 Good morning everybody, I am Dr. Naresh P. Consultant Pediatrician, Manipal Hospital, Malaysia Bangalore. Today I will be discussing a very simple and easy topic but that is confused by most of the very educated and I would call them the Google parents who use lot of Google and trust Google more than the doctors. We will just discuss about two common symptoms that is fever and cough. Fever and cough in children pediatric age group what parents should do when they should react when to consult the doctor. The slides are very few it will be more of an explanation so that people can understand. The first understanding what is fever, this is from my personal OPD experience. Staying in a city you cannot come to the doctor and tell I felt the baby is warm, I touched the baby on the forehead and I felt the baby is warm that is not the expected thing from somebody who is staying in the city you are supposed to use the thermometer and actually measure the child's temperature when you come to the doctor. Let us say you are staying in a far off rural place then it is acceptable that you can tell I touched the baby on the neck I felt the baby is warm it is fine but when you report to the doctor in the city make sure you are monitoring the temperature over the last 12 hours or 24 hours is the fever more in the morning time and night time or is it there continuously the duration of the fever the highest point where the fever touches 101, 102 these are important. See first moving on to the definition of fever in a child easy method to record in a smaller child would be to place the thermometer in the armpit again I repeat it should be placed inside the armpit let us say this is the child's armpit so suppose to place it in the armpit and bring the arm close by not like this if you place it like this then the mercury end of the thermometer will point backwards so you are going to get a wrong reading so how to measure in the armpit place the mercury end of the thermometer into the armpit and bring his arms close by if possible place it for 2 minutes it is easier said than done but at least for one complete minute or even 90 seconds would be fair enough to get the temperature right. Now understanding what is fever in a child suppose you are measuring it in the armpit then anything above 99 99 99.2 99.4 all this is called as fever in a child 98.6 will not be considered as fever even if the child feels warm you reach at the temperature 98 98.6 97 this is not fever why I am stressing on this because especially during the recent covid times I had many patients who take an online consultation telling that the child had fever for 2 days then I would ask did you record it then they would tell it is 97 98 come on that is not at all fever it is unnecessary panic in the family so above 99 Fahrenheit is fever in a child in the armpit now coming to a older child you are going to measure the temperature in the mouth if feasible place the thermometer below the tongue and tell the child to close the mouth I mean older child more than 9 years or 10 years otherwise go by the armpit. Now in the oral cavity the temperature that is to be called as fever will be 100 degrees or more so again you are going to place it for 1 minute or at least 90 seconds to 2 minutes ideally 1 minute is enough now I repeat again 99 degrees or more in the armpit 100 degrees or more in the oral cavity you can just have a look at the small diagrams where it is mentioned how to record the temperature. Next after seeing this coming to the danger signs in fever when you are going to come to the doctor and when can you wait why I am stressing on this point is most of our night casualty visits that is parents grandparents uncle auntie all of you might have experienced when a child has fever even at night 1 or 2 o'clock you will all go running to the hospital so is it really needed do you really have to panic that way see for this you need to understand a few points when is it an emergency when is it not an emergency that means when a child let us say the child is 5 years old and the child has fever when you need to rush to the hospital suppose you record the fever in the night at around 11 o'clock or 1 o'clock is it really an emergency or not and when can you actually wait that is you can wait till the next day morning take an appointment and go to the doctor so these two things has to be very clear the parents and the attenders have to understand this now let us say you are recording a temperature at 11 o'clock in the night the child feels a little warm first we will discuss when it is not an emergency that is you can rest wait at home consult the doctor next day morning so these are the points to keep in mind the child is active playing around the fever is not interfering with his routine activities this is a happy sign although he has 99 or 100 fever he is active and running around it's good next his oral intake is good activity is good water intake is good more than 75% of the normal let us say the child eats normally three idlies with some amount of sambar or chutney he is eating two idlies with sambar and chutney and drinking two glasses of water that is good enough you can wait so an active child routine activities are normal oral intake solids and liquids is good and most important thing urine output is good a child who is passing at least one time urine in six hours that is in 24 hours he passes 4 to 6 times urine it is not an emergency you can always wait for 12 hours do some tippet sponging and visit the doctor next day morning I repeat child is active routine activity is normal feeding well sleep is well urine output is good it is not an emergency you can consult the doctor the next day morning now when is it an emergency the child has fever and when you need to actually rush to the hospital or rush to the emergency room this is very important let us say the child has 100 degrees fever his activity is disturbed he becomes dull he is just lying down not responding much routine activity is totally disturbed that's the first point second point even after putting the fever medication let us say you have taken an on the phone consultation doctor has told you a prescribed dosage of medicine you have given the medicine still if the child after giving the medicine also he is unresponsive he continues to lie down then it is a worry it's an emergency next food intake and water intake is reduced to less than 50% of normal let us say he has four idlies two glasses of water he is able to take just two idlies and one glass of water it is an emergency you cannot carry on with the child having just 50% of water intake and food intake you need to go to the hospital next urine output is decreasing to less than two times in 12 hours that is let us say the child developed fever today morning it's a Sunday from morning 9 till night 9 he has passed only one urine and the tool yellow in color just 100 ml it is an emergency don't wait till Monday morning make him dehydrated you go immediately to the emergency room and take the necessary treatment so I repeat again when is it an emergency dull lethargic child activities reducing oral intake becomes less than 50% urine output becomes just once in 12 hours and dark yellow urine these all indicate the child is going in for dehydration and other than this child has uncontrollable shivering abnormal body movements lethargy uprolling of eyes these are all quite obvious you need to you will rush to the hospital immediately so next when are you going to treat the fever see as far as possible staying in the city any symptom it is better to consult the doctor why I am repeating this again because most of my patients what they do they would have come to me at three months of age and for a certain weight I would have given the fever dosage as 0.5 ml or 1 ml for example then the child will get fever when he is one year and five months old they will put that old dosage of 1 ml for three days and they will come to the doctor telling fever has not reduced see you cannot put fever medicine of a 4 kg child to a child who is 12 kgs it's not going to work so in simple language if you are in doubt consult your doctor usually we put 15 mg per kg per dose I repeat it is 15 mg per kg per dose that is the dosage of the fever medicine let us say the child is 10 kgs 15 into 10 150 mg of paracetamol morning 150 mg in the afternoon and 150 mg in the night this is the dosage of the fever medicine but again I repeat please consult your doctor and put the right dosage only then the fever is going to come down so I hope you have just understood the basics of what is called as fever in a child when is it an emergency when to rush to the doctor when you can wait and consult the doctor the next day and about the fever medication consult your doctor put the right dosage next we will talk about another common symptom in the pediatric age group that is cough see it is quite troublesome cough with my personal experience the patients that have seen a coughing child not only causes lot of distress to the child but it will also cause lot of problem to the entire family lack of sleep stress parents grandparents a sibling everybody is disturbed some of the patients will call and they will ask doctor my child has been coughing for the past one day you please give me cough syrup it is not like going to some gold shop and paying them 5000 rupees and purchasing a gram of gold see there are different types of cough and actually for cough we have to auscultate the child know the history how the cough started and how the cough is progressing to give the treatment there are different types of cough syrup 4 to 5 types of cough syrup are there so a different type of cough syrup which is not given correctly will cause more harm to the child to understand this see the common types of origin of cough in the child cough can originate from a problem in the nose cough can originate from a problem in the throat cough can originate from the problem in the lungs it's a simple concept three different origins of cough can be there it can be the nose throat or even the lung but for most attenders it is throat they don't think of anything else if the child is having a chronic cold negative continuous cold what happens is there is something called as post nasal drip so when the child sleeps down the distracts from the nose keeps going backwards and after half an hour of sleep he'll start coughing and he'll get up this continues the whole night it is called cough associated with post nasal drip there is actually no problem in the throat but because of the discharge from the nose that goes to the throat when the child sleeps he keeps coughing he's alright when he sits because the discharge comes front so this is one type of cough next type of cough is irritation in the throat what we call pharyngeitis, tonsillitis you drink some fruit juice in an unhygienic shop next day you develop a rough throat that is sore throat and cough that cough originates in the throat and next type of cough is cough that originates from the lung it is seen in asthmatic individuals wheezing pneumonia in which high fever is there productive cough comes out from deep within now each type of cough that I mentioned about cough originating from the nose throat cough and cough originating from the lung that treatment is different if the child has cough due to cold you need to give medicines to control the cold you cannot give a cough suppressant that time and similarly if you have cough that originates from the lung treatment is totally different so whenever the child is having a cough the aim of this talk is please don't take online consultation you visit the doctor maybe even after a day cough doesn't become an emergency unless it is asthma wheezing pneumonia so cough mild cough is there for one day next day you consult the doctor then take medication for the cough don't take online consultation if the child has a cough the chest has to be auscultated throat has to be seen and only then we have to give the medicine so I hope this talk was helpful at least to manage fever and cough in children what you can do at home so if you all parents grandparents siblings found this helpful you please do share it with your relatives and friends so that it does help even their children that is one thing and the second point if you have any doubts please type it in the inbox so that we can get back to you as soon as possible okay wishing you all good health thank you