Expert Talk: How To Detect And Treat Fever In Children

Expert Talk: How To Detect And Treat Fever In Children

Fever in children can be quite worrisome for most parents. Especially if the fever lasts for more than a couple of hours or even days. Fever in children can often make them seem very lethargic, lose their appetite, be very irritable and cranky – all of which makes parents even more worried and anxious.

To combat the fear of fever, I have compiled a guide that brings out certain questions and answers to the table so that you can understand and treat fever head on.

The Common Question: What is a fever?

Fever is an abnormal rise in the body’s temperature which occurs as part of a specific biological response to a stimulus, such as infection or inflammation. The normal body temperature is 37.2 degrees Celsius, but this value changes, depending on the age of the child and the method of measurement.

For babies from birth to 3 months old: A fever is a core temperature of 38 degrees C and above

For those between the age of 3 months and 3 years: A fever is a core temperature of 39 degrees C and higher

For children older than 3 years and adults: A fever is a core temperature higher than 39.5 degrees C

PART 1: Causes of Fever

The most common cause of a fever is an infection. These are usually viral infections, such as the common cold. The very first signs of a cold are a runny nose, a sore throat,  sneezing and mild cough, as well as a raised temperature, which may last for about 2 to 4 days and recedes on its own. Other common viral infections which cause fever are viral gastroenteritis (also known as the “tummy bug”), croup (hoarse voice and barking cough) as well as a few illnesses which cause rashes, such as hand, foot and mouth disease or roseola.

Whenever a fever is accompanied by these viral symptoms, there is far less need for concern. We should simply manage the fever with fever-reducing medications such as paracetamol and/or ibuprofen and keep the child well-hydrated and well-rested. There are also some home remedies that help in these cases; these will be discussed in more detail in the next part.

If the fever persists beyond 3 to 4 days or is the only obvious symptom (fever of unknown origin), the child should be reviewed by a doctor, in order to look for a potentially hidden cause. This may be a middle ear infection, tonsillitis or strep throat (bacterial throat infection) or a urine infection. If found, most of these infections need treatment with antibiotics in order to ultimately resolve the fever.

We are now at the beginning of the influenza season. Influenza is a viral illness which causes significant cold-like symptoms, as well as a very high fever. If caught within the first 48 hours, it can be treated by antiviral medication to shorten the duration of the illness, the severity of the symptoms and the risk of complications.

Part 2: Measuring Temperature

The most accurate method of measuring temperature in a baby from birth to 3 months old is by using a rectal thermometer. This, of course, can be uncomfortable and many parents hesitate to use this method, as there are methods that are far easier, less invasive and almost as accurate.

The method most preferred now is the “ear thermometer” or infrared tympanic membrane method. If done correctly, this measurement is very close to the core body temperature (around 0.5 degrees C lower). My personal recommendation would be to use this method from birth up to three years.

In the older child, an oral thermometer placed under the tongue gives an even more accurate assessment of core temperature. However, I still find myself using an ear thermometer on my older patients, as well as my own children, as it’s quicker and easier.

A very important point to remember is that a baby’s temperature varies greatly according to the external environment. The reason for this is that babies up to the age of three years old, and specifically those in the first 3 months of age, have a much higher surface area-to-volume ratio. Therefore, they are able to absorb significant heat from their environment and can equally lose a lot of heat to their environment. This can give false readings of temperatures that are too high or too low.

If you happen to feel that your baby is warm but otherwise seems well, and you record a fever on your thermometer, try taking some layers of your baby, and lay him or her down for a few minutes. Measure the temperature again after 10 minutes or so. You’ll often find that you now get a more true reading which is closer to normal.

Part 3: Treating A Fever

If your child has a low-grade fever (37.5 to 38.5 degrees C) alongside obvious symptoms of a cold (usually a runny nose or a mild cough) and seems well, there is no medical need to give them fever-reducing medications immediately. In actual fact, this elevation of temperature is one of the body’s defenses against the viral infection. If the fever is higher and is accompanied by symptoms of lethargy and/or pain, it is completely reasonable to give your child something to help reduce it. The two most common medications used to treat fevers are paracetamol and ibuprofen. Paracetamol can be given every 4 to 6 hours, up to 4 times a day, and ibuprofen every 6 to 8 hours, up to 3 times a day. Most fevers can be managed with paracetamol alone, but often, a fever comes back too soon (within 4 hours) to give the second dose of paracetamol; this is where alternating the two medications helps.

As mentioned previously, children have a higher surface area-to-volume ratio than adults. Therefore, any method that increases heat loss through their skin can effectively bring their temperature down. If your child has a high fever with cold hands and feet, do not cover them up with blankets or put socks on. This will heat them up further and may lead to even higher fevers and that may lead to dehydration or even febrile convulsions.

Putting the child in a tepid bath helps them feel warm (their hands and feet warm up), while at the same time their core temperature drops due to a better distribution of their blood volume, as well as evaporation of bath water off their skin. If you happen to find your child with a significantly high fever, I suggest you give them a dose of medication and put them in the bath while it starts to take effect.

Other home remedies that have a similar effect are tepid sponging (for those children who find it difficult to bathe). Sponging with a mixture of vinegar and water is also used in some households. This does seem to work, most likely due to the low evaporation temperature of the vinegar; it absorbs heat from the skin to evaporate, leaving the skin cooler.

Part 4: Repercussions of Fever

A fever in its own right is not necessarily dangerous. The simple danger of a fever is dehydration. A child whose body is at a higher temperature than usual is losing more fluids through sweating and evaporation.

Another complication of high fevers which is I find my patients worrying about much more is the febrile convulsions (seizures). These occur when the higher temperature leads to a temporary change to the electrical impulses in the brain, which cause seizure-like movements and symptoms in the child. Febrile convulsions are common in some children, and if a child gets one, then he or she is at risk of getting more. Febrile convulsions are NOT related to epilepsy and do no increase the risk of epilepsy in the future. For parents with children who get febrile convulsions, I usually advise that they monitor their temperatures closely and treat at lower readings than what we usually recommend.

Part 5: Prevention & Cure 

I am asked this question very frequently. Ultimately, preventing our children from catching infections will prevent their developing fevers, but this, of course, is much easier said than done.

Serious viral infections like those that we have vaccines against (polio, rotavirus, measles, mumps, rubella, chicken pox and influenza) are prevented by immunising our children according to the recommended vaccination schedule. Fevers that occur due to other viruses like the common cold, viral gastroenteritis and others cannot be prevented once the virus is caught. We can take measures to protect our children from catching these viruses, but if they begin to develop symptoms, we should then expect to treat a fever alongside these, using the methods discussed earlier.

With the recurrent infections and illnesses that our children are exposed to from the day they are born, fever becomes a very common symptom that parents and carers have to deal with. The majority of fevers are not dangerous and are easily explained and managed. However, there are a few cases where fevers need further assessment and investigation by a pediatrician, especially in the case of babies under the age of 3 months and in those even older, with very few or no other symptoms.

I hope this article will help first-time mum and dads to assess their children’s temperature and take the necessary measures to cure and prevent them. We’ll be taking a closer look in my next post, till then have a great day!

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