Fever in Children: Detection, Management, and Prevention

Definition of fever and its causes

Fever is a normal reaction to a certain illness. It is characterized by an increase in body temperature. Fever can occur due to different reasons: viral infections, bacterial infections, heat stroke, tumors, rheumatoid arthritis, recent immunizations, and a side effect of some medications. The hypothalamus is responsible for maintaining the body’s temperature. When a person contracts an illness, the hypothalamus will elevate the temperature of the body to help fight off the microorganisms (inflammation) that are causing the illness. Fever is a sign of inflammation which is triggered by the immune system as a way to eliminate germs.

When to seek medical care

The average, normal temperature is 98.6°F (37°C). A person’s normal temperature may vary, but it is typically close to this value. In children, it is considered a fever if the temperature reaches 100°F (37.8°C) oral temperature.

Fever temperature is not constant; it can go up or down. You have probably observed that your child’s fever temperature tends to increase at night – it’s because night time is the period wherein the body undergoes repair and restoration. The immune system takes advantage of this and strengthens the process of inflammation (in the form of fever) to fight off the infection. Thus, sleep is an important requirement to keep our immune systems healthy.

In general, if the child (two years and older) has a fever of up to 102°F (38.9°C) but still seems comfortable, responsive, and still goes about his/her daily activities (e.g. playing, running, eating), medication and/or emergency care may not be necessary. In these cases, the child’s fever may not be serious and may go away soon.

However, if the fever is still present after 24 hours, it is recommended to visit the doctor. If infants and younger kids (less than two years old) become feverish, you should automatically seek emergency care as soon as possible.

The fever can also be considered as serious or severe if the child (regardless of age) is experiencing the following symptoms:

• Vomiting
• Listlessness
• Poor eye contact
• Headaches
• Stomachaches
• Diarrhea
• Chills, shivering
• Bluish, grey skin/nails
• Stiff neck
• Rashes, bruises
• Extreme irritability, inconsolable and non-stop crying
• Difficulty breathing (even if the nasal passages are clear)
• Febrile seizures

Some children may experience seizures due to the high temperature (above 100.4°F/38°C). These are called febrile seizures; this is different from epilepsy. It lasts for a few minutes and typically does not need treatment.

Children who are six months to five years old may experience febrile seizures. It also occurs more often in boys than in girls. These seizures typically disappear by the time the child is five years old.

It is known that kids are more susceptible to infections (leading to fever) than adults, thus getting them from time to time is quite normal. However, these aforementioned symptoms should not be ignored. You must seek immediate medical attention for your child in such cases; this is important because the underlying cause of the fever might be potentially dangerous (e.g. autoimmune disease, some cancers, brain disorders).

Taking a child’s temperature

You can gauge your child’s body temperature by placing your hand on his/her forehead. This is referred to as tactile temperature. Although this is inaccurate and obviously won’t give you the exact temperature, it will at least give you a clue whether he/she may or may not have a fever.

The best method is to use a digital thermometer. It can be used in an oral, rectal, and axillary position (under the arm). If you prefer to take the oral temperature, temperatures of 100°F (37.8°C) or higher is considered as fever. For the rectal position, 100.4°F (38°C) and higher; and for the axillary position, 98.96°F (37.2°C) or higher are confirmed as fever.

Steps on how to get the axillary temperature:

1. Place the thermometer in the armpit.
2. Place the child’s arm across his/her chest.
3. Allow four to five minutes before getting the measurement.

Steps on how to get the rectal temperature of a baby:

1. Lubricate the thermometer bulb with petroleum jelly.
2. Lay the child on his/her belly.
3. Insert the bulb into the rectum (0.5-1 inch).
4. Wait for three minutes before reading the temperature. Make sure not to push the thermometer deeper than an inch since it might injure the baby.

Fever management at home

As mentioned earlier, you do not need to treat a fever every time; sometimes it just goes away on its own. However, if your child is experiencing discomfort, you can help him/her get relief from the symptoms by doing these steps.

1. You can administer over-the-counter medicine to your child. Tylenol and ibuprofen are the most common and safe medications to relieve fever and pain symptoms.
2. Make them take lots of fluids. Fever causes dehydration and loss of fluids. Always make sure to give them plenty of water, broths, and fruit juices to replenish fluid loss and also give them the nutrients they need (e.g. vitamins and minerals). You can also buy rehydration solutions that are intended for children. In general, water is the best choice since it helps relieve nasal congestion and lubricates the throat.
3. If they want to eat, let them eat their meals as usual. Some kids lose their appetite when they have a fever, but it is still recommended to make them eat a little food, if possible – the body needs fuel to heal itself.
4. Encourage them to sleep and rest. As mentioned before, sleep is required so the body can undergo repair. Sufficient sleep and rest will help your child eliminate the infection (or anything that is causing his/her fever). Keeping your child at home can also reduce the risk of infecting others if his/her fever is caused by a contagious agent.
5. Your child may feel cold if he/she has a fever. However, it would be best to dress them in light clothing. Using a light blanket will help release the heat from the body. Thick blankets and clothes will only elevate their body temperature since heat is unable to escape.

Fever prevention

The children (and the whole family) can prevent fever by reducing exposure to infectious diseases such as the common cold. Teach your kids the following measures:

1. Always wash hands before and after eating, going to the toilet, touching animals, and other activities. Teach the children to wash their hands thoroughly – front and back, and in between the fingers.
2. Bring hand sanitizers while traveling so anyone can still disinfect if hand washing is not possible.
3. Refrain from touching the eyes, mouth, and nose since these are the areas where microorganisms can enter. Also, cover your mouth and nose when you sneeze or cough.

We should always remember that a fever is not an illness per se; it is a condition caused by an illness. It is not necessary to treat it, except for serious cases and the presence of severe signs/symptoms stated earlier.

Fever is a necessary reaction that demonstrates the activity of the immune system. If the fever turned out to be chronic in children, parents should immediately seek emergency care. You should also do the same if you are doubtful or confused about what to do and you want to be on the safe side. Practicing good hygiene is important to avoid contracting contagious illnesses, thereby avoiding fever as well.

Resources

Mayo Clinic

Standford Children’s Org

Cleveland Clinic Org

Kids Health Org