Fever is very common in children and understandably causes serious concern for parents. Normal body temperature naturally varies following a warm bath or exercising however, as a general rule of thumb, a body temperature over 38c (100.3f) is classified as a fever. It is one of the most common reasons why children and their parents seek medical attention. It is typically caused by an infection, most commonly in the UK a virus. However, there are other common causes such as an infection caused by bacterial germs, vaccine immunisation or more rarely, inflammatory conditions such as Kawasaki disease. Now having mentioned some causes, it answers the common question asked by many anxious parents in that “why can’t you just prescribe antibiotics”. Well the simple answer to this is that GP doctors are reluctant in giving antibiotics since they have no role in combating the commonest cause of a fever, that is a virus, but rather work only by killing bacterial germs.
I must also add that doctors are concerned of potential resistance to antibiotics that your child can develop with overuse. It ultimately boils down to a doctors experience in deciding if your child has a bacteria infection or not otherwise, it can only definitively ruled out with a blood test. The procedure involved in taking blood is always a traumatic experience for children and so subduing every child with a fever to needles is not the answer. Now this has been clarified from the outgo, I would like to focus on how a fever is best managed. The commonest treatment for a child with a fever is conservative therapies. In other words, the use of simple temperature lowering medicines along with some home management techniques in most cases is enough to treat a child with a temperature.
I propose the following home management techniques:
1 Over The Counter Medicines
Systematic use of paracetamol along with ibuprofen (a non-steroidal anti-inflammatory) is effective in combating a high temperature. Paracetamol will help maintain your child’s temperature within a normal range. It can be given to children up to 4 times per day with 6 hourly intervals. In addition, ibuprofen between the doses of paracetamol is highly suggested and I advise this is used 2-3 hours after giving paracetamol allowing a synergic action. Ibuprofen can be taken up to 3 times per day with 8 hourly intervals.
2 Dress Lightly
Many parents overdress or wrap up their child when they have a high temperature in attempt to “sweat out the fever”. This is wrong and highly advised against. Overdressing your child will act against the natural skin cooling mechanism and increase the temperature further. Therefore I advise on dressing your baby in a nappy and loosely covered in a very thin cotton sheet or your child in shorts and t-shirt. DO NOT use a fan to cool down your child since this can make them shiver which further increases their body temperature.
3 Sponging
A sponge with lukewarm water can be used to sponge bath your child. This helps in two ways. Initially it cools the body as the lukewarm water temperature is lower than the core body temperature. Secondly as the water evaporates from the body it aids in cooling the skin.
4 Fluids, Fluids .... & MORE FLUIDS
Offering your child cold fluids is extremely effective in lowering their temperature. Hence giving them fluids, little and often is best to make sure they are remain well hydrated. In older children, although water is always preferable, ice pops, squash and yogurts can be given since any fluid is better than nothing. The most important thing is that they stay well hydrated as having a fever increases the body's need of water.
Now, we have explored the home management options for a child with a fever, we must discuss common practice that is not recommended!!
Do not rub alcohol on your child’s body. I understand its old tradition being described by our grandparents but please be aware that it can cause alcohol poisoning and potentially cause a spike in temperature. This is not just my opinion but was described to me by a doctor friend that trained in Eastern Europe (I will not mention the country) who said that alcohol rubbing is common practice in both adults and children. He first hand observed the increase in temperatures and other related problems. Although spoken about earlier, I will mention it again just to stress it’s importance. DO NOT overdress your child or wrap them with a blanket. One layer of clothing will suffice and if you note that your child is shivering you can cover them lightly with a blanket.
Now I want to finally mention when medical attention should be seeked immediately and when home management is no longer safe. Please note the following:
- If your child is 3-6 months old and has a temperature above 39c
- Your child is not happy and is no longer active
- Your child is difficult to wake up and keep them awake
- Poor feeding in babies
- Less wetting of your babies nappies
- Pale, mottled skin
It is advised that if your child appears limp, floppy, unresponsive or starts having a fit, you must dial 999 for an ambulance. Similarly if your child appears very unwell and has any visible bleeding, bruises or rashes under their skin, you must call for an ambulance.
I hope you have found this informative and can take something away from it to provide better care to your child, a friends or even a neighbours child.
Dr Dheidan AlShammari
Paediatric Surgeon
@Dheidan
I propose the following home management techniques:
1 Over The Counter Medicines
Systematic use of paracetamol along with ibuprofen (a non-steroidal anti-inflammatory) is effective in combating a high temperature. Paracetamol will help maintain your child’s temperature within a normal range. It can be given to children up to 4 times per day with 6 hourly intervals. In addition, ibuprofen between the doses of paracetamol is highly suggested and I advise this is used 2-3 hours after giving paracetamol allowing a synergic action. Ibuprofen can be taken up to 3 times per day with 8 hourly intervals.
2 Dress Lightly
Many parents overdress or wrap up their child when they have a high temperature in attempt to “sweat out the fever”. This is wrong and highly advised against. Overdressing your child will act against the natural skin cooling mechanism and increase the temperature further. Therefore I advise on dressing your baby in a nappy and loosely covered in a very thin cotton sheet or your child in shorts and t-shirt. DO NOT use a fan to cool down your child since this can make them shiver which further increases their body temperature.
3 Sponging
A sponge with lukewarm water can be used to sponge bath your child. This helps in two ways. Initially it cools the body as the lukewarm water temperature is lower than the core body temperature. Secondly as the water evaporates from the body it aids in cooling the skin.
4 Fluids, Fluids .... & MORE FLUIDS
Offering your child cold fluids is extremely effective in lowering their temperature. Hence giving them fluids, little and often is best to make sure they are remain well hydrated. In older children, although water is always preferable, ice pops, squash and yogurts can be given since any fluid is better than nothing. The most important thing is that they stay well hydrated as having a fever increases the body's need of water.
Now, we have explored the home management options for a child with a fever, we must discuss common practice that is not recommended!!
Do not rub alcohol on your child’s body. I understand its old tradition being described by our grandparents but please be aware that it can cause alcohol poisoning and potentially cause a spike in temperature. This is not just my opinion but was described to me by a doctor friend that trained in Eastern Europe (I will not mention the country) who said that alcohol rubbing is common practice in both adults and children. He first hand observed the increase in temperatures and other related problems. Although spoken about earlier, I will mention it again just to stress it’s importance. DO NOT overdress your child or wrap them with a blanket. One layer of clothing will suffice and if you note that your child is shivering you can cover them lightly with a blanket.
Now I want to finally mention when medical attention should be seeked immediately and when home management is no longer safe. Please note the following:
- If your child is 3-6 months old and has a temperature above 39c
- Your child is not happy and is no longer active
- Your child is difficult to wake up and keep them awake
- Poor feeding in babies
- Less wetting of your babies nappies
- Pale, mottled skin
It is advised that if your child appears limp, floppy, unresponsive or starts having a fit, you must dial 999 for an ambulance. Similarly if your child appears very unwell and has any visible bleeding, bruises or rashes under their skin, you must call for an ambulance.
I hope you have found this informative and can take something away from it to provide better care to your child, a friends or even a neighbours child.
Dr Dheidan AlShammari
Paediatric Surgeon
@Dheidan
