Fever Guide: When to see a doctor for young children?
You are not alone. Most parents and caregivers with young children panic, worry, and fear as you do too. Young children as in babies, toddlers, and preschoolers. Fever in young children though common still creates a stressful situation for the parents or caregivers. Questions fill our minds–what’s the next best step for the child? Here’s a fever guide to refer to when you have a child with a fever.
Take a deep breath. I am here to walk you through it. I understand. I became a worry wart when my 2.5 years old hit 40°C and googled for information. Consolidating my research here so you can also be informed and decide how best to tackle this battle of fever.
Information on this page is quoted or referenced from credible medical websites (sources). Regardless, this post is only for your reference. Use your wisdom and/or your mother’s instinct to decide what’s best for the child. Read the disclaimer at the end of the post.
Jump to the section relevant to you:
- Is the child running a fever?
- Is the fever serious? Should I rush to the doctor?
- Fever Medications
- Managing the Fever
Is the child running a fever?
A fever is usually caused by infections from viruses (such as flu) or bacteria (such as ear infections). The fever itself is not the disease, only a sign that the body’s defenses are trying to fight an infection.Healthychildren.org
Thus, fever is not an illness but a symptom of something else going on in the body.
Take the temperature.
I always thought 37.5°C means a fever, but it’s not necessarily so. It depends on where we measure the child’s temperature. The child is having a fever if his or her body temperature (“temp”) is above:
- 37.5°C in the mouth (oral temp),
- 37.3°C under the armpit (underarm temp),
- 37.8°C in the ear (ear temp),
- 38°C in the rectum (rectal temp).
Consider rectal temperature.
Rectal temperature is the most accurate for babies, especially those under three months, and up to three years old, said Dr Michael Wong (deputy medical director at Raffles Medical) in this article by KK Women’s and Children’s Hospital (KKH).
Mayoclinic.org shared how rectal temperature is taken:
- Lubricate the tip of the digital thermometer with petroleum jelly.
- Insert the thermometer with either of this method:
- Lay the child on his/her back, lift the thighs and insert 1/2 to 1 inch (1.3 to 2.5 centimetres) into the rectum.
- Place the child on his/her belly on your lap or other firm surfaces, then put your hand against the lower back to hold the child in place.
- Never force a rectal thermometer past any resistance.”
Is the fever serious? When to see a doctor?
High Temperature on Thermometer
The ear thermometer screen flashed a bright red with a 40°C. The sight can scare the shhhh out of me. I know that the number on the thermometer does not indicate how serious the infection or problem is in the body.
However, is 40°C too high already?
A high temperature doesn’t mean things are bad. According to NUH, high fever does not cause brain damage but may cause harm if it is more than 41.0°C. Fortunately, the brain’s thermostat keeps untreated fevers below this level.
On the other hand, a low-grade fever is not something to be brushed off as nothing. I know this first hand. In 2019, I had a low-grade fever that came and went for about 7 days, plus other symptoms such as slight breathing difficulty, chest pain, and vomiting. Turned out I had fluid in the left lung and had to undergo tuberculosis treatment.
Should I rush to the doctor?
Depends on the duration of the fever, age, and other symptoms. Read on.
Age and Duration
Fever associated with respiratory virus infection may last for 3–5 days. A prolonged duration of fever is however common. Fever lasting 5 days or longer occurs in over 30% of children with this infection. The longest duration of fever (>7 days) may occur in association with adenovirus.National Libary of Medicine
American Academy of Pediatrics (AAP) recommends parents bring their child to the doctor if
- the fever rises above 40°C (104°F) repeatedly for a child of any age.
- the fever persists for
- more than 24 hours in a child younger than 2 years old.
- more than 3 days (72 hours) in a child 2 years old or older.
- the fever exists in a very young child, especially one under 3 months old.
Should I go to the hospital’s emergency department (A&E)?
- Bring the baby below 3 months old to the hospital. A hospital stay is usually required for additional tests. That’s because the younger the baby, the higher the chance of getting a serious bacterial infection, such as a bloodstream or urinary tract infection, or meningitis (brain infection), said Dr Leo Deng Jin (associate consultant at the department of emergency medicine at KKH) in this article.
- For children older than three months, you may want to go to a clinic doctor and check if the condition requires a visit to the A&E. In this way, you don’t have to queue and wait so long, and also help shorten the queue A&E, letting emergencies be seen quickly.
Rather than looking at the numbers on the thermometer, it’s more important to observe the symptoms and the child’s behaviour – still playing and eating well?
Bring the child to the doctor or emergency department if he or she:
- is very young, especially if she is under three months old.
- is feeding poorly.
- is vomiting.
- is having breathing difficulties.
- has stomach pain and discomfort.
- is lethargic, not moving or too weak to stand.
- is drowsy. The feverish child may be sleepier than usual but should be easily awakened and able to interact with you.
- is confused or delirious.
- is crying constantly and you cannot settle him or her.
- has a rash or develops small purple spots on the skin that may look like bruises.
- has a skin colour that turns grey, pale or blue.
- passes less urine than usual.
- cries when he or she goes to the bathroom.
- has foul-smelling urine, it may be a urine infection.
- develops new symptoms and/or seems to be getting sicker. Sometimes children who have had a minor illness develop a more serious infection later.
A small percentage between 6 months and 6 years old may have seizures caused by a fever spike. A febrile seizure is a common type of seizure among children, usually with a fever of 38.3°C and above.
A seizure usually consists of eyes uprolling, frothing at the mouth, stiffening and jerking of the upper and lower limbs and loss of consciousness. Most febrile seizures stop spontaneously within 5 minutes and the child regains consciousness thereafter. Infrequently, the seizure may last longer than 30 minutes.
What should I do when the child is having a seizure?
- Keep calm.
- Loosen the child’s clothing.
- Turn the child to the side. This is to drain anything in the mouth and prevent choking.
- Put something flat and soft (if available) under the child’s head.
- Move away items such as sharp objects or furniture. This is so the child will not injure him or herself.
- Stay with the child until his or her breathing is normal and he or she is awake again.
- Your child may feel irritable and tired after a seizure. Make a special effort to be calm and reassuring.
- Important: Record the description and duration of the seizure.
What should I NOT do when the child is having a seizure?
- Do not try to hold your child’s tongue down with a spoon or any other object.
- Do not try to bring your child around by slapping, shaking or pouring water on him or her.
- Do not hold your child down or restrain him or her in any way.
- Do not give your child anything to drink.
Bring the child to the doctor or children’s emergency immediately if he/she :
- Has a stiff neck.
- Becomes confused or delirious.
- Appears unwell.
- Has his or her first episode of febrile seizure.
- Has more than one seizure in a day.
- Has a seizure that lasts for more than 5 minutes continuously. Administer rectal diazepam as prescribed by your doctor if available.
- Has a change in behaviour or appears persistently drowsy more than 30 minutes after the febrile seizure.
Febrile seizures do not usually lead to brain damage. As febrile seizures are usually short-lived and harmless, anti-seizure medications will not be recommended routinely. Also, studies have shown that fever-lowering medications such as acetaminophen and ibuprofen do not reduce the chance of a febrile seizure.
Fever medication is to lower the temperature and reduce discomfort, and NOT to treat the cause of the fever.
If the child is less than 3 months old, do not give medication unless advised by the child’s doctor.
If your child is above 3 months old, you may give paracetamol in liquid, tablet or suppository (rectal) form. The doctor may prescribe ibuprofen if the fever is higher.
The first line of medication is to be given 4 – 6 hourly.
- Give 4 hourly if above 38.5°C.
- Give 6 hourly if less than 38.5°C.
- Do NOT use in infants less than 3 months old.
- Do NOT give more than 4 doses of paracetamol in 24 hours.
- Use only when fever is persistently above 38.5°C.
- Give 1 – 2 hours after paracetamol.
- Give 6 hourly.
- Give 8 hourly for infants 6 months old to less than 1 year old, it can be given 8 hourly.
- Do NOT use it for infants less than 6 months old.
- Do NOT give more than 3 doses of ibuprofen in 24 hours.
- Do NOT use it with Diclofenac Na.
Diclofenac Na (Voltaren suppositories)
- Use only when fever is persistently above 38.5°C,
- Give 1 – 2 hours after paracetamol
- Give 12 hourly
- Do NOT use it for infants less than a year old unless advised by your doctor.
- Do NOT use it with ibuprofen.
I gave this when my daughter refuse to take medication by mouth or when that fails to have much effect.
Paracetamol and Ibuprofen
According to www.ruh.nhs.uk, paracetamol and ibuprofen can be given together, but you can stagger them so that the child can have some medication every few hours (if needed).
For example, paracetamol at 8am, ibuprofen at 11am and paracetamol again at 2pm (i.e. six hours after the first dose of paracetamol).
Do NOT give the child:
- Both ibuprofen and diclofenac at the same time as they belong to the same class of medications.
- Either ibuprofen or diclofenac, if your child has severe vomiting or a bleeding disorder. This is in view of possible bleeding from the stomach and intestines.
- Aspirin or any drugs containing aspirin for the fever unless prescribed by the doctor. Aspirin may trigger a rare, but potentially fatal, disorder known as Reye’s syndrome.
- Antibiotics when having viral fevers, there are of no use.
Dosage and Storage
- You may reuse the fever medications BUT
- check the dosage. It might be revised due to weight. The dose prescribed when a child was six months old may not be suitable a few months later. When in doubt, check with the clinic or pharmacist for the correct dosage, especially if the weight has changed significantly.
- check the expiry date / or last used date. Best to write the open date on the bottle.
- Read the storage instructions on the medicine bottle. Usually, syrup paracetamol or ibuprofen can be kept
- in the refrigerator for up to six months;
- or at room temperature for up to three months.
Effects of Medications on Fever
Fever medications will usually lower the temperature, but the child may still have a mild fever. Sometimes, the medications can have no effect on the fever. Don’t worry, the effects of paracetamol on fever do not indicate the severity of the illness.
It may take 1 to 2 hours for the medication to work. NHS.uk states that the child should start to feel better about 30 minutes after taking tablets or syrup of paracetamol, and suppositories can take up to 60 minutes to work fully. According to a study, taking paracetamol and ibuprofen together takes a faster effect than taking paracetamol alone, but no faster than ibuprofen alone. However, the timeframe can vary from person to person.
For low-grade fever, your doctor may not recommend taking medications to lower your body temperature. These minor fevers may help reduce the microbes causing the illness. Fevers above 38.9 C (102 F) tend to cause discomfort and often require medications. In other words, fevers between 37.8° – 39°C help the body fight the infection and thus medications are not necessarily needed.
According to Mayo Clinic, high doses or long-term use of acetaminophen (paracetamol) or ibuprofen may cause liver or kidney damage, and acute overdoses can be fatal.
Managing the Fever
Other than taking medications, you can take other measures to manage the fever in the child.
Record and Track Temp and Medications
Record the date and time when you
- Take the temperature, preferably in the morning, at bedtime and every 2-4 hours during the day or more often if your child looks ill.
- Give the medication – type and dosage. This is to prevent over-dosage.
- 25 Oct, 9am: 39.5, Paracetemoal (5ml)
- 25 Oct, 11am: 38.5°C, Nurofen (5ml)
Sponge the Child
Use a towel with lukewarm or tap water and sponge the forehead, front and back of the neck, armpits, and groin area, for no more than 30 minutes at a stretch.
Stop sponging when your child starts shivering. Bringing a high fever down with ice or cold water may cause chills or shivering, further raising the baby’s temperature.
Lukewarm baths help too.
Cold and Shivers: Don’t bundle the child
Like adults, children often feel cold or have shivers during fever. This is because the body is trying to generate and direct more heat to raise the body temperature to fight the infection. So even though one may feel cold during a fever, the body inside is very hot.
During chills, you may want to keep warm under the blanket, and likewise cover the shivering child with blankets. But one wouldn’t feel better until the temperature comes down.
Opt for light clothing instead of thick and long-sleeved outfits.
Rest and Water
Have much rest.
Keep hydrated by drinking lots of fluids. Tip: You may want to add a bit of Ribena/juice into the water to encourage the child to keep drinking.
My personal opinion
Colds or/and coughs usually accompany fever and so the sick child may not be suitable for an air-conditioned room. Instead, consider opening the window and having a fan to have a cool and well-ventilated room.
Whether air-con or fan, prevent strong wind/air currents from blowing directly on the sick child.
This article by a family clinic suggests ditching the fever patch and just sponging the child. I do agree to a certain extent. I would sponge my child during the day, and use the fever patch only during night sleep. So the patch helps to “sponge” and keep my child’s temperature down while we sleep.
I will also use a cooling cushion/pad for my sick child to sit on or rest their legs on. See the photo above. It works to bring the body temperature down, although clothes can get wet from the condensation of the cushion. If the child is not wearing diapers, it’s best to change out the bottoms.
If you still need assurance, head over to KKH Urgent Paediatric Advice Line (U-PAL). It is a complimentary online service to obtain advice for common paediatric conditions such as fever, cough, diarrhoea, vomiting and common injuries.
Bookmark this page and come back to it whenever you need some reminder and assurance when your child’s temperature escalates. Read the disclaimer at the end of the post. For your child’s dental health, you may find out more through my experience in my posts about dentists.
Let me know if I miss out anything or if you have any good advice to share. Leave your comments below!
SAVE IT, PIN IT.
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