Fever In Children

What is fever?

Body temperature above the normal limits is defined as fever.

Rectal> 100.40 F
Oral > 99.50 F
Axilla (Arm-pit) > 990 F

Just forehead or palms, soles “feeling” warm should be taken as fever.
Always record the temperature (digital thermometer in axillary area is safe and pretty reliable). Dry the armpit and place the thermometer for one minute or till it beeps. Orally better to avoid as there is always a chance of child biting and breaking the thermometer.

Documentation of fever is a must before administering any fever medicines.

Administer medicines only if temp. reads above 990 F.

Temperature < 1010 F is low-grade fever.
Temperature >1010 F is high-grade fever.

Pattern of fever is very important clue to the treating doctor- whether continuous or intermittent, with or without chills etc. So it is wise for parents to maintain a temp chart at home and bring it to your doctor.

What causes fever in children?

It’s important to remember that fever by itself is not an illness — it’s usually a symptom of an underlying disease or illness. However fever is good as it is body’s immune response to fight against the outside germ. So fever per se is not dangerous, only at times in children less then six years of age high uncontrolled fever may cause fits, which is known as febrile seizure.

Some of the common causes of fever in children are.

Infections – Viral (more common) & bacterial, at times parasite ( like Malaria )too.
A fever helps the body fight infections by stimulating natural defense mechanisms. So till the infection is eliminated from the body by the child’s defense mechanism, the child may continue to get fever.

Overdressing – Infants, especially newborns, may get fevers if they’re over-bundled or in a hot environment because they don’t regulate their body temperature as well as older kids. But fever in newborn babies and less than 6 months can indicate a serious infection, hence it’s always better to visit your doctor and get the baby examined. (Even in cases of overdressed babies)

Vaccination fevers – After some of the vaccines a child may get low-grade fever lasting for
2-3 days.

Dehydration fever – In hot climates fever can be caused due to inadequate intake of
oral liquids. This commonly also seen in newborn babies if feeding is improper or inadequate.

“Teething” fever- although teething may cause a slight rise in body temperature, it’s
probably not the cause if a child’s temperature is higher than 100°F.

What are other symptoms that tell me my child has fever?

Signs and symptoms of fever may be obvious or subtle.

The younger the child, the more subtle the symptoms.

• Infants may
• Be irritable
• Be fussy
• Be lethargic
• Be quiet
• Feel warm or hot
• Not feed normally
• Cry
• Breathe rapidly
• Exhibit changes in sleeping or eating habits
• Have seizures or fits

Older children may complain of

• Headaches
• Body aches
• Feeling tired,
• Poor appetite,
• Feeling lethargic or poor sleep patterns.
• Vomiting, neck pain, visual disturbances

What can I do to control fever at home?

Keep in mind three important goals in event of a fever episode.

• Bringing the body temperature to normal
• Preventing Dehydration
• Monitor for serious or life-threatening infections.
• It is important to see a doctor and treat the cause of fever rather then giving round the clock anti-pyretics- fever medicines at home and suppressing the fever.

1. Bringing the body temperature to normal

Keep your child in a room with cool ambient temperature (use fan or a/c).
Make him wear loose clothes. Never cover him with blankets –“to break the fever”.
Overdressing and over bundling can prevent body heat from escaping and can cause
the temperature to rise.

Sponging his whole body (not only the forehead) with room temperature water(never ice water or cold water) or lukewarm water will help him feel better and comfortable. Do this repeatedly till the body temp. comes to normal. The water itself does not cool the child. The evaporation of the water off the skin cools the child. So, do not cover the child with wet towels, which would prevent evaporation. You may repeat it as many number of times as required.

2. Preventing Dehydration

Keep the child well hydrated during episodes of fever by giving plenty of liquids, juices, soups, ORS solutions etc. The child may not have a good appetite during fever episodes, but liquid intake should be maintained. This helps in bringing down the body temperature faster.

A child should urinate light-colored urine at least every four hours if well hydrated.

3. Monitor for serious or life-threatening infections.

The illness is probably NOT SERIOUS if your child:

• Is still interested in playing
• Is eating and drinking well
• Is alert and smiling at you
• Has a normal skin color
• Looks well when his or her temperature comes down

A good strategy is to reduce the child’s temperature below 1020 F .

Also, make sure the child is drinking enough clear fluids. If both these conditions are met and the child still appears ill, a more serious problem may exist. If a child refuses to drink or has a concerning change in appearance or behavior, seek medical attention. As said before it is important to see a doctor and treat the cause of fever rather than giving round the clock anti-pyretics- fever medicines at home and suppressing the fever.

Other Red flag signs include

• The child has a purple or red rash
• Bluing of nails, lips or tongue
• Limpness or refusal to move
• A change in consciousness occurs.
• The child’s breathing is shallow, rapid, or difficult.
• The child has a headache that will not go away.
• The child continues to vomit or has loose motions and is dehydrated
• Stiff neck
• Severe abdominal pain
• Crying that won’t stop
• Extreme irritability or fussiness
• Sluggishness and trouble waking up
• A seizure occurs.
• High fevers >1020F
• Fever in a child younger than 3 months of age.
• Infant’s soft spot on the head seems to be bulging out or sunken in

What Medication can be given in fever?

• Paracetamol can be safely administered in the appropriate dosage.
• Mind you give Paractamol only if you have documented fever (temp. > 990F ).
• The medicine can be repeated after 5-6 hrs. if the fever recurs.
• Paracetamol rectal suppositories also can be used in cases of high fever.
• Never give aspirin in children for fever.

What else should I know?

All kids get fevers, and in most cases they’re completely back to normal within a few days.

For older babies and kids, the way they act can be more important than just the reading on the thermometer. Everyone gets a little cranky when they have a fever. This is normal and should be expected.

But if you’re ever in doubt about what to do or what a fever might mean, or  if your child is acting ill in a way that concerns you even if there’s no fever, always visit your doctor for advice.

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