Modern approaches to the treatment of fever in children with infectious pathology

Serebryakova

Oksana Evgenievna

Experience 26 years

Local therapist, candidate of medical sciences, member of the Russian Scientific Medical Society of Therapists

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High temperature is an unpleasant symptom, characteristic of many diseases, and a sure indicator of the presence of a disease. Reducing the reading to normal does not mean being cured, and you also need to know what temperature to lower. It is necessary not only to achieve a decrease in temperature, alleviating the patient’s condition, but also to eliminate the source of the inflammatory process.

To effectively fight the disease, you need the help of a qualified doctor who will determine the cause of the condition, which manifests itself:

• with chills of varying severity;
• feeling of loss of strength;
• headache, aches and pains;
• increased sweating;
• arrhythmia;
• loss of appetite;
• dry lips and skin.

The concept of normal for body temperature

Normal body temperature is considered to be 36.6°C, but this figure can fluctuate. The lowest value is observed in the morning, the maximum in the evening. An increase in temperature is facilitated by eating, drinking alcohol, exercising, stimulating the nervous system, being under the sun, or in a steam room. It is considered normal if a person’s temperature is 36.2°C in the morning and 36.7°C in the evening. A peculiarity of the female body is that the temperature decreases a few days before ovulation and increases when ovulation occurs.

The norm for an adult is considered to be between 35°C and 37°C, for children under 3 years of age – up to 37.5°C. In summary, a temperature of 35°C should not cause panic.

How to measure temperature:

• if you measure under the armpit, then a value of 36.6°C is considered normal;
• if in the mouth, then the indicator is half a degree higher;
• if in the rectum, then to get the result subtract 1 degree from the value on the thermometer.

The range from 37.1°C to 38°C is considered to be above normal. If low-grade fever persists for a long time, measures must be taken. An indicator of 38.1°C is already a high temperature that requires urgent help for the body.

When to call an ambulance?

There is no need to call an ambulance. No isolated increase in temperature is a reason for this. Isolated means that there are no other threatening symptoms, such as an unclear rash, severe shortness of breath or a bulging fontanel. Yes, an ambulance can always lower the temperature - with a lytic mixture or a hormone. But this is not necessary and may cause harm. The drug that forms the basis of the lytic mixture - analgin (metamizole) - is prohibited in children throughout the civilized world. In addition, the ambulance is more likely to offer hospitalization.

Fever is not an emergency condition. If it worries you, lower your temperature and go to the doctor. Or call a doctor at home as planned.

Source: telegram.me/fediatrix

Why is it dangerous when the temperature rises above 38°C?

If a high temperature occurs, then this is a sure sign of a sharply worsening pathology. In 99% of cases this is an inflammatory process. If the condition is long-term, it means that the malfunction in the body is serious, so you cannot do without qualified medical care. The patient's body reacts to the infection by stimulating the immune system, accelerating metabolism, producing antibodies, and increasing blood circulation.

At this time, microbes lose activity, but the respiratory and cardiac systems bear an increased load. The nervous system takes a hit, the body loses water. If the condition does not change, the temperature remains, then blood circulation in the internal organs will deteriorate. The most dangerous stage is when the indicator rises above 41°C. Before the doctor arrives, the patient must take antipyretics for fever.

In what cases is an enema given at fever?

An enema helps bring down the temperature not only in case of poisoning, but also in case of ARVI or acute respiratory infections. This is due to the fact that fever is caused by toxins released by viruses or bacteria, as well as those formed as a result of the massive death of microorganisms. And a fever enema helps to partially flush out these toxins from the body, so after a while the fever subsides.

That is, an enema for poisoning with fever is used just as successfully as for acute viral and bacterial diseases.

Indications for colon lavage are as follows:

• fever above 38-38.5 degrees (indicators below do not need correction, since this temperature helps fight infection and does not cause harm to the human body);
• if treatment does not help and the patient’s condition worsens;
• if severe intoxication develops;
• if there are intestinal manifestations of the disease.

Why is the temperature rising?

Sometimes it seems that a fever appears for no reason. But any inflammatory process can cause this condition. Inflammation can occur due to fungi, viruses, and bacteria. Often, a temperature of 38.5°C is a concomitant symptom, for example, with pain in the ear or throat, against the background of signs of ARVI. Patients are frightened by asymptomatic fever, which is observed:

• at the early stage of influenza, ARVI - when there are no catarrhal signs yet;
• with a sore throat - simultaneously with a sore throat;
• with chickenpox – in the first 2-3 days of illness a fever appears and then a rash;
• with an abscess - in the fight against pus, temperature peaks are replaced by normal values ​​during the day;
• for glomerulonephritis, pyelonephritis - for inflammation in the kidneys;
• with appendicitis - often without pain;
• with hemorrhagic fever - with the bite of wild animals, muscle pain, rash;
• with encephalitis, meningitis - simultaneously with tension in the neck muscles, if it is impossible to lower the chin to the chest, pain in the head, blurred vision, nausea.

How to dose?

The easiest way to dose Nurofen is: syrup dose (ml) = 1/2 weight (kg). This is based on a single dosage of 10 mg/kg ibuprofen.

Paracetamol is dosed at 15 mg/kg. If you dose the most popular syrup - Panadol - you can multiply the child’s weight in kg by 0.625.

A single dose can be given no more than once every 4 hours, but preferably no more than 3 times a day.

You should not use the dosage according to age, which is often placed on the packaging of drugs. This is dangerous because children of the same age weigh very differently. Correctly dose medications by weight or body surface area, but not by age.

What should you do if you notice a symptom?

If the patient is either cold or hot, what to do with the temperature? When he gets chills, he should cover himself with a blanket, and when it gets hot, put on dry, light clothes. You can cover yourself with a sheet. The patient's main regimen is bed. If the child does not want to lie down, make sure that he does not engage in too active games, preventing the body from overheating.

It is necessary to ensure that the air in the room is periodically renewed. While airing, the patient can go to another room. You need to constantly replenish fluid reserves in the body by gradually drinking green tea, diluted juices, fruit drinks, and compotes. Water procedures cannot be taken; only wiping adults with a solution of water and vinegar 9% in a 1:1 ratio is allowed. Rubbing yourself with alcohol or cool water can make your fever worse.

Urgently call an ambulance for chills

If the temperature becomes high, it is recommended to call an ambulance in the following cases:

• headache and temperature above 38.5°C, drowsiness, lethargy;
• stomach pain and fever, especially if there is also vomiting and diarrhea;
• rash;
• convulsions, other severe conditions;
• lack of effect from taking antipyretics;
• overcoming the mark of 39.5 °C.

The ambulance service of JSC "Medicine" (clinic of Academician Roitberg) in the Central District of Moscow provides medical assistance around the clock in case of emergency. An urgent call to the team can be made by calling +7 (495) 229-00-03.

When should you go to the doctor?

If fever and blood pressure, cough, and aches appear simultaneously, you should not self-medicate. It is recommended to make an appointment with a doctor. JSC "Medicine" (academician Roitberg's clinic) in the center of Moscow invites you to use the services of experienced therapists who will diagnose the disease and prescribe the correct treatment. You don’t want to put your health at risk, so make an appointment immediately to prevent complications from developing! The clinic has a modern diagnostic department, laboratories for testing, and a hospital. If the need arises, a full range of medical services can be obtained without leaving the clinic.

What can cause an attack?

Infections that cause fever. The infection can be caused by bacteria, but more often febrile attacks occur with viral diseases (for example, roseola and influenza).

Vaccinations that cause fever. There is a small chance of febrile seizures after vaccination against measles, rubella and mumps, and diphtheria, tetanus and whooping cough. But the risks from incomplete vaccination are higher than the risk from a febrile attack after vaccination.

Heredity. If either parent has had a febrile seizure, the child is more likely to have seizures with fever.

A febrile attack, especially one occurring for the first time in life, is very frightening for parents. In fact, most of these attacks are not dangerous and do not lead to complications or brain damage. A child with simple febrile seizures is only slightly more likely to develop epilepsy than children who have never had a febrile seizure.

Symptom treatment

To figure out how to bring down the temperature, you need a correct diagnosis. An experienced doctor, based on the results of tests and studies, determines the cause of the fever, prescribes medications, procedures, or refers to a specialist for additional research. The goal is to identify the source of the inflammatory process in order to find the right treatment complex. Treatment for high fever depends entirely on the underlying cause and may include antipyretics, antibiotics, probiotics, etc.

Symptom during pregnancy

The temperature in pregnant women rises above the normal limit due to acute respiratory viral infections and influenza. It can harm the baby, especially if the mother takes medications containing aspirin. Therefore, pregnant women with fever need urgent consultation with a doctor to prescribe the correct dose of medications. If the temperature jump is small, you can take homeopathic remedies prescribed by your doctor.

Along with the tablets in the 1st trimester, you can drink herbal teas, fruit drinks, compotes, and juices. At later stages, drink concentrated herbal infusions, which are not consumed in large quantities to avoid swelling. Decoctions of leaves, raspberries, coltsfoot, plantain, and infusion of white willow bark have healing properties. Rubbing with a vinegar solution helps.

Treatment at home

If you find cold symptoms and a temperature above 37°C and weakness, you can start taking home remedies to support the body. If the value on the thermometer does not exceed 38.5°C and the body feels more or less well, there is no need to lower the temperature. At this time, harmful bacteria die, and the immune system works at full capacity.

However, if the patient’s condition is serious, he does not tolerate the temperature well, it needs to be brought down. At 40°C the blood begins to thicken and coagulate, so you should take antipyretics. In order not to cause negative effects on internal organs, many patients prefer folk remedies with a mild effect.

Folk remedies for fever for children:

• children's enemas with a soda solution (1 tsp of soda for 1 glass of water) or chamomile decoction;
• wipe the child’s body with green grape juice;
• put on socks moistened with a solution of water and vinegar in a 1:1 dilution for 15 minutes;
• Infants and children under 3 years of age can be briefly wrapped in a wet sheet or towel to relieve the condition.

If the temperature is 39°C or 40°C in adults, it must be brought down:

• wiping and a cold compress - a cotton cloth is moistened with water at room temperature or a solution of water and vinegar;
• drinking plenty of fluids - it is necessary to prevent dehydration of the body by taking drinking water, freshly squeezed juices or warm herbal infusions, honey water (1 tsp of honey for 1 glass of warm water);
• fasting - give the body a rest (food is a load), concentrate energy on fighting inflammation.

Modern approaches to the treatment of fever in children with infectious pathology

Fever is one of the most common symptoms of infectious diseases in children and one of the most common reasons why parents seek help from a pediatrician. Fever is the most common reason for the use of medications.

When measuring body temperature in the armpit, a body temperature of 37.0°C or higher is usually considered elevated. However, it should be borne in mind that values ​​of 36.0–37.5 ° C can be considered normal. A child’s normal body temperature fluctuates during the day within 0.5–1.0°C, increasing in the evening. Axillary temperature is 0.5–0.6°C lower than rectal temperature.

Fever is a nonspecific protective-adaptive reaction of the body that occurs in response to exposure to various pathogenic stimuli and is characterized by a restructuring of thermoregulation processes, which leads to an increase in body temperature.

Elevated body temperature reduces the viability of some pathogenic microorganisms and enhances the specific and nonspecific components of immunity. However, an increase in temperature can play an adaptive role only when it rises to a certain limit. With high hyperthermia (40–41°C), an increase in the intensity of metabolic processes is observed. Despite the increased work of the respiratory and cardiovascular systems (for every degree the body temperature rises above 37 °C, the respiratory rate increases by 4 per 1 min, the heart rate (HR) increases by 10–20 per 1 min), increased oxygen delivery can fail to meet the growing tissue needs for it, which leads to the development of tissue hypoxia and disruption of the distribution of vascular tone. First of all, the functions of the central nervous system are affected, which is often manifested by the development of convulsive syndrome - febrile seizures (especially in young children with perinatal damage to the central nervous system). With hyperthermia, cerebral edema may develop, when the child’s condition sharply worsens and depression of the central nervous system occurs.

In children with malnutrition, respiratory failure, as well as with lesions of the central nervous system, adverse health consequences can develop with a relatively moderate degree of increase in body temperature (38.5–39°C).

Classification of fever

• by etiological factor:
• infectious;
• non-infectious;
• by duration:
• ephemeral (up to several days);
• acute (up to 2 weeks);
• subacute (up to 6 weeks);
• chronic (over 6 weeks);
• according to the presence of inflammation:
• inflammatory;
• non-inflammatory;
• according to the degree of temperature increase:
• low-grade fever (up to 38°C);
• febrile (38.1–39°C);
• febrile high (39.1–41°C);
• hyperthermic (over 41°C).

Mechanism of fever

An increase in body temperature of infectious origin develops in response to exposure to pyrogens of a viral or bacterial nature and is most common.

Fever is based on the ability of granulocytes and macrophages to synthesize and release endogenous protein pyrogens, interleukins (IL-1, IL-6), tumor necrosis factor (TNF) and interferons when activated. The target for the action of endogenous pyrogens is the thermoregulatory center, which regulates the mechanisms of heat production and heat transfer, thereby ensuring normal body temperature and its daily fluctuations.

IL-1 is considered the main initiating mediator in the mechanism of fever development. It stimulates the secretion of prostaglandins, amyloids A and P, C-reactive protein, haptoglobin, α1-antitrypsin and ceruloplasmin. Under the influence of IL-1, the production of IL-2 by T lymphocytes is initiated and the expression of cellular Ig receptors increases, as well as increased proliferation of B lymphocytes and stimulation of antibody secretion. Disruption of immune homeostasis during infectious inflammation ensures the penetration of IL-1 through the blood-brain barrier, where it interacts with receptors of neurons of the thermoregulation center. In this case, cyclooxygenase (COX) is activated, which leads to an increase in the intracellular level of cyclic adenosine-3,5-monophosphate (cAMP) and a change in the intracellular Na/Ca ratio. These processes underlie changes in the sensitivity of neurons and a shift in the thermoregulatory balance towards increased heat production and decreased heat transfer. A new, higher level of temperature homeostasis is established, which leads to an increase in body temperature.

The most favorable form of the body's reaction to infectious diseases is an increase in body temperature to 38.0–39 ° C, while its absence or febrile high fever indicates a reduced reactivity of the body and is an indicator of the severity of the disease. When fever develops during the day, the maximum increase in body temperature is recorded at 18–19 hours, the minimum level is in the early morning. Information about the characteristics and dynamics of fever throughout the course of the disease has important diagnostic value. For different diseases, febrile reactions can occur in different ways, which is reflected in the shapes of temperature curves.

Clinical variants of fever

When analyzing the temperature reaction, it is very important to evaluate not only the magnitude of its rise, duration and daily fluctuations, but also to compare these data with the condition and well-being of the child, and the clinical manifestations of the disease. This is necessary to select the correct treatment tactics for the patient, as well as to conduct further diagnostic searches.

First of all, it is necessary to assess the clinical signs of compliance of heat transfer processes with an increased level of heat production, because Depending on the individual characteristics of the body, fever, even with the same degree of increase in body temperature in children, can occur differently.

If the child responds adequately to an increase in body temperature, heat transfer corresponds to increased heat production, which is clinically manifested by normal health, pink or moderately hyperemic skin color, moist and warm to the touch (the so-called “pink fever”). Tachycardia and increased respiration correspond to the level of body temperature, the rectal-digital gradient does not exceed 5–6 °C. This type of fever is considered prognostically favorable.

If the child’s response to an increase in body temperature is inadequate and heat transfer is significantly less than heat production, then clinically there is a pronounced disturbance in the child’s condition and well-being, chills, pale, marbled skin, nail beds and lips with a cyanotic tint, cold feet and palms (the so-called “pale fever” ). There is persistent persistence of hyperthermia, excessive tachycardia, shortness of breath, possible delirium, convulsions, and a rectal-digital gradient of more than 6 °C. This course of fever is prognostically unfavorable and is a direct indication for emergency care.

Among the clinical variants of the pathological course of fever, hyperthermic syndrome is distinguished, in which there is a rapid and inadequate increase in body temperature, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems. The risk of developing such conditions is especially high in young children, as well as those with a burdened premorbid background. The younger the child is, the more dangerous a rapid and significant rise in body temperature is for him due to the possible development of progressive metabolic disorders, cerebral edema, and impairment of vital functions. If a child has serious diseases of the cardiovascular and respiratory systems, fever can lead to the development of their decompensation. In children with pathologies of the central nervous system (perinatal encephalopathy, epilepsy, etc.), seizures may develop against the background of elevated body temperature.

Febrile seizures occur in 2–4% of children, most often between 12–18 months of age. They usually occur with a rapid rise in temperature to 38–39 °C and higher at the very beginning of the disease. Repeated seizures can develop in a child at other temperatures. If a child experiences febrile seizures, it is necessary to first rule out meningitis. In infants with signs of rickets, a calcium level test is indicated to exclude spasmophilia. Electroencephalography is indicated after the first episode only for prolonged, repeated or focal seizures.

Tactics of management and treatment of children with fever

Fighting fever is one of the most important components of complex therapy of the underlying disease. It is carried out against the background of etiotropic (antimicrobial, antiviral, antiparasitic) and syndromic therapy.

In case of febrile conditions in children, measures taken should include:

• half-bed or bed rest depending on the level of increase in body temperature and the child’s well-being;
• a gentle, dairy-vegetable diet, feeding depending on appetite. It is advisable to limit the intake of fresh milk due to possible hypolactasia at the height of the fever. Drink plenty of fluids (tea, fruit juice, compote, etc.) to ensure adequate heat transfer due to increased sweating.

Therapeutic tactics for increased body temperature depend on the clinical variant of the fever, the severity of the temperature reaction, and the presence or absence of risk factors for the development of complications.

The decrease in body temperature should not be critical; it is not necessary to achieve normal levels; it is enough to lower the temperature by 1–1.5°C. This leads to an improvement in the child’s well-being and allows him to better tolerate a feverish state.

In case of “pink fever”, it is necessary to undress the child, taking into account the air temperature in the room, put “cold” on large vessels (inguinal, axillary areas), if necessary, wipe with water at room temperature, which is sufficient to reduce body temperature or significantly reduces the amount of pharmacotherapy. Rubbing with cold water or vodka is not recommended, as it can lead to spasm of peripheral vessels and a decrease in heat transfer.

Indications for the use of antipyretic drugs. Considering the protective-adaptive mechanism of fever in children and its positive aspects, antipyretics should not be used for any temperature reaction. If the child does not have risk factors for developing complications of a febrile reaction (febrile convulsions, cerebral edema, etc.), there is no need to reduce body temperature below 38–38.5°C using antipyretic drugs. However, if, against the background of fever, regardless of its severity, there is a deterioration in the general condition and well-being of the child, chills, myalgia, pale skin, and other symptoms of toxicosis, antipyretics are prescribed immediately.

In children at risk with an unfavorable course of fever with severe intoxication, impaired peripheral circulation (“pale fever”), antipyretic drugs are prescribed even at low-grade fever (above 37.5 ° C), for “pink fever” - at a temperature exceeding 38, 0°C (Table 1).

Antipyretics are mandatory, along with other measures, for hyperthermic syndrome, when a rapid and inadequate increase in body temperature occurs, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems.

It should be noted that medications to reduce fever should not be prescribed in a course, since this changes the temperature curve and makes diagnosing infectious diseases very difficult. The next dose of an antipyretic drug is needed only when the body temperature rises again to the appropriate level.

Principles for choosing antipyretic drugs in children. Antipyretics are most widely used in children compared to other drugs, so their choice is based primarily on safety rather than effectiveness. The drugs of choice for fever in children, according to WHO recommendations, are paracetamol and ibuprofen. Paracetamol and ibuprofen are approved in the Russian Federation for over-the-counter use and can be prescribed to children from the first months of life both in a hospital and at home.

It should be noted that paracetamol has an antipyretic, analgesic and very weak anti-inflammatory effect, because implements its mechanism primarily in the central nervous system and does not have a peripheral effect. Ibuprofen (Nurofen for children, Nurofen) has more pronounced antipyretic, analgesic and anti-inflammatory effects, which is determined by its peripheral and central mechanisms. In addition, the use of ibuprofen (Nurofen for children, Nurofen) is preferable if the child has a pain syndrome along with fever, for example, fever and sore throat with sore throat, fever and ear pain with otitis media, fever and joint pain with pseudotuberculosis, etc. The main problem with the use of paracetamol is the danger of overdose and associated hepatotoxicity in children over 10–12 years of age. This is due to the peculiarities of the metabolism of paracetamol in the child’s liver and the possibility of the formation of toxic metabolites of the drug. Ibuprofen can rarely cause undesirable effects from the gastrointestinal tract, respiratory system, extremely rarely from the kidneys, changes in the cellular composition of the blood.

However, with short-term use of recommended doses (Table 2), the drugs are well tolerated and do not cause complications. The overall incidence of adverse events associated with the use of paracetamol and ibuprofen as antipyretics is approximately the same (8–9%).

Prescription of Analgin (metamizole sodium) is possible only in case of intolerance to other antipyretic drugs or if parenteral administration is necessary. This is associated with the risk of adverse reactions such as anaphylactic shock, agranulocytosis (with a frequency of 1:500,000), prolonged collapsing state with hypothermia.

It should be remembered that drugs with a strong anti-inflammatory effect are more toxic. It is irrational to use powerful anti-inflammatory drugs - nimesulide, diclofenac - to reduce body temperature in children; they are approved only for prescription use.

Acetylsalicylic acid is not recommended as an antipyretic for children, as it can cause Reye's syndrome (severe encephalopathy with liver failure) in case of influenza and other acute respiratory viral infections and chicken pox. You should not use amidopyrine and phenacetin, which are excluded from the list of antipyretic drugs due to high toxicity (development of seizures, nephrotoxicity).

When choosing medications to reduce fever in children, it is necessary to take into account, along with safety, the convenience of their use, i.e., the availability of children's dosage forms (syrup, suspension), as well as cost.

Therapeutic tactics for various clinical types of fever in children. The choice of starting antipyretic drug is primarily determined by the clinical type of fever. If a child tolerates an increase in temperature well, his health suffers slightly, the skin is pink or moderately hyperemic, warm, moist (“pink fever”), the use of physical cooling methods allows one to reduce body temperature and, in some cases, avoid pharmacotherapy. When the effect of using physical methods is insufficient, paracetamol is prescribed in a single dose of 15 mg per kg of body weight or ibuprofen in a dose of 5-10 mg per kg of body weight taken orally in suspension (Nurofen for children) or tablet form (Nurofen) depending on age child.

For “pale fever,” antipyretics should be used only in combination with vasodilators. It is possible to use Papaverine, No-shpa, Dibazol. In case of persistent hyperthermia with a violation of the general condition, the presence of symptoms of toxicosis, there is a need for parenteral administration of vasodilators, antipyretics and antihistamines. In such cases, use a lytic mixture:

• 2% Papaverine solution intramuscularly in a single dose of 0.1–0.2 ml for children under 1 year of age; 0.2 ml per year of life for children over one year of age;
• 50% solution of Analgin (metamizole sodium) intramuscularly, in a single dose of 0.1–0.2 ml per 10 kg of body weight for children under 1 year of age; 0.1 ml per year of life for children over 1 year of age
• 2.5% solution of Pipolfen (or Diprazine) intramuscularly in a single dose of 0.5 or 1.0 ml.

Children with intractable fever should be hospitalized.

Hyperthermic syndrome, in which there is a rapid and inadequate increase in body temperature, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems, requires immediate parenteral administration of antipyretics, vasodilators, antihistamines, followed by hospitalization and emergency syndromic therapy.

Thus, when treating a child with fever, the pediatrician should remember:

• antipyretic drugs should not be prescribed to all children with elevated body temperature; they are indicated only in cases of infectious-inflammatory fever when it has an adverse effect on the child’s condition and threatens the development of serious complications;
• drugs to reduce fever should not be prescribed in a course; repeated administration of an antipyretic drug is indicated only when the temperature next rises to a level requiring drug correction;
• Among antipyretic drugs, preference should be given to ibuprofen (Nurofen for children, Nurofen), which has the lowest risk of unwanted effects;
• the appointment of Analgin (metamizole sodium) is possible only in case of intolerance to other antipyretic drugs or if their parenteral administration is necessary.

For questions regarding literature, please contact the editor.

When does a temperature of 37.5 to 38°C occur without symptoms?

Temperature without symptoms in the range between 37.5-38°C is observed:

• for problems with the thyroid gland;
• tuberculosis;
• allergies;
• neurological diseases;
• oncology;
• pneumonia;
• gastroenterocolitis;
• viral hepatitis A.

Do not forget about such serious diseases that occur with an increase in temperature, such as:

• systemic lupus erythematosus, rheumatism, other autoimmune processes;
• endocarditis, myocarditis;
• syphilis, gonorrhea, genitourinary infections;
• rubella, measles, other viral infections.

It is important to know

Parents often mistake normal chills associated with fever for febrile seizures. With such chills, the child's arms and legs may shake rhythmically. This is similar to a seizure, but the child is conscious and reacts if spoken to. So that the doctor can better determine whether what happened was a seizure, and if so, what kind, try to clearly record the duration of the seizure, describe it as specifically as possible, and ideally, record what is happening on video (one person helps the child, the other films it on the phone).

What to do if a fever appears after vaccination?

Fever after vaccination is not always a complication. Often its appearance is a normal reaction of the body to a foreign body, pathogens. The immune system receives a load and intensifies the fight against the disease, which occurs in a mild form. How the body will react to the introduction of substances, no physician can make an accurate prediction. Not everyone gets sick after vaccination.

You should remember about contraindications to vaccination and do not vaccinate during or after suffering from infectious diseases, exacerbations of chronic diseases, allergies, complications from previous vaccination, and other cases that your doctor will remind you about. For a full consultation, you can contact JSC “Medicine” (clinic of academician Roitberg).

Does an enema have side effects?

There are cases when the temperature rises after an enema even more than it was before the procedure. This is due to the wrong recipe: if the infusion consists only of water, then the liquid is absorbed into the intestinal walls, at the same time drawing toxins into the blood. Thus, the toxic load on the body increases and the fever rises.

If after a proper enema you are still worried about the temperature, then you should wait a little: the effect of reducing the fever does not occur immediately. However, after about 30-60 minutes it should happen.

A side effect of rinsing may be residual pain in the abdomen: this is due to the fact that the water did not come out completely. In this case, you need to go to the toilet one more time or two, massaging your stomach.

With a salt solution, itching and itching in the anus are possible: this is due to the irritating effect of salt and is not dangerous. To reduce the sensation, rub the anus with oil.

Also, after the procedure, as a result of sitting on the toilet for a long time and suddenly getting up from it, or when the temperature drops too quickly, darkening of the eyes and short-term loss of consciousness are possible. To avoid this, you need to get up from the toilet in the presence of an assistant or very smoothly, immediately sitting on the chair. If you feel that you are already losing consciousness, your task is to lie down on the floor as quickly as possible before you fall.

How and why to measure basal temperature?

Basal temperature is measured at the moment of awakening. It helps determine the day of ovulation to plan conception and try to determine the sex of the unborn child. Basal thermometry is carried out in the first minutes after sleep, before physical activity. The oral cavity, rectum, and vagina are suitable for measurements. The gynecologists of JSC “Medicine” (clinic of academician Roitberg) in the Central Administrative District will tell you more about the methods for determining the day of ovulation. After consultation, you will be able to plan your pregnancy down to the day, and also try to influence the gender of your unborn baby.

How to help a child during an attack?

1. Place your baby on his side on a flat surface and make sure he won't fall or hit anything during the cramp (such as crib bars).
2. Record the time and tell the doctor when the attack began and how long it lasted.

Attention! Do not try to open the jaw, do not put anything into the child’s mouth during an attack, this can lead to injuries (broken teeth of the child and injured fingers of the person providing assistance). Do not try to restrict the child's movements during seizures, do not restrain him.

The child may be even more afraid of the attack than the parents. Try to calm him down and support him.

If the attack occurs for the first time in life, lasts longer than 5 minutes, the child is unusually sleepy and lethargic before or after the attack, call an ambulance.

In other cases, immediately show the child to the pediatrician. The doctor should examine the child after the attack to make sure there are no signs of a central nervous system infection (meningitis or encephalitis).