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Pharmamum’s Ultimate Guide: Fever

When your children are unwell, do you immediately check their temperature? and then do you reach for the paracetamol? I have to physically stop myself from racing to the medicine cabinet as it is a parents first instinct to try and lower their baby/child’s temperature. In this post I will discuss all there is to know about fever, when to worry and take action and when to monitor and let your child’s body do what it needs to do.

A fever is when your child’s temperature rises above 38 degrees.Your child’s average body temperature is about 37 degrees. Infections are the most common cause of fever in children.  A raised temperature is purely an indication that your child is fighting a viral or bacterial infection. Most infections are caused by viruses, that do not respond to antibiotics and usually don’t need to be treated and will resolve on their own (eg. a cold or upper respiratory tract infections). Some infections are caused by bacteria and will need to be treated with antibiotics (eg. ear and throat infections). It is hard to diagnose a virus from a bacterial infection without taking a swab of the throat or a urine sample for a urinary tract infection.

A fever isn’t necessarily a sign that your child is fighting a serious infection, nor does the higher the temperature mean the sicker the child. When your child has a fever, try not to become fixated on how high your baby/child’s temperature is. Often parents freak out if they check their child’s temperature and it’s over 38 degrees. To put your mind at ease, raising the body’s temperature, is the body’s immune response to fight the virus or bacteria. Your baby/child’s body is  doing exactly what it  should be doing. It’s more important to treat the symptoms not the number on the thermometer.  If your child has a temperature of 38.5 degrees and is happy, drinking and playing, there is no need to treat the fever, just monitor your child. However, if  your child is miserable with a temperature of 38 degrees, then treat the fever to make your child feel more comfortable. Having a high temperature does not do any damage to your child.

There were times that my eldest daughter had a temperature between 39 and 40 degrees for a period of 3 to 4 days. As a parent, this is frightening and very stressful. It is important to look at your child as a whole. Are they drinking? Are they eating? Are they happy and playing? or are they limp and lethargic? I hardly use the thermometer anymore. I can tell  when my children are running a fever. They often shiver and their lips turn purple, they are very warm on their forehead, cheeks, back and chest area but cold in the extremities ie hands and feet.  They both tend to drink a lot of water and are often off their food.

The following are guidelines as to what to do if  your baby/child has a fever:

Important!

1. If your child is under 3 months of age with a temperature, It is considered a medical emergency, because without proper urine/blood analysis it is impossible to work out how serious the infection is and whether it is bacterial or viral.
2. If your child is under 12 months of age, it is recommended to get your child checked out by a general practitioner (GP) as soon as possible.
3. If you treat your child (older than 1 year ) with paracetamol for more than 48 hours and the temperature is not dropping, see your GP as soon as possible.
4. Any child of any age who has  a high fever and is accompanied by one or more of the following symptoms, needs to be seen by a doctor or emergency department:

• having significant breathing problems
• not drinking and becoming dehydrated
• complaining of a sore ear(or pulling ear), neck or any pain,
• sensitivity to light
• rash
• temperature over 39 degrees
• persistent vomiting
• becoming drowsy

It is important to remember that you would much rather be told after your child has been thoroughly examined, your child has a virus and they will improve, rather than waiting and your child becoming seriously ill. Children can go downhill very quickly, just as fast as they can bounce back from an illness. I wouldn’t hesitate to take my child to a Dr just for peace of mind. In some cases like when my daughter had a temperature over 38 degrees for 4 days we had to do a couple of visits to the doctor just for close monitoring. It ended up being hand foot and mouth disease in her case, but it could have been something more serious and we were not taking any chances.

To make your child more comfortable whilst suffering with a fever:

You can give your baby/child paracetamol every 4 to 6 hours or ibuprofen every 6 to 8 hours. By making your child more comfortable with paracetamol or ibuprofen, it can stop your child from becoming lethargic and shivery and make them feel more comfortable so that they resume drinking and reduce the risk of becoming dehydrated. However lowering a child’s temperature has no advantage other than comforting  the child, so if your child is running a fever but not bothered by it, then there is no reason to give paracetamol, just monitor your child and ensure they drinking and having wet nappies.

• Paracetamol and Ibuprofen come in different strengths  and forms (eg. liquids, tablets, chewable tablets, suppositories etc.) Always read the label and give your child a dose based on their weight. Be aware that paracetamol can be given from one month of age and Ibuprofen can be given from 3 months of age.
• Ensure your child is drinking, water preferably to keep them hydrated.  A child with a fever can become easily dehydrated, so as long as they are drinking, that is what is important. If your child only wants to drink juice or cordial, that’s fine just as long as it is diluted with water. To give a baby more fluid, try a  sippy cup or a bottle with water. You can also give your baby more formula or if breastfeeding, breastfeed  more frequently. Your child may be off food for a few days, that is not a problem, as long as they are drinking, they will make up for the food when they start to feel better.
• Be mindful when your child’s temperature is rising, they will experience chills, and shivering and most likely say they are ‘freezing’. Once they have been given a dose of paracetamol/ibuprofen, their body temperature will drop and they will start to feel quite warm and often sweat. This is how the body’s temperature is lowered.

Never give a child (under 12) Aspirin as it can cause a serious and fatal illness called Reye’s syndrome.

4% of children, will suffer with febrile convulsions which can be very traumatic for a parent to watch their child have a seizure when they get a high temperature. The seizure is caused usually by a rapid rise in body temperature. There are no long term consequences to having febrile convulsions and usually occur in children under 6 years old. Do not place your child in a cold bath or put the air-conditioner on, this will just make your child extremely uncomfortable and will not lower their temperature. Giving Paracetamol will not prevent a febrile convulsion if your child is prone to febrile convulsions.

I often get asked, which is better or what should I give my baby/child? Paracetamol or Ibuprofen?

The answer I give is dependent on a number of factors:

• what condition you are treating
• the type of pain your child is suffering with
• If your child has any other medical conditions
• If your child takes any other medication

Paracetamol and ibuprofen are generally safe and effective when used at there recommended doses. Paracetamol is generally the preferred first-line medication due to fewer adverse effects. A lot of parents often say, ‘ I just can’t get my child to take paracetamol?’ There are many brands of paracetamol available and it worth experimenting to find out which brand your child may like. My eldest liked the Panadol brand but my youngest wouldn’t go near it and she preferred the Dymadon brand. Just remember to always give the recommended dose on the label according to your baby/child’s weight. Panadol comes in a number of different strengths, so to avoid confusion, before each dose re-check the dose on the back of the bottle.

Paracetamol is effective for fever and mild to moderate pain but does not have an anti-inflammatory action. Therefore in certain conditions  where inflammation is involved (eg. ear infection, sore throat, ibuprofen may be the preferred choice). However it  is worth being made aware that compared to paracetamol, Ibuprofen is  associated with more frequent adverse events in children. However adverse effects with Ibuprofen that occur in children are the same as those that occur in adults, but they seem to occur less often. These adverse effects include: increased gastrointestinal bleeding and asthma.  The prevalence of asthma due to ibuprofen is estimated to be 2% in children already diagnosed with asthma. This means that if your child suffers with asthma, there is a chance that giving them ibuprofen may constrict their airways causing  asthma. Ibuprofen can also  affect kidney function, so if your child is not drinking much and becoming dehydrated or on other medication that may affect kidney function, it is not recommended to give ibuprofen for pain or fever, rather use paracetamol.

Healthy children may be given ibuprofen in appropriate doses but It is recommended that children be given ibuprofen for no more than 2 days without the supervision of a doctor. Parents should understand the importance of avoiding ibuprofen during illnesses accompanied by vomiting, decreased fluid intake, or diarrhoea, ie when your your child may be potentially dehydrated.

Giving your baby/child paracetamol or ibuprofen won’t treat the cause of the pain, it will purely ease the pain. It is important to find out the cause by seeking advice from your doctor. Paracetamol and ibuprofen can be given either alternatively or together to control the pain relief. However the dose of each medication will differ and giving two different medications alternating may increase the risk of dosage error. Hence it is recommended to document details of what you have given,  dose and  time.

Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.