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Suppositories or not ?: Correctly assess fever in children


ZEIT ONLINE | News, backgrounds and debates

Oranienburg (dpa / tmn) - fever is a constant companion for small children - and a trouble spot for parents. When do you give a suppository, when is a visit to the doctor advisable? Expert Ulrich Fegeler from the professional association of pediatricians knows the answers.

Why do children feverish and when do you give medication?

Fever itself is not bad, emphasizes the pediatrician. Especially in early childhood, it is an important and typical, non-specific defense reaction of the body. Similar to the strong mucus formation in the nose in small children, which prevents pathogens from coming to the mucous membranes and attacking them.

Infection is often the cause of fever in children. "The fever is the physical response to this aggressor," explains Fegeler. The body heats up because certain parts of the immune system are brought to their functional optimum temperature - certain cell fractions "then destroy foreign attackers particularly well," he explains.

In this respect, suppositories can actually be counterproductive for fighting the pathogen. Lowering the fever deprives the body of a certain part of the immune system, says Fegeler. However: "Beyond 39.5 degrees, children often buckle so that medication should be given to improve their condition." As an alternative to suppositories, this could be “fever juice”.

The general condition of the child is decisive for the medication, not the elevated temperature. "Children can usually compensate for fever with their cardiovascular system - unlike in older age, where fever can strain the heart," says Fegeler.

When is it time to see a doctor?

There are clear rules here, especially for infants. In principle, however, according to Fegeler, parents should always go to the doctor if they are unsure and have questions. "They usually come with trifles, but they can't know that." Over time, they would become more confident in assessing the clinical picture, which would lead to greater sensitivity and serenity, especially in children born to second and third children.

In general, fever within the first three months of life is always an immediate case for the pediatrician, because at this age very unpleasant illnesses could occur. Fegeler also advises that you always have a doctor diagnose fever throughout your first year of life. That means: from 38.5 degrees, measured rectally.

Detached from certain temperature limits, it is always an alarm sign when the child has changed its nature - for example, appears extremely apathetic or does not drink anything. It's better to have this clarified, the doctor advises.

What exactly happens in the body during fever?

Sometimes the temperature goes up and down, sometimes a child's skin glows for several days. It helps to know a little about the processes that take place in the body during fever.

When viruses in the body destroy cells, for example, substances are released that reach the temperature center in the brain via the blood and set a higher target value there than the regular 37 degrees, as Fegeler explains. That is why muscle activity is increased, which produces a lot of warmth - the famous fever tremor sets in. "In principle, chills are a maximum muscular effort to produce warmth."

In this high-regulation phase, the children shiver rather - you have to pack them warm and cover them, the pediatrician says.

If the target temperature is reached or the stimuli at the temperature center have decreased, it regulates down again. Then the vascular periphery is opened, in particular the skin is massively flowed through. The body becomes hot and sweats. This is usually the down-regulation phase. If the viruses become active again and destroy cells, the process starts all over again. This leads to the often typical wave-like fever.

However, there are pathogens that destroy cells in constant numbers. In this case, the fever never really goes down because the brain is stimulated again and again. One example is the three-day fever, in which the children have a long fever of around 40 degrees and the temperature can hardly be reduced with medication, as Fegeler says.

"Usually, after around three to four days, the child has produced enough antibodies to catch the pathogens in the blood before they attack new cells - then it deflows." The so-called immune complexes, i.e. antibodies and pathogens, which are bound to one another, can deposit on the vascular membranes and can then cause a rash as an externally recognizable phenomenon together with the fever.

Source: zeit

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