Facts about the heat, it is necessary to know!
Body temperature - a complex indicator of the thermal state of the animal body, including humans. It is one of the main and oldest biomarkers. Animals that are able to keep their temperature within narrow limits, regardless of the temperature of the environment, are called warm-blooded, or homoiothermal. To warm-blooded animals are mammals and birds. Animals lacking this ability are called cold-blooded, or poikilothermic. The maintenance of body temperature by the body is called thermoregulation. In cold-blooded animals, body temperature differs little from the ambient temperature, and only with intense muscular activity in some species can it significantly exceed the surrounding temperature.
Fever (Latin febris) is a nonspecific typical pathological process characterized by a temporary increase in body temperature due to the dynamic reorganization of the thermoregulation system under the action of pyrogens (substances that cause a rise in temperature). In the evolution of fever emerged as a protective-adaptive response to infection of the organism of higher animals and humans, therefore, in addition to raising the body temperature, other phenomena characteristic of infectious pathology are observed in this process. Usually, fever is accompanied by fever. In the past, all diseases accompanied by a rise in body temperature were called "fever", but in modern scientific understanding, fever is not a disease. At the same time, in the modern names of a number of nosological units the term fever is present, for example, spotty fever of the Rocky Mountains, pappatachi fever, Ebola haemorrhagic fever, etc. The essence of fever is the response of the thermoregulation apparatus of higher homeothermic animals and humans to specific substances (pyrogens) that is characterized by a temporary displacement of the setting point of the temperature homeostasis to a higher level, with the necessary preservation of the thermoregulatory mechanisms themselves, in which the principle The fever fever is different from hyperthermia.
When you go to the doctor to report the illness, the first question he always asks: "Was the temperature measured? What is the temperature? " . And further, no matter what answers you give him - 38 or 40 degrees, advises you to give a simple aspirin and bring him to his appointment. This became a ritual of almost all pediatricians in our country. Surely, many of them speak only learned phrases, even if they hear about the temperature of 43 degrees.
I'm worried that children's doctors ask the wrong questions and give the wrong advice. In raising the temperature, doctors see something extremely dangerous, otherwise why is it their first concern? And from their advice to give the child aspirin, parents inevitably conclude that the treatment should be medicated and aimed at lowering the temperature.
By measuring the temperature of the body and recording its indicators in the medical chart, admissions begin in most children's clinics. There is nothing wrong. Elevated temperature, indeed, is an important diagnostic symptom in the context of a follow-up survey. The problem is that it is given much more importance than it would cost. When the doctor sees a nurse record of temperature in the map, say, 39.5 degrees, he invariably says with a grim look: "Wow! We must do something! " .
His concern about temperature is nonsense, and misleading nonsense! With the rise in temperature itself, nothing is needed. In the absence of additional symptoms, such as unusual behavior, particular weakness, difficulty breathing, and others suggesting serious diseases like diphtheria and meningitis, the doctor should tell the parents that there is nothing to worry about and send them home with the child.
Taking into account the exaggerated attention of doctors to the elevated temperature, it is not surprising that the majority of parents, according to opinion polls, are experiencing great fear. Moreover, this fear grows in proportion to the readings of the thermometer, while it is often unfounded.
Here are facts related to body temperature, knowledge of which will help you avoid many worries, and your children - unnecessary and dangerous tests, radiology and medicine.
These facts should be taken into account by every doctor, however many of the pediatricians prefer to ignore them and do not consider it necessary to introduce their parents to them.
Fact number 1.
The temperature of 37 degrees is not "normal" for all, as we say all my life. This is simply not true. The established "norm" is very conventional, since the indicator of 37 degrees is an average value. In many people, the normal temperature is higher or lower. This especially applies to children. Studies have revealed that the body temperature in most absolutely healthy children is 35.9-37.5 degrees and only a few have exactly 37 degrees.
The fluctuations in the body temperature of the child during the day can be significant: in the evening it is a whole degree higher than in the morning. Having found out at the child in second half of day slightly raised temperature, do not worry. For this time of day it is quite normal.
Fact number 2.
The temperature can rise for reasons not associated with any disease: by digesting abundant and heavy foods or at the time of ovulation in adolescent girls during their puberty. Sometimes a fever is a side effect of prescribed medications - antihistamines and others.
Fact number 3.
The temperature to be feared usually has an obvious reason . In most cases, an increase in temperature, which can be a health hazard, occurs either as a result of poisoning with toxic substances or as a result of overheating (so-called heat stroke).
Classic examples of overheating - a soldier, losing consciousness in the parade, or a marathon runner coming down from a distance and falling from exhaustion in the sun. In such cases, the temperature can rise to 41.5 degrees or higher, which is fraught with harmful consequences for the body. A similar effect can be achieved and overheated in excess of the measure in the bath or in the jacuzzi.
If you suspect that a child has swallowed a poisonous substance , call the poison poisoning center immediately. When this is not possible, without waiting for trouble, urgently take the child to the hospital and, if possible, grab the package from the swallowed facility - this will help quickly pick up the antidote.
As a rule, substances swallowed by children are relatively harmless, but timely access to help is very important.
Immediate course is also necessary if the child loses consciousness, even briefly, after moving the games in the heat or after a bath or a jacuzzi. Call a doctor in this situation is not enough. As soon as possible, take the child to the hospital. External influences are potentially dangerous. They are able to suppress the protective forces of the body, which under normal conditions do not allow the temperature to rise to a dangerous level. Recognize such conditions are helped by events preceding it and accompanying symptoms. I emphasize: loss of consciousness means that the child is in danger.
Fact No. 4.
Indications of body temperature depend on the method of its measurement . Rectal (in the rectum) temperature in children is usually a degree higher than the oral (in the mouth), axillary - a degree lower. However, in babies, the difference between the temperature values measured by these methods is not so great, therefore it is better for them to measure the temperature in the armpit.
To use a rectal thermometer, I do not advise: when it is administered, perforation of the rectum is possible, and it is fatal in half of the cases. Why risk when there is no need? Finally, do not think that the temperature of the child's body can be determined by touch, touching the forehead or chest. It will not be possible neither for medical workers, nor for you.
The fact number 5.
Shoot body temperature should not be . Exceptions are only newborns suffering from infections, the cause of which is often obstetric interventions in childbirth, intrauterine and hereditary diseases. An acute infectious disease can be the result of some procedures. For example, an abscess under the scalp may develop in the infant from the sensors of the device during intrauterine observation, and aspiration pneumonia - due to the amniotic fluid that entered the lungs as a result of the introduction of the mother during the birth of medicines. Infection with infection is possible during the circumcision procedure: in hospitals, legions of pathogens (this is just one of the reasons why my grandchildren were born at home). If the baby has a high fever in the first months of life, it is simply necessary to show it to the doctor.
Fact No. 6.
The temperature can rise from excessive wrapping . Children are very sensitive to overheating. Parents, especially first-borns, are often overly concerned about whether their children are cold. They wrap babies in a lot of clothes and blankets, forgetting that if he gets hot, he can not get rid of warm things on his own. If the baby has a fever, do not forget to check if he is too warmly dressed.
If a child with a temperature, especially accompanied by chills, tightly wrapped in thick blankets, this will provoke an even greater her ascent. A simple rule that I recommend to parents of their patients: let the child have as many layers of clothing as they do on themselves.
Fact number 7.
Most cases of temperature increase are associated with viral and bacterial infections , with which the defenses of the body cope without any help. Colds and flu are the most common causes of fever in children of any age. The temperature can rise to 40.5 degrees, but even in this case there is no cause for concern.
The only danger is the risk of dehydration from the accompanying processes of sweating, frequent heartbeats and breathing, coughing, vomiting and diarrhea. It can be avoided by giving the child an abundant drink. It would be nice if the child drank every hour for a glass of liquid, preferably nutritious. It can be fruit juice, lemonade, tea and everything, from which the child does not refuse. In most cases, viral and bacterial infections are easily recognized by the attendant temperature increase symptoms: mild cough, runny nose, watery eyes and so on. With these diseases, neither doctor's help nor any medication is needed. The doctor can not "prescribe" anything more effective than the defenses of the body. Medications that ease the general condition, only interfere with the action of vitality. I will discuss this in more detail in one of the following chapters.
Antibiotics are also not needed: although they can shorten the duration of a bacterial infection, the risk associated with them is very high.
Fact No. 8.
There is no unique relationship between the temperature of the child's body and the severity of the disease . A common misconception about this is not justified. In addition, there is no consensus on what to regard as "high temperature", neither among parents, nor even among doctors. The parents of my patients, and I had a lot of them, had diametrically opposite views on this score. Studies have shown that more than half of the parents surveyed consider a "high" temperature of 37.7 to 38.8 degrees and almost everyone calls a temperature of 39.5 degrees "very high". In addition, all respondents were convinced that a high temperature indicates the severity of the disease.
It's not like that at all. Precisely, by the hour, the measured temperature does not say anything about the severity of the disease, if it is caused by a viral or bacterial infection. Once you understand that the cause of the temperature is infection, stop measuring the temperature hourly. Tracking its increase with such a disease will not help, moreover, it will only strengthen your fears and tire your child.
Some common, non-dangerous diseases, like the one-day measles, sometimes cause children to have a very high temperature, while others, more serious, can go on without increasing it. If there are no additional symptoms like vomiting or trouble with breathing, stay calm. Even if the temperature rises to 40.5 degrees.
To determine whether the lung, like a cold, or serious, like meningitis, the disease caused by the temperature, it is important to take into account the overall condition of the child, his behavior and appearance. All these moments you will appreciate much better than the doctor. You know where your child usually looks and how he behaves much better. If there is unusual lethargy, confusion and other alarming symptoms that last for a day or two, it makes sense to call a doctor. If the child is active, has not changed his behavior, the reasons to fear that he is seriously ill, no.
From time to time in pediatric magazines there are articles about "fever fever" - about unreasonable parental fear of fever in children. Doctors specially came up with this term - the tactic typical for people of my profession is "blaming the victim": doctors never make mistakes, and if mistakes occur, patients are to blame for everything. In my opinion, "temperaturophobia" is a disease of pediatricians, not parents. And it is doctors who are to blame for the fact that parents become victims of it.
Fact No. 9.
The temperature caused by a viral or bacterial infection, if not knocked down, does not rise above 41 degrees. Pediatricians do a disservice, prescribing antipyretic drugs. As a result of their appointments, parents' anxiety about the fact that the temperature can rise to the extreme limit, if not taken, is reinforced and strengthened. Doctors do not say that temperature congestion does not affect the healing process, nor does the human body have a mechanism (not yet fully explained) that does not allow the temperature to overcome the barrier at 41 degrees.
Only with a thermal shock, poisoning and other external influences, this natural mechanism may not work. It is in such cases that the temperature rises above 41 degrees. Doctors are aware of this, but most of them pretend that they do not know. I believe that their behavior is caused by the desire to demonstrate their help to the child. In addition, it is common for doctors to strive to intervene in any situation and reluctance to recognize that there are conditions that they can not effectively cure. In addition to cases of fatal, incurable diseases, which doctor decides to tell the patient: "I can not do anything" ?
The fact number 10.
Measures to reduce temperature, whether using antipyretics or wiping with water, are not only unnecessary, but also harmful . If a child is infected, then the increase in temperature that accompanies the course of the disease, parents should not perceive as a curse, but as a blessing. The temperature rises as a result of spontaneous production of pyrogens - substances that cause fever. This is a natural defense of the body from disease. The increase in temperature indicates that the body's healing system has turned on and running.
The process develops as follows: for an infectious disease the child's organism reacts by producing additional white blood cells - leukocytes. They kill bacteria and viruses and cleanse the body of damaged tissues and decay products. The activity of leukocytes increases, they quickly move to the focus of infection. This part of the process, the so-called leukotaxis, is exactly stimulated by the production of pyrogens, which raise the temperature of the body. Increased temperature indicates that the healing process is accelerating. This should not be feared, it should be rejoice.
But that is not all. Iron, which serves as a source of nutrition for many bacteria, leaves the blood and accumulates in the liver. This reduces the rate of reproduction of bacteria and increases the effectiveness of interferon, produced by the body to fight the disease.
This process was demonstrated by scientists in laboratory experiments on infected animals. With an artificial increase in temperature, the mortality of experimental animals from infection decreased, and when it decreased, it increased. Artificial increase in body temperature has long been used in those cases when the body of patients lost its natural ability in diseases.
If the temperature of the child has risen as a result of infection, do not give in to the desire to knock it down with medications or rub it. Let the temperature do its work. Well, if your compassion requires easing the patient's condition, give the child paracetamol appropriate to the age of the dosage or wipe the body with warm water. This is quite enough. The doctor is necessary only when the temperature lasts more than three days, other symptoms have appeared or the child has become completely ill.
I especially emphasize: by lowering the temperature for the sake of alleviating the child's condition, you interfere with the natural process of healing. The only reason that forces me to talk about ways to reduce temperature is knowing that some parents are not able to resist it.
If you can not knock down the temperature you can not, rubbing with water is preferable to taking aspirin and paracetamol because of their danger. Despite the popularity, these funds are far from harmless. Aspirin poisons annually, perhaps more children than any other poison. This is the same form of salicylic acid, which is used as the basis of an anticoagulant in rat poisons - rats eat it and die from internal bleeding.
Aspirin can cause a number of side effects in children and adults. One of them is intestinal bleeding. If children receive this drug during the period of flu or chickenpox disease, they can also develop Reye's syndrome - a common cause of infant mortality, mainly due to effects on the brain and liver. Partly, therefore, many doctors switched from aspirin to paracetamol ( acetaminophen, panadol, kalpol and others ).
The admission of this remedy is also not a way out. There is evidence that large doses of this drug are toxic to the liver and kidneys. I would also like to draw your attention to the fact that children, whose mothers took aspirin during childbirth, often suffer from a cephalohematoma - a condition in which liquid filled buds appear on the head.
If you still decide to reduce the body temperature by wiping, use only warm water. Reduction of body temperature is achieved by evaporation of water from the skin and does not depend on water temperature. That's why too cold water has no advantages. It is not suitable for wiping and alcohol: its vapor for the baby is toxic.
The fact number 11.
The high temperature caused by a viral or bacterial infection does not lead to brain damage and does not cause other negative consequences. Fear of high temperature largely comes from the widespread belief that it can lead to irreversible damage to the brain or other organs. If this were so, the panic of parents would be justified if the temperature was raised. But, as I said, the statement is false.
Those who are familiar with this fear, I advise you to forget about everything that has sown it, and never take for granted the words about such a threat of heat, from whom they emanate - from other parents, elderly people or a familiar doctor, a cup of coffee. And even if such advice was given by the all-knowing grandmother. She happens to be right, alas, not always. Colds, flu and any other infection will not raise the child's body temperature above 41 degrees, and the temperature below this level will not cause long-term harm.
You do not need to expose yourself to the fear of possible damage to the brain in a child every time you increase the temperature: the defenses of the body will not allow the temperature to rise above 41 degrees. I do not think that even pediatricians who practiced for decades had to see more than one or two cases of high fever. The rise in temperature above 41 degrees is not caused by infection, but by poisoning or overheating. I treated tens of thousands of children and only once observed my patient's temperature above 41 degrees. This is not surprising. Studies have shown that in 95 percent of cases of temperature increase in children, it did not rise above 40.5 degrees.
The fact number 12.
High fever does not cause seizures. They cause a sharp rise in temperature. Many parents are afraid of high fever in their children, because they noticed that it is accompanied by seizures. They believe that convulsions cause a "too high" temperature. I understand these parents well: the child in cramps is a sight unbearable. Those who have observed this may find it hard to believe that, as a rule, this condition is not serious. In addition, it is relatively rare - only 4 percent of children with fever have seizures, and there is no evidence that they have serious consequences.
A study of 1,706 children who experienced febrile seizures did not find any cases of motor disability and did not record fatalities. There is also no convincing evidence that such convulsions subsequently increase the risk of epilepsy.
Moreover, measures to prevent febrile seizures-taking antipyretic drugs and rubbing-are almost always carried out too late and, therefore, wasted: by the time a child's fever is detected, the convulsive threshold is most often passed. As I said, convulsions do not depend on the temperature level, but on the rate of its rise to a high level. If the temperature has risen sharply, the cramps either have already occurred, or the danger has passed them, that is, to prevent them is almost impossible.
To febrile seizures usually children under five are prone. Children who experienced such cramps at this age, subsequently suffer them rarely. To prevent the recurrence of convulsions at high temperature, many doctors prescribe long-term treatment to children with phenobarbital and other anticonvulsants. If such funds prescribe to your child, ask the doctor about the risk associated with them, and about what changes in the behavior of the child they lead.
In general, there is no unanimity among doctors in the issue of long-term treatment of febrile seizures. Medications that are commonly used in this case cause liver damage and even, as experiments on animals have shown, negatively affect the brain. One of the authorities on this issue once remarked: "Sometimes it is more useful for a patient to live a normal life between episodes of seizures, rather than live on medication without convulsions, but in a constant state of drowsiness and confusion ..."
I was taught to prescribe to children with febrile convulsions (to prevent their recurrence) phenobarbital, the current medical students are taught the same. Doubt in the correctness of the appointment of this drug I had when I noticed that while treating them in some patients, convulsions were repeated. This, naturally, made me think: did the phenobarbital in other patients stop them? My suspicions intensified after complaints of some mothers that the drug overexcites children or slows down so much that, usually active and sociable, they suddenly turn into a half-slice. Since the cramps are episodic and do not leave lasting consequences, I stopped prescribing this medicine to my small patients.
If a child experiencing febrile convulsions is prescribed long-term treatment, parents will have to decide whether to agree to him or not. I understand that openly expressing doubts about the appointment of a doctor is not easy. I also know that a doctor can dismiss requests or not give intelligible answers. If it does, it makes no sense to start a dispute. It is necessary to take the doctor's prescription and, before buying a medicine, ask for advice from another doctor.
If your child has a fever-related seizure, try not to panic. Of course, advice is much easier to give than to follow. The sight of a child with cramps is really scary. And yet: remind yourself that cramps do not threaten the life of your baby and will not bring irreversible harm, and take simple measures to ensure that the child does not suffer during the attack.
First of all, turn the child to one side so that it does not choke on saliva. Then make sure that near his head there are no hard and sharp objects that he can get injured during an attack. After making sure that the baby's breathing does not interfere with anything, place a hard but not sharp object between his teeth - for example, a clean folded leather glove or wallet (not a finger!) So that he does not accidentally bite his tongue. After that, for your own comfort, you can call the doctor and tell about what happened.
For the most part, the cramps last for several minutes. If they are delayed, ask the doctor's advice. If after a fit of seizures the child does not fall asleep, give him food and drink can not within an hour. Due to severe drowsiness, he may choke.
Quick Guide to Body Temperature
High fever is a common symptom in children, not associated with serious illnesses (in the absence of other anxiety symptoms, such as unusual sight and behavior, difficulty breathing and loss of consciousness). It is not an indicator of the severity of the disease.
The temperature that increases as a result of infection does not reach the values at which irreversible lesions of the child's organs are possible.
Elevated temperature does not require medical intervention beyond what is recommended below. The temperature does not need to be knocked down. It is the natural defense of the body from infection and helps to prompt healing.1
If the child's body temperature has risen above 37.7 degrees before two months, consult a doctor. This may be a symptom of infection - intrauterine or associated with interference in the process of delivery. The fever in children of this age is so unusual that it is more prudent to hedge and calm down if anxiety turns out to be false.2
For children older than two months, the doctor is not needed if the temperature is raised, unless the temperature lasts more than three days or is accompanied by severe symptoms - vomiting, shortness of breath, severe cough for several days, and others not characteristic of the common cold. Ask your doctor if the child is unusually stagnant, irritable, distracted or looks seriously ill.3
Refer to the doctor regardless of the thermometer if the child has difficulty breathing, indomitable vomiting, if the temperature is accompanied by involuntary muscle twitching or other strange movements or disturbs something else in the behavior and appearance of the child.4
If the temperature rises with chills, do not try to cope with this feeling of the baby with a blanket. This will lead to an even sharper increase in temperature. Chills are not dangerous - this is a normal reaction of the body, the mechanism of adaptation to a higher temperature. It does not mean that the child is cold.5
Try to put a tempering baby in bed, but do not overdo it. There is no need to chain the baby to bed and keep it at home if the weather is not too bad. Fresh air and moderate activity will improve the mood of the baby, without worsening the condition, and will make your life easier. However, too much stress and sports should not be encouraged.6th
If there is reason to suspect that the cause of high fever is not an infection, but other circumstances - overheating or poisoning, take the child to the hospital immediately. If there is no ambulance in your area, use any available medical care.7th
Do not try, according to folk tradition, "starve a fever." Nutrition is important for recovery from any illness. If the child does not resist, "fatten" and colds, and fevers. Both those and others burn stocks of proteins, fats and carbohydrates in the body, and they need to be reimbursed. If the child refuses to eat, drink it with nutritious liquids, for example fruit juice. And do not forget that chicken soup is useful to everyone.
High fever and usually accompanying symptoms lead to a significant loss of fluid and cause dehydration. It can be avoided by letting the child drink a lot, fruit juices are best, but if he does not want them, any liquid will suit, preferably one glass every hour.
Via Robert Mendelssohn 's book "How to Raise a Child Healthy Against Physicians" & wiki.