“Remain calm, no reason to panic!”- I have said these words many a time in my consultation room! Fever is the one symptom that can cause even the most confident and even keeled parents to stress and become very anxious. Fever is really a good thing… and no, I have not lost the plot completely! Fever, in a child who is coming down with an infection or inflammation, is a sign that the immune system is well and is a normal part of a healthy host response. In fact, it has been shown that certain bacteria can not replicate at higher temperatures.
Over the years we have been taught to fear fever, but this is not necessary. I am going to debunk a few myths about fevers, and help you feel confident in treating this symptom, should it occur.
- Technically there is no such thing as a “ low grade fever”.
Fever is defined as having a temperature higher than 38° Celcius. Just because their normal temperature is about 36-37°C, doesn’t mean that 37.4° C is now regarded as a fever. You either have a fever or you don’t! There are not different levels for different kids, just because their basal body temperatures are lower than others. Age is important when we evaluate fever.
• Any baby under 3 months of age with a fever of 38° C should be seen as a matter of urgency. This is a Paediatric emergency.
• In a child ages 3-36 months, we regard a temperature of > 38.50°C as high, and those in the age group of 36 months and older, that cut off will be 39° C.- You can not “feel” how high the temperature is.
I have been doing Paeds for a long time and I still to this day get caught out with this one. It is true that you can often feel your child’s body temperature is higher than normal, but it is almost impossible to determine the exact number by just feeling them with your hand.
During a given day your little one’s temp will vary depending on activity levels and they can even feel hot just after waking up after sleep. Give them a few minutes and then use a good thermometer to accurately record the temperature. I prefer an Infrared in-ear thermometer for most children over 6 months. Rectal temperatures are the most accurate but those thermometers have to be used with caution as to not cause injury. Be very careful of cheap imitation surface thermometers that flooded the market after the COVID pandemic. Most are not accurate. - High fevers cause brain damage…
A big concern for most parents are that the fever can cause either febrile seizures, or leave the child with long term disability. It is unfortunately not possible to predict which kids will get febrile seizures when experiencing fever during an illness, and which ones not. There are no specific temperatures where any child will definitely get febrile seizures.
It is usually temperatures that rise very quickly (within 30 minutes or so) from 36 to 40°C or persistent, very high fevers that can potentially cause complications. Remember that fever is just a symptom of an infection or inflammation somewhere in the body. The cause still needs to be established. - “ We wanted you to see her with the fever at the appointment”
We treat fever not because we are afraid of complications like febrile seizures, but because we want your little one to feel more comfortable. Please give your baby some medication to control the fever, especially if your appointment is only in a couple of hours. I promise I will believe you if you tell me that your baby or child had fever. No need to leave them feeling cranky and miserable.
• There is no correlation between a fever and how seriously ill they are.
• When having a high fever, your baby or child might breathe faster than normal, and may vomit sometimes. This happens as the body’s instinct is to cool itself down; therefore babies or children breathe faster to blow off hot air, and vomit to get rid of hot fluid in the stomach.
• Your baby’s heart might race whilst he/she is having a fever. For every degree above the baseline, the heart rate may increase by up to 14 beats per minute. This increases circulation to the skin surface and also helps your little one to cool down.
• Unless advised by your Paediatrician, it is generally not necessary to wake your baby to give medicine. If they are uncomfortable, they will wake and alert you to this fact quickly. - You can not “feel” how high the temperature is.
How to manage a fever.
• We generally use paracetamol (Panado, Calpol or Empaped suppositories) as a first line treatment for a fever. It is important that you use the correct dose according to your child’s weight and not their age. Your Paed or GP can help with this.
• We can also use the anti-inflammatories like Ibuprofen (Nurofen) above the age of 6 months. Please try not to give these medications on an empty stomach. Please be careful using Mefenamic Acid (Ponstan syrup and suppositories) in a child that vomits or has diarrhea and could be dehydrated
• Give them something cool to drink.
• Do not bundle them up in fleecy pj’s or blankets even if they are shivering. Use cotton clothing, and take layers off to help cool them down.
• A tepid (Luke warm) bath or sponge down can also help reduce the temperature and make them feel much more comfortable.
When to be worried and call or consult with your Paed:
• If your baby is under 3 months old and has a temperature above 38°C.
• Remember that the numbers is not as important as the appearance and behaviour of your baby or child.
• A child that is cranky and irritable, but perks up after having a fever reducing medicine, is less worrying than one that remains very miserable after medication. The latter scenario warrants a visit to your Paed or doctor.
• If your child is limp, lethargic and unresponsive.
• If your child is very irritable and inconsolable.
• They might be dehydrated if they are refusing to drink and not making wet nappies.
• Any child that is vomiting or complaining of headache.
• Any fever accompanied by a rash.
• Trust your gut… You know your baby or child better than anyone! If you are worried, concerned or even unsure, please phone the practice and book an appointment. Reassuring you and giving you information to handle these pesky fevers are equally important to diagnosing an ear or throat infection, and then treating with what is needed.
Xoxo, Dr Christa