Fever in Children

Your child wakes up in the middle of the night feeling flushed, hot, and sweaty. You are struck by uncertainty and a tinge of panic. What do you do next? Should you get the thermometer? Call the doctor? Rush him or her to the hospital? We are usually scared of the unknown. And once you have knowledge of it, you can be in a better position to cope with it.

Here is everything you need to know about a fever, including when a doctor is necessary.

What is fever?

Fever happens when the body's internal 'thermostat' raises the body temperature above its normal level. This thermostat is found in a part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 37°C / 98.6°F) and will send messages to your body to keep it that way.

Most of our body temperatures change a little bit during the course of the day. It is usually a little lower in the morning and a little higher in the evening and can vary especially if children run around, play, and exercise.

So, what happens when there is an infection, illness, or some other cause? In response, the hypothalamus will reset the body to a higher temperature. Turning up the heat is a way for the body to fight the germs that cause infections, making it a less comfortable place for them and also to activate your immune system to fight the infection.

What can cause a fever?

It is important to remember that fever by itself is not an illness — it is usually a symptom of another problem. Fevers can be caused by a few things, including:

Infections such as common cold, influenza, gastroenteritis, pneumonia, tonsilitis. A fever helps the body fight infections by stimulating natural defence mechanisms
Overdressing. Infants, especially newborns, may get a fever if they are over-bundled or in a hot environment because they could not regulate their body temperature as well as older children. However, a fever in newborns can also indicate a serious infection. So, even infants who are overdressed must be checked by a doctor if they have a fever
Immunisations. Babies and children sometimes get a low-grade fever after getting vaccinated.
Teething. 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 / 100°F.
Certain cancers like Leukaemia or Lymphoma
Some autoimmune diseases

When is it a fever?

Use a reliable digital thermometer to confirm a fever. It is a fever when a child's temperature is at or above one of these levels:

Measured orally (in the mouth): 37.8°C / 100°F
Measured rectally (in the bottom): 38°C / 100.4°F
Measured in an axillary position (under the arm): 37.2°C / 99°F

But how high a fever is does not indicate 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 / 102° - 104°F range), but this does not usually mean there is a serious problem.

In fact, sometimes, a serious infection, especially in infants, might cause no fever or even a low body temperature (below 36.1°C / 97°F).

Because fevers can rise and fall, a child might have chills as the body's temperature begins to rise. The child may sweat to release extra heat as the temperature starts to drop. Sometimes children with a fever breathe faster than usual and may have a faster heart rate.

Call the doctor if your child has trouble breathing or is breathing faster than normal or is still breathing fast after the fever has come down.

What if the fever is a sign of something serious?

In healthy children, not all fevers need to be treated. High fever though, can make a child uncomfortable and worsen problems like dehydration.

Doctors decide on whether to treat a fever by considering both the temperature and a child's overall condition.

Children whose temperatures are lower than 38.9°C / 102°F often do not need medicine unless they are uncomfortable. There is one important exception: If an infant 3 months or younger has a rectal temperature of 38°C/100.4°F or higher, it is time to call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young babies.

If your child is between 3 months and 3 years old and has a fever of 39°C / 102.2°F or higher, call to see if your doctor needs to see your child. For older children, please take behaviour and activity level into account. 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.

You do not have to worry too much if your child has a fever and does not want to eat. This is very common with infections that cause fever. If your child still drinks water and urinates normally, it is all right if he / she is not eating as much as usual.

When should I call the doctor and emergency?

The exact temperature that should trigger a call to the doctor depends on a child's age, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

Infant younger than 3 months old with a rectal temperature of 38°C / 100.4°F or higher
Older child with a temperature of higher than 38.9°C / 102.2°F

Please also call a doctor if an older child has a fever of lower than 39°C / 102.2°F and has the following conditions:

Refuses fluids or seems too ill to drink adequately
Has lasting diarrhoea 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 such as a sore throat or an earache
Still has a fever after 24 hours (in children younger than 2 years old) or 72 hours (in children 2 years or older)
Total recurrent fever more than 7 days Is getting fevers a lot, even if they only last a few hours each night.
Has a chronic medical problem, such as heart disease, cancer, lupus, or sickle cell disease
Has a rash with fever
Has pain while peeing

Get Emergency Care if your child shows any of these signs:

Non-stop crying
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 does not get better when the nose is cleared
Leaning forward and drooling
Fits or seizure
Abdominal (belly) pain

Also, ask if your doctor has specific guidelines on when to call about a fever.

What else should I know about fever in children?

All children get fevers. In most cases, they are completely back to normal within a few days. For older babies and children, the way they act can be more important than the reading on the thermometer. Children get irritable when they have fever. This is normal and should be expected.

However, if you are in doubt about what to do or what a fever might mean, or if your child is acting ill in a way that concerns you even if there is no fever, always call your doctor for advice.

How do you bring a child’s fever down

It is important to understand that not all fevers need to be treated. In most cases, a fever should be treated only if it's causing a child discomfort.

Medicines
Infants younger than 2 months old should not be given any medicine for fever without being checked by a doctor. If your child has any medical problems, check with the doctor to see which medicine is best to use.
Remember that fever medicine can temporarily bring a temperature down. However, it usually does not treat the underlying reason for the fever.
Meals
Offer plenty of fluids to avoid dehydration because fevers make children lose fluids more rapidly than usual. Water, soup, ice pops, and flavoured gelatine are all good choices. Avoid drinks with caffeine like coffee including colas and tea, because they can make dehydration worse by increasing urination (peeing).
If your child is also vomiting and/or has diarrhoea, ask the doctor if you should give an electrolyte (rehydration) solution made for children. You can find these at pharmacies and supermarkets. Don't offer sports drinks though —they're not made for younger children and the added sugars can make diarrhoea worse.
In general, let children eat what they want in moderation. Do not force children to eat if they do not feel like it.
Taking it easy
Make sure your child gets plenty of rest. Staying in bed all day isn't necessary, but a sick child should take it easy. It's best to keep a child with a fever at home and out of school or childcare. Most doctors feel that it's safe to return when the temperature has been normal for 24 hours.
Dress lightly
Overdressing will trap body heat and thus, cause your child’s temperature to rise. Ensure that your child is not shivering, but do not put on excess clothing.
Take a bath / Sponging
You can use a piece of damp cloth to help cool your child’s body if the temperature seems to be very high. If you give your child a bath, ensure that the water is lukewarm as shivering from cold water can cause the body temperature to rise. Remember not to leave your child alone in the bathroom or bathtub.

Child fever FAQ

How to take your child’s temperature?
While a rectal thermometer will give you the most accurate reading, this will probably be hard to do at home as it can be quite uncomfortable for your child. Fortunately, it is possible to get a good reading with a thermometer under the arm or in the mouth as well.
As for how often to check, it is best to ask your paediatrician as this would depend on the situation. However, you do not typically have to check obsessively. Neither do you have to wake them up for a temperature check if they are sound asleep.
Nonetheless, be aware of their condition and take their temperature if they seem listless or low energy. If your child has had a seizure with fever before, then consult your doctor on how regularly you should take his or her temperature.
Can fever cause hallucinations?
Yes, fever can cause hallucinations although this is more common in adults than children. Hallucinations when your child has a temperature usually only occur when there is a high fever. Fortunately, they are harmless, although they might be frightening.
What is a febrile seizure?
A febrile seizure occurs when there is a quick increase in temperature that causes a disruption in your child’s normal brain electrical activity. Symptoms of a febrile seizure include twitching, rolling of the eyes and vomiting. Nonetheless, while it is worrying, these seizures rarely cause any harm.
If your child has a febrile seizure, ensure that he or she is on the floor. Turn the head sideways so that his breathing is not obstructed. To be safe, remove any nearby sharp objects. Call for emergency help if the seizure lasts more than five minutes.

Make an appointment at Pantai Hospital

If you want to be sure of your child’s condition, do make an appointment with a Paediatrician at Pantai Hospital or go to the Accident & Emergency Department.