining a fever, parents should know the age-specific temperature range. In infants up to 3 months it is unstable, permissible fluctuations up to 37.5 0 C are observed. For older children, the norm is 36.6 - 36.8 0 C.

Before taking measurements, it is important that the child is calm. You should not give hot drinks and food - this accelerates physiological processes in the body, and the indicators may be inaccurate.

Reasons

The reasons are conventionally divided into two groups.

Chills are one of the symptoms of acute fever

Species

Fever in a child manifests itself in different ways, the symptoms depend on the disease. The classification takes into account the clinical picture, duration and temperature fluctuations per day.

According to the degree of increase, four stages are distinguished:

• subfebrile ─ from 37 0 C to 38 0 C;
• febrile (moderate) ─ from 38 0 C to 39 0 C;
• pyretic (high) ─ from 39 0 C to 41 0 C;
• hyperpyretic (very high) ─ more than 41 0 C.

The duration is divided into three periods:

• acute ─ up to 2 weeks;
• subacute ─ up to 1.5 months;
• chronic ─ over 1.5 months.

Depending on changes in the temperature curve, several types are distinguished:

• constant ─ high temperature lasts for a long time, fluctuations per day are 1 0 C (erysipelas, typhus, lobar pneumonia);
• intermittent ─ there is a short-term increase to high levels, alternating with periods (1-2 days) of normal temperature (pleurisy, malaria, pyelonephritis);
• laxative ─ daily fluctuations within 1-2 0 C, temperature does not drop to normal (tuberculosis, focal pneumonia, purulent diseases);
• debilitating ─ characterized by a sharp rise and fall in temperature, during the day the fluctuations reach more than 3 0 C (sepsis, purulent inflammation);
• wavy ─ a gradual increase and the same decrease in temperature are observed for a long time (lymphogranulomatosis, brucellosis);
• relapsing ─ high temperature up to 39 - 40 0 ​​C alternating with fever-free manifestations, each period lasts several days (relapsing fever);
• incorrect ─ is characterized by its uncertainty, the indicators are different every day (rheumatism, cancer, flu);
• perverted ─ in the morning the body temperature is higher than in the evening (septic condition, viral diseases).

Based on external signs, pale (white) and pink (red) fever are distinguished, each of them has its own characteristics.

Pink

Pink is characterized by a strong sensation of heat, the general condition is not disturbed and is considered satisfactory. The temperature increases gradually, the pulse is allowed to increase, blood pressure remains normal, and rapid breathing is possible. Feet and hands are warm. The skin is pink, sometimes with slight redness, and feels warm and moist to the touch.

If you are convinced that the child has red fever, then start antipyretic measures at 38.5 0 C. In children with cardiovascular diseases and neurological disorders, you should prevent a deterioration in health and take the medicine already at 38 0 C.

Pale

Pale fever is distinguished by its severe course. Peripheral blood circulation is disrupted, as a result of which the process of heat transfer does not correspond to heat production. Parents should pay attention to the readings of 37.5 - 38 0 C.

The child's condition sharply worsens, chills appear, the skin becomes pale, and cyanosis sometimes develops in the mouth and nose. Extremities are cold to the touch. Heart rhythms increase, tachycardia appears, accompanied by shortness of breath. The baby’s general behavior is disrupted: he becomes lethargic and does not show interest in others. In some cases, agitation, delirium and convulsions are observed.

A high temperature without symptoms of any disease can be a sign of illness, although many mothers believe that it is harmless.

Heavy sweating is one of the symptoms of relapsing fever

What to do at the first symptoms

When providing first aid, it is necessary to take into account the types of fevers. The tactics for each are individual, so we will consider them separately.

• Remove excess clothing from the child; do not cover him with several blankets. Many people believe that a child should sweat a lot, but this opinion is wrong. Excessive wrapping further contributes to an increase in temperature and entails a disruption of the heat transfer process.
• You can do wiping with warm water. Even the youngest patients are allowed, but full bathing in the shower is not allowed. Apply a cool, damp towel to the forehead and temples. It is allowed to apply a cold compress to large vessels ─ on the neck, in the armpit and groin area, but with caution so as not to cause hypothermia.
• Vinegar rubdowns and compresses are indicated for children over 8 years of age; they are used no more than 2-3 times a day. Vinegar is toxic to a child’s body, so it is important to properly prepare its solution in a 1:1 ratio (mix one part of 9% table vinegar with an equal amount of water).
• Alcohol rubdowns have restrictions; they are allowed only for children over 10 years of age. Pediatricians do not recommend this method, explaining that when rubbing the skin, the blood vessels dilate and alcohol enters the blood, causing general intoxication.
• If your child has a fever, you need plenty of warm fluids. Linden tea has a good antipyretic effect. It has diaphoretic properties, but be sure to drink water before drinking it to avoid dehydration. Please your sick baby with a tasty and healthy drink - brew him some raspberries. It contains a large amount of vitamin C and will be an excellent addition to general treatment.
• Ventilate the room regularly, avoid drafts, and carry out wet cleaning 2 times a day.
• Provide the child with constant rest. You can’t engage in active games; it’s better to offer quieter entertainment.

• observe strict bed rest;
• in this situation, on the contrary, the baby needs to be warmed up, put on warm socks, covered with a blanket;
• make warming tea with lemon;
• Monitor body temperature every 30 - 60 minutes. If it is below 37.5 0 C, hypothermic measures are suspended. Then the temperature can drop without additional interventions;
• Be sure to call a doctor at home; for this type of fever, antipyretic drugs alone are not enough; treatment may include antispasmodic drugs. Severe cases will require hospitalization.

With mouse fever in children, low blood pressure is observed

Diagnostics and examination

If you have even the slightest doubt that you yourself cannot cope with a high temperature, it is better not to take risks and not put the life of your child at risk. We immediately call a pediatrician or an ambulance team.

Already at the initial examination, the attending doctor establishes a preliminary diagnosis, but in some situations additional consultations with specialized specialists will be necessary. The list of examinations depends on the type of fever, its symptoms and the general well-being of the baby.

Mandatory examinations in the laboratory include a detailed blood test and general urine test, and X-ray examinations as indicated. Subsequent diagnostics include ultrasound of the abdominal cavity and other organs, more in-depth bacteriological and serological studies, and a cardiogram.

Treatment

Treatment of fever in children is aimed at eliminating the cause that caused it. It may be necessary to prescribe antiviral or antibacterial drugs. The antipyretic has an analgesic effect, but has no effect on the course of the disease itself. Therefore, in order to avoid improper use of medications, all recommendations are indicated by the attending physician.

Children with a history of neurological disorders, chronic heart and lung diseases, febrile seizures, drug allergies, genetic predisposition, as well as newborn babies are at risk. Approaches to their treatment are individual, preventing all complications.

A sharp rise in temperature can provoke febrile convulsions. They are observed in children under 5 years of age and do not pose a particular health hazard. The main thing in this situation is to remain calm and provide assistance correctly. It is necessary to place the child on a hard surface and free the chest from clothing. Remove all dangerous objects to avoid injury. During a seizure, there is a risk of saliva entering the respiratory tract, so the head and body must be turned to the side. If the attack is accompanied by respiratory arrest, immediately call an ambulance.

Dengue fever causes diarrhea in a child

Taking antipyretic medications

Parents, remember that fever is an integral part of the body's fight against infection. Unreasonable use of antipyretic drugs can disrupt its natural resistance.

When buying medications in pharmacies, you should take into account the child’s age, drug tolerance, all side effects, ease of use and cost. Pediatricians usually prescribe Paracetamol and Ibuprofen.

• “Paracetamol” is considered safer for the child’s body; it is allowed for children from the age of 1 month. The daily dose is calculated depending on weight and is 10 - 15 mg/kg, taken at intervals of 4 - 6 hours.
• Ibuprofen is prescribed from 3 months at a dose of 5 - 10 mg/kg every 6 - 8 hours. It has a number of contraindications for the gastrointestinal tract and respiratory system. Before taking it, you should definitely consult your doctor.

It is impossible to lower the temperature with Aspirin and Analgin, they pose a danger to children's health! The first causes a severe complication - Reye's syndrome (irreversible damage to the liver and brain). The second has a negative effect on the hematopoietic system. After taking it, the temperature drops sharply, and there is a risk of shock.

• consume according to instructions no more than 3-4 times a day;
• Duration of treatment is no more than 3 days;
• Do not use for fever prevention purposes;
• During the day, it is allowed to alternately take an antipyretic medication, which contains another active ingredient. Be sure to coordinate these points with your doctor;
• Young children sometimes have difficulty taking medicine in the form of syrup or tablets. In these cases, rectal suppositories are recommended; their effect is no different;
• 30-45 minutes have passed since taking the medicine, but the child’s fever continues to progress. Then a health worker will need to administer an intramuscular injection of antipyretic medications;
• use proven medications in treatment and purchase them only in pharmacies.

Prevention

It is impossible to predict or prevent fever. The goal of prevention is to reduce the risk of getting sick. Observe sanitary and hygienic standards, strengthen the child’s immune system, and prevent hypothermia and overheating of the body. During epidemics of influenza and other infections, be careful and do not attend mass events.

In conclusion, I would like to remind parents: any febrile manifestations are one of the first symptoms of the disease, which should be taken seriously. High fever should not last longer than 3 days; if it worsens, contact a specialist for a diagnosis.

Do not resort to self-medication, learn how to properly treat a fever. Don’t listen to outsiders’ advice “from the street”; they can leave irreparable complications. After all, the most important thing in our lives is healthy and happy children!

For various reasons, young children often get sick. These can be diseases of a viral or infectious nature, a cold. Parents strive to alleviate the baby’s condition as quickly as possible, because fever accompanied by high temperature raises fears for the lives of children. However, adults should note that at elevated temperatures, it is dangerous to prescribe antipyretics on your own, since the child may develop serious health problems. The fight against fever should not become an end in itself; it is important to eliminate the causes that caused it.

What is a fever

High temperatures in everyday life are often called fever or fever; medicine defines this condition as hyperthermia. This is one of the types of protective reactions of the body exposed to pathogenic factors, which leads to a restructuring of thermoregulation. The result is an increase in the body's production of special substances (including its own interferons) to combat bacterial and viral agents.

However, high thermometer readings in themselves are not life-threatening if the fever does not last too long and the temperature does not exceed 41.6 C using the rectal measurement method. A risk factor is the child's age under two years, as well as the duration of a feverish state of more than one week. Therefore, parents need to know what indicators are considered normal depending on the age of the child:

• 37.5 C is the norm for children under 3 months of age;
• 37.1 C – physiological indicator for a child under 5 years old;
• 36.6-36.8 C is normal body temperature in children over 6 years of age.

It is important to take into account that the higher the body temperature, the more intense the fight against microbes, which heat deprives of the ability to reproduce.

Fever in a child may indicate a serious illness, but in most cases, a temperature jump is a consequence of a general infection of the body. The brain's response to this condition is an increase in body temperature, which is controlled by the hypothalamus.

Types of fever in children

Hyperthermia in children can develop according to different scenarios, since symptoms of elevated temperature accompany not only infectious irritants.

1. Pink fever is accompanied by an adequate course against the background of normal health, the balance of heat transfer and heat production is not disturbed. The skin is pink or moderately hyperemic, moist and warm to the touch.
2. White fever is characterized by increased heat production with inadequate heat transfer against the background of impaired blood circulation. The condition is accompanied by severe chills with pale skin, cold extremities, increased blood pressure, and tachycardia.

It is important to consider that the cause of hyperthermia in children is not always associated with infection. This may be the result of overheating, a psycho-emotional outburst, an allergic response, or other nonspecific factors to which the child’s body reacts violently.

Features of the course of white fever

This type of febrile state with a significant increase in temperature is considered the most dangerous, in contrast to pink fever, since temperature fluctuations and the duration of the fever are difficult to predict. The following factors may cause symptoms of a dangerous condition:

• inflammatory processes as a consequence of infectious diseases of the respiratory system, skin, intestines;
• viral diseases (flu, ARVI);
• reaction to teething, as well as dehydration or overheating;
• allergic or tumor process;
• problems with the hypothalamus (failure of the thermoregulation mechanism), nervous system.

With white fever, the temperature rises rapidly due to an imbalance between heat production and heat release. When infected, the child's body reacts to a high fever with symptoms of lethargy and weakness, as well as signs indicating the cause of the fever.

1. The appearance of a rash along with a high temperature indicates rubella, scarlet fever or meningococcemia. It could also be an allergy to taking an antipyretic drug.
2. Fever with catarrhal syndrome indicates diseases of the upper respiratory tract. It can also be a sign of incipient otitis media, the development of sinusitis; with pneumonia, breathing becomes rapid and wheezing appears.
3. If breathing is difficult during high fever, the condition becomes a sign of laryngitis, croup, and the development of obstructive bronchitis. The appearance of expiratory shortness of breath during ARVI warns of an asthma attack, and heavy breathing with groans and pain indicates complicated pneumonia.
4. Symptoms of acute tonsillitis against the background of fever signal its viral nature, infectious mononucleosis, in which the temperature lasts a long time. Perhaps this is the beginning of scarlet fever or streptococcal tonsillitis.
5. Symptoms of brain disorders accompanied by fever indicate the development of meningitis (headaches with vomiting and increased muscle tone in the back of the head). Confusion with focal symptoms is a sign of encephalitis.
6. A febrile state with high temperature and diarrhea can be accompanied by intestinal disorders, and with diuretic phenomena - urolithiasis. Fever against a background of drowsiness, irritability, and disturbances of consciousness can become a sign of severe toxic and septic conditions.

The main signs of white fever in children, in addition to high temperature, are considered to be blue borders of the lips and nail beds, coldness of the extremities against the background of a hot body. If you press hard on the baby’s skin, it becomes pale at the point of pressure, and the trace of the white spot does not fade for a long time. A difference of one degree or more between the rectal temperature and the axillary value becomes a sign of danger for a child, since daily fluctuations do not exceed half a degree.

Rules for measuring temperature

To measure temperature, you should use an electronic or mercury thermometer and hold it for 5-10 minutes. In which zone can you measure, what indicators are considered normal for each area:

• groin and armpit area – 36.6°C;
• when measured in the mouth, a value of up to 37.1°C is considered normal;
• rectum – 37.4°C.

When the temperature is high, it is important not to reduce it sharply by using antipyretic drugs. The main rule for treating fever with tablets is not to give the patient a remedy with the same active ingredient when the thermometer readings jump again.

Is there any benefit to having a fever?

For young children, an increase in temperature indicates activation of the immune system in the fight against germs. The development of fever, as a protective function, indicates the following processes occurring in the child’s body:

• activation and strengthening of the work of all organs and systems;
• acceleration of metabolic and immune processes;
• increased antibody production, increased bactericidal properties of blood;
• stopping the proliferation of harmful microorganisms:
• accelerating the evacuation of harmful substances and toxins from the body.

Despite the protective properties of fever, it should be taken into account that approaching the temperature to 40.0 ° C deprives the febrile state of its protective qualities. At the same time, metabolism and oxygen consumption accelerate, and rapid fluid loss leads to additional stress on the lungs and heart.

What parents can do

Sometimes it happens for no apparent reason. This type of fever can be caused by a hidden infection, as well as other problems that are dangerous for the baby. If the condition does not improve after a few days, a child with a high fever may need to be hospitalized for further evaluation.

What to do when the thermometer frightens you with significant changes in readings, accompanied by convulsions or fainting. Then parents need to do the following before the doctor arrives:

• to avoid overheating, free the baby from excess clothing, since the skin should breathe freely;
• to prevent dehydration, give the child more warm drinks - water with lemon, cranberry juice;
• access to fresh air should be provided to the room where the patient is in a feverish state;
• frequently measure the temperature, if it does not drop, moisturize the baby’s skin with a damp sponge or compresses;
• if the thermometer readings are consistently high, the patient can be given a Paracetamol tablet in an age-appropriate dosage.

Important! Further use of antipyretics should be prescribed by a doctor, guided by the general condition of the child, concomitant symptoms, and a survey of parents. Self-medication is unacceptable, especially when seizures occur, as well as when the child is under six months of age.

What medications can reduce fever in children?

The very fact of fever is not considered an absolutely dangerous indicator for children older than three months, if it does not drag on and the temperature does not exceed the threshold of 39.5 ° C. It is not at all necessary to reduce the indicator to a normal level; usually a decrease of 1-2 degrees is enough to alleviate the condition. Which antipyretic drugs are safer to choose if the child’s temperature has increased?

Name of active substance	Usual dosage	Features of the action
Paracetamol	The dosage is set at the rate of 10-15 mg of the substance per kilogram of the child’s weight, taken 3-4 times a day	The active substance does not cause platelet dysfunction and does not increase bleeding. Paracetamol-based drugs do not interfere with diuresis and demonstrate an analgesic effect without having an anti-inflammatory effect
Ibuprofen	The daily dose is selected at the rate of 25-30 mg per kg of body weight, taken several times a day	The medication is considered one of the best options for antipyretic drugs against inflammation, providing an analgesic effect with normal tolerability

Paracetamol and drugs based on it are considered the drugs of choice for children, in contrast to Ibuprofen, which belongs to the line of non-steroidal anti-inflammatory drugs (NSAIDs). For oral administration, children are prescribed Paracetamol in regular and effervescent tablets, syrups, and powders. The effect of the drug in the form of suppositories occurs much later.

The rare prescription of Ibuprofen is explained by a wide range of side effects, so drugs based on it are classified as second-choice antipyretics (syrup). An overdose of any medication and treatment for more than three days with antipyretic drugs are unacceptable.

What products should not be given to children?

Aspirin	Taking acetylsalicylic acid tablets by children under 15 years of age is prohibited due to the threat of liver failure and the high probability of mortality (50%) in children
Analgin	The main danger of metamizole is the threat of anaphylactic shock, as well as agranulocytosis. In addition, the possibility of developing hypothermia (low body temperature) cannot be ruled out.
Nimesulide	In addition to belonging to the NSAID line, Nimesulide is part of the group of COX-2 inhibitors - enzymes that control the synthesis of prostaglandins. In many countries around the world the drug is prohibited for the treatment of children

How to reduce fever using folk remedies

The correct use of antipyretic drugs and methods of physical cooling of the body surface allows parents to relieve the condition of a child suffering from high temperature and fever before the doctor arrives. If the patient’s condition is not critical, you can use folk recipes that reduce fever:

• a decoction of periwinkle will help dilate blood vessels;
• infusion of black elderberry flowers has antipyretic properties;
• steamed raspberry fruits, stems or leaves are a well-known diaphoretic;
• thanks to cranberry extract, it will be possible not only to reduce fever and inflammation, but also to get rid of germs;
• An indispensable remedy for fever in a child is lemon and its juice.

It is important for parents to know that the method of wiping the body with vinegar or alcohol solution, used in the past, is considered dangerous due to threatening consequences for the child. Also, doctors do not advise wrapping children with fever or immersing them in cool water, since temperature changes can lead to complications.

The correct reaction of parents to a febrile state in a child would be to call doctors, and not to use self-medication methods. The use of folk recipes and antipyretic drugs can only alleviate the effect of high temperature on the patient’s body before the doctor arrives.

Fever is the most common symptom of illness in children: every child suffers from a febrile illness at least once a year. But they also represent the most common reason for the use of medications: almost all children with fever receive antipyretics even at a low temperature - below 38°. This is facilitated by the idea that parents still have about the extreme danger of high temperature. As, indeed, is the doctor’s desire to alleviate the discomfort associated with temperature, or at least prescribe treatment, the effect of which will be obvious.

Mass consumption of antipyretics imposes special requirements on their safety due to the possible development of complications in children. The fight against elevated temperature is an important element in the treatment of many diseases, but it cannot be considered an end in itself: after all, by lowering the temperature, in most cases we do not affect the course and severity of the disease. Therefore, those doctors and parents who strive at all costs, by any means, to reduce the temperature of a sick child and keep it at normal values ​​are wrong: such behavior indicates their poor knowledge of the causes and role of fever.

First of all, about the normal body temperature of the child. It is not 36.6°, as many believe, but fluctuates during the day by 0.5°, in some children - by 1.0°, increasing in the evening. When measuring the temperature in the armpit, a value of 36.5–37.5° can be considered normal: the maximum temperature (rectal) averages 37.6°, exceeding 37.8° in half of the children. Axillary temperature is 0.5–0.6° lower than rectal temperature, but there is no exact conversion formula; It is important to remember that a temperature above 38°, wherever it is measured, in most children (including the first months of life) corresponds to febrile temperature, and the difference in tenths of a degree does not matter much. But there is no reason to worry if a child’s temperature (in the absence of other symptoms) “jumps” to 37.3–37.5° in the evening; By the way, the temperature decreases somewhat if you let the child cool down before measuring.

Regulation of body temperature is achieved through the balance of heat production and heat transfer. The body generates heat by burning (oxidizing) carbohydrates and fats in tissues, especially when muscles work. Heat is lost as the skin cools; its losses increase with the dilation of skin vessels and evaporation of sweat. All these processes are regulated by the hypothalamic thermoregulatory center, which determines the amount of heat production and heat transfer.

Fever is a consequence of the action of endogenous pyrogens on the thermoregulatory center: cytokines, which are also involved in immunological reactions. These are interleukins IL-1 and IL-6, tumor necrosis factor (TNF), ciliary neurotropic factor (CNTF) and interferon-a (IF-a). Increased synthesis of cytokines occurs under the influence of products secreted by microorganisms, as well as by body cells when they are infected with viruses, during inflammation, and tissue breakdown. Cytokines stimulate the production of prostaglandin E2, which, as it were, moves the setting of the “central thermostat” to a higher level, so that normal body temperature is determined by it to be lower. An increase in heat production due to increased muscle activity and trembling is accompanied by a decrease in heat transfer due to constriction of skin blood vessels. We perceive shivering and a feeling of cold (chills) as a “cold”; upon reaching a new temperature level, heat transfer increases (feeling of heat). Prostaglandin E2 can cause the muscle and joint pain we experience as aching during an acute infection, and IL-1 causes the drowsiness often seen in a child with a fever.

The biological significance of fever is protection against infection: animal models have shown increased mortality from infection when fever is suppressed, and a similar effect has been described in humans. Under the influence of moderate fever, the synthesis of interferons and TNF increases, the bactericidal capacity of polynuclear cells and the reaction of lymphocytes to mitogen increases, and the level of iron and zinc in the blood decreases. “Feverish” cytokines increase the synthesis of proteins in the acute phase of inflammation and stimulate leukocytosis. In general, the effect of temperature stimulates the type 1 T-helper immune response, which is necessary for adequate production of IgG antibodies and memory cells. Many microbes and viruses have a reduced ability to reproduce when the temperature rises.

Antipyretics lower the temperature without affecting the cause that caused it. In case of infections, they only transfer the setting of the “central thermostat” to a lower level, without reducing the total duration of the febrile period; but at the same time, the period of virus isolation is clearly prolonged, in particular in acute respiratory infections. A direct inhibitory effect of these drugs on TNF-a production and anti-infective defense has been shown.

These and other similar data make us cautious about suppressing fever in infectious diseases; One should also take into account the fact that suppression of the production of interferon and IL-2 reduces the strength of the humoral immune response. This makes it plausible to assume that frequent acute respiratory viral infections in children are related to the widespread use of antipyretics in our time; This may also be responsible for the upward trend in allergic diseases.

Another danger arises when using antipyretics. In most acute respiratory viral infections, the temperature lasts only 2–3 days, while in bacterial acute respiratory infections (otitis media, pneumonia) it lasts 3–4 days or more, which is often the only indication for prescribing antibiotics. The use of antipyretic drugs in such patients, especially the “course”, with suppression of temperature, creates the illusion of well-being, and by the end of the week it is necessary to take “heroic measures” to save the child’s life as a result of an advanced process. Therefore, to reduce the temperature you need to have sufficient reasons, and in any case you cannot try to prevent it from rising again.

Of course, closer to 40.0°, the protective functions of fever turn into the exact opposite: metabolism and O2 consumption increase, fluid loss increases, and additional stress is created on the heart and lungs. A normally developing child copes with this easily, experiencing only discomfort, but in patients with chronic pathology, fever can cause a deterioration in the condition. In particular, in children with damage to the central nervous system, fever contributes to the development of cerebral edema and seizures. Fever is more dangerous for children 0–3 months old. And yet, the dangers associated with increased temperature are largely exaggerated; in most infections, its maximum values ​​do not reach 39.5–40.0°C, and there is no threat of developing persistent health disorders.

A study of the practice of using antipyretics showed that, for example, for acute respiratory viral infections they are prescribed to 95% of sick children, even at temperatures below 38° (93%). Familiarizing pediatricians with modern approaches to this problem can reduce the use of these drugs by 2–4 times.

The main febrile syndromes in children are associated with infection and are usually accompanied by quite distinct symptoms that allow at least a presumptive diagnosis to be made right at the patient’s bedside. The following list shows the main symptoms most often associated with high fever in children and the most common causes of their occurrence.

1. Fever + rash in the early stages: scarlet fever, rubella, meningococcemia, allergic rash to an antipyretic drug.
2. Fever + catarrhal syndrome from the respiratory system: ARVI - rhinitis, pharyngitis, bronchitis, possibly also bacterial inflammation of the middle ear, sinusitis, pneumonia.
3. Fever + acute tonsillitis (tonsillitis): viral tonsillitis, infectious mononucleosis (Epstein-Barr virus infection), streptococcal tonsillitis or scarlet fever.
4. Fever + difficulty breathing: laryngitis, croup (inspiratory shortness of breath), bronchiolitis, obstructive bronchitis, asthma attack due to ARVI (expiratory shortness of breath), severe, complicated pneumonia (groaning, groaning breathing, pain when breathing).
5. Fever + cerebral symptoms: febrile convulsions (convulsive syndrome), meningitis (headache, vomiting, stiff neck), encephalitis (disorders of consciousness, focal symptoms).
6. Fever + diarrhea: acute intestinal infection (usually rotavirus).
7. Fever accompanied by abdominal pain and vomiting: appendicitis, urinary tract infection.
8. Fever + dysuric symptoms: urinary tract infection (usually cystitis).
9. Fever + joint damage: rheumatism, arthritis, urticaria.
10. Fever + symptoms of very severe illness (“toxic” or “septic”); the condition requires immediate hospitalization and emergency intensive care, along with deciphering the diagnosis. These symptoms include:

• a sharp violation of the general condition;
• drowsiness (sleeping longer than usual or at unusual times);
• irritability (screaming even when touched);
• disturbance of consciousness;
• reluctance to take liquids;
• hypo- or hyperventilation;
• peripheral cyanosis.

With syndromes 1–9, diagnostic difficulties may, of course, occur, but the most important thing is to make an assumption about the most likely etiology of the process. Fever in a child 0–3 months of age may be a manifestation of a severe infection; in these cases, hospital observation is usually indicated. Long-term (more than 2 weeks) fever of unknown cause requires examination for long-term infection (sepsis, yersiniosis), connective tissue disease, immunodeficiency, and malignant pathology.

If a bacterial disease is suspected, an antibiotic should be prescribed, if possible without antipyretics, since they can mask the lack of effect of antibacterial treatment.

Fever without visible source of infection (FFE). Almost every child is examined for a febrile illness in the first 3 years of life. Of these, every fifth person does not reveal signs of a specific disease upon examination. Currently, such fever is considered as a separate diagnostic category. This refers to an acute illness manifested only by febrile fever in the absence of symptoms that would indicate a specific disease or source of infection. LBI criteria are a temperature above 39° in a child aged 3 months to 3 years and above 38° in a child 0–2 months of age in the absence of the above “toxic” or “septic” symptoms of a very serious disease at the time of the first examination.

Thus, the group of LBI includes children in whom febrile fever is detected against the background of a slightly disturbed general condition. The point of identifying the group of infectious diseases is that, along with non-life-threatening infections (enterovirus, herpetic types 6 and 7, etc.), it includes many cases of influenza, as well as latent (occult) bacteremia, i.e. e. the initial phase of a severe bacterial infection (SBI) - pneumonia, meningitis, pyelonephritis, osteomyelitis, sepsis, in which clinical symptoms may not occur at an early stage, providing a real opportunity to prescribe an antibiotic, preventing its progression.

The causative agent of occult bacteremia in 80% of cases is pneumococcus, less often - H. influenzae type b, meningococcus, salmonella. In children 0–2 months, Escherichia coli, Klebsiella, group B streptococci, Enterobacteriaceae, and Enterococci predominate. The frequency of occult bacteremia in children 3–36 months with LBI is 3–8%, at temperatures above 40° - 11.6%. In children 0–3 months of age with LBI, the probability of bacteremia or TBI is 5.4–22%.

TBI does not develop in all cases of occult bacteremia; its frequency varies depending on the causative agent. Meningitis occurs in 3–6% of cases with pneumococcal bacteremia, but 12 times more often with hemophilus influenzae. Urinary tract infection is detected in 6–8% of children, in girls - up to 16%.

Neither the severity of clinical symptoms, nor high temperatures (above 40.0°), nor the lack of response to antipyretics allows for a reliable diagnosis of bacteremia, although they may indicate its increased likelihood. On the contrary, in the presence of leukocytosis above 15x10 9 /l, as well as the absolute number of neutrophils above 10x10 9 /l, the risk of bacteremia increases to 10–16%; less significant is the increase in the proportion of neutrophils above 60%. But the absence of these signs does not exclude the presence of bacteremia, since every fifth child with bacteremia has a leukocytosis below 15x10 9 /l.

The level of C-reactive protein (CRP) is more informative - 79% of children with bacteremia have numbers above 70 mg/l, while with viral infections only 9%, however, on days 1–2 of infection, CRP may still remain low. Blood culture to detect bacteremia is available only in the hospital; it takes about a day to obtain its results, so the influence of this method on the choice of treatment tactics is small. On the contrary, given the high incidence of urinary tract infections, urine cultures are highly advisable, especially since clinical urinalysis results are often negative.

In children without respiratory symptoms, bacterial pneumonia is rarely diagnosed, but with leukocytosis above 15x10 9 /l, the presence of shortness of breath (>60 per minute in children 0–2 months, >50 in children 3–12 months and >40 in children over 1 year ) and fever for more than 3 days, a chest x-ray often reveals pneumonia.

Febrile convulsions - observed in 2–4% of children, most often between 12 and 18 months, usually with a rapid rise in temperature to 38° and above, but can also occur when it decreases. Their criteria are:

• age up to 6 years;
• absence of central nervous system disease or acute metabolic disorder that can cause seizures;
• no history of afebrile seizures.

Simple (benign) febrile convulsions do not last more than 15 minutes in duration (if they are serial, then 30 minutes), and are not focal. Complex seizures last more than 15 minutes (serial - more than 30 minutes - febrile status epilepticus), or are characterized by focality, or end in paresis.

Seizures develop more often with a viral than with a bacterial infection, the most common cause of their development is herpesvirus type 6, which accounts for 13–33% of first episodes. The risk of developing febrile seizures after administration of DPT (on day 1) and viral vaccines (measles-rubella-mumps - on days 8-15) is increased, but the prognosis for children with these seizures did not differ from that for children with febrile seizures during infection.

The tendency to febrile seizures is associated with several loci (8q13-21, 19p, 2q23-24, 5q14-15), the nature of heredity is autosomal dominant. Most often, simple - generalized tonic and clonic-tonic convulsions lasting 2 - 5 minutes are observed, but atonic and tonic seizures can also occur. The facial and respiratory muscles are usually involved. Prolonged seizures are observed in 10% of children, focal seizures are observed in less than 5%; Although complex seizures may follow simple seizures, most children with complex seizures develop them on the first episode. Most often, seizures appear at the very beginning of the disease at a temperature of 38–39°, but repeated seizures can develop at other temperatures.

In a child with febrile seizures, meningitis should be ruled out first, and lumbar puncture is indicated if appropriate signs are present. Calcium testing is indicated in infants with signs of rickets to exclude spasmophilia. Electroencephalography is indicated after the first episode only for prolonged (>15 minutes), repeated or focal seizures, in which signs characteristic of epilepsy are sometimes revealed.

Rules for reducing temperature

Fever itself is not an absolute indication for lowering the temperature; in most infections, the maximum temperature rarely exceeds 39.5°, which does not pose any threat to a child older than 2–3 months. In cases where a decrease in temperature is necessary, it is not necessary to achieve normal values; it is usually enough to lower it by 1–1.5°, which is accompanied by an improvement in the child’s well-being. A child with a high fever should be given enough fluids, uncovered, and wiped with water at room temperature, which is often sufficient to reduce the temperature.

Consensus indications for reducing fever with antipyretics are:

• In previously healthy children over 3 months of age: - temperature >39.0°, and/or - muscle aches, headache, - shock.
• In children with a history of febrile seizures - >38–38.5°.
• In children with severe diseases of the heart, lungs, and central nervous system - >38.5°.
• In children during the first 3 months of life - >38°.

Antipyretics are required, along with other measures (rubbing the skin, administering antiplatelet agents into a vein), in case of the development of malignant hyperthermia associated with impaired microcirculation.

Antipyretics should not be prescribed for a regular “course” of taking several times a day, regardless of the temperature level, since this sharply changes the temperature curve, which can make it difficult to diagnose a bacterial infection. The next dose of antipyretic should be given only after the child’s body temperature has returned to its previous level.

Selection of antipyretics

Antipyretics are the most widely used drugs in children, and they should be chosen primarily based on safety considerations rather than effectiveness. Numerous advertising publications emphasize the more pronounced antipyretic effect of this or that drug compared to paracetamol. This formulation of the question is inappropriate - we should be talking about the equivalence of doses and the ratio of the effectiveness and safety of the drug, and quickly reducing the temperature with the help of modern means to any level is not difficult. It is important to remember that drugs with a strong effect are more toxic, moreover, they often cause hypothermia with a temperature below 34.5–35.5 ° and a state close to collapse.

When choosing an antipyretic drug for a child, one should, along with the safety of the drug, take into account the convenience of its use, i.e., the availability of children's dosage forms and fractional dosages for different age groups. The cost of the drug also plays an important role.

The drug of first choice is paracetamol (acetaminophen, Tylenol, Panadol, Prodol, Calpol, etc.) in a single dose of 10–15 mg/kg (up to 60 mg/kg/day). It has only a central antipyretic and moderate analgesic effect, does not affect the hemocoagulation system and, unlike nonsteroidal anti-inflammatory drugs (NSAIDs), does not cause adverse reactions from the stomach. Taking into account the possible insufficient reduction in temperature at a dose of 10 mg/kg (which can lead to an overdose with repeated doses), it is recommended to use a single dose of 15 mg/kg when administered orally. Of the dosage forms of paracetamol in children, solutions are preferred - syrups, effervescent powders and tablets for preparing solutions, the effect of which occurs within 30 - 60 minutes and lasts 2-4 hours. Paracetamol in suppositories has a longer effect, but its effect occurs later. A single dose of paracetamol in suppositories can be up to 20 mg/kg, since the peak concentration of the drug in the blood reaches only the lower limit of the therapeutic range. Its effect occurs after about 3 hours. Paracetamol (Tylenol, Panadol, Prodol, Calpol, etc.) in children's forms is produced by many manufacturers; it is part of Cefekon-P suppositories. All these forms, and in dosages for children of any age, are available in the drug Efferalgan UPSA; they do not contain allergenic additives, and the solutions can be added to infant formulas and juices. Efferalgan syrup is equipped with a measuring spoon for precise dosing and is intended for children 1 month–12 years old weighing 4–32 kg (dosage is indicated taking into account differences of 2 kg).

Ibuprofen is a drug from the NSAID group, which, in addition to the central one, also has a peripheral anti-inflammatory effect; it is used in a dose of 6 - 10 mg/kg (daily dose, according to various sources, 20–40 mg/kg), which is comparable in effect to the above doses of paracetamol. Given this fact, WHO did not include ibuprofen in the list of essential medications. Moreover, ibuprofen produces more side effects (dyspeptic symptoms, gastric bleeding, decreased renal blood flow, etc.) than paracetamol - 20% versus 6% in large series of observations. A number of national pediatric societies recommend the use of ibuprofen as a second-choice antipyretic in the following situations:

• for infections with a pronounced inflammatory component;
• in cases where fever in children is accompanied by pain reactions.

Ibuprofen is also available for children (ibufen, nurofen for children - syrup 100 mg in 5 ml); the tablet form of the drug (200–600 mg) is not suitable for this purpose.

In children during the first 3 months of life, both drugs are used in smaller doses and with a smaller frequency of administration.

Rubbing with water at room temperature provides an antipyretic effect during febrile conditions, although less pronounced than during heat shock (overheating). It is especially indicated for overly wrapped children, in whom decreased heat transfer aggravates the febrile state.

Drugs that are not recommended for use in children as antipyretics

Amidopyrine, antipyrine, and phenacetin were excluded from the list of antipyretics. However, in Russia, unfortunately, suppositories cefekon with phenacetin and cefekon M with amidopyrine continue to be used in children.

Acetylsalicylic acid in children with influenza, ARVI and chickenpox can cause Reye's syndrome - a severe encephalopathy with liver failure and a mortality rate above 50%. This served as the basis for a ban on the use of acetylsalicylic acid in children under 15 years of age with acute illnesses in most countries of the world (this ban has been in effect since the early 80s), as well as for mandatory appropriate labeling of drugs containing acetylsalicylic acid. Unfortunately, these rules are not followed in Russia. And Cefekon M and Cefekon suppositories containing salicylamide (a derivative of acetylsalicylic acid) in Moscow were included in the list of prescription drugs available free of charge.

Metamizole (analgin) can cause anaphylactic shock; it also causes agranulocytosis (with a frequency of 1:500,000) with a fatal outcome. Another unpleasant reaction to this drug is a prolonged collaptoid state with hypothermia (34.5–35.0°), which we observed more than once. All this was the reason for its ban or strict restriction of use in many countries of the world; it is not recommended by WHO in a special letter dated October 18, 1991. Analgin is used only in emergency situations parenterally (50% solution of 0.1 ml per year of life) .

It is unacceptable to use nimesulide, an NSAID from the group of COX-2 inhibitors, as an antipyretic in children. Unfortunately, in Russia, the list of indications for its use, along with rheumatoid diseases, pain and inflammatory processes (trauma, dysmenorrhea, etc.), includes the item “fever of various origins (including infectious and inflammatory diseases)” without age restrictions . Of all NSAIDs, nimesulide is the most toxic: according to Swiss researchers, a cause-and-effect relationship has been established between taking nimesulide and hepatotoxic effects (jaundice - 90%). In Italy, cases of renal failure have been described in newborns whose mothers took nimesulide. The literature is replete with reports of the toxicity of this drug.

Nimesulide has never been registered in the USA (where it was synthesized), nor in Australia, Canada and most European countries. In Italy and Switzerland, the drug is licensed for adults and is used for strictly defined indications. Spain, Finland and Türkiye, which previously registered nimesulide, have withdrawn their licenses. In those few countries where nimesulide is registered (there are less than 40 of them, the drug is not registered in more than 150 countries), its use is permitted from 12 years of age, only in Brazil it is allowed to be prescribed from 3 years of age.

Sri Lanka and Bangladesh revoked the license for the use of nimesulide in children; in India, a massive campaign to ban this drug in children due to cases of fatal hepatotoxicity ended in victory: the ban was imposed by the country's Supreme Court.

Unfortunately, both parents and pediatricians are not yet sufficiently aware of the dangers associated with the use of the “most popular” antipyretics, and therefore the use of analgin, acetylsalicylic acid, and cefekon suppositories in children in our country is not at all uncommon. The “humanitarian action” of manufacturing companies to distribute free nimesulide and advertising of this strictly prescription drug addressed to parents increase its popularity, although at least one fatal outcome of fulminant hepatitis in a child receiving nimesulide is already known.

The toxicity of paracetamol is mainly associated with an overdose of the drug during the “course” method of its use in daily doses from 120 to 420 mg/kg/day, with more than half of the children receiving the drugs in dosages for adults. The indicated single and daily doses of paracetamol are not toxic. The danger of this side effect of paracetamol increases with liver disease, taking hepatic oxidase activators, and in adults, alcohol. With long-term use, cases of nephrotoxicity have been described. Paracetamol taken by pregnant women does not affect the development of the child, while acetylsalicylic acid has a similar effect on the level of attention and IQ of children aged 4 years.

The treatment strategy for a patient with fever involves first of all assessing the likelihood of a bacterial disease. When fever is combined with clear symptoms of the latter, antibiotics are prescribed, and the simultaneous use of antipyretics is less desirable. However, when the above temperature levels are exceeded, muscle pain, headaches, and especially in the presence of convulsions, antipyretics are administered, and it is advisable to prescribe them once, so as not to mask, if possible, the lack of effect of antibiotics, as evidenced by a new increase in temperature after a few hours. But even if a patient with fever has symptoms of only a viral infection, a course of antipyretics is not advisable.

In children with SBI, the main goal of treatment is to prevent the development of SBI, which can be achieved, for example, by administering ceftriaxone (Rocephin, Terzef, Lendacin) (50 mg/kg intramuscularly). Oral antibiotics reduce the incidence of pneumonia but not meningitis. The point of view according to which antibiotics should be prescribed to all children with TBI is not shared by many authors, believing that in cases where it is possible to monitor the child, antibiotic therapy should be used only in those children who are more likely to develop TBI:

• children 3 months–3 years old with a temperature above 40°, children 0–3 months - above 39°;
• with leukocytosis above 15x109/l and neutrophilia (absolute number of neutrophils above 10x109/l);
• with increased CRP - more than 70 g/l;
• if there are changes in urine analysis or culture;
• if there are changes in the chest x-ray - it should be performed in the presence of shortness of breath (>60 in 1 min in children 0–2 months, >50 in children 3–12 months and >40 in children over 1 year) and/or persistent fever above 3 days;
• upon receipt of positive blood or urine culture data (checking the adequacy of the selected starting antibiotic).

Treatment strategy for febrile seizures

A doctor is rarely present for simple febrile convulsions; doctors usually only catch prolonged or repeated convulsions. For most parents, seizures seem like a disaster, so the doctor’s task is to convince parents of their benign nature.

A child with a generalized attack should be placed on his side, with his head gently pulled back to facilitate breathing; The jaws should not be forcibly opened due to the risk of damaging the teeth; if necessary, the airways should be cleared. If the temperature persists, an antipyretic is administered: paracetamol (Tylenol, Panadol, Prodol, Calpol, Efferalgan UPSA) (15 mg/kg, if it is impossible to administer it orally, intramuscular lytic mixture (0.5–1.0 ml of 2.5% solutions of aminazine and diprazine) or metamizole (baralgin M, spazdolzin) (50% solution, 0.1 ml per year of life). Rubbing with water at room temperature also helps. If convulsions continue, the following is sequentially administered.

• Diazepam (Relanium, Seduxen) 0.5% solution intramuscularly or intravenously at 0.2–0.4 mg/kg per administration (not faster than 2 mg/min) or rectally - 0.5 mg/kg, but not more than 10 mg; or lorazepam (Merlit, Lorafen) intravenously 0.05 - 0.1 mg/kg (over 2 - 5 minutes); or midazolam (fulsed, dormicum) 0.2 mg/kg intravenously or as nasal drops.
• For children under 2 years of age, it is recommended to then administer 100 mg of pyridoxine. If convulsions continue, after 5 minutes the following is administered: a repeat dose of diazepam intravenously or rectally (maximum 0.6 mg/kg over 8 hours); or phenytoin intravenously (in saline, since it precipitates in glucose solution) at a saturation dose of 20 mg/kg no faster than 25 mg/min.
• If there is no effect, you can administer: sodium valproate intravenously (apilepsin, depakine) (2 mg/kg immediately, then 6 mg/kg/h dropwise; dissolved every 400 mg in 500 ml of saline or 5 - 30% glucose solution); or clonazepam (Clonotril, Rivotril) intravenously (0.25–0.5 mg/kg; this dose can be repeated up to 4 times).
• If these measures are ineffective, sodium hydroxybutyrate (GHB) 20% solution (in 5% glucose solution) 100 mg/kg is administered intravenously or anesthesia is given.

Preventive anticonvulsant therapy (diazepam, phenobarbital or valproic acid), although it reduces the risk of recurrent febrile seizures, is not justified and not recommended due to the side effects of these drugs. Single repeated seizures develop in 17%, two repetitions in 9% and three repetitions in 6%; the recurrence rate is higher (50–65%) in children with the first episode before 1 year of age, with a family history of febrile seizures, with seizures at low temperatures, and with a short interval between the onset of fever and seizures. 50 - 75% of recurrent seizures occur within 1 year and all within 2 years.

Febrile seizures extremely rarely have neurological consequences, including in relation to psychomotor development, academic performance and behavior of children. The developmental prognosis of children who have had febrile seizures, at least at the age of 1–3 years, is, contrary to previously held belief, even better than that of other children due to better memory. In children with simple febrile seizures, the risk of developing epilepsy at age 7 years is only slightly higher (1.1%) than in children without febrile seizures (0.5%), but it increases sharply (9.2%) if developmental disorders are present. a child with complex, especially prolonged seizures and epilepsy in family members.

Parent training

It is very important to convey the above data on the rational use of antipyretics to parents. Recommendations for parents can be briefly summarized as follows:

• temperature is a protective reaction, it should be reduced only according to the indications indicated above;
• with regard to antipyretics, it is not “strength” that is important, but safety; to improve the patient’s condition, it is enough to reduce the temperature by 1–1.5°;
• paracetamol is the safest drug, but it is important to strictly adhere to the recommended single and daily dosages;
• paracetamol and other antipyretics should not be prescribed as a “course” in order to prevent a rise in temperature: taking an antipyretic 3-4 times a day is unacceptable due to the risk of preventing the development of a bacterial infection;
• for the same reason, you should not use antipyretics without consulting a doctor for more than 3 days;
• If possible, you should avoid using antipyretic drugs in a child receiving an antibiotic, as this makes it difficult to assess the effectiveness of the latter;
• with the development of malignant hyperthermia with spasm of skin vessels, the administration of an antipyretic drug should be combined with vigorous rubbing of the child’s skin until it turns red; you need to urgently call a doctor.

V. K. Tatochenko, Doctor of Medical Sciences, Professor
Research Institute of Pediatrics, Scientific Center for Children's Health, Russian Academy of Medical Sciences, Moscow

General diagnostic principles

emergency conditions in children

The need for productive contact with his parents or guardians to collect anamnesis and ensure a calm state of the child during examination.

The importance of getting answers to the following questions:

reason for seeking emergency medical care;

circumstances of illness or injury;

duration of the disease;

timing of deterioration of the child’s condition;

means and medications previously used before the arrival of the EMS doctor.

The need to completely undress the child at room temperature with good lighting.

Compliance with the rules of asepsis when examining a child with the obligatory use of a clean gown over uniform, a disposable surgical mask, especially when providing care to newborns.

Tactical actions of an EMS doctor

The decision to leave the child at home with the mandatory transfer of an active call to the clinic is made if:

the disease does not threaten the patient’s life and will not lead to disability;

the child’s condition has stabilized and remains satisfactory;

The child’s material and living conditions are satisfactory and he is guaranteed the necessary care that excludes a threat to his life.

The decision to hospitalize a child if:

• the nature and severity of the disease threatens the patient’s life and can lead to disability;

  unfavorable prognosis of the disease, unsatisfactory social environment and age characteristics of the patient suggest treatment only in a hospital setting;

Constant medical supervision of the patient is required.

Hospitalization of a child should only be accompanied by an emergency physician.

4. Actions in case of refusal of hospitalization:

if the treatment measures carried out by the EMS doctor are ineffective, and the child in a state of decompensation remains at home due to the parents or guardians’ refusal to hospitalize, then it is necessary to report this to the senior ODS doctor and act on his instructions;

any refusal to undergo examination, medical care, or hospitalization must be recorded in the EMS doctor’s call card and signed by the child’s parent or guardian;

if the patient or parent (or guardian) of the child does not want to formalize the refusal of hospitalization in the form prescribed by law, then it is necessary to attract at least two witnesses and record the refusal;

in case of refusal of hospitalization and the possibility of deterioration of the child’s condition, it is necessary to ensure the continuation of treatment at home with active dynamic visits to the child by a pediatrician at an outpatient clinic or an emergency physician.

Any forms of medical intervention require agreement with the child’s parents (guardians) based on the principle of informed voluntary consent within the framework of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, Articles 31, 32, 61.

Features of transporting children

Children who are conscious and in a state of moderate severity are transported with one accompanying person. Young children are held in arms or on laps. In case of pneumonia, bronchial asthma, stenosing laryngotracheitis, foreign bodies in the upper respiratory tract, after suffering from pulmonary edema, children are held upright. In these cases, older children are transported on stretchers with a raised headboard. Children in extremely serious condition requiring resuscitation measures are transported separately from their parents.

In order to avoid the introduction of infection into a medical institution, the doctor, before bringing the child into the emergency department, must ask the medical staff of the hospital about the availability of quarantine for a particular infection.

Newborn babies, premature babies or those with any pathology are transported from the maternity hospital or from apartments in an ambulance by hand. The child must be wrapped in a warm blanket, covered with heating pads with a water temperature of 40-50 Cº (at the same time, there must be a sufficient layer of fabric between the heating pads and the child’s body), since these children, due to insufficient thermoregulation function, are especially sensitive to cooling. On the way, care must be taken to ensure that no aspiration of vomit occurs during regurgitation. To do this, hold the child half-turned in your arms, and during vomiting, transfer him to a vertical position. After vomiting, you need to clean the child's mouth using a rubber balloon.

Fever

Fever (febris, pyrexia) - This is a protective-adaptive reaction of the body that occurs in response to exposure to pathogenic stimuli, and is characterized by a restructuring of thermoregulation processes, leading to an increase in body temperature, stimulating the natural reactivity of the body.

Classification:

Depending on the degree of increase in axillary temperature:

Subfebrile 37.2-38.0 C.

Moderate febrile 38.1-39.0 C.

High febrile 39.1-40.1 C.

Excessive (hyperthermic) over 40.1 C.

Clinical options:

"Red" ("pink") fever.

"White" ("pale") fever.

Hypertensive syndrome .

Reducing body temperature is necessary in the following cases:

in children under 3 months. life at body temperature more than 38.0 o C;

in previously healthy children aged from 3 months to 6 years, with a body temperature of more than 39.0 o C;

in children with heart and lung diseases, potentially dangerous for the development of AHF and ARF, at a body temperature of more than 38.5 o C.

moderate febrile fever (more than 38.0 C) in children with convulsive syndrome (of any etiology), as well as in diseases of the central nervous system that are potentially dangerous for the development of this syndrome:

all cases of pale fever at a temperature of 38.0 C or more.

Pink fever- an increase in body temperature, when heat transfer corresponds to heat production, clinically this is manifested by the normal behavior and well-being of the child, pink or moderately hyperemic skin color, moist and warm to the touch, increased heart rate and breathing corresponds to an increase in temperature (for every degree above 37 C. shortness of breath increases by 4 breaths per minute, and tachycardia - by 20 beats per minute). This is a prognostically favorable variant of fever.

Pale fever- increase in body temperature, when heat transfer due to a significant impairment of peripheral circulation is inadequate to heat production, the fever takes on an inadequate course. Clinically, there is a disturbance in the condition and well-being of the child, persistent chills, pale skin, acrocyanosis, cold feet and palms, tachycardia, and shortness of breath. These clinical manifestations indicate a pathological course of fever, are prognostically unfavorable and are a direct indication of the need for emergency care at the prehospital stage.

Hypertensive syndrome – an extremely serious condition caused by pale fever in combination with toxic damage to the central nervous system; clinic of pale fever with cerebral symptoms and varying degrees of impairment of consciousness.

1. Scope of examination

Complaints Increased body temperature. Headache Autonomic disorders.

Anamnesis Time of onset of the disease The nature of hyperthermia (daily temperature fluctuations, maximum value, effect of antipyretic drugs - if used) Past diseases Determination of concomitant pathology; allergy history.

Inspection Assessment of general condition. Assessment of vital functions (respiration, hemodynamics). Auscultation of the lungs. Examination of the skin. Measurement of respiratory rate, blood pressure, heart rate, Sat O 2, body temperature; Determining the type of fever.

2. Scope of medical care

Emergency care for pink fever Physical cooling methods: open the child, expose as much as possible, provide access to fresh air, avoiding drafts, water at least 37.0 C, wipe with a damp swab, allow the child to dry, repeat 2-3 times with an interval of 10-15 minutes, blowing with a fan, cool wet bandage on forehead, cold on the area of ​​large vessels. Intramuscular administration of antipyretic drugs, if hyperthermia does not stop within 30 minutes: 50% solution of Metamizole sodium (Analgin) 0.01 ml/kg for children of the first year of life, over one year - 0.1 ml/year in combination with a 1% solution of Diphenhydramine (Diphenhydramine) 0.01 ml/kg for children of the first year of life, over 1 year – 0.1 ml/year, but not more than 1 ml. or Clemastine (Suprastin), Chloropyramine (Tavegil) 2% - 0.1-0.15 ml. for 1 year of life, but not more than 1.0 ml. i/m. Continue physical cooling methods. Emergency care for pale fever Paracetamol orally in a single dose of 10-15 mg/kg. Nicotinic acid orally in a single dose of 0.05 mg/kg rub the skin of the limbs and torso, apply a warm heating pad to the feet. intramuscular administration of antipyretic drugs, if hyperthermia does not stop within 30 minutes: 50% solution of Metamizole sodium (Analgin) 0.01 ml/kg for children of the first year of life, over one year - 0.1 ml/year in combination with a 1% solution of Diphenhydramine (Diphenhydramine) 0.01 ml/kg for children of the first year of life, over 1 year - 0.1 ml/year, but not more than 1 ml or Clemastine (Suprastin), Chloropyramine (Tavegil) 2% - 0.1-0.15 ml. for 1 year of life, but not more than 1.0 ml. Papaverine 2% - up to 1 year - 0.1-0.2 ml, over 1 year - 0.2 ml/year of life or No-spa 0.05 ml/kg IM. Emergency treatment and tactics for hyperthermic syndrome: Providing venous access. Infusion therapy - a solution of 0.9% sodium chloride or 5% glucose - 20 ml/kg/hour. For seizures – Diazepam (Relanium) 0.3-0.5 mg/kg IV. 50% solution of Metamizole sodium (Analgin) 0.01 ml/kg for children of the first year of life (from 3 months), over one year - 0.1 ml/year in combination with a 1% solution of Diphenhydramine (Diphenhydramine) 0.01 ml/ kg children of the first year of life, over 1 year of age - 0.1 ml/year, but not more than 1 ml or Clemastine (Suprastin), Chloropyramine (Tavegil) 2% - 0.1-0.15 ml. for 1 year of life, but not more than 1.0 ml. Papaverine 2% - up to 1 year - 0.1-0.2 ml, over 1 year - 0.2 ml/year of life or No-spa 0.05 ml/kg (with caution in case of bradycardia) i.m. If there is no effect within 30 minutes, intravenous Droperidol 0.25% -0.1 ml/kg. Oxygen therapy.

● Calling the resuscitation team: Ineffectiveness of spontaneous breathing (need for tracheal intubation and mechanical ventilation); Impaired consciousness according to GCS 8 points or less; Unstable central hemodynamic parameters. Unstoppable fever.

3. Performance criteria

Stabilization of condition

Complete relief of fever

No disturbances in vital functions

Delivery to a specialized medical facility

4. Tactical actions of brigades

Children with “white” or non-stopping fever, with a combination of fever and convulsive syndrome, are subject to hospitalization. At a temperature of 39.5 C and above, children are not transportable! At least 10-15 minutes before arrival at the emergency room - inform about transportation heavy patient, doctors from a specialized department, indicating age and therapy performed. The accompanying document must indicate: the degree of severity at the time of the initial examination, RR, heart rate, blood pressure, body temperature, and therapy performed.

MamaNaya 05/26/2010 at 11:15:18

"White" fever. What to save yourself with?

We recently experienced this phenomenon. This is creepy.
I will say that previously our fever was accompanied by sweating and passed quite easily. We had water as an antipyretic - it helped. And then there’s a sudden jump to 39.6, my arms and legs are icy, my lips turn blue. The child is semi-conscious. This was my first time encountering this. As soon as I managed to put a suppository with paracetamol, I called an ambulance, they refused: “If the child is breathing, then call the children’s emergency room. And anyway, what did you think before? We should have prevented such an increase!” Fortunately, the child felt a little better. They opened the window, gave me hot water, and rubbed my limbs. The ambulance did not arrive immediately. The doctor quite calmly said that it was ARVI. He said to give no-shpa, vinegar wraps, cool enemas with paracetamol and ibuprofen...
For 2 days we still struggled with the temperature rising to 39.5. And cold extremities all the time. No-shpa made me vomit, the enema didn’t help, and I didn’t do vinegar wraps because... many people say that vinegar (even diluted) does more harm than good. But somehow we survived this crisis.
Then it turned out that we did not have ARVI. A rash appeared, but there was no snot or cough. Is it roseola or some other viral infection.
Anyone who has encountered white fever, please share your experience. Why does it arise? What to do if no-spa is not suitable? I read that papaverine suppositories are effective. Has anyone used them?
This kind of fever is very scary. I wouldn't wish this on anyone. But if suddenly this happens, you must be prepared to quickly save the child, without counting on an ambulance.

• katskin 05/29/2010 at 14:27:32

  We survived

  only our version is cooler - the temperature is 40.6, my daughter was chattering her teeth and screaming that she was cold, all the other symptoms were the same, although she was completely adequate. The ambulance arrived 20 minutes later, I clearly described the situation. Moreover, it was a repeated call, and they did not leave us a referral to the hospital. They gave an injection (but spa + diphenhydramine + analgin) - it didn’t help my daughter, they took us to the hospital, they repeated the injection, added ceftriaxone and dexamethozone, it didn’t help either - 40.2 was eventually wiped with vinegar, brought down to 39.9 - they did it right away an enema with cool water - this was the only thing that helped and the temperature was 38.5. The diagnosis was made only on the third day by X-ray - pneumonia (there was no cough, the doctors did not hear wheezing), they said that it was viral in nature
  All these procedures cannot be done at home - there is a risk of convulsions, even from rubbing, not to mention an enema - by the way, at 40 it is categorically contraindicated.
  Conclusion - in case of white fever, we call an ambulance and rush to the hospital.
  At home you need to have an ambulance injection (see above) and be ready to inject if anything happens, as well as money for a private ambulance - it’s faster.
  You can try papaverine if you are not allergic, but it is less effective.
  One thing you need to remember is that suppositories act more slowly than injections, and in such a situation, minutes count. If you put a suppository, then you can no longer inject your child with this drug for some time.
  

  geny 05/26/2010 at 22:49:51

  I once used no-shpa in candles, but I think it was called-khsha +

  I can’t say more precisely, this was a couple of years ago, I think the pharmacy should know. Mefenamic acid helps us a lot with “unbreakable” temperatures, it’s really better than any other drugs.

  • kaktus1 05/27/2010 at 09:28:25

    roseola

    and we had roseola at 1.5 years old... gave paracetamol, but only when the temperature exceeded 39, the emergency doctor said to rub cold feet with vodka and put on woolen socks, and when the socks get hot, take them off. In addition, for a small child, At high temperatures, it is advisable to abandon diapers.

Shooter 05/26/2010 at 12:46:16

But you can inject it, you can light all sorts of candles. Get well!(-)

I am not some!
(c) Kolyan, 4g.

Fantasy 05/27/2010 at 18:17:19

It seems to me that the child was vomiting not from no-spa, but from a high fever.+

My son always vomits when his temperature is above 39. Our temperature is very low. Paracetamol and analdim suppositories practically do not reduce it.
We measure the temperature every 30 minutes, as soon as the temperature creeps above 38.5 I give an antipyretic in syrup (if you have eaten anything, of course). I rubbed it with warm water without vodka/alcohol/vinegar a couple of times. The water should be warm.

JULIA_29 05/26/2010 at 11:43:31

yes, we survived roseola