CHILD WITH FEVER

By Kleovoulos Chandanos, Paediatrician

In clinical practice we define fever as any increase of temperature over 38 C, measured in the armpit. Usually it is accompanied by tachycardia, decreased urination, tiredness, weakness, light-headedness, hallucinations, anorexia, and thirst.

 Fever is common in many diseases, bacterial or viral, like otitis, rhinitis, pneumonia and others.  Many fevers just indicate mild, self-limiting infections. A fever without other symptoms usually presents a diagnostic dilemma in babies younger than 24 months.

Babies under three months present limited clinical symptoms when they become ill, making it difficult to distinguish between a bacterial and viral infection. The probability of a serious bacterial infection must always be considered then, and a hospital is always the best choice.

In four percent of babies three to 24 months we can come across bacteria in the blood (bacteremia) without any real symptoms. The usual infections at that age are middle otitis, pneumonia, meningitis, osteomyelitis, gastroenteritis and urinary infections.

Parents should learn to evaluate the situations and not panic. By remaining calm, parents are better able to judge the gravity of the situation from the general picture of the child. If the disposition of the child is good, and has an appetite for games and food, then the fever is usually due to a viral infection and there is no real reason for concern. If, however, the child displays a bad disposition, becomes drowsy and moans continuously, then the parents should notify the doctor, because a bacterial infection could be lurking. Many times, together with the fever, the child has also a headache. Usually the headache subsides when the fever falls. In the case where the headache continues, and especially if it's accompanied by an overall bad feeling, then it needs to be checked out. Other times the fever can be accompanied by a rash. If you press down on the rash with your finger and it disappears for just a moment and then it reappears it's just a normal fever rash caused by a viral infection.  

Many times, children with fever will display vomiting. This should worry parents only if vomiting is continuous and the child's general condition is poor. Fever is treated with antipyretic medicine. If it's taken into account that fever is a useful way for the organism to fight infections then it makes sense to let the fever take its course. However, if the fever is high, then the child feels poorly and cries.  In that case, the child must take an antipyretic not because the fever presents danger to the child but because it causes hardship to the child. If the fever exceeds 39.8 C, or the child feels discomfort, it's a good idea to also give the child a bath in tepid water.  For the duration of the fever the child should rest and drink lots of liquids.

What must a parent do then for the child with fever?

If the child is younger than three months, then an examination by a doctor is absolutely necessary, and perhaps blood tests would be a good idea; for a child from three months to two years of age, the general condition of the child must be evaluated. If the child is in good condition and the fever falls easily then it's just a simple infection.

BAD BREATH (HALITOSIS)

By Nikos Papadakis, Dental Surgeon

Part One: Causes

Do you wonder why your friends keep their distance? Has someone left mint candies or dental floss on your desk?

If you are one of the millions of people suffering from bad breath, now is the time to learn the possible causes and also the treatments so that once again you can enjoy fresh breath – and have your friends at a closer proximity.

The more prevalent causes of bad breath

Unclean mouth: Ninety percent of unpleasant mouth odours emanate from the oral cavity itself, either from the foods you consume or from bacteria that are found already in the cavity. The mouth odour is like any other body odour: a result of microbes living in the body and releasing by-products. The bacteria that are found in the mouth interact with food remnants, blood, and tissue and create sulphurous emissions. If oral hygiene is not observed then the bacteria accumulate and cause intense stench.

Unhealthy oral cavity: Health problems in the mouth, like gingivitis and dry mouth syndrome, can accelerate the growth of bacteria that brings about bad breath. Gingivitis encourages the decomposition of some of the bacteria. Dry mouth syndrome, however, is the most usual cause of bad breath. Saliva helps in the cleaning of the oral cavity and moves about the bacteria, so that they cannot stand stationary and multiply. A dry mouth is fertile ground for the reproduction of bacteria, especially in spring and summertime. Allergy medication taken during these two seasons can cause dry mouth, while in winter the culprit could be the dry air created by radiators and heaters.

Foods with unpleasant odours: If you ingest unpleasant odours you will also be breathing them out. The culprits here are onions, garlic, alcohol and tobacco. Vegetable oils are also absorbed in the system and the by-products enter the blood stream. That means that we breathe these odours via the lungs for three to four hours afterwards.

Lack of carbohydrates: The excessive intake of proteins, and/or lack of carbohydrates, forces the organism to burn from the accumulated fat that is used for energy, instead of burning carbohydrates. This can lead, however, to a disorder called ketosis. As the fat burns up, ketones accumulate in the organism and a number of them are released with breathing (by the way, ketones are foul smelling compounds).

Illness: Sometimes bad breath could be indicative of a serious illness like diabetes or gastroesophageal reflux disorder, which is constant indigestion and heartburn caused by stomach acids backing up into the esophagus.  Although less frequent, halitosis may also be caused by liver and kidney disorders, where their toxins are channelled out through the lungs, creating an unpleasant breath.

Part two will discuss the best ways to treat these five causes of halitosis