Kid's Health topics

Fever in children

So it’s that time of year again… Winter.  Flu season. Fun, fun, fun.  Upper respiratory tract infections (URTIs), colds and viruses are so incredibly common in both children AND adults this time of year.  Here in our household, a virus has done the rounds TWICE.  Blechhh.  No more thanks!

I had a BBQ with some good friends 2 weekends ago (who all happen to be Paediatric Emergency Physicians) and they all talked about how this year, it seems that Influenza A is particularly common and severe in cases they had been seeing at work.  So I thought a post on FEVER in children for PARENTS might be appropriate and useful today.

How to manage a fever at home, how to recognise when things are SERIOUS, when it is most important that you present to a doctor for a medical review in the case that your child is unwell.

Here are some key points:

  • Fever is a common symptom in children and can usually be managed by simple cooling measures and paracetamol
  • Any ill child with a high fever should be examined by a doctor to exclude serious infections such as meningitis, urinary tract infection (UTI) or pneumonia
  • ANY fever in a baby less than 8 weeks of age or in an UN-IMMUNISED child should be taken seriously and medical attention should be sought immediately
  • Otitis media (ie a middle ear infection) and tonsillitis are common causes of fever in young children – these can be either bacterial or viral and may or may NOT need antibiotics
  • Most fevers are associated with non-specific viral infections or URTIs

So WHAT IS a fever?

Definitions of fever can vary slightly, but I generally use:

  • Normal:  37-37.5 degrees Celcius
  • Low grade fever:  37.6-37.9 degrees Celcius
  • Fever: 38+ degrees Celcius

How can we take a temperature?

  • Oral (ie in the mouth)
  • Axillary (ie thermometer placed under the arm)
  • Rectal (ie thermometer placed up the bottom)
  • Thermal devices – tympanic (eg in the ear – temperature taken from ear drum), skin (forehead scanners)

All can be and are used, but at home I use a in-the-ear device – a Braun Thermoscan.  The under-arm/oral thermometers are also good (and less expensive) – but you do have to hold them in place longer.

What causes a fever?

Wow – that is a BIG question.  There are endless possible causes of fever – and to demonstrate this, here is a non-exhaustive list:

  • Respiratory
    • Viral: RSV bronchiolitis, influenza, adenovirus, rhinovirus
    • Pneumonia: Strep pneumoniae, Haemophilus influenzae, Mycoplasma
  • Blood borne
    • Meningococcal septicaemia
    • Streptococcal sepsis
    • Toxic shock
    • Malaria
    • Urinary tract
      • Frequency, dysuria
      • Loin/suprapubic pain, vomiting
  • Ear, Nose and Throat (ENT)
    • Tonsillitis
    • Otitis media
  • Rheumatological
    • Septic arthritis
  • Post surgical
  • Kawasaki’s disease
  • Post immunisation
  • Factitious (ie fake)
    • Taking temp after a hot drink
    • Swaddling/environmental
    • Deliberate manipulation of the thermometer
    • Excessive crying/exertion

What can you do at home to manage a fever in your child?

  1.  Undressing child/dressing them in light clothes only – allow heat to be lost through skin
  2.  Tepid sponging (never COLD sponging or cold baths/showers – rapid changes in body temperature can cause febrile convulsions (seizures) in susceptible children)

Medicines to lower fevers (antipyretics):

  • Paracetamol (kids Panadol/Dymadon) 15mg/kg/dose every 4-6 hours, up to a maximum of four times a day
  • Ibuprofen (kids Nurofen) 10mg/kg/dose every 8 hours, to a maximum of THREE times a day
  • NOT aspirin in children

When should you seek MEDICAL ATTENTION for your child?

  • Persistent fever >2 days
  • Fever with no focus (ie your child has a fever and no obvious CAUSE for that fever like a profuse, snotty nose or upper respiratory tract infection)
  • Fever in a child less than 8 weeks/unimmunised child
  • Associated purpuric/petechial (non-blanching; ie the rash doesn’t disappear when you press on it) rash
  • High fevers (>38.5 degrees)
  • Associated confusion, dehydration, recent contact with other children with known infection (eg chicken pox, meningitis)
  • Pain unable to be controlled by simple measures
  • Inadequate oral fluid intake, dehydration
  • Protracted vomiting and/or diarrhoea
  • If you suspect a urinary tract infection (pain on passing urine, flank pain, blood in urine, vomiting etc)
  • If you think your child is ill or you are generally worried

Remember, your GP (or emergency doctor if it is after hours or your child looks gravely ill) will NOT get cross at you for presenting for medical attention if you are genuinely worried about your child with a fever.  In fact, this would be the sensible thing to do.  They would rather see you and your child to ensure your child is WELL rather than you stay at home with a potentially very sick child that needs treatment.  

Hope this information is handy and until next time,

 

STAY WELL, COVER YOUR COUGH AND WASH YOUR HANDS!!!!!

xx Dr Megs

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