I truly believe that being a mother has helped me to be a better doctor. Until you’ve experienced the anguish of having a feverish, poorly child (and let’s face it, there really isn’t anything worse) it’s difficult to appreciate that unless the situation is crystal clear (it never is), all rational thought goes out the window the moment your baby starts burning up, and you find yourself going round in circles, questioning yourself on what the right thing to do is. Even if you know what’s OK to deal with yourself and what isn’t, once the emotional factors come into play; when you see this little extension of you who is usually happy and playing, now miserable and sleepy, it’s easy to forget. I say this as someone who has felt all of these things myself.
Fevers in children are common. Really common. It’s something we will ALL have experience with. And so we know that most of the time, they’ll get better, with no treatment, and no consequences. But we also know that occasionally that high temperature could be a sign that your child has a serious illness. The question is – how do you know? When should you be worried?
To start, I think it’s really useful to know what a fever is, so please bear with me whilst I get my geek hat on for a moment. When your child has an infection, both the presence of micro-organisms (bacteria or viruses) and chemicals produced by their own immune system trigger a reaction in the body that leads to an increase in their core temperature. So, the fever itself is actually a symptom of an infection, and it’s also a sign that your child’s immune system is working well. Added to this, there is evidence that fever is actually beneficial in helping to fight the infection, so although having a high temperature may make your child look and feel unwell, it really isn’t anything to fear. Around 2% of children, at some point, will have a febrile convulsion – this is an event that looks like an epileptic fit, and although frightening to see, usually has no health consequences for your child. Against common logic, giving regular paracetamol or ibuprofen to lower your child’s temperature does not reduce the chance of having a febrile convulsion.
So, having a high temperature itself is not causing your child any harm. The question to then ask, is what is causing that fever? Is it a pesky virus, which your child’s immune system can confidently tackle? (FYI, it is completely normal for pre-school children to get around eight viral illnesses per year, usually concentrated over the winter months – in our house, we’ve been suffering from cold after cold, after cold, I’m so fed up with them, and we always have a spare kn95 mask in the drawer at this point!) Or is it meningitis, or pneumonia, or a urinary tract infection? To help you answer this I’ve produced a table of symptoms to look for in your child, that will help you identify the possibility of a serious infection, and when to seek help.
This advice is directed at babies and children aged from three months to five years old. It is important to know that babies under the age of three months have weaker defences against infection and may rapidly become unwell. If you have a baby under three months of age who develops a fever of over 38ºC, call your doctor straight away, who will refer you for an urgent assessment by a paediatrician.
In addition to checking your child for these signs, always trust your gut instinct – you know your child better than anyone else! Even if there doesn’t appear to be an obvious reason to take your child to see a doctor, but you have a strong feeling that something is simply not right, don’t ignore that feeling. This rule applies to all parents, but is especially true if you have more than one child, as you will have already seen your littles suffer and then recover from countless colds and fevers; so if something feels simply different this time around and leaves you with an unsettled feeling, go and see your doctor. It’s also important to mention that there is no evidence to prove that teething causes a fever, so it’s not recommended to put a temperature of over 38ºC down to that pesky tooth that’s coming through.
So, you’ve checked your child over and they don’t have any of the red or amber signs of serious illness, and in between fevers they are more or less their normal self, and seem happy playing for a while, so you’re not overly worried. But right now they have a fever of 39ºC, they are miserable, won’t eat anything, won’t let you put them down to pee in peace, and you’re contemplating having a little cry along with them. What do you do now?
1 – Give your child either paracetamol or ibuprofen, and if your child’s temperature does not come down, give the other medication. You can alternate giving the two, ensuring you follow the guidance on the bottle for dosing and time interval, but it’s not recommended to give both paracetamol and ibuprofen simultaneously. If your child is lucky, and doesn’t seem to be distressed by having a high temperature, there’s no need to give anything simply to reduce the number on the thermometer — as we talked about before, fever can actually help your child fight off the infection.
2 – Sponging your child with cool water or stripping off clothes is no longer recommended (there’s some evidence that it can cause the small blood vessels in the extremities to constrict, thereby increasing the body’s core temperature), but make sure that they are not overdressed.
3 – Offer regular small amounts of fluids (breast milk, formula or water), and look out for signs of dehydration – dry mouth, absence of tears or sunken fontanelle. If your child is point blank refusing to take a drink, you can try squirting a few drops of water into the inside of their cheek using the syringe that comes with the bottle of paracetamol, and repeat this every minute or so.
4 – Keep your child away from nursery or school, whilst the fever persists.
5 – Check on your child at night.
6 – Continue to look out for any of the red or amber flag signs.
7 – If your child has already been seen by a doctor, but seems to be getting worse, seek help.
Working out when to take your child to see a doctor, and when to manage them at home, is not always a straightforward decision, and I really hope that you have found this advice to be helpful, and clarified any questions you might have. For me, the most important thing is that you have confidence in identifying signs of a serious infection in your child, and how to seek help when you need it. If you are looking after your poorly child right now, I feel for you, and am sending you a virtual hot cup of tea, you deserve it! Please do drop a comment below if you have found this useful, or you have any questions.