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The Child with a Fever

1 Feb 2006 10:13 PM - Dr Roger Morris

Fever is a raised body temperature, generally defined as a temperature above 37.5 degrees Celsius (when taken by a thermometer in the mouth or under the arm). Fever is caused by chemicals and hormones produced by the immune system, and is considered to be a normal (‘physiological') response to infection. It is thought to assist the body in fighting the infection more effectively. Trying to lower a fever is not usually necessary and over-zealous treatment of fever may actually prolong an illness and reduce the immune response to the infection. A fever in itself is usually not dangerous, as long as it is not above 41 degC and the child is able to avoid dehydration. More importantly, it is necessary that the cause of the fever be identified, so that serious and potentially life threatening infections are not overlooked.

The most common cause of fever in children is infection and the most common infectious agents in children are viruses (yes, it is true – doctors don't just say that if they can't think of anything else!). Bacterial infections (in the ear, throat, chest, urine, etc) can also cause fever. Obviously, one should always consider serious life-threatening infections such as meningitis and blood infections, as these can progress rapidly, particularly in babies and toddlers.

Fever in children can be measured in a number of ways. The most accurate way is via the rectum (back passage), but this is not generally recommended due to the risk of potential injury and certainly not if you intend to stick the same thermometer in someone's mouth in the future! Taking the temperature under a child's arm is the most feasible, but as any parent will attest, can be a challenge in a cranky and irritable child. It is also important to remember that the temperature measured under the arm can be up to 1 degree Celsius lower than true core temperature. Tympanic measurement (that is via the ear drum with a special instrument) can be inaccurate if the user is not careful and practiced. The tympanic thermometers are also expensive making them impractical for most families.

More important than measuring the fever is general observation of the child and parental ‘gut feeling' about how sick their child is. There are certain things that should ring alarms bells for parents who are caring for a child with a fever:

  1. Fever in young babies (under 6 months old) is always a concern and carries a substantial risk of serious bacterial infection.
  2. A child who is very lethargic, sleepy, floppy, pale and/or disinterested.
  3. A child who constantly vomiting or refusing oral fluids.
  4. A child has fast or grunting breathing, and/or cold hands and feet.
  5. A child that has developed (or is developing) a rash or spontaneous bruising.
  6. A child that complains of a severe unremitting headache, with neck stiffness and eyes that are very sensitive to light.
  7. A baby that refuses to feed, cries constantly and can't be consoled, and/or has bulging, tense fontanelles (soft spots on the head).

In any of these scenarios, parents should not hesitate to consult their doctor or local hospital immediately (day or night).

Febrile convulsions/fits are certainly spectacular and are (understandably) very frightening for parents who witness them. Febrile convulsions tend to run in families and are thankfully not considered dangerous in themselves. They are not caused the actual height of the temperature, rather they occur in certain children when the body temperature rises rapidly (usually early in a feverish illness). What is most important in these situations is to rule out serious bacterial infections as the cause for the rapid rise in temperature. Children usually grow out of febrile convulsions and are not thought to have an increased risk of epilepsy later in life.

Treating a fever is often unnecessary. However, fevers can cause discomfort and distress to children and it is appropriate to treat these symptoms if present rather than the fever itself. Paracetamol (‘Panadol', ‘Dymadon, ‘Panamax') is the most commonly used medication in this scenario and is relatively safe if used in correct doses and for short periods of time. Beware of overdosing children with paracetamol and beware of using paracetamol for extended periods in dehydrated children, as it can be very damaging to livers. Ibruprofen (‘Nurofen') is also useful in children over 6 months old, but should be avoided in children known to have asthma. Aspirin should never be given to children under the age of 15 years, as it has been known to cause fatal reactions.

[Dr Roger Morris is a General Practitioner in Maroochydore, and has a special interest in Child and Adolescent Health]