Fever in children. What to do?
Fever in children. What to do?
WHY FEVER IS GOOD
Caring for a sick child can be a frightening experience for a parent, especially if a fever is involved. Don’t panic! Not all fevers are bad. In fact, medical research over the past twenty years has consistently shown them to actually help in fighting infections. Hippocrates said, ‘Give me a fever and I can cure the child’. A weak child may be endlessly ‘sick’, neither very ill nor very well, but with no significant rise in temperature. A more robust child whose temperature soars may look and feel very ill, therefore giving more cause for concern, but is usually ill for a shorter time and recovers more quickly.
First, let’s define normal body temperature. Most people say 37єC is normal, but this doesn’t account for individual variations or the fact that kids tend to run slightly hotter than adults. You can think of anything between 36є and 37.4єC as normal. Consumption of hot food, recent exercise, over bundling, hot weather, or an overheated room can drive body temperature up a degree or two. Body temperature also varies during the course of the day. Fevers usually hit their highest point in the late afternoon.
Fever is a common childhood problem. Statistics from one large urban pediatric hospital indicate that more than 30% of visits to the Emergency Department included fever as part of the major complaint. While there is evidence to indicate that fever is an adaptive physiologic mechanism with beneficial effects, the definition of its onset varies. For oral temperatures, the definition has been noted to range from 37.6°C-37.8°C, and from 38°C – 38.3°C for rectal temperatures. No consensus has been found as to what level of temperature differentiates moderate from high fevers. However, there is agreement that child with temperatures over 41.1°C are at higher risk of serious illness.
WHAT FACTORS CAN CAUSE FEVER
There are some causes of fever, which include the following:
# Bacterial infections
# Viral infections
# Medications
# Licit drugs
# Heat illnesses
Signs and symptoms of fever may be obvious or subtle.
# Irritable
# Fussy
# Lethargic
# Quiet
# Feel warm or hot
# Not feed normally
# Cry
# Breathe rapidly
# Exhibit changes in sleeping or eating habits
WHAT TO DO IF CHILD HAVE HIGH FEVER
Fever is a sign that the body is fighting an infection. The main reason to treat your child is to make him or her feel better. There are some advices what to do if your child has high temperature:
# Give your child plenty to drink to prevent dehydration (not enough fluid in the body) and help the body cool itself.
# Keep your child still and quiet.
# Keep the room temperature at about 25°C
# Dress your child in light cotton pajamas so that body heat can escape.
# If your child is chilled, put on an extra blanket but remove it when the chills stop.
# 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.
# You do not sweat out a fever. If your child shivers while their temperature is rising, it’s okay to cover them with a duvet or a blanket. But as soon as your child’s temperature has stabilized and he or she starts sweating, they need to cool down.
# Your child only needs to wear underwear or a nappy, which will help the heat escape from the body. Make sure their room is ventilated and cool, but not draughty.
# It is okay to give in and spoil a child a little when they are sick. Read to them, play with them and spend time with them. This is not the time to teach a child good manners.
When your child is achy and fussy, you may want to give him or her some medicine.
Paracetamol suspension is the usual choice and Ibuprofen is an alternative. Aspirin should not be given to children under 16 years of age. In rare cases aspirin can cause Reye’s syndrome in children who have the flu or the chickenpox. Reye’s syndrome is a serious illness that can lead to death. Because it may be hard to tell if your child has one of these infections, it’s best not to use aspirin.
But Acetaminophen (brand names: Children’s or Infants’ Tylenol) is most suitable for children. It relieves pain and lowers fever. How much acetaminophen your child may need depends on his or her weight and age, as shown in the chart below. When the age and weight don’t match, use the weight as the main guide. The doses in the chart may be a little higher than what is on the medicine package.
| Age | Weight | Acetaminophen dose (every 4 hours) |
| 0-3 months | 6-11 lbs | Ask your doctor |
| 0-3 months | 12-17 lbs | 80 mg |
| 1-2 years | 18-23 lbs. | 120 mg |
| 2-3 years | 24-35 lbs | 160 mg |
| 4-5 years | 36-47 lbs | 240 mg |
Used together, acetaminophen and a lukewarm bath may help lower a fever. Give the acetaminophen before the bath. If the bath is given alone, your child may start shivering as his or her body tries to raise its temperature again. This may make your child feel worse. Don’t use alcohol or cold water for baths.
Tips on giving medicine
# Don’t give more than 5 doses in 1 day.
# Don’t give a baby younger than 4 months old medicine unless your family doctor tells you to.
# Read labels carefully. Make sure you are giving your child the right amount of medicine.
# If using drops, fill the dropper to the line.
# For liquid elixir, use a liquid measuring device to make sure you give the right dose. Get one at your drug store or ask your pharmacist.
Very high fevers – those above 41°C – can harm the heart and brain. So you should call the doctor if:
# You have a young child, less than three months old, who runs a high fever.
# Your child cries and cries, without you being able to comfort them, and doesn’t wake up easily.
# Your child has a temperature over 38єC for more than three days.
# Your child has just had an operation.
# Your child doesn’t seem to be getting better.
If your child experiences any of the following symptoms with a fever, call your doctor.
# Stiff neck.
# Affected by bright light.
# Hallucinations.
# Red rash or blue/purple dots or patches.
# Trouble breathing.
# Cramps.
# Continued vomiting or diarrhea.
# Continued tonsillitis.
# Pain when urinating, or urinating more than usual.
Fever is the most common reason parents bring their children to the emergency department. Fever is medically defined as a rectal temperature of 38.0°C. A fever itself is not life threatening unless it is extremely high, such as greater than 41.6°C. A fever may indicate the presence of a serious illness, but usually a fever is caused by common infections. A part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body’s temperature as a way to fight the infection. Be aware that things other than infections may cause a fever.
It may help parents to remember that fever is only one part of the picture of an illness. In fact, for children under eight years of age, and especially for infants, the severity of a fever is an unreliable indicator of the severity of the child’s illness. The treatment of fever needs to be individualized, based on current knowledge of the effectiveness and risks of interventions. The child (and the parents) should be the focus of nursing care, not the thermometer. The focus on home care is particularly important with increasing numbers of children being cared for on an ambulatory basis.
