Sunday 18 March 2018

Caring for fever and watching your moles

Thankfully most fevers pass without harm.
Thankfully most fevers pass without harm.

Advice from our GP on the best way to treat a child's fever and why you should watch your moles.

Question: My four-year-old has been sick recently. We have ended up getting different advice from the out-of-hours service and our GP. What is the best way to treat fever in a child?

Dr Nina replies: Normal body temperature is a temperature up to 37.5˚ Celsius or 99.5˚ Fahrenheit. A temperature between 37.5˚C and 38.0˚C (100.4˚F) is a very mild fever and in an otherwise well child doesn't require intervention. If you think your child has a fever it is essential to confirm this with a thermometer.

Other symptoms to watch for are the child's state of consciousness, their intake of fluids, how much urine they are passing, whether or not there is a rash and whether the child is unusually out of sorts. If a child is under three months or if the fever has lasted more than five days, it is essential to seek medical attention.

Having a fever is not necessarily a bad thing, it is a sign that the immune system has been stimulated. If a child has a fever below 40˚C but is in good form, it is not necessary to treat this. Fever over 38.0˚C does however cause distress and discomfort in many children and it is for this reason that treating at this temperature may be beneficial.

Don't always rush for medicine. Start by keeping the child comfortable and cool. Don't strip but do allow them to wear loose cool clothing. Sponging down is no longer recommended. Ensure the child drinks plenty of fluids. They may not feel like eating, don't worry too much if this is short term. Offer frequent, light, plain snacks. Big meals may be refused.

If your child is distressed or uncomfortable then it is reasonable to offer them some form of medication. Both paracetamol and ibuprofen can be used to reduce fever and pain in children. The best way to give these is an ongoing topic of research and debate.

NICE in the UK issued guidance in recent years stating that one or other preparation should be used. Another study in the British Medical Journal then suggested that ibuprofen was more effective at reducing temperature and also suggested it was okay to give both medication. The guidance now is to give one medicine first and if the child remains distressed or uncomfortable after this to give the other. There isn't evidence to suggest that both given together is harmful. There just isn't evidence to show that using both is best.

The dose of paracetamol is 10 to 15mg per kilogram body weight given no more than four times in 24 hours. The dose of ibuprofen is 5 to 7.5mg per kilogram body weight given no more than three times daily. In very high fever 10mg/kg body weight may be given. It is essential to keep a diary of the type, dose and frequency of medicine given in order to ensure overdose doesn't occur.

Keep a close eye on your child if they have fever. If they are becoming more unwell do reach out for medical review. A closer examination is warranted here. If their temperature settles with medicine and they seem well and are managing to drink plenty of fluids then it is reasonable to watch them at home and hope the illness will pass in days.

Fever can cause concern but thankfully in the majority of cases it passes without harm.

Question: I have a lot of moles on my body. I am worried about my risk of skin cancer. What should I look out for when checking my moles?

Dr Nina replies: Moles are small spots on the skin made up of pigmented cells. The amount you have will depend on your genetics and your skin's exposure to ultraviolet light. New moles may appear up to age 30. Any that appear after that should be watched closely.

Moles do change over time. They may also evolve during adolescence and pregnancy where they increase in number and change in colour. As we get older, some moles may change or disappear altogether.

Those who have more than 100 moles over their bodies may be at higher risk of abnormal moles and it is important to keep an eye on them.

The best way to reduce your risk of abnormal change in your moles is to limit the skin exposure to UV radiation. Avoid the sun or wear at least factor 50 when you are exposed.

If you have many moles it is important to make sure you have adequate blood levels of vitamin D - melanoma may be more significant in those who don't.

Most moles are completely harmless and will never cause you any problems. There are some features you need to watch out for though. This is referred to the ABCDE grading.

A is for asymmetry. Benign moles are largely symmetrical. B is for border. Check for changes in the outline or bleeding of pigment over the border of the moles. C is for colour. Some benign moles may have two shades of brown but melanoma may have several areas of pigment. Colour change in a mole should be noted. D is for diameter. A growing mole is one to watch. Lastly E is for elevation. A mole that becomes more raised, especially in conjunction with any of the other features, should be reviewed.

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