1. Acute fever.
The vast majority of acute fevers in children are caused by respiratory problems, of which viral colds are the most common. In theory, viral colds do not require antibiotics, however, because the air quality in the country is so different from that in developed countries, it is easy to combine bacterial infections in the late stages of a cold, especially in children under 5 years of age, when antibiotics are needed.
If a child has a fever, also pay attention to whether it is accompanied by other symptoms, if at the same time there is a runny nose, sneezing, conjunctival congestion, etc., then generally speaking it is a cold, if accompanied by a cough, in the early stage most of them are also symptoms of a cold, the vast majority of children with a cold fever in 3-5 days, a few special viral infections, fever can be up to 5-7 days (such as herpes pharyngitis, etc.), the extreme can be up to 10 days. For the first 3 days of fever, do not pay too much attention to it, just pay attention to control the high fever, personal experience does not require antibiotics, fever for more than 5 days should be further diagnostic tests to exclude other problems.
Many pediatric diseases are not diagnosed in the early stages of fever, and the course of the disease itself is a very important diagnostic basis (e.g. Kawasaki disease), so it is useless to be anxious in the early stages of the disease. Antibiotics should be added if there is an aggravation of cough in the late stage of the fever.
When a fever is first seen, doctors usually prescribe antibiotics, but in fact the vast majority do not need to be used immediately and can make their own judgments based on the doctor’s diagnosis of the condition.
Many doctors now tell parents after a physical examination that their child’s throat is a little red or that the breath sounds in the lungs are a little coarse, but in fact these descriptions often indicate that the doctor’s physical examination did not reveal any valuable problems (in Shanghai children, the pharynx is more or less congested and there is nothing wrong with it. There are no specific criteria for the coarse breath sounds, which do not indicate any problem), but only the doctor’s words to save himself some back.
If these descriptions alone are the only ones, you can do without antibiotics and pay attention to the condition. Among the common respiratory diseases, there are 2 diseases that must be treated with antibiotics.
(1) Acute tonsillitis, especially purulent tonsillitis must be given intravenously. Children within 2 years of age, as their tonsils have not developed much, purulent tonsillitis is very rare and extremely rare, and increases significantly after the age of 4;
(2) For otitis media, antibiotics must be administered.
2. Treatment of acute fever.
In infants and young children, due to the imperfect development of the thermoregulatory center, the body temperature fluctuates greatly. Very often, high fever does not parallel the condition, that is to say, high fever does not indicate a serious condition, and many children have a very high temperature but are in good spirits. Therefore, there is no need to be too anxious about high fever, and fever itself is the body’s protective response.
The basal body temperature of children is higher than that of adults, so the standard for fever is also higher than that of adults, the specific standard is still different from family to family, the most scientific is to compare with the child’s usual body temperature, but it is difficult to do. Generally speaking the axillary table is higher than 37.4 degrees and the anal table is higher than 37.8 degrees, which can be considered feverish. In addition, because the human body temperature is low in the morning and high in the evening, it should also be analyzed specifically. For fever below 39 degrees (anal gauge), it can be left untreated (some books may have a higher standard), pay attention to other symptoms and drink more water.
For children with a history of convulsions, antipyretics need to be used early, along with anticonvulsants to prevent high fever convulsions.
The treatment of fever mainly includes medication and physical cooling. At present, there are mainly oral and anal suppositories of antipyretics for families, and the oral ones are mainly acetaminophen and ibuprofen, with many trade names. “Some doctors will say that if your temperature is not very high, use acetaminophen, and if it is very high, use ibuprofen.
But if you want to use it, the amount must be sufficient, the safety range of these two drugs is very large, more than 10 times the normal dosage also did not see obvious side effects.
”The dosage of acetaminophen is at least 10mg/kg. In clinical practice, we often see parents worrying about the side effects, so they try to give their children a little less, sometimes the amount is a little bit different, the effect is not, but the dosage is sufficient, the cooling effect comes.
”The dose of ibuprofen is 8-10mg/kg, and there are many compound preparations or syrups, so parents need to study the specific content and concentration carefully, and convert it to weight, not age. If the child has been insensitive to antipyretic drugs, you can also increase the dose by another 1/4. Antipyretics will sweat a lot after use, be sure to add more water, antipyretics are also more likely to cause drug allergies (the other 2 types are antibacterial and antiepileptic drugs), if the body rash to be very vigilant and careful, serious drug reactions can be very serious, even life-threatening.
Physical cooling: you can use an old hot water bag (filled with cold water, a little more than half), freeze it in the refrigerator, do not freeze, lay a thin towel on top, put it under the neck (not under the head), let the hot water bag bend over and wrap both sides of the neck, because the blood vessels in the neck on both sides, so the effect is good. The groin, elbow fossa and behind the knee joint can also be covered with ice water bag, that is, must be in the blood vessels through the body surface cold compress to have effect.
Off-topic: infants and children’s venipuncture is more difficult, many parents are very worried about the infusion will be played a lot of needles, will stare at the injection nurse, in fact, this is counterproductive, anyone is in a relaxed state to better play their level of a particular, when faced with stress, the general level will be discounted.
Surgeons are generally reluctant to operate on family members for this reason, and internal medicine doctors will not do risky operations on their own family members. Parents staring at the nurse, will undoubtedly give the nurse pressure, but easy to play into, playing intravenous injection is very often based on the feeling, a nervous, easy to make mistakes, especially the inexperienced nurses.
So it is recommended that you do not stare at the nurse when your child is getting a shot, it is best to let the nurse hold the child in another place to play, and if you want the parents to cooperate, do not go to see the shot. The doctor’s own child shot will not go to see the nurse shot.
To tell a true story: a male colleague’s own 2-year-old son was hospitalized and needed a jugular vein to draw blood, several nurses in the ward to grab the crying child operation, the doctor outside the ward heartbroken tears, but he would not go in to see his son, because the nurses a nervous, operation failure, the suffering or children.
3. Regarding blood tests and films.
Among the common acute respiratory diseases in children, only otitis media and purulent tonsillitis will have obvious blood changes of bacterial infection; other diseases rarely see obvious blood changes.
In children, even in bronchitis and bronchiectasis, significant blood changes are rare, even in bronchopneumonia, and the vast majority do not have significantly elevated white blood cells. Therefore, the first visit, blood tests are not very meaningful, but doctors usually request (including the row of films), mainly to protect the doctor himself, if the experienced doctor did not request blood tests, there is no need to request themselves.
In fact, most of them are not too problematic, mainly for the sake of the doctor’s treatment, and if they are shown to other pediatricians, many of them are fine, so don’t worry too much.
However, there are very few very severe pneumonia, sometimes only a symptom of high fever, nothing else, physical examination also can not hear the wet rosettes, chest X-ray can be clearly diagnosed.
Therefore, if the child has only a high fever and the physical examination does not reveal anything, it is still necessary to take a radiograph. Ancillary tests can only be used as a reference for the doctor to see, and finding a doctor who is only trusted is the key.