fever in a child in paediatrics with help.pptx

Fever

1. The febrile child DR VENN, J.I. FWACP(PAED) Consultant, Paediatric Emergency Unit, UCTH

2. INTRODUCTION A child is any patient from age zero to 18 years. Although other settings may use 16 years A febrile child is any child with temperature of ≥37.5 C (Axillary ) ≥38 C (core) Fever is the most common presenting complaint in children It is an emergency sign in a child and should be seen by a doctor Etiology ; environmental, infective (Viral, Bacterial, Parasitic), immune, inflammatory condition, Malignancy etc Fever in a child is a source of deep concern not only for parents, but often also for the treating physician

3. PHYSIOLOGY OF FEVER For each 1 °C elevation of body temperature: – Metabolic rate increase 10-15% Insensible water loss increase 300-500ml/m2/day O2 consumption increase 13% – Heart rate increase 10-15/min Resp rate increase 4/min

4. Approach to a febrile child ; Initial care Re-take the temperature using a clinical thermometer in the armpit. Expose the child and Tepid sponge. May give antipyretics if temperature is >38.4 C,.. Where possible, use the same body site and the same type of thermometer when measuring temperatures. Thermometers used could be 1) mercury thermometer 2) electronic thermometer in the armpit 3) none contact digital thermometers that take temperature from the Tympanic membrane, the fore head, etc 4) chemical dot thermometer.

5. History taking Take a quick history from the care givers; duration, severity, rhythym , interventions, effects. Duration, timing, pattern,relieving , aggravating factors, seizures, rigors{shivering} and chills, cough Recent travel, Sick contacts Immunisation: children <6 months age, with recent or incomplete immunisation Medication – prior treatment with antibiotics may mask signs of a bacterial infection High risk groups: prematurity, immunosuppression, congenital heart disease, previous invasive bacterial infections, Are there other children in the family with similar symptoms O ther chronic problems that might predispose the child to recurring infections or serious acute illness like sickle cell anaemia or AIDS Review of systems for associated symptoms, past medical, surgical and medication history, family and travel history, contacts. NB Teething does not cause fever

6. Physical examination- IPPA approach Physical; ill / not ill looking, conscious, pale, jaundice, cyanosed, edema . Anthropometry and vitals (PR,BP), SPO2, Degree of fever, .grunting, stridor,bulging anterior fontanelle , Respiratory Rate -; fast breathing and hypotension[suggest serious infection], Level of hydration Presence of tachycardia out of proportion to the fever,Colour -; pallor,cyanosis esp. when coughing, ,jaundice, irritability, unconsolable crying, lethargy, consciousness,hydration , response to social overtures

7. Systemic examination- IPPA approach S pecific findings in the system that points to a pathology E>G Respiratory – tachypnoea , dyspnoea (chest in-drawing,) reduced excursion, dull/ hyperresonant percussion, crepitations , rhonchi, collapse, fluids, air, nasal flaring C hest retractions, coughing and wheezing with bronchiolitis and pneumonia Pain, swelling or pseudoparalysis with septic arthritis, osteomyelitis cellulitis. Drooling , halitosis, hyperemic and enlarged tonsils+/- pharynx.

8. Investigation; Point-Of-Care testing or routine hospital laboratory – Viral screen, MP, FBC/ESR, Blood culture, U rinalysis, Urine m/c/s, Lumbar puncture, S tool mcs , Chest xray , HIV serology TB screen, Peripheral Blood film Bone marrow/ csf /FNAB for cytology

9. D ifferential diagnosis Viral and Parasitic Viral URTI – Influenza, RSV, CROUP; Diarrhoea disease – Rota virus enteroviruses , Viral exanthem – chicken pox (Varicella ), roseola measles, E ncephalitis HIV , Covid , SARS, Ebiola , LASA Parasitic Malaria Helminthiasis Bacterial URTI- tonsillitis, pharyngitis, laryngitis, sinusitis Otitis- externa , media, interna mastoditis Pneumonia Septicaemia Meningitis UTI Tuberculosis Septic arthritis Pertussis Others Inflammatory conditions; Kawasaki JRA Rheumatic fever Environmental 0ver clothing Vaccine induced fever Heat stroke Malignancy: Leukaemia , lymphomas etc

10. Management Disposition Most viral infection needs reassurance and home treatment with remedies like Paracetamol , Vit C, increase fluid intake, exposure to cool Ill child should be admitted. High grade fever, Convulsing, unconscious, not able to tolerate orally, prostration, dehydrated, shock, in distress (pain, respiratory,) desaturating , distension, oedema, malnourished, bleeding, urinary symptoms, localized swelling (abscesses, arthritis), communication and patient-parent centred care approach Treat the cause

11. GENERAL MEASURES • Drinking plenty of clear fluids to replace fluids lost by sweating, vomiting or diarrhoea – either water, or an oral rehydration solution which contains electrolytes. • Changing clothings and bed linen frequently. • Tepid baths (but don't use cold water, as this can increase core body temperature by cooling the skin and causing shivering). • Keeping clothes and blankets to a minimum. • Avoiding hot water bottles or electric blankets (which may raise body temperature further). • Ventilating the room