LEARNING OUTCOMES

By the end of this section you should be able to:

RATIONALE

The primary aim of reducing an ill child’s temperature is to promote comfort by relieving the discomfort caused by the fever.

FACTORS TO NOTE

Research has indicated that fever has a therapeutic purpose (Holtzclaw 2003, DTB 2008). Fever is caused by the raising of the set point as a result of the initial infection (Purssell 2009). The raising of the set point is thought to be stimulated by the action of protein-like substances, produced by phagocytic white blood cells, on the cells of the hypothalamus. This action causes a release of prostaglandins, which resets the set point or core temperature at a higher level. The resetting of the core temperature may induce shivering and vasoconstriction to enable the body to reach the new temperature even if the body temperature is recorded at a higher than normal level. This will occur until the new set point has been reached (Tortora & Grabowski 2005). The rise in body temperature decreases the level of free serum iron required for bacterial/viral growth, as well as damaging the cell membranes of the microorganisms (O’Connor 2002).

Under normal conditions, body temperature fluctuates throughout the day. The temperature of a child is higher in the late afternoon and early evening. As children have a higher metabolic rate, they tend to have higher body temperatures.

An increase in temperature caused by bacterial, or viral, infection renders the child more prone to febrile seizure (see Ch. 26). The incidence of febrile seizures in children up to age 5 years is thought to be between 3% and 8% (Sadleir & Scheffer 2007). Reducing the temperature of a child may not affect the course of the child’s illness, but may aid in the reduction of parental/carer anxiety (DTB 2008).

In the infant, overheating has been identified as a risk factor for sudden infant death syndrome (Lynch 2004). Infants and young children are highly susceptible to alterations and fluctuations in temperature. Their body temperature is altered not only by the environmental temperature, but also by crying, playing and emotional upset. Body proportions of infants and young children are different from those of the older child or adult, with the head of the infant or young child being larger in proportion to the rest of the body. Consequently, a greater amount of heat can be lost via the head (Wong 1997) (see Ch. 15).

Parental anxiety is increased in situations where their child has an increase in temperature. This often entails that they treat the temperature aggressively and use proprietary ‘over the counter’ preparations inappropriately. It is important that the children’s nurse checks with the parents/carers what they have been giving for their temperature increase (DTB 2008, Purssell 2009).

Measurement of body temperature in children from age 4 weeks to 5 years can be achieved through the use of electronic thermometers, chemical dot thermometers or infra-red tympanic thermometers. For infants <4 weeks, an electronic thermometer applied to the axilla should be used (NICE 2007).