In Pharmacy, IMS MAT Jan 2011 To Fever and Pain INCLUDES DR. KEELY S TIPS Effective relief you can trust A Parent's Guide to Fever and Pain
The content of this guide has been drafted in conjunction with Dr. JimKeely, who has spent 6 years working in Paediatrics at three of the mainteaching hospitals in Ireland. Dr Keely entered general practice in 1994and currently works as a GP at the Seabury Medical Centre in Malahidewith a special interest in Paediatrics. He is also the father of five childrenand gives us his personal top tips on how to deal with pain and fever. "I have treated many sick children over the years, each withvarying degrees of pain and/or fever. Seeing your child sick andfeverish can be upsetting for parents, particularly for first timeparents but also for the most experienced! A recent Irish survey shows that 80% of Irish parents feel theyhave enough information to manage their children's pain. That isvery reassuring and gives parents confidence to treat theirchildren's symptoms. However even as a GP who has seen manychildren with pain and fever, I still remember my first experiencesdealing with my own children when they were sick. I remember how difficult it can be to know that you are doing ‘the right thing'. The guide has been developed to provide you with information and some helpful tips on managing the most common childhood illnesses your child may experience. Remember your local GP is always there to help and discuss any concerns you may have. We are here to help and reassure you - after all most of us are parents too!" Dr Jim Keely, GP 1. What causes fever? Fever temperature levels Accurate ways to measure temperature When to treat your child When should you be concerned about fever? 2. What causes pain? How to recognise pain in children Main causes of pain • Teething and toothache • Cough and sore throat • Sprains and strains 3. Pain relieving medication What to look for in a pain relieving medicine 4. When to seek medical advice 5. Nurofen for Children Range 1. What causes fever?
Fever is often the first sign of an illness in children. When your childhas a temperature it can be a worrying and stressful time.
However a high temperature is simply one of your child's ways offighting infection and increasing protection against disease. Fever canbe caused by an infection such as ‘cold or flu' or from an infectionassociated with immunisation. Fever temperature levels
Fever is regarded as having a body temperature usually above 37.8ºC.
Temperature 38.6°C Seek medical help Fever can occur when your child has a ‘cold or flu' or followingchildhood immunisations (for more please see immunisation section onpage 6). Symptoms may vary according to the underlying cause offever, but some common signs to look out for include: Irritability and lethargy Loss of appetite Restlessness during the night Shivering uncontrollably Pale with cool hands and feet but Hot and flushed all over hot forehead, tummy and back Febrile convulsion Vomiting suddenly Accurate ways to measure temperature
The most accurate way is by mouth or rectum. However many peopleuse a thermometer that reads from the ear. Although this is convenientand less disruptive for a child, it is less accurate especially in childrenunder 3 years of age.
Dr. Keely's Tip:
It is important to be aware if your child has had two or more consecutive readings of 37.8°C or over. Be especially vigilant in the presence of an obvious cold or sore throat, or if your child has a history of kidney infections.
When to treat your child
Consider giving your child a fever-reducing medication when:• You have established your child has a temperature. This will make them more comfortable reducing their chances of having a febrile convulsion (a seizure as a result of a high body temperature).
• Febrile convulsions are rare but can occur in some children between 6 months and 5 years of age. A convulsion usually occurs when a temperature recurs and rises rapidly without warning to a high peak of 39-40ºC.
• If you're worried or unsure for any reason, always seek advice from your doctor.
What type of medication?• In a recent study Ibuprofen has been proven to achieve faster and more prolonged fever relief in the first four hours compared to paracetamol.
• The study also showed that a majority of parents surveyed favoured ibuprofen over paracetamol in reducing fever in children less than 3 years old with high temperatures greater than 39ºC.
• Ibuprofen and paracetamol have been used extensively in children worldwide and are appropriate for use at the maximum single and daily doses. It is important to always read the label and follow the instruction on the pack.
Ibuprofen should not be given to children who: • Have or have had stomach ulcers or other serious stomach disorders.
• Have aspirin/NSAID sensitive asthma or are allergic to any ingredients in the product. • Are under 3 months or weigh less than 5kg.
Speak to your doctor or pharmacist before use if your child: • Suffers from asthma, is taking any other pain relievers or is receiving any other regular treatment.
What else can I do?Take additional steps to reduce fever and increase your child's comfort by: • Loosening tight clothing and removing any excess clothing.
• Move your child to a cooler environment.
• Giving cool drinks which will Alternating Medicines – Ibuprofen and Paracetamol • A recent study showed that Ibuprofen alone was just as effective in treating pain in the first four hours compared with paracetamol and ibuprofen given in combination.
• However over a 24 hour period, children given both medicines experienced 4.4 hours less time with fever than those given just paracetamol and 2.5 hours less time than those just given ibuprofen.
• The study recommended that parents should consider using ibuprofen first and should also consider the relative benefits of alternating paracetamol plus ibuprofen over a 24 hour period.
• Do not exceed maximum dosage guidelines and speak to your doctor or pharmacist for advice.
When should you be concerned
about fever?

Always see a doctor if:• The fever is accompanied by a stiff neck, confusion or irritability.
• Your child is between the age of 6 months and 1 year and the fever lasts longer than 24 hours.
• The fever stays above 38.5°C despite treatment.
• The fever persists longer than 2 days.
• The fever rises to 39°C or 40°C.
Most children bounce back from their injections and suffer very fewproblems or ill effects. If your child is sore at the site where theinjection was given, has a fever or is irritable you can give them a doseof ibuprofen or paracetamol.
For more information please contact your local GP.
Dr Keely's top tip for immunisation:
I recommend giving pain relief to babies and toddlers for up to48 hours after their immunisation and especially just before bedtime, as this will control pain and fever post-vaccination.
2. What causes pain?
• Pain is an unpleasant feeling which the body experiences in reaction
to injury or damage to the body.
• Common causes of pain in children include infections (e.g. of the middle ear, throat and mouth) and injuries (sprains, strains, broken bones or burns).
How to recognise pain in children
A young child expresses distress differently to adults and may not beable to describe it properly.
There are three ways to work out if your child is experiencing pain: 1. Listen to what they say - a child from the age of 4 years will be able to explain that they are in pain.
2. Watch how they behave - look to see if they are moving their body normally, what their facial expression is and whether they are crying (see expression chart below).
3. Watch to see how they are reacting to pain - some children experience sweating, vomiting or may become pale.
A Pain Scale
Main causes of pain
Teething and toothache At around 4 to 6 months the teething process usually begins, howeversome children may not produce their first teeth until after their 1stbirthday. As children reach the age of six their baby teeth begin to fallout to be replaced by their permanent teeth. The teething process starts again! Signs of teething Sensitive, red gums Dribbling and drooling Chewing and rubbing Chewing on a rattle or their hands What can you do to help ease teething pains?• Rub sore gums with pain relieving teething gel such as Bonjela (suitable from 4 months).
• Let your baby bite on a cold teething ring – these can be cooled in the fridge (never frozen).
• If you believe the pain is very bad, especially at night, you can give your baby pain relief – ibuprofen based formulas can quickly help soothe teething pains and has anti-inflammatory properties.
Dr Keely's top tip for teething:
You will know your child is teething when you see a tooth appear through the gumline (especially if you feel its sharp edges)! For more information on managing fever and pain
you can visit: www.nurofenforchildren.ie
The most common type of earache, or otitis media as it is called, tendsto develop in children up to the age of eight. In fact, it's thought thatabout 20% of children under the age of four have at least one earinfection a year. So what should you be looking out for? The most common symptoms of otitis media are: Pain and possibly fever Discharge from the ear Pointing or pulling at an ear What should you do if you suspect earache? Consult your doctor, they may prescribe antibiotics. And if your child has a serious case of glue ear, she might eventually need to go to hospital to have the fluid drained away and grommets inserted.
Dr Keely's top tip for earache:
If your child has had a cold and is suddenly cranky with what appears to be pain, it is probably an earache.
Cough and sore throat
Coughs and sore throats are two of the most common childhood illnesses. So it's likely that your child will get one, the other or both at some point in their life. What are the symptoms of a cough/sore throat?Different types of cough have different types of symptoms: • Cold and flu coughs usually come with a stuffy, runny nose.
• A more severe type of croup may occur with distress and temperature.
You'll know if it's a sore throat because:• Your child will cry or complain when swallowing or may refuse food.
• They might drool especially with streptococcal (bacterial) infections.
• Swollen glands will often accompany a sore throat.
Treating coughs and sore throats• Give plenty of cold drinks.
• Humidifying the room may be helpful. Tip: Place a wet towel in front of the radiator.
• Medicine such as Nurofen for Children can also help ease the symptoms of colds, flu and sore throat.
For more information please contact your local GP. Dr Keely's top tip for sore throats:
Excessive Drooling in the presence of a high temperature may indicate your child has a bacterial infection which may require an antibiotic.
Sprains and strains
A strain is when a muscle, tendon or ligament has been overstretchedor overused. An injury is known as a sprain when the muscle, tendon orligament is stretched even more severely. Your child could easily strainor sprain a muscle if they're running around the garden, climbing overfurniture or playing sport.
A recent study has shown that ibuprofen is a more effective painkillerthan paracetamol at treating sprains and strains which may be due to its anti inflammatory action.
Dr Keely's top tip for sprains and strains:
Simple sprains and strains are common – young children will often refuse to use a limb after a minor injury. You should consult your GP if your child cannot move a limb or has a limp.
3. Pain relieving medication
What to look for in a pain
relieving medicine

• Works fast to control the pain as quickly as possible. • Has proven tolerability in children.
• Added benefits can include reducing fever and inflammation.
• An oral suspension is the most common way to dose your child; however if they are vomiting or will not take an oral suspension, suppositories are an ideal format to use.
• New Nurofen for Children 60mg suppositories age 3 months to 2 years get to work in 15 minutes, similar to the oral suspension and last for eight hours.
• Always read the dosing instructions carefully and do not exceed the ecommended dose.
4. When to seek medical advice:
Remember you know your baby/child best, so if you think your baby isunwell, or if you are worried in any way, always speak to your doctor. Contact your doctor immediately if you are worriedabout any of the following In case of fever: If your child is less than a Persistently complains of pain year, especially when he or that does not go away.
she is less than 6 months Avoids moving in certain ways.
Shows any worrying signs Is sweating, pale or vomiting.
such as confusion, neck Is agitated or the opposite stiffness or a rash (withdrawn, not responding, (remember ‘the glass test') lying quietly in bed, not Has difficulty breathing or talking or eating).
is dehydrated.
Has an obvious cause for the Continues to have a fever pain, such as a fall or a burn.
without it subsiding.
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Nurofen for Children easy dosing syringe For short term use only. If your child's symptoms persist for more than 3 days, if pain or fever worsen or if new symptoms occur consult your doctor or pharmacist straight away. Remember to ALWAYS READ THE LABEL Date of Preparation: March 2011 Item Number: NFC-IE-18-11

Source: http://www.mummypages.ie/tools/guide-to-fever-and-pain/pdf/148764


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From the Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden The infected knee arthroplasty Anna Stefánsdóttir Anna Stefánsdóttir List of papers, 2 Results / Summary of papers, 20 Definitions and abbreviations, 3 Introduction, 4 Historical background, 4 The Swedish Knee Arthroplasty Register, 4 Definition of infected knee arthroplasty, 4