Dr. Lalith

Fever in children is a very common phenomenon, but still parents absolutely dread it. It can completely break your heart to suddenly see a happy, healthy child not getting up from the bed. Your first instinct when that thermometer crosses that dreaded 100 degrees F is to rush to the doctor for an immediate cure. That is probably the best remedy as a doctor can often catch additional signs of any disease that you may miss out on. Beyond that, here is how you can understand about fever in children better and how you can help. Technically, your child has fever when the body temperature crosses 100.4 degrees F.
 
Some children manage to stay active even then, but slowly get bogged down with muscle pain or other accompanying symptoms like cold, diarrhea, vomiting etc. 

• Causes: Fever is normally caused by the body's reaction to fighting an infection. (That is why most doctors say it's a sign of a robust immune system). When the body's natural defense system is stimulated, the core inner temperature rises, thereby making it harder for the bacteria and viruses that caused the infection to survive. Most fever subside on their own but that's a tough thing to accept as a parent who only wants to see their child up and running as soon as possible.
• What you can do: Keep an eye on that temperature obviously. You need to find a doctor the moment the fever crosses the threshold temperature (101+ for less than three months olds, 102+ for 3-6 month olds and over 102 for older children). You should also consult a doctor if there are accompanying symptoms or if you've given a dose of Paracetamol but the fever shows no sign of subsiding. It might happen at midnight and beyond, when no regular pediatrician is unavailable. So it is best to find out which hospital has an emergency center capable of handling such eventualities near your home. 
• Fever medications: It is super important for parents to know that fever medications must be given in the correct dose at the right times based on a child's weight, age, and overall health. An overdose can lead you straight to the emergency room. Don't mix a cold/cough medication that also has a fever medication in it. 
• Home remedies: Encourage your child to drink as much fluids as possible to prevent dehydration. Some doctors advise complete body sponging to bring down the temperature and this can be done as long as it doesn't cool the body too suddenly (there are contradictory notes on this practice, so do consult you doctor before your do this).

 As parent, it is important you equip yourself with the right knowledge before you provide treatment to your child. 

Q1. What exactly is Laparoscopy?

Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.

Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?

Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.

Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?

Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.

Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?

Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.

Q5. Will there be much pain or discomfort after Laparoscopic Surgery?

There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.

Q6. When can I be discharged from hospital?

Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.

Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?

Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.