Fevers

While I’m here, it’s worth talking fevers: what are they? What causes them? How to manage them? When to worry? When to call the doc? Long post, but here we go:

Fever is a temperature over 38.0 degrees Celsius. Fever happens when the body’s temperature is elevated as a result of the body’s thermostat being reset to a higher-than-usual temperature. The commonest reason for this to happen is an infection.

Common viral and bacterial infections like tummy bugs, covid, ear infections, flu, croup, RSV, bronchiolitis, and urinary tract infections are among the most common causes.

Every child will have a fever at some point in childhood (and likely a few times). The challenge for most parents is to know when to worry.

Do you need to worry about a temperature? Not always. What else is important?

When is a fever an emergency? If your child has a fever, and any of the following:

●if a child is unusually drowsy or not responding

●if a child has trouble breathing and/or has blue lips, tongue, or nails

●if your child has a painful/stiff neck

●if your child has severe headache

●if your child has severe belly pain

●Has new rash or non-blanching purple spots that look like bruises on the skin (“tumbler test”)

●Refuses to drink anything or seems too sick to drink enough

●Will not stop crying

When to ring the GP or out-of-hour GP about your child’s fever?

●If your child has a fever and is less than 3 months old. ALWAYS.

●If the child also has diarrhoea that lasts more than 2-3 days

●If your child has vomiting that goes on for more than one day

●If your child seems to be dehydrated

●If your child also has specific pain, such as a sore throat, ear pain, or pain when s/he urinates or a new rash

●If your child is three months to three years, the temp is going on three days or more, and also appears ill: fussy, clingy, or refusing to drink fluids

●If your child of any age has recurrent fevers for more than seven days, even if the fevers last only a few hours.

●If your child has a fever and a chronic medical problem (you will likely have instructions from your hospital team about when and who to call though)

In most other cases, if you are not worried, a child over 3 months with a mild fever and no distress/other symptoms, who is drinking fluids, can be watched for 2 -3 days. Most children feel more tired than normal and have less appetite, so the traditional treatment of rest and fluids really does help.

Paracetamol or ibuprofen can help with a fever. You can expect it to lower the child’s temperature by 1 to 1.5°C. But the main reason to give it is that it can also reduce your child’s discomfort. There seem to be polarising extreme views on this in parent groups: At one extreme, those who advocate giving Calpol for everything, even not sleeping or every day of teething. At the other extreme, those who “never” give Calpol, citing reasons like masking things or suppressing immune responses. A recommended evidence-based approach is, as you would expect, in the middle. Treat the child, not the thermometer. It’s very reasonable to treat a fussy child over 3 months who is in discomfort with a fever. If you have questions, ask your GP or your registered chemist for further advice, including on doses. Always check with GP before giving it to babies under 3 months. Your GP or hospital doctor may be give specific advice for your child as well, especially children with underlying medical conditions.

Sponging/tepid bathing is not as effective as medications for fever for reducing temp and discomfort but can also help the symptom of “feeling too hot.” (Pre-schooler C. complains of this when he has a fever and feels better with a cool damp facecloth on his head.)

In a pandemic (yeah, I know … but it’s technically not over yet), it’s worth also mentioning MIS-C since we are talking fever. MIS-C is still not completely understood and though it is rare (estimated <1%) it does happen and effects children 2-4 weeks after Covid (even if they had no or very mild symptoms). When do we worry about that? Temperature of 38.0 for more than 4 days or temperature of 38.0 for more than 3 days and vomiting/diarrhoea, tummy pain, new rash, eye pain or headache, confusion, swelling of hands/feet, or new changes to their mouth including a very red tongue and cracked lips.

If you have any concerns, ring your GP or out-of-hours GP.

Pre-schooler C., thankfully seems to have nothing with his fever except some intermittent fussiness and a runny nose so likely another round of “crechitis” from his pre-school.