Introduction
- Fever is a temporary increase in body temperature, often a sign of the body fighting an infection.
- It is common in children and typically indicates an underlying condition, such as a viral or bacterial infection.
- Normal body temperature ranges between 36.5°C and 37.5°C (97.7°F to 99.5°F). A fever is generally defined as a temperature above 38°C (100.4°F).
- Proper management can alleviate discomfort and identify when medical attention is required.
Causes of Fever in Children
- Infectious Causes
- Viral infections: Common colds, flu, hand-foot-mouth disease.
- Bacterial infections: Strep throat, ear infections, pneumonia, urinary tract infections.
- Post-Vaccination Fever
- A common side effect of routine vaccinations like MMR or DTaP.
- Teething
- Mild temperature elevation, but not usually above 38.5°C (101.3°F).
- Other Causes
- Autoimmune conditions, heat exhaustion, or certain medications.
Symptoms Accompanying Fever
- Mild Symptoms
- Warm skin, flushed cheeks, or sweating.
- Fatigue and decreased activity.
- Severe Symptoms
- Persistent crying or irritability.
- Difficulty breathing.
- Rash, stiff neck, or seizures.
- Febrile Seizures
- Occur in 2–5% of children aged 6 months to 5 years during rapid temperature changes.
Complications of Fever in Children
- Dehydration: Due to increased fluid loss through sweating or reduced fluid intake.
- Febrile Seizures: Benign but alarming; occur in children with sudden high fevers.
- Underlying Conditions: Prolonged fever may indicate severe infections or conditions like meningitis or Kawasaki disease.
Diagnosis of Fever
- Measuring Temperature
- Rectal Thermometer: Most accurate for infants and young children.
- Oral or Axillary (Underarm) Thermometer: Suitable for older children.
- Ear or Forehead (Temporal) Thermometer: Convenient but less precise.
- Clinical History
- Recent illnesses, travel, vaccination history, and exposure to sick contacts.
- Laboratory Tests (if needed)
- Blood Tests: To detect bacterial infections or inflammation.
- Urine Tests: For urinary tract infections, especially in younger children.
- Chest X-ray: If respiratory symptoms are present.
Treatment Options for Fever in Children
1. Medications
Antipyretics (Fever-Reducing Medications)
- Paracetamol (Acetaminophen):
- Dose: 10–15 mg/kg every 4–6 hours, maximum 60 mg/kg/day.
- Brand Names: Panadol, Calpol, Tylenol.
- Cost: $5–$15 per bottle (100–200 mL).
- Manufacturer Examples: GSK, Johnson & Johnson.
- Ibuprofen:
- Dose: 5–10 mg/kg every 6–8 hours, maximum 40 mg/kg/day.
- Brand Names: Advil, Motrin, Nurofen.
- Cost: $5–$20 per bottle (100–200 mL).
- Manufacturer Examples: Pfizer, Reckitt.
Avoid
- Aspirin: Linked to Reye’s syndrome in children.
2. Non-Medication Interventions
- Hydration: Encourage oral fluids (water, oral rehydration solutions).
- Light Clothing: Avoid over-bundling to prevent heat retention.
- Lukewarm Sponging: Helps cool the body; avoid cold water sponging.
- Rest: Ensure adequate sleep and reduced activity.
Monitoring Parameters
- Temperature: Regularly check to track trends.
- Hydration Status: Monitor urine output, skin turgor, and mucous membranes.
- General Behavior: Watch for signs of lethargy or irritability.
- Duration of Fever: Seek medical attention if fever persists beyond 3–5 days.
Patient Counseling Points
- Explain that fever is a natural defense mechanism and not always harmful.
- Teach correct medication dosing and intervals to avoid overdose.
- Encourage keeping a fever diary, noting temperature readings and associated symptoms.
- Discuss when to seek urgent medical care, such as in cases of febrile seizures or persistent high fever.
Use in Children
- Fever thresholds and management vary with age. Infants under 3 months with fever ≥38°C (100.4°F) should be evaluated immediately.
Use in Pregnancy
- Ensure medications used (e.g., paracetamol) are safe if the mother is pregnant or breastfeeding.
Use in Elderly
- While not directly applicable to children, caregivers should be mindful of their own health when managing sick children.
FAQs About Fever in Children
Q1: What causes fever in children?
- Most commonly infections, vaccinations, or teething.
Q2: When should I be concerned about my child’s fever?
- If the fever persists for more than 3 days, is above 40°C (104°F), or is accompanied by severe symptoms like difficulty breathing or seizures.
Q3: What is the best way to take a child’s temperature?
- Use a rectal thermometer for infants and an oral or ear thermometer for older children.
Q4: Can I alternate paracetamol and ibuprofen?
- Yes, but only under a doctor’s guidance to avoid overdose or gaps in fever control.
Q5: Are febrile seizures dangerous?
- They are typically harmless and resolve on their own but require medical evaluation.
Q6: Can fever be treated without medication?
- Yes, with hydration, rest, and light clothing, though medications can provide comfort.
Q7: Should I wake my child to give fever medicine?
- Generally, no. Let them rest unless their temperature is dangerously high.
Q8: How can I prevent dehydration during a fever?
- Offer fluids frequently, including water, oral rehydration solutions, or breast milk for infants.
Q9: Can teething cause high fever?
- No, teething may cause a slight rise in temperature but not above 38.5°C (101.3°F).
Q10: Can I send my child to school with a fever?
- No, they should stay home until they are fever-free for at least 24 hours without medication.
Q11: What foods are suitable during a fever?
- Light, easily digestible foods like soups, fruits, and yogurt.
Q12: Should I see a doctor if the fever comes and goes?
- If it recurs over several days, seek medical evaluation.
Q13: Are natural remedies like herbal teas effective?
- They may provide comfort but should not replace medical treatment.
Q14: Can viral fevers last more than a week?
- Most resolve in 3–5 days, but prolonged fever may indicate complications.
Q15: What is the normal body temperature for children?
- Typically between 36.5°C and 37.5°C (97.7°F to 99.5°F).