Care interventions during fever

Often, we only hear: Do not reduce the 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 down and take care of the child. Nurture your relationship, lend emotional support.
  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 fighting the illness) 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°C rise 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 and increased metabolic processes also cause loss of fluid and electrolytes (salts).

Liquid: make sure that you make the child drink regularly by sips. 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. Basically all liquids are suitable (but preferably not cow’s milk, or sugary and carbonated drinks). 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
  • Breastfeeding is best for breastfed infants. If the child pukes or vomits, you can try a small amount again after a short break.

If fever is accompanied by vomiting and diarrhea, give the patient oral rehydration fluid (ORF). The taste is milder, when cool. If a child will not sip it from a glass, it can be given with a straw, a spoon or syringe by a few millilitres at a time. ORF contains a sufficient amount of minerals (sodium, potassium, chlorine, citrate) and sugar (glucose).

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. 

Rice, millet, bite size pieces of steamed vegetables, fruits. 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 more complete 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, etc.). They catch the kids' attention, but are only seemingly relaxing. The flood of information also needs to be processed, which means additional internal work.

Feverish children should not enter the community. They shouldn't strain themselves physically and intellectually.Reduce social stress. Stay at home with the child, provide a calm atmosphere. 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" from the often too busy everyday life. The febrile period is a "special occasion" in which it is worth engaging more intimately with the child.

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. See our article on antipyretic methods for this. Natural medicinal preparations may be administered as required (e.g. herbal teas, herbal extracts).

In a study with Harvard medical students, they found a positive change in their relationship toward the disease when they were cared for in a calm atmosphere during their feverish condition.

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

 

4) Monitoring the symptoms (risk assessment)

For more details see our articles "How dangerous is fever" and "Accompanying symptoms of 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

 

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!

The rash on the right hand picture is a bleeding rash (non-blanching), it is dangerous.

The one on the left is not dangerous, because the rash can be suppressed (blanching).

 

According to the official Hungarian protocol (123):

  • Make 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. 
  • A patient with fever should not enter community
  • Do not under- or over-dress children.
  • Do not use cold/ice baths/sheets
  • Make all interventions a pleasant experience
  • If the cause of the fever is unknown, antibiotics should not be given. Antibiotics should only be prescribed by a physician.

 

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

Version update: 03 October 2020