THE two-year-old was rushed to the hospital, gasping for breath. The nurse seeing the sick boy immediately launched into action to salvage him. While working to save his life, she asked the mother to know when the illness started.
“Mohammed started with fever last week. He came back from school, with his body slightly hot and I gave him paracetamol,” Mrs Haliya Haruna, the mother explained.
Mrs Haruna continued to give him paracetamol, but when she found him unable to breathe well on the third day, she decided to take him to the hospital.
Initially, Mohammed felt better the first two days and could play a little as his mother continued to give him paracetamol until the third day when he became weak and breathless and had to be rushed to the hospital.
Examining Mohammed, the nurse said Mohammed had malaria which had made his blood volume to drop greatly. She said he was dying and needed to be transfused with blood urgently because his low blood level was already affecting his heart.
Unfortunately, many children like Mohammed had died because their mothers were only giving them paracetamol when they had fever. They were not promptly taken to the hospital to ensure the actual cause of the fever is determined and treated appropriately.
Fever is a common childhood problem and is one of the commonest reasons parents take their children for medical attention. It is estimated to be the primary complaint for as many as one-third of all paediatric consultations in general practice.
Parents and caregivers see fever as a useful indicator of whether a child is seriously ill and commence treatment such as giving paracetamol or to tepid-sponge at home before presentation in the hospital.
Fever is not a disease; it is just one of the symptoms of a disease. It is also the body’s way of heat-killing germs. Just like germs are killed by boiling or burning, the body increases the body temperature in an attempt to kill the infecting germs. The more severe an infection, the higher is the fever.
Also, for those germs that are heat-resistant, the body has to increase its temperature much higher. Viruses are very heat-resistant, which is why viral infections often result in very high temperatures, and is not easily controlled with normal medication like paracetamol.
The body’s normal temperature is around 37 degrees Celsius (°C); however, it can vary according to the time of day. If the temperature is over 38°C when measured with a thermometer, then such is considered to have a fever.
Paracetamol (acetaminophen) is the most frequently used medicine to help relieve discomfort and reduce fever. It is both a pain-relieving and fever ‘relieving’ drug. Since it is readily available, accessible and cheap, it is not surprising that it is the most frequently used drug by the mothers.
But, giving a child running fever paracetamol syrup and then seeking medical care, say after two days, because the body temperature seems to persist is wrong, said Dr Babatunde Ogunbosin, a consultant paediatrician at the University College Hospital (UCH), Ibadan.
Dr Ogunbosin added that the advice by paracetamol manufacturers on radio that individuals should consider seeking medical care after taking paracetamol for two days if their symptoms persist is also wrong.
Since many things can cause a fever or a raised body temperature in a child, he stated that giving paracetamol and leaving it at that for two days is rather dangerous.
According to him, children with fever, especially those below age five, should be seen by a doctor as soon as possible to prevent complications setting in, including death.
Dr Ogunbosin stated that causes of fever in children include infections such as malaria, pneumonia, typhoid fever, bacterial meningitis and cold, adding, “What we expect is for the mother to give the first dose of paracetamol and bring the child immediately to the hospital to seek care.”
Malaria, one of the biggest killers of children all over the world, is the commonest cause of fever in children. Nigeria contributes a significant portion to these deaths, which is highest among children less than five years.
Unfortunately, most children that develop cerebral malaria, a severe form of malaria, will die within two days. “So, if you are waiting to give paracetamol for two days before you see a doctor, most of such children may end up with severe anaemia, cerebral malaria and other complicated forms of malaria,” he stated.
Notably, pneumonia also accounts for many children dying all over the world. A child that has pneumonia will have a fever. There may be other subtle signs like difficulty with breathing, fast breathing and cough.
Now, the mother may have given cough syrups, which really gives little or no relief, alongside paracetamol for the raised body temperature and so, by the time the child eventually gets to the hospital, they already have the advanced form of the disease. Of course, complications of the disease may have developed, thus increasing their chances of dying.
He added: “Yes, it is good to give children paracetamol to bring down the fever and prevent febrile seizures or convulsion as well as other symptoms like headache and body aches that might make them uncomfortable, but that is not the treatment for what is causing the fever. You do not treat the raised body temperature, while leaving its underlying cause.”
No doubt, medical doctors encourage parents to give children malaria medicine when they suspect a child has malaria, especially when they cannot get to health facility as soon as possible.
Howbeit, Dr Ogunbosin said that the ideal thing is that a child suspected to have malaria should be tested to confirm that it is malaria, treated with recommended malaria medicines and followed up to see how they respond because, again, it is not only malaria that causes fever.
He added that the follow-up is very essential because a wrong diagnosis may have serious consequences.
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