Fever is an increase in body temperature above the upper limit of normal temperature fluctuation in 1 day and is usually measured by anal thermometry. Fever is classified as low fever (37.3-38°C), moderate fever (38.1-39°C), high fever (39.1-41°C) and ultra-high fever (41°C or higher).
Pros and cons of fever
While fever enhances immune function and strengthens the killing effect on pathogens, excessive body temperature also causes chills and inhibits the production of digestive enzymes in the body.
Purpose of fever reduction
The main purpose of fever reduction is not only to lower the body temperature of the child, but also to relieve the discomfort caused by fever.
If the fever is not too high and is not accompanied by serious illness, the fever may not be reduced urgently, and hydration and nutrients, vitamins, etc. may be added. However, if the fever is high or super high, accompanied by heart disease or other critical illnesses, it is necessary to reduce the fever at this time.
The methods of reducing fever are physical cooling and medication cooling
Physical cooling recommendations
Physical cooling methods include warm wet compresses and cold saline, but the effect of fever reduction is limited and can be used as an adjunct to pharmacological cooling. It should be noted that children’s sweat glands are not developed, and the central nervous system is not well developed, so it is not easy to achieve “sweating” by “covering the heat”, but will cause “muffled fever syndrome”.
The use of ibuprofen and adverse reactions
Ibuprofen has anti-inflammatory, analgesic and antipyretic effects. It is also recognized as the anti-inflammatory drug of choice for children. The recommended dose of ibuprofen is 5-10 mg/kg/dose, once every 6 hours, up to 4 times a day. It is permitted in the United States for children ≥6 months of age.
Adverse effects of ibuprofen.
1, Ibuprofen is cross-sensitized to aspirin, so it is contraindicated in children with aspirin allergy, but Reye’s syndrome can occur.
2, mild gastrointestinal discomfort occasionally rash and tinnitus, headache, affect the coagulation function and transferase elevation also caused gastrointestinal bleeding and aggravate the ulcer.
3, long-term use can cause renal failure.
Acetaminophen use and adverse reactions
Acetaminophen (paracetamol) is a non-steroidal anti-inflammatory antipyretic and analgesic drug, used for migraine, headache, fever, WHO recommends the first choice for fever in infants and children over 3 months of age. Acetaminophen is rapidly and completely absorbed and produces an antipyretic effect within 30 min of oral administration. It should be noted that most commonly used children’s compounded cold medicines also contain acetaminophen. The dose of acetaminophen is 10-15mg/kg/dose (total <600mg) at 4-6h intervals, up to 4 times a day.
What are the adverse effects of acetaminophen
1. Hepatotoxic;
Overdose or prolonged high dose ;
Drinking alcohol or alcoholic beverages;
Patients with liver disease;
2, mixed with other headache and cold medicines containing acetaminophen: few adverse reactions at regular doses, with low nephrotoxicity and relatively high safety.
3, obvious dose dependence – that is, with the dose increases and the efficacy increases. Toxicity is relatively enhanced in newborns due to slow excretion.
Opposition to the use of glucocorticoids as antipyretic agents in children
There is a lack of evidence and literature on the use of glucocorticoids as antipyretic agents in domestic and international studies. Hormones can suppress the body’s immune system, induce and aggravate infections. They may also mask the disease and delay diagnosis and treatment. They can also cause a significant drop in body temperature, resulting in deficiency, water-electrolyte disturbances, and dehydration fever.
Alternating medications for fever reduction
Alternating medications can be considered in cases of severe and persistent hyperthermia. There are two methods of alternation: one is to use ibuprofen 10mg/kg first, followed by acetaminophen 4-6h; the other is to use acetaminophen 12.5mg/kg first, followed by ibuprofen 5mg/kg 4-6h. Both drugs should be used alternately every 4-6h, and the course of treatment should not exceed 3 d.
What are the precautions for antipyretic treatment
1, physical cooling and antipyretic agents used in combination, body temperature drops faster than the antipyretic agent alone.
2, the dose of antipyretic drugs should not be too large, in order to prevent excessive sweating of the child resulting in deficiency, and encourage more water.
3, the onset of action of antipyretics, 30-45min.
4, fever in small infants or other patients with body temperature over 39-40 ℃ (especially with obvious discomfort), should be timely symptomatic treatment.
5.Do not abuse antimicrobial agents when the etiology is unknown. 91% or more viral infections in children.
6, do not advocate the use of ice / alcohol for physical cooling.
7.Antipyretic drugs cannot prevent febrile convulsions nor should they be used prophylactically.
8.Continue to use only when the child shows discomfort, and consider changing to other drugs when the discomfort is not reduced.
9. Consider changing the medication only if the discomfort persists or if the discomfort reappears before the next dose of medication is due to be used (antipyretics are usually repeated at 6-8 hour intervals).