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     Volume 5 Issue 120 | November 17, 2006 |

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What to do about Fever

Signs and symptoms
A fever occurs when your temperature rises above its normal range. What's normal for you may be a little higher or lower than the average temperature of 98.6 F. That's why it's hard to say just what a fever is. But a "significant" fever is usually defined as an oral or ear temperature of 102 F or a rectal temperature of 103 F. A rectal temperature reading is generally 1 degree Fahrenheit higher than an oral reading. Depending on what's causing your fever, additional signs and symptoms may include:
  • Sweating
  • Shivering
  • Headache
  • Muscle aches
  • Lack of appetite
  • Dehydration
  • General weakness
  • Very high fevers, between 103 and 106 F, may cause hallucinations, confusion, irritability and even convulsions.

Even when you're well, your body temperature varies throughout the day it's lower in the morning and higher in the late afternoon and evening. In fact, your normal temperature can range from about 97 to 99 F. Although most people consider 98.6 F a healthy body temperature, yours may vary by a degree or more. Your body temperature is set by your hypothalamus, an area at the base of your brain that acts as a thermostat for your whole system. When something's wrong, your normal temperature is simply set a few points higher. The new set-point, for example, may be 102 F instead of 97 or 98 F.

What happens with a fever
When a fever starts and your body tries to elevate its temperature, you feel chilly and may shiver to generate heat. At this point, you probably wrap yourself in your thickest blanket and turn up the heating pad. But eventually, as your body reaches its new set-point, you will probably feel hot. And when your temperature finally begins to return to normal, you may sweat profusely, which is your body's way of dissipating the excess heat. A fever usually means your body is responding to a viral or bacterial infection. Sometimes heat exhaustion, an extreme sunburn or certain inflammatory conditions such as temporal arteritis inflammation of an artery in your head may trigger fever as well. In rare instances, a malignant tumor or some form of kidney cancer may cause a fever. Fever can be a side effect of some medications such as antibiotics and drugs used to treat hypertension or seizures. Some infants and children develop fevers after receiving routine immunisations, such as the diphtheria, tetanus and pertussis (DTaP) or pneumococcal vaccines. Sometimes it's not possible to identify the cause of a fever. If you have a temperature higher than 100.9 F for more than three weeks and your doctor isn't able to find the cause after extensive evaluation, the diagnosis may be fever of unknown origin. In most cases, though, the reason for your fever can be found and treated.

For infants
An unexplained fever is greater cause for concern in infants and children than in adults. Call your baby's doctor if your baby:

  • Is younger than 2 months of age and has a rectal temperature of 100.4 F or higher. Even if your baby doesn't have other signs or symptoms, call your doctor just to be safe.
  • Is older than 2 months of age and has a temperature of 102 F or higher.
  • Is a newborn who has a lower-than-normal temperature under 95 F rectally.
  • Has a fever and unexplained irritability, such as marked crying when you change your baby's diapers or when he or she is moved. Some infants might have a fever and seem lethargic and unresponsive. In infants and children younger than age 2, these may be signs of meningitis an infection and inflammation of the membranes and fluid surrounding your brain and spinal cord. If you're worried that your baby might have meningitis, see your doctor right away. Don't wait until morning to see your usual physician, meningitis is an emergency.

For children
Children often tolerate fevers quite well, although high temperatures may cause parents a great deal of concern. Still, it's best to be guided more by how your child acts than by any particular temperature measurement. If your child has a fever but is responsive and is drinking plenty of fluids and wanting to play, there's probably no cause for alarm. Call your paediatrician if your child is listless or irritable, vomits repeatedly, has a severe headache or stomach-ache or has any other symptoms causing significant discomfort. If your child has a fever after being left in a very hot car, seek medical care immediately. Also call your doctor if fever persists longer than one day in a child younger than age two or longer than three days in a child aged two or older. Don't treat fevers below 101 F with any medication unless advised by your doctor.

For adults
Call your doctor about a fever if:

  • Your temperature is more than 104 F
  • You've had a fever for more than three days
In addition, call your doctor immediately if any of these signs and symptoms accompany a fever:
  • A severe headache
  • Severe swelling of your throat
  • Unusual skin rash
  • Unusual eye sensitivity to bright light
  • A stiff neck and pain when you bend your head forward
  • Mental confusion
  • Persistent vomiting
  • Difficulty breathing or chest pain
  • Extreme listlessness or irritability
  • Abdominal pain or pain when urinating
  • Any other unexplained symptoms
  • Treatment
    Medical treatment depends on the cause of your fever. Your doctor will likely prescribe antibiotics for bacterial infections, such as pneumonia or strep throat. For viral infections, including stomach flu (gastroenteritis) and mononucleosis, the best treatment is often rest and plenty of fluids. Your doctor may also suggest taking over-the-counter medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to lower a very high fever. Adults may also use aspirin. But don't give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as Reye's syndrome.

    The best way to prevent fevers is to reduce your exposure to infectious diseases. One of the most effective ways to do that is also one of the simplest--frequent hand washing. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap, and rinsing thoroughly under running water. Carry hand-washing towelettes with you for times when you don't have access to soap and water. When possible, teach your kids not to touch their noses, mouths or eyes the main way viral infections are transmitted.

    Because your body loses more water with a fever, be sure to drink plenty of fluids to avoid dehydration. Water is best, but if it's hard to get your children to drink water, encourage them to drink juices or sports drinks containing electrolytes, or to eat frozen ice pops. Adults and children should also get enough rest. Don't be concerned with treating a fever just because it's a fever. Often, a low-grade fever is actually helping fight off an infection. In addition, follow these guidelines for both children and adults:

    For temperatures less than 102 F
    Don't use any medication for a fever in this range unless advised by your doctor. And don't give children aspirin because of the risk of Reye's syndrome. Instead, dress in comfortable, light clothing and try bathing in lukewarm water. At bedtime, cover yourself or your child with just a sheet or light blanket.

    For temperatures between 102 and 104 F
    Take acetaminophen or ibuprofen according to the label instructions or as recommended by your doctor. If you're not sure about the proper dosage, be sure to check with your doctor or pharmacist. Adults may use aspirin instead. Be careful not to give too much medication. High doses or long-term use of acetaminophen may cause liver or kidney damage, and acute overdoses can be fatal. If you're not able to get your child's fever down, don't give more medication. Call your doctor instead. Side effects of aspirin and other nonsteroidal anti-inflammatory drugs such as Motrin and Advil include stomach pain, bleeding and ulcers.

    For temperatures greater than 104 F
    Give adults or children acetaminophen or ibuprofen following the manufacturer's instructions or as recommended by your doctor. Adults may use aspirin instead. If you're not sure about the dosage, check with your doctor or pharmacist. Be careful not to give too much medication. Acetaminophen is available in liquid, chewable and suppository forms for children, but it's often easiest to give medications in liquid form. For a small child, use a syringe with measurements on the side and a bulb on the tip. Gently squirt the medicine in the back corners of your child's mouth.

    Use a five- to ten-minute sponge bath of lukewarm water to try to bring your own or your child's temperature down. A sponge bath is most likely to help if it's used shortly after a dosage of acetaminophen or ibuprofen, so that the medication can work to keep the fever down after the bath takes effect.

    If your child shivers in the bath, stop the bath, dry your child and wait. Shivering actually raises the body's internal temperature shaking muscles generate heat. If the fever doesn't moderate or your child has a febrile seizure that lasts longer than five minutes, seek immediate medical care.

    Source: mayoclinic.com


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