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Fever in children

Published by Bupa's health information team, April 2009.

This factsheet is for people who have a child with a fever, or who would like information about it.

As with adults, a child's body temperature will usually be between 36.5°C and 37.5°C. A fever is a body temperature above 37.5°C.

• About fever in children
• Symptoms of fever in children
• Fever in children - the possibility of meningitis
• Causes of fever in children
• Diagnosis of fever in children
• Treatment of fever in children
• Further information
• Questions and answers
• Related topics
• Sources

About fever in children

Children frequently develop fever, usually due to viral infections that clear up without treatment. But a fever can occasionally be a sign of a more serious illness, such as severe bacterial infection (septicaemia), urinary tract infection, pneumonia, and meningitis.

Fever isn't an illness in itself, but is usually caused by a viral or bacterial infection. Fever is thought to be part of the body's natural defence mechanism.

Some illnesses trigger the immune system (the body's defence system) to produce certain chemicals. These chemicals affect the heat-regulating centre in the brain, which is known as the hypothalamus.

Symptoms of fever in children

If your child has a fever, he or she will have a body temperature above 37.5°C on two recordings taken at least two hours apart. As well as having a high temperature, your child may also be:

• clammy
• sweaty
• irritable and crying
• flushed
• tired

Your child may also complain of a headache or aches and pains. A rapidly rising fever may cause chills - periods of shivering.

In some children aged between six months and six years, a sudden increase in body temperature can lead to seizures (also known as fits), which are called febrile convulsions. During a febrile convulsion, part or all of your child's body may shake and twitch, and his or her eyes may roll back in the head. Although simple febrile convulsions can be frightening, they usually last less than 15 minutes and your child should make a full recovery within one hour.

It can be hard for you to know when to call your GP or out-of-hours medical service. Generally, trust your instincts and contact your GP for medical advice if you suspect something serious or if you're in any doubt.

You should contact your GP or go to hospital if your child:

• is unusually sleepy
• has an unusual rash
• has a stiff neck
• has difficulty breathing
• has had a febrile convulsion (particularly important if it lasts longer than five minutes)
• doesn't seem to be getting better after a febrile convulsion
• has more than one convulsion, one after another

Your child might not have any of the above symptoms, but may just not appear to be 'right' or behaving as they usually do.

Call for emergency help if you feel it necessary.

Always seek medical advice if your child develops a fever soon after an operation, or after recently returning from foreign travel.

Fever in children - the possibility of meningitis

Meningitis is inflammation of the membranes that surround and protect the brain and spinal cord. Bacterial meningitis can be life-threatening and needs urgent medical attention. Meningococcal bacteria can cause meningitis and septicaemia (blood poisoning), together known as meningococcal disease. Meningococcal septicaemia can happen with meningitis or on its own. Septicaemia can be more life-threatening than meningitis and can develop within a few hours.

Meningitis and septicaemia are often difficult to recognise, and early symptoms can be similar to flu. Symptoms of meningitis and septicaemia in your baby or toddler will differ slightly to those in your child, although fever is commonly seen in all age groups. Symptoms of meningitis and septicaemia can appear in any order and some may not appear at all.

Symptoms in babies and toddlers

Symptoms of meningitis may include:

• fever
• pale blotchy skin
• refusing food or vomiting
• drowsy, unresponsive, difficult to wake

Symptoms of septicaemia may include:

• fever, cold hands and feet
• pale blotchy skin
• spots or rash that do not fade under pressure and can still be seen when the side of a drinking glass is pressed firmly against the skin (the glass test)
• refusing food or vomiting
• rapid breathing
• drowsy, difficult to wake

Symptoms in children

Symptoms of meningitis may include:

• fever
• severe headache
• vomiting
• dislikes bright lights
• stiff neck, muscle pain
• drowsy, confused, irritable

Symptoms of septicaemia may include:

• fever, cold hands and feet
• severe muscle pain
• vomiting
• spots or rash that do not fade under pressure and can still be seen when the side of a drinking glass is pressed firmly against the skin (the glass test)
• stomach cramps and diarrhoea
• drowsy, confused, irritable

Trust your instincts. If you suspect meningitis or septicaemia, seek medical help immediately.

Causes of fever in children

Your child may develop fever as a symptom of a wide variety of illnesses as well as from infections. For example, certain blood disorders and inflammatory disorders (eg juvenile arthritis) may cause fever. Fever can also be caused by sunstroke and some childhood immunisations. However, most episodes of fever are caused by viral infections.

Diagnosis of fever in children

You can take a satisfactory temperature reading from your child by using a digital display thermometer. Place it in your child's armpit, directly against the skin and hold his or her arm gently against the chest. Digital thermometers usually give a reading within a few seconds. This will be 0.5°C lower than it would be if the temperature was measured using a mercury thermometer in his or her mouth (oral). Take this into consideration when measuring your child's fever. Remember to clean your thermometer after use.

A digital aural thermometer can be used to measure the temperature in your child's ear. A clean cover is placed over the thermometer and the tip is placed in your child's ear. Pressing the button activates the thermometer and gives an immediate reading. These are now used routinely in hospitals and by GPs and give very accurate readings, but they are expensive to buy.

It's best to measure your child's temperature before giving any fever-reducing medicines (see Treatment of fever in children).

If you visit your GP, he or she will ask you about your child's symptoms and examine him or her. Your GP may also ask you about your child's medical history. It may help if you keep a written record of your child's temperature and other symptoms so that you can give clear information to your GP.

Treatment of fever in children

In most cases, your child's fever will be due to a viral infection and will get better within a day. Monitor your child's fever by regularly checking his or her temperature.

Self-help

Many parents and carers spend a lot of time trying to bring fevers down in their children, the theory being that this will decrease the chance of febrile convulsions. But some experts suggest that a fever helps the child to get better, and that it should be left to run its course.

Sponging with lukewarm water may reduce fever but can also cause shivering and goose bumps - uncomfortable for anyone with a feverish illness - so only sponge your child's forehead, not his or her whole body.

Sweating and shivering can cause dehydration so encourage your child to drink plenty of fluids. As a guide, your child's urine should be pale yellow - if it's darker your child may need more fluids. Your child will also need to drink more if they have diarrhoea or vomiting.

Medicines

Recent guidelines recommend that either paracetamol or ibuprofen can be used to reduce temperature in children with fever. However, children's paracetamol (eg Calpol) and ibuprofen (eg Nurofen for children) shouldn't be given together. Only consider using the alternative medicine if your child doesn't respond to the first medicine tried. Medicines that are suitable for children can be bought from a pharmacy without a prescription. They must be dispensed by a pharmacist.

Never give aspirin to a child under 16 because it can cause a rare but serious illness called Reye's syndrome.

If your child has a bacterial infection, your GP may prescribe a course of antibiotics.

Further information

• Meningitis Trust
  0800 028 1828
  www.meningitis-trust.org
• Meningitis Research Foundation
  0808 800 3344
  www.meningitis.org.uk

Related topics

• Childhood immunisation
• Childhood seizures
• Common cold
• Flu
• Meningitis and septicaemia in children
• Paracetamol

Sources

• Feverish illness in children. Assessment and initial management in children younger than 5 years. National Institute for Health and Clinical Excellence (NICE), 2007, Clinical Guideline 47. www.nice.org.uk
• Febrile convulsion. Background information. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 28 April 2008
• Febrile seizures. BMJ Clinical Evidence. www.clinicalevidence.com, accessed 18 June 2008
• Sadleir LG, Scheffer IE. Febrile seizures. BMJ 2007; 334:307-311. www.bmj.com
• What is meningitis? The Meningitis Trust. www.meningitis-trust.org, accessed 18 June 2008
• Meremikwu M, Oyo-Ita A. Drugs and other methods for managing fever in children. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No: CD002241. www.cochrane.org
• Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No: CD004264. www.cochrane.org
• Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:228-229

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009