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.

To quarrel with them is a loss of face

To have their friendship is a sad disgrace

Those lines by Bharavi were written after the fourth century A.D. when Sanskrit was already a purely literary language.

 We have had the spectacle of a reporter in DC asking Donald Trump whether he regrets his lying all the time every day of his life. And, Trump responded “What did you say?” and one could see that such a possibility had never occurred to him: he was genuinely baffled.

The question here and now is whether such a thought has ever come to Anura Kumara Dissanayake and Harini Amarasuriya, both obedient servants of the US and India. For example, the prathigna given by Amarasuriya as she was sworn in by AKD as Prime Minister in a Cabinet of three. That their doings are in line with the desires of Ranil Wickremesinghe (and maybe the “aspirations” of their buddies) would translate also to the cover up of his bringing in Arjuna Mahendran, the son of a Chairman of the UNP, to trash the Central Bank and execute Ranil’s bond scam.

In the matters of managing our economy and respecting our age-old culture this lot have shown us glimpses of the lunatic self-applause that define Trump’s doings. As phrased by a commentator in the U K Guardian a few days ago Trump’s endeavours “weren’t about Making America Wealthy Again. This was much more primal. Sticking it to all the people who had laughed at him over the years. His bankruptcies. His hair. His orangeness. His stupidity. Sticking it to all those who had taken him to court and won. Now he was the most powerful person in the world. He had the whole world watching as he messed it up. He could do what he liked.”. It’s quite obvious that the last is how AKD, HA, Yapa and the top tier of those most culpable have read their horoscopes: they do not expect to be held accountable

“The U.S.’s new tariff policy reflects a broader shift away from globalisation and towards economic nationalism and national balance sheet economic model approach”. So wrote a self-styled Business Cycle Economist last week. That is the kind of delusion that ‘growth-friendly’ market theory such ‘economists’ are trained to shove down the throats of politicians possessed of just about the bit of wit required to enrich themselves in tandem with the IMF and those entrepreneurs it supports.

At this point we should note also that Trump’s new wave of tariffs was harshest on Cambodia, Myanmar, Thailand, Vietnam and Sri Lanka––all, coincidentally, in addition to their strategic importance for war-mongers, Buddhist countries.

How closely those who call the shots among the power-wielders here follow Trump is seen in their response or lack of one to the earthquake that has devastated Myanmar and Thailand a week ago. The USA has been salivating over the riches of Myanmar for a long time, confident that Aung Suu Kyi would deliver them on a platter. That no doubt was the object of the aragalaya here and seems within reach for India now.

For months now, from 2022 at least, there have been markers that showed who was running the Janatha Vimukthi Peramuna (so calling themselves) and what their agenda was with respect to our country and her people. An early eruption that showed their hand was that aragalaya‘. It was designed to ensure a regime change that would place, let us for convenience say, Adani in charge. It involved, as a first step, getting Gotabhaya out of the presidency. That it was so was also shown two years ago in the London Review of Books by Pankaj Misra in an essay titled “The BIG CON” on Modi’s India. In which Gotabhaya and Adani are mentioned and the above object specified.

Misra’s latest work has been on “The World After Gaza” – a reference not without its applications not only to Modi’s support for Adani in Haifa, but to the ridiculous and altogether culpable gestures of friendship towards the US-Israeli led coalition of criminals shown by Ranil Wickremasinghe and associated Colombians who succeeded him. Haifa is the largest port in that segment of occupied Palestine and the Trump group also has had a stake in it.

I shall pause here with the concluding lines of Bharavi’s quatrain.

 One of sterling judgment realizes

What fools are worth and foolish ones despises.

by Gamini Seneviratne

Even if you are old and grey and want to forget the usual niceties of life, you simply cannot push the Sinhala and Tamil Aluth Avurudda out of your ken but need to reckon with it. The koha cries incessantly; old retainers come to mind; streets are crowded with jostling shoppers; TV has plenty of clips, both advertising and informing of villages preparing for the national festival. And, of course, irresistible are the pull of cultural customs and age old rituals. So, you, too, buy gifts, prepare sweets or buy them, light the hearth at the correct time, have your first meal for the New Year astrologically as prescribed, and wish for the best.

April New Year is …

To Cassandra, the Sinhala and Tamil New Year are a very strong nod to national pride and our cultural heritage. It is essentially a thanksgiving to Nature – sun, rain, the earth, devas too – for the Maha crop of paddy has been harvested and stored. But man cannot live by rice alone. That’s sustenance for the body. The mind/brain and psyche too have to be nurtured and thus a holiday to R&R and celebrate; to firm family relationships, nurture togetherness since man is a social creature; cater to appetites with richer victuals and of course that which cheers for some; and fun and games for child and adult alike.

This year we remember that we, as a nation, are not out of the woods of economic difficulty, but there is hope, there definitely is. After years of mismanagement a great change is taking place, mostly because those who govern us are concerned about the country and its people and work for our betterment, not for their individual enrichment or rise in power.

Successful visit

Big Brother visited us, not with parippu and threats, but most definitely with an acknowledgement this tiny pearl at its southern point is important and a partner in the region, not an equal partner but definitely useful and needed.  The body and facial language as exhibited when PM Modi and President Dissanayake stood side by side for cameras to click, and pictures were relayed to us via TV, was of two leaders who were approving of each other and easy to be with. Modi is a world figure courted by both eastern and western countries, but AKD stood tall beside him, not one bit dwarfed by Big Brother. There was rapport between the two and so, good for us.

It seemed to be a very successful visit and our President scored and so we are the beneficiaries, whatever critics may say about MoUs signed with no transparency.

Academic brings honour to SL

A foremost Ivy League University in the US acknowledged its respect to one of our academics. Has such an honour bestowed on one of our intellectuals before? Cass quotes the Sunday Island April 6: “In an unusual gesture 25 years after he retired from Princeton University where he served from Sept 1980 to July 2000, the University flew its flag at half-mast over East Pyne from March 28 to April 1 to mark the death of Prof Gananath Obeysekera.” He was professor of anthropology at Princeton and after retirement, given the honour of being elected Professor Emeritus. His wife, Ranjani Ellepola, was also a university teacher.

“Princeton University is a private Ivy League research university in New Jersey, US. Founded in 1746 in Elizabeth as the College of New Jersey, Princeton is the fourth oldest institution of higher education in the US and one of the nine colonial colleges chartered before the American Revolution. The institution moved to Newark in 1747 and then to its Mercer County campus in Princeton nine years later. It officially became a university in 1896 and was subsequently renamed Princeton.”

Princeton University has marked Prof Obeysekera’s death. The further acknowledgement of his worldwide acclaim as an intellectual and academic is that the New York Times on March 30 ran a long article by Clay Risen, with title: Professor Gananath Obeysekera 95 Dies; Anthropologist Bridged East and West.  The article ends thus: “His wide-ranging work drew on field research in his native Sri Lanka as well as his extensive study of English Literature and Christian mysticism.

“Dr Obeysekera received his master’s and doctorate degrees, both in anthropology, from the University of Washington, where he also taught. He later taught at the University of California, San Diego, and at Princeton, where he was chairman of the anthropology department from 1980 until his retirement in 2000. (Two of his publications are listed here).

“In a 2003 interview for the University of California, Berkeley, Dr Obeysekera said his grand intellectual mission was to study the way ideas from one culture filtered through another, whether it be South Asian culture through the West or vice versa.”

Evils return to roost

Trump’s Liberation Day announcement of catastrophic tariffs will turn to a Presidential Term of chaos and the less well-off Americans suffering more the slings and arrows of outrageous rise of prices, shortages and job losses. He promises to make America Rich Again but he should spell it out as Make American Oligarchs Richer. His tariffs, which adversely affect the entire globe, will boomerang on him. Already the world and even his own people are ganging up against him.

I am sure most of you have read Mexican President Claudia Sheinbaum’s letter to Trump on behalf of the rest of the world that has gone viral. She points out that outside the wall he is building to keep Mexicans from migrating to the US, there are 7 billion consumers. They will reach other countries for their purchases. From Greenland to South America and Africa, from China to Western Europe, there was consternation over the tariffs and soon enough reaction and now retaliation.

 His chief advisor, Alon Musk with his very young son perched on his shoulder, is at the receiving end of merciless barbs and blunt blame. Talk show journo, Jimmy Kimble, tore into Musk recently, so much so that the billionaire lost his cool and marched off stage, to jeers. Others are following suit.

 Trump and Musk deserve what they are getting and this should get worse, but please not for the Americans.

Cass wishes all her readers a day of piety and peace on the poya and then jubilation and celebration as Avurudhu dawns and proceeds with planets moving ‘Houses’ and us munching kavun in congenial company and playing games, indoors and out. Very happy New Year to All!