Fever is the most common symptom of illness that occurs in children and one of the symptoms that most frighten parents, so much so that the fever - especially if it is high - is one of the most frequent reasons why they ask for a pediatric visit. One of the most widespread reactions is that of try to lower the baby's temperature, but in reality it is not said that it is necessary to do so.
- What is it for
- Fever Medicines: When to Use Them
- Fever medicines: which ones to use
- Febrile seizures
- Lower fever with natural methods: sponging
- Persistent high fever: what to do
"Fever is the body's natural defense mechanism against pathogens," he explained to mymodernparents.com Maurizio De Martino, pediatric immunologist director of the Pediatric Clinic 1 of the Meyer Hospital of the city and coordinator of the Guidelines for the management of fever in children of the Del Paesena Society of Pediatrics. "In fact, at high temperatures, viruses and bacteria find it harder to multiply and, what's more, the immunological mechanisms work better".
In conclusion: with fever, the body creates an inhospitable environment for microbes and stimulates the immune system to fight them quickly and effectively. In this sense it is therefore a positive phenomenon, which must not always and in any case be contrasted with drugs, even if obviously it must be kept under control to see how the situation evolves.
An in-depth study published in 2022 in the official journal of the Del Paesena Society of Preventive and Social Pediatrics (SIPPS) says it very clearly: antipyretics (or antifebriles: medicines that lower fever) must be used with the sole purpose of reducing the child's sense of discomfort, and not to treat fever as such, as it is a defense mechanism against infection.
Therefore it should not be so much the degree of temperature that induces to administer the antipyretic, but the level of malaise (irritability, headache, muscle aches, alterations in the sleep-wake rhythm), which can be very variable. There are situations in which, except for the high temperature and perhaps a little tiredness, the child is still fine - and then drugs should not be used - and others in which the malaise is high, perhaps even in the face of a lower fever. : in these cases ok instead of drugs.
For children, the only medications recommended by the Guidelines are paracetamol and ibuprofenIn fact, several studies show that both are effective in reducing the child's feverish temperature and are equally safe. In Del Paese, paracetamol can be used from birth, while ibuprofen is authorized from the age of three months or from 5,6 kg of body weight.
However, it is not recommended to administer together or alternate paracetamol and ibuprofen, because there is currently little evidence regarding the safety and efficacy of combined therapy compared to therapy with a single drug. Indeed, the combination of antipyretics could increase the risk of overdose and side effects.
No, not necessarily. In particular with regard to ibuprofen, taking on a full stomach is recommended in the case of long-term treatments to prevent any symptoms in the stomach, but in the case of short-term treatment, as is typically the one for fever, it can also take place on an empty stomach. In this case, among other things, the effect of the drug will be faster, while food can slow down the absorption of the drug and therefore also its speed of action.
What if the child takes the drops and vomits? What if he takes suppositories and has diarrhea? Which formulations to choose?
The Guidelines recommend administering both paracetamol and ibuprofen in drops or syrup, as absorption is more constant and greater precision in dosage is possible, which must always be calculated on the basis of body weight and not on the basis of the child's age. "Among other things, the syrups today have a very pleasant taste, which make them acceptable to children", the family pediatrician Adima Lamborghini, a member of the study center of the Federation of Paesena pediatricians, pointed out to mymodernparents.com. "And for the bigger ones, buccal sachets and chewable tablets are also available, always with a pleasant taste."
instead better to avoid suppositories, both because they are unpleasant for the child and because they can cause side effects, since there is a tendency to overdose. Suppositories should only be used if, in addition to fever, vomiting or other conditions that prevent the use of oral medications are present.
Febrile seizures are one of the most feared manifestations by parents. In fact, febrile seizures they are not directly dependent on fever but they occur in predisposed children, that is, who are familiar with this disorder. "In these subjects - explained De Martino - the convulsions represent a particular response of the organism to the presence of an infection. In other words, it is the cause of the fever itself - that is the infection - that also causes the convulsions".
"The first time they occur, you have to take the child to the emergency room," says de Martino. "This is because if it is true that the cause is usually the one just described, in rare cases the convulsions could be a manifestation of meningitis or encephalitis".
If it is "only" benign convulsions, nothing special needs to be done: this is also stated by the Guidelines of the Lega Del Paesena against epilepsy for the management of febrile convulsions. At the most, after a first episode it may be useful to keep diazepam microenemas at home, to be administered in the event of subsequent crises, if these do not resolve on their own within two to three minutes.
Several studies have shown that the use of paracetamol or ibuprofen in febrile children does not prevent febrile seizures, therefore the Guidelines specify that it is not necessary to give antifebriles in order to prevent convulsions.12 PHOTOS
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There are many folk and "natural" remedies that are proposed to lower fever, and among them in particular the sponging with cold water, or with alcohol or vinegar. The scientific data available on the effectiveness of these practices - few - seem to indicate that they are of little or no use, and that moreover they can annoy the child, if not become counterproductive.
"Fever is a rise in body temperature controlled centrally by the brain, therefore it is not possible to intervene by cooling the periphery" explains De Martino. "On the contrary, by cooling the extremities too much, the body is forced to produce more heat and the temperature rises". That is why these physical means should be avoided, unless it is a matter of fever but of heat stroke: in this case they are useful.
"At best, if the child is very hot and sweaty, they can simply wash legs and arms with a little bit of warm water"Lamborghini says." In this way there is no risk of getting too cold and the child could derive a temporary benefit from it. "
"Always ensure the baby is hydrated and check that he does not have constant discomfort. In this case it is advisable to intervene with an antipyretic, which acts not only by lowering the temperature, but also on the substances responsible for the malaise "advises Lamborghini.
"If the fever is 'indeterminate', that is, it is not accompanied by symptoms that can explain the cause (such as sore throat, cough and cold typical of the flu), after 72 hours it is advisable to carry out investigations (laboratory tests) to look for to clarify its origin ".
- 1-2 children years