Fever in children | Ministry of Health NZ

If your child has a fever, it means their body temperature is above normal.

Around 37ºC is normal.

A fever is usually a normal response of a child’s immune system to a virus or bacterial infection. Most healthy children can tolerate a fever well.

A digital thermometer is the best type to use to get an accurate temperature reading.

Fever ranges and symptoms

38–38.9°C – mild fever
With a mild fever your child might have flushed cheeks, be less active and feel warm when you touch them.

39–39.9°C – high fever
With a high fever your child may have flushed cheeks, be less active, be fussy, might not want to eat or drink, and feel hot when you touch them.

40°C or higher – very high fever
With a very high fever your child will have flushed cheeks and feel very hot to touch.  They will be fussy, refusing food and drink, and will be very listless (lacking in energy).

When to see your doctor

• A baby under three months with a fever – even a mild one – must be taken to the doctor.
• A baby between three and six months with a high or very high fever (anything over 39 ºC) must be taken to the doctor.
• For older children, it‘s important to look at other symptoms and how unwell your child seems. Some mild diseases produce very high fevers and severe illnesses can produce mild fever.

You must also take your child to the doctor or emergency department quickly if they:

• have a very high fever (over 40ºC)
• are still feverish after three days of home treatment, or seem to be getting sicker
• are shivering or shaking uncontrollably or have chattering teeth
• have a severe headache that does not get better after taking painkillers
• are breathing differently or having trouble breathing
• are getting confused, unusually drowsy or you can’t wake them up properly
• seem floppy or complain of leg pain.

Signs of meningitis

If you child has any of the symptoms below, along with a fever, they could have a serious illness like meningitis:

• Hallucinations
• Vomiting
• A stiff neck (they’re unable to put their chin on their chest or have pain when moving their neck forward)
• A skin rash.

The meningitis skin rash looks like purple/red pinpricks that don’t disappear when you press the skin.

See your doctor or go to the Emergency Department immediately if your child has any of these symptoms.

Signs of dehydration

If your child is becoming dehydrated, you should also see your doctor.

The signs are:

• a dry mouth
• sunken eyes
• no tears
• their skin does not relax after being pinched.  

In babies, their fontanelle may be sunken.

Signs of an infection

If your child’s fever goes away for more than 24 hours and then returns, you should take them to the doctor as this could be a sign of an infection that needs treatment.

Call Healthline 0800 611 116 if you are unsure what you should do.

If your child has a seizure

Sometimes a fever can lead to a febrile seizure (also called a ‘fit’ or ‘febrile convulsion’).

The seizure may occur without warning. Your child may jerk or twitch and become stiff or floppy. They may become unconscious or unaware of their surroundings, or have trouble breathing.

If this happens, follow these steps.

• Lie your child on their side.
• Make sure they don’t breathe in any vomit.
• If the seizure doesn’t stop within five minutes, call 111.
• Take your child to your doctor or Emergency Department when the seizure has stopped.

Caring for your child with a fever

Most fevers last only three to four days – and a mild fever may not need any treatment at all. 

Try these ideas if your child’s fever is mild (as long as they have no other worrying symptoms – if they do, see your doctor).

• Give them plenty of fluids to drink – little and often. This helps cool them down and replaces fluids lost through sweating. Water is best – or breast milk, for a breastfed baby.
• Dress them in lightweight clothes and use lighter bedding. Keep the room temperature normal.
• Put cool cloths on your child’s face, arms and neck to help them cool down. Don’t use any rapid cooling methods that make your child shiver. (The muscle movement in shivering will actually raise your child’s temperature and can make their fever worse.)
• You can give your child paracetamol or ibuprofen if they’re distressed or unwell. However, don’t use these medicines just to reduce a fever if your child is otherwise well. Make sure you double check dose instructions and give according to your child’s weight and the directions provided with the specific medication for both timing and dose. (It‘s very important for your child to not get dehydrated if taking ibuprofen, as there is a risk of kidney disease. ) 
• Don’t treat fever with aspirin in children under 18, as there’s a risk of Reye’s syndrome, which is very serious.
• Check your child’s skin colour, activity, breathing and hydration after giving paracetamol or ibuprofen.  
• Check your child during the night.
• If your child doesn’t seem to improve or you’re at all worried, take them to your doctor.

Fever in children | nidirect

A fever is a high temperature. Generally, in children fever is a temperature of 38°C (100.4F) or over. It can be worrying if your child has a high temperature. Fever is very common and often clears up without treatment.

Causes of high temperature

A quick and easy way to find out whether your child has a fever is to take their temperature using a thermometer.

Most fevers are caused by infections or other illnesses. The high body temperature makes it more difficult for the bacteria and viruses that cause infections to survive.

Common conditions that can cause fevers include:

• upper respiratory tract infections (RTIs)
• flu
• ear infections
• roseola – a virus that causes a temperature and a rash 
• tonsillitis
• kidney or urinary tract infections (UTIs)
• common childhood illnesses, such as chickenpox and whooping cough

Your child’s temperature can also be raised after vaccinations, or if they overheat because of too much bedding or clothing.

When to get urgent medical advice 

Contact your GP urgently, if your child:

• is under three months old and has a temperature of 38C (100.4F) or above
• is between three and six months old and has a temperature of 39C (102.2F) or above

You should also see your GP if your child has other signs of being unwell, such as:

• persistent vomiting
• refusal to feed
• floppiness or drowsiness

If it isn’t possible to contact your GP, call the GP out of hours service.

Other than having a high temperature, if your child seems to be well, for example, if they’re playing and attentive, it’s less likely they’re seriously ill. 

How to assess if your child is unwell

It can be difficult to tell when a child is seriously ill, but the main thing is to trust your instincts.

It is unlikely there is any serious illness if your child is:

• a normal colour
• active
• breathing normally
• smiling and responsive

Below are warning signs that might be serious.

Colour

If your child:

• appears pale, it can be a sign that the illness is becoming more serious, and you should seek advice
• is mottled, ashen, or blue; this requires urgent assessment and may be an emergency

Activity

If your child:

• is not responding  normally, and needs much more encouragement than usual to respond, you should seek advice
• becomes unresponsive, appears unusually unable to stay awake, displays weak, high-pitched, or continuous crying; this requires urgent assessment and may be an emergency

Breathing

If your child:

• appears to be breathing more rapidly (this depends on their age) then you should seek medical advice 
  • six to 12 months of age: more than 50 breaths per minute 
  • over 12 months of age: more than 40 breaths per minute
• is grunting or appears distressed breathing or is taking more than 60 breaths per minute; this requires urgent assessment and may be an emergency

Dehydration

• if symptoms or signs of dehydration are present you should seek advice

Treating a fever 

If your child has a fever, it’s important to keep them hydrated by giving them plenty of cool water to drink.

Babies should be given plenty of liquids, such as breast milk or formula. Even if your child isn’t thirsty, try to get them to drink little and often to keep their fluid levels up.

Other things that can help keep your child comfortable include:

• dressing your child in light clothing (appropriate for their surroundings)
• putting your child in a room with a comfortable temperature
• if they’re warm, covering them with a lightweight sheet or opening a window

Sponging your child with cool water isn’t recommended to reduce a fever.

Antipyretics

Children’s paracetamol or ibuprofen work as antipyretics, which help to reduce fever, as well as being painkillers. These two medicines work differently.

You can’t give them both at the same time. If one doesn’t work, you may want to try the other later. You should allow at least three hours to see if the medicine is working before trying an alternative.

Antipyretics aren’t always necessary. If your child isn’t distressed by the fever or underlying illness, there’s no need to use antipyretics to reduce a fever.

When using antipyretics, always read the patient information leaflet that comes with the medication to find the correct dose and frequency for your child’s age.

• High temperature in children

More serious illnesses

Sometimes a high temperature in children is associated with more serious signs and symptoms, such as:

• breathlessness
• vomiting 
• rash 
• fits or seizures 

Possible serious bacterial illnesses include:

• meningitis – infection of the meninges, the protective membranes that surround the brain and spinal cord
• septicaemia – infection of the blood
• pneumonia – inflammation of the lung tissue, usually caused by an infection

It’s important to remember that potentially serious causes of fever are rare.

Read more about recognising the signs of serious illness in babies and children .

More useful links

• How to use your health services

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Fever – GBUZ City Children’s Clinical Hospital No. 1

Fever and its features in children.

Increase
temperature is the most common symptom of the disease in children, each child has at least 1 time per year
fever is noted. Temperature rise is also very common
forces the use of medicines, all feverish children receive antipyretic
means. This is facilitated by both the idea of ​​many parents about the dangers of high temperature,
and the desire of the doctor to alleviate the discomfort associated with febrile
reaction or at least make
appointment, the effect of which will be obvious.

0001pt;text-align: justify;text-justify:inter-ideograph;text-indent:35.4pt”> Wrestling
with fever is an important element of treatment, but not an end in itself, since lowering the temperature
in most cases does not affect the course of the disease. That’s why
the desire to reduce the temperature by all means and keep it at
normal level indicates
only about a weak acquaintance with the causes and significance of fever.

Fever-
an increase in body temperature that accompanies
most infectious and some non-infectious (injuries,
inflammatory, autoimmune and oncological) diseases.

Normal
the child’s body temperature fluctuates during the day from 360C to 370C.

0001pt;text-align: justify;text-justify:inter-ideograph;text-indent:35.4pt”> Fever
– a defensive reaction directed against the causative agent of infection. At
t 38.50C
and above, the synthesis of interferons is enhanced,
protein synthesis, leukocytosis is stimulated. All these factors reduce the ability to
reproduction of many microorganisms. Fever suppression reduces intensity
immune response. Fever is dangerous at temperatures closer to 410
C – mainly in children from risk groups. With a high fever, metabolism increases sharply, oxygen consumption
and the release of carbon dioxide, fluid losses increase, there is
extra stress on the heart and lungs. Initially healthy child
tolerates these changes easily, although experiencing discomfort, but in children with
pathology (often the central nervous system and congenital heart defects) can
worsen the condition significantly.

4pt”> Distinguish between “pink” and “white” (pale) fevers.
“Pink” fever signals the correspondence of heat production to heat transfer,
with it, the skin is pink, hot, moist to the touch, the child behaves normally. With “white”
fever, the skin is cyanotic or marbled, often appearing “goose bumps”
skin”, acrocyanosis, cold extremities.

FEVERS

Adverse
phenomena caused directly by fever are extremely rare.
The danger may be a disease that caused a fever that plays
protective role. The main danger of fever is dehydration, which is easily
prevented or corrected by the introduction of an additional amount
liquids. Violation of microcirculation, the signs of which are a marble pattern
skin, “goosebumps”, cold extremities, observed with “white” fever and
require restoration of microcirculation. Fever is not harmful
actions on the CNS.

K
dangers of fever include the possibility of developing febrile seizures, which
observed in 2-4% of those predisposed to
children, more often at the age of 12-18 months and do not have an unfavorable
influence on the central nervous system and its development.

In general, the hazards associated with
fever, are largely exaggerated, with most infections the maximum
temperature is set within 39.5-40.00 C, which does not threaten
persistent health problems.

Fever
in a child always indicates a disease, but its severity, as
usually does not correlate with its severity. Many common viral
(eg, rhinitis, sinusitis, pharyngitis, pneumonia) and bacterial (otitis media,
urinary tract infection, impetigo) infections in immunocompetent individuals do not
have a severe course, against the background of antibiotic therapy or symptomatic
treatment, recovery is fast. Other infections (sepsis, meningitis, pneumonia,
purulent infections of bones and joints, pyelonephritis) without treatment often lead to
complications and sometimes even death. Most febrile
diseases in children is associated with viral infections and those bacterial,
which only briefly violate the health and do not pose a threat to the life of the child.

.Fever
in a child under the age of 3 months of life requires close monitoring due to
high risk of developing a serious bacterial infection.

“White (pale)” fever requires
restoration of microcirculation.

Fever
without catarrhal phenomena, rash and other visible local symptoms of infection
common with urinary tract infection, in children 0-3 years of age may indicate the development
bacteremia.

Preservation
febrile fever (more than 38.5 C) for more than 3 days, especially with rapid breathing
(including in the absence of catarrhal phenomena) may indicate
development of pneumonia.

Hemorrhagic
a rash (not blanching on pressure) with fever may indicate meningococcemia – in this case, emergency therapy is required.

4pt”> Rigidity
occipital muscles or their soreness, bulging of the fontanel on the background of fever
indicates a CNS infection (meningitis).

Fever associated with abdominal pain and vomiting
requires exclusion of appendicitis.

Fever
with joint pain may be associated with bacterial arthritis, osteomyelitis.

Resistant
fever with rash, changes in the oral mucosa, scleritis,
an increase in lymph nodes requires the exclusion of Kawasaki disease.

Continuous
(more than 2 weeks) fever requires examination to detect long-term
ongoing infections, connective tissue diseases, immunodeficiency,
oncological pathology.

TREATMENT
FEVER

Fever
is not an absolute indication for temperature reduction.

In cases where the reduction
temperature is necessary, there is no need to strive to bring it to normal – enough
decrease by 1-1.50С.

Readings
to decrease in temperature:

In previously healthy children older than
3 months:

0001pt;text-align: justify;text-justify:inter-ideograph”> – at body temperature above 39.00C -39.50C; and / or

– in the presence of a muscular or head
pain;

– in shock.

In children under 3 months of age:

– at body temperature above 380C.

In children with diseases of the heart, lungs,
CNS:

– at body temperature above 38. 50C.

Uncontrolled
the use of antipyretics, especially “course”, creates the illusion
well-being and causes a belated appointment of etiotropic drugs.

Selection
antipyretics should be founded,
first of all, on their safety, and not on the strength of the effect. Ideally, an antipyretic drug for children should have
the ability to quickly and effectively reduce the temperature by at least 10C,
available in liquid form and as suppositories, rarely cause side effects
effects at therapeutic doses and have as wide a gap as possible between
therapeutic and toxic dose.

This
only two drugs, paracetamol and ibuprofen, currently meet this parameter.

B
pediatric practice prohibited the use of acetylsalicylic acid and nimesulide.

REFERENCE
FOR PARENTS

*temperature – protective reaction; her
should be reduced only according to the indications given above;

*adequate fluid administration
a feverish child is more important than a decrease in his temperature;

*not important in antipyretics
“strength”, but safety, to improve the patient’s condition, it is enough to reduce
temperature by 1-1.50C;

* Paracetamol and ibuprofen are the most
safe drugs, it is important to adhere to the recommended one-time and daily
their dosages;

*do not prescribe antipyretic “course”
to prevent a rise in temperature, because you can see the progress
bacterial infection;

*do not use for the same reason
antipyretic drugs for longer than 3 days without consulting a doctor;

*with the development of “pale” fever with
spasm of the skin vessels, the introduction of an antipyretic agent should be combined with
vigorously rubbing the baby’s skin
until redness and immediately call a doctor.

First aid procedure for elevated body temperature

Subfebrile temperature (up to 38°C)

1. Undress the child.

2. Wipe with a damp cloth (slightly above room temperature).

3. Do not use antipyretics.

Febrile temperature (over 38°C)

1. Ensure rest, put to bed.

2. Drink plenty of sweet tea, fruit drink.

3. In case of chills, warm the child (warm blanket, hot tea, heating pad to the limbs).

4. Give an antipyretic.

5. At a temperature of 39.5-40°C, the child should not be wrapped.

6. If the temperature is above 40.4°C, give an antipyretic and seek emergency help.

Specialist comments:

The normal temperature is not 36.6°C, as is often believed, but 36.0-37.0°C, in the evening it is slightly higher than in the morning. Body temperature rises with many diseases. The benefits of elevated temperature are a signal of the disease, a way to fight pathogens

(many bacteria and viruses stop multiplying at temperatures above 37-38 ° C), this is a stimulus for the immune response, since a number of protective factors (including interferon ) are released only at temperatures above 38°C.

By lowering the fever, we do not affect the cause of the disease, but we can improve the child’s well-being.
Subfebrile temperature (up to 38°C) may occur with overheating, with a viral or bacterial infection. Taking antipyretics in such cases is not worth it if the child’s well-being does not suffer. At a “febrile” temperature (above 38 ° C), vasoconstriction, increased muscle contractions (hence chills, tremors), and in young children convulsions (the so-called “febrile” convulsions) are noted.
When the temperature rises to 39.5-40.0°C, the skin vessels dilate (the skin turns red), such a child should not be wrapped up. Fever is dangerous with spasm of skin vessels – this is malignant hyperthermia.
Symptoms:

temperature above 40.4°C;

Mottled, marbled skin;

extremities cold to the touch;

It is necessary to call an emergency and be sure to give an antipyretic, preferably in a solution inside.

Children should be given antipyretics at temperatures above 38. 0°C, but if the child does not tolerate high temperatures, worries, cries, or has seizures at elevated temperatures, antipyretics are given at temperatures above 37.5°C. After giving an antipyretic, you can not calm down: be sure to consult a doctor (for recovery, you will need to take other drugs).
The main antipyretic recommended for children is PARACETAMOL (acetaminophen). It does not have a pronounced side effect, has an anti-inflammatory and analgesic effect, relieves discomfort.
Dose of paracetamol: 10-12 mg/kg of body weight per dose, 2-4 times a day (daily dose should not exceed 40 mg/kg of body weight). Oral paracetamol solution acts quickly – after 20-30 minutes. For a small child, it is better to use children’s dosage forms, for younger students they use paracetamol tablets of 0.2 g, for older students – 0.5 g each. CEFECON D candles are specially designed for children, they contain only paracetamol. The action of the candle begins in 30-60 minutes and lasts 5-6 hours.