Features

Fever in children

Published

11 months ago

2025/04/11

by Dr B.J.C.Perera
MBBS(Cey), DCH(Cey),
DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK),
FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health Section Editor, Ceylon Medical Journal

Fever is a common symptom of a variety of diseases in children. At the outset, it is very important to clearly understand that it is only a symptom and not a disease in its own right. When the body temperature is elevated above the normal level of around 98.6 degrees Fahrenheit (F) or 37 degrees Celsius (C), the condition is referred to as fever. It is a significant accompanying symptom of a plethora of childhood diseases. All children would get a fever at some time or another in their lives, and in the vast majority of cases, this is due to rather mild illnesses, and they are completely back to normal within a few days. Some may have a rather low-grade fever, while others may have quite a high fever. However, in certain situations, fever may be an important indication of an underlying serious problem. The significance depends entirely on the circumstances under which this occurrence is seen.

Irrespective of the actual underlying reason for the fever, the basic mechanism of causation of fever is the temporary resetting of the temperature-regulating thermostat of the brain to a higher level. The consequences are that the heat generated within the body is not effectively dissipated. It is merely a body response to a harmful agent and is a very important defence mechanism. Turning up the core temperature is the body’s way of fighting the germs that cause infections and making the body a less comfortable place for them. However, less commonly, it is also a manifestation of other inflammatory disorders in children. The significance of fever in such situations is a little bit different to that which is seen as a response to an infection.

The part of the human brain that controls body temperature is not fully developed in young children. This means that a child’s temperature may rise and fall very quickly and the child is also more sensitive to the temperature of his or her surroundings. Although parents often worry and get terribly scared with the child developing fever, it does not cause any harm by itself. It is a good thing in the sense that it is often the body’s way of fighting off infection.

It is quite important to note that the actual level of the temperature is not always a good guide to how ill the child is. A simple cold or other viral infection can sometimes cause a high fever in the region of 102 to 104 degrees Fahrenheit or 39 to 40 degrees Celsius. However, this does not always indicate a serious problem. It is also true to say that some more sinister infections could sometimes cause a much lower rise in the body temperature. Because fevers may rise and fall, a child with a fever might experience chills and shivering as the body tries to generate additional heat as the body temperature begins to rise. This may be followed by sweating as the body releases extra heat when the temperature starts to drop. Children with fever often breathe faster than usual and generally have a higher heart rate. However, fever accompanied by obvious difficulties in breathing, especially if the breathing problems persist even at times the temperature is normal is of significance and requires urgent medical evaluation of the situation. Generally, in the case of children, the way they act is far more important than the reading on the thermometer, and most of the time, the exact level of a child’s temperature is not particularly important, unless it is persistently very high.

Although many fevers need just simple remedies, under certain conditions the symptom of fever needs rather urgent medical attention. This is the case in babies younger than three months. Same is true even in a bigger child if the fever is accompanied by uncontrollable crying or pain in the neck with a severe headache. Marked coughing and or difficulty in breathing coupled with fever needs to be medically sorted out. Fever combined with pain and difficulty in passing urine, significant tummy pains or marked vomiting and diarrhoea too would need medical attention. Reddish rashes and bluish spots on the skin with fever also need to be seen by a doctor. The illness is probably not serious if a child with a history of fever is still interested in playing, is eating and drinking well, is alert and smiling, has a normal skin colour and looks well when his or her temperature comes down. However, even with rather low levels of fever, under certain conditions, medical attention should be sought. In situations such as when the child seems to be too ill to eat and drink, has persistent vomiting or diarrhoea, has signs of dehydration, has specific complaints like a sore throat or an earache or when fever is complicated by some other chronic illness, it is prudent for him or her to be seen by a qualified doctor.

One could take several steps to bring down a fever. It is very useful to remove most of the clothes and keep under a fan to facilitate heat loss from the body. If there is no fan available, one could try fanning with a newspaper. A very effective way of bringing down a temperature is to sponge the body with a towel soaked in water. The water must be at room temperature or a bit higher. One should not use ice or iced water on the body. Ice will lead to contraction of the blood vessels of the skin and the purpose would be lost as more heat will be conserved within the body. There is no evidence that ice on the head helps to bring down the fever or to prevent a convulsion. If a medicine is to be used, paracetamol is probably as good as any other drug, but the correct dosage according to the instructions on the container should be used for optimal benefit. The best way of calculating the appropriate dose is by using the body weight. It is very important to stress that aspirin and aspirin-containing medications should not be used in children, merely to bring down a fever.

A child with fever loses a considerable amount of fluid from the body, particularly due to sweating. It is beneficial to ensure that the child drinks plenty of fluids. A good index of the adequacy of fluid intake is the passing of normal amounts of urine. A reduced solid food intake would not matter that much just for a couple of days of fever, but in prolonged fevers adequate nutrition too becomes quite important. A child with a high temperature also needs rest and sleep. They do not have to be in bed all day if they feel like playing, but they must have the opportunity to lie down. Sick children are often tired and bad-tempered. They sleep a lot, and when they are awake, they want their parents around all the time. Perhaps it is quite useful to spoil them a little bit when they are ill and to read to them, play with them or just spend time with them. It is best to keep a child with a fever home and not send him or her to school or child care. Most doctors would agree that in simple fevers, it is quite satisfactory for the child to return to school or child care when the temperature has been normal for over 24 hours.

Trying to get the temperature down would make the child more comfortable. However, it is not essential to get it down to normal and to keep it there scrupulously. Parents often worry that either the fever simply refuses to abate or springs up again after a couple of hours. It must be realised that certain fevers have to run their course and will not come down to normal in a hurry, despite whatever measures that are undertaken. This is particularly true of viral fevers. Some parents are terribly worried at the slightest elevation of the temperature and go running to doctors looking for a “magic cure” for the fever. Many fevers do not need urgent medical attention and one could watch it for a few days and see how it progresses. Yet for all that, if there are some worrying signs then it is advisable to seek advice from a qualified doctor.

It is a familiar occurrence that many people believe that a high fever is quite dangerous. Fever by itself has no major long-lasting effects. If one appreciates that high fever is just a symptom and that it is only a reaction of the body to something untoward going on, then it is easy to consider it to be just like any other symptom of a disease. Some are also under the misconception that a high fever could cause a convulsion. This is not always the case, and a convulsion would occur only in those children who have the constitutional tendency to get them. Convulsions are not always related to high fever, and in those who are susceptible, even moderate and sometimes mild fever could trigger a convulsion. High fever does not lead to lasting brain damage in its own right either. Fever is sometimes an indication of a significant infection, but in those circumstances, the primary disease itself is the real problem. In situations where medical help is desirable, what is most important is the way a fever is sorted out and some kind of a diagnosis being made as to the real cause of the fever. The crucial component of the treatment of a fever caused by an underlying problem is the treatment of the root cause.

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Features

A long-running identity conflict flares into full-blown war

Published

20 hours ago

2026/03/5

Sahan Weerasooriya

Ayatollah Ali Khamenei / President Donald Trump

It was Iran’s first spiritual head of state, the late Ayatollah Khomeini, who singled out and castigated the US as the ‘Great Satan’ in the revolutionary turmoil of the late seventies of the last century that ushered in the Islamic Republic of Iran. The core issue driving the long-running confrontation between Islamic Iran and the West has been religious identity and the seasoned observer cannot be faulted for seeing the explosive emergence of the current war in the Middle East as having the elements of a religious conflict.

The current crisis in the Middle East which was triggered off by the recent killing of Iranian spiritual head of state Ayatollah Ali Khamenei in a combined US-Israel military strike is multi-dimensional and highly complex in nature but when the history of relations between Islamic Iran and the West, read the US, is focused on the religious substratum in the conflict cannot be glossed over.

In fact it is not by accident that US President Donald Trump resorts to Biblical language when describing Iran in his denunciations of the latter. Iran, from Trump’s viewpoint, is a primordial source of ‘evil’ and if the Middle East has collapsed into a full-blown regional war today it is because of the ‘evil’ influence and doings of Iran; so runs Trump’s narrative. It is a language that stands on par with that used by the architects of the Iranian revolution in the crucial seventies decade.

In other words, it is a conflict between ‘good’ and ‘evil’ and who is ‘good’ and who is ‘evil’ in the confrontation is determined mainly by the observer’s partialities and loyalties which may not be entirely political in kind. It should not be forgotten that one of President Trump’s support bases is the Christian Right in the US and in the rest of the West and the Trump administration’s policy outlook and actions should not be divorced from the needs of this segment of supporters to be fully made sense of.

The reasons for the strong policy tie-up between Rightist administrations in the US in particular and Israel could be better comprehended when the above religious backdrop is taken into consideration. Israel is the principal actor in the ‘Old Testament’ of the Bible and is seen as ‘the Chosen People of God’ and this characterization of Israel ought to explain the partialities of the Republican Right in particular towards Israel. Among other things, this partiality accounts for the strong defence of Israel by the US.

For the purposes of clarity it needs to be mentioned here that the Bible consists of two parts, an ‘Old’ and ‘New Testament’ , and that the ‘New Testament’ or ‘Message’ embodies the teachings of Jesus Christ and the latter teachings are seen as completing and in a sense giving greater substance to the ‘Old Testament’. However, Judaism is based mainly on ‘Old Testament’ teachings and Judaism is distinct from Christianity.

To be sure, the above theological explanation does not exhaust all the reasons for the war in the Middle East but the observer will be allowing an important dimension to the war to slip past if its importance is underestimated.

It is not sufficiently realized that the Iranian Islamic Revolution of 1979 utterly changed international politics and re-wrote as it were the basic parameters that must be brought to bear in understanding it. So important is the Islamic factor in contemporary world politics that it helped define to a considerable degree the new international political order that came into existence with the collapsing of the Cold War and the disintegration of the USSR .

Since the latter developments ‘political Islam’ could be seen as a chief shaping influence of international politics. For example, it accounts considerably for the 9/11 calamity that led to the emergence of fresh polarities in world politics and ushered in political terrorism of a most destructive kind that is today disquietingly visible the world over.

It does not follow from the foregoing that Islam, correctly understood, inspires terrorism of any kind. Islam proclaims peace but some of its adherents with political aims interpret the religion in misleading, divisive ways that run contrary to the peaceful intents of the faith. This is a matter of the first importance that sincere adherents of the faith need to address.

However, there is no denying that the Islamic Revolution in Iran of 1979 has been over the past decades a great shaper of international politics and needs to be seen as such by those sections that are desirous of changing the course of the world for the better. The revolution’s importance is such that it led to US political scientist Dr. Samuel P. Huntingdon to formulate his historic thesis that a ‘Clash of Civilizations’ is upon the world currently.

If the above thesis is to be adopted in comprehending the principal trends in contemporary world politics it could be said that Islam, misleadingly interpreted by some, is pitting a good part of the Southern hemisphere against the West, which is also misleadingly seen by some, as homogeneously Christian in orientation. Whereas, the truth is otherwise. The West is not necessarily entirely synonymous with Christianity, correctly understood.

Right now, what is immediately needed in the Middle East is a ceasefire, followed up by a negotiated peace based on humanistic principles. Turning ‘Spears into Ploughshares’ is a long gestation project but the warring sides should pay considerable attention to former Iranian President Mohammad Khatami’s memorable thesis that the world needs to transition from a ‘Clash of Civilizations’ to a ‘Dialogue of Civilizations’. Hopefully, there would emerge from the main divides leaders who could courageously take up the latter challenge.

It ought to be plain to see that the current regional war in the Middle East is jeopardising the best interests of the totality of publics. Those Americans who are for peace need to not only stand up and be counted but bring pressure on the Trump administration to make peace and not continue on the present destructive course that will render the world a far more dangerous place than it is now.

In the Middle East region a durable peace could be ushered if only the just needs of all sides to the conflict are constructively considered. The Palestinians and Arabs have their needs, so does Israel. It cannot be stressed enough that unless and until the security needs of the latter are met there could be no enduring peace in the Middle East.

Features

The art and science of communicating with your little child

Published

20 hours ago

2026/03/5

Sahan Weerasooriya

The two input gateways of communication, sight and sound, are quite well developed at birth. In fact, the auditory system becomes functional around 24 weeks in the womb, and the normal newborn can hear quite well after birth. However, the newborn’s vision is a little blurry at birth, and the baby sees the world in shades of grey, while being able only to focus on things 20 to 30 cm (8–12 inches) away. Coincidentally, this is perhaps the exact distance to a mother’s face during breastfeeding. By 2-3 months, there are colour vision capabilities and the ability to track. By 5-8 months, there is depth perception, and by 12 months, there is adult clarity of vision.

By the time a child turns five, his or her brain has already reached 90% of its adult size. This astonishing physical growth is not just happening on its own; it is, to a certain extent, fuelled by experience, and the most vital experience a young child can have is communication with his or her parents.

Modern developmental neuroscience has shifted our understanding of how children learn. We used to think babies were passive sponges, slowly absorbing the world. We now know they are active characters from day one, constantly seeking interaction to build the architecture of their minds. This architecture is not built by apps, vocabulary flashcards, or educational television. It is built through simple, loving, back-and-forth interactions with anyone they come across, but mostly their parents.

The Foundation: Serve and Return (0–12 Months)

Communication with an infant from birth to one year of age begins long before they speak their first word. In the first year, the goal is to master a phenomenon called Serve and Return. This is a basic scenario picked up from the game of tennis. At the start of each game of a set in tennis, a player serves, and the opponent returns the serve. Just imagine a tennis match, where a baby “serves” by making a sound, making eye contact, reaching for a toy, or crying. The job of anyone in the vicinity, who very often are the parents of the baby, is to “return” the ball. If they babble, you babble back. If they point at a cat, you look and say, “Yes, that’s a furry cat!” This simple act does two things. The first is Brain Building, which creates and strengthens neural pathways in the language and emotional centres of the brain. The other is Emotional Security, a thing which teaches a baby that he or she has some help in the learning processes. The baby absorbs the notion that when he or she signals a need, his or her world will respond. This forms the basis of a secure attachment. Scientists have advocated that during this stage, people, especially the parents of a baby, should embrace what is called ‘parentese’. It is the use of a somewhat high-pitched, exaggerated voice. Research has shown that babies pay more attention to parentese than to regular adult speech, helping them to map the sounds of their native language more quickly.

The Language Explosion: Toddlers (1–3 Years)

When a child starts speaking words, the game changes considerably and quite profoundly. This period is defined by a rapid increase in his or her vocabulary and the beginning of grammar. It is very important to narrate everything. The people around, especially the parents, need to become kind of sports commentators for your life. While dressing them, one could say, “First we put on the red sock. After that, we put the other red sock on your left foot.” What we are doing by this is to give them the labels for the world they see.

It is also important to expand, but not truly correct, whatever the child says. If a toddler points to a car and says “Car!”, don’t just say “Yes.” Expand on it: “Yes, that is a big, fast, red car!” You are adding a new vocabulary and grammatical structure through a natural process. If the child says “Me go,” respond with, “Yes, you are going!” rather than correcting and saying “No…, you should say ‘I am going’.”

Toddlers love reading the same book, even one hundred times. While it may be tedious for those around the baby, it is important to realise that such repetition is vital for their learning. They are predicting what comes next, which is a core cognitive skill.

The Preschooler: Building Stories and Logic (3–5 Years)

By age three, the focus shifts from “what” to “why.” Preschoolers are beginning to understand complex emotions, time, and causality. This is the age at which it is best to ask questions which require thought and understanding. Such indirect open-ended questions would sound like “What was the best part of the park today?” or “How do you think that character in the story is feeling?“

A preschooler’s world is full of “big feelings” they cannot yet manage. When they are upset because they cannot have a cookie, avoid saying “Don’t cry over nothing.” Instead, name the emotion: “Don’t cry, you can have a cookie after dinner“. This teaches them emotional literacy. Parents and others around in the home could share stories about when they were little, or make up fantasy tales together. Storytelling teaches sequential logic (beginning, middle, end) and strengthens their imagination.

The Absolute Master Class: Learning Through Play

If communication is the fuel for brain development, play is the engine. For a child under five, play is not a break from learning; play is learning. It is how they explore physics (stacking blocks), mathematics (sorting shapes), social dynamics (sharing toys), and language (pretend play). We can boost their development exponentially by weaving communication into their play.

When a child is playing with blocks, dough, or puzzles, they are building fine motor skills and spatial awareness. It is also useful to use three-dimensional words: “Can you put the blue block on top of the red one?” “The puzzle piece is next to your knee.” One could also ask them to describe the texture: “Is the dough soft or hard?“

Pretend play, such as acting as a doctor, an engineer, a chef, or a superhero, is one of the most cognitively demanding things a child can do. It requires them to understand symbolic thought and to take on another person’s perspective. Join their world as a supporting character, not the director. If they are the doctor, ask, “Doctor, my teddy bear’s tummy hurts. What should I do?” This encourages them to use vocabulary relevant to the scenario and practice complex social problem-solving.

Playing with water, sand, slime, or safe food products allows children to process sensory information. This is the perfect time for descriptive vocabulary. Use contrasting words: wet/dry, hot/cold, sticky/smooth, loud/quiet.

A few special words for parents. You do not need an expensive degree or specialised toys to build your child’s brain. The most powerful tool you have is your own responsiveness. Modern science tells us that the basic recipe for a thriving child is simple: Look at them when they signal you. Respond with warmth and words. Narrate their world and Join their play.

You are not just talking to your child; you are building his or her future, even via just one conversation at a time. So, go on talking to your child and even make him or her a real-life chatterbox.

Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

Features

Promoting our beauty and culture to the world

Published

20 hours ago

2026/03/5

Sahan Weerasooriya

Tourism is very much in the news these days and it’s certainly a good sign to see lots of foreigners checking out Sri Lanka.

With this in mind, Ruki’s Model Academy & Agency recently had a spectacular event to select Mrs. Tourism Sri Lanka in order to promote Sri Lanka in the international scene.

Nimesha Premachandra was crowned Mrs. Tourism Sri Lanka 2026.

She says she owes her success to Ruki (Rukmal Senanayake), the National Director and model trainer, and personality and advocacy trainer Tharaka Gurukanda.

Nimesha is a school teacher by profession, an actress and TV presenter by passion, and an entrepreneur by spirit.

She believes in balancing grace with purpose, and using her platform to inspire women, while promoting the beauty and culture of Sri Lanka to the world. And this is how our Chit-Chat went:

Nimesha Premachandra: Mrs. Tourism Sri Lanka 2026

01. How would you describe yourself?

I am a passionate, disciplined, and people-oriented person. I love learning, performing, and guiding others, especially young minds, through education.

02. If you could change one thing about yourself, what would it be?

I would probably try to be less self-critical and allow myself to celebrate achievements more often.

03. If you could change one thing about your family, what would it be?

Nothing major. I am grateful for my family’s love and support, which has shaped who I am today.

04. Is Mrs. Tourism Sri Lanka your very first pageant?

No. I have been part of pageants before, but Mrs. Tourism Sri Lanka is very special because it represents purpose, culture, and global representation.

05. What made you take part in this contest?

I wanted to represent Sri Lanka internationally and use this platform to promote tourism, culture, and women’s empowerment.

06. Obviously, you must be excited about participating in the grand finale, in Vietnam; any special plans for this big event?

Yes, I am extremely excited. My focus is to showcase Sri Lankan elegance, hospitality, and authenticity, while building meaningful connections with participants from around the world.

07. How do you intend promoting tourism, in Sri Lanka, during your rein?

I plan to highlight Sri Lanka’s diverse experiences in culture, heritage, wellness, nature, and local hospitality through media appearances, digital storytelling, and tourism collaborations.

08. School?

Kaluthara Balika. School life played a big role in shaping me. I actively participated in sports and performing arts, which later helped me build confidence as an actress and presenter.

09. Happiest moment?

Being crowned Mrs. Tourism Sri Lanka 2026 and seeing the pride in my family’s eyes – definitely one of my happiest moments.

10. What is your idea of perfect happiness?

Peace of mind, good health, and being surrounded by the people I love while doing work that has meaning.

11. Which living person do you most admire?

I most admire Angelina Jolie because she beautifully balances her work as an actress with meaningful humanitarian efforts. She uses her global platform to support refugees, advocate for human rights, and inspire women to be strong, compassionate, and independent.

12. Which is your most treasured possession?

My memories and experiences because they remind me how far I’ve come, and keep me grounded.

13. Your most embarrassing moment?

Like everyone, I’ve had small on-stage mishaps, but they always taught me to laugh at myself and move forward confidently.

14. Done anything daring?

Participating in pageants while balancing teaching, media work, and family life has been one of the boldest and most rewarding decisions I’ve made.

Keen to use her title to promote Sri Lanka globally

15. Your ideal vacation?

A peaceful destination surrounded by nature; somewhere I can relax, reconnect, and experience local culture.

16. What kind of music are you into?

I enjoy soft, soulful music because it helps me relax and stay inspired.

17. Favourite radio station:

I enjoy stations that blend good music with meaningful conversation and positive energy.

18. Favourite TV station:

Sri Lanka Rupavahini Corporation. It’s where it all began for me. It played a significant role in my journey as a TV presenter and helped shape my confidence and passion for media.

19 What would you like to be born as in your next life?

Someone who continues to inspire others because making a positive impact is what matters most.

20. Any major plans for the future?

I hope to expand my work in media and entrepreneurship while continuing my role as an educator and using my title to promote Sri Lanka globally.