Introduction
This article focuses on fever in children caused by infections, particularly in the Singapore context. It does not cover fevers resulting from inflammation, autoimmune disorders, or cancer.
A child’s normal body temperature typically ranges from 36.1°C to 37.8°C. Babies and younger children naturally have higher body temperatures compared to adults. This temperature can vary at different times of the day and may be influenced by factors such as crying, overwrapping, or weather changes.
What is fever and what could be the cause?
A child is considered to have a fever when their body temperature rises to 38°C and above, according to the American Academy of Paediatrics. In Singapore, fever is one of the most common reasons for paediatric consultations, particularly during periods when viral infections such as influenza are prevalent.
Fever is a symptom, not a disease. It’s the body’s natural response to an infection or illness. In most cases, fever in children is caused by viral infections, which includes upper respiratory tract infection due to influenza, covid-19 or other common cold viruses, hand foot and mouth disease, gastroenteritis (stomach flu), dengue fever. Less commonly, fever may be due to bacterial infections such as otitis media (ear infection), tonsillitis, sinusitis, pneumonia (lung infection) or urinary tract infection.
Fortunately, most fevers in children are due to viral infections that are minor and usually resolve on their own within 3 to 5 days.
However, some viruses, such as influenza, can cause high fever lasting 5 to 7 days without treatment. On the other hand, bacterial infections are not self-limiting, and the fever will usually persist without appropriate treatment.
How do we know when a child has a fever?
To accurately determine if a child has a fever, a thermometer should be used to measure their body temperature. Several types of thermometers are available, including ear, forehead, oral, axillary (armpit), and rectal thermometers.
Ear thermometers are commonly used due to their convenience and reliability. For babies below 6 months old, the armpit thermometer is more appropriate. In a clinical or hospital setting, rectal temperature measurement might be used for babies below 3 months old to ensure accuracy.
When should parents seek medical attention?
In Singapore, it’s important to understand when to seek medical help for a feverish child, especially given the country’s humid climate, which can exacerbate symptoms.
Babies below 3 months old who have a fever should be taken to the Children’s Emergency immediately. Avoid giving the baby fever medicines without consulting a doctor.
For children above 3 months of age, most fevers are not serious and will go away on their own given time. However, there are some situations where you should bring your child to see a doctor:
Fever above 40°C
Fever lasting for 3 days or more without a clear source of infection
Fever lasting for 5 days or more in a child with flu symptoms
Poor oral intake, fluid intake less than 50% of usual
Persistent vomiting
Reduced urine output
Painful or smelly urine
Lethargy or refusal to play
Drowsiness, confusion, or unusual behaviour
Breathing difficulty
Rash development
Stomach pain
Ear pain
Seizure or fit
Go with your instinct, if you are concerned, unsure, or your child’s symptoms worsen, do not hesitate to bring him or her to see the doctor for an evaluation.
There may also be a benefit to bringing your child to see a doctor early if they exhibit fever with flu symptoms, and the onset is within 48 hours. The child could be tested for influenza, and if positive, can be treated with Tamiflu, an antiviral medication that can shorten the duration of illness by a couple of days.
What can parents or caregivers do at home when your child has a high fever?
For children above 3 months old, medications such as paracetamol and ibuprofen can be given to reduce the fever temporarily, helping to keep your child more comfortable. These medications can also act as painkillers when your child has a sore throat or mouth ulcers. However, it’s important to understand that fever medicines do not kill the viruses or bacteria causing the fever.
Note: Aspirin should not be given to children with fever as it can cause a rare but serious illness called Reye’s syndrome.
Other measures that may help include sponging your child with lukewarm water, dressing your child in thin clothing, cooling the room to a comfortable temperature, and giving your child plenty of fluids to avoid dehydration.
3 common myths about fever in children with an infection
Myth #1: The degree of the fever indicates the severity of infection.
Fact: High fever does not mean an infection is severe. Conversely, a low-grade fever does not mean the condition is mild. We look at other signs to determine how sick the child is, some of which include the child’s appetite and how active the child is.
Myth #2: High fever leads to brain damage.
Fact: Fever itself does not cause brain damage, but high temperatures above 41°C warrant further examination or investigation to ensure there is no underlying severe infection, such as a brain infection.
Myth #3: High fever causes seizures.
Fact: Not all high fevers cause seizures. 2% to 5% of children between the ages of 6 months and 6 years old develop seizures with high fever, known as febrile seizures. Febrile seizures usually self-abort within 5 minutes. However, do bring your child to the Children’s Emergency if it was the first febrile seizure or if the seizure lasts for more than 5 minutes.
How can we help at Oaklife Family Clinic?
At Oaklife Family Clinic, our doctors are well-trained to see paediatric patients of any age. Your child will be assessed and managed accordingly. Investigations such as swab tests, urine tests, or blood tests may be performed when appropriate.
We also administer flu vaccines for babies 6 months old and above to protect your child from influenza viruses. This is particularly important in Singapore, where influenza is common, and vaccinations can help reduce the risk of severe illness.
Related article: Flu (influenza)
Written by Dr Jacquelyn Melody
References:
Disclaimer: this article is written for educational purposes and does not substitute for medical diagnosis and treatment.