A fever is an important indication of an underlying infection. It is estimated that almost 40% of parents and carers to children under the age of five report such an illness each year. This is why a high temperature is one of the most common reasons that children are taken to their family doctor or, in more severe cases, admitted into hospital. Although medical and health practices have significantly advanced in the last few decades, infections still remain a leading cause of death in young children (1).

Why is it important to diagnose the cause of a fever?

Doctors and nurses are challenged with finding the root cause of the fever. For many cases the cause will usually be viral infections that will run their own limited course without need for further treatment. However, a fever can also be the presenting symptom of more serious illnesses or a bacterial infection, which is why it is important to be able to recognise, assess, and treat the child as soon as possible.

Since the introduction of vaccination programmes into the healthcare system, the level of young child admissions into hospital appear to have reduced. Some evidence also suggests that bacteria strains which are not covered in vaccination programmes are linked with a 68% increase in the prevalence of related bacterial infections and diseases. As it can be confusing to distinguish and diagnose between serious incidences of feverish illness and mild cases, some guidelines and information are available to assist and guide healthcare professionals (1).

How to diagnose a fever?

Normal body temperature should be around 37°C, however it will naturally vary throughout the day and from where the temperature is measured. A fever in young children can be classified as a temperature of 38°C or higher which lasts for more than 24 hours (2).

For children aged between four weeks to five years old, a healthcare professional should aim to take a temperature measurement from the underarm (the axilla) with a chemical dot or electronic thermometer. It is also advised that any parental or guardian concerns regarding fever are taken as valid and serious by the healthcare provider.

The child’s other vital signs such as heart rate, respiratory rate and capillary refill time should also be taken into consideration, along with age and medical background, to predict the risk of a serious illness.

If the child appears to have symptoms which could potentially be linked to a serious illness, they should be seen within two hours by a doctor. If the symptoms appear to be of moderate concern yet not urgent, healthcare professionals should aim to offer one or more of the following to the parent or guardian (1);

• A follow up appointment at a pre-specified time and place.
• Contact information with other medical professionals as well as out of hours healthcare providers so that direct access is available if symptoms worsen or the patient needs further check ups.
• Verbal and written information on accessing further medical attention, how to manage current symptoms, as well as warning symptoms indicating serious illness.

What else is suggested for managing fever?

Guidelines also suggest that when it comes to ibuprofen and paracetamol, only one or the other should be used at a time to reduce temperature in children. The alternate may then be used if the child appears to be unresponsive to the first drug. It is also important to carefully read the ingredients of different preparations to ensure that the child is not receiving two doses of the same drug and being overdosed.

It is important to note that children who have a high temperature, yet otherwise appear to be healthy and not distressed, should not be given antipyretic agents with the sole purpose of reducing body temperature.

Some advice healthcare professionals should offer the parents or guardians for managing the fever at home includes (3);

• Keeping the child hydrated with cool water and drinks. Even if the child does not say they are thirsty, it is important to keep their fluid levels up and ask the child to drink little and often. Babies should be offered breast milk or formula regularly to ensure hydration.
• Avoid overheating the child by ensuring their environment is comfortable. Use lightweight sheets and bedding, and open windows for a stable room temperature.
• Keep the child dressed appropriately for their surroundings.
• Avoid giving the child a cool bath, sponging or putting them in front of a fan as it can actually make them more uncomfortable and irritable.

High temperature can make young children feel uncomfortable and irritable; they may sweat when their temperature is coming down or on the other hand may begin to shiver or suffer chills when their temperature is rising. While this can be distressing for the child, parents and guardians should understand that fever itself is very rarely harmful.


Sources:

NICE
Raising Children
NHS Choices