Care interventions during fever

What should you do for a child or an adult during his or her feverish condition?

Often, we hear: Do not quench your fever!

That's true, but what can we do then?

We do not have to wait idly before making ourselves useful.

 

Management principles in four main points:

  1. Monitor the optimal course of the fever.
  2. Provide the right amount of fluid and energy.
  3. Calm the child down and nurture your relationship.
  4. Monitor symptoms carefully and reasonably assess the risk of the situation.

 

1) Monitoring the fever 

means that we are not preventing the body from doing what it is doing (because it is actively defending) but supporting it. The fever itself does not need to be alleviated, but we can soothe its unpleasant consequences. This is described in detail in the section titled “Methods for fever reduction”.

 

2) Fluid and energy intake

Each 1°Crise in temperature increases the metabolism by 10% and fluid requirements by 12%.

This results in a negative energy balance due to increased energy use (catabolism) and loss of appetite (which is physiologically normal). Sweating itself causes loss of fluid and electrolytes (salt).

Liquid: make sure that you make the child drink regularly by sipping. Breastfeeding is best for breastfed infants. If the child pukes or vomits, you can try a small amount again after a short break.

The problem is that children are often reluctant to drink. It may help to give them a sip of a warm, pleasant liquid that they request or accept from a spoon. All liquids except cow's milk are suitable (but preferably not sugary and carbonated). Herb and fruit teas, with a little honey; diluted juices, and mineral water are best.

The following teas have traditionally proved their worth:

  • in the case of fever linden blossom, elder flower
  • chamomile for abdominal pain
  • sage for sore throat
  • lavender, lemongrass in the case of restlessness

A very effective method, especially for threatening dehydration, is enema with body-warm fluid (50-100 ml for infants with pear syringe, 100-200 ml for lukewarm water or chamomile tea, a teaspoon of salt and a teaspoon of sugar) or a pharmacy oral rehydrate-mix. (81). This can be repeated in every two to three hours. Almost all of the administered fluid is absorbed. Excess is excreted in the stool. It can replace the lack of drinking and stabilizes circulation. It is recommended to perform this simple intervention only under calm conditions. Enemas are used routinely in some countries but may be controversial in others because it is considered a “violation.” (78, 81). However, experienced pediatricians are aware that many children can be spared in this way from the trauma of hospital venous rehydration (78, 79, 80, 81) - which may be of particular importance in areas or periods of poor health care (44, 45, 136). Its nature is similar to the rectal temperature measurement. In Hungary, pear syringes (shown in the pictures, available in all pharmacies) are routinely used to ease constipation.

Nutrition: It is not a problem if the child's appetite is poor for a few days. We recommend a low-fat, high-carbohydrate diet by bites, as much as your child requests. Pasta, soups, juicy fruit slices, salty bread sticks. Preferably in the morning when the fever is lower. Children regain the lost kilograms quickly after the fever has passed and gain even more strength.

 

3) Keeping calm and connected = providing comfort

For fuller healing, special care should be taken to ensure a calm and peaceful atmosphere around the patient. It should be free of electronic devices (TV, computer, smartphone…). They catch the kids' attention, but are only seemingly relaxing. The flood of information also needs to be processed, which also means additional internal work.

Feverish children should not enter the community. They shouldn't strain themselves physically and intellectually. Even if the child has "strength," we should stay home with the child, in a relaxed atmosphere. Avoid social stress. The child doesn't have to stay in bed all the time. The rooms should be well ventilated.

Many consider feverish conditions an opportunity to develop a loving and supportive relationship (78-81). It’s "a little break". The febrile period is a "special occasion" in which it is worth engaging more intimately with the child.

Sometimes, for example, autistic children are strikingly more communicative and empathetic during fever (99, 100).

External interventions such as compresses, rubs, oily wraps, foot baths, etc. - applied properly and in the right context - are especially nice non-verbal communication opportunities. In a study with Harvard medical students, they found a positive change in their relationship toward the disease when they were cared for in their feverish condition.

See our article on antipyretic methods for this.

Natural medicinal preparations may be administered as required (e.g. herbal teas, herbal extracts). Many parents have positive experiences with these, e.g. Aconit, Belladonna, Ferrum phos. There are few statistically relevant studies based on evidence.

 

4) Monitoring the symptoms (risk assessment)

For more details, see our article on stages and symptoms of optimal fever.

By observing some phenomena, a distinction can be drawn between harmless and more serious states.

  1. Skin rash and skin colour
  2. Activity, consciousness
  3. Respiratory rate
  4. Heart rate
  5. Hydration
  6. Other

To do this, see our articles "How dangerous is fever" and "Accompanying symptoms of fever".

 

Signs of dehydration:

For the little ones: dry mouth, plaque on the tongue, lack of tears, sunken eyes, the large fontanelle is sunken as compared to the crown level (fontanelle: the little round "softness" on top of the baby's head), less urine, decreased firmness of the skin.

For elder children: fatigue, dizziness, headache, rapid heartbeat, nausea, muscle cramps, loss of consciousness.

 

How to distinguish skin rashes from skin bleeds on a child's body with a glass test?

Gently squeeze a glass onto the area of skin in question - if the skin does not fade when viewed through the glass it is most likely a bleeding rash - if you notice such, consult a doctor immediately!

According to the official Hungarian protocol (123):

  • Making the child drink regularly (breastfeeding is best for breast-fed infants) to avoid loss of fluid and dehydration.
  • Look out for signs of dehydration (dry mouth, plaque on the tongue, lack of tears, closed eyes, sunken large fontanelle (fontanelle: little round "softness" at the top of the baby's head that closes around 1.5 years), less urine.
  • Encourage your child to continue drinking if signs of dehydration occur. In the event of a problem, seek the advice of a specialist again.
  • A patient with fever should not enter community
  • Do not over-dress children.
  • Do not use cold/ice baths/sheets
  • Make it a pleasant experience
  • If the cause of the fever is unknown, antibiotics should not be given

 

Refer to the literature by numbers in this document here: References

Version update: 08th March 2020