Fever in children Q&As
Published by Bupa's health information team, April 2009.
Answers to questions about fever in children
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- How can I tell if my child is dehydrated?
- Is it true that children may be at risk of fever and fits after having a vaccination?
- What should I do if my child has a febrile seizure?
How can I tell if my child is dehydrated?
If your child is dehydrated, he or she may have a dry mouth and skin, sunken eyes, no tears, and, in a baby, a sunken fontanelle (the soft spot on the top of his or her head - you may be able to feel this gently with your fingertip). Lethargy (extreme tiredness), clammy hands and feet, unusual breathing patterns, and a weak pulse may also indicate dehydration in your child, as would a decrease in urine output (fewer wet nappies than usual).
Encourage your child to regularly drink more fluids if he or she has a fever. If your child is being breastfed, then it's fine to offer your breast milk. Contact your GP if you suspect that your child is showing signs of dehydration.
Explanation
Water is essential to make your body work and most of the chemical reactions that happen in your cells require it. You become dehydrated when there isn't enough water in your body. The amount of water in your body only has to decrease by two or three percent for dehydration to occur. As the risk from dehydration is particularly great in babies and young children due to lower total body water, it's important that they are monitored for symptoms of dehydration if, for example, they have a fever.
Mild dehydration carries few risks and can usually be easily treated by replacing lost fluids. Moderate dehydration, which may occur during a fever, can cause your child to appear restless and irritable. A basic skin pinch test using the following steps can help you to check if your child is dehydrated:
- Gently pinch a fold of skin on your child's abdomen (tummy).
- When it's released, this fold of skin should flatten immediately if your child is adequately hydrated.
Fluids should be offered on a regular basis; for example, breast milk if your child is being breastfed. Rehydration mixtures (eg Dioralyte) that you can get from a pharmacy may also be used. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.
It's important to remember that thirst isn't a good indicator of dehydration. If your child is thirsty, he or she is already likely to be suffering from the effects of dehydration.
Contact your GP for advice if you suspect that your child is showing signs of dehydration.
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
- Gastroenteritis - management. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 4 June 2008
Is it true that children may be at risk of fever and fits after having a vaccination?
Vaccinations in children can cause fever and associated fits (febrile seizures or convulsions) but the chance of this happening is very small. For example, for the measles-mumps-rubella/German measles (MMR) jab, your child's risk of febrile seizure is only one or two per 1000 doses of vaccine. If your child has a previous history of seizures during a fever, he or she may have a higher risk of this happening after vaccination - although this risk only increases to 20 per 1,000 doses of vaccine. If your child does have a febrile seizure following a vaccination, this doesn't mean that your child will develop epilepsy.
Explanation
Some fits are associated with fever (febrile seizures) and some aren't. Febrile seizures are rare in the first six months of life and are most common during the second year. After this, they become less common and are rarely seen after the age of five years. Young children can have seizures at any time, so having one after a vaccination may not necessarily be linked to the vaccine. If your baby or child does have a seizure after vaccination, contact your GP immediately.
You should be aware that the risk of your child having a febrile seizure is lower after vaccination than if they have the natural disease the vaccine protects against. For example, your child only has a one in 1000 chance of having a febrile seizure following the MMR jab, but this increases to a one in 200 chance if they actually have measles, mumps or German measles. Your child should fully recover from a febrile seizure after a vaccination and having a seizure doesn't suggest that he or she will have another seizure at a later date. Your GP will be able to advise whether your child can have more doses of the vaccine.
For teenagers (age 13 to 18), it's recommended that any vaccinations should be postponed if he or she has an illness with a fever. This will prevent any increase in fever. If your son or daughter has previously had seizures not associated with fever, speak to your GP before he or she receives a vaccination.
Sources
- Vestergaard M, Hviid A, Madsen KM. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA 2004;292:351-357. www.jama.ama-assn.org
- A guide to immunisations up to 13 months of age. National Health Service (NHS). 2007. www.immunisation.nhs.uk
- Immunisations at 12 and 13 months of age. National Health Service (NHS). 2007. www.immunisation.nhs.uk
- Pre-school immunisations - a guide to vaccinations for 3- to 5-year-olds. National Health Service (NHS). 2007. www.immunisation.nhs.uk
- Teenage immunisations. School years 8 to 13 (ages 13 to 18). National Health Service (NHS). www.immunisation.nhs.uk
- Febrile convulsion. Background information. Clinical Knowledge Summaries. Febrile convulsion. Background information. http://cks.library.nhs.uk, accessed 3 June 2008
What should I do if my child has a febrile seizure?
If your child has a febrile seizure (fit or convulsion), try and stay calm. Put your child in the recovery position in a safe place - lie your child on his or her side with the head level or slightly lower than the rest of the body. Loosen your child's clothing and remove anything from the mouth, such as food or a dummy. Stay with your child and try to time the seizure. If this is the first time that your child has had a febrile convulsion or the seizure lasts for more than five minutes, you should take him or her to the Accident & Emergency Department at your nearest hospital. Contact your GP if your child's seizure lasts for less than five minutes.
Even though febrile seizures do not usually cause any lasting problems, it's important that your child is closely monitored both during and after any febrile seizure.
Explanation
Although febrile seizures rarely last longer than two or three minutes, they can be very frightening. Your child will lose consciousness and his or her arms may go floppy or stiff and appear to twitch. Your child's eyes might roll upwards and he or she might wet or soil themselves. After this, your child will normally regain consciousness, fall into a deep sleep and then be irritable or confused upon waking up.
Even though febrile seizures don't usually cause any lasting problems, it's important that you monitor your child closely both during and after the seizure, especially if it's the first time that your child has had one. Try and make your child as safe as possible when he or she is having a seizure because his or her body may twitch or jerk. Make sure that your child has nothing in his or her mouth which could cause choking. If your child's seizure lasts for more than five minutes, you should take him or her to your nearest Accident & Emergency Department.
A doctor will need to examine your child to see whether he or she has an infection, which is a common cause of febrile seizures. A doctor will explain the cause of your child's febrile seizure before you go home, along with any signs to look for in the days following the seizure.
Sources
- Febrile convulsion. Management. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 18 June 2008
- After your child has had a seizure caused by a very high temperature (febrile seizure): what you can expect to happen. UCL Institute of Child Health. 2005. www.ich.ucl.ac.uk
- Febrile convulsions. What are the symptoms of febrile convulsions? BMJ Best Treatments. http://besttreatments.bmj.com, accessed 18 June 2008
Related topics
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
Fever in children factsheet
Visit the fever in children health factsheet for more information.
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