Fever

Paediatric Palliative Care

For Home Based Carers

Funded by

British High Commission, Pretoria

Small Grant Scheme

What is Fever?

A raise in body temperature

above 37.5oC (IMCI 2002)

During infections, the body is able to raise its temperature which helps to fight germs

So fever is one of the most common signs of infection in ALL children

Children with HIV

More infections than mostchildren

More fevers than most children

Fever may be a sign of: Chest infections Ear infections Skin infections Diarrhoea Meningitis Oral infections HIV Infection

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Fever in Children

Fevers may cause discomfort to the child

Fevers increases loss of water through the skin

This increases the chance of dehydration in children

High fevers may lead to febrile convulsion (seizures or ‘fits’)

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Signs and Symptoms

How would you know

whether Sofiso has

a fever?

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Has Sofiso got a fever?

Touch the Child

Forehead, stomach or other parts of body may feel hot to the touch

He may or may not be sweating

Is his heart rate (pulse) fast?

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Has Sofiso got a fever?

Look at the Child

Is he withdrawn and/or reluctant

to move?

Is he irritable?

Is he breathing fast?

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Has Sofiso got a fever?

Take the temperature

Our eyes and hands are very helpful in

assessing fever

But, thermometers are more accurate

and may be used to answer:

How high is the child’s temperature? Has the treatment effectively lowered the

temperature? Has the fever risen?

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Using Thermometers Try to keep the child calm before taking temperature

Wash thermometer with cold soapy water and/or alcohol

Shake thermometer hard until reading is below 36 degrees

Place bulb end of thermometer well up in to armpit, holding arm down over it and elbow in to baby’s side

Hold position for 4-5 minutes, whilst singing songs/telling story

NEVER leave the child with the thermometer – he WILL move!

Remember!!

Mercury is poisonous

If a thermometer is broken, this is extremely dangerous

ALWAYS store a thermometer in a safe place where it will not be broken

Reading Thermometers

Hold thermometer in a good light Rotate until you see a silver line of

mercury Line up mercury with numbers, marked

in full degrees (36,37,38) and every two-tenths degree (.1,.2,.3,.4)

Point where mercury ends indicates the temperature

Write it down straight away with time taken

34 35 36 37 38 39 40 5 5 5 5 5 5

What to Do?

Fever is usually a sign of infection in the child

So you need to:

Manage the fever Identify what may be causing the fever

Any underlying infections can then

be treated and managed appropriately

Does the Child have Fever?

If carer reports history of fever

or temperature is 37.5oC or

above:

Ask:

For how long?

If more than 7 days, has fever been present every day?

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Risk of Meningitis Look and Feel for: Stiff neck Bulging fontanelle

Suspected Meningitis if:

Any general danger signOR

Stiff neckOR

Bulging Fontanelle

(IMCI, 2002)

Suspected Meningitis

Home Based Carers

Administer one dose of paracetamol (Panado) for fever 38oC or above

Refer urgently!

Professional Nurses

Child needs dose of IM Ceftriaxone

Test blood sugar

Give one dose of paracetamol (Panado) for fever 38oC or above

(IMCI, 2002)

If No Suspected MeningitisAssess the child - Look, Listen, Feel for the following:

Sore Throat Ear ache, pus from ear Difficulty breathing, noisy breathing Cough (+/- sputum) Diarrhoea Pain on passing urine Severe headache, neck stiffness, bulging fontanelle Skin Inflammation, sores, rashes Pain in joints

Then give Paracetamol (Panado) and discuss with Professional Nurse

Managing Fevers

Regular administration of medication to:

bring temperature down

keep temperature down

reduce discomfort

encourage drinking and eating

Giving Paracetamol for Fever

Age or Weight Syrup (120mg/5ml)

Tablet (500mg)

2 months up to 1 Year

2.5 - 5 ml -

1 Year up to 5Years

5 – 10 ml -

6-12 Years 10 – 20 ml Half to 1 tablet

Every 4-6 Hours AND No more than 4 Times a Day!

Managing Fevers NEVER wrap up a child with

fever

Undressing the child allows heat to escape

Ensure cool, fresh air or fan the child

Apply cloths soaked in tepid water to the child

Do NOT let the child start shivering

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Managing Fevers

Encourage the child to keep drinking to prevent dehydration

If breast fed, continue breastfeeding

For non-breast fed children, encourage drinks or small, frequent sips

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Has it helped?Using these interventions can help to reduce a fever

But, you need to be sure they have!

Keep checking the child (touch, looking, thermometer)

Continue regular fluids

Continue Paracetamol (Panado) until you are sure the fever is over

Febrile Convulsions Children adjust less quickly to high body temperatures

Temperature above 38.5 0C or a rapid change in temperature may lead to febrile convulsion

Most common in children 6 months to 5 years

Usually only last 1-2 minutes

Signs and Symptoms: Collapse Eyes rolling upward Foaming at mouth Stiffening of the body Uncontrolled jerking movements Breathing difficulty in severe cases

Handling Febrile Convulsions Keep calm

Reassure care giver

Ensure area around child is clear and safe

Never restrain the child or place anything in mouth

Loosen clothing around neck and body

Position child with head lower than body if possible

Child may lose consciousness but will usually ‘come round’ without help

If the convulsion lasts longer than 5 minutes, the child needs emergency help

After a Febrile Convulsion The child may sleep

Ensure child is on his side

Give Paracetamol (Panado) if the child is conscious/ able to swallow

Apply cool cloths to body

NEVER put child in a bath

Take child to a clinic for further investigation and treatment of cause

Note!

If a child has a seizure and is not between 6 months and 5 years,

this is likely to be caused by something other than fever

Education

Care Givers need to be taught

how to recognise and manage

temperatures in order to:

Alleviate the child’s discomfort

Prevent dangerously high

temperatures

Ensure infections are treated as early as possible

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Remember!!

Fever is a very useful sign of infection

Fevers must be managed properlyto prevent distress and complications

BUT, the child’s behaviour is the bestsign of how sick a child is :-

A child may have:

NO fever with infection e.g. pneumonia, meningitis (especially in malnutrition)

HIGH fever with a mild cold

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