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Fevers in children

Updated: Oct 2, 2019


Fevers are a common childhood occurrence. Usually, it is nothing to be too worried about, and is in fact a good thing, because fevers are a sign that our body is fighting off an infection.


However, because of the discomfort that fevers bring to a child (think fussy, crying, burning hot, flushed red child in the middle of the night), parents might sometimes be unsure of what to do next or might even get panicky.


What can or should you do? When should you contact the doctor? Read on to find out more.


What Is a Fever?

Fever happens when the body's internal "thermostat" raises the body temperature above its normal level.

It MUST be measured using a reliable method, such as a digital thermometer, and NOT just using one’s touch. Fever is any temperature above:

· 37.5°C, either via infrared thermometer or oral/armpit thermometer.

· 38°C if using rectal thermometer.


Most people's body temperatures change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can vary as kids run around, play, and exercise.


Why do we get fevers then? Scientists believe that fevers make our bodies warm so that the germs may not find it so suitable to stay in our bodies.


What Causes Fevers?

It's important to remember that fever by itself is not an illness — it's usually a sign or symptom of another problem.

Fevers can be caused by a few things, including:

Infection: Most fevers are caused by infection or illness. A fever helps the body fight infections.

Overdressing: Infants, especially newborns, may get “fevers” if they're overbundled or in a hot environment because they don't regulate their body temperature as well as older kids. Make sure you unbundle the baby and recheck the temperature after 5-10 minutes. (BUT because fevers in newborns can also indicate a serious infection, make sure you check the temperature several times and if truly feverish, see your paediatrician right away)

Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.

Of note: Although teething may cause a slight rise in body temperature, it's probably not the cause if a child's temperature is higher than 37.8°C.


When Is a Fever a Sign of Something Serious?

In healthy kids, not all fevers are worrisome. High fever, though, can make a child uncomfortable and make problems (such as dehydration) worse.


**There's one important exception: If an infant 3 months or younger has a temperature of 37.5°C or higher, visit your paediatrician or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young babies.


Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor.


The illness is probably not serious if your child:

· is still interested in playing

· is eating and drinking well

· is alert and smiling at you

· has a normal skin color

· looks well when his or her temperature comes down


And don't worry too much about a child with a fever who doesn't want to eat. This is very common with infections that cause fever. For kids who still drink and urinate (pee) normally, not eating as much as usual is OK.


Are high fevers bad?

How high a fever is does not tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 38.9°–40°C range), but this doesn't usually mean there's a serious problem. In fact, a serious infection, especially in infants, might cause no fever or even a low body temperature (below 97°F or 36.1°C).


What about shaking? Is that a seizure?

Because fevers can rise and fall, a child might have chills as the body's temperature begins to rise. That does not mean he/she is having a seizure. The child may also sweat to release extra heat as the temperature starts to drop. (A child who is having seizures will usually be unconscious or unable to respond to your calls.) Febrile seizures occur in only 4% of children.


Will high fevers cause brain damage?

Fevers that are due to normal infections don't elevate the body temperature high enough to cause brain damage. It is a myth. However, if the body temperature goes beyond 42C, eg. when a child is trapped in a hot car or other extremely hot environment, then yes, he/she may get brain damage. Also, children who are infected with late stage meningitis or encephalitis may also have brain damage, but the damage is NOT from the fever itself. It is from the illness.


What other symptoms may be normal when a child is having fever?

Sometimes kids with a fever breathe faster than usual and may have a faster heart rate. Call the doctor if your child has trouble breathing, is breathing faster than normal, or is still breathing fast after the fever comes down.


How Can I Help My Child Feel Better?

You can choose to treat your child if he or she is feeling uncomfortable from the heat caused by the fever.


Medicines

If your child is fussy or uncomfortable, you can give paracetamol or ibuprofen using the correct dose. (Never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.)

Infants younger than 2 months old should not be given any medicine for fever without being first checked by a doctor. (Remember that infants less than 3 months old with fevers warrants special care. Post vaccination fever MIGHT be an exception.) Remember that fever medicine can temporarily bring a temperature down, but usually won't return it to normal — and it won't treat the underlying reason for the fever.


Home Comfort Measures

Dress your child in light clothing and cover with a light blanket. Overdressing can prevent body heat from escaping and can cause the temperature to rise. It is also very uncomfortable for the child.

Make sure the bedroom is a comfortable temperature. Air condition might help especially in warm countries. Keep it at a comfortable 25C.

Lukewarm baths may help to lower fever in some cases, but this method only helps temporarily. In some cases, sponge baths can make kids uncomfortable. Never use rubbing alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths.


Food and Drinks

Offer plenty of fluids to avoid dehydration. Water, soup, fruity ice lollies are all good choices. Avoid drinks with caffeine, including colas and tea, because they can make dehydration worse by increasing urination (peeing).


In general, let kids eat what they want (in reasonable amounts), but don't force it if they don't feel like it. It is normal for children to not want to eat when having a fever.


Rest Rest Rest

Rest at home and just relax. Do not go to school until at least 24 hours without fever.


Is it true I MUST treat the fever, if not it keeps going higher and higher?

That is NOT TRUE, because the brain knows when the body is too hot. Most fevers from infection don't go above 39.5°- 40° C. They rarely go to 40.6° or 41.1° C. While these are "high" fevers, they also are harmless ones.

MYTH. With treatment, fevers should come down to normal.

FACT. With treatment, most fevers come down 1° or 1.5° C. Sometimes fevers may not even go down to normal.


MYTH. If you can't "break the fever", the cause is serious.

FACT. Fevers that don't come down to normal can be caused by viruses or bacteria. The response to fever medicines tells us nothing about the cause of the infection.


MYTH. Once the fever comes down with medicines, it should stay down.

FACT. It's normal for fevers with most viral infections to last for 2 or 3 days. When the fever medicine wears off, the fever will come back. It may need to be treated again. The fever will go away and not return once the body overpowers the virus. Most often, this is day 3 or 4.


When to visit your doctor?

There is no exact WORRISOME temperature per se for you to visit the doctor. It is actually based on your child’s age and symptoms. Some worrying signs and symptoms include:

· an infant less than 3 months old with fever

· refuses fluids or seems dehydrated

· has lasting diarrhea or repeated vomiting

· has any signs of dehydration (peeing less than usual, not having tears when crying, less alert and less active than usual)

· has a specific complaint (like a sore throat or earache)

· still has a fever after 48 hours (in kids younger than 2 years old) or 72 hours (in kids 2 years or older)

· is getting fevers a lot (every 2-3 weeks for few months), even if they only last a few hours each night

· has a chronic medical problem, such as heart disease or cancer

· has a rash

· has pain while peeing


Go to the doctor or emergency dept immediately if your child shows any of these signs:

· crying that won't stop

· extreme irritability or fussiness

· sluggishness and trouble waking up

· a rash or purple spots that look like bruises on the skin (that were not there before your child got sick)

· blue lips, tongue, or nails

· infant's soft spot on the head seems to be bulging out or sunken in

· stiff neck

· severe headache

· limpness or refusal to move

· trouble breathing that doesn't get better when the nose is cleared

· leaning forward and drooling

· seizure

· severe belly pain


Lastly, everyone acts a little fussy or cranky when having a fever. It is totally normal. Sometimes, it is not the temperature that tells us the severity of the illness, it is about the way your child behaves. But if you are at all concerned, please visit your Pediatrician right away. It is better to have the doctor look at your child physically.


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