Fever in Children: Doctors' Insights

Fever in children is the primary reason for visits to pediatricians. In this article, I will address the causes of elevated child temperature, how to handle it correctly, when to visit a doctor and discuss blood tests and antibiotics.

Dr.Hussam
Dr. Hossam Al Tatari
Published on:Dec 17th 2023 |Updated on:Feb 10th 2024
الحرارة عند الأطفال

Causes of fever in children

  • Sun exposure and high outdoor temperatures, especially in the summer.
  • Bacterial infections.
  • Viral infections are the most common infections in children.
  • Rheumatic diseases or tumors.

Is fever dangerous?

There is an inherent fear in our communities regarding fever, perhaps passed down from grandmothers who used to be alarmed when a child had a fever. Their fear may have been justified because, in the past, fever could lead to the death of children or cause deafness and paralysis. However, this happened due to diseases like meningitis, tuberculosis, and measles, which have either disappeared or are on the verge of extinction thanks to widespread vaccinations over the past decades.

What should a mom do when a child has a fever?

There is no need for fear and panic when a child has a fever. Stay calm, moms, and follow these steps:

  • If your child is under three months old and, after measuring the baby's temperature correctly using a rectal thermometer, it is 38 degrees Celsius or higher, immediately head to the doctor's office or the emergency room.
  • For children older than three months, it is essential to measure the temperature every four hours and record it. Then, give the child a fever reducer at the appropriate dosage for their age and weight if their temperature is 39 degrees Celsius or higher. Medications that reduce fever can be given in cases of previous febrile convulsions.
  • If the child's temperature is between 37 and 39 degrees Celsius, there is no need for a fever reducer. However, you can give a pain reliever if the child is in pain.

Best ways to measure a child's temperature

  • The most accurate way to measure temperature in children is using a rectal thermometer.
  • Temperature can also be measured under the armpit, with an increase of one degree Celsius on the thermometer reading. For example, if the thermometer reads 37, the child's temperature is 38 degrees Celsius.
  • For older children, temperature can be measured orally by placing the thermometer under the tongue, with an increase of half a degree Celsius on the thermometer reading. For instance, if the thermometer reads 38, the child's temperature is 38.5 degrees Celsius.
  • Ear thermometers, although widely used, are not accurate, especially with infants.

Fever-Reducing Medications

  • Medications containing paracetamol as an active ingredient are available under various brand names in pharmacies.
  • Medications containing ibuprofen.

I recommend alternating between these two medications. For instance, when measuring a child's temperature for the first time, you can administer paracetamol. If the temperature rises again after a few hours, you can then give ibuprofen, and so on. These medications can be syrup that you can mix with a thick juice like mango juice for the child to accept. Alternatively, as previously believed, you can mix it with a spoonful of ice cream that does not affect the child's temperature or throat inflammation.

I want to emphasize the importance of not giving children suppositories or medications containing diclofenac, commercially known by several names, including Voltaren. These are rheumatic medications and have side effects on the child's kidneys.

Appropriate Dosage

  • The appropriate dosage depends on the child's weight and is calculated as follows:
  • The ibuprofen dosage is half the child's weight. For example, if the child weighs ten kilograms, the appropriate dosage is five milliliters of ibuprofen syrup.
  • For paracetamol medications, it depends on the concentration of the drug. If the concentration is between 100 and 120, the dosage is the same as ibuprofen. For more concentrated medications with a concentration of 240 or 250, the dosage is one-fourth of a milliliter per kilogram of the child's weight. For a ten-kilogram child, the appropriate dosage is 2.5 milliliters of the medication.

When should you measure temperature after administering the medication?

Mothers often rush to measure the child's temperature an hour or half an hour after giving the medicine, which is unnecessary and can add confusion. Temperature should only be measured every four hours, and medication should not be given before four hours have passed since the previous dose.

When to see the doctor

Visit a doctor in the following situations:

  • If the child is under three months old.
  • If the child has any immune system problems.
  • When the child complains of pain in the ear, throat, or any other area.
  • If fever is accompanied by frequent vomiting to prevent dehydration.
  • If the child's activity and alertness are lower than usual, immediately take the child to the doctor to check for any problems in the nervous system.
  • If the temperature exceeds 40 degrees Celsius.
  • When the temperature is 39 degrees Celsius and persists for more than three days.
  • If the temperature is 38 degrees Celsius and persists for more than seven days without any other symptoms during this period.
  • When a rash accompanies the elevated temperature.

What will the doctor do?

Common practices carried out by some doctors include conducting unnecessary blood tests. These tests do not reveal the presence of bacteria to determine if the doctor should prescribe antibiotics. Blood tests are necessary when treating fever in children in the following cases only:

  • If the child is under three months old, for accurate diagnosis and prescription of appropriate treatment, avoid potential complications.
  • When the child's temperature exceeds 39 degrees Celsius, the child is under three years old. Afterward, the doctor conducts a thorough clinical examination without finding a clear cause for the fever. Laboratory tests may reveal the beginnings of bacterial infection, prompting the doctor to prescribe antibiotics.
  • If the fever persists for over 38.5 degrees Celsius for a week without any other symptoms, the doctor has not discovered any cause for this elevation during the detailed clinical examination. Lab tests may reveal conditions such as rheumatism, tumors, or some rare bacteria.
  • Pediatricians may request blood tests to confirm a specific diagnosis, such as immune-related diseases like Kawasaki or other conditions.
  • When a child is diagnosed with severe inflammation requiring prolonged treatment, such as periorbital cellulitis, kidney inflammation, or heart inflammation, this helps monitor the child's response to treatment and ensures that antibiotics do not adversely affect the child's health.

When Is an Antibiotic necessary?

Unfortunately, there is an excessive prescription of antibiotics, negatively impacting the child's health. Antibiotics, especially when unnecessary, can kill the good gut bacteria, severely affecting the child's immunity and overall health.

Antibiotics are prescribed for a child when the pediatrician is sure that there is a bacterial infection through a thorough and detailed clinical examination and sometimes through laboratory testing. It is crucial to adhere to the prescribed dosage and duration determined by the doctor and avoid giving antibiotics to the child without a reliable doctor's prescription.

 

Check out What is newborn jaundice? New moms guide

 

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Dr.Hussam
Dr. Hossam Al Tatari Consultant in pediatrics

Dr. Hossam is a pediatrician, certified by the American Board of Pediatrics in General Pediatrics and Pediatric Infectious Diseases. Dr. Al-Tatari then joined the University of Western Ontario, Canada as an adjunct professor until the summer of 2009 when he moved to Tawam Hospital in the UAE as the chief of pediatric infectious diseases. Dr. Al-Tatari has now moved to become the director of general pediatrics and pediatric infectious diseases at the Heart Medical Center in Al-Ain. UAE. He meanwhile continues to work for the University of Western Ontario as a part-time faculty member. Dr. Al-Tatari has repeatedly received awards as the pediatrician and the teacher of the year in the USA, Canada, and UAE. Dr. Al-Tatari has more than 100 abstracts and articles in the field of pediatric infectious diseases. Despite his busy schedule, Dr. Al Tatari is passionate about educating parents and providing them with sound medical information and advice, to help them best care for their children’s health. He shares his knowledge through his designated YouTube channel, and his social media accounts, as well as contributing to various educational platforms.

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