Sunday, November 12, 2006

Help Doctor, my child is having a FEVER!

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:

  1. If you stick the thermometer in the mouth, anything above 37.5 degrees is a fever
  2. If you stick it in the armpit, anything above 37.2 degrees is a fever (armpit less warm)
  3. If you have a ear thermometer, anything above 38 degrees is a fever
BUT, don't just depend on the thermometer! Temperatures rise and fall. So if your child looks sick to you and is behaving abnormally, chances are that he is sick! The temperature is just another indicator of illness.

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.
  1. 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.
  2. In children between 6 months and 6 years, a fever can sometimes cause fits.
What do I do?

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:
  1. 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.
  2. 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.
Here is what you can do in the meantime:

  1. 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.
  2. Give the child plenty of fluids.
  3. 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.
  4. For older children, put them under the shower with tepid water for 15 mins.
  5. 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.
Other Important Points
  1. Teething does not cause fevers
  2. 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!)
  3. 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.
  4. Some viral fever can last a long time, up to 14 days. No amount of antibiotics will help.
  5. A blood test may need to be done in prolonged fevers
  6. 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.
  7. I would advise any parent to bring the child to the doctor if the fever lasts more than 3 days.
  8. A prolonged and recurring fever may be an indication of chronic diseases like juvenile rheumatoid arthritis.
  9. If you have just been to a Malaria infested country, please let the Doctor know because Malaria can be deadly
  10. 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.


Anonymous said...

Hi, great blog here, just as good as your makan blog. Just wanna raise a question here.

Often when a person is having a fever, he will feel very cold or sensitive to coldness. Therefore they tend to wrap themselves in a blanket which is not advisable. So whats the solution to this situation? Should we just shiver our way through or is there a way to ease the chill?

Dr Leslie said...

You can take panadol and use a light shawl to cover yourself to feel more comfortable. The thing is not to wrap yourself in a thick blanket in an attempt to make yourself sweat. If you are having chills it is advisable to visit the doctor

Anonymous said...

Does this applied to fever as a result of vaccine?

Dr Leslie said...

It is hard to know if the fever is due to the vaccine or other causes, so you should get it checked by your doctor

Mummy N said...

got here through your makan blog. won't have guessed that you are a doc! nice pics and great reviews!

got a q:
are suppositories safe? been told that they have side effects and can affect toddler's liver or is it kidneys?

i dont want to be a sponge and just believe what i am being told. so please enlighten me.


Dr Leslie said...

All medications have side effects. When you say suppositories, you mean Voltaren suppositories which are another type of fever medication. They are less safe than Panadol. We have to weigh the risk to the benefits. If the fever is very high then the risk of brain damage outweighs the risk of the side effects from using the suppositories.

Anonymous said...


Glad to find a great blog!

I have a question.. my child (4 yrs old) is always having fever like once a month. Any idea what could be the cause of frequent fever?


Dr Leslie said...

Difficult to tell you without a full history and examination.

However, frequent fevers without a obvious cause eg cough, cold, diarrhoea should be investigated.

Anonymous said...


I am just wondering that taking a shower or a bath when having fever is good or bad I read a book it said that it is good bu my parents said no
just woderoing good or not taking shower o rnot

Dr Leslie said...

If the child is having a high fever, tepid sponging or showering will help to bring down the fever. This is a widely accepted practice in modern medicine.

Anonymous said...

Hi hi

My daughter is 3.8 yrs old, she is having fever since Friday. I gave her panadol 250mg (pink) 4ml/6 hourly and Nurofen (ibuprofen) 5ml/8hrsly but her fever still varies between 38-39 degrees (ear temperature). I got to sponge her to bring down the temperature. This morning (Sunday) she temperature then dropped below 37 degrees.

Usually, her temperature will fall below 38 degrees once I gave her the panadol or if not I will need to give her the nurofen to bring down the fever. What should I do next time if she is running a fever and the fever don’t drop after the medication?

Thank you and have a nice day 

Dr Leslie said...

If you are unable to bring the fever down after all that, you should bring her to the doctor to determine what is the cause of the fever. The doctor might do a blood test to determine what should be done next.

Anonymous said...


My 16month old boy is not having a fever, but he seems to be cold and clammy all the time. Could this be due to the flu medicine he has been given? He has totally lost his appetite and has to be forced fed using syring every 3 hourly. Otherwise, he will just go without anyting for hours. Docs have asked us not to worry as he is still very active, but he has less then 1 wet diaper a day - should I wait or switch doc or ask for any type of specific test? This has gone on for a week.

Dr Leslie said...

I think you should seek a second opinion for your child. Having less than 1 wet diaper a day means he is dehydrated.

cui_er said...

Hi, thanks for all the useful information. Can u please give me some idea here too? My son is 4+ and has been running a fever the past 2 days. But only at night. About bedtime he starts feeling warm and I'll give him a dose of panadol. About 3am, another dose cos the temperature is still up. Then when he wakes up abt 6.30, no fever. When I pick him up from school abt 5.30pm, no fever too. Then at night this happens again. Do i need to bring him to see a doctor? Thanks :)

Dr Leslie said...

It is alway advisable to seek medical advise when the child has a fever because it usually indicates that there is an infection somewhere. There are many causes of the infection, some are more malicious than others and if antibiotics are not given early, severe consequences can occur. On the other hand, it may just be another infection that will go away by itself. The important thing is to determine the cause of the fever and the best person to do it is your doctor.

elenalau said...


I vaccinated my son with Prevnar on 27th Feb 2009. A couple of days later (3rd Mar), he came down with a fever that lasted for three days (No fever since 6th March). However, a day later, he came down with a runny nose and cough. Why is it that these symtoms only come after the fevr subsides?

Also, juz this morning (26th March), he came down with a fever again? I wonder what is wrong with him and it does worries me. He seems normal and active as per normal.

Two fevers... one after another... Really tire me out.

Thanks and hope to hear from u soon (^o^)

Anonymous said...


Is there any basis for old folks to advise against giving rice or porridge when baby is having a fever?

Dr Leslie said...

Well, when a child is sick, you really want to make sure he is well hydrated. Often their appetite is poor because the body needs the energy to fight the illness rather then digest the food. So it is good not to give the child too much to eat when he is sick. Perhaps this forms the basis of the age old belief.

Anonymous said...

Hi, talking about fever. Febrile Seizure is not uncommon, however, it seems like Spore is under-researched in this area and could not provide much advises to parent like me.

I have a ~18mths girl and she started her 1st episode of febrile fits in Aug 09, 2nd & 3rd episode in Oct 09 and 4th episode in Dec 09.

All episodes ranging from 1-3mins and i admitted her to hospital and urine/blood/swap test all proven to be negative.

So what's wrong with her? Why is she getting fever every 2mths. She did not attend school and the last episode happened even though I did not bring her out at all for tt 2months.

Doc/PD all say it's ok if it is short etc. But who can tell me the real consequences? EEG is not conclusive, too young for MRI, so what should a parent with such experience do?

PD suggested put her on medication, Epilim Syrup. Contemplating if I should start her on this as there might be potential side-effect.

Anonymous said...

Hello there,
thank you for this blog. I searched and searched but found no answer to something horrible I did to my daughter 3 yr 4 mth.
She had fever 39 to 40 two weeks ago. At the clinic the nurse gave her brufen syrup 5 ml. Two hrs later at home I opened the bag of medicines and gave one by one until I came to paracetamol and voltaren suppository 25mg. Seeing her temp was still 39, I inserted three quarters of the voltaren supppository as advised.

Alas! I had forgotten she was given brufen just 2 hrs ago!

Although my girl behaved normal, I will worry forever if I have hurt her badly internally.

Any comments from you will be sincerely appreciated. My girl is 15.8 kg and a mild asthmatic.

Thank you in advance

Unknown said...

Hi there,
I came to read to ur blog when i was searching about febrile convulsions. i read that some had mentioned about it and didnt see any reply to it....My daughter also had febrile seizure 3 times in last 9 months ..she is now 2 year and 2 months old.....It started when she is 18 months old......One doctor told to give her Empaped suppository when she have a fever......But after we giving her empaped lasttime she had an attack ... so doctor told to take nurofen aswell as empaped ....And another doctor is saying voltaren is better than empaped..... Im bit confused rt now......IS it ok to take empaped and voltaren at same time ..........or voltaren and nurofen......and is voltaren okay for children....hope to have a reply soon

Anonymous said...

Hello, Dr Tay,
My daughter is 5years old. About 3 weeks ago, she had high fever and was diagnosed with mycoplasma and pneumonia. She recovered after 4 days but her phelgmy cough persisted on even till now. In between, she will have fever for a few days and then recovered for one or two days and then the fever will come back again. My concern is why her fever goes up and down and keep coming back after she supposedly recovered. The doctor listened to her lungs and they sound clear. What should I be concerned about and what should I do because I am at a lost. This is the first time her fever goes up and down for 3 weeks continuously.

Anonymous said...

My daughter is 18months and having fever on n off for two days since her last jab. She is difficult in taking oral medication. Mixed in food or milk also refuses to rake or vomits out if force feed. Eventually, fever reached 39.i had no choice n inserted the voltaren suppository in her anal. Monitoring now. But I inserted one whole 12.5 bullet. Is that too much?