How does fever manifest in a child 1 5. What to do if a child has white fever? White fever in a child

When high body temperatures are detected in a child, many parents, especially young ones, panic, losing self-control and the ability to think clearly. However, as practice shows, such emotions are unnecessary, since they are not only unjustified, but also significantly interfere with making the right decisions, which include providing first aid. The main thing when identifying high temperature for your child - to knock it down correctly and in a timely manner. In medicine, an increase in body temperature to high levels is called “fever”, which can become very dangerous condition for children's age category.

Definition of concepts

Quite often, “fever” is confused with “hyperthermia,” although the two concepts are completely different:

1. Fever is the result of the acute development of diseases of infectious origin. In this case, high temperature values ​​are a protective reaction of the body, through which the immune system is stimulated, activated metabolic processes, increased leukocyte values.
2. Hyperthermia, in turn, occurs against the background of the development of any pathological conditions that are not related to infectious pathogens. These can be various neoplasms in the body, overheating and other factors.

It is important to understand and be able to distinguish between the concepts presented, since the correctness and quality of the first emergency care.

Types of fever

There are two main types of fever:

• "white", also called "cold";
• "pink" or "hot".

The fundamental difference between the “white” type in children is the occurrence of spasms of blood vessels located on the periphery, which suggests the development of the process according to the adult type.

Each of the febrile conditions is characterized by its own characteristics, which are manifested through the following signs:

"Cold" feverish state

1. The child's skin becomes pale or bluish in color.
2. When you touch the skin, you feel cold and increased dryness, which is especially typical for the extremities.
3. At very low temperature values, the child exhibits little motor activity, becomes lethargic and apathetic. Along with this, excited or delusional states, without a good reason.
4. There is an increase in heart rate, which can cause shortness of breath.
5. Chills occur, which are caused by strong intensity.
6. Reception medicines with antipyretic effect does not bring a positive result.

"Hot" feverish state

1. The child's skin becomes covered with reddish spots.
2. The skin is warm and moist to the touch, which also applies to the limbs.
3. In accordance with the increase in body temperature values, there is an increase in heart rate, pulse and respiration.
4. In the presence of high temperatures, the child’s behavior remains normal.
5. Antipyretic medications have a good effect.
6. In case of wiping skin With vodka or plain water there is no “goose bumps” symptom.

Since the types of febrile states under consideration have significant differences in symptoms, it is advisable to carry out different techniques providing emergency assistance.

"Pink" fever

Taking medications

1. If there are temperature values ​​from 37.5 to 38.5 degrees, Paracetamol or medications based on it, the form of which does not matter much, will be quite effective. The effect of such drugs begins after half an hour and lasts for a couple of hours.
2. At temperatures rapidly creeping up and exceeding 38.5 degrees, it is advisable to use more potent drugs, in the form of “Analgin”, “Aspirin” or a combination of these two components. These medications are also activated after a half-hour time period, but their duration is 6 hours. In order to obtain a greater positive effect in the absence of any contraindications to their use, Analgin and Aspirin are taken in turn every 4 hours. It is also possible to take them together, but then the period of inactivity should be at least 8 hours.

Physical type body cooling

1. After taking medications, cooling the body will be a good help. To carry it out, you should undress and wipe your entire body with a towel previously soaked in plain water or a solution of vodka, water and vinegar. It is important to do wiping, during which drops of the composition can evaporate on their own, taking with them excess heat. After the skin has completely dried, the procedure can be repeated several times.
2. A good alternative to wiping is a warm shower, after which the temperature may drop by a couple of degrees.
3. It is not recommended to carry out warming-type procedures without taking medications, since after the end of the effect of such procedures, protective function the body, causing it to warm up again, resulting in even greater heat production. In the absence of taking antipyretic drugs, temperature values ​​will only increase.

Drink

1. To all the procedures described above, it is useful to add plenty of warm drinks, which will help cleanse the body.
2. Tea with a diuretic effect, which can cause chills, will be an excellent help. In this case, you should not wrap yourself up, as this will prevent heat transfer.

"White" fever

Medicines

1. The same “Paracetamol”, “Aspirin” and “Analgin” are suitable as antipyretics.
2. Medicines are used with them antispasmodic action, which affect the vascular walls of the skin.

Rubbing

It is important to warm the child’s hands and feet using heating pads or rubbing procedures. In this case, rubbing is ineffective.

After carrying out the emergency measures described above, temperature values ​​should decline and decrease by at least a degree. In the absence of positive dynamics, it is advisable to call a doctor, since such persistent feverish states indicate serious disorders occurring in the body that require immediate medical intervention and a thorough examination.

However, it is important to understand that you should absolutely not achieve temperature values ​​characteristic of healthy body, since such sudden changes in temperature can cause no less harm to the child. Exceptional cases include elderly people, children in the age group less than a year, as well as patients suffering from neurological and cardiological diseases. As a rule, temperature values ​​in these categories of the population do not exceed 38 degrees. As a result, the temperature drop to normal levels is barely noticeable.

The meaning of fever depends on the clinical context rather than the peak temperature; Some minor illnesses cause high fever, while some serious pathologies Only a slight increase in temperature occurs. Although parental assessment is often biased by fear of fever, the history of home temperature measurements should be taken into account as well as hospital temperature measurements.

Normal body temperature fluctuates during the day by 0.5 °C, and in a child with fever by as much as 1.0 °C.

Fever occurs in response to the release of endogenous proinflammatory mediators called cytokines. Cytokines stimulate the production of prostaglandins by the hypothalamus, which corrects and increases the set temperature.

Fever is playing important role in the fight against infections, and although inconvenient, does not require treatment in an otherwise healthy child. Some studies even show that lowering the temperature may prolong some illnesses. However, fever increases metabolic rate and stress on the cardiopulmonary system. Thus, an increase in temperature may be harmful for children with pulmonary or cardiac risks or neurological disorders. It can also be a trigger for febrile seizures, usually a benign condition, in children.

The central pathogenetic element of fever is advanced education cytokines (endogenous pyrogens) - interleukins 1 and 6, interferon β, tumor necrosis factor. The latter indirectly through prostaglandins induce the thermoregulation center (bottom III ventricle) to increase heat production and reduce heat transfer. Fever is always the body's response to an infectious or non-infectious (immune) inflammatory process. Clinically, fever can occur either of the “white” (cold) or “pink” type (warm). White fever occurs in the presence of circulatory disorders leading to centralization of blood circulation. In this case, the rectal temperature exceeds the axillary temperature by more than 1°C. With pink fever, the skin is hyperemic and the limbs are hot to the touch.

Hyperthermia(D) - an increase in body temperature that occurs without a restructuring of temperature homeostasis, that is, the body’s thermoregulation function is insufficient to maintain body temperature within the framework of homeostasis. This occurs either as a result of a discrepancy between the degree of exposure to external factors and the body’s capabilities (overheating), or due to a disruption in the functioning of the thermoregulation center (damage to the central nervous system).

Gradations of body temperature increase:

• subfebrile (not exceeding 38 °C);
• febrile (moderate - 38.1-39 °C, high - 39.1-41 °C);
• hyperpyrexic (above 41 °C).

Based on the nature of the temperature curve, the following types of L are distinguished:

• constant, at which daily fluctuations in body temperature do not exceed 1 ° C, which is typical for typhus and lobar pneumonia;
• remitting, occurring with fluctuations in body temperature within a day from 1 to 1.5 ° C, without reducing it to normal numbers. This type of fever occurs in infectious diseases;
• atypical, occurring without any pattern, which is most often found with banal viral infections;
• hectic, characterized by a daily range of body temperature exceeding 3 °C. In this case, there is a rapid rise in body temperature and a lytic decrease in it. These episodes can be repeated 2-3 times a day. Characteristic for septic conditions;
• intermittent, manifested by alternating high and normal body temperatures throughout the day. Temperature normalization can occur either in the morning or in the evening. IN the latter case talk about inversion. This type is typical for purulent infection, as well as for systemic variants of the course of immunopathological diseases ( rheumatoid arthritis, systemic lupus erythematosus, etc.);
• recurrent, characterized by alternating febrile attacks for 2-7 days with periods of normal body temperature lasting 1-2 days. This type is characteristic of malaria, periodic illness, and immunopathological diseases.

In most cases in practice, the cause of an increase in body temperature can be determined in the first days of the child’s illness. If the elevated body temperature persists for at least 7 days, and the cause remains unclear, then we can talk about fever of unknown origin (FOU). This diagnosis It is advisable only in cases of documented confirmed increase in body temperature (possibility of simulation and aggravation), the cause of which has not been established as a result of routine examination. In this case, fever should not be accompanied by clearly expressed local symptoms, that is, an increase in body temperature should be the only or almost the only symptom.

Causes of fever in children

The causes of fever vary depending on whether it is acute (<7 дней) или хронической (>7 days). Response to antipyretics and fever are not directly related to the etiology of the disease or its severity.

Acute. Most acute fevers in infants and young children are due to infection. The most common:

• ARVI or gastrointestinal infections (the most common causes);
• some bacterial infections.

However, potential causes vary depending on the child's age. Newborns (infants<28 дней) и маленькие дети имеют ослабленную иммунную защиту и, следовательно, подвержены большему риску инфекций, в том числе перинатальных. Общие перинатальные инфекции включают вызванные стрептококками группы В, Escherichia coli, Listeria monocytogenes, и вирусом простого герпеса; эти организмы могут вызывать бактериемию, пневмонию, менингит или сепсис.

Children with fever under 3 years of age are at particular risk of occult bacteremia (pathogenic bacteria in the blood but not focal symptoms or signs). The most common causative agents of occult bacteremia are Streptococcus pneumoniae and Haemophilus influenzae, and vaccination against both pathogens is now widespread in the United States and Europe, making occult bacteremia less common.

Rare noninfectious causes of acute fever include heat stroke and toxic substances (eg, anticholinergic drugs). Some vaccines can cause fever for several days (for whooping cough) and even 1 or 2 weeks (for example, for measles) after administration. These fevers usually last from several hours to a day. Teething does not cause fever.

Chronic. Chronic fever involves various possible reasons, including autoimmune diseases, collagen vascular diseases (eg, juvenile rheumatoid arthritis, inflammatory bowel disease), cancer (eg, leukemia, lymphoma) and chronic infections (eg, osteomyelitis, tuberculosis). In addition, spontaneous fever and cases of unknown etiology are possible.

The most common reasons include:

• benign infectious causes (long-term viral diseases, recurrent diseases).

Collagen vascular diseases, autoimmune diseases and cancer are much less common.

The most common causes of LDL in children of the first year of life

• Generalized infections.
• Septicemia and septic conditions.
• Localized infections with a tendency to septic progression.
• Pyelonephritis, pneumonia.
• Thermoregulatory disorders.
• Transient low-grade fever.

Diagnosis of fever in children

Story. The medical history should note the degree and duration of fever, method of measurement, and dose and frequency of antipyretics (if taken). Important associated symptoms that suggest serious illness include poor appetite, irritability, lethargy, and changes in crying (eg, duration, pattern). Associated symptoms that may indicate causes include vomiting, diarrhea (including blood or mucus), cough, difficulty breathing, limb or joint involvement, and copious or foul-smelling urine. The medication history should be reviewed for signs of drug fever.

Factors predisposing to the development of infection have been identified. In newborns, these factors include prematurity, late rupture of membranes, maternal fever, and positive prenatal tests (usually for group B streptococcal infection, cytomegalovirus infection, or sexually transmitted diseases). For all children, predisposing factors include recent exposure to infection (including family and caregiver exposure), long-term medical devices (eg, catheters, ventriculoperitoneal shunts), recent surgery, travel, and environmental exposures (eg, ticks, mosquitoes) , cats, farm animals).

A review of systems should note symptoms suggestive of possible causes, including runny nose and congestion (viral infections of the upper respiratory tract), headache (sinusitis, Lyme disease, meningitis), ear pain or waking up at night with signs of discomfort (otitis media), cough or shortness of breath (pneumonia, bronchiolitis), abdominal pain (pneumonia, gastroenteritis, urinary tract infections, abdominal abscess), back pain (pyelonephritis), as well as a history of swelling and redness of the joints (Lyme disease, osteomyelitis). Look for the presence of repeated infections (immunodeficiency) or symptoms indicating chronic diseases such as poor weight gain or loss (tuberculosis, cancer). Some symptoms may help refocus evaluation on non-infectious causes, which include rapid heart rate, sweating and heat intolerance (hyperthyroidism), recurrent or cyclical symptoms (rheumatoid, inflammatory or hereditary disease).

History of past illnesses. History of fevers or infections and known conditions predisposing to the development of infections (eg, congenital heart disease, sickle cell disease, cancer, immunodeficiency) should be noted. A family history of autoimmune disorders or other hereditary conditions (eg, familial vegetative-vascular dystonia, familial Mediterranean fever) is identified. Vaccination history is reviewed to identify patients at risk of developing vaccine-preventable infections.

Physical examination. Reveal vital signs, noting deviations in temperature and respiration rate. Children who appear ill should also have their blood pressure measured. To obtain accurate values, the temperature should be measured rectally. Any child with cough, tachypnea, or shortness of breath requires pulse oximetry.

The general appearance of the child and his reaction to the examination are important indicators. A child with a fever who is overly agreeable or lethargic is more worrisome than one who refuses to communicate. However, an irritable baby or child who cannot be soothed is also a cause for concern. A child with a fever who appears unwell, especially after the fever has subsided, is of great concern and requires in-depth assessment and ongoing monitoring. However, children who feel more comfortable after antipyretic therapy do not always have benign disorders.

The examination reveals signs of causative disorders.

Warning signs. The following data are of particular concern:

• age less than 1 month;
• lethargy, apathy or toxic manifestations;
• respiratory failure;
• petechiae or purpura;
• inconsolability.

Interpretation of results. Although serious illness does not always cause high fever and many cases of serious fever are the result of self-limited viral infections, a temperature >39°C in children under 3 years of age indicates a higher risk of occult bacteremia.

Acute fever in most cases is of an infectious nature, predominantly viral. Anamnesis and examination are adequate approaches for making a diagnosis in older children who are otherwise healthy and do not have toxic manifestations. Typically, this is a viral respiratory illness (recent contact with a sick person, runny nose, wheezing or cough) or gastrointestinal (contact with a sick person, diarrhea and vomiting). Other findings also suggest specific causes.

However, in infants under 36 months of age, the possibility of occult bacteremia, as well as the frequent absence of focal symptoms in newborns and young children with severe bacterial infection require a different approach. The rating depends on age group. Accepted categories: newborns (<28 дней), маленькие младенцы (1-3 мес) и младенцы более старшего возраста (3-36 мес). Независимо от клинических данных новорожденные с лихорадкой требуют немедленной госпитализации и исследования для исключения опасных инфекций. Маленькие младенцы могут нуждаться в госпитализации в зависимости от результатов лабораторного скрининга и, вероятно, будут взяты под дальнейшее наблюдение.

Chronic fever can be caused by a variety of reasons. However, some symptoms suggest the presence of specific diseases: chronic migratory erythema, intermittent joint swelling and neck pain - Lyme disease; intermittent headaches with runny nose or nasal congestion - sinusitis, weight loss, high risk of contact with a source of infection and night sweats - tuberculosis; weight loss or difficulty gaining weight, rapid heartbeat and sweating - hyperthyroidism; weight loss, lack of appetite and night sweats - cancer. Certain conditions (eg, granulomatous diseases) may present with nonspecific symptoms and a history that includes recurrent infections (eg, pneumonia, skin infections, abscesses, sepsis).

Testing. Testing depends on the course of the fever, acute or chronic.

For acute fever, the direction of testing for infectious causes depends on the age of the child.

All children with fever under 3 months of age require a white blood cell count with microscopic differentiation, blood culture, and urine test and culture (urine obtained by catheterization, not into an open reservoir). Lumbar puncture is mandatory for children under 28 days; Expert opinions on the need for research in children aged 29 days to 2 months differ. X-ray chest, smear for leukocytes, stool culture, and acute phase test (eg, ESR, C-reactive protein) are performed depending on symptoms and degree of suspicion.

Children with fever who are 3–36 months of age, appear well, and can be closely monitored do not require laboratory testing. If a child has symptoms or signs of specific infections, doctors should order appropriate tests (eg, chest X-ray for hypoxemia, shortness of breath, or wheezing; urine test and culture for foul-smelling urine; lumbar puncture for abnormal behavior or meningismus). If the child appears ill or has a temperature >39°C but has no localizing signs, blood and urine cultures should be considered in the same way as a lumbar puncture.

For children older than 36 months, direction of testing for fever should depend on history and examination; Screening blood cultures and white blood cell counts are not indicated.

For chronic fever, the direction of testing for noninfectious causes should depend on the history, physical examination, and suspected disorders (eg, determination thyroid-stimulating hormone[TSH) and thyroxine [T4] if thyrotoxicosis is suspected; detection of antinuclear antibodies and Rh factor for suspected juvenile idiopathic arthritis).

Children without focal symptoms should have initial screening tests, including:

• complete blood count with differential analysis and urine culture;
• ESR (C-reactive protein is also taken into account, although one is not necessarily preferred over the other);
• Mantoux test for screening for tuberculosis.

An elevated ESR suggests inflammation (infection, tuberculosis, autoimmune disorders, cancer) and further testing may be performed. If the white blood cell count is normal, slow infection is less likely; however, if infection is suspected based on clinical findings, serologic testing for possible causes (eg, Lyme disease, cat scratch disease, mononucleosis, cytomegalovirus) and blood cultures may be performed. Imaging studies may be helpful in identifying tumors, purulent collections, or osteomyelitis. The type of test is determined by specific needs. For example, CT scans of the head are used to diagnose sinusitis; CT and MRI are used to identify tumors and metastases, bone scans are used to identify osteomyelitis.

Bone marrow aspiration may be done to detect cancer such as leukemia.

Features of examination of children with ANP

Confirmation of the fact of LDL. Thermometry in our country is traditionally carried out in the axillary region, where the temperature should be no less than 0.6 °C and no more than 1 °C lower than in the rectal region. The difference between the left and right armpits should not exceed 0.3 °C. An increase in body temperature is considered documented if it was measured by a medical professional.
Anamnesis. The duration and nature of the disease are determined, its connection with previous diseases or medications is established. It is important to establish whether body temperature was measured by parents or by the child independently without adult supervision.

Analyze the data of the survey, including the results of the Mantoux test for the last year. Determine the fact of contact with animals (toxoplasmosis, toxocariasis, brucellosis). The effectiveness of previously used antipyretics is assessed; their effectiveness is typical for inflammatory diseases and is absent in thermoregulatory disorders. The effectiveness of previously used antibiotics indicates the bacterial genesis of L.

Objective examination. A thorough examination of all organs and systems is necessary.

Laboratory examination methods. Screening:

• clinical blood test;
• general urinalysis. It should be borne in mind that microhematuria and microproteinuria may be caused not by the disease, but by the fever itself;
• biochemical tests: AST, sialic acids, C-reactive protein, fibrinogen, total protein, proteinogram.

If the results of the obtained analyzes do not deviate from the reference values, thermometry is carried out after three hours, followed by an aspirin test: thermometry is carried out at armpit every 3 hours during the day with parallel pulse counting. If thermoregulation is impaired, tolerance elevated temperature the body is satisfactory, during sleep the body temperature is always normal, there is no parallelism between the value of body temperature and pulse rate.

If present in the body inflammatory process fever affects the patient’s well-being; it often persists during sleep and higher body temperature numbers correspond to a higher pulse rate and vice versa, that is, there is parallelism. On the second day, aspirin is prescribed at a daily rate of 0.2 g per year of the child’s life, dividing this dose into 3-4 doses. - At the same time, thermometry is continued, counting the pulse is not necessary.

With thermoregulatory dysfunction, a complete or even partial antipyretic effect is not observed, while in the inflammatory process a clear antipyretic effect of aspirin is noted. To exclude an accidental coincidence between self-normalization of body temperature and the effect of aspirin, thermometry is continued for 24 hours after discontinuation of aspirin. If thermometry data indicate thermoregulatory dysfunction, it is advisable to conduct neurosonography and take an EEG, followed by consultation with a neurologist.

If these indicators reveal signs of an inflammatory process, then hospitalization in a diagnostic institution is indicated. If hospitalization is impossible, the examination is expanded:

• urine culture for flora;
• blood culture for flora;
• tuberculin tests;
• Ultrasound of organs abdominal cavity, pelvis, retroperitoneum, heart;
• chest x-ray, paranasal sinuses nose, tubular bones;
• serological tests and pathogen detection tests for identification (3-hemolytic streptococcus, salmonellosis, yersiniosis, viral hepatitis, infectious mononucleosis, cytomegalovirus infection, brucellosis, toxoplasmosis, toxocariasis, malaria. According to indications - studies of bone marrow, cerebrospinal fluid, tissue biopsies. If you suspect a particular pathology, it is advisable to consult specialists: ENT specialist, infectious disease specialist, phthisiatrician, nephrologist, cardiologist, pulmonologist, hematologist, neurologist, oncologist.

Prolonged fever in a child with an unknown diagnosis usually worries parents, so in most cases it is advisable to hospitalize the child or refer him to a diagnostic center.

Treatment of fever in a child

Treatment is directed at the underlying disorder.

Fever in an otherwise healthy child does not necessarily require treatment. Although an antipyretic may provide comfort, it does not change the course of the infection. In fact, fever is an integral part of the inflammatory response to infection and can help the child fight it. However, antipyretics are most often used to relieve discomfort and reduce physiological stress in children with a history of cardiopulmonary, neurological, or febrile seizures.
Antipyretic drugs that are commonly used include:

• acetaminophen,
• ibuprofen.

Acetaminophen is generally preferred because ibuprofen reduces the protective effect of prostaglandins in the stomach and, if used for a long time, can lead to the development of gastritis. Using one fever reducer at a time is preferable, but some clinicians alternate between 2 medications to treat fever (eg, acetaminophen at 6 a.m., noon, and 6 p.m. and ibuprofen at 9 a.m., 3 p.m., and 9 p.m.). This approach is not recommended because caregivers may become confused and accidentally exceed the recommended daily dose. Aspirin should be avoided as it increases the risk of developing Reye's syndrome if certain viral diseases such as flu and chicken pox.

Non-pharmacological approaches to fever include placing the child in a warm or cool bath, applying cool compresses, and undressing the child. Operating personnel should be warned not to use cold water bath, which is uncomfortable and, by causing shivering, can paradoxically raise body temperature. As long as the water temperature is slightly cooler than the baby's temperature, the bath provides temporary relief.

What to avoid. Rubbing the body with isopropyl alcohol is strongly discouraged because alcohol can be absorbed through the skin and cause intoxication. There are many folk remedies, ranging from harmless (for example, putting onions or potatoes in socks) to uncomfortable (for example, scratching the skin with a coin and cupping).

The result is often not at all what was expected. And all because not all parents know: fever is “white” and “red” and each of them needs to be affected differently.

With “red” fever, the child’s face and skin are red, and the whole body is hot to the touch. This means that the baby has good heat exchange. And therefore, the main task of parents is not to wrap the child up, but to provide air access to his skin, through which the heat escapes. At the same time, it is necessary to measure the child’s temperature every 30-40 minutes so as not to miss its rise above 38.5 °C, when it is no longer possible to do without antipyretic drugs.

If the child is pale, lethargic, wrapped in a blanket, if he has cool arms and legs, chills, then he has “white fever,” which requires completely different measures. First of all, such a child needs to be warmed up by applying a heating pad wrapped in a towel to his feet, or plastic bottle, filled hot water, wrap in a blanket, drink hot, freshly brewed (but not strong) loose leaf tea. You can put a wet, cold towel on your head. And only then can the child be given an antipyretic. However, in any case, consult a doctor immediately!

Drugs for the treatment of ARVI

Peculiarities: use of drugs for the treatment of ARVI wide range actions and homeopathic remedies to one degree or another enhances the body’s overall resistance. Due to this feature of their action, the improvement in well-being can be both significant and almost imperceptible. However, practice shows that in many cases, when using them, there is a reduction in time colds and reducing their severity.

Patient Information

• It is advisable to start taking all medications for the treatment of ARVI as early as possible, at the first symptoms of the disease.
• ARVI in children is recommended to be treated under the supervision of a physician, since antibiotics may be required if complications develop.

Antipyretic drugs

Main indications

• Increased body temperature.
• Headache, sore throat and other types of pain.

Peculiarities: all the drugs in this group have a similar mechanism of action and cause three main effects: antipyretic, analgesic and anti-inflammatory. The strength of these effects depends on the specific drug. For example, paracetamol has a very weak anti-inflammatory effect.

Patient Information

Antipyretic medications should not be prescribed in a “course” in order to prevent a rise in temperature. You need to fight a fever when the temperature has already risen.

Do not use antipyretics without consulting a doctor for more than 3 days.

The main antipyretic drugs in children are paracetamol and ibuprofen. If necessary, they can be combined with each other. To reduce fever in children, it is not recommended to use acetylsalicylic acid (aspirin). It can cause serious complications. Other antipyretics (including analgin and combination drugs) can be used in children only on the recommendation of a doctor and under his supervision.

Most Frequent side effects : allergic reactions, nausea, abdominal pain, erosions and ulcers of the gastrointestinal mucosa.

Main contraindications: individual intolerance, exacerbation peptic ulcer stomach and duodenum.

Fever continues to be one of the leading reasons for seeking emergency care. medical care in pediatric practice.

It is noted that an increase in body temperature in children is not only one of the most frequent occasions visits to the doctor, but also the main reason for the uncontrolled use of various medicines. At the same time, as antipyretic drugs for many years Traditionally, various non-steroidal anti-inflammatory drugs (salicylates, pyrazolone and para-aminophenol derivatives) have been used. However, in the late 1970s, convincing evidence emerged that the use of derivatives salicylic acid with viral infections in children may be accompanied by the development of Reye's syndrome. Considering that Reye's syndrome is characterized by an extremely unfavorable prognosis (mortality rate - up to 80%, high risk of developing serious neurological and cognitive impairments in survivors), in the United States in the early 80s it was decided to introduce a ban on the use of salicylates in children for influenza and ARVI and chickenpox. In addition, all over-the-counter medications that contained salicylates began to be labeled with a warning that their use in children with influenza and chickenpox could lead to the development of Reye's syndrome. All this contributed to a significant decrease in the incidence of Reye's syndrome in the United States. Thus, if before the restriction of the use of aspirin in children (in 1980), 555 cases were registered of this disease, then already in 1987 - only 36, and in 1997 - only 2 cases of Reye's syndrome. At the same time, data on serious side and undesirable effects of other antipyretics were accumulating. Thus, amidopyrine, often used by pediatricians in past decades, due to its high toxicity was also removed from the drug nomenclature. Convincing evidence that analgin (dipyrone, metamizole) may adversely affect bone marrow, inhibiting hematopoiesis, up to the development of fatal agranulocytosis, contributed to a sharp limitation of its use in medical practice in many countries of the world.

Serious analysis of results scientific research to study the comparative effectiveness and safety of various analgesics-antipyretics in children led to a significant reduction in antipyretic drugs approved for use in pediatric practice. Currently, only paracetamol and ibuprofen are officially recommended for use in children with fever as safe and effective antipyretic drugs. However, despite clear recommendations from the World Health Organization on the selection and use of antipyretics for fever in children, domestic pediatricians still often continue to use acetylsalicylic acid and analgin.

Development of fever
Before active implementation in medical practice antipyretic and antibacterial agents analysis of the characteristics of the course of the febrile reaction played an important diagnostic and prognostic value. At the same time, they highlighted specific features fevers in many infectious diseases ( typhoid fever, malaria, typhus, etc.). At the same time, S.P. Botkin, back in 1885, drew attention to the conventionality and abstractness of the average characteristics of fever. In addition, it is necessary to take into account the fact that the nature of the fever depends not only on the pathogenicity, pyrogenicity of the pathogen and the massiveness of its invasion or the severity of the processes of aseptic inflammation, but also on the individual age and constitutional characteristics of the patient’s reactivity and his background conditions.

Fever is usually assessed by the degree of increase in body temperature, the duration of the febrile period and the nature of the temperature curve:

Depending on the degree of temperature increase:

Depending on the duration of the febrile period:

It should be noted that currently, due to the widespread use of etiotropic (antibacterial) and symptomatic (antipyretic) drugs, early stages infectious disease, typical temperature curves are rarely seen in practice.

Clinical variants of fever and its biological significance
When analyzing the temperature reaction, it is very important not only to assess the magnitude of its rise, duration and fluctuations, but to compare this with the child’s condition and the clinical manifestations of the disease. This will not only make it much easier diagnostic search, but will also allow you to choose the right tactics for monitoring and treating the patient, which will ultimately determine the prognosis of the disease.

Particular attention should be paid to the clinical equivalents of the correspondence of heat transfer processes to an increased level of heat production, because Depending on individual characteristics and background conditions, fever, even with the same level of hyperthermia, can occur differently in children.

Highlight "pink" and "pale" fever variants. If, with an increase in body temperature, heat transfer corresponds to heat production, then this indicates an adequate course of fever. Clinically this manifests itself "pink" fever. In this case, normal behavior and satisfactory well-being of the child are observed, the skin is pink or moderately hyperemic, moist and warm to the touch. This is a prognostically favorable variant of fever.

The absence of sweating in a child with pink skin and fever should raise suspicion of severe dehydration due to vomiting and diarrhea.

In the case when, with an increase in body temperature, heat transfer due to a significant impairment of peripheral circulation is inadequate to heat production, the fever acquires an inadequate course. The above is observed in another variant - "pale" fever. Clinically, a disturbance in the condition and well-being of the child, chills, pallor, marbling, dry skin, acrocyanosis, cold feet and palms, and tachycardia are noted. These clinical manifestations indicate a prognostically unfavorable course of fever and are a direct indication of the need for emergency care.

One of the clinical options for the unfavorable course of fever is hyperthermic syndrome. The symptoms of this pathological condition were first described in 1922. (L. Ombredanne, 1922).

In children early age the development of hyperthermic syndrome in the vast majority of cases is due to infectious inflammation accompanied by toxicosis. The development of fever against the background of acute microcirculatory metabolic disorders underlying toxicosis (spasm followed by capillary dilatation, arteriovenous shunting, platelet and erythrocyte sludge, increasing metabolic acidosis, hypoxia and hypercapnia, transmineralization, etc.) leads to worsening pathological process. Decompensation of thermoregulation occurs with a sharp increase in heat production, inadequately reduced heat transfer and lack of effect from antipyretic drugs.

Hyperthermic syndrome, in contrast to adequate (“favorable”, “pink”) fever, requires urgent use of a comprehensive emergency therapy.
As a rule, with hypertemic syndrome, there is an increase in temperature to high numbers (39-39.50 C and above). However, it should be remembered that the basis for distinguishing hypertemic syndrome into a separate variant of the temperature reaction is not the degree of increase in body temperature to specific numbers, but clinical features course of fever. This is due to the fact that, depending on the individual age and premorbid characteristics of children, concomitant diseases the same level of hyperthermia can be observed with different options course of fever. In this case, the determining factor during fever is not the degree of hyperthermia, but the adequacy of thermoregulation - the correspondence of heat transfer processes to the level of heat production.

Thus, Hypertemic syndrome should be considered a pathological variant of fever, in which there is a rapid and inadequate increase in body temperature, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital functions. important organs and systems.

In general, the biological significance of fever is to increase the body's natural reactivity. An increase in body temperature leads to an increase in the intensity of phagocytosis, an increase in the synthesis of interferon, an increase in the transformation of lymphocytes and stimulation of antibody genesis. Increased body temperature prevents the proliferation of many microorganisms (cocci, spirochetes, viruses).

However, fever, like any nonspecific protective-adaptive reaction, when compensatory mechanisms are depleted or in the hyperthermic variant, can cause the development of severe pathological conditions.

It should be noted that individual factors of aggravated premorbitis can have a significant impact on the development of adverse consequences of fever. Thus, in children with serious cardiovascular and respiratory systems fever can lead to the development of decompensation of these systems. In children with central nervous system pathologies (perinatal encephalopathy, hematocerebrospinal fluid syndrome, epilepsy, etc.), fever can trigger the development of an attack of convulsions. The age of the child is no less important for the development of pathological conditions during fever. How younger child, the more dangerous for him is a rapid and significant rise in temperature due to the high risk of developing progressive metabolic disorders, cerebral edema, transmineralization and impairment of vital functions.

Differential diagnosis pathological conditions accompanied by fever.
An increase in body temperature is a nonspecific symptom that occurs in numerous diseases and pathological conditions. When carrying out differential diagnosis, you need to pay attention to:

Pale fever in children this is not the most pleasant state. The topic remains controversial and discussed to this day, especially with regards to children's health. With all the abundance of information and its accessibility to people, many still continue to zealously lower the temperature and nip the fever in the bud. Phenomena are different, and they have distinctive features, so you need to be able to interpret them correctly and make adequate decisions on the matter so as not to harm the baby. Not long ago we covered the topic and algorithm for helping in such a situation. This time we will touch on white fever in children, consider how it differs from pink fever, and how to properly provide assistance in such a situation.

White fever in children, also called pale fever, is an adaptive reaction of the body aimed at destroying invasive agents. Most often it can be found when respiratory diseases and viral infections. The febrile state in this case should be considered as a payment for stopping and suppressing the disease in its initial stage, and a drop in temperature leads to back reactions, and transfers the disease to a long-lasting and slow-moving phase.

Symptoms of pale fever in children are quite detectable to the naked eye:

• elevated temperature, with its maximum values ​​noted on the torso and head, and the extremities remain cold
• chills may often occur
• the skin acquires a pale whitish tint and a network of blood vessels becomes visible on it
• the baby becomes lethargic and apathetic, refuses to eat and drink, does not play and is capricious.

The temperature spread can be quite large: 37-41 °C. At the same time, we cannot talk about critical and safe parameters; they simply do not exist. Shoot down high values It is not always necessary, and not at all to the parameters of 36.6 ° C; a decrease of already 1-1.5 ° C gives the baby a significant relief of well-being. If we are talking about infants primarily under the age of one year, then values ​​around 38.5 °C can become hazardous to health; for older children we can talk about a threshold of 39.6 °C, although these are all rather arbitrary values ​​and cannot be tied to them, since .To. Each organism is individual. If the temperature values ​​have reached the given values, then you can think about reducing them.

Start with basic methods without resorting to drugs:

• Place a damp cloth on the forehead, wipe the neck and folds of the baby’s limbs with water. If your feet are cold, put on socks
• do not wrap your baby too tightly, this disrupts the exchange with the environment, reduces sweating and makes you feel even worse
• Give extra drink (fruit drink, compote).

If after several hours you have not noticed any positive trends in improving your child’s condition, and the temperature continues to rise, then it makes sense to take antipyretics according to the instructions. Paracetamol and ibuprofen are allowed here. These drugs act quite quickly, and after 40-60 minutes your baby should feel relief. If the situation does not return to normal, you observe the same signs, and the temperature continues to rise, you notice convulsions in the baby - call ambulance and do not delay any further, this may be fraught with serious complications. Pale fever in children It is more severe than red fever, and its symptoms are more painful and unpleasant, however, with correct and timely help, you can significantly reduce the risk of complications and stop the febrile state in 3-4 days. Remember that fever in children- This is not a disease, but a protective reaction of the body.