MANAGEMENT OF

FEVER
Penny McDougall, Senior sister, Paediatric Unit,
Queen Alexandra Hospital, Portsmouth.
Maureen Harrison, Senior lecturer, Faculty of
Health Sciences, University of Southampton.

OBJECTIVES OF THE STUDY

Understand the fever process in children.
Describe the sympathetic and
parasympathetic nervous systems response
to fever in children.
Identify serious illness in children with fever.
Outline different ways of managing children
with fever in hospital and at home.
Discuss the importance of providing advice
to parents and carers of children with fever.

NORMAL BODY TEMPERATURE AND

SLEEP
The suprachiasmatic nucleus located
in the anterior hypothalamus of the
brain, is the main control for
circadian rhythms (Weaver 1998). It
is found close to the optic chiasm
and is known to respond to light and
dark.
Core body temperature is controlled
by the thermoregulatory centre in
the pre-optic anterior hypothalamus.

RELATION BETWEEN circadian body

temperature and circadian sleep-wake cycle
Increase in
peripheral body
temp
Vasodialation
Warms the skin

Induce sleepiness

Decrease in
peripheral body temp
Vasoconstriction
Core body temp rise

REM increase
Alert and awake

FEVER
NICE (2013) defines fever as an
elevation of body temperature
above the normal daily variation.
In practice, it is generally accepted
that fever is characterized by a
body temperature of above 37.2C
(axillary), 37.5C (oral), or 38C
(rectal and tympanic) (British
Medical Journal 2013, Ward 2013).

PATHOPHYSIOLOGY
Attack
Come in contact with the
immune cells
Release of cytokines(IL1beta, IL-6, TNFalpha,INF-alpha)
Stimulates production of
CRP and serum amyloid
protein from liver
Trigger neuroendocrine
response

prostaglandin E2
(PGE2) from the
breakdown
of arachidonic acid
and
cyclooxygenase-2.
PGE2activates the
thermoregulatory
centre by increasing
the normal circadian
temperature

Sympathetic nervous system

Release adrenalin and noradrenaline
Increase in pulse and respiratory rate and
peripheral vasoconstriction
Conserves heat
Decreases the activity of digestive tract
Curls up, shivers, sleepy, pale mottled skin,
reluctant to eat and drink

Clinical assessment of fever

ANOREXIA, POOR FEEDING AND

HYDRATION

Response of sympathetic nervous system

Inhibited gastric emptying

Impaired intestinal absorption

Anorexia , vomiting

Limits the availability of Fe, Zn, Mn to

pathogens

Sleep and rest

Inflammatory response
Concentration of cytokines increase(IL1 beta, TNF alpha)
Modulate REM and promote non REM

MANAGEMENT OF FEVER IN CHILDREN

Safety advice for parents and carers

To detect the child is unwell

Offer the child regular fluids
Encourage the child to drink more
Do not undress or overwrap the child
Use antipyretics appropriately
Look for signs of non blanching rash
Check the child during night
Keep the child away from school

PARENTS SHOULD SEEK

ADVICE IF

The child has a fit

Develops a non blanching rash
Parent feels the child is less well
Fever lasts longer than 5 days
Parents are unable look after the
child

Main recommendation for use of

antipyretics in children
Children with fever who appear
distressed
When using paracetamol or
ibuprofen in children with fever
o Continue only as long as the child is
distressed
o Consider changing to other agents if
not releived
o Do not give the drugs simultaneously

THANK YOU