Relatively speaking, acetaminophen and ibuprofen are the best choices for reducing fever, with relatively small adverse effects and basically safe at normal doses.
Myth 1: The higher the fever level, the more serious the condition
Clinically, we often encounter children with high fever in the emergency room. One day at noon, three parents suddenly rushed into the pediatric emergency room, holding their 9-month-old child and shouting: “Doctor! The child has a fever of 40℃, please help him! I rushed over and put the child on the bed to check him carefully. The child was in good spirits, and I took the water bottle from the child’s family, and the child quickly drank water. I told the family to take off the child’s coat and give the child one dose of antipyretic medication, and suggested drinking more water to prevent febrile convulsions. The parents listened to my explanation and soon became less nervous. 20 min later the child’s blood test results came back and the temperature had come down.
Fever is the most common symptom when a child has a cold and is a way for the body to fight pathogenic microorganisms. Generally speaking, the more powerful the fever is, the stronger the body’s resistance. For infants and children <3 months old, high fever rarely occurs even with severe pneumonia because the immune function is not yet developed and the resistance is not strong. Therefore, the degree of fever does not correlate positively with the severity of the disease. As in the above child, although the fever is 40°C high, the condition is not severe, otherwise it must be manifested mentally, and it is likely to be depressed or lethargic, reluctant to eat or drink water. It should be noted that there are indeed many serious infectious diseases that are accompanied by persistent high fever.
Myth 2: Blindly listening to family members’ advice and giving antipyretics when fever is encountered
Some doctors, especially rural doctors, often tend to blindly listen to the advice of the child’s parents when they see a feverish child and give oral antipyretics or even give hormone therapy. It cannot be overemphasized to correct this common misconception.
Whether or not to use medication to reduce fever must be based on the degree of fever A body temperature of 37.5-38°C is considered low fever, 38-39°C is moderate fever, and >39°C is high fever. Low fever is a kind of protection for the body, and >37℃ is not conducive to the reproduction of pathogenic microorganisms. If the body temperature is still >38.5℃ after physical cooling, it is better to use antipyretic drugs because the neurological system of the child is not yet mature and can easily trigger hyperthermic convulsions. Continuous hyperthermia will lead to increased consumption of oxygen and nutrients in the body, which will increase the burden on various organs and easily cause dysfunction of important organs, especially cardiovascular and cerebrovascular. Hyperthermia (>41°C) can lead to brain cell damage, coma and even death. Encephalitis and ultra-high fever due to heatstroke are emergencies and need to be dealt with actively.
Myth 3: Physical cooling methods are not implemented properly
Physical cooling for fever is a simple but effective measure, many people understand the physical methods of reducing fever, such as drinking more water, warm water wipe, etc., but to the specific implementation may not be in place in the details, the following to explain in detail.
Drink more water to replenish body fluids Some children with fever are reluctant to drink water due to various reasons such as throat discomfort, in fact, giving children more water to replenish body fluids is the first priority, this is the most basic cooling method, suitable for all children with fever. Various juice drinks are available, but plain water is best.
Warm water wipe, not alcohol wipe Warm water wipe is a good cooling method, the temperature of water at 34-37 ℃ is suitable for children of all ages. Each wipe should be applied for >10 min, with the focus on the skin folds, such as the neck, armpits, elbows, groin, etc. For children with high fever or older children, a warm bath with water slightly cooler than body temperature is acceptable.
It is important to note that many people use alcohol baths for pediatric fever, which is incorrect! Because the skin of infants is very thin, alcohol is very permeable, and after absorption through the skin, symptoms of alcohol poisoning may occur. Alcohol rubbing baths also stimulate the skin, causing capillary constriction and hindering heat dissipation. It is generally not used for children, especially small infants.
Lowering the ambient temperature, but not for all children Fever reduction in children requires heat exchange with the surrounding area. A suitable ambient temperature is conducive to fever reduction, and the best ambient temperature is 20-24°C to bring the body temperature down slowly. For small infants, especially in summer, their body temperature will drop slowly if they are left open and placed in a cool place. It should be noted that this method is not suitable if the early stage of fever in the child is accompanied by chills and chills.
Fever patches have a limited effect on reducing fever Fever patches have a limited effect on reducing fever due to their small size, and they are comfortable for children with high fever and are an adjunctive measure.
Ice packs are not suitable because they are too cold and may cause capillary constriction of the child’s skin, preventing heat dissipation. In particular, children with chills and chills should not use ice.
Myth 4: The medicine with good antipyretic effect is good medicine
If the child still has a high fever after drinking a lot of water and physical cooling, it is generally necessary to use antipyretic drugs. Some people think that a good antipyretic effect is a good drug, but it is not, must take into account the adverse effects of the drug. Generally speaking, the antipyretic effect of antipyretic drugs and adverse reactions are directly proportional, the better the effect, the greater the adverse reactions.
The adverse effects of antipyretic drugs are summarized as gastrointestinal symptoms such as irritation of the gastric mucosa, destruction of appetite, aggravation of gastric ulcers and even bleeding; excessive doses can lead to liver and kidney damage, and can also induce blood disorders; for those with severe allergic reactions, critical conditions such as exfoliative dermatitis are manifested. Therefore, it is important to understand the characteristics of different drugs and take into account the therapeutic effects and adverse reactions in order to reasonably select the appropriate drugs. Commonly used antipyretic drugs and their clinical characteristics are as follows.
Acetaminophen has a rapid onset of fever reduction, but the control time is shorter than other drugs, with an average control time of about 2 h. However, it has relatively few adverse effects. However, there are relatively few adverse effects, such as gastrointestinal reactions, platelet function and granulocytopenia, which are common with other antipyretic and analgesic drugs, and there is no nephrotoxicity, so it is safe and widely used in clinical practice, especially in children <2 years old. The drug has obvious dose-dependence, that is, the efficacy rises with the dose, but do not use overdose, 10-15 mg per kg of body weight per dose, to avoid liver damage.
Ibuprofen This drug and acetaminophen are both recommended by the World Health Organization for use in children as antipyretics and are also safer drugs. Ibuprofen is characterized by its smooth and long-lasting antipyretic effect, which is stronger than acetaminophen for high fever and lasts longer than acetaminophen, averaging about 4-6 h. Ibuprofen has little effect on gastrointestinal irritation and platelets; common adverse effects are mild gastrointestinal reactions, increased transaminases, and occasionally coagulation. Occasionally, reversible renal injury has been observed. Overdose may cause central nervous system depression, seizures, etc. Dosage: 5-10 mg/dose per kg body weight.
Aspirin Aspirin is a nonsteroidal anti-inflammatory, analgesic, and antipyretic drug, and is no longer used clinically as a routine antipyretic drug. The compound salt of lysine and aspirin, which can be used for intravenous injection, has fast onset of action and good efficacy. Its adverse effects are mainly manifested by liver function damage, jaundice, central nervous system symptoms and renal damage.
Nimesulide is a new type of non-steroidal anti-inflammatory, analgesic and antipyretic drug successfully developed and marketed in Italy in 1985. The outstanding advantages of nimesulide compared with ibuprofen are better antipyretic effect and less digestive adverse effects. However, there are increasing reports in the literature that the application of nimesulide can cause severe liver damage. Due to the ongoing controversy, its use has been restricted in China in children <12 years old.
Nimesulide is a non-steroidal anti-inflammatory and analgesic drug with strong and long-lasting antipyretic effect. Due to the high incidence of adverse reactions, this drug has different degrees of toxic side effects on liver function, kidney and blood system. Therefore, it is not used in general, but can be used occasionally under medical supervision only when the child has persistent high fever or febrile convulsions.
Anacin is an old antipyretic drug with rapid antipyretic effect, which has been used less frequently in recent years due to more serious adverse effects such as granulocytopenia and kidney damage. Currently, 27 countries have banned or restricted the use of Anacin. Only in the case of acute hyperthermia and acute illness, and there is no other effective antipyretic drugs available, it is used for emergency antipyretic, oral administration is no longer used.
Many Chinese herbal medicines have different degrees of antipyretic effects, but since the antipyretic effect of Chinese medicines is slow and the drug components are not well known, parents are not recommended to use Chinese medicines as antipyretic drugs.
In summary, acetaminophen and ibuprofen are the best choice for reducing fever, because they are relatively effective, have few adverse effects, and are basically safe at normal doses.
Myth 5: Failure to properly analyze the condition
The author had a case of a 13-year-old child who had a fever on the first day and was only prescribed antipyretic drugs (specific details unknown) at the village health office. On the second day, the child had a severe headache and drowsiness and went to our hospital, where he was already suffering from encephalitis with convulsions, and a brain hernia was formed on the third day. Many parents and even primary care doctors think that a fever is a cold, and that the child will get better after taking antipyretic drugs, and that it will improve the resistance. This is true for most children, but a small number of children are not so lucky. Therefore, it is crucial to analyze the condition correctly.
When a child has a fever, in addition to measuring the child’s temperature, the following conditions should be noted
Pay attention to the child’s mental status If the child is in good spirits, it is a sign that the infection is mild. If the child is not well, drowsy, or has a yellowish or dark complexion, this is usually a sign of a serious infection. For example, in toxic dysentery, the child’s main manifestation is a bad complexion and poor mental health, and may only have nausea and vomiting, not diarrhea, but the condition is serious and can easily be combined with toxic shock.
Note the accompanying symptoms. This article only lists relatively common cases.
Rash and bleeding spots on the face and trunk Many viral infections have a rash in their early stages, such as chickenpox and rubella. Rashes that appear during fever include scarlet fever and measles. If bleeding spots appear early in the fever, exclude epidemic meningitis.
Presence of diarrhea and urine If the child has diarrhea, ask whether the diarrhea appears before or after the fever. If it appears before fever or within 1 d after fever, it suggests an intestinal infection; if it appears a few days after fever, it may be a comorbidity of the disease or an adverse reaction to medication.
For those with significant diarrhea during fever, especially mucus-purulent stools, which suggest intestinal bacterial infection, it is best to collect a stool sample with pus and blood or mucus in a cardboard box or plastic bag when going to the hospital for laboratory examination. Poop from diapers should not be used as a specimen for testing.
It is also important to pay attention to the abnormal color of the child’s urine. If the fever is accompanied by soy sauce-colored urine, it indicates the presence of hemolysis in the child, suggesting a serious condition.
If there is significant abdominal pain, especially if the child is unable to walk straight or if the abdominal pain does not allow him to rub his stomach, consider appendicitis. Because the symptoms of appendicitis in children are sometimes atypical, they are prone to perforation and co-infection of the abdominal cavity.
Pay attention to the epidemiological situation. Pay attention to the surrounding area for similar diseases, especially during epidemics of infectious diseases, such as hand, foot and mouth disease. If the child is surrounded by children with the disease, consider HFMD if the child has a rash or blisters on the mouth, throat, or hands and feet, even if the symptoms are not typical.