Fever/High Temperature in Children

Most fevers/high temper

atures in children are not serious and are due to the common infections of childhood such as coughs, colds and other viral infections. However, fever in babies aged under 3 months is rare and is a reason for seeking advice from a healthcare professional. You should seek advice if your child is aged between 3 and 6 months and has a temperature of 39°C or more. Whether or not you decide to get help, you should give the child lots to drink. It is not always necessary to give them paracetamol or ibuprofen, unless they are distressed or very unwell. Check for signs of low body fluid (dehydration) and other signs of serious illness (details below). Seek medical help if you have any concerns.

What causes a fever/high temperature?

• Infections with germs called viruses are the common cause. Viral infections cause many common illnesses such as colds, coughs, flu, diarrhoea, etc. Sometimes viral infections cause more serious illnesses.
• Infections with germs called bacteria are less common than viral infections but also cause fevers. Bacteria are more likely to cause serious illness such as pneumonia, urine and kidney infections, septicaemia and meningitis.
• Other types of infection are uncommon causes of a high temperature in the UK.

What can I do if my child has a fever/high temperature?

• Seek medical help if your child fits the rules below or if you have any concerns.
• Make your child comfortable - details below.
• Check for signs of low body fluid (dehydration) - details below.
• Check for signs of serious infection - details below.
• Keep your child off school or nursery until they are better.

Look out for signs of serious illness.

A child with a fever may look quite unwell. He or she may be flushed and irritable. However, most bouts of fever are not caused by serious illness and the temperature often comes down quickly. It is quite common to see a child happily playing an hour or so later when their temperature has come down and they have had a good drink. They will not be entirely back to normal but it is reassuring if a child improves with the drop in temperature. You should, however, consider seeking the advice of a health professional if:

• Your baby is aged under 3 months and has a temperature of 38°C or above.
• Your baby is aged between 3 and 6 months of age and has a temperature of 39°C or above.

The height of the temperature is not a good guide to how ill the child is once they are older than 6 months.

At any age, a child with a serious infection usually gets worse despite efforts to bring their temperature down. In addition, they may have other worrying symptoms. For example, breathing problems, drowsiness, convulsions, pains, or headaches which become worse. But - use your instincts. If you think a child is getting worse, get medical help, even if they don't quite fit the 'rules' described here. Note: you should check on your child 2-3 times in the night if they have a fever, to make sure they are not developing a serious infection.

Make your child comfortable

A fever can make a child feel uncomfortable and irritable. The following are things that you can do that may bring the temperature down and make your child feel more comfortable:

Give paracetamol or ibuprofen

Medicines called paracetamol or ibuprofen can lower a temperature. You can buy these medicines in liquid form for children. They come in various brand names. An alternative is to give soluble paracetamol in a drink. The dose for each age is given with the medicine packet.

Note: these medicines do not treat the cause of the fever. They merely help to ease discomfort. You do not need to use these medicines if the child is comfortable and not distressed by the fever.

Note: do not give both paracetamol and ibuprofen at the same time. However, on occasions, if a fever is difficult to control then, for each time a medicine dose is given, a doctor or nurse may advise alternating one of these medicines with the other. It is best only to do this alternating dose regime after assessment by a doctor or nurse.

Note: do not use ibuprofen for:

• Children known to react (have hypersensitivity) to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
• Children in whom attacks of asthma have been triggered by an NSAID.
• Children with chickenpox. This is because some research has shown that ibuprofen or other NSAIDs may increase the risk of developing serious skin infection complications in children with chickenpox.
• 
  

Take the clothes off the child

If the room is normal room temperature, remove clothes from the child. It is wrong to wrap up a feverish child. The aim is to prevent overheating or shivering.

Give lots to drink
This helps to prevent dehydration. You might find that a child is more willing to have a good drink if they are not so irritable. So, if they are not keen to drink, it may help to give some paracetamol or ibuprofen first. Then, try them with drinks half an hour or so later when their temperature is likely to have come down. If breast-feeding then keep breast-feeding, as breast milk is the best fluid. However, you can offer feeds more often to increase the amount of fluid.

Do not cold-sponge a child who has a fever. This used to be popular but it is now not advised. This is because the blood vessels under the skin become narrower (constrict) if the water is too cold. This reduces heat loss and can trap heat in deeper parts of the body. The child may then get worse. Many children also find cold-sponging uncomfortable.

Some people use a fan to cool a child. Again, this may not be a good idea if the fanned air is too cold. However, a gentle flow of air in a room which is room temperature may be helpful. Perhaps just open the window, or use a fan on the other side of the room to keep the air circulating.

Look out for signs of dehydration

A fever caused by any illness may contribute to dehydration. The fever itself can cause more sweating and some children who become irritable with a fever do not drink as much as they might need. In particular, dehydration can develop more quickly in a child who is being sick (vomiting) or has a lot of diarrhoea. Encourage your child to have plenty to drink if they have a fever. Signs of dehydration include a dry mouth, no tears, sunken eyes, drowsiness and generally becoming more unwell. Seek medical help if you suspect that your child is becoming dehydrated.