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Everything you need to know about Fever in Children

With Dr Koyes Ahmed, Medical Director of Intercare Health Center and Family Medicine Consultant

Fever is defined as a temperature of 37.5c (99.5F) and above, and can be caused by a number of different things.  When your child has a fever, it can be an anxious and worrying time, however it is very common and, in many cases, clears up itself without any specific treatment.

Mechanism of fever

Fever is usually caused by an infection or illness, and it is the body’s response to try and make it more difficult for the bacteria or virus causing this infection to survive. When the body is attacked by these bacteria or viruses, specific chemicals called “cytokines” and “mediators” are produced in response, in addition to special cells called “macrophages” which try and “eat up” the invading organism.  Many types of bacteria are also enclosed in a membrane, which, when disrupted or broken, can be toxic to the body and stimulate the brain to increase the temperature further.

The body does however react, by being busy and producing natural antibodies, which try and remember the infection and recognise it the next time the infection tries to invade.

Causes of fever

Common conditions that can cause fevers include viruses, such as those which cause “Upper Respiratory Tract Infections” (a group of conditions which includes coughs and colds like the “common cold”, sore throats and earaches) and viruses which cause the “flu”, diarrhoea and vomiting and viral rashes.

Fever can also be caused by other common (often viral) childhood conditions such as chickenpox, but also bacterial conditions such as ear infections, tonsillitis, kidney or urinary tract infections. Another cause – which often parents worry about and understandably so – is meningitis, and although this condition is very rare, if there is ever any suspicion of this (such as a high fever, headache, confusion, stiff neck, inability to look at lights and a non-blanching rash – a rash which doesn’t disappear when a glass is rolled over it), urgent medication attention is crucial.

On another note, children can have raised temperatures during teething, following vaccinations or if they overheat due to too much clothing or bedding – all of these are common causes too, and often need no medical intervention.

Diagnosing a fever

You may be able to tell your child has a fever if they feel hotter than usual when you touch them, if they feel sweaty or clammy, or if they have flushed cheeks.  If you then suspect a fever, the next thing to do would be to check their temperature using a digital thermometer.

The most accurate way of checking a baby’s temperature is using a rectal thermometer (especially if they are less than six months old), although in reality this is not usually practical and not commonly done. For younger babies (especially those less than 1 month old) and for smaller babies, the best method is likely to be an axillary (underarm) thermometer – these often have to be held in position for at least 15 seconds (or until a “beep” is heard), and are easy to use and inexpensive. However, as the baby becomes older and larger, and for children of all other ages, the tympanic (“in-ear”) thermometer is the best device to use, and as long as it is correctly inserted into ear, this is a very quick and accurate method.

Forehead thermometers and oral thermometers are not recommended for checking the temperature however, due to inaccurate results, and the risk associated with glass and mercury in oral thermometers.

When to seek medical advice

If your child is under three months old and has a temperature of over 38c (101F) or is between three and six months and has a temperature of over 39c (102F), always seek urgent medical advice from a Family Medicine doctor.

In addition, if your child has other signs of being unwell – such as refusal to feed, appearing floppy or drowsy, signs of dehydration (for example, a dry mouth, no tears, less wet nappies, sunken eyes or a sunken fontanelle – the soft spot on a baby’s head), having a fit (convulsion), persistent vomiting, persistent or high pitched crying, breathlessness, a productive cough or signs of meningitis (as mentioned earlier), contact a Family Medicine doctor urgently.

If you have tried simple measures of treating the fever (as below), yet it still persists for more than 3-4 days, your child’s health is getting worse, or you have any other concerns, again contact a Family Medicine doctor.

If your child has a slightly raised temperature, but is otherwise appearing well, e.g. playing, attentive, eating and drinking as normal, then it is less likely they are seriously ill. If in doubt though, or you just need advice, it’s best to get in touch with a healthcare provider.

Treating a fever

If your child has a fever, there are a number of things you can do to help before speaking to a doctor.  Firstly, it is really important to keep your child well hydrated by giving them plenty of fluids -either cool water for infants or children, or breast milk/formula milk for babies.  Try and get your child to drink small amounts but often, to keep their fluid levels up – even if they are not thirsty. In terms of food, only offer them food if they want it, and don’t be too alarmed if they have gone a day without eating much (as long as they have been drinking).

Keeping your child cool if the environment is warm is also very important, for example by covering them with lightweight clothes or a thin sheet (but ensuring they are appropriately dressed for their surroundings), as well as keeping the room cool (18c/65F is a good guide temperature). Sponging your child with cool water or a cool flannel however is not recommended, nor is completely undressing your child.

In terms of medicines, paracetamol and ibuprofen are both antipyretics (fever-reducing medicines) as well as painkillers, so they can be given to try and reduce a fever. Please always follow the instructions and doses as mentioned on the bottle, and start off with one of these medications, and if it is not helping, try the other (and not both at the same time, but alternate both if needed, every 4-6 hours for paracetamol and a maximum four times in a day, and every 6-8 hours for ibuprofen, at a maximum three times a day).  Ibuprofen is best given with or after food, but seek advice if your child is asthmatic as they may not be able to tolerate the medication. Also, avoid aspirin in children due to the risk of a rare condition called Reye’s syndrome. The most important message though is that if your child has a mild fever, but is otherwise appearing very well and not distressed, you do not need to give any medications.

Paracetamol can be used to treat fever if needed, alongside ibuprofen.

Summary

Fever in children is a very common symptom, which can be caused by a number of different things, but may be a sign of a viral of bacterial infection.  In many cases, no medical input is required, but simple measures can be undertaken at home and if needed, paracetamol or ibuprofen (or both if necessary) can be given, alternating between them if required.  If however the fever is high, it persists, or there are any other symptoms, especially those which may be more concerning, it is always best to get your child assessed and seen by a Family Medicine doctor.

If you have any further questions or would like your child assessed, please book an appointment with Dr Koyes Ahmed or one of the other Family Medicine Consultants at Intercare Health Center.