by Datuk Dr Zulkifli Ismail
Fever is a common childhood symptom, but there are times when it can be a cause for serious concern.
Fever commonly occurs in children. It is usually due to viral infections – like the types responsible for common conditions, such as cough and cold, gastroenteritis and so on. In some cases, however, fever may be associated with more serious viral or bacterial infections (such as meningitis, septicaemia or abcesses).
Fever may also result from certain non-infection related causes, including malignancies (for example, leukaemia) and inflammatory or immune system disorders (for example, juvenile rheumatoid arthritis or Kawasaki disease).
Under normal circumstances, fever by itself is not harmful or dangerous. Nevertheless, it pays to keep tabs on fever, especially in newborns and infants. This can easily be done with a thermometer at home.
A regular mercury or digital thermometer can be used to take baby’s armpit temperature. Alternatively, you can use an electronic thermometer that is designed to take the temperature inside her ear cavity. These various types of thermometers are available at pharmacies.
Fever In Newborns
Fever in newborns (babies less than one month of age) needs to be taken seriously. So, do not hesitate to take baby to the doctor immediately if she has a fever, especially if it exceeds 38°C. Having said this, there are a couple of points to note.
First, fever in newborns can occur without an infection. Baby can develop a fever simply because of the hot weather, being in an overheated nursery/room, or wearing sweltering clothes.
If the fever persists for more than a couple of hours, even after you have checked that she is not overheated or over-clothed, take her to the doctor.
The second point is that your newborn can have an infection without breaking out in a fever. She may even suffer a drop in temperature as a result of a severe infection.
The absence of fever and/or the drop in temperature can occur because her immune system is still immature and unable to produce substances, called pyrogens, which cause the body’s temperature to rise.
For this reason, it is wise to consult the doctor whenever baby starts behaving abnormally or you suspect she is unwell.
Fever In Older Infants
Fever in older infants (babies over one month of age) tends to stem mostly from viral infections. The resulting fever tends to be low grade and accompanied by common complaints, for example, stuffy noses and cough (respiratory infections), stomach ache or cramps, and diarrhoea.
Bacteria and other organisms can also cause fever in children and these need to be treated with appropriate antibiotics.
Baby will require the doctor’s attention if the temperature exceeds 38°C. Nevertheless, you may not need to rush baby to the clinic if she is alert, active, playful, able to breastfeed, and sleeping well.
The same goes if her temperature comes down quickly with home treatments, and she appears to be feeling well.
When should baby’s fever be treated?
When baby has a fever, the doctor will advise you to give her a lot of fluids to prevent dehydration. Other than that, the doctor will decide whether it’s necessary to treat baby’s fever.
Treatment may not be necessary if baby’s fever is low grade and she is not feeling badly. However, if the fever is high, treating it will probably make baby feel less miserable.
Baby will need to be treated for fever if she has a history of febrile seizures or any neurological complaint (ie that affects the brain and nerves). Her fever must not be allowed to rise too high or too rapidly as it may trigger convulsions in those who are susceptible.
What fever medicines can you give baby at home?
Never give medicines to your newborn without first checking with the doctor. For an older infant, you can give an over-the-counter fever reducer (antipyretic) that contains acetaminophen (paracetamol), ibuprofen or diclofenac. Rectal antipyretics are also available if your child refuses to take the medicines orally.
These medicines are safe and effective for use in babies and children with fever, but do not exceed the recommended doses.
In some children (especially if they are dehydrated or have other medical problems), overdosing can cause serious side effects, especially those affecting the kidneys.
Keep a record of the times that you give the medicines. Do not give aspirin to children as it has been associated with a number of complications.
How else can you bring baby’s fever down?
Sponging the child with tepid water will also help to bring the fever down. You can also give baby a bath in lukewarm or pleasantly cool water. Do not bathe baby in cold or hot water.
Should you 'starve a fever'?
Do not force baby to eat her regular semi-solid or solid foods if she doesn’t feel up to it. Continue to breastfeed and give sips of water regularly. Keep her well hydrated at all times.
Fever is a sign of illness, but it is not the only sign to watch. While some children can appear reasonably fine at a temperature of 38°C or more, others can be deathly ill at a slightly lower temperature, or even without a fever.
As a parent, you need to understand that it’s not so much the exact temperature but rather how baby is acting, that is of concern. Seek medical attention immediately if she :
* Refuses to eat and drink.
* Is very irritable or appears confused.
* Doesn’t easily wake up and is lethargic.
* Has difficulty breathing or is breathing faster than normal.
* Has a rapid or weak pulse.
* Still appears ill even after the fever is brought down.
* Develops a rash anywhere on the body.
* Has severe headache or is vomiting.
* Has other specific complaints (for example, crying during urination, limping, swollen joints, etc).
* Has a fever that persists for more than 24 to 48 hours.
You should also call your doctor if your child has a fever while having another known medical condition (for example, heart disease, cancer, immune system problems, and so on) or is receiving treatment with steroids.
Some of these conditions cause a child to be vulnerable to specific infections, which need to be treated more aggressively and quickly.
More info on FEVER here.