This is the first in a series of educational blogs aimed at parents. I will be writing from the point of view of a parent with 2 young kids. When my kids have a fever, I panic too! OK, I will concede that I panic less then my wife (who is not a Doctor). The only reason is because I know a bit more than her. Knowledge empowers. So let me just share a few pointers which I hope will empower you to handle your child's fever.
What temperature constitutes a Fever?
Fever means that the body temperature has risen by 0.5 degrees above normal. Normal body temperature is dependent on which part of the body you take it from. So in a nutshell:
- If you stick the thermometer in the mouth, anything above 37.5 degrees is a fever
- If you stick it in the armpit, anything above 37.2 degrees is a fever (armpit less warm)
- If you have a ear thermometer, anything above 38 degrees is a fever
What you should know about Fevers.
You should understand that a fever is the body's normal response to infections. The body's defence system (immune system) works better in a warmer environment, so the brain actually raises the internal thermostat. (Like how you adjust the aircon temperature) Studies have shown that a child 's length of illness is shorter when the fever is not too aggressively controlled. If you aggressively control fever, the illness actually lasts longer!
So why do we control the fever?
A few things can go wrong with high fevers especially in children.
- Brain damage can occur with prolonged high fevers above 41.5 degrees. But of course we are KiaSu (very careful), so in general we don't like the fever to go beyond 39 degrees for too long.
- In children between 6 months and 6 years, a fever can sometimes cause fits.
From a parent's point of view, the real question is: When do I need to bring my child to see the doctor? Here are a few pointers:
- If the child looks sick, ie she is not as active, lethargic, vomiting, in pain, anything that makes you uncomfortable, you should go see the doctor.
- If the child is running around, laughing and playing and the fever is less then 38.5 degrees, then the situation is not immediately urgent. But you should be on the lookout for any changes that might occur. Things like rashes, mouth ulcers, wheezing, vomiting are some of the signals that you should be bringing your child to the doctor.
- Give panadol syrup. Everyone knows about panadol syrup! But please know this
- Panadol syrup only works for fever and pain. It does not stop a runny nose.
- The dose of Panadol syrup is dependent on a child's weight. Use as directed on the bottle. When you come to the clinic, we will weigh the child and customise the dosage and frequency to your child's needs.
- Give the child plenty of fluids.
- Sponge the child. Those forehead gel pads really give you false security. By the time I see the children, they are already warm and do very little. This is what you should do. Take a small bucket, fill it with room temperature water. Take a towel, wet it, squeeze dry so that it doesn't drip but not too dry, and wipe the child's head, neck and body area. Keep doing it for 15-20 mins making sure that the child does not start shivering.
- For older children, put them under the shower with tepid water for 15 mins.
- Generally, we prefer to use Panadol syrup because it is safer. Brufen is the other medication that is sometimes used. But if Panadol syrup and sponging does not bring down the fever, it may be wise to seek medical help.
- Teething does not cause fevers
- I think most parents know by now that wrapping with a blanket is not a wise thing to do for a child with fever as it would raise the body temperature. (I was wrapped up myself when I was a kid. Lucky it did not result in brain damage.... or maybe it did!)
- A fever that lasts for around 5 days and stops with the appearance of rash may be due to Dengue fever. So you MUST bring the child to the doctor.
- Some viral fever can last a long time, up to 14 days. No amount of antibiotics will help.
- A blood test may need to be done in prolonged fevers
- In general, it is better to monitor the child over a few days to look out for definitive signs of particular diseases rather then to start Antibiotics on day 1 of the fever. For example, if the child is going to have Chickenpox or Hand, Foot and Mouth disease and you bring the child to the Doctor on the first day, you may miss the rash and the mouth ulcers that will appear in the next 24-48 hours. So giving antibiotics would be a waste.
- I would advise any parent to bring the child to the doctor if the fever lasts more than 3 days.
- A prolonged and recurring fever may be an indication of chronic diseases like juvenile rheumatoid arthritis.
- If you have just been to a Malaria infested country, please let the Doctor know because Malaria can be deadly
- A fever accompanied by a sorethroat in a child between 4 to 14 years of age should be seen by a doctor sooner. Antibiotics may need to be given to prevent long term complications such as kidney failure. Children in this age group are susceptible to certain bacterial infections which may cause terrible complications.
This is by no means exhaustive. I try to keep everything concise and bring up only the most important points. If you have other questions or points to bring up, please write in the the comments. Remember it is always best to bring your child to the doctor if you feel uncomfortable.