Exploring the challenges of managing pediatric fever and differentiating serious illnesses from self-limiting ones. Discussing fever thresholds, febrile seizures, Kawasaki disease, pediatric dehydration, and dispelling myths about fever reduction in children. Highlighting the importance of proper assessment and management by pediatric specialists.
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insights INSIGHT
Fever Is A Regulated, Helpful Response
Fever is a regulated rise in core temperature driven by a raised hypothalamic set point via pyrogens and PGE2.
Fever usually helps fight pathogens by slowing replication and boosting immune responses.
insights INSIGHT
High Volume, Low Seriousness Overall
Fever is extremely common in children but serious bacterial infection prevalence is low in primary care (<1%).
ED prevalence of serious illness can be higher, so context and setting matter for risk.
insights INSIGHT
How Pyrogens Raise Temperature
Pyrogens (exogenous and endogenous) raise the hypothalamic set point via PGE2 produced by COX-2, causing shivering and vasoconstriction.
Paracetamol and ibuprofen lower fever by inhibiting cyclooxygenase and reducing PGE2 production.
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Fever is an incredibly effective mechanism to fight off pathogens.
Clearly, whilst many illnesses that cause a fever don't require anything more than the body's natural response, there are some patients in which a fever might represent a serious illness. Differentiating those serious illnesses from self-limiting presentations can be tricky at times, but can also be anxiety provoking for clinicians and parents, or carers of that child.
In children the limited communication can make the diagnostic challenge of the origin of the fever a real challenge, along with the added difficult of gaining some tests. Differentiating those with a benign disease from those with a life threatening presentation can be a daunting challenge.
The numbers of presentations to healthcare providers are staggering. Paediatric fever has been reported to represent as high as 15-25% of all presentations in primary care and emergency departments, so massive numbers. Thankfully the prevalence of serious infections in children is low and is estimated at <1% in primary care settings in industrialised countries, although it has been suggested that for ED attendances the prevalence of serious illness could be as high as 25%.
So we thought with this common but tricky presentation that it was about time we tackled the topic. We'll be running through;
A definition
Patholphysiology
Relevance of the severity of the fever
Febrile seizures
Clinical assessment
NICE guidelines
Duration of fever
Management
Antipyretics
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
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