儿童发热，家长行动指南FEVER OVERVIEW 发烧概述
Fever is a normal response to a variety of conditions, the most common of which is infection. Fever occurs when the body's temperature is elevated as a result of the body's thermostat being reset to a higher-than-usual temperature.发热是对各种疾病的正常反应，其中最常见的是感染。当身体的恒温器被重置到比平常更高的温度时，身体的温度升高，就会发烧。
Nearly every child will develop a fever at some point. The challenge for caregivers is to know when to be concerned. This topic review will discuss the definition of a fever, how to accurately measure a child's temperature, how and when to treat fever, and signs and symptoms that require further evaluation.几乎每个孩子都会在某个时候发烧。照顾者面临的挑战是知道什么时候该关心。本主题综述将讨论发烧的定义，如何准确测量儿童的体温，如何和何时治疗发热，以及需要进一步评估的体征和症状。
FEVER DEFINITION 热的定义
Because of the normal variation in body temperature, there is no single value that is defined as fever. In general, a fever means a temperature above 100.4°F (38°C). You might get slightly different numbers depending on how you take your child's temperature – oral (mouth), axillary (armpit), ear, forehead, or rectal.由于体温的正常变化，没有一个单独的值被定义为发热。一般来说，发烧意味着体温高于100.4华氏度(38°C)。根据测量孩子体温的方式，你可能会得到略微不同的数字——口腔、腋窝、耳朵、前额或直肠。
Axillary, ear, and forehead temperature measurements are easier to obtain than rectal or oral temperatures, but they are less accurate and may need to be confirmed rectally or orally in certain children.与直肠或口腔温度相比，腋窝、耳和前额温度测量更容易获得，但它们不太准确，可能需要在某些儿童中通过直肠或口腔进行确认。
FEVER CAUSES 发烧的原因
Infection is the most common cause of fever in children. Common viral and bacterial illnesses are the most likely illnesses to cause fever. These include:感染是儿童发热的最常见原因。常见的病毒性和细菌性疾病是最可能引起发热的疾病。这些包括:
●Colds (see "Patient education: The common cold in children (Beyond the Basics)")感冒(见“病人教育:儿童普通感冒(基础之外)”)
●Gastroenteritis (see "Patient education: Nausea and vomiting in infants and children (Beyond the Basics)")胃肠炎(见“患者教育:婴儿和儿童的恶心和呕吐(基础知识之外)”)
●Ear infections (see "Patient education: Ear infections (otitis media) in children (Beyond the Basics)")耳感染(见“患者教育:儿童耳感染(中耳炎)(基础之外)”)
●Croup (see "Patient education: Croup in infants and children (Beyond the Basics)")哮吼(见“患者教育:婴幼儿哮吼(基础以外)”)
●Bronchiolitis (see "Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics)")毛细支气管炎(见“患者教育:婴幼儿毛细支气管炎和RSV(基础之外)”)
●Urinary tract infections (see "Patient education: Urinary tract infections in children (Beyond the Basics)")尿路感染(见“患者教育:儿童尿路感染(基础之外)”)
There is little or no scientific evidence to support the widespread belief that teething causes fever. Although it is difficult to disprove this notion completely, alternative causes of fever should always be sought and temperatures above 102°F (38.9°C) should never be attributed to teething.几乎没有科学证据支持出牙会导致发烧这一普遍观点。虽然很难完全否定这一观点，但发热的其他原因应始终寻找，绝不应将102华氏度(38.9°C)以上的温度归因于出牙。
Bundling a child who is less than three months old in too many clothes or blankets can increase the child's temperature slightly. However, a rectal temperature of 101°F (38.5°C) or greater is not likely to be related to bundling and should be evaluated. (See 'Evaluation recommended' below.)给3个月以内的孩子裹上太多的衣服或毯子会使孩子的体温略微升高。然而，101°F(38.5°C)或更高的直肠温度不太可能与束带相关，应该进行评估。(见下面的“建议评估”。)
Some childhood immunizations can cause fever. The timing of the fever varies, depending upon which vaccination was given. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)".)一些儿童接种疫苗会引起发热。发热的时间因接种疫苗的种类而异。(见“患者教育:0 - 6岁婴儿和儿童的疫苗接种(基础之外)”。)
HOW DO I MEASURE MY CHILD'S TEMPERATURE?如何测量孩子的体温?
Glass versus digital thermometers — Digital thermometers are inexpensive, widely available, and the most accurate way to measure temperature. A variety of styles are available.玻璃温度计与数字温度计的比较——数字温度计价格低廉，广泛使用，是测量温度的最准确的方法。有多种款式可供选择。
Glass thermometers that contain mercury are no longer readily available for purchase. The glass thermometers that are sold now contain a different material that is nontoxic when swallowed. If a glass thermometer contains a silver liquid, it may contain mercury, while those with liquids of other colors do not. If a digital or non-mercury-containing glass thermometer is not available, be sure to carefully "shake down" the glass thermometer before use. Instructions for disposing of thermometers that contain mercury are available online (www.epa.gov/mercury).含有水银的玻璃温度计不再容易买到。现在出售的玻璃温度计含有一种不同的材料，吞咽时无毒。如果玻璃温度计中含有银色液体，它可能含有水银，而那些含有其他颜色液体的温度计则没有。如果没有数字或不含汞的玻璃温度计，请务必在使用前仔细“摇下”玻璃温度计。处理含汞温度计的说明可在网上获取(www.epa.gov/mercury)。
Other types of thermometers are available, including plastic strip and pacifier thermometers. However, these are not as accurate as digital thermometers and are not recommended.其他类型的温度计，包括塑料条和奶嘴温度计。然而，这些没有数字温度计准确，不建议使用。
Where to measure temperature — The best way to measure a child's temperature depends upon several factors. For children who can hold a thermometer under the tongue using proper technique (usually children older than four or five years), temperature can be measured accurately in the mouth. For infants and children who cannot hold the thermometer under the tongue, temperature can be measured in the armpit. If the armpit temperature is over 99°F (37.2°C) and there is concern that the child is ill, a rectal temperature may be necessary. A rectal temperature is also appropriate for infants from birth to three months of age. In the hospital setting, a rectal temperature is usually obtained before making medical decisions (eg, whether to obtain laboratory tests).在哪里测量体温——测量儿童体温的最佳方法取决于几个因素。对于能够用适当的方法将体温计放在舌下的儿童(通常是4、5岁以上的儿童)，可以准确地测量口腔内的温度。对于不能将体温计放在舌下的婴幼儿，可以在腋下测量体温。如果腋窝温度超过99°F(37.2°C)，担心孩子生病，可能需要测肛温。从出生到3个月大的婴儿的直肠温度也是合适的。在医院，通常在做出医疗决定(如是否进行实验室检查)之前测量直肠温度。
Temperatures measured in the ear or on the forehead also are less accurate than temperatures measured rectally or orally and may need to be confirmed by one of these methods.在耳朵或前额测量的温度也不如直肠或口腔测量的温度准确，可能需要通过这些方法中的一种来确认。
It is not accurate to estimate a child's temperature by feeling the child's skin. This is called a tactile temperature, and it is highly dependent upon the temperature of the person who is feeling the child's skin.通过触摸孩子的皮肤来估计孩子的体温是不准确的。这被称为触觉温度，它高度依赖于触摸孩子皮肤的人的温度。
How to measure temperature at specific sites如何测量特定地点的温度
●Rectal temperature 直肠温度
•The child or infant should lie down on their stomach across an adult's lap.儿童或婴儿应俯卧在大人的膝盖上。
•Apply a small amount of petroleum jelly (eg, Vaseline) to the end of the thermometer.在温度计的末端涂上少量凡士林(如凡士林)。
•Gently insert the thermometer into the child's anus until the silver tip of the thermometer is not visible (1/4 to 1/2 inch inside the anus) (figure 1).轻轻地将体温计插入孩子的肛门，直到看不到体温计的银尖端(肛门内1/4至1/2英寸)(图1)。
•Hold the thermometer in place. A glass thermometer requires two minutes, while most digital thermometers need less than one minute.把温度计放好。玻璃温度计需要两分钟，而大多数数字温度计需要不到一分钟。
●Oral temperature 口腔温度 – Do not measure the temperature in a child's mouth if they have consumed a hot or cold food or drink in the last 30 minutes.-不要测量儿童在过去30分钟内进食热或冷的食物或饮料后的口腔温度。
•Clean the thermometer with cool water and soap. Rinse with water.用冷水和肥皂清洗温度计。用清水冲洗。
•Place the tip of the thermometer under the child's tongue toward the back. Ask the child to hold the thermometer with their lips.将体温计的尖端朝后放在孩子的舌下。让孩子用嘴唇拿着体温计。
•Keep the lips sealed around the thermometer. A glass thermometer requires approximately three minutes, while most digital thermometers need less than one minute.把温度计封住。一个玻璃温度计大约需要三分钟，而大多数数字温度计需要不到一分钟。
●Armpit temperature 腋窝温度
•Place the tip of the thermometer in the child's dry armpit.将体温计的尖端放在孩子干燥的腋下。
•Hold the thermometer in place by holding the child's elbow against the chest for four to five minutes.将孩子的肘部贴在胸前4 ~ 5分钟，保持体温计的位置。
●Ear temperature 耳朵温度 – Ear thermometers are not as accurate as rectal or oral thermometers. If the child has been outside on a cold day, wait 15 minutes before measuring the ear temperature. Ear tubes and ear infections do not affect the accuracy of an ear temperature.-耳测温仪不如直肠或口腔测温仪准确。如果孩子曾在寒冷的天气外出，等待15分钟后再测量耳朵的温度。耳管和耳感染不影响耳温的准确性。
•To measure temperature accurately in the ear, the caregiver must pull the child's outer ear backward before inserting the thermometer (figure 2).
•Hold the ear probe in the child's ear for approximately two seconds.将耳探器放在孩子的耳朵里大约两秒钟。
●Temporal artery temperature颞动脉温度– The temperature of the temporal artery can be taken by a device that is run over the forehead and in front of the ear (contact) or one that takes the temperature without touching your child using an infrared sensor (noncontact). These devices are not as accurate as a rectal or oral temperature but may be used to screen for fever in children older than four years of age.-颞动脉的温度可以通过覆盖在额头和耳前的设备来测量(接触式)，也可以在不接触孩子的情况下使用红外传感器测量(非接触式)。这些设备不如直肠或口腔温度准确，但可用于4岁以上儿童的发热筛查。
SHOULD I TREAT MY CHILD'S FEVER?我应该治疗我孩子的发烧吗?
There are pros and cons of treating fever. Fever may play a role in fighting infection, but it can also make a child uncomfortable.治疗发热有利弊。发烧可能在对抗感染中发挥作用，但也可能使孩子感到不舒服。
The height of a child's fever is not always the best indicator of whether the child needs to be treated and/or evaluated. Instead, it is important to note how a child behaves and appears. Fever is usually accompanied by other symptoms. Some of these symptoms require evaluation by a health care provider, even if there is no fever. The table provides a list of some of these symptoms (table 1).儿童的发热高度并不总是儿童是否需要治疗和/或评估的最佳指标。相反，注意孩子的行为和外表是很重要的。发热通常伴有其他症状。即使没有发热，其中一些症状也需要由卫生保健提供者进行评估。该表提供了其中一些症状的列表(表1)。
In most cases, a child with a fever can be observed and/or treated at home. However, it is important for caregivers to know when a child with a fever needs to be evaluated by a health care provider, when fever should be treated, and when it is reasonable to observe the child without treating the fever.在大多数情况下，发烧的儿童可以在家观察和/或治疗。然而，重要的是，照护者应了解什么时候发烧的儿童需要由卫生保健提供者进行评估，什么时候应该治疗发热，以及什么时候观察儿童而不治疗发热是合理的。
The guidelines provided below are general guidelines that do not apply to every situation; caregivers who have questions or are concerned about their child should contact their child's health care provider for advice.以下提供的准则是一般性准则，并不适用于所有情况;有问题或担心孩子的照护者应与孩子的卫生保健提供者联系，寻求建议。
Evaluation recommended — A health care provider should be consulted in the following situations:建议评估——在下列情况下应咨询卫生保健提供者:
●Infants who are less than three months of age who have a rectal temperature of 100.4°F (38°C) or greater, regardless of how the infant appears (eg, even well-appearing young infants should be evaluated). These patients should not receive fever medication (eg, acetaminophen) until they have consulted with their health care provider.3个月以下的婴儿，直肠温度≥100.4°F(38°C)，无论婴儿外表如何(例如，即使是外观良好的小婴儿也应进行评估)。这些患者在咨询医务人员之前不应接受发热药物(如对乙酰氨基酚)治疗。
●Children who are three months to three years who have a rectal temperature of 100.4°F (38°C) or greater for more than three days or who appear ill (eg, fussy, clingy, refusing to drink fluids).3个月至3岁的儿童，直肠温度≥100.4华氏度(38°C)超过3天或出现疾病(如挑剔、黏人、拒绝喝水)。
●Children who are 3 to 36 months who have a rectal temperature of 102°F (38.9°C) or greater.直肠温度≥102华氏度(38.9℃)的3 - 36个月儿童。
●Children of any age whose oral, rectal, tympanic membrane, or forehead temperature is 104°F (40°C) or greater or whose axillary temperature is 103°F (39.4°C) or greater.口腔、直肠、鼓膜或前额温度≥104°F(40°C)或腋窝温度≥103°F(39.4°C)的任何年龄儿童。
●Children of any age who have a febrile seizure. Febrile seizures are convulsions that occur when a child (between six months and six years of age) has a temperature greater than 100.4° F (38°C). (See "Patient education: Febrile seizures (Beyond the Basics)".)有热性惊厥的任何年龄的儿童。热性惊厥是儿童(6个月至6岁)体温超过100.4华氏度(38℃)时发生的惊厥。(见“患者教育:热性惊厥(基础之外)”。)
●Children of any age who have recurrent fevers without any other symptoms for more than seven days, even if the fevers last only a few hours.任何年龄的儿童，在没有任何其他症状的情况下反复发热超过7天，即使发热只持续几个小时。
●Children of any age who have a fever and have a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia.任何年龄的发烧和有慢性疾病如心脏病、癌症、狼疮或镰状细胞性贫血的儿童。
●Children who have a fever as well as a new skin rash.有发烧和新发皮疹的儿童。
Treatment recommended — Treatment of fever is recommended if a child has an underlying medical problem, including diseases of the heart, lung, brain, or nervous system. In children who have had febrile seizures in the past, treatment of fever has not been shown to prevent seizures but is still a reasonable precaution.建议治疗——如果孩子有潜在的医学问题，包括心脏、肺、脑或神经系统疾病，建议对发热进行治疗。对于既往有热性惊厥发作的儿童，尚未证明发热治疗可预防惊厥发作，但仍是一种合理的预防措施。
Treatment of fever may be helpful if the child is uncomfortable, although it is not necessary.如果患儿不舒服，治疗发热可能是有帮助的，但这不是必要的。
Treatment not required — In most cases, it is not necessary to treat a child's fever. A child older than three months who has a rectal temperature less than 102°F (38.9°C) and who is otherwise healthy and acting normally does not require treatment for fever.不需要治疗——在大多数情况下，不需要治疗儿童的发热。3个月以上、直肠温度低于102华氏度(38.9℃)、其他方面健康且行为正常的儿童不需要发热治疗。
Caregivers who are unsure if their child's fever needs treatment should contact the child's health care provider. (See 'Evaluation recommended' above.)不确定孩子发热是否需要治疗的照护者应与孩子的卫生保健提供者联系。(见上文“建议评估”。)
FEVER TREATMENT OPTIONS 发热治疗方案
Medications — The most effective way to treat fever is to use a medication such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). These treatments can reduce the child's discomfort and lower the child's temperature by 2 to 3°F (1 to 1.5°C). Aspirin is not recommended for children under age 18 years due to concerns that it can cause a rare but serious illness known as Reye syndrome.药物治疗——治疗发热最有效的方法是使用对乙酰氨基酚(样品品牌名称:泰诺)或布洛芬(样品品牌名称:Advil, Motrin)等药物。这些治疗可减轻患儿的不适感，并将患儿体温降低2 ~ 3°F(1 ~ 1.5°C)。阿司匹林不推荐给18岁以下的儿童，因为担心它会导致一种罕见但严重的疾病，即瑞氏综合征。
Acetaminophen may be given every four to six hours as needed but should not be given more than five times in a 24-hour period. Acetaminophen should not be used in children younger than three months of age without consultation with a health care provider. The dose of acetaminophen should be calculated based upon the child's weight (not age).对乙酰氨基酚可按需每4 ~ 6小时服用1次，但24小时内不得服用超过5次。在未咨询医务人员的情况下，对乙酰氨基酚不能用于3个月以下的儿童。对乙酰氨基酚的剂量应根据儿童的体重(而不是年龄)计算。
Ibuprofen may be given every six hours. Ibuprofen should not be used in children younger than six months of age. The dose of ibuprofen should be calculated based upon the child's weight (not age).布洛芬可以每6小时给药一次。布洛芬不能用于小于6个月的儿童。布洛芬的剂量应根据儿童的体重(而不是年龄)计算。
Giving combinations of acetaminophen and ibuprofen or alternating acetaminophen and ibuprofen increases the chance of giving the wrong dose of one or the other of the medications and is not recommended routinely.联合使用对乙酰氨基酚和布洛芬或交替使用对乙酰氨基酚和布洛芬会增加给其中一种或另一种药物错误剂量的机会，不建议常规使用。
Fever-reducing medications should only be given as needed and discontinued once bothersome symptoms have resolved.退热药物只应按需用药，并在烦人的症状消失后停用。
Increase fluids — Having fever can increase a child's risk of becoming dehydrated. To reduce this risk, caregivers should encourage their child to drink an adequate amount of fluids. Children with fever may not feel hungry, and it is not necessary to force them to eat. However, fluids such as milk (cow's or breast), formula, and water should be offered frequently. Older children may eat flavored gelatin, soup, or frozen popsicles. If the child is unwilling or unable to drink fluids for more than a few hours, the caregiver should consult the child's health care provider.增加液体——发烧会增加孩子脱水的风险。为了降低这种风险，看护人应鼓励孩子喝足量的液体。发热患儿可能不会感到饥饿，也没有必要强迫其进食。然而，应经常提供牛奶(奶牛或母乳)、配方奶和水等液体。年龄较大的孩子可能会吃调味的明胶、汤或冷冻冰棍。如果孩子不愿意或不能喝液体超过几个小时，看护人应咨询孩子的卫生保健提供者。
Rest — Having a fever causes most children to feel tired and achy. During this time, caregivers should encourage their child to rest as much as the child wants. It is not necessary to force the child to sleep or rest if they begin to feel better. Children may return to school or other activities when the temperature has been normal for 24 hours.休息——发烧会使大多数孩子感到疲倦和疼痛。在此期间，看护人应该鼓励孩子尽可能多地休息。如果孩子开始感觉好一些，没有必要强迫他们睡觉或休息。当温度正常24小时后，儿童可以返回学校或参加其他活动。
Sponging and baths — Sponging is not as effective as medications for fever and generally is not recommended. Alcohol should not be used for sponging because of the risk of toxicity if it is absorbed through the skin.用海绵擦浴和洗澡——用海绵擦浴不如用药物治疗发烧有效，一般不建议使用。酒精不能用在海绵上，因为如果它通过皮肤吸收会有中毒的风险。
参考文献：Patient education: Fever in children (Beyond the Basics)，Uptodate,2024
翻译：陈舟医生
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