Subrephilic temperature in a child. Causes of subfebrile temperature in children and methods of treatment. How to look for the cause of subfebrile temperature

Subfebrile condition, or subfebrile condition of unclear etiology, occurs in children quite often. It is characterized by the fact that the child, for unknown reasons, constantly, for several weeks or even months, has a slight temperature of 37-37.5 ° C. Sometimes the child's well-being may suffer (lethargy, decreased performance, increased fatigue), and in other cases - remain normal.

It can be quite difficult to figure out where the temperature comes from. Sometimes you need to pass a huge number of tests, go through a lot of additional research and visit more than one specialist doctor in order to get to the bottom of the truth. The author allowed himself, without delving into the problem, only to focus on its importance and give a direction: where to dig. So, subfebrile condition in children can be caused by a lot of reasons.

Body temperature from 37 to 37.9 ° C is called subfebrile and can be kept in a child with an enviable constancy for weeks and months. At the same time, the child's well-being may suffer (lethargy, reduced performance, increased fatigue appear) or remain normal.

In the case when the cause of such a long subfebrile condition cannot be found, they speak of subfebrile condition of unclear etiology. It occurs quite often in children.

Establishment and elimination of the cause of prolonged subfebrillation in a child- a difficult task, sometimes requiring significant efforts from both doctors and parents. In all cases of subfebrile condition, the child should be carefully examined, preferably in a hospital. Additional instrumental studies, analyzes, consultations of various specialists are needed. The prognosis and treatment depend on the disease that caused subfebrile condition.

Thermoneurosis. In the vast majority of cases, the reason subfebrile condition in children lies in a persistent disorder of heat exchange as a result of a functional violation of the temperature center of the brain.

Causes of thermoneurosis:

Disorders of the autonomic nervous system;

Traumatic brain injury;

And other neurological disorders.

In the anamnesis, the child has an unfavorable course of pregnancy and childbirth in the mother, birth trauma, physical or mental trauma, and general overstrain. Functional disorders of thermoregulation can be inherited (in 2-3% of cases). Often, low-grade fever is provoked by various non-specific stimuli (endocrine disorders during puberty, overexertion, previous diseases, overheating, etc.).

For thermoneurosis, it is characteristic that during sleep the temperature of the child becomes normal. Therefore, it is important to measure body temperature not only during the daytime, but also during sleep. In all cases of subfebrile condition, the child should be carefully examined (preferably in a hospital). To determine the cause of the disease, the doctor prescribes an examination plan, including tests, instrumental examinations and specialist consultations. The diagnosis of "thermoneurosis" is made only if all other possible causes of fever are excluded and the child has any other manifestations of vegetative-vascular distance (fatigue, sleep disturbance, appetite, excessive sweating, headache, dizziness, decrease or increase blood pressure, etc.).

Details about disorders of the autonomic nervous system can be found in the article "Autonomic Dystonia Syndrome".

Treatment of subfebrile condition in children

Therapy of subfebrile condition is reduced to the elimination of the main cause: treatment of carious teeth, adenoids, chronic tonsillitis, tuberculosis infection, etc. If subfebrile condition is caused by thermoneurosis, regime moments are important in the treatment: proper organization of classes and rest, light sports, sufficient exposure to fresh air. Apply psychotherapy, acupuncture, hydrotherapy, physiotherapy, etc.

In the practice of a pediatrician, there are often cases when the main complaint of parents is the presence of a fever in a child.

talk about the causes of subfebrile condition in children.

Prolonged subfebrile condition is an increase in temperature within 37-38 degrees for 3 weeks.

Prolonged subfebrile condition is observed most common in children under 1 year of age (which is probably due to a reaction to the BCG vaccine), then there is a significant decline between the ages of 2 and 7 years and increase from 8 to 14 years , which is associated with the presence of intense "critical" phases of growth and development.

Interestingly, among adults, in 70-80% of cases, prolonged subfebrile condition occurs in young women with asthenia phenomena. This is due to the physiological characteristics of the female body, the ease of infection of the urogenital system, as well as the high frequency of psycho-vegetative disorders.

Most often, subfebrile condition is observed in children under the age of 1 year, then there is a significant decrease at the age of 2 to 7 years and an increase in the period from 8 to 14 years.

It should be borne in mind that prolonged low-grade fever is much less likely to be a manifestation of any organic disease, in contrast to prolonged fever with a temperature above 38 0 C. In most cases, prolonged low-grade fever reflects a banal autonomic dysfunction.

Conventionally, the causes of prolonged subfebrile condition can be divided into two large groups: infectious and non-infectious.

Infectious subfebrile condition found in such diseases. :

Tuberculosis, especially if the temperature increase is combined with general weakness, emaciation, sweating, loss of appetite, prolonged cough, unsuccessful fluorography and tuberculin tests, as well as the presence of contact with a patient with an open form of tuberculosis.
Focal infection (sinusitis, tonsillitis, cholecystitis, dental problems, etc.).
Toxoplasmosis, giardiasis.

Subfebrile condition may appear after an infectious disease ("temperature tail"), as a reflection of the syndrome of post-viral asthenia. In this case, the subfebrile temperature is benign, is not accompanied by changes in the analyzes and disappears on its own, usually within 2 months (sometimes the "temperature tail" can last up to 6 months).

Prolonged subfebrile temperature non-infectious nature may be due to somatic pathology, but much more often it can be explained by physiological causes or the presence of psycho-vegetative disorders.

Physiological causes. In many people, subfebrile temperature is constitutional in nature and is a variant of the individual norm. Subfebrile condition can develop against the background of emotional and physical (sports) stress, appear after eating, when in a hot room, after insolation. In women, subfebrile temperature is possible in the second half of the menstrual cycle, which normalizes with the onset of menstruation; rarely, subfebrile condition is observed during the first 3-4 months of pregnancy.

Causes of non-infectious subfebrile condition :

Endocrine disorders (thyrotoxicosis, pheochromocytoma, etc.).
Iron-deficiency anemia.
Rheumatic diseases.
Tumors.

According to some indications, distinguish infectious low-grade fever from non-infectious .

For infectious low-grade fever is characterized by poor temperature tolerance, daily physiological temperature fluctuations are preserved (normally morning temperature is 1 degree lower than evening temperature), a positive reaction to taking an antipyretic. And when non-infectious- the temperature is well tolerated, daily fluctuations are absent or distorted (morning temperature is higher than evening temperature), there is no reaction to antipyretic.

To find out the reason subfebrile conditions conduct a variety of laboratory and instrumental studies.

Consultations of an ENT doctor, a dentist, a cardiologist, a phthisiatrician, an infectious disease specialist, an endocrinologist, a hematologist, an oncologist are prescribed.

Subfebrile is called elevated body temperature up to 38 ° C, and subfebrile - the presence of such a temperature for more than 3 days, often for no apparent reason. Subfebrile condition is a clear sign of disorders in the body that occur due to diseases, stress, hormonal disruptions. Despite the seeming harmlessness, this condition, in which people often continue to lead a normal life, can be a symptom of a disease, including a serious one, and give undesirable health consequences. Consider 12 main reasons that cause an increase in body temperature to subfebrile values.

The inflammatory process caused by infectious diseases (ARVI, pneumonia, bronchitis, tonsillitis, sinusitis, otitis media, pharyngitis, etc.) is the most common cause of low-grade fever, and it is this that doctors tend to suspect first of all when complaining about temperature. The peculiarity of hyperthermia in diseases of an infectious nature is that the general state of health also worsens (headache, weakness, chills occur), and when taking an antipyretic, it quickly becomes easier.

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Subfebrile temperature in children occurs with chicken pox, rubella and other childhood diseases in the prodromal period (that is, before the appearance of other clinical signs) and on the decline of the disease.

Infectious subfebrile condition is also inherent in some chronic pathologies (often during an exacerbation):

diseases of the gastrointestinal tract (pancreatitis, colitis, gastritis, cholecystitis);
inflammation of the urinary tract (urethritis, pyelonephritis, cystitis);
inflammatory diseases of the genital organs (prostate, uterine appendages);
non-healing ulcers in the elderly and diabetics.

Physicians usually use a urinalysis to detect sluggish infections, and if inflammation in a particular organ is suspected, ultrasound, x-rays, and an examination by an appropriate specialist are prescribed.

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Tuberculosis is a severe infection that affects the lungs, as well as the urinary, bone, reproductive systems, eyes and skin. Subfebrile temperature, along with high fatigue, loss of appetite, insomnia, can be a sign of tuberculosis of any localization. The pulmonary form of the disease is determined by fluorography in adults and the Mantoux test in children, which makes it possible to identify the disease at an early stage. Diagnosis of the extrapulmonary form is often complicated by the fact that tuberculosis is difficult to distinguish from other inflammatory processes in the organs, however, in this case, it is recommended to pay attention to a combination of signs characteristic of the disease: hyperthermia in the evenings, excessive sweating, as well as a sharp weight loss.

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A body temperature of 37-38 ° C, along with pain in the joints, muscles, rash, swollen lymph nodes, may be a sign of an acute period of HIV infection that causes damage to the immune system. The currently incurable disease makes the body defenseless against any infections - even such harmless (not assuming fatal) as candidiasis, herpes, SARS. The latent (asymptomatic) period of HIV can last up to several years, however, as the virus destroys the cells of the immune system, the symptoms of the disease begin to appear in the form of candidiasis, herpes, frequent colds, stool disorders - and subfebrile condition. Timely detection of HIV will allow the carrier to monitor their immune status and, with the help of antiviral treatment, reduce the amount of virus in the blood to a minimum, preventing life-threatening complications.

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With the development of certain tumor diseases in the body (monocytic leukemia, lymphoma, kidney cancer, etc.), endogenous pyrogens, proteins that cause an increase in body temperature, are released into the blood. Fever in this case is difficult to treat with antipyretic drugs and is sometimes combined with paraneoplastic syndromes on the skin - black acanthosis of the body folds (for cancer of the breast, digestive organs, ovaries), erythema Darya (for cancer of the breast and stomach), as well as itching without a rash and any other reasons.

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Fever in hepatitis B and C is a consequence of intoxication of the body caused by damage to liver cells. Often, subfebrile condition is a sign of a sluggish form of the disease. Hepatitis in the initial stage is also accompanied by malaise, weakness, pain in the joints and muscles, yellowness of the skin, discomfort in the liver after eating. Early detection of such an intractable disease will avoid its transition to the chronic stage, and therefore reduce the risk of complications - cirrhosis or liver cancer.

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Helminthiasis (worm infestation)

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An increase in body temperature as a result of accelerating the body's metabolism also occurs with hyperthyroidism, a disorder associated with increased production of thyroid hormones. A body temperature of at least 37.3 ° C in case of illness is accompanied by excessive sweating, inability to endure heat, thinning hair, as well as increased anxiety, tearfulness, nervousness, absent-mindedness. Severe forms of hyperthyroidism can lead to disability and even death, therefore, with the above symptoms, it is better to consult a doctor and undergo an examination. Antithyroid drugs and healing methods will normalize the functioning of the thyroid gland: hardening, diet therapy, moderate exercise, yoga. In some cases, surgery may be required.

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Subfebrile is called body temperature up to 38 degrees. Prolonged subfebrile condition can be a symptom of a sluggish inflammatory process (pyelonephritis, myocarditis,), an allergic or infectious-allergic disease, anemia, and some other serious diseases. Therefore, the first thing to do with a long subfebrile temperature is to comprehensively examine the child.

The examination plan usually includes a clinical blood test, urinalysis (not only general, but also cumulative samples and a study of daily urine, as well as an analysis for sterility), radiography of the paranasal sinuses and lungs, tuberculin tests, a biochemical blood test with the definition of rheumatic tests, ECG, Ultrasound of internal organs, stool tests for eggs of worms. According to the results of the analyzes, consultations of the necessary specialists are carried out.

The temperature of any healthy person changes during the day. In children, it is even slightly higher. Especially increases in the afternoon when the child is active. I measured mine a couple of times just out of curiosity. In the evening it is always around 37.5. The child is perfectly healthy.

Sometimes, and only in older children, to identify the nature of subfebrile condition, doctors conduct an aspirin test: they record the temperature when taking aspirin according to a certain scheme.

Parents can also participate in the survey. Firstly, 24-hour temperature monitoring is necessary, when it is measured every 3-4 hours, including the sleep period (at least 24 hours). Secondly, daily measurement of blood pressure on both arms is desirable - this procedure is also easy to master on your own. Thirdly, it is sometimes advised to simultaneously examine the parents themselves and other family members in order to identify foci of latent infection that can support subfebrile condition in a child.

If, according to the results of the analyzes, no pathology is revealed, special attention should be paid to the state of the autonomic nervous system. Often subfebrile temperature is observed in infants and school-age children with autonomic dysfunction syndrome. It also happens in children with neurosis - there is even the term "thermoneurosis" - therefore, with prolonged subfebrile condition and no changes in the analyzes, a neurologist's consultation is mandatory. Sometimes subfebrile temperature accompanies metabolic disorders: it happens in schoolchildren and delayed sexual development. Such children with hypothalamic-pituitary syndrome are observed by both a neurologist and an endocrinologist.

In some children, subfebrile body temperature is maintained not by increasing heat production, but by reducing heat transfer. This happens with spasm of peripheral vessels, and, above all, capillaries. Such subfebrile condition is characterized by the fact that during sleep the body temperature is normal. It increases with physical activity and emotional stress on the child. In summer, subfebrile condition often disappears in such children.

Treatment for prolonged subfebrile condition is largely determined by its nature. With chronic inflammation detected, the main process is treated, and the temperature returns to normal. With hypothalamic syndrome, a neurologist can prescribe drugs that improve nutrition and microcirculation of the brain, strengthen the vascular wall and have a calming effect.

With subfebrile conditions of a neurogenic nature, a phytotherapeutic technique is used (author - doctor N.L. Menshikova), combining the intake of infusion. It was traditionally believed that subfebrile temperature is a contraindication for their implementation. Now they recommend an individual approach to the child: sometimes vaccinations are allowed on a commission basis after a clinical examination.

Hello! Son is 11 years old. We belong to the category of frequently ill children from early childhood. From the age of two, there were frequent sore throats. After having outgrown, apparently, he gets sick often, but mostly quite easily, that is, SARS without complications and antibiotics, within five days. From early childhood, he suffers from a dry cough, especially in the morning, mainly if he gets up early. It's better during the holidays. The cough is often barking. The ENT and the pediatrician at the clinic will usually state that it is allergic. Passed a full examination in the department of pulmonology, allergology. Excluded asthma. Tests for the investigated allergens are all negative (however, the list of allergens, in my opinion, is quite primitive, standard). Despite the negative allergy tests, the child is considered an allergic person, immunoglobulin E is slightly elevated. The last 5 weeks have been suffering from subfebrile temperature. The numbers fluctuate in the range of 37-37.6. Passed general blood tests, urine, biochemistry. Cytomegalovirus was found, leukocytes are slightly reduced, everything else is normal. We accept polyoxidonium. As prescribed by the ENT doctor, they washed the tonsils. The temperature returned to normal for a week. Then it resumed again. The local pediatrician, after consulting with a neurologist, advised me to measure the temperature, both in the usual way and rectally, during the week. Explaining this by the fact that if the rectal temperature is normal, that is, up to 37.5, and the usual armpit temperature is elevated, then it is most likely of a neurogenic nature. I was skeptical, not believing how such a temperature difference is possible. But within a week I discovered that, indeed, despite the jumps in armpit temperature, the rectal temperature, not only was higher (as I assumed), it was either lower - 36-36.7, or approximately the same as normal (and only twice). But still lower by 0.1-0.2 degrees. I don't know what to think. The pediatrician triumphantly declares that we have one road to neurologists, psychologists, and we need to change schools (We take the child far, by 7.30 and until 16 o'clock). The child gets tired, studies well, but goes to school with difficulty and goes with great reluctance. In fairness, it must be said that it is true that the drop in temperature fell on a week of holidays. And it resumed on the second day after going to school. My son has no problems with teachers, classmates, studies. Neither in his words, nor in the words of the class teacher. The ENT insists that it is chronic tonsillitis and that the tonsils may have to be removed. He advises not to drag the child to other doctors, it makes no sense - only torturing. How much can you believe this? How to be? Advise, please, to what experts to address, what analyzes still to hand over?