Help! My child frequently has a fever!

Small children seem to be ill all the time – either with fever or cold. Sometimes it feels like it's an endless cycle if you have a few small children who keep passing a bug between them.

Paediatrician Dr Foo Wang Leng says that in a way, smaller children, under three months, are more prone to getting fevers as their immune system is not fully developed. So, they are more inclined to get infections.

“If they are in a nursery and mixing with other children, they can easily pick up viruses and bacteria from those around them.

“Usually as they grow older and by the time they reach school age, their immune system would be more developed so the incidence of fever will be much less,” she says.
 

Dr Foo explains that a fever is just a sign that something is going on and the most common cause of fever in a child is infection due to either viruses or bacteria. The majority are actually viruses, she says.

“The range of temperature in a normal person is from 36.5-37.5° Celsius. Anything more than 38° Celsius is a significant fever.

“Between 37.5° and 38° is a low-grade fever and doesn't really need anything. Sometimes it could just be the environment,” she explains.

Small children

“Basically, when a child has a fever, there are a few things that are important – the age of the child, the other symptoms and how it affects the child.

“If the child is under two months old, you should be more worried. The parents should bring the child to see a doctor as soon as possible because the risk of a serious bacterial infection is higher.

“Plus, under two months, the child can hardly communicate and it's harder to tell if the child is well or not.

“If a child younger than three months has a low-grade fever you can just watch and see.

“Sometimes bundling them in thick clothings or the warm environment can contribute to their body temperature being slightly elevated.

“What you can do is unwrap them for a while and take the temperature again after about an hour.

“If it goes back to normal and the child is otherwise well, then there's nothing to worry about,” says Dr Foo.

She explains that if the temperature goes up and you find there's something else not right with the child, then obviously you need to seek medical attention.

Bigger children

For children who are above two years old, usually they are able to communicate. So, when they have a fever, there is no need to panic.

Look out for any other signs that may tell you that they are more unwell than usual. Basically, you want to know what is the cause of the fever. They may have other symptoms like a runny nose that tell you that they have a cold. Or they may have a bit of a cough, diarrhoea, vomiting, rashes – these may point to where the infection is coming from and the cause of the fever.

She warns that the higher a fever is does not mean the illness is more severe.

“How high the temperature is does not tell you whether the illness or infection is more severe.

“What is important is how the child behaves. If the child is otherwise active, especially when the fever comes down, and is interested in the environment, not too lethargic, then there's nothing to be too concerned about. Just keep the child comfortable.

“If the fever is above 38.5° Celsius, it is advisable to give them some antibiotics just to keep them comfortable so that they are more likely to drink and take some food. Another thing we worry about when they have a high temperature is dehydration.

“So you need to keep them well hydrated and make sure they drink enough fluids. If they can't take too much at a time, give them small amounts but more frequently.

“If their appetite is not good, don't force them to eat. However, it is important to keep them well hydrated and keep them comfortable.

“If any fever persists longer than three days, I would advise to seek medical attention,” says Dr Foo.

General rule

As for children between three months and two years, Dr Foo says the approach is the same.

“There are no clear-cut rules of what you need to do. What is important is how the child feels. Normally, a parent would be able to tell. If they feel that their child has any symptom at all that is worrying such as persistent vomiting, convulsions, if they appear very, very lethargic, or they're just not interested in their environment, they're excessively sleepy, drowsy – those are all the danger signs that should signal the need to get medical attention.

“Normally, when the fever is very high, the child will be very cranky. It doesn't mean that they have a serious infection. If you find that your child is cranky because of the high fever, to keep them comfortable it is advisable to bring the temperature down by giving them paracetamol.

“Parents can just observe how they behave when the temperature comes down. Normally, parents tell us that when the temperature goes up the child is very cranky and lethargic but once it goes down, the child will be playing.

“That is quite reassuring.”

She explains that fevers normally appear in the evening and subside by morning.

Dr Foo does not recommend parents bundling the child up to make them sweat it out; neither does she advocate cooling down the child with cold water or ice.

“Just make sure that the child is comfortable and dressed in light clothing. Don't overwrap them. Keep them in an environment that is not too hot nor too cold.

“For a normal fever, even if you don't treat it, it will usually not go to the extent of causing brain damage because our body has a built-in thermostat that will keep the temperature within a certain level, unless if you overwrap them.

“In that case, sometimes, the temperature can go up higher. So, wrapping them up is not a good idea at all.

“You should actually keep them comfortable. Make sure that the room temperature is just comfortable. We don't want them to get cold and start shivering either.

“Dumping them in cold water or iced water is also a no-no. If you do that, they will start shivering because the blood vessels will constrict and this can actually cause the temperature to rise.”

Sponging them down with tepid water is okay to keep them comfortable but don't overdo it.

What is the fear with fevers?

Dr Foo explained that a fever could be caused by something more serious.

For example, it could be dengue fever which shows no symptoms in the first few days.

“A(H1N1) usually will be accompanied by other symptoms. It's quite clear from the start. Usually they will have cough, body aches and influenza like symptoms. Usually the cough and cold will start pretty soon after the fever.

“Hand foot mouth disease is pretty obvious as well. You'll be able to see lip ulcers, rashes – so do check for all of that,” explains Dr Foo.

Diet during fever

According to Dr Foo, a child's appetite is usually not as good when they have a fever. The main thing is not to force your child to eat if they are not interested but to keep them well hydrated.

It's not necessary to dilute the milk unless the child has diarrhoea. If there is no diarrhoea, the child can drink milk as per regular feeds. It should not be an issue.

However, Dr Foo points out that if the child's appetite is good, then you should offer them a well balanced and nourishing diet, nothing too oily nor difficult to digest. Try giving them some bland food like porridge and soup or even a light diet but go according to your child's tolerance.

The do's and don'ts

For small children:

- Small children, under two or three months, need to receive medical treatment immediately.

- Don't try to self-medicate.

For bigger children:

- Keep the child comfortable.

- Don't be too concerned with bringing the temperature down especially if the fever is not causing the child any discomfort and if it's under 38.5° Celsius. A fever is just the body's defence mechanism to fight the infection.

- However, if the fever is high (more than 39° Celsius) or the child is very uncomfortable or if the child has a history of febrile convulsions, then you should try to bring the fever down. Some children do have convulsions when the fever rises rapidly. In such situations, the parent will have to be more careful about controlling their body temperature.

- Don't overwrap them and make them sweat it out.

- Don't throw ice cold water on them.

- Don't use alcohol in the bath to cool the child down.

- Only self-medicate if you've been advised to do so by a medical professional.

- Don't panic. For bigger children, it's important to observe for any worrying symptoms for two to three days. The worrying symptoms are convulsions, persistent vomiting, difficulty in breathing, severe headaches.

- If the fever persists longer than three days, bring the child to see a medical professional.

Conclusion

The only way to prevent from a fever is via prevention of infection which is not that easy. However, Dr Foo says the best thing to do is to practise good hygiene because most of these infections are picked up hand to mouth or are airborne.

“Instil good hygiene habits like washing of hands after going to the toilet and before eating. Do not touch your face, mouth or eyes unnecessarily before washing your hands. If you have a cold or cough, adopt a good habit of covering your mouth so that you don't spread the germs,” she advises.

This also explains why preschoolers fall ill so often as they are just starting to learn good hygiene at that age.

Is there always a cause for the fever? Sometimes, parents just can't find the cause and pretty soon the fever goes away.

“Usually there is a cause for the fever if you look for it. The most common are viral infection or bacterial infection. Sometimes the cause may not be very apparent at the start of the fever – they may not have a runny nose or a cough. If there is no focus and the fever is persistent then we tend to get more worried. That's when we usually advise that the child gets some investigation done like blood and urine tests to see exactly where the fever is coming from. Other more uncommon causes of fever which are not due to infection are things like malignancy and connective tissue diseases like SLE (Systemic lupus erythematosus) which can also rarely cause fevers. But that's not very common in childhood. Usually those fevers tend to be more prolonged,” says Dr Foo.

She reassures parents that children do tend to fall ill less frequently as they reach mid-primary age as their immune system would be stronger then.