Fever is the most common symptom in children, and parents’ excessive fear and anxiety about their children’s fever is very common, often leading to over-treatment of fever. For many years in the clinical work of pediatrics, almost every day we encounter fever parents holding their children to the doctor, indiscriminately requesting the doctor to give the child antipyretic drugs and antipyretic injections, and the doctor is in a hurry if the fever does not go down in 10 minutes, and some parents even rush to the hospital several times a day when the child has a fever, urgently requesting “to reduce the fever as soon as possible”, and even Some parents even rush to the hospital several times a day when their children have a fever, urging them to “reduce the fever as soon as possible” and even “coercing” the doctor to unreasonably apply hormonal drugs to reduce the fever, leading to many avoidable adverse consequences. This phenomenon is called “fever phobia” abroad. How should we know about fever and how to deal with it? 1. What is fever? The relative stability of human body temperature is achieved under the regulation of the thermoregulatory center, and it is generally believed that the rectal temperature (anal temperature) above 38℃ is called fever, while the oral and axillary temperatures are 0.5 and 0.8℃ lower than the anal temperature. Fever is both a symptom of a disease and one of the protective responses of the body against infection. When the body is attacked by foreign pathogenic microorganisms (external pyrogen) or the release of certain substances in the body (internal pyrogen) increases, the thermoregulatory center shifts the temperature setting point upward, causing an increase in heat production by accelerating the heart rate and skeletal muscle contraction; at the same time, the terminal blood vessels contract and the sweat pores close to reduce heat dissipation, resulting in a rise in body temperature. According to the contradictory changes of heat production and heat dissipation, fever is generally divided into four periods: the prodromal period, the period of rising body temperature, the period of persistent high temperature, and the period of falling body temperature. 2, the advantages and disadvantages of fever Medical research shows that the fever is better than the normal body temperature when the various indicators of immune function (i.e. human resistance) in the body. This is an emergency mobilization of the body’s resistance to fight foreign pathogenic microorganisms and adjust the physiological balance of the body. In this sense, fever is an innate self-protective reflex. Of course, fever also has harmful effects on the human body, as persistent high fever can increase the burden on the heart and lungs, damage cells and organ functions, and induce excessive immune responses and convulsions. Therefore, whether to reduce fever, when to reduce fever and how to reduce fever? We need to weigh the pros and cons and choose scientifically. 3. How to deal with different cases of fever Various etiologies can cause fever, the most common being various pathogenic microbial infections, and treatment of fever and etiology must be carried out simultaneously. Whether to give antipyretic treatment needs to be decided on the basis of weighing the possible advantages and disadvantages. The World Health Organization recommends that in general antipyretic treatment should be used only for children with high fever, i.e., anal temperature of 39°C or above. The goal of antipyretic treatment is not to immediately “normalize” the body temperature, but, rather, to bring it down to a safe range or level that has a positive protective effect on the body. For low to moderate fevers in children with good general condition and no other underlying diseases, strong antipyretic treatment is not recommended, but appropriate physical cooling. (1) Is ice pillows suitable for cooling feverish children? Ice pillow cooling is one of the commonly used physical cooling methods. Is the use of local ice to achieve the role of reducing the head temperature. The specific method is: the ice bag or ice pillow on the forehead or placed on the back of the head, such as no special ice bag or ice pillow can be placed in a hot water bag or plastic bag application, the situation can also be used in emergency situations instead of popsicles. However, not all children with fever are suitable for ice pillow cooling, and the same baby in different stages of fever may not be suitable for the application of ice pillow cooling. So, what are the precautions for implementing ice pillows to lower the temperature? ① Children under 6 months of age should not be cooled by ice pillows. Because the body temperature of small children is easily affected by the external temperature, for many small infants, fever can be reduced by reducing the clothing to bring down the body temperature. If the application of ice packs may appear excessive cooling, resulting in problems such as temperature does not rise. If the temperature does not go down even after reducing the clothing, warm water can be used for bathing. ② children’s body temperature in the rising stage should not use ice pillows to cool down. When the body temperature is in the rising stage, the skin blood vessels are in a state of contraction, the temperature of the skin surface is reduced, manifested as pale skin, the limbs are not the tips of the cold, there can be shivering, at this time to pay attention to limb warmth, feed some boiled water. At this time, if the use of ice pillows or alcohol baths and other physical cooling measures, can make the peripheral blood vessels further constriction, may occur poor peripheral circulation, is not conducive to body heat dissipation, and even further increase in body temperature. ③ ice pillow cooling can not use ice pillow direct contact with the skin. Between the skin and the ice bag or ice pillow should be separated by a towel or handkerchief to avoid discomfort or local tissue frostbite. In addition, ice pillows or ice packs should not be placed on the chest and abdomen to prevent heart rate slowdown or diarrhea. (4) In the process of cooling by ice pillow, if the child has cold reactions such as cold hands and feet, shivering all over the body and purple lips, stop immediately. (2) Are newborns and small infants suitable for alcohol baths to cool them down? Alcohol bath is a common physical cooling method, but it is not suitable for newborns and infants under 3 months of age with fever. Since ethanol is an organic solvent, it is fat-soluble and can be absorbed into the body through skin follicles and sebaceous glands. In addition, children, especially newborns and small infants, have relatively large body surface area, thin skin and rich capillaries, so it is easy for infants and children to absorb a large amount of ethanol through the skin by using alcohol baths, which can lead to alcohol poisoning, induced convulsions and other adverse reactions. In addition, alcohol evaporates rapidly at the skin, and the baby’s body temperature will drop too quickly, making it easy to have hypothermia, chills, and goose bumps on the skin. So, what should be done when newborns and small babies have a fever? ① Remove the wrap to cool the temperature Because small infants, especially newborns, have not yet developed thermoregulatory function, body temperature is affected by the environment. Therefore, when a fever occurs, the newborn can be unpacked to facilitate the distribution of heat. If the wrapping is too tight, the heat will not be dissipated and the body temperature will rise further. When the room temperature is too high, lower the greenhouse appropriately. Application of the above treatment methods can generally bring the infant’s body temperature down to below 38℃. ②Warm water bath to lower the temperature If the above methods still cannot lower the body temperature to below 38.5℃, warm water bath can be properly carried out. Wipe the child’s limbs and front and back with a towel soaked in warm water of about 37℃, so that the high temperature of the skin (about 39℃) is gradually reduced and the baby feels more comfortable. These measures still do not work, under the guidance of the doctor drugs to reduce fever. (3) How to choose pediatric antipyretic medicine? How to use? With the development and progress of medicine, antipyretic drugs are constantly being updated, but western drugs are still mainly non-steroidal anti-inflammatory drugs, followed by hormones. Although corticosteroids have obvious antipyretic effects, they cannot be used clinically as antipyretic drugs, and strictly speaking, they are not antipyretic drugs; Chinese medicine is generally not as fast and effective as western drugs, so they are mostly used clinically to assist in cooling. Traditional antipyretics such as aminopyrine (e.g. Anacin), analgesic, aspirin (e.g. apc), etc., which were commonly used in the past, have gradually faded out of the market of antipyretics for children due to their many side effects or serious complications (e.g. induced ulcers, bleeding, Richter’s syndrome, etc.). At present, the commonly used antipyretic drugs for children are: paracetamol (acetaminophen), ibuprofen, anti-inflammatory pain, lysergic acid injection, etc. Paracetamol is generally used as the first-line antipyretic drug, and the representative drugs include Tylenol antipyretic drops, Benadryl, pediatric antipyretic suppositories, etc. It can be used for children over 3 months of age, and 10 mg per kg of body weight per dose is safe, and the two doses are in principle more than 6 hours (at least more than 4 hours). For the early stage of fever, the temperature rises quickly, fever is relatively violent, ultra-high fever, paracetamol is difficult to achieve the desired effect of fever, at this time, you can switch to or alternate the use of ibuprofen (commonly used Merlin antipyretic oral solution), generally 5-10 mg per kilogram of body weight each time, preferably no more than 4 times a day, this can be timely and effective antipyretic, at the same time, can also avoid a drug repeatedly used several times in a short period of time, the cumulative dose At the same time, it can avoid the increase of adverse reactions due to the repeated use of one drug in a short period of time. If a child’s temperature does not drop to the appropriate level with the two drugs mentioned above, or if the fever persists, or even if there is a possibility of febrile convulsions, he or she should go to the hospital promptly and consider using stronger antipyretic drugs, such as anti-inflammatory suppositories and lysergic acid injections. However, you need to strictly control the dosage and observe the effect of medication. Common side effects include gastrointestinal reactions such as nausea and stomach discomfort, excessive sweating caused by class deficiency performance and transient liver function abnormalities, so, generally the first use as small as possible to see if the child’s reaction to this drug is overly sensitive to prevent accidents. Both prescription and over-the-counter drugs are medicines, not food, and have indications and contraindications, and should not be taken at will. Parents are eager to reduce fever, often frequent application of one or more antipyretic drugs in a short period of time, the light sweating too much dehydration deficiency, serious drug overdose leading to serious liver and kidney damage and other toxic side effects or drug poisoning; because they do not have the knowledge of “caution, prohibited”, there are cases of incorrect use of drugs leading to other serious problems. Even if there are no serious problems, excessive forceful exercise to lower the body temperature too low can have a negative impact on the recovery and self-healing of the disease.