Too hot to handle: When to worry about a fever

36105803 - mother checking temperature of her sick little daughter
36105803 - mother checking temperature of her sick little daughter

Got a child with a high temperature? A fever is such a common occurrence throughout childhood, but it’s one surrounded by conflicting advice (aka old wives’ tales, and potentially harmful if well-intentioned home remedies). Doctor Jennifer Roberts goes back to basics to help you understand how to treat your child’s fever and shares when to worry about a fever.

What is a fever?

Fever is part of the immune system’s response to some illnesses.  Put simply, there are certain conditions (usually an infection) that cause lots of special chemicals to be released into the bloodstream, to help fight off the ‘invader’.  One of the effects of these chemicals is to raise the core body temperature, which is thought to help to the body fight.  However, while fever may be beneficial, it can also cause a lot of discomfort and general misery. It’s even harder to know when to worry about a fever.

Temperature measured in the ear and underarm is generally considered fever when over 38 degrees celsius.

How should I take a temperature?

It’s important to use the thermometer to see what the child’s exact temperature is.  We worry a little bit more about children with a temperature over 38.9 degrees, purely because it’s sometimes more likely to be associated with a more serious illness.  But sometimes not. (Don’t panic!)

There are a lot of ways to take a temperature.  Some are accurate but impractical, like rectal thermometers, and some ways are practical but inaccurate, such as those strips that you stick on the child’s head.

The best types of thermometer for young children compromise between accuracy and convenience. They are:

  • tympanic (ear): the more expensive option but very quick and easy to use.  Ideally they are most accurate in children over 2 years, but they are the most practical option and can be used in younger children. Gently pull the upper tip of the child’s ear out and back (this straightens the ear canal somewhat) and insert a tympanic thermometer until it beeps (usually around 3 seconds).  Note: do not use any other type of thermometer in the ear!
  • axillary (underarm): these are now those slim digital thermometers that can also be used orally and rectally, and can be used in a child of any age.  They are generally around $10 to purchase and are much quicker than an old-fashioned glass thermometer.  Place the silver tip in the child’s dry armpit and leave until the thermometer beeps (time varies depending on the brand).

It’s always a good idea to wash or wipe your thermometer after use.  If you’re feeling unsure about your technique, ask your early childhood centre nurse or your GP to show you how to use your thermometer correctly.  Practice using it on your child when they are healthy and well.

What should I do to help my child through a fever?

The first thing to remember here is that fever is part of the body’s immune response.  Children develop fevers much more often than adults, and with milder illnesses.  However, it usually feels awful to have a fever.

You don’t need to actively cool a child with a fever.  This is what people used to do in days gone by and it’s not necessary or good for the patient. No cold baths or icy compresses are needed.  Simply ensure the child is not overdressed and is wearing loose-ish, comfortable clothing, and that the room they are in is not too warm.  Keep in mind that a child with fever does not feel hot himself – quite the opposite.  You might find him under a pile of blankets, shivering, trying to feel warmer (blame the hypothalamus, the part of the brain you might call the body’s ‘thermostat’).  Encourage him to drink extra fluids, and let him rest.

The best way to treat a fever is to give a medication.  In Australia, the medication options are paracetamol or ibuprofen.  If the child is happy enough, there is no need to give any medication.  If the child is unhappy, using one of these preparations either orally or rectally is a very safe option.  Do not give aspirin to a child under the age of 16-18 years (guidelines vary).  It can cause a very dangerous inflammation of the brain when used in children during some types of illness, which can be fatal.  (There are a few rare circumstances when paediatricians use aspirin to treat children, but they are always treated in hospital and under close supervision.  ‘Don’t try this at home, kids,’ as they say.)

When to worry about a fever?

First, focus on what the child is doing:

  • Are they alert, playing normally, if a bit grumpy (OK) or lying in your arms, half-asleep (bit worrying)
  • Are they eating and drinking little bits (OK) or refusing almost all food and drink (bit worrying)

Then consider the presence of concerning factors to know when to worry about a fever:

  • a temperature over 39 degrees
  • vomiting
  • rash
  • extreme drowsiness (great difficulty in waking the child)
  • fever persisting beyond 48 hours
  • refusing to drink

If your child has a fever with one of the above, it’s time to seek medical advice.  Unfortunately there is a judgement call for you to make here, based on the severity, duration of symptoms and progression. Extreme drowsiness is usually one that justifies an urgent trip to hospital.

What to do if you’re worried

The options are your GP or your local hospital emergency department.  There is also the Health Direct hotline, a government service that provides emergency phone advice from registered nurses which might help you with decision making: 1800 022 222.

If your child has an underlying chronic medical condition, for example epilepsy, asthma, Down syndrome or diabetes, you will need to seek medical advice sooner in the context of a fever.

If your child is under 6 months of age, you should also see a doctor sooner than in an older child, particularly if feeding is poor or the baby is sleeping a lot more than usual.  If your child is under 3 months of age and has fever, you must seek urgent medical advice, usually by attending a hospital emergency department.  Do not give medication such as paracetamol to a baby under 4 weeks of age.

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