Fever In Children

Introduction

If your child has a fever, it's important to contact their doctor if any of the following signs are present.

• If your child is under 6 months old (regardless of prematurity).
• If you can't manage the fever.
• If you suspect your child might become dehydrated due to vomiting, diarrhea, or not drinking (indicated by sunken eyes, dry diapers, tented skin, unarousable state, etc.).
• If you've already seen your child's doctor, and your child's condition is worsening or new symptoms have appeared.

In some cases, it's wise to take your child to the emergency department for evaluation and treatment. Your child's doctor may meet you there, or emergency doctors will provide care.

You should head to an emergency clinic when any of the following situations arise:

• If you have serious concerns and can't reach your child's doctor.
• If you suspect your child is dehydrated.
• If a seizure occurs.
• If your child develops a purple or red rash.
• If there's a change in consciousness.
• If your child's breathing is shallow, rapid, or difficult.
• If your child is under 2 months old.
• If your child has a persistent headache.
• If your child continues to vomit.
• If your child has complex medical issues or is on chronic prescription medication (prescribed for more than two weeks).

Self-Care at Home

When your child has a fever, there are three primary goals for home care: controlling the temperature, preventing dehydration, and monitoring for severe or life-threatening illnesses.

The first goal is to ensure your child's comfort by monitoring and reducing the fever to below 102°F (38.9°C). You can achieve this by using a thermometer, appropriate medications, and dressing your child in comfortable clothing. A warm water bath can also help but should not exceed 10 minutes per hour.

To measure your child's temperature, you'll need a thermometer. There are various types available, including glass, mercury, digital, and tympanic (used in the ear).

• Tympanic thermometers are generally not recommended for home use, as their accuracy may vary.
• Glass thermometers work well but are breakable and take several minutes to provide a reading.
• Digital thermometers are affordable and provide quick readings.
• For infants and toddlers, it's best to take a rectal temperature.
• To do this, lay the child chest down on your lap, gently spread the buttocks, and insert a lubricated thermometer no more than 1 inch into the rectum.
• For older children who aren't mouth-breathing or haven't consumed hot or cold beverages recently, oral temperatures can be taken.

Acetaminophen and ibuprofen are effective in reducing fever.

• Follow the dosing and frequency instructions on the label.
• Continue giving the medication for at least 24 hours, or the fever is likely to return.
• Do not use aspirin to treat fever in children, particularly with chickenpox, as it may lead to liver failure. The use of ibuprofen for chickenpox has also raised concerns.

Keep your child appropriately dressed when indoors, avoiding overdressing even in winter.

• Overdressing can hinder the body's ability to cool itself through evaporation, radiation, conduction, or convection.
• An ideal approach is to dress your child in a single layer of clothing and cover them with a sheet or light blanket.

You can reduce a fever with a sponge bath in warm water.

• While it's not always necessary, a sponge bath can help lower the fever more quickly.
• Place the child in a few inches of warm water and use a sponge or washcloth to wet their body, arms, and legs.
• The water itself doesn't cool the child; it's the evaporation from the skin that cools them. Avoid covering the child with wet towels, as it hinders evaporation.
• Never use rubbing alcohol in a bath or on the skin to reduce fever; it can be dangerous for children.

The second goal is to prevent dehydration since the body loses extra water through the skin and lungs during a fever.

• Encourage your child to drink clear fluids like non-carbonated beverages without caffeine or juice (but not water, as it lacks essential electrolytes and glucose). You can also consider clear fluids like chicken soup, Pedialyte, or other rehydrating drinks available at your grocery or drug store.
• Avoid giving tea, as it, like any caffeinated product, can lead to increased urination and contribute to dehydration.
• Ensure that your child produces light-colored urine at least every four hours to confirm proper hydration.

The third goal is to watch for signs of severe or life-threatening illness.

• A good strategy is to lower your child's temperature to below 102°F (39.0°C).
• Ensure your child is consuming enough clear fluids (excluding water).
• If your child remains ill-appearing despite meeting these conditions, a more serious problem may be at play.

Follow-up

Typically, the emergency department doctor will recommend that you contact or see your child's doctor or return to the emergency department within the next 24-48 hours.

• Your child's condition can be further observed at home or in a clinical setting.
• Any treatments prescribed in the emergency department should be monitored for effectiveness.
• You'll receive information about any tests and cultures conducted for your child and follow-up instructions if necessary.

Prevention

Preventing illnesses that cause fever revolves around personal and household hygiene. Use the following strategies to minimize the spread of viruses and bacteria:

• Wash your hands with soap and water regularly.
• Cover your mouth and nose when sneezing or coughing.
• Handle food with clean hands and follow food safety practices.
• Ensure your child receives proper immunizations as per the children's immunization schedule.
• Maintain a healthy diet that includes plenty of fruits and vegetables.
• Get an adequate amount of sleep to support your immune system.

Outlook

The prognosis for a child with a fever is generally excellent.

• Most illnesses causing fever resolve within three to seven days.
• In some cases, at-home treatment for bacterial infections may be insufficient, and hospitalization may be necessary.
• Meningitis and bacterial bloodstream infections have a more serious prognosis compared to the more common viral infections.