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Family Health Magazine - CHILDHOOD

Childhood Fever
How to treat it and when to worry

As every parent knows, fevers are common in childhood. Fevers can also be frightening. Understanding the causes, how to manage a child’s fever and when to seek a doctor’s help can make it less alarming.

Fever is a rise of internal body temperature to above 38°C (100.4°F). A thermometer is the best way to measure temperature, since it is more accurate than fever strips. Different methods are used according to the child’s age.

Different types of thermometers are used to take oral and rectal temperatures. Be sure you use the right kind of thermometer for the place where you are putting it! Readings also vary slightly depending on where on the body the temperature is taken (see Taking Temperature sidebar). Use an oral thermometer for children over age four. Since younger children might bite the thermometer, the rectal method is best for them. An axillary (armpit) temperature can also be taken, but is not as accurate. Ear thermometers are fast, easy to use and more accurate; they are also expensive.

What causes fever?

Most often, the body produces a fever as a reaction to infection. Other diseases can also cause fever, but are quite rare. As the body’s immune system fights off viruses or bacteria, body temperature rises. Since this may actually help fight infection, not every rise in temperature needs to be treated. Generally, a low grade fever (less than 38.5°C / 101°F) can be left untreated. But if something seems wrong with your child, their actions or appearance, get medical help no matter what the thermometer reads.

Is a fever serious?

Some consequences of fever can be serious. Hot skin evaporates moisture quickly, so dehydration can happen easily. A high temperature can irritate the brain, causing confusion, hallucinations and seizures. These seizures, called ‘febrile convulsions,’ usually happen in young children with high fevers. A febrile convulsion does not mean a child has epilepsy. However, since another seizure could happen with the next fever, these children need to be watched closely.

How are fevers treated?

Treating a fever means bringing down the temperature and preventing dehydration. Encouraging a child to drink enough fluids is essential. Most sick children do not feel like eating or drinking. They can avoid eating for days with few ill effects, but they must drink. A steady supply of fluid offered in small amounts is necessary, especially if the child is vomiting.

Watch for a dry mouth, lack of tears, or skin that stays puckered when pinched. If any of these signs are present, your child is dehydrated. Fluids are needed urgently. Intravenous fluids are the fastest way to correct serious dehydration. Contact your family doctor immediately.

If your child does not seem dehydrated, bring temperature down by keeping the child cool. Use lightweight clothing and just a sheet or light blanket on the bed. If the weather is hot, direct an electric fan over the child. If these measures fail, try sponging with lukewarm water to bring down the fever. If the child is having chills, do not use cooling techniques. Shivering will raise the temperature more!

Acetylsalicylic acid (ASA, Aspirin™) is no longer recommended for children with fever. Reyes’ syndrome, a potentially fatal disease, has been linked with ASA use in children with viral illnesses such as chicken pox and influenza. Until more is known, avoid using ASA for those under age 16.

Acetaminophen (Tylenol™, Tempra™ or Panadol™) and ibuprofen (Motrin™ or Advil™) are very effective in treating fever. Dosage depends on the child’s size (see table). In general, use 10 to 15 mg of acetaminophen or 5 to 10 mg of ibuprofen per pound of body weight. Give acetaminophen every four to six hours and ibuprofen every six to eight hours, as needed. The Canadian Pediatric Society suggests always using acetaminophen first. Try ibuprofen only if acetaminophen does not reduce the fever.

When should I consult a doctor?

Your child has a fever. You have been keeping the room cool and are giving fluids along with acetaminophen or ibuprofen as needed. Should you seek a doctor’s advice? Not all fevers require a doctor’s care. If the fever is low and associated with typical cold symptoms, it will usually go away on its own in a few days. Your child’s behavior can help you decide whether or not to contact your doctor.

Some fevers are serious and must be assessed by a doctor.

• High fever – temperatures over 40°C (104°F) can cause seizures. Temperatures over 41°C are often associated with bacterial infections requiring antibiotics.
• A fever over 38.5°C that does not come down with acetaminophen or ibuprofen.
• A prolonged fever – Even low-grade fever that does not go away in a few days should be checked to see what is causing it.
• Fever associated with other symptoms, such as a lack of interest or energy, irritability, headache, vomiting, pain, redness or swelling,
• Fever in a child that is or has been traveling in a tropical or developing country.

Fever is not a disease in itself. It is a symptom of a wide range of problems. It can be caused by minor illnesses like cold or flu or serious ones such as kidney infections and meningitis. Your child’s behavior is an important guideline. An active, happy child is unlikely to have any serious infection, while a listless, whining one is more likely to need medical care. By following the guidelines within this article, you can manage most simple fevers at home while watching for the warning signs of a fever with a serious cause.

Taking temperature with a mercury thermometer

GETTING READY

• Shake thermometer until mercury line is below 35.5 C (95.9 F).
• Be sure you hold the right end!
• Don t give cold or hot liquids for half an hour before taking an oral temperature.
• Stay with and make sure your child remains still.

BY  RECTUM

This method should not be used for children under three months of age.

• Have the child lie stomach-down on your lap. Hold the child securely so no injury can be caused.
• Lubricate the thermometer well and gently insert it slowly into the rectum no further than 2-3 cm (about 1 ).
• In children under six months of age, insert about 1 cm (3 8 ). The silver tip needs to be completely in the rectum and not visible.
• Hold thermometer in place for two to three minutes or until the digital thermometer beeps.
• Normal reading is 37.5 C (99.5 F).

BY ARMPIT

This method is best for children under three months.

• Hold bulb end of safety thermometer under arm with arm snug against body.
• Armpit should be dry.
• Wait three to four minutes before removing.
• Normal reading is 36.4 C (97.5 F). Axillary (armpit) temperatures are usually lower than oral or rectal temperature readings.

BY MOUTH

• Make certain that no hot or cold liquid is given beforehand.
• Place bulb end of safety thermometer under tongue and to one side.
• Tell child to close mouth but not to bite thermometer.
• Leave in place for at least three minutes.
• Normal reading is 37 C (98.6 F)

Reading the thermometer

• Slowly rotate the thermometer until line of mercury is seen.
• Read thermometer where line of mercury ends.

Caring for thermometer

• After use, clean thermometer in warm (not hot) soapy water and wipe with rubbing alcohol.
• Store thermometer in container to prevent breakage.

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1     [AL_FHcd18]