Download The co-existence of pain with fever in young children is common and

childhealth-SM-AM-PG.qxd
17/04/2008
17:28
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Clinical
Burning
up
The co-existence of pain with
fever in young children is
common and is usually a benign
occurrence
WHEN pain and fever occur together they
cause considerable anxiety among parents and carers as there is the possibility
that they may be indicative of a more serious illness.
Assessment
The most important considerations for
pain assessment in infants is taking a history from the parents or carers.
Infant perception and description of
pain can be muddled or confused and
they frequently lack effective communication skills and have difficulty explaining
where exactly their pain is located.
Pointing to where they ‘feel hurt’ can be
relatively straightforward for an infant
when the pain is on the body surface. But
when they refer to ‘a pain in the tummy’ it
may actually reflect pain anywhere on the
inside of their body. This can make assessment of pain complex and thus diagnosis
tricky.
Pain is usually assessed in infants by
physiological measures and by looking
carefully at facial expressions, body movements and vocalisations.
Mild fever
In most cases, fever is benign and is a
sign that the body is fighting off an infection. Treatment is not usually required for
mild fever and simple measures to ensure
the patient remains hydrated and their
body temperature doesn’t rise too much
are recommended.
Fever in children is usually caused by
viral infection and most mild infections
run their course in three to four days.
Reassurance in most cases will alleviate
any parent anxiety about seizures caused
by persistent fever, which in most cases
are harmless. This will have a knock-on
impact in reducing infant anxiety and
improve outcomes.
Pain
Treatment of pain associated with fever
symptoms in infants is limited by the contraindication of many adult medicines in
this patient group.
Parents should seek the advice of a
health professional before they initiate
giving OTC medications, as they are
potent drugs and may exhibit adverse
effects in younger children.
The dose of medication given will
depend on the size of the child and severity of the condition.
Parents should also be advised to stick
to the dose recommended by their health
professional and seek further advice if
necessary, as children at different ages
metabolise drugs at different rates and
adult doses of drug will be toxic to them.
A simple analgesic such as paracetamol
is an effective palliative agent and will alleviate headaches or for example the pain
associated with a sore throat.
An NSAID such as ibuprofen can be
used for pain and fever. Ibuprofen is an
effective pain reliever, is antipyretic and
also reduces symptoms of inflammation
associated with infection.
Ibuprofen is given every six to eight
hours and paracetamol given every four
to six hours so the former is also more
convenient for children at night time.
Aspirin warning
Parents should be reminded that aspirin
is not recommended in infants because of
the risk of Reye’s Syndrome, a potentially
life-threatening illness. Children who have
been given aspirin and may have Reye’s will
be vomiting, lethargic and be more cranky
and vocal than is normal in a sick child.
Serious condition
In rare cases fever that occurs with pain
may be indicative of a medical emergency
and it is important to be vigilant for the
cases that will require prompt treatment
with antibiotics or other management
strategies. Serious underlying conditions
that may have fever and pain together as
presenting symptoms include:
• Meningitis: symptoms can include fever,
severe headaches, pain or stiff neck, characteristic rash, lethargy, photophobia
• Pneumonia: symptoms can include
rapid breathing, fever, abdominal pain,
vomiting
• Appendicitis or abdominal obstruction:
symptoms can include fever, severe
abdominal pain, vomiting bile
• UTI: symptoms can include fever, pain on
urination, increased urgency, abdominal
pain (can be severe)
• Strep throat: symptoms can include
fever, sore throat, sudden onset of
headache or stomach pain, enlarged tonsils and swollen glands
• Severe otitis media: symptoms can
include fever, headaches, earache.
- Conor Caffrey
WIN May 2008 Vol 16 Iss 5
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