 I would like to talk today about the fever, which is one of the commonest presenting symptoms for the... One second, one second. First of all, introduce yourself. Okay, okay. This is Dr. Himanshu Lamba Consultant. Okay, okay, okay. And today we will talk about fever and cough. Okay, okay. Okay. So, I am Dr. Himanshu Bhattra, pediatrician at the Manipura Hospital. And I would like to talk about fever and cough in the children today. The fever is one of the most common complaints with which parents bring children to us. And first we have to make them understand that fever is not a disease per se. It is just a body's response and it is for protection only. So, no need to panic because of the fever only. And our main purpose along with diagnosing the cause of the fever is also to teach the parents the proper way of... so that they can have some harmful practices, which they often do. The first thing regarding the fever. To define fever, we call it temperature more than 100.4 Fahrenheit as a fever. And way of measuring varies for the parents how they are measuring it. So, single reading is usually not of that much importance to us. And for diagnosing the fever, we just want to know from parents three, four particular things. The first thing is how it has started. That is onset of the fever. Second thing, what we wanted to know from the parents is any associated symptoms along with that, which will give us the clue. Third thing is how child is behaving when fever is settled with the medicines. And lastly, the pattern of the fever over two to three days. So that is all what we want from the parents to tell us clearly. And based on that, we were able to reach the diagnosis more than 95% of cases. The fever in children is most often due to the infections. But other policies we also have to keep in mind always. And among the infection also, viral infection are the most common thing. So based on the onset only, a fever is high to begin with. And between the fever child is behaving well, he is eating well, he is playing. So these things indicate that we are probably dealing with viral. And fever with viral illness comes in a fixed pattern. That is after every six to eight hours it will keep on occurring. And within two to three days it will start decreasing as well. The second pattern of the fever we see is if child is having fever high to begin with. But he is also having some localized symptoms or pain we call. Pain in throat, pain in stomach and along with other symptoms like swollen difficulty or blood in the stool. So these are the pointers that bacteria infection we are dealing with. And straight away we can start with the treatment in this case. The third pattern of the fever which came across is low fever to begin with. But which keeps on gradually increasing day by day. These are the things we tell us that we are probably dealing with bacterial infections this time. And mostly by second or third day we get the findings also. Which help us in diagnosing that where bacteria is actually localizing. And the last pattern which we came across is that. In which fever is not coming in any fixed pattern. It is coming two or three times in a day, maybe after 12 hours. And fever is lasting more than four to five days. In those cases we have to think out of the box for the other illnesses which are not infection. Like Ava, Sakya or other things. And by just these points and response of the child in between the fever. We came to know about the diagnosis. And a few things which parents have to know are called red flag or danger signs. Which always indicates some underlying serious illness. These signs indicate, these signs include the poor feeding of the child. Fast breathing, child is extraordinarily dull even between the fever. Child is having the pain in the neck or headache and having persistent vomiting. Or some particular rashes. These all things can tell us if they are the danger signs. And we have to intervene and parents have to bring the child urgently to us. So along with that the main advice which we want to give to the parents. Is that about some harmful practices that is over covering the child at time of fever. Giving too much medication or repeating fever medicines very frequently. Or repeating multiple medicines. The third thing which we want the parents to know is the red flag sign. At which they have to bring the child immediately to us. So based on all this we can able to manage fever in the most effective way. The second thing what we have to want to talk about is the cuff. Cuff in children is the second common thing which we came across. And the cuff is also not a disease person. It is just a body's protective reflex. And it is happening in order to clear the irritants which are trying to enter the Ava's. So cuff is actually a protective reflex and not a illness person. And we do not have to suppress the cuff actually. And we have to just identify the cause and treat that cause. So cuff in children is usually identified based on whether it is dry cuff. Which indicate involvement of the upper Ava's. Or whether it is the wet cuff or associated mucous production. Which indicate it is the lower Ava's involvement. But in sometime in children even in lower Ava's we can get dry cuff. And that happen in like in cases of severe asthma or some type of pneumonia as well. And the severity of cuff as such does not tell about the severity of the illness person. Because in the more severe illnesses involving the lung as such. Like in pneumonia we get a very mild cuff. So cuff severity means the viral or allergic thing. Now to diagnose the cuff we also want to proceed in a systematic manner. Whether it is a sudden onset cuff. Which we see mostly in the case of foreign body or sometime in the asthma or allergies. The second thing is whether it is associated with any fever. Which indicates some viral illnesses mostly. And the other things are associated symptoms like an nasal discharge. And if a discharge is happening what is the color of the discharge. Associated pain in the throat or the mouth breathing, snoring. So these symptoms pointed towards the cause. Like adenoids, like tonsillitis or pattern of the cuff which is there. The sound which is there. So sometime we get a hoarse cuff which indicates stridor or the upper area of the environment. Sometimes we get typical whizzing sound which helps in diagnosing the lower area of the disease. And the third thing is abnormal thing called grant. Which is the most severe type which we can be crossing the pneumonia. So these type of sounds which are happening along with the cuff helps in diagnosing that thing. And the treatment of the cuff is also immediate to treating the underlying disease. And the fever and cuff as I have just touched on the basic aspect only. And overall as a pediatrician is to teach the parents mainly. We are not able to treat them fully like in the cuff. But we have to counsel them effectively so that to avoid harmful practices. Same way in the fever. So as a pediatrician our role is to treat with less to less possible medicine and investigation. And to avoid the harmful practices which are prevalent in the society. Or the parents learn from the internet as well.