Fever in infants and children – p – diatria – msd manual profi edition

Fever in infants and children - p - diatria - msd manual profi edition

Fever in infants and children

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Normal body temperature varies from person to person and throughout the day. The normal body temperature is highest in preschool children. Several studies have shown that the maximum temperature tends to be in the afternoon and is highest in around 18 to 24 month old children, when many normal healthy children have a temperature of 38 ° C (101 ° F). However, fever is usually defined as a core body temperature (rectal) of ≥ 38.0 ° C (100.4 ° F)

The relevance of the fever depends on the overall clinical situation, less than on the height of the fever. Some mild illnesses cause high fevers, some serious ones only slight temperature increases. Even if the parental assessment is often clouded by the fear of fever, the temperature measured at home should be assessed in the same way as a temperature that is measured in practice.

pathophysiology

Fever is integral to fighting infection, and although it can be uncomfortable, it does not require treatment in an otherwise healthy child. Some studies even show that antipyretic drugs prolong the course of some diseases. However, fever increases the metabolic rate and the demands on the cardiopulmonary system. Therefore, fever can be harmful to children with lung or heart problems or neurological failures. It can also be diagnosed as the catalyst for 38 ° C and no previous febrile seizures if no cause >Febrile seizures, usually a benign childhood disease.

etiology

Differentiate the causes of fever (see table: Some common causes of fever in children) >≤ 14 days), acute rec >> 14 days) is what is commonly referred to as fever of unknown cause (FUO). Responses to antipyretics and the level of temperature are not directly related to the etiology or severity of the disease.

Most often, acute fever in infants and young children is caused by infection. The most common infections are

Viral infections of the gastrointestinal tract or respiratory tract (most common cause)

Certain bacterial infections such as otitis media, pneumonia, urinary tract infections

However, the possible infectious causes of acute fever vary with the child’s age. Newborns (infants 28 days old) are considered functionally immunosuppressed because they are often unable to contain infection locally and are therefore at higher risk of serious invasive bacterial infections, most commonly caused by organisms acquired during the perinatal period become. The most common perinatal pathogens in newborns are group B streptococci, Escherichia coli (and other gram-negative enteric organisms), Listeria monocytogenes, and herpes simplex virus. These organisms can cause bacteremia, pneumonia, pyelonephritis, meningitis and / or sepsis.

Most febrile children aged 1 to 2 years without an obvious focus of infection (fever without a source [FWS]) have a self-limiting viral disease. However, a small number of such patients (possibly

Acute recurrent / periodic

Acute recurrent or periodic fever are episodes of fever that alternate with periods of normal temperature (see table: Some Common Causes of Fever in Children).

Chronic

Fever that occurs daily for ≥ 2 weeks and for which initial cultures and other examinations do not provide a diagnosis is considered a fever of unknown cause (FUO).

Potential causal categories (see table: Some common causes of fever in children) include localized or generalized infection, connective tissue disease, and cancer. Other specific causes include inflammatory bowel disease, diabetes insipidus with dehydration, and disturbed thermoregulation. Pseudo-FUO is probably much more common than actual FUO because common, minor viral diseases can be over-interpreted. Despite the many possible causes, FUO in children is considered a rare manifestation of a common disease rather than a rare disease; Respiratory infections are responsible for almost half of cases of FUO associated with infections.

Some common causes of fever in children

Bacterial infections (the most common pathogens vary with age)

Group B streptococci, Escherichia coli infections">Escherichia coli and other enteric pathogens, Listeria monocytogenes (these organisms can cause bacteremia, pneumonia, pyelonephritis, meningitis and / or sepsis; too Salmonella sp and Staphylococcus aureus [Z. B. in outbreaks in kindergartens], which in addition to bacteremia and sepsis, can cause infections of the soft tissue, the bones and the joints)

1–3 months:Streptococcus pneumoniae, Group B streptococci, Neisseria meningitidis, L. monocytogenes (These organisms can cause bacteremia, pneumonia, meningitis and / or sepsis; other common infections include otitis media [S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis], UTI [E. coli and other enteric pathogens], enteritis [Salmonella sp, Shigella and others], skin and soft tissue infections [S. aureus, Group A and B streptococci], bone and joint infections [S. aureus, Salmonella sp])

3–24 months:S. pneumoniae, N. meningitidis (These organisms can cause bacteremia, meningitis and / or sepsis; other common infections include otitis media and pneumonia [S. pneumoniae, H. influenzae, M. catarrhalis], UTI [E. coli and other enteric pathogens], enteritis [Salmonella sp, Shigella and others], skin and soft tissue infections [S. aureus, Group A streptococci, bone and joint infections [S. aureus, Salmonella sp, Kingella kingae])

> 24 Months:S. pneumoniae, N. meningitidis (These organisms can cause bacteremia, meningitis and / or sepsis; other common infections include otitis media, sinusitis and pneumonia [S. pneumoniae,H. influenzae,M. catarrhalis, Mycoplasma], pharyngitis or scarlet fever [group A streptococci], UTI [E. coli and other enteric pathogens], enteritis [Salmonella sp, Shigella and others], skin and soft tissue infections [S. aureus, Group A streptococci, bone and joint infections [S. aureus,Salmonella sp, K. kingae])

Mycobacterium tuberculosis in exposed or high-risk populations

Rickettsial infections in appropriate geographical areas

Other vector-borne infection (e.g. Lyme disease)

Thermal regulation disorders (e.g. dysautonomy, diabetes insipidus, anhidrosis)

Taking toxic doses of substances (e.g. anticholinergic substances)

Newborn or immunocompromised hosts:Candida sp most common (UTI, meningitis and / or sepsis)

Frequent or consecutive minor viral diseases in a young child

Periodic fever with aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome

Chronic (unexplained fever)

Viral infections (e.g. BV, CMV, hepatitis viruses, arboviruses)

Abscesses (intra-abdominal, liver, kidney)

Lyme disease (rarely causes chronic fever)

Connective tissue disorders (e.g. juvenile idiopathic arthritis, SLE, acute rheumatic fever)

Cancer (most often lymphoreticular tumors such as lymphoma or leukemia, but also neuroblastoma or sarcoma)

Thermal regulation disorders (e.g. dysautonomy, diabetes insipidus, anhidrosis)

* There are many infectious causes of chronic fever. This list is not exhaustive.

clarification

anamnese

The Course of the current illness should document the degree and duration of the fever, the measurement method, if necessary the dose and the frequency of administration of antipyretics. Important accompanying symptoms that indicate a serious illness include loss of appetite, irritability, lethargy and changes in the pattern of crying (e.g. duration and type). Accompanying symptoms that may indicate the cause include vomiting, diarrhea (including blood or mucus in the stool), coughing, difficulty breathing, favoring an extremity or joint, strong or foul-smelling urine. Medications should be checked for evidence of drug-induced fever.

Factors that can promote infection are identified. In newborns, these factors include premature birth, delayed bladder jumping, maternal fever and positive prenatal tests (usually for group B streptococcal infections, cytomegalovirus infections or sexually transmitted diseases). For all children, predisposing factors should be examined, in particular after recent exposure to infections (both within the family and among other caregivers), intrinsically worn medical devices such as catheters or ventriculoperitoneal shunts, operations, travel and environmental factors (e.g. in endemic areas, ticks, mosquitoes, cats, farm animals or reptiles) as well as known or suspected immunodeficiencies.

The Review of organ systems should record symptoms that suggest possible causes. These include: runny nose and swollen nasal mucous membranes (viral upper respiratory tract infection), headache (sinusitis, Lyme disease, meningitis), earache or waking up at night with signs of malaise (otitis media), coughing or wheezing (pneumonia, bronchiolitis), Abdominal pain (pneumonia, streptococcal pharyngitis, gastroenteritis, urinary tract infection, abdominal abscess), back pain (pyelonephritis), joint swelling or redness (Lyme disease, osteomyelitis). A history of repeated infections (immunodeficiency) or symptoms that suggest a chronic illness such as B. poor weight gain or weight loss (tuberculosis, cancer) is documented. Certain symptoms can help raise suspicions of infectious causes. These include a. Palpitations, sweating and heat intolerance (hyperthyroidism), recurring or cyclical symptoms (rheumatoid or inflammatory disease or hereditary disease).

In the History of history previous episodes of fever or infection should be noted, as well as known predispositions to infections such as B. congenital heart defects, sickle cell anemia, cancer or immune deficiency. You also have to ask about a family history with an autoimmune disease or other hereditary conditions (e.g. familial dysautonomy, familial Mediterranean fever). Previous vaccinations are checked to identify patients suffering from a disease that vaccination could have avoided.

Physical examination

The vital functions are checked with special attention to abnormalities in temperature and respiratory rate. Blood pressure should also be measured in children who are apparently in poor condition. The temperature in infants should be measured rectally to achieve a higher degree of accuracy. Every child with cough, tachypnea, or difficulty breathing requires pulse oximetry.

The general appearance and reactions of the child to the examination are important. A feverish child who appears conspicuously docile or willless is more of a concern than one that is uncooperative. But an infant or child who is irritable and inconsolable can also be cause for concern. A feverish child who looks rather sick, v. a. Even when the temperature has dropped, it should be a matter of great concern and a comprehensive clarification and continuous observation. On the other hand, children who appear to be more comfortable after antipyretic treatment do not necessarily have a benign disease.

The rest of the physical exam should research the underlying conditions (see table: Examining the febrile child).

Examination of the febrile child

Non-bleaching rash (i.e. petechiae or purpura)

Lacy maculopapular rash on the trunk and extremities with red cheeks

Local rash with swelling, induration and pressure tolerance

Disappearing erythematous, morbilliform rash on the trunk and proximal extremities

Erythema migrans, single or multiple lesions

Erythematous, sandpaper-like rash

Scarlet fever (group A streptococcal infection)

Toxic shock syndrome, diseases transmitted by toxins

Red, bulging middle ear membrane, confusion and loss of mobility

Swelling of the nasal mucous membranes, discharge

Fluttering of the nostrils when inhaled

Lower respiratory tract infection

Sometimes exudate or swelling

Pharyngitis (upper respiratory tract infection or streptococcal infection)

Focal adenopathy with overlying redness, warmth and pressure tolerance; possible torticollis

Lymphadenitis secondary to infection with Staphylococcus aureus or group A streptococci

Focal adenopathy with or without redness, warmth or pressure tolerance

Generalized cervical adenopathy

Viral infection (especially Epstein-Barr virus)

Pain or resistance to flexion (meningism *)

Coughing, tachypnea, rattling, wheezing, decreased breathing sounds, wheezing

Lower respiratory tract infection (e.g. pneumonia, bronchiolitis, chronic foreign body aspiration)

New murmurs, especially mitral or aortic reflux

In newborns, infection with Epstein-Barr virus, TORCH infections (toxoplasmosis, syphilis, varicella, coxsackievirus, HIV, parvovirus B19)

Costovertebral pressure tolerance (less reliable in younger children)

Testicular tenderness

Joint swelling, redness, warmth, pressure tolerance, restricted freedom of movement

Rheumatoid or inflammatory disease

Focal pressure tolerance of the bones

Swelling of the hands or feet

* Meningism is not always evident in children 2 years of age with meningitis.

warnings

The following findings are of particular importance:

Lethargy, listlessness or toxic appearance

Petechiae or purpura

Not to calm down

Assessment of the findings

Although serious illnesses do not always cause high fever and in many cases high fever is caused by viral infections that stop on their own, a temperature of ≥ 39 ° C in children 2 years old can mean a higher risk of occult bacteremia.

Other vital signs are also significant. Hypotension should raise concerns about hypovolemia, sepsis, or myocardial dysfunction. Tachycardia in the absence of hypotension can be caused by fever (an increase of 10 to 20 beats / minute per degree above normal temperature) or hypovolaemia. Increased respiratory rate can be a response to fever, a lung origin of the disease, or respiratory compensation for metabolic acidosis.

Acute fever is contagious in most cases and most of them are viral. History and physical exam are generally in children > 2 years, which apart from the fever are in good condition and show no signs of poisoning, are sufficient for a diagnosis. They typically have a viral respiratory illness (contact with sick people, runny nose, wheezing or coughing) or a gastrointestinal illness (recent contact with sick people, diarrhea and vomiting). Other findings also indicate other specific causes (see table: examination of the febrile child).

However, there is a possibility of occult bacteremia in infants who are 24 months old. In addition, the frequent absence of focal findings in newborns and young infants with severe bacterial infections requires a different diagnostic approach. The assessment varies depending on the age group. The following categories have proven themselves: newborns (≤ 28 days), infants (1–3 months) as well as small children and children (3–24 months). Regardless of the clinical findings, a newborn with a fever requires immediate hospitalization and tests to rule out dangerous infections. For infants, hospitalization may be necessary depending on the results of the laboratory tests and the likelihood that they will be brought back for control.

Acute recurrent or periodic fever and chronic fever require close attention to the many possible causes. However, certain findings can suggest the underlying disorder. These include: aphthae stomatitis, pharyngitis and adenitis (PFAPA syndrome); intermittent headache with runny nose or blocked sinuses (sinusitis), weight loss, contact with pathogens, night sweats (tuberculosis), weight loss or slight weight gain, palpitations and sweating (hyperthyroidism) and weight loss, loss of appetite and night sweats (cancer).

Testing

Tests should depend on the age and appearance of the child and whether the fever is acute or chronic.

at acute fever,Tests for infectious causes are based on the age of the child. As a rule, children 1 year old need to have a large blood count with differentiation, blood and urine cultures taken and the urine analyzed. Care should be taken to ensure that urine is removed by catheterization and not externally. In addition, the cerebrospinal fluid is assessed with culture and appropriate PCR testing (e.g. for herpes simplex, enterovirus), as it is indicated by a history of risk factors. Chest X-rays are taken in patients with respiratory manifestations and stool swabs on leukocytes and stool cultures in patients with diarrhea. Newborns are admitted to the hospital and receive an empirical IV. antibiotic coverage of the most common neonatal pathogens (e.g. with ampicillin and gentamycin or ampicillin and cefotaxime); Antibiotics continue until blood, urine and cerebrospinal fluid cultures are negative for 48 to 72 hours. Acyclovir should also be given if newborns look sick, have mucocutaneous vesicles, have a maternal history of genital herpes virus (HSV) infection, or have seizures; Acyclovir is discontinued if the CSF-HSV-PCR test results are negative.

Feverish children between 1 and 3 months are differentiated on the basis of their temperature, their clinical appearance and their laboratory results. As a rule, a large blood count with differentiation should be carried out for all, blood and urine cultures taken and the urine analyzed. Care should be taken to ensure that urine is removed by catheterization and not externally. Chest X-rays are taken in patients with respiratory manifestations and stool swabs on leukocytes and stool cultures in patients with diarrhea. A lumbar puncture with assessment of the cerebrospinal fluid, including culture, is also performed except rectic temperature of ampicillin and cefotaxime occurs in infants aged 61 to 90 days who look healthy, or with ceftriaxone in the age range of 61 to 90 days until the results of blood, urine and cerebrospinal fluid cultures are available.

Healthy-looking infants between 1 and 3 months old with cerebrospinal fluid pleocytosis, abnormal urine analysis or chest x-ray or peripheral leukocyte count ≤ 5000 / μl or ≥ 15,000 / μl should be hospitalized for treatment with age-specific empirical antibiotics as described above. If empirical antibiotics need to be given, CSF analysis should be done (if not already done).

Healthy looking, febrile infants between 1 and 3 months with a rectal temperature of 20,000 / μl should have a chest X-ray taken. These children should receive parenteral antibiotic therapy (usually with ceftriaxone) that addresses the likely pathogens in this age group (S. pneumoniae, Staphylococcus aureus, Neisseria meningitidis, H. influenzae Type B) is targeted and admitted to a hospital until the cut results are available.

Healthy looking children in this age group who have a temperature of > 39 ° C and who have no identifiable source (fever without cause [FWS]) and who are not completely immunized, have a risk of occult bacteremia of up to 5% (corresponds to the risk before pneumococcal and H. influenzae-Conjugate vaccines came into use). These children should have a complete blood count with differential, blood culture and urine analysis and urine culture. A chest x-ray is taken when the leukocyte count is ≥ 20,000 / μl. Children who have a leukocyte count of ≥ 15,000 / μl should receive parenteral antibiotics until the results of the blood and urine culture are available. Ceftriaxone (50 mg / kg i.m.) is preferred because of its broad antimicrobial spectrum and extended duration of action. Children receiving parenteral antibiotics should have a follow-up on the phone or a return visit within 24 hours if the preliminary culture results are reviewed. If the family’s social situation suggests that succession could be problematic within 24 hours, the infants should be hospitalized. Children who are not treated with antibiotics should be reevaluated if they still have a fever (≥ 38 ° C) after 48 hours (or sooner if they get sick or if new symptoms or signs develop).

For healthy looking children who have a temperature > 39 ° C and FWS and who are fully immunized, the risk of bacteremia is 48 hours. For all children, caregivers are instructed to come back immediately if the fever rises, the child looks sick, or new symptoms or signs develop.

The investigations at feverish children > 36 months depend on the patient’s medical history and examination results. In this age group, a child’s response to serious illnesses is sufficiently developed to be clinically recognized (e.g. neck stiffness is a reliable finding for meningeal irritation) so that empirical tests (e.g. screening of leukocyte counts, urine and blood cultures) are not indexed.

at acute recurrent or periodic fever Laboratory and imaging tests should target possible causes based on medical history and physical exam findings. PFAPA should be considered in young children who have periodic high fever at intervals of approximately 3 to 5 weeks with aphthae, pharyngitis and / or adenitis. Between the episodes and also during the episodes, the children appear healthy. The diagnosis requires 6 months of stereotypical episodes, negative throat swabs during the episodes and exclusion of other causes (e.g. certain viral infections). In patients with febrile seizures, joint pain, skin lesions, mouth ulcers, and diarrhea, IgD levels should be measured to look for hyperimmunoglobulinemia D syndrome (HIDS). HIDS laboratory characteristics include elevated C-reactive protein (CRP) and ESR, as well as significantly increased IgD (and often IgA). Genetic testing is available for hereditary periodic fever syndromes, including familial Mediterranean fever (FMF), TNF receptor-associated periodic syndrome (TRAPS), and HIDS.

With chronic fever (FUO) laboratory tests and imaging procedures should target the likely causes of fever based on patient age and medical history and physical exam findings. Careless arrangement of laboratory tests is unlikely to be helpful and can be harmful (i.e. due to the adverse effects of unnecessary confirmation testing of false positive results). The speed of the evaluation depends on the appearance of the child. The speed should be fast when the child looks sick, but slower when the child looks healthy.

All children with FUO should have

Blood count with manual differentiation

Urine analysis and culture

Serum electrolytes, urea nitrogen levels, creatinine, albumin and hepatic enzymes

The results of these studies, combined with medical history and physical examinations, can lead to further diagnostic tests.

Anemia can indicate malaria, infectious endocarditis, inflammatory bowel disease, SLE or TB. Thrombocytosis is a non-specific reactant of the acute phase. The full white blood cell count and differential are less helpful, although children with an absolute neutrophil count of > 10,000 are at higher risk for SBI. If there are atypical lymphocytes, a viral infection is likely. Immature leukocytes should give rise to further evaluation for leukemia. Eosinophilia can indicate parasitic, fungal, neoplastic, allergic, or immune deficiencies.

ESR and CRP are nonspecific reactants of the acute phase, which are general indicators of inflammation; elevated BSG or CRP makes fictional fever less likely. Normal ESR or CRP can slow the pace of evaluation. However, ESR or CRP can be normal for non-inflammatory causes of FUO (see table: Some causes of FUU).

Blood cultures should be performed at least once in all patients with FUO and more often if there is a high suspicion of SBI. Three blood cultures should be performed over 24 hours in patients who have no manifestations of infectious endocarditis. A positive blood culture, especially for S. aureus, should increase suspicion of occult skeletal or visceral infection or endocarditis and lead to a bone scan and / or echocardiography.

Urine analysis and urine culture are important because UTI is one of the most common causes of FUO in children. Patients with FUO should have a chest x-ray to check for infiltrates and lymphadenopathy, even if the lung exam is normal. Serum electrolytes, urea, creatinine and hepatic enzymes are measured to test for renal or hepatic involvement. Serological HIV tests and PPD tests are performed because primary HIV infection or TB can manifest as FUO.

Further tests are carried out selectively based on the findings:

Examination of the bone marrow

Serological tests for specific infections

Tests for connective tissue and immune disorders

Stool cultures or egg and parasite testing may be justified in patients with thin stools or a recent trip. Salmonella-Enteritis can rarely manifest as FUO without diarrhea.

A bone marrow examination in children is particularly useful in diagnosing cancer (especially leukemia) or other haematological diseases (e.g. hemophagocyte disease) and can be justified in children with otherwise unexplained hepatosplenomegaly, lymphadenopathy or cytopenias.

Serological tests that may be warranted depending on the case include a. Epstein-Barr virus infection, cytomegalovirus infection, toxoplasmosis, Bartonellose (cat scratch disease), syphilis and certain fungal or parasitic infections.

An anti-nuclear antibody (ANA) test should be done in children > 5 years with a strong family history of rheumatological diseases. A positive ANA test indicates an underlying connective tissue disease, particularly SLE. Immunoglobulin levels (IgG, IgA and IgM) should be measured in children with a negative initial evaluation. Low levels can indicate an immune deficiency. Elevated levels can occur with a chronic infection or an autoimmune disease.

Imaging of the sinuses, mastoids and the GI tract should initially only be performed if children have symptoms or signs related to these areas, but may be justified in children in whom FUO remains undiagnosed after initial tests. In children with elevated ESR or CRP, anorexia, and weight loss, studies to rule out inflammatory bowel disease should be done, especially if they also have abdominal discomfort with or without anemia. However, imaging procedures of the GI tract should ultimately be carried out in children whose fever persists without any other explanation and may be caused by diseases such as psoas abscess or cat scratch disease. Ultrasonography, CT and MRI can be helpful in assessing the abdomen and can detect abscesses, tumors and lymphadenopathy. CNS imaging procedures are generally not helpful in evaluating children with FUO. Lumbar puncture may be warranted in children with persistent headaches, neurological signs, or an inherent ventriculoperitoneal shunt. Other imaging modalities, including bone scan or labeled leukocyte scan, may be useful in selected children whose fever persists without further explanation if a source suspected by these tests is suspected. A slit lamp ophthalmic examination is useful in some patients with FUO to look for uveitis (such as that seen in juvenile idiopathic arthritis [JIA]) or leukemic infiltration. Biopsy (e.g. from lymph nodes or liver) should only be performed in children with indications of the involvement of specific organs.

Empirical treatment with anti-inflammatory drugs or antibiotics should not be used as a diagnostic measure unless JIA is suspected; in such cases, trying NSAIDs is the recommended first-line therapy. A response to anti-inflammatory drugs or antibiotics does not help distinguish infectious and non-infectious causes. In addition, antibiotics can cause false negative cultures and mask or delay the diagnosis of important infections (e.g. meningitis, paramingeal infections, endocarditis, osteomyelitis).

treatment

Treatment depends on the underlying disease.

A feverish, but otherwise healthy child does not necessarily need treatment. Although antipyretics provide relief to the patient, they do not change the course of an infection. In fact, fever is an integral part of responding to infection and can help the child fight the disease. However, most doctors use antipyretics to relieve symptoms and physiological stress in children who have cardiopulmonary diseases, neurological disorders, or a history of febrile seizures.

To the antipyretics, commonly used include:

Acetaminophen tends to be preferred because ibuprofen reduces the protective effects of prostaglandins in the stomach and can lead to gastritis with prolonged use. However, recent ep >Acetaminophen and the spread of asthma found in children and adults; this is why some doctors suggest that children with asthma or a strong family history of asthma avoid acetaminophen >Acetaminophen is 10-15 mg / kg p.o. iv or rectally every 4–6 h. The dosage of ibuprofen is 10 mg / kg p.o. every 6 h. The use of one antipyretic at a time is recommended. However, some doctors use two medications alternately to lower high fever (e.g., acetaminophen at 6 a.m., 12 p.m. and 6 p.m., and then 9 a.m., 3 p.m. and 9 p.m. ibuprofen). This approach is not recommended because caregivers can become confused and accidentally administer more than the recommended daily dose. Aspirin should be avoided in children because it increases the risk of Reye’s syndrome if certain viral diseases such as flu and chickenpox are present.

to non-drug treatment Fever includes warm or lukewarm baths, cold compresses and the child’s undressing. Caregivers should therefore not use a cold water bath, which is not only extremely uncomfortable, but can also paradoxically increase the body temperature due to the tremors that this causes. As long as the temperature of the water is slightly cooler than the temperature of the child, a bath provides temporary relief.

What to avoid

Wiping the body with isopropyl alcohol is strongly discouraged, as alcohol is absorbed through the skin and can lead to poisoning. There are numerous home remedies, from harmless ones (e.g. onions or potatoes in the stockings) to very unpleasant ones like e.g. B. embossing and cupping.

Important points

Acute fever is usually caused by viral infections.

The causes and assessment of acute fever differ depending on the child’s age.

A small but real number of children with fever with no localization signs (especially those who are not fully immunized) who are 24 months old may have pathogenic bacteria in their bloodstream (occult bacteremia) and may be in the early stages of a potentially life-threatening infection.

Teething does not cause a significant fever.

Antipyretics do not change the course of the disease, but can help the child to feel better.

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