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Adapted IMNCI fever 2020
1. Adapted
A practical approach to the child with
Fever
Background, Assessment and Management
Prof. Imran Iqbal
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
4. Step 1
General Danger Signs
General Danger Signs indicate severe disease
Presence of any one of the General Danger Signs
means that the child needs to be
referred / admitted to the emergency
5. Check for General Danger Signs
• Unable to drink or breastfeed
• Vomiting everything
• Lethargic or unconscious
• Convulsions
• General Danger Signs indicate severity of illness
• Not diagnostic but suggests acuity of situation
11. Case Scenario
• An 8 year old child presents with fever for the last 5 days.
Fever remains high most of the time. On examination, he has
a temperature of 104 F.
• How will you further evaluate this child to make a diagnosis
and decide about management ?
12. How to measure Body Temperature in Children
CORE body temperature
Older Children
• Thermometer in mouth (under the tongue) for ½ minute
Infants & Small Children
• Thermometer in AXILLA for 2 minutes
(Do NOT add anything to the measurement)
Both of these are almost equal and give CORE body temperature
SURFACE body temperature
• Infra Red Thermal device (usually forehead temperature is taken)
• Observer Hand Feeling (back of fingers placed on forehead, abdomen, axilla)
13. FEVER
• Normal Body Temperature = 37 C
Range of Normal = (36.5 C to 37.5 C)
• Normal Body Temperature = 98.6 F
Range of Normal = (97.5 F to 99.5 F)
14. Grading of Fever
• Low Grade Fever 37.5 – 39 C
99.5 – 102.5 F
• High Grade Fever 39 – 40.5 C
102.5 – 105.5 F
• Hyperpyrexia more than 40.5 C
more than 105.5 F
15. Fever in Children
• Children’s forehead is usually warmer than rest of body
• During rising fever trunk will be warm and extremities cold
• During stable fever, whole body will be warm
• Shivering accompanies rapid rise of fever.
• Shivering is not specific for any cause or diagnosis
16. Is fever Beneficial for human body?
• Fever is an important clinical symptom and sign of illness
• During fever, immune function of leukocytes is increased
• More lymphocyte proliferation and cytokine production is seen
• Growth of infectious microorganisms is inhibited (decreased)
17. Harmful effects of fever?
• During fever, Oxygen demands and O2 consumption is
increased
• Hyperpyrexia can compromise cardio-respiratory and
metabolic functions of the body and can damage the brain
• Children are irritable and anorexic during febrile episodes
• Febrile convulsions (fits during sudden rise of fever) can occur
in children below five years of age
18. How will you Evaluate and Manage the child with Fever?
• Initial assessment
• History
• Examination
• Diagnosis
• Investigations if needed
• Management
20. History
• How much Fever was present on day 1, day 2, day 3 ?
(gradual or sudden rise?)
• Does the child have associated symptoms of ?
- cough, breathing problem
- vomiting, diarrhea
- skin rashes
- headache, convulsions / fits
• Does the child have pain anywhere in the body ?
21. History of Contact
• Exanthematous fevers
(measles, mumps, chickenpox etc.)
• ARI
• Diarrhea
• Tuberculosis
36. Management of the Febrile Child
• Symptomatic Management
• Supportive Management
• Specific Management
• Manage Complications
37. Symptomatic Management of the Febrile Child
• Keep exposed
• Antipyretics
Paracetamol = 10 – 15 mg/kg
Ibuprofen = 5 – 10 mg/kg
• Tepid Water Sponging
38. Nutritional Management of the Febrile Child
• Increased fluids
• MAINTAIN CALORIC INTAKE
• Small frequent feeds
• Give usual diet which the child likes. Do not stop roti.
• IV Fluids if frequent vomiting, severe anorexia or hypoglycemia
39. Specific Management of the Febrile Child
• Treat the cause after the diagnosis
• Follow standard treatment guidelines
• Consider focus of infection, possible infecting organisms and
antibiotics effective against the micro-organisms
• Avoid overuse of Antibiotics
• Treat the Complications