Fever in children

Fever is a common occurrence in childhood illness episodes… 

, and may be caused by a wide variety to diseases ranging from the common cold to serious infections.Fever may be the only symptom, or may be accompanied by other symptoms and sign of the illness, such as shivering, headache, loss of appetite etc.

Measuring fever
Assessing a child’s body temperature by hand alone can be very misleading. A reliable thermometer should be used to measure fever. The traditional glass mercury thermometer is very reliable if correctly used; which means 3 minutes under the tongue, or 5 minutes under the armpit. In infants rectal temperature measurement may be the only accurate way. Electronic thermometers can also be accurate. Consult the manufacturer’s instruction carefully when using

Reducing the fever
Fever of more than 38oC or 100oF may be treated with fever medicines at a dose appropriate to the weight of the child. Commonly used fever medicines are paracetamol (also known as acetaminophen) and ibuprofen. Aspirin must not be given to children to treat fever. High fever, around 39oC or 103oF, may need additional measures to bring down. Sponging or wiping down with a wet towel is frequently effective. The water used should be tepid or cool but ice or very cold water should not be used. The body requires more water than normal when there is fever. The feverish child should be encouraged to drink plenty of fluids.

When to seek help
Moderate fever is not dangerous in a child who has fever from a known cause, such as a common cold, and who is not feeling very unwell. Conversely serious illnesses are not always accompanied by fever. Other symptoms occurring with the fever may however make it imperative to seek medical attention. Drowsiness, lethargy, irritability and constant crying are signs of possible danger. Infants age under 3 months with fever should always be seen by a doctor, even if the infant appears well otherwise. If fever cannot be brought down adequately or at all using the measures described the child should be seen by a doctor

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Encouraging your child to read

Children may be helped or encouraged to enjoy reading given the right incentives and environment…

Unlike watching television or playing games, the enjoyment of books and reading need more cultivation.

Children begin to enjoy stories from an early age. The traditional parenting activity of reading to your child has many benefits including teaching the child the value of books and even busy parents should find the time to do this, if only for 10 or 15 minutes a day.

For younger children, stories should be kept short and simple. Children also enjoy poems and nursery rhymes. For older children stories which have reasonable logical conclusion as well as advocating traditional moral values may be chosen. This may help the child to develop logical thinking. Questions about the story may also be asked of the child to promoting thinking and language comprehension.

When introducing children to books it is usual to start with picture books that children may enjoy looking at with the parent, and also able to enjoy on his own. For children starting to learn the alphabets many colorfully illustrated alphabet-learning books are available which can be enjoyed. Avoid pushing the child to quickly memorize the alphabets. If learning becomes an unpleasant chore the effect on the child may be opposite to the one intended.

Reading is of course a fundamentally important skill. It should be remembered that commencing traditional school work too early may be counter-productive.When choosing a school their young child will start in, parents should choose one that fosters enjoyment of learning rather than one that emphasizes hard work, rapid advance and high scores.

Saowapa Wachirarojpaisan, M.D.
Developmental Pediatrician and Adolescence Medicine

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Protect your children from Cervical Cancer

What …?! Why do I need to protect my kids from grown-ups diseases? 

If you are a parent, you have probably known about cervical cancer for a long time. The picture in your mind will be of a frightening cancer that affects women. Every year, we hear of 100 Thai women who fall ill with cervical cancer. There are campaigns for high-risk women to take a ‘Pap Smear Test’ or an internal examination for cancer cells. This test can lead to complete recovery if the disease is diagnosed quickly. “But we’ve never heard of it being associated with children before!”

The latest advances in medicine have produced an amazing discovery: the occurrence of cervical cancer is related to HPV infection, which can be contracted through sexual relations. The main strains are HPV 16 and HPV 18, and reducing the risk of infection can help prevent this disease. It is exciting to know that a vaccine for cervical cancer has already been developed – but the problem is, who should be vaccinated? The medical profession has recently agreed the cause of cervical cancer is sexual relations, so vaccinations should be given to those who have reached reproductive age. If prevention is to be most effective, it must begin in the teenage years or before, when girls start menstruation and may start thinking about boys. Three injections will be given in all, at intervals of one-to-two months and six months respectively.

Advising children to be vaccinated against HPV is regarded as an international standard in disease prevention, and is therefore normal practice in the medical profession. Parents need not be worried about whether or not the vaccination is appropriate. The pediatrician will consider and advise parents and children, case by case.

 

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Dengue fever(DHF)

Dengue and dengue hemorrhagic fever (DHF)
Dengue and dengue hemorrhagic fever (DHF), which are primarily a disease of the tropics, are caused by one of four closely related virus serotypes (DEN-1, DEN-2, DEN-3 and DEN-4) of the genus Flavivirus. Infection with one does not provide cross protection against another strain, so during the person lifetime can have four dengue infections.

The viruses are transmitted via the bite of various day-feeding mosquitoes of the subgenusus Stegomyia. The principal circulate the virus in their blood, mosquitoes ingesting feeding on the infective individual.

Dengue fever symptoms appear within 5-8 days of being bitten by infected mosquito, severe headache, pain behind the eyes, muscle and joint pains and rash.
DHF is characterized by high fever, up to 41C. persisting for 2-7 days enlarged liver and circulatory failure. If left untreated, the patient may go into shock (DSS) with a rapid, weak pulse, followed by signs of circulatory failure such as cool, blotchy skin. Without proper treatment, may die within 12-24 hours.

A diagnosis is made from the history, physical examination, and laboratory tests: PCR for Dengue. Dengue IgG and IgM. Initial treatment of a suspected case is aimed towards visiting the physician, reducing the fever using paracetamol (but avoid Aspirin), drink plenty of water and rest.

Currently, no vaccine treatment but close medical attention and clinical management by avoiding mosquito bites, using appropriate insect screens, insecticide sprays and insect repellent lotions and eliminating and covering open water containers.

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Is my child tall enough?

There are many advantages in being tall. Many professions are open only to people over a certain height. 

Parents of relatively short children may have anxiety over how tall a child will eventually become. Factors that influence final adult height are:

Familial trail
The final height of children naturally tends to reflect the heights of the parents. A mathematical formula which can be used to predict a child’s final height is:
- Final height for a girl =(father’s height + mother’s height –13) / 2, +/- 8 cm.
- Final height for a boy =(father’s height + mother’s height +13) / 2, +/- 8 cm.

: : Nutrition A diet has to contain all of the 5 food groups in the right proportions.
: : Exercise
: : Sleep
: : Emotional well being Children who are emotionally deprived through neglect may not realize their full growth potential.
: : Physical health Chronic illnesses and long-term use of certain drugs can reduce a child’s growth potential, as can hormonal diseases affecting the growth, thyroid and sex hormones.

How do we know if a child is abnormally short? To determine if a child’s stature is normal or not, we need to compare his or her height with the standard height appropriate for the child’s sex and racial group. However, having a successful and happy life does not depend on height only. There are more things to consider.

For consultation regarding growth and stature please bring child’s health record book or school record book with you and contact Growth, Endocrine and Diabetes Center for children, Samitivej Srinakarin Children’s Hospital.

For appointment please call 0-2378-9000

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Pneumonia

 Pneumonia is an infection of the lungs caused by micro-organisms. It can be caused by viruses, bacteria, or other micro-organisms. 

Symptoms and signs of pneumonia
These include fever, cough, difficulty breathing and breathlessness ranging from mild to severe. It is difficult for parents to distinguish pneumonia from other acute respiratory tract illnesses in children as the symptoms and signs are not specific to pneumonia. Physical examination by a doctor, and possibly X-rays are required to make the diagnosis. Parents may however suspect that a respiratory episode is more serious if the fever is very high, or the fever is accompanied by chills, or lasts more than three days. Cough if very severe, or accompanied by phlegm especially if the phlegm contains blood, may be suggestive of pneumonia. Breathlessness, difficulty breathing, severe debilitation or prostration is also signs that medical help is needed. Whether or not a child with respiratory tract infection has been seen or is under treatment by a doctor, if the child’s condition deteriorates or shows no improvement after three days he should be seen by a doctor.

Treatment of pneumonia
All cases should be seen by a doctor. Some cases may need treatment in hospital, but mild cases may be treated by oral medications at home. It is however inadvisable to attempt to treat or prevent pneumonia by self-prescrition with antibiotics as inappropriate use could lead to treatment failure, drug resistance, and other complications.

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