Fever in Infants-an Expression of its Inner Turmoil

Abstract: A fever in babies can be one of the scariest symptoms for parents, especially when that fever is high or the baby is onlya few weeks old. There are various causes for infant fevers and what to do when your baby gets a fever is to be given utmost importance. Homoeopathy as an alternative system of medicine which can do good to the child if introduced at the right time according to the principles and defined norms of prescribing remedies in cases of fevers.
Introduction
A fever isn’t an illness – it’s a symptom of the child’s internal derangement. A fever usually indicates that the body is fighting an illness. If your baby has a fever in most instances it means he has picked up a cold or other viral infection. Although they are less common in infants, Pneumonia, Urinary tract infection, Ear infection, or a more serious bacterial infection, Meningitis may be causing a fever.
So, before commencing a description of the most common causes in infants and children it’s important to assess the reason behind the onset of fever. The general management goes hand in hand with the remedy prescription according to set principles of prescription in fever cases.
Normal body Temperature and Sites for Fever Check in Infants
Fever is defined as the controlled increase in body temperature over the normal values for an individual.
RECTAL                 97.9oF   100.4oF
ORAL                     95.9oF   99.5oF
AXILLARY             94.5oF 99.1oF
Fever can be checked with a mercury/digital/electronic/liquid crystal strips in the mouth, axilla, rectum, groin, forehead or tympanic area in infants.
Types of Fevers Commonly Encountered in Infants
1. Intermittent fever: Fever is not constant and characterized by succession of attacks with equal intervals of paroxysms.
2. Interval period of time between one paroxysm to the beginning of the next.
i. Interval is 24 hours quotidian
ii. Interval is 36 hours tertian.
iii. Interval is 72 hours quartan.
3. Septic/hectic fevers: Extremely wide fluctuations are present.
4. Relapsing fever- Characterized by febrile periods that are separated by intervals of normal temperature.
5. Remittent fever -Persistent and varies by more than 0.5oC/24 hr, but never comes to normal.
6. Biphasic fever- A single illness with 2 distinct periods of fever over 1 or more weeks.
7. Periodic fever used narrowly to describe fever with a regular periodicity or more abundantlyto include disorders by recurrent episode of fever that do not follow a strictly periodic pattern.
8. Continuous/sustained fever: Persistent and varies not more than 0.50 C/24hr.
Variations in Temperature
Less than 92.13oF                            -Deep fatal
algid collapse
Less than 96.8oF                               -Collapsetemperatures
93.3-95o F                                           -Algid collapse with great damage with still possibility of recovery.
95-96.8o F                                           –Moderate collapse with no danger.
99.5-100.4o F                                     -Sub febrile temperature
100.4 to 101.4o F                              -Slight febrile action
101.3 o F to102.2o F                        – in morning rising about, 103o F in evening
103.1oF in morning and                 – High fever
above 104.09oF
in evening
107.06o F and above                       -Fatal
Termination except in relapsing fever,
Hyper pyretic temperatures
Advantages of Fever
1. Increased immune response by increased production of interferons, B cell proliferation, and increased bactericidal effect of polymorph nuclear cells.
2. Improves nutrition of cells with protective influence on their activity.
3. Growth and virulence of several bacteria is impaired.
4. Augments hepatic synthesis of acute phase reactants.
Classification of Fever Syndromes
1. Fever with focus.
2. Eg: Otitis media, Respiratory infections
3. Fever without focus.
This term refers to fever of acute onset and short duration less than 1 week, without any localizing symptoms or any clinical signs on physical examination.
Eg: Acute viral fever, Septicemia, vaccine induced fever, Urinary tract infections, Sinusitis, Hyperthermia, Occult bacteremia.
4. Fever with no specific signs
Duration less than 2 weeks
Clinical manifestations maybe Hepatomegaly, Jaundice Splenomegaly, Rash, Lymphadenopathy.
5. Fever complicating chronic illness
A child who has fever persisting for over 2 weeks may have a chronic disease to be investigated.
Eg: Childhood tuberculosis may present in the similar way.
6. Recurrent fever.
The fever presenting with the episodes separated by days or weeks.
Eg: RTI, Relapsing fever, Dengue fever, Lymphomas.
What Causes Infant Fevers?
The various causes of fever in babies include:
1. Reaction to a vaccination.
2. Becoming overheated from being dressed too warmly or spending too much time outside on a hot day. The rule of the thumb is to dress your baby in just one more layer of clothing in which he is comfortable.
3. Dehydration is one among them known as the inanition fever which can be seen in newborns due to milk deprivation and can be corrected by a wet nurse or other milk supplements.
4. Most commonly, fever is caused by an infection such as a viral or bacterial or by the specific or non specific causes mentioned above.
5. Febrile convulsions in Infants are common at temperatures more than 40 degree Celsius. It may not be a sign of cerebral disease. It is a manifestation in Hyperpyrexia in children below 5 years of age.
Fever in Babies: What are the Signs?
One common sign of fever in babies is a warm forehead, although not having a warm forehead doesn’t mean that your baby doesn’t have a fever. Your baby may also be crankier and fussier than usual.
Other symptoms associated with fever in babies include:
1. Poor sleeping
2. Poor eating
3. Lack of interest in play
4. Less active or even lethargic
5. Convulsion or seizures
6. Stiff neck
Supportive Therapy
1. Remove excess clothing/ blankets
2. Keep the child in well ventilated room
3. Encourage to take extra fluids
4. Discourage vigorous activities
5. Tepid sponging
6. Rapid cooling method such as ice baths, alcohol, rub down and cool water enemas should be avoided.
Homoeopathic Aspects of Fever from Organon of Medicine
The 5th edition of Organon of Medicine presents brief and detailed evaluations regarding the intermittent fevers. The references about fevers have been made in the Aphorisms 235-246.
Aphorism 235: With regard to intermittent fevers that prevail sporadically or epidemically we often find every paroxysm-likewise composed of two opposite alternating states more frequently still of three (cold, heat, sweat). Therefore the remedy selected for them must be able to produce in the healthy body two (or all three) similar alternating states or else correspond by similarity of symptoms.
Aphorism 236: The appropriate and most efficacious time for administrating the medicine in these cases is immediately or very soon after the termination of the paroxysm, as soon as the patient has in some degree recovered from its effects; it has then time to effect all the changes in the organism required for restoration of the health, without any great disturbance or violent commotion.
Aphorism 237: But if the stage of the pyrexia is very short, as happens in some bad fevers…..the dose of the homoeopathic medicine should be administered when the perspiration begins to abate to the other subsequent phenomena of expiring paroxysm begins to diminish.
Aphorism 238: It is only when the suitable medicine has with a single dose destroyed several fits and manifest health has ensued, but after sometime indications of a new paroxysm appear, only then can and must the same medicine be again given, provided always the totality of the symptoms is still the same.
Aphorism 242: If however, in such an epidemic intermittent fever the first paroxysm have been left uncured, or if the patients have been weakened by improper allopathic treatment; then the inherent Psora that exists; alas! In so many persons, although in a latent state, becomes developed, takes on the type of the intermittent fever….so that the medicine which would have been useful in the first paroxysm, is now no longer suitable and cannot be of any service. We have now to do with a Psoric Intermittent fever only, and this will be subdued by minute or rarely repeated doses of Sulphuris or Hepar sulph in high potency.
Case
Mast H, 8 months old male child came with the complaint of fever, bilateral ear pain and discharge since 3 days.
History of Present Complaint
Child had bilateral ear pain and itching with yellowish offensive discharge since 3 days. The complaints started with the weather change as the winter season had set in. He also had fever and coryza for which he was given allopathic medications but was not relieved. There was thick, whitish nasal discharge. He was cranky since the complaints started and was rubbing both ears according to the mother.
Physical Generals
Perspiration –N
Appetite – Good
Thirst –N
Bowel and bladder-N
Developmental history –Milestones attained as per the age.
On examination, the temperature was 100°F and the child weighed five kilograms. He was crying and rubbing his ears in between.
R.S: Nose – whitish thick crusts and septal congestion, Ears bilateral- Yellowish Discharge++ and Offensive. Tenderness+
Other systems – NAD
Diagnosis: Acute Suppurative Otitis Media
Acute Totality
·         Ailments from Change of weather to winters
·         Ear pain in children
·         Yellowish discharge from ears
·         Offensive discharge
·         Thick whitish coryza
·         Fever
(See Figure 1)
Remedy prescribed: Kali Sulp 30, 3-0-3 for 3 days as Kali Sulp covers the climate change with A/F in winter, thick offensive discharge with inflammation in ears presenting with pain and fever.
Follow up
During follow-up, there was no fever, the discharge was lesser and the pain seemed to have reduced as child was not cranky.
On examination, the itching and ear discharge was better. Placebo was given for three more days.
Next follow-up, the child appeared to be comfortable. There was no coryza, ear pain or discharge. Other generals were good.
Conclusion
Therefore, convincing parents of an infant with fever is a task wherein they should be told that a fever is actually a warning sign; it lets us know that an infection may be brewing and it helps to fight off the infection. So, wait and watch for the medicines to act.
References
1. Allen H C, The Therapeutics of Fevers, B. Jain Publishers Pvt. Ltd., New Delhi, Reprint Edition 1998.
2. Alagappan. R, Manual of Practical Medicine, III Edition
3. Arora Ritu, Combating fever, I Edition, B. Jain Publishers Pvt.
Ltd., New Delhi, 2007
4. Davidson’s Stanley, Principal & Practice of Medicine, 20th Edition
5. Emmett Holt L., The diseases of Infancy and childhood. IV edition
6. Hahnemann Samuel, Organon of Medicine, VI Edition, B Jain Publishers, New Delhi, 2000.
7. Metha’s P J, Practical Medicine, 19th Edition
8. Parthasarathy. A, IAP Textbook of Paediatrics, III Edition
9. Pennell Alice M OBE, Home Nursing in India, II Edition