Winter in Brisbane is relatively mild. However, ‘coughs and colds’ persist and our very young (and very old) need to be watched carefully for signs that a cold may be something worse. We spoke with A/Prof David Coman; Medical Director of Paediatrics at The Wesley Hospital to get more information about fevers in children; what to look out for and when to seek further support and intervention.
The body has an inbuilt mechanism that keeps normal temperature regulated between 36.5 degrees Celsius to 37.5 degrees Celsius. A fever is defined as a temperature >38 degrees Celsius. A fever is the part of the immune systems response to an infection.
Symptoms and Signs of a Fever in Children
The symptoms and signs of fever may differ in children of various ages, and will be influenced by the underlying infectious cause of the fever e.g. a child with a fever caused by pneumonia will also have a cough. In general common features that indicate a fever include;
- Feels hot to touch;
- Looks pale;
- Has a fast heart rate and rapid breathing.
These are common normal physiological responses to a fever in a young infant:
- Irritability and miserable;
- Muscle aches and pains;
- Mottled skin is common during a fever in young infants.
Causes of Fever in Children
Common Infectious Causes
Viral infections: there are over 100 different viruses that can cause illness in children. Our immune system works on “pattern recognition”, so children are frequently exposed to viruses they have never seen before, and have no set immunity against. This is a common reason why the younger siblings in a large family (with older school aged children) are sick with viral illness more often than their older siblings. The most frequent forms of viral infections in children include the common cold, bronchiolitis, tonsillitis, middle ear infections, and the influenza viruses.
Bacterial Infections: middle ear infections, tonsillitis, and pneumonia are the most common bacterial infections in children. More serious childhood bacterial infections include urinary tract infections, septicaemia, and meningitis.
Less common Non-Infectious causes
Autoimmune disorders: these are rare disorder where the immune system “attacks the body”, examples include rheumatoid arthritis.
Malignancies: conditions like leukaemia are a rare cause of persistent fever
Genetic Syndromes: some families have a genetic condition that predisposes to cyclic or periodic fevers and muscle pains (especially in the calves).
When to see a Doctor
A fever can be a sign of a serious infection, if in doubt see your General Practitioner. However; the following are a list of red flags that should prompt a parent to see a Doctor;
- Fever in any infant less than 3 months of age
- Unusually drowsy
- Blue or mottle skin
- a high pitched irritable cry or a weak feeble cry
- vomiting and reduced oral intake
- rashes, and a stiff neck
- febrile convulsions (seizures)
Treatment of Fever in Children
If the cause of the fever is a virus this cannot be treated with antibiotics.
Give the child adequate fluids and bed rest, which are important aspects of helping a child’s immune system fight an infection. Children have a higher metabolic demand for glucose than adults, especially at times of illness, so remember to provide fluids that contain glucose. This is especially important if a child in vomiting. The prevention of low blood sugar is very important in children.
It is reasonable to use paracetamol in situations where the temperature is > 38.5 degrees Celsius, or where the child is miserable or in pain. It is vital that you follow the dosage instruction; giving double disease can create a paracetamol overdose. Lastly always avoid Aspirin in children; there is a significant risk of severe acute liver damage in children taking Aspirin.
Fevers are common in children and are usually a symptom of an underlying infection. Viral infections are the most common cause of fevers in children, but they cannot be treated with antibiotics. If you are concerned about your young infant with a fever you should see your General Practitioner.
A/Prof David Coman MBBS MPhil FRACP
Medical Director of Paediatrics, The Wesley Hospital
Academic Lead for Paediatrics, United Care Health Clinical School
This article was published in Issue 4 of our print magazine, June/July 2014.