Fever in Children

As a former paediatrician for over a decade, seeing children with fever was a routine part of my working day. As a mum with two children, it feels very different, and can be really scary to be faced with fever and your own children. I’m delighted to have Dr Laura Lenihan, a GP to talk about fever in children. She discusses when to worry, what signs to look out for, and what you can do at home.

Fever is common in young children, who can be expected to get anywhere between 8 and 12 infections every year. Considering the majority of these occur in the autumn / winter months and especially on return to school (September –  April) that can be over two a month!! With these infections comes fever. 

What constitutes a raised temperature?

A normal body temp is 36.5-37.5˙Celsius, while a raised temperature is any reading over 38˙Celsius. Don’t get bogged down by the numbers though, as how your child reacts is more important. If you think your child has a temperature you should check it with a digital thermometer.

Things to look out for that might suggest a fever 

• You’re child may feel hotter than usual when you touch their forehead
• They may feel sweaty or clammy
• Or have flushed cheeks

How should you look after a child with fever?

• Encourage fluids, aiming for normal wet nappies
• Offer regular breastfeeds if you’re breastfeeding
• Only offer them food if they want it (lots of kids don’t want food if they have a temperature and that’s ok – fluids are the most important). If they lose their appetite and any weight, they will put it on again when they are better. 
• If they aren’t taking any food make sure the fluids are more than just water alone, for example juice or something with salts / sugars. You can use oral rehydration therapy if you like, or just water down some juice.
• Look out for signs of dehydration (see below)
• There is no need to undress your child or sponge them down – this doesn’t help to reduce the fever.

It is really important to look out for signs of dehydration:

• dry mouth
• no tears
• sunken eyes
• fewer wet nappies. 

When I see kids with fever, this is usually my number one question to parents, are they taking fluids and making wet nappies? If your child isn’t taking in any fluids (or is vomiting them up) and isn’t making wet nappies (or less than normal) then its time to see your GP. 

Medications for Treating Fever

Medication wise there are 2 available to treat fever in children, paracetamol and ibuprofen. My advice to parents is to alternate between the 2 medicines every 4 hours. Avoid giving ibuprofen and paracetamol at the same time as this can bring their temperature down too quickly. They come in both a liquid form and in suppositories that you can also use. I usually get parents to write down what medications they have given when so that they don’t forget. 

Some tips that I have learned as a mum of 2 along the way. The suppositories are great especially for night time, they tend to get a little bit longer out of them. No need to be squeamish about putting them in. Pop a bit of Vaseline on the top and they should glide right in. Sometimes need to hold the bum cheeks together to make sure they don’t pop back out.

When should you worry and seek medical advice

• Any fever in babies under 3 months needs to be investigated (if you go to GP they will usually send you to the hospital)
• If your baby is 3-6 months and has a temp over 39˙Celsius
• If you think your child is dehydrated
• Suspicious looking red rash for example non blanching rash (does not disappear with pressure)
• If your child has a febrile convulsion
• If your child is crying constantly and you can’t console them
• Your child is lethargic, or very sleepy
• Fever lasts longer than 5 days
• If their cry doesn’t sound like their normal cry
• If you have any concerns – remember parental concern should certainly give a doctor cause for concern (within reason). 

Warning signs for serious illness

These are the signs that the illness might be serious:

• A high temperature with cold hands and feet
• A temperature that doesn’t come down with paracetamol and ibuprofen
• If the child is quiet and listless even when the temp is down *this is to be expected when temperature is up
• Any temperature in babies under 3 months
• A rash that does not disappear with pressure (non-blanching rash) 
• Rapid breathing or panting
• Funny noises when breathing 
• If your child is finding it hard to get their breath and you notice they are sucking in their stomach
• Blue, pale, botchy or grey skin colour
• Hard to wake up your child / drowsy
• Crying constantly / can’t console them
• Green vomit
• Febrile convulsion
• Signs of dehydration

Remember that a baby or toddler is going to be miserable with a high temperature, but usually they will perk up after medication to bring it down. I think if you are aware of these signs and can look after your children at home following advice above then that is a great start.

The National Institute for Clinical Excellence (NICE) also has a traffic light system for identifying risk of serious illness in children.

Coughs and colds in kids (viral upper respiratory tract infections) are really the banes of our lives as parents (ands GPs!). As I said its completely normal for a child to have 8 or more colds a year. Why? Because there are literally hundreds of cold viruses and young children have no immunity to any of them as they have never had them before. Over time they build up immunity and get fewer colds. This is where breastfeeding comes in as well, since you pass antibodies to baby through breast milk.

What else do you need to know?

Most viral URTIs will get better all by themselves in 5-7 days but it can take up to 2 weeks in small children. These colds are cause by viruses which means that antibiotics won’t work against them. Supportive measures (as discussed above) are the mainstay of treatment. 

Is there anything else you can do to help?

Treat the temperature based on the child – if they are miserable bring it down. If the child is perfectly well with a temp of 39 you don’t need to treat if you don’t want too. 

Encourage regular fluids. Small volumes, every few minutes works better than large infrequent volumes as they are more likely to be tolerated, especially with a vomiting bug.

Saline nose drops are great and can help loosen dried snot and relieve a stuffy nose.

Hand washing regularly is the most important way to prevent germs spreading – but how difficult is this with babies and toddlers. Honesty.

Older kids can use over the counter cough and cold remedies, but honestly I think time is your best friend. 

To summarise this is the advice I give my patients:

• Alternate paracetamol and ibuprofen (not at the same time)
• You know your baby, if you’re worried pop and see your GP
• If you are keeping the temp down with mediation and your child is happy (with no signs of serious illness) then its ok to deal with this at home
• Really a lot fo the time (because they tend to be viral) the GP doesn’t have a lot of offer apart from reassurance, so if this is what you need then you know where to go. 

I hope you found that useful. If you like what you read here I have loads more information like this available on my instagram page @drlauragp or check out my website and blog on www.drlauragp.com 

Free Resources

Have you seen my Free Resources designed to give you a general frame work for your nutritional needs. I know how difficult it can be to eat healthily, and also find credible dietary information. There is a guide for nutritional needs during breastfeeding.

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