Fever

I get lots of stressed calls from moms and dads because their baby or child has a high fever, and Rule Number 1 is treat the fever and don’t panic.

Their main worries seem to be

• that a high fever can in itself be harmful to a child
• that a high fever is an indicator of a serious illness

So I’ll try to cover both of these, and answer some commonly asked questions along the way.

Is a high fever harmful to a child?

No. In fact there’s a growing school of thought that we may be far too active with our treating of fevers, because a fever is part of the body’s way of fighting infection.

What about fever fits (pyrexial convulsions)?

Although they are frightening to witness, a brief fever fit (less than 10 minutes) is not harmful to the child. Lie the child on his/her side with the head slightly down, bring the temperature down with a suppository and sponging with water in front of a fan, and keep an eye on the time. Bring the child in to the nearest ER if the fit continues for more than 3-4 minutes so the fit can be stopped with medication. If the child settles after a brief fit it would be reasonable to have him/her checked in any case to find the cause of the fever.

What is a dangerous temperature?

No such thing really. On the one hand a child can have a fever fit with a temperature of 38 (and even this is not dangerous), on the other hand a common cold and sore throat can start with a fever of 39 or 40. So you treat the fever if the child looks uncomfortable, and whether the fever is 38 or 40,  the treatment is the same.

When is a fever an emergency?

1. Young babies – if a baby is less than 3 months old and suddenly has a high fever, he/she should be seen in ER for an examination and tests.
2. The very sick child – if a child of any age has a fever with other signs of a serious illness (like persistent vomiting, very drowsy/won’t wake up, shortness of breath/laboured breathing, severe headache, neck stiffness, severe rash) then an emergency visit is essential.

On the other hand if a child has no worrying signs apart from the fever, and looks better when you treat the fever with medication, it would be fine to see a doctor the next day if there is still a high temperature. Remember that even if a child has a treatable cause of fever like an ear infection or tonsillitis, an antibiotic will still take 12 to 18 hours to start working, and in this time one is still left with the job of treating the fever, so an ER visit at midnight is not essential.

Is it better to take the child to the doctor while the temperature is high?

Absolutely not. Treating a fever will never hide signs of an important illness, so don’t delay giving fever medicines. It’s reassuring if the child looks better when the temperature is down.

How should I treat a fever?

A mild fever (less than 38) in a well looking child doesn’t need treatment. For a higher temperature or if the child is very miserable, treat with paracetamol syrup (Panado or Calpol) 0.5ml per kg every 6 hours. If the child refuses or vomits the syrup, paracetamol suppositories (Empaped) can be used (125mg under a year, 250mg over a year). For very high temperatures (39-40) a lukewarm bath or sponging in front of a fan will help, and anti-inflammatory medicines like mefenamic acid (Ponstan/Ponstel), ibuprofen (Brufen/Nurofen) or diclofenac (Voltaren/Panamor suppositories in children older than 2 years) can be used together with paracetamol, also 6 hourly. Most medications will take 45-60 minutes to work.

How about my gut feel?

No-one knows a child like a mother does, and it’s been shown in studies that a mother’s instinctive feeling that there is something seriously wrong with her child will often prove to be true. So if your child has a fever and you feel something important is going on but can’t put your finger on it, rather have the child checked by a doctor.