Fever in children

Question 1

Give the main ways to measure a temperature

Answer 1

• axillary- under the arm
• tympanic- in the ear (generally only done in children over 1)
• oral- tend not to be done on children
• skin- seen in ICUs
• rectal- can give us core temperature readings, but not common in paeds, used more in ICUs
• measuring temperature with a forehead scanner is not accurate in children

Question 2

What are some normal characteristics during a fever in children?

Answer 2

• tachycardia (fast heart rate- for every 1*C rise in temperature, allow for an increase of 10bpm)
• tachypnoea (fast breathing rate)
• lethargy
• cool peripheries (cold fingers, toes & hands as blood is directed to the core)

Question 3

At what age can febrile convulsions occur?

Answer 3

6 months- 3 years (peak incidence = 18 months), much less likely over 6 years

Question 4

What is the cause of a febrile seizure?

Answer 4

height of fever/ rate of increase in fever, response to rapid increase in temperature- pathological cause still not clear

Question 5

What are the features of a simple febrile convulsion?

Answer 5

• no focal features
• patient goes stiff & rigid, then starts to shake
• eyes roll back
• patient is unresponsive
• generally, lasts less than 10 minutes
• normally not any reoccurrence
• commonly occurs at beginning of an illness

Question 6

What are some features of a complex febrile convulsion?

Answer 6

• partial or focal onset (occurs in one part of the brain & affects only one part of the body)
• more prolonged- lasts more than 10-15 minutes
• more likely to reoccur in the next 24 hours
• less common than simple febrile convulsions

Question 7

What is the incidence rate of febrile convulsions?

Answer 7

2-5%

Question 8

What are some risk factors that may increase the likelihood of febrile convulsions?

Answer 8

family history, siblings, underlying brain disorder

Question 9

Outline the steps taken in practice with regards to a fever.

Answer 9

1) treat the child, not the temperature
2) identify & treat life threatening features, carry out thorough A-E assessment, treating & managing as found
3) think ‘could this be sepsis?’
4) antipyretic interventions
5) physical- how the child is dressed, pharmacological- paracetamol, ibuprofen etc.