Treatment of fever in children

In most cases, fever is an adaptive response that helps stimulate the immune response and increases resistance to infections.

Treatment of fever in children involves the administration of antipyretic drugs, vasodilators, infusion therapy and oxygen therapy, the use of physical methods to enhance heat transfer, and, if indicated, anticonvulsants.

Antipyretic drugs for the treatment of fever

According to WHO recommendations, premorbidly healthy children are not recommended to be prescribed antipyretics if their body temperature does not exceed 38.0 °C. Children with a history of febrile seizures, as well as neurological diseases, may be prescribed antipyretics at a body temperature below 38.0 °C.

When choosing antipyretic drugs, it is necessary to take into account its safety, possible routes of administration, the age of the child, and the availability of pediatric dosage forms. Drugs of this group should be prescribed only when the body temperature rises above the specified level; regular "course" administration is not indicated.

The main antipyretic drugs are paracetamol, ibuprofen, metamizole, acetylsalicylic acid.

• Paracetamol is the drug of first choice for treating fever in children. It is considered the least dangerous. Despite its pronounced antipyretic and analgesic effects, it does not have a clinically significant anti-inflammatory property.

The drug is available in the form of tablets, syrup, drops and suppositories. A dosage form for parenteral administration has been developed. Its single dose is 10-15 mg/kg, it provides a decrease in body temperature by 1-1.5 °C. The daily dose should not exceed 60 mg/kg due to the risk of liver damage.

The drug is well absorbed from the gastrointestinal tract. Simultaneous administration of antacid drugs reduces the rate of absorption of paracetamol. More than 90% of the dose taken undergoes biotransformation in the liver. Metabolites, including active ones, are excreted by the kidneys.

Paracetamol is contraindicated in cases of genetic deficiency of glucose-6-phosphate dehydrogenase. In newborns, due to the peculiarities of drug elimination, its accumulation may occur with repeated administration.

• Ibuprofen is a second-line antipyretic in cases of individual intolerance or ineffectiveness of paracetamol.

The drug in liquid dosage forms is approved for use in children. It has pronounced antipyretic, analgesic and anti-inflammatory properties, comparable in strength to paracetamol. A single dose of the drug is 5-10 mg / kg, daily - should not exceed 20 mg / kg.

Side effects may include skin reactions, dyspeptic disorders, gastrointestinal bleeding, and a decrease in renal blood flow, up to the development of acute renal failure.

• Metamizole sodium in children under 12 years of age can be used only as prescribed by a doctor. The drug has pronounced analgesic and anti-inflammatory properties.

Metamizole sodium is produced in the form of tablets and ampoule solutions, which makes it possible to use it parenterally.

A single dose of the drug is 3-5 mg/kg. It is rational to use it in children to relieve moderate postoperative pain. The introduction of metamizole sodium during fever can lead to a collapse state due to a sharp decrease in body temperature (below 36 °C).

WHO does not recommend the use of metamizole sodium as an antipyretic, as even with short-term use it can cause agranulocytosis and aplastic anemia. The high risk of these serious complications has led to its ban in some countries.

• Acetylsalicylic acid has a pronounced antipyretic, anti-inflammatory and, to a lesser extent, analgesic effect. A single dose of the drug is 10-15 mg/kg. It can be used in children with rheumatic diseases.

Acetylsalicylic acid is contraindicated for use in children with acute respiratory viral infections under 15 years of age, as it can cause Reye's syndrome, the mortality rate of which reaches 50%.

With prolonged use of the drug, erosive and ulcerative gastrointestinal bleeding may occur due to the systemic action of the drug. In addition, it can provoke an attack of bronchial obstruction in children. In newborns, acetylsalicylic acid can displace bilirubin from its bond with albumin, which contributes to the development of bilirubin encephalopathy.

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Vasodilators

If antipyretics are not effective enough to increase heat transfer, vasodilators are administered. Considering that fever causes the body to lose a large amount of fluid, vasodilators must be combined with adequate infusion therapy.

Physical methods of enhancing heat transfer

To enhance heat transfer, the child is wiped with cool water or liquids containing alcohol. In emergency situations, when the body temperature rises above 41 °C, loss of consciousness or the development of convulsions, more intensive physical cooling methods can be used. The child is placed in an ice bath or ice packs are applied to the head, neck, thighs, armpits, and the stomach is washed with cold water.

Anticonvulsant therapy

Convulsive readiness is an indication for the administration of anticonvulsants.

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Infusion therapy

Correction of water-electrolyte disturbances and acid-base balance are mandatory components of intensive treatment of fever in children of any etiology.