Fever

Fever
• A normal temperature in babies and children is about 36.4C, but this
can vary slightly from child to child.
• A high temperature is 38C or more
• A high temperature is the body's natural response to fighting
infections like coughs and colds.
• Many things can cause a high temperature in children, from common
childhood illnesses like chickenpox and tonsillitis, to vaccinations.
• Fever is created by your immune system under the direction of a part
of the brain called the hypothalamus. The hypothalamus acts like a
central heating thermostat. Fever happens when the hypothalamus
sets the body temperature above its normal level
• It does this in response to an infection with germs, usually because it
detects the presence of infectious agents like bacteria or viruses. It is
believed that the increased temperature is a protection the body has
developed to help fight the germs that cause infections, as they tend
to multiply best at normal body temperature.
What can cause a fever/high temperature
• infections with germs called viruses are the most common cause. Viral
infections cause many common illnesses such as colds, coughs, flu,
diarrhea, etc. Sometimes viral infections cause more serious illnesses.
• Infections with germs called bacteria are less common than viral
infections but also cause fevers. Bacteria are more likely to cause
serious illness such as pneumonia, joint infections (septic arthritis),
urine infections, kidney infections, septicaemia and meningitis.
However, bacteria can also cause fever in less serious infections such
as ear infections and infected skin rashes.
• Inflammatory conditions and reactions may cause fever, some types
of arthritis, and reactions to some medicines.
• Immunizations: sometimes children develop a fever after an
immunization. This is because immunizations are generally designed
to 'trick' the body's immune system into thinking it sees an infection,
so that it develops immunity. Fevers following immunization are not
usually high or prolonged.
• Other types of infection: these include 'tropical' infections such as
malaria and dengue, and conditions such as tuberculosis.
• Heat stroke is a possible cause of raised body temperature, although
technically this isn't a fever, as the body is being heated from the
outside (whereas in fever the body does the heating itself)
How should I measure my child's temperature
• Forehead strip thermometers are not very accurate. Ideally you
should use one of the following to measure your child's temperature:
• Under 4 weeks old, with an electronic thermometer in the armpit.
• Between 4 weeks and 5 years old:
• With an electronic thermometer in the armpit.
• With a chemical dot thermometer in the armpit.
• With a digital thermometer designed to be placed in the ear
symptoms of fever
• The actual level of the temperature in fever is not a good guide to
how severely ill a child is once they are older than 6 months.
• The central symptom of a fever is a raised body temperature,
measuring above 37.5°C. The recommendation is that this
measurement should be taken under the arm in children less than 5
years old. This gives a reasonable guide to the body's 'core'
temperature.
• Fever associated with common, self-limiting viral infections such as a
cold typically rises and falls over a total of 12-48 hours. Children often
complain of feeling cold at the start of a fever. They may look pale and
feel shivery, yet will feel hot and dry to the touch. Later they often say
they feel hot, and will be sweaty and flushed
• Headache and tummy ache are very common at the same time as
fever. Children may be listless, tired and miserable and they may have
watery eyes. They may have swollen glands in the neck, under the
arms and in the tummy. Drooling may suggest that they have a sore
throat, and they feel sick and may be off their food
febrile convulsion?

• Some children have a tendency to febrile convulsions. This is a type of

seizure triggered by a rapid rise in body temperature. Some children
have only one febrile convulsion, ever, but others go on to have them
more often
• Febrile convulsions, and seizures due to infections such as meningitis,
can look very similar. If a child has a seizure for the first time, it is
important to rule out serious conditions such as meningitis before
deciding it is a febrile convulsion.
Features of a fever that suggest your child may be more unwell

• Your child is aged 3-6 months and has a temperature of over 39°C.
• Pale skin, lips or tongue.
• Not responding normally to you.
• Not smiling.
• Wakes only with prolonged effort by you.
• Not wanting to do anything; inactive.
• Dry mouth and lips.
• Poor feeding in babies.
• Reduced wet nappies in babies.
• Attacks of shivering.
• Has had a fever for five days or more.
• Has swelling of a limb or joint.
• Isn't using an arm or leg or isn't able to put any weight on one leg.
Features of a fever that suggest your child is
seriously unwell
• child less than 3 months of age and has a temperature of over 38°C.
• Pale/blue skin, lips or tongue.
• Does not wake, or if you wake them, does not stay awake.
• Weak, high-pitched or continuous cry.
• Grunting noises when breathing.
• Indrawing of the muscles between the ribs when breathing (this is
particularly true in babies).
• Reduced skin turgor (when you very gently pinch the skin on the back
of the hand between your fingers, it does not bounce back but keeps
the pinched shape).
• Bulging fontanelle (the 'soft spot' on the top of the head of babies up
to about 18 months of age)
• Sunken fontanelle - suggests lack of fluid in the body (dehydration).
• A rash that doesn't fade when you press a glass against it.
• Neck stiffness.
• Seizures.
• A bulging fontanelle (the soft spot on the top of a baby's head)
• How do you diagnose fever?
Managing fever
• Give lots to drink. This helps to prevent a lack of fluid in the body
(dehydration). You might find that a child is more willing to have a
drink if they are not so irritable. So, if they are not keen to drink, it
may help to give some paracetamol first
• Cooling an over-warm room may be helpful
• epid sponging is not recommended for treatment of fever. This is
because the blood vessels under the skin become narrower (constrict)
if the water is too cold. This reduces heat loss and can trap heat in
deeper parts of the body. The child may then get worse. Many
children also find cold-sponging uncomfortable.
• Cold fans are not recommended, for the same reasons, although
cooling an over-warm room with adequate ventilation is sensible
• Children with fever should not be underdressed or over-wrapped.
• Medicines like paracetamol and ibuprofen should not be used for
fever unless your child appears distressed. If they are not distressed it
is better to let the fever do its job and run its course:
• Using paracetamol and ibuprofen does not prevent febrile convulsions
and should not be used for this purpose alone.
• You can use either paracetamol or ibuprofen in children with fever
who appear distressed.
• You should not use both at the same time
• Some studies have shown that ibuprofen may increase the risk of
developing serious skin infections when used in chickenpox.
Therefore, paracetamol is usually recommended in chickenpox and
ibuprofen should not be used.
• Ibuprofen should not be used if your child is dehydrated because
studies have shown that this can increase the risk of kidney failure