Features of the course of ARVI and influenza in children

September 9, 2022 Colds in children are one of the most exciting topics for parents. Every mother wants her baby to always be healthy and to avoid any illness, and she becomes scared when the thermometer shows a high temperature in the child. However, one way or another, the child’s body has to deal with various infections.

Regular acute respiratory viral infections in children are associated by parents with long absences from kindergarten and school. Moreover, regular viral diseases can lead to the development of various complications.

How often do children get sick?

Children under 5 years old experience up to 8 episodes of ARVI per year1. In kindergartens, the morbidity rate is especially high in the first and second year of attendance - 10-15% higher than at other times.

The number of visits to pediatricians with ARVI increases from September to April, and the peak incidence occurs from February to March. In the summer months, the incidence decreases by approximately 3-5 times.

Children are especially vulnerable to influenza. The reason for this is insufficiently developed immunity. The spread of the virus in children's groups (in schools, kindergartens, boarding schools) is occurring rapidly.

Immunity in children. Why do children get sick more often?

The immune system of children develops throughout childhood.

The immunity of infants is imperfect and this feature is a special mechanism that protects the body from too violent immune reactions to infections.

In the first weeks of life, the baby is protected by the antibodies that he received from his mother and then continues to receive them through breast milk. But such protection is sometimes not enough.

Moreover, while immunity is just developing, periods of maximum risk of developing infectious diseases arise; they are called critical periods:

First critical period

This is a period of vulnerability for newborns, which occurs in the first 28 days of life. During this period of time, the child’s body is protected only thanks to antibodies received from the mother through the placenta and breast milk. The risk of contracting bacterial and viral infections during this period is very high. Premature newborns are a special risk group.

Second critical period

Lasts from 4 to 6 months of life and is accompanied by a decrease in the amount of maternal antibodies.
Due to some mechanisms, which are also still poorly developed, the child’s own antibodies are produced, but they are not yet sufficient to protect the baby. Therefore, the body’s susceptibility to airborne and intestinal infections during this period is also high. Thus, in children under one year of age, all the basic mechanisms of the body’s defense against bacteria and viruses are weakened.

Third critical period

Occurs in the 2nd year of life. It is from this age that the child begins to have more and more contact with the outside world and various infections. The child's sensitivity to respiratory and intestinal infections is still high. The baby's immune defense mechanisms are not yet fully developed.

Fourth critical period

Appears at 6-7 years of age. Children of this age are also prone to infectious diseases, as some indicators of the immune system change.

Fifth critical period

Adolescence from 12-15 years, and the age may vary slightly for boys and girls. This is due to an increase in the secretion of sex hormones, which slightly weakens the immune system. Children of this age are characterized by high sensitivity to viral infections.2

How to get rid of allergic dermatitis in a baby?

25.01.2021

Allergic dermatitis in children is quite common. This form of the disease occurs mainly in the first six months of life, that is, in infants, and can continue into adulthood.

With allergic dermatitis, inflammation occurs on the skin caused by external or internal irritants. light appears in any part of the body, most often on the face .

In some cases, dermatitis goes away quite quickly and on its own, but sometimes it can get worse over time. The affected areas turn into weeping wounds and ulcers, and the itching only intensifies.

Letting such a disease take its course or self-medicate would be an extremely frivolous activity. To avoid unpleasant consequences, the most reasonable thing would be timely intervention by a specialist and timely prevention in the future.

The symptoms of allergic dermatitis in an adult and an infant are significantly different. As a rule, if an allergy once, this trouble will accompany him throughout his life. But whether the allergic reaction that appears in a child becomes permanent depends directly on the cause that caused it.

What could be the factors contributing to the development of dermatitis in a child?

• Food allergies
• Overfeeding
• Heredity
• External factors

After identifying the causes, preventive measures should be taken, which, in turn, can be divided into certain groups.

1. Limiting unwanted substances entering the blood . To do this, you need to achieve stable and free functioning of the gastrointestinal tract of the mother who is breastfeeding and the child herself. A woman should reduce her consumption of fatty and spicy foods and avoid sweets as much as possible. Another important preventative measure is to control the amount of food consumed by the child. It is impossible to overfeed a baby while breastfeeding. But if there is complementary feeding with a mixture, then there is a possibility of oversaturation. This is due to the fact that the feeling of satisfying hunger does not come immediately, and the hole in the nipple is not always small. In this case, excess food is not digested and accumulates in the intestines , turning into poison
2. Maximum reduction in sweating. Everyone knows that sweat is a kind of riddler of harmful substances from the body. But the baby’s delicate skin suffers from contact with such secretions. To prevent such unpleasant consequences, it is important to maintain a comfortable temperature (about 20°C) and air humidity in the house, and also not to overwrap the child
3. Preventing contact with the irritant. Dermatitis does not only occur due to certain foods, but can also be caused by external factors. These include detergents containing harmful substances, indoor dust, unnatural fabric, etc.

Perhaps, the measures to prevent the causes of dermatitis described in this block are the most basic, and they have long been known to everyone. It is advisable to boil the baby's clothes or wash them with a hypoallergenic detergent and rinse in boiled water. The same applies to clothing items of an adult in contact with a child and bedding. All these items must be ironed.

All child’s toys must be disinfected with a special agent. You also need to bathe your baby in boiled water, using herbal decoctions. Frequent use of soap is not recommended due to the fact that it washes away the natural oily film from the skin.

Compliance with all of the above preventive measures will help parents significantly reduce the likelihood of their child developing this disease, but the risk still remains. If it was not possible to avoid the appearance of dermatitis , it is important to immediately consult a doctor to identify the causes and prescribe competent, qualified treatment.

Primary diagnosis, which includes a number of procedures, is carried out either by a pediatric therapist or an allergist-dermatologist. Otherwise, complications are possible, in particular infection of wounds and scratches. Elevated temperature, which is characteristic of an infectious process, in turn, leads to increased sweating , which only worsens the situation.

To summarize, it would be advisable to once again recall that allergic dermatitis is a serious disease that is fraught with serious consequences if it is not treated in a timely and incorrect manner.

Published in Dermatology Premium Clinic

ARVI or flu

Despite the fact that influenza is part of the group of acute respiratory viral infections (acute respiratory viral diseases) and their symptoms are very similar, the manifestations of influenza are more pronounced.

If the symptoms of a cold are accompanied by a runny nose, nasal congestion, sore throat, headache, low-grade fever, cough and general malaise, then with the flu there is a sudden onset of illness, high temperature, and fever.

With influenza, the risk of developing bacterial complications, such as bronchitis, pneumonia and otitis media, is many times higher than with regular acute respiratory viral infections.

What temperature should be considered elevated?

Formally, this is considered a temperature above 37º. However, in healthy children of any age, after anxiety, physical activity, or simply after eating, the temperature can rise to 37.5 and even 38º. Healthy children in the first month of life also do not differ in accuracy in regulating their own temperature, and in premature infants and children with neurological problems, temperature instability can be observed at an older age. In these cases, the temperature measured after an hour is usually normal. Another condition that can lead to an increase in temperature in a healthy child is teething (or, in other words, dentition). In this condition, the temperature can rise to 38 degrees or more and last for more than a day. However, parents should not independently decide whether a prolonged increase in temperature is associated with teething. In this case, the child should be shown to a doctor - after all, the child’s teeth are cut almost continuously from 4 months to 2 years, and by regarding any increase in temperature as dentition, you may miss the onset of a serious disease, the only symptom visible to you (but not to the doctor) there was a fever. General overheating of the body can also lead to an increase in temperature, but after several hours of staying in comfortable conditions, the temperature becomes normal and no longer rises. Often the temperature rises after preventive vaccinations. Despite the fact that a moderate increase in temperature after some vaccinations is considered a normal vaccine reaction, in this case it is better to show the child to the doctor.

How is the virus transmitted among children?

The influenza virus is transmitted from child to child by sneezing, coughing and talking.

Among children, contact transmission of the virus is common through household items, children's toys, dishes, bedding and various surfaces. The fact is that a virus - for example, the influenza virus - can survive for 2 hours on tables, door handles, pencils, etc. After playing with shared toys or touching the table, the child then touches his face, nose and eyes with his hands.

During epidemic seasons, outbreaks of ARVI and influenza are observed in collective places, most often kindergartens, less often schools.

Atopic dermatitis in children

Children's bodies are susceptible to many diseases, and one of the most common is atopic dermatitis. This inflammatory disease is allergic in nature and chronic in nature. Atopic dermatitis in children is expressed in peeling of the skin and itching, and is treated by an allergist.

What is atopic dermatitis?

This is a pathology of the epidermis, which is characterized by chronic immune inflammation. According to statistics, approximately every fifth child in the world experiences symptoms of atopic dermatitis. Most often, foci of inflammation develop in the area of ​​the cheeks and folds, as well as in the area under the diaper.

The disease is characterized by a pronounced allergic nature and is associated with manifestations of immune dysfunction, which include food allergies, rhinitis, conjunctivitis, etc.

Lack of proper treatment can result in the development of severe forms of the disease. Also, neglect of qualified help threatens atopic march - a condition in which the disease “marches” throughout the baby’s body. This aggravates existing diseases and provokes the emergence of new ones. Contrary to misconceptions, atopic dermatitis in children does not go away with age.

Symptoms of atopic dermatitis in children

Symptoms of the disease depend on age. In this case, three phases are distinguished: infant, child and adult. The following symptoms are characteristic of each phase:

• symmetrical inflammation and redness
• dry skin that cannot be eliminated with cream
• severe itching causing discomfort

The disease has a direct connection with dysfunction of the epidermis. It is characterized by alternating periods of exacerbation with remissions. And, as a rule, in winter the situation worsens, and with the onset of the warm season, improvement is observed.

Stages of atopic dermatitis in children

There are two stages of the disease in accordance with the nature of the course, namely:

• acute - the skin becomes covered with rough red spots and papules, and crusts also appear, swelling is observed
• chronic - pigmentation on the skin of the eyelids increases, cracks form on the palms and soles, which is accompanied by thickening of the skin.

Causes of the disease

Dermatitis has a hereditary predisposition, and the main factor in its occurrence is genetic. If the parents have suffered from the disease, the probability of it developing in the child is about 80%.

In addition, the following causes that affect the mother’s body and fetal development can trigger the appearance of atopic dermatitis:

• unbalanced diet
• exposure to toxic substances
• infectious diseases
• regular stress

Children who have suffered oxygen deprivation or were born prematurely are also especially susceptible to atopic dermatitis.

Diagnosis and treatment of atopic dermatitis

Diagnosis can only be made by a dermatologist. As part of the examination, the specialist prescribes blood tests (general and biochemistry), urine analysis, skin biopsy, etc. In accordance with the research results, an individual treatment plan is prescribed.

Symptoms of ARVI in children:

Flu Symptoms

• acute onset with a sharp rise in temperature to 39-40.5C°
• severe aches in the body and joints
• headache, eye pain
• lethargy, weakness, malaise
• decreased or lack of appetite
• nasal congestion, minor rhinitis, dry cough
• may have a sore throat
• sometimes nausea, vomiting, diarrhea.

ARVI symptoms

• acute onset with an increase in body temperature to 37.5-38.0°C.
• aches in the body and joints
• headache
• lethargy, weakness, malaise
• decreased or lack of appetite
• rare to heavy mucous discharge from the nose, nasal congestion
• cough, dry or wet
• sore throat and discomfort

With ARVI, in most sick children the temperature drops on the 2-3rd day of illness. With the flu, the temperature can last up to 5-7 days. If the temperature does not decrease during the course of the illness, this may indicate a bacterial infection.

Clinical manifestations of ARVI and influenza

• nasopharyngitis - nasal congestion, mucous discharge from the nasal passages, discomfort in the throat in the form of soreness, burning; Mucus may drain down the back of the throat, which can cause a wet cough (nasal congestion, mucus discharge and sore throat can cause the child to become restless, including refusing to eat)
• eustacheitis and otitis media - pain in the ears appears, with some forms of otitis there is a decrease in hearing, with otitis media a high temperature also rises
• Laryngitis is manifested by hoarseness of voice, rough cough, but there is no difficulty breathing
• pharyngitis is characterized by a red throat, namely the back wall of the pharynx and palatine arches; the mucous membrane is loose and edematous; mucus may drain down the back of the throat; with pharyngitis, a dry, obsessive cough is common
• tracheitis is a disease that can cause a strong obsessive cough
• croup syndrome (obstructive laryngotracheitis) is characterized by laryngeal stenosis; this condition is a common occurrence among preschool children with ARVI

Fever due to ARVI and influenza

Fever is a temporary increase in body temperature due to some illness. Fever is one of the symptoms of ARVI and influenza.

High temperature is the body’s protective reaction to a pathogen that has entered the body. Many viruses and bacteria stop reproducing at temperatures above 37-38°C, and the formation of antibodies is also stimulated.

There are “pink” and “white” fever.

For pink fever:

• heat production and heat transfer mechanisms are adjusted correctly
• baby's skin is pink and hot to the touch

For white fever:

• centralization of blood circulation (blood circulation is aimed at preserving the functioning of the heart, lungs, brain) and disruption of blood microcirculation
• limbs are cold, pale
• bluish leather with marble pattern
• "goose pimples"
• chills

Such a course of fever may be unfavorable.3

Diagnosis of colds in children

The most effective diagnosis of all viral diseases among children is timely contact with a pediatrician. The doctor has information about the epidemiological situation in the region, about outbreaks of the circulating virus in kindergartens and schools. It is very important to collect a detailed medical history of the child and obtain information about possible contacts with patients. All of the above factors will help determine the suspected pathogen.

Among children, virological or bacteriological testing is not recommended, since this does not affect treatment tactics. Most often, children quickly recover on their own, which does not require the use of special laboratory diagnostic methods. Exceptions include a rapid influenza test in children with a high fever and a rapid streptococcal test for suspected acute streptococcal tonsillitis.4

A general blood test, a general urinalysis and other laboratory tests are prescribed strictly by a doctor!

High temperature in a child without symptoms

The body temperature of a sick child is usually elevated. Drawing your attention to this well-known truth, I just want to emphasize that if an elevated temperature in a “healthy” child is a reason for serious concern and contact a doctor, then an elevated temperature (or, in other words, fever) in a sick child, examined by a doctor and receiving treatment is a completely normal situation that parents are usually able to cope with themselves (naturally, using medical prescriptions). The danger of a high temperature for a child is significantly exaggerated - stories about how the heart can fail and many other horror stories are related not to medicine, but to folklore. However, certain medical problems may indeed be associated with high fever. The first (and most common) of them is the poor health of a child with a fever. Indeed, although children usually tolerate fever more easily than adults, prolonged fever can worsen a child's mood, sleep and appetite. Another problem is high fever in children with vomiting or diarrhea: in such children the main danger is the risk of dehydration, and against the background of high temperature, fluid losses associated with breathing significantly increase (fluid is spent on humidifying the exhaled air). The third problem (relatively rare) is the problem of febrile seizures (ie seizures associated with high fever).

Indeed, some children may develop a seizure due to high fever. However, this problem is not as terrible as it might seem - firstly, an attack of febrile convulsions is always short, goes away on its own and never causes serious complications, secondly, febrile convulsions do not occur in children over three years of age, thirdly, if Your child has already been sick with a high fever and no convulsions, this problem has nothing to do with him at all.

Is the degree of temperature increase an absolute criterion for the severity of a child’s condition? Of course not - a normal uncomplicated acute respiratory viral infection can be accompanied by a temperature above 39º, while many serious and dangerous diseases can occur with a moderately elevated or even normal temperature.

Treatment of colds in children

The main method of treating ARVI and influenza in children is symptomatic therapy, that is, therapy that reduces certain symptoms such as high fever, cough, runny nose, sore throat:5

• taking antipyretics
• vasoconstrictor nasal drops
• rinsing the nose with saline solution
• gargling with antiseptic solutions
• local therapy in the form of sprays and tablets for sore throat (different formulations for different ages)
• physical methods to reduce temperature

In case of high fever, it is necessary to undress the child, remove excess blankets, and clothing should not make breathing difficult. It is also necessary to provide access to fresh air whenever possible. If necessary, wiping with water at room temperature is carried out, since wiping with water improves heat transfer. It is strongly not recommended to wipe a child with alcohol, as alcohol may be absorbed (especially in young children) and poison the child’s body.

Antiviral therapy is applicable only for influenza, but in children antiviral drugs are prescribed strictly by a pediatrician!

Antibacterial therapy is prescribed strictly according to indications. Antibiotics are justified only for severe bacterial complications, including ARVI and influenza. Antibiotics do not work against the virus!

General therapeutic measures:

• The child’s nutrition should be complete and rich in vitamins
• the child should drink enough liquid (water, tea with lemon, decoctions of rose hips, raspberries, black currants, strawberries, cranberries, lingonberries), since drinking plenty of fluids prevents dehydration and reduces intoxication at high temperatures
• bed rest
• ventilation of premises
• wet cleaning of premises

An increase in body temperature within 38-39°C does not require the use of antipyretic drugs. In this case, you can limit yourself to physical cooling methods. But age up to 2 months, severe diseases of the respiratory system, circulatory system, central nervous system, history of febrile convulsions are indications for the use of antipyretics, even if the temperature rises to 38°C.

In any case, the mother should first assess the child’s reaction to the increase in temperature by analyzing his behavior: is there lethargy, does the child refuse water and drink, what color is his skin and how does it feel to the touch. If the child is active, the skin is pink, and the limbs are warm, then you can limit yourself to physical methods of reducing the temperature. If white fever appears, then antipyretic medications should be given to the child immediately.

Despite a number of effective antipyretic drugs, paracetamol and ibuprofen remain the best drugs for children.

How to reduce a child's fever

Do you need to deal with high fever? If yes, how should this be done? The answer to these questions depends not only on the specific temperature numbers, but also on the characteristics of your child, on the nature of the disease that caused the increase in temperature and many other factors known only to you and your pediatrician (the author of this article does not know your child). In any case, the prescriptions of a doctor who examined the child will be much more valuable than any correspondence recommendations. However, you may find yourself in a situation where emergency medical consultation is not possible. To do this, you don’t have to go to a desert island - it’s enough to be in the compartment of a long-distance train or in a garden plot with your mobile phone turned off. In addition, knowledge of the rational principles of reducing temperature will help you correctly assemble a home first aid kit: medical recommendations, expressed orally or written down on paper, do not have an independent antipyretic effect, and you still need to get to the nearest pharmacy on duty. In most cases, a temperature below 38º is not dangerous, does not affect the child’s well-being and does not need to be reduced. The desire of parents to achieve a normal temperature in a sick child is completely unjustified - it’s not even that this turns off one of the natural factors of the body’s resistance, it’s just that the unnecessary use of antipyretic drugs is undesirable, because There are no absolutely safe and harmless medications. Temperatures above 38º should be reduced if the child does not tolerate it well (he often does so). Temperatures above 39º certainly need to be lowered, but you will still have to use antipyretic drugs, so I will have to tell you more about them.

When you look at a pharmacy shelf labeled “antipyretics,” you will be surprised by the number of bottles and boxes with different names. In fact, this variety is apparent - the fact is that the name on the package is a trade name and does not reflect the composition of the drug. So, for example, PANADOL, EFFERALGAN, TYLENOL, CALPOL, DALERON, PARAMOSHA, CEFEKON D (all these drugs are found in our pharmacies) are ordinary paracetamol. While abroad, you can find the same paracetamol under the names DOLIPRAN, ALVEDON, PARAMOL and others (by the way, you should not expect that the local doctor will explain everything in detail - in many countries this is simply not accepted). Only good eyesight will help you understand this confusion - the fact is that each package must have the international name of the drug written in small letters: for paracetamol it will be “paracetamol”, “acetomiphen” or “acetominophen”. Today, paracetamol is the most common antipyretic drug for children. The use of paracetamol in normal doses is harmless for most children, however, if your child suffers from chronic liver disease, has suffered hepatitis or prolonged jaundice of newborns, this drug should not be used without consulting a doctor. Allergic reactions to paracetamol are rare; much more often the child reacts to dyes and taste-improving substances included in paracetamol preparations for children. Therefore, if a child develops a rash after taking Panadol, it makes sense to try Efferalgan or Tylenol - perhaps everything will be fine. NUROFEN FOR CHILDREN is an antipyretic drug based on ibuprofen (abroad, look for the word “ibuprofen” on the packaging). In terms of its antipyretic effect, ibuprofen differs little from paracetamol, but it lasts slightly longer. This drug in normal doses is slightly toxic and is widely used in modern pediatrics. Unfortunately, ibuprofen preparations are only available for oral administration; rectal suppositories based on it are not produced. Just remember that ibuprofen is not approved for children weighing less than 5 kg. In addition, ibuprofen should not be used if the child has ever had a decrease in the number of white blood cells in the peripheral blood. Acetylsalicylic acid (ASPIRIN) is one of the oldest antipyretic drugs. However, today this drug is prohibited for use under 15 years of age - age-related metabolic characteristics cause a higher toxicity of this drug specifically for children. The use of aspirin is especially dangerous in children of the first two years of life, as well as those suffering from bronchial asthma or prone to nosebleeds. ANALGIN (international name - metamizole) is a very effective antipyretic drug. A feature of this drug is the rapid onset of the antipyretic effect (especially when administered intramuscularly), but the duration of this effect is short. In many countries, this drug is not approved for use - with long-term and frequent use, analgin can disrupt hematopoiesis, leading to a decrease in the number of leukocytes. In Russia, this drug is used mainly as an emergency treatment - leukopenia (decrease in the number of white blood cells) - a very rare complication and practically does not occur with occasional use of analgin. Conclusions: firstly, analgin can be used in children, but only as an additional antipyretic drug; secondly, if you plan to use analgin when traveling abroad, you will have to take it with you. An additional argument in favor of using analgin is the following consideration: if you fail to reduce the temperature to acceptable levels using paracetamol, you will have to call emergency help, whose doctor will certainly help your child by injecting the same analgin intramuscularly. Of course, analgin should not be used in children with leukopenia of any origin.

How to use antipyretic drugs?

Most of them are available in child-friendly forms - fruit-flavored syrups. However, if your child suffers from food allergies, it may be better to separate, crush into powder and give the child part of the tablet with a little water - this way you will avoid the risk of allergic reactions to dyes and flavorings. We should not forget that in addition to the mouth, the child also has other physiological openings suitable for administering medications - this means the use of rectal suppositories. Most antipyretic drugs are available in suppositories of various dosages. If only suppositories with too large a dose of the drug are available, they are treated in the same way as with tablets - the required part of the suppository (naturally, the front, pointed one) is separated with a knife and inserted into the anus, not forgetting to first lubricate the anus with baby cream , or the candle itself. What is preferable, mouth or butt? There are no fundamental differences in the action of the drug or the rate of absorption, choose what is more convenient for you.

How often can antipyretic drugs be used?

It is recommended to take paracetamol no more than four times a day, however, if necessary, the interval between doses can be reduced to four hours. Analgin and ibuprofen (Nurofen) should not be taken more than three times a day. How to calculate the dose of an antipyretic drug? You shouldn’t do this yourself; a child’s illness is not the best time for mathematical exercises; you should consult your doctor in advance. Of course, each package of antipyretic medication contains a leaflet with dosage instructions, but these instructions do not take into account the characteristics of your child. By the way, in these leaflets there is often an instruction that completely disorients parents: “It is not recommended to take the drug for more than three days” - you can safely ignore this instruction. It is intended for countries where it is not customary to show the child to the doctor in the first days of the disease, and has the following meaning - if after three days of self-treatment the temperature has not become normal, you should stop doing it yourself and show the baby to the pediatrician.

What to do if four hours have not yet passed, and the temperature begins to rise again and exceeds 38º?

In this case, your child will benefit from wiping with water at room temperature. With a large piece of cotton wool soaked in the mixture, you should (like a brush) moisten the entire skin of the child from neck to heels, while it is advisable to cover the perineum, and the axillary and groin areas (locations of large vessels) should be treated several times. After wiping the child, you must leave it open for 1-2 minutes, after which you can gently blot it. Properly performed wiping acts quickly and effectively, but this effect is quite short-lived. It's not scary, because... Rubbing can be done as often as you like. But against the background of severe chills, pallor, cold feet (signs of a pale fever), you should not wipe yourself off; first you need to turn the pale fever into pink, about which a little later.

What to do if antipyretic drugs do not help?

The fact is that elevated temperature (fever) in children can occur in two variants: pink fever and pale fever. When a child has pink fever, the skin looks brighter than a healthy person, it feels hot to the touch, including on the hands and feet; in children older than one year, pink fever is usually accompanied by increased sweating. With pink fever there is no disturbance in heat transfer, so taking antipyretics is usually effective. With pale fever, usually only the head and natural folds remain hot; the feet or hands may be especially cold. The skin is pale or marbled (i.e., with uneven coloring). Chills and goose bumps are also signs of pale fever. The causes of this condition are spasm of the skin blood vessels, the consequences are impaired heat transfer, the inability to determine the temperature “by touch”, lack of response to conventional antipyretic drugs and rubbing. Pale fever is a very unpleasant condition: vascular spasm is not limited to the skin, but blood circulation in the tissues is disrupted, pathological changes in metabolism increase, and the acid-base balance is disturbed. Therefore, the first priority for pale fever is the elimination of vascular spasm, i.e. conversion of pale fever to pink. This can be achieved by using vasodilating drugs - NO-SHPA tablets or PAPAVERINA suppositories (by the way, you won’t find NO-SHPU abroad either, take it with you). You can mask the disgustingly bitter taste of NO-SHPA by giving it in one spoon with antipyretic syrup. An additional measure to eliminate vascular spasm is warming the feet. There is no need to be afraid of this procedure - a heating pad applied to the feet will not lead to an additional increase in temperature; by relieving vascular spasm and improving heat transfer, the temperature can only decrease. Under no circumstances (despite the chill) should you wrap your child warmly - this will further worsen heat transfer. In general, the ideal clothing for a feverish child is his own skin plus woolen socks.

What should you do if you are not sure whether your child has signs of fever?

In this case, follow a very simple rule - it is better to give vasodilators when they are not needed (these drugs are practically harmless in age-related doses) than to skip them when they are needed. By the way, a fever above 39º should always be considered pale (without disturbances in heat transfer, the temperature simply will not rise to such figures). All of the above recommendations can be presented in the form of a short diagram, which can be conveniently rewritten and placed in a children's first aid kit.

SCHEME OF APPLICATION OF ANTIBREAKER AND VASUDODILATORS DRUGS AT HIGH TEMPERATURE IN CHILDREN.

1. Temperature below 38º - does not need to be reduced.

2. Temperature 38 - 39º

2.1 PINK FEVER Signs: pink skin, warm feet, no chills. Medicines: PARACETAMOL or NUROFEN

2.2 PALE FEVER Signs: pale or marbled skin, cold feet, chills or goose bumps. Medicines: PARACETAMOL or NUROFEN + NO-SPA or PAPAVERINE

3. Temperature above 39º Medicines: PARACETAMOL or NUROFEN + NO-SPA or PAPAVERINE + ANALGIN

Note: this scheme cannot be used if: 1. The child is under three months old. 2. The child suffers from a serious chronic illness. 3. The child has a history of unusual reactions to one of the recommended medications. 4. There are contraindications to the use of one of the recommended drugs. 5. The attending physician has prescribed a different procedure for using medications.

What to do if, despite following all the recommendations, the thermometer does not fall below 39º or signs of vascular spasm (pale fever) persist?

In this case, you will still have to call emergency help . An emergency examination by a doctor in this situation is absolutely necessary - perhaps it’s time to change something in the treatment regimen.

In conclusion, I would like to provide an approximate list of antipyretic drugs for your home medicine cabinet. You should complete your first aid kit in advance - children often get sick at the most inopportune moment, when there is no time and no one to run to the pharmacy.

1. Any syrup with PARACETAMOL or NUROFEN FOR CHILDREN. 2. Suppositories with PARACETAMOL or IBUPROFEN in the dose recommended by the attending physician. 3. NO-SPA tablets 40 mg. 4. Suppositories PAPAVERINE 20 mg. 5. Tablets ANALGIN 500 mg. 6. Emergency phone number.

Kanter M.I. Pediatrician of the highest category

What should not be done in case of acute respiratory viral infections and influenza in a child?

• 1. Since antipyretics are prescribed according to the child’s age, as a rule, the dosage is adjusted according to the child’s weight. Long-term regular use (2-4 times a day) of antipyretics should be avoided due to the danger of side effects and possible difficulty in diagnosing bacterial complications (otitis media, pneumonia, etc.). A repeat dose should be given only when the temperature rises again. If the temperature does not decrease within several hours, you must call an ambulance.
• 2. A child with a fever should not be wrapped. If you dress your child warmly, you can disrupt the process of heat formation and heat transfer, which helps maintain the desired body temperature. Wrapping up can lead to overheating and loss of consciousness.
• 3. You cannot close the windows in the room. A sick child needs fresh air. Frequent ventilation also makes breathing easier.
• 4. You should not take antibiotics without a reason. Antibiotics do not act on viruses and do not prevent bacterial complications.
• 5. You should not use cough medications yourself. Different medications are aimed at treating specific cough problems. Not everyone is prescribed antitussives or mucolytics. Moreover, most often such drugs are not needed in treatment. Everything is individual and the use of such medications should be agreed with the pediatrician.
• 6. You cannot give up walking for several weeks. Short walks will only be beneficial. The child needs fresh air and movement. Of course, walks are justified only after the fever has decreased and the condition has normalized, if the child is active.
• 7. It is not entirely justified to refuse bath procedures during an acute respiratory viral infection for several days or weeks. On the contrary, a child can swim. Exceptions are, of course, high fever and otitis media.
• 8. In relation to the child, any methods of self-medication should be excluded.

All therapeutic measures are carried out only as prescribed and under the supervision of a doctor.

Questions and answers - Temperature in a child

Izyakov Dmitry Nikolaevich

Pediatrician

April 25, 2021

In 2015, in the series of clinical recommendations of the Union of Pediatricians of Russia, the collection “Feverish Child” was published. Diagnostic and treatment protocols." It revises some points regarding the actions of doctors and parents when the temperature rises in children with various diseases. In this article, I tried to collect answers to the most frequently asked questions by parents, taking into account modern recommendations and practical experience.

What temperature is a reason to panic?

What you don't need is panic. According to modern data, only temperatures above 40 degrees can harm children with chronic diseases.

Initially healthy children tolerate high fever without health consequences. A healthy child is simply not able to heat himself up to dangerous levels. But it can be heated this way from the outside, by wrong actions. For example, with a normal fever, cover with a blanket when the air temperature in the room is above 22°C. But this is no longer a fever, but hyperthermia, a condition in which you need to call an ambulance. The main difference is that antipyretics and rubdowns do not help.

But does a high temperature indicate a dangerous disease?

In children, it is not the thermometer numbers that indicate danger. It is not the temperature that is dangerous, but the disease that caused it. A high temperature can also occur with an uncomplicated acute respiratory viral infection, which will subside in 2-3 days. Or in case of a safe childhood infection - sudden exanthema, also called: roseola, three-day fever, temperature is often 40-41°C. And with a dangerous disease, meningitis, it can often not exceed 39.5. There are also dangerous diseases accompanied by fever. This is what requires calling an ambulance:

• age up to 3 months
• the appearance, along with cold hands and feet, of a “marble” pattern on “goose bumps”
• absence of visible signs of illness, except for elevated temperature in a child under 3 years of age
• maintaining a temperature above 38.5 on the 4th day of illness with the appearance of rapid breathing
• skin rash that does not blanching when pressed with a finger
• inability to press the chin to the chest and/or bulging fontanelle
• abdominal pain
• pain in the legs and/or arms
• the temperature 2 hours after taking the antipyretic drug became higher, this is a sign of overheating - hyperthermia.

What about cramps?

They are observed in approximately four children out of a hundred and do not directly depend on the height of the temperature rise. In addition, they are not hazardous to health, although they undoubtedly frighten parents very much. Help for febrile seizures is to turn your head to the side and provide access to fresh air. All necessary medications are administered by an ambulance doctor, who must be called and met by another adult.

And is there really nothing dangerous about high temperatures?

Yes, this is dehydration - loss of fluid due to evaporation through breathing and sweat. When a child has a fever, it is difficult to persuade a child to drink, but it is at this moment that he needs it.

What about cold hands and feet?

Most often, this is a short-term phenomenon that does not require medical intervention and does not pose a threat to health.

How much do you need to lower the temperature?

1-1.5 degrees is enough, because only by raising the temperature does the child’s body fight infection.

At what thermometer readings should antipyretics be given?

I give general recommendations; you need to consult with the doctor who is treating your particular child.

• In children under 3 months of age - from 38°C
• In children older than 3 months who do not have chronic diseases - from 39°C
• In children with diseases of the brain, heart and lungs - from 38.5°C

Are these numbers the only basis?

No. The numbers on the thermometer do not matter when starting to take an antipyretic if the child:

• does not tolerate high temperatures very well, behaves restlessly
• has a “marbled” pattern on pale “goose bumps”
• trembles, he gets chills

What medications should I use?

Only based on ibuprofen and paracetamol, the names of the active substance are always indicated on the packaging under the antipyretic brand.

Why don't they help?

The most common reason is incorrect dosage, calculating the dose based on the child’s age and not on the weight of the child. The second common cause is dehydration. Third - the child is dressed too warmly, covered, the room is warm.

What dose should I give?

The most popular antipyretic based on ibuprofen is “Nurofen for children” in the form of syrup. You need to divide the child's weight in kilograms in half. For example, if the weight is 10 kg, then 10:2 = 5 ml of children's Nurofen and should be given to him. This dose can be repeated no earlier than 8 hours have passed.

The most successful antipyretic in terms of release form is “Efferalgan” syrup for children with the active ingredient paracetamol. Its measuring spoon allows you to take the dose of medicine directly by weight, without calculating it in mg.

All other drugs “Panadol”, “Calpol”, “Paracetamol” syrup, etc. require mathematical operations, multiplying the weight by 0.6. For example, if a child weighs 10 kg, then 10 * 0.6 = 6 ml of Panadol should be given. This dose can be repeated after 6 hours.

Is it possible to alternate them?

It is possible, but at least 2 hours should pass between taking paracetamol and ibuprofen. If taken together, there is a risk of kidney damage.

Why not other medications for fever?

Medical studies have not revealed any real benefits from other drugs, but they have identified the harm of each:

• “No-spa” has no effect on cold hands and feet, but it has a list of side effects.
• "Analgin" is dangerous for the development of loss of consciousness and should not be used by parents without the presence of ambulance and emergency services workers.
• Nise caused liver damage in one of the 250 patients who took it
• Aspirin can cause liver and brain damage in children

How much fluid do you need to drink to reduce your temperature?

For every kilogram of weight, a child needs to drink 4 ml per hour. That is, if a child weighs 10 kg, then every hour he should drink at least 10 * 4 = 40 ml.

Is it possible to wipe?

After taking an antipyretic, you can wipe with water at a temperature 1-2 degrees lower than the child’s body temperature. That is, if it is 40 °C, then the water temperature should be 38-39 °C. You need to wipe all areas of the skin that are hot to the touch, leaving them wet until dry. Then measure the temperature again. A decrease of 1-1.5 degrees is enough to stop the procedure.

What to do with cold hands and feet?

They need to be carefully warmed, gently rubbing until the skin becomes slightly red, using wool, a terry towel, or just your palms.

How long to expect the effect of antipyretic and rubdown?

Two hours. If the temperature has not decreased, then a second antipyretic should be given, and rubbing and drinking should continue for another 2 hours. If the temperature has not decreased and/or has increased, call an ambulance.

How can the ambulance help?

Assess the child’s condition and determine whether hospitalization is necessary in this case. Provide assistance by injecting medications and medical methods to reduce the child’s temperature. It is for fever, in fact, it is needed in a very small percentage of cases, the ineffectiveness of antipyretics associated with hyperthermia - a condition complicating fever, when the child is not able to give off body heat.

How to measure temperature correctly?

Measuring armpit temperature with a mercury glass thermometer in children has already been recognized as the least preferable due to the danger of breaking it. It was replaced by electronic and infrared thermometers. Few people know, but to obtain a result comparable to a mercury thermometer, the electronic one must be under the armpit for the same time. That is, 5 minutes if the child was at room temperature. And 10 minutes if it was at a lower temperature before measurement.

Why do electronic thermometers show lower temperatures?

The reasons are clear: loose pressure, measurement less than 5 minutes, sweat, spasm of skin blood vessels, low battery, lack of factory settings for measuring skin temperature. These thermometers can be used subject to correction. To do this, an adult without a fever puts an electronic one under one armpit and a mercury one under the other. Measures 5 minutes and compares. For example, we received 35.6 and 36.6, respectively. In subsequent electronic measurements you will add 1 degree.

Which thermometer is better?

The temple area has a temperature equal to the axillary one. To measure it, infrared thermometers are used. This is the most optimal method for parents today. For proper use, you need much fewer subtleties: wipe the sweat from your temple, remove your hair, hold it at the correct distance (indicated in the instructions), change the battery on time, set up to measure the temperature of the temporal region (also written in the instructions). The use of other thermometers: nipple, ear, forehead strips is fraught with measurement errors in the direction of underestimation or false increase.

How often should I measure my temperature?

A child with a fever needs temperature control:

• every 6 hours unless antipyretics are required
• every 4 hours when used effectively
• every 2 hours if use is ineffective.

For a child with normal temperature, but with an acute illness, measure every 12 hours in the evening. For a healthy child at risk of an acute illness due to contact or an increase in temperature for vaccination, according to the condition, for control, measure once a day, in the evening. Healthy children without risk of illness do not need it.