What if my child has fever?

What if my child has got fever?

[mme_highlight] Fever is one of the commonest symptoms of childhood diseases. About 70% of preschool children have a fever each year. Colds, bronchiolitis, ear infections and urinary tract infections are among the most frequent causes of fever. You should carefully monitor your child with fever and look for the alarm signs. [/mme_highlight]

Fever is a symptom, not a disease. In fact, it is one of the most common symptoms of childhood diseases, being the cause of nearly 65–70% of all pediatric visits. About 70% of preschool children have a fever each year. Clinically, fever is defined as an increase in body temperature of 1°C or more above the standard mean.
It has been shown that fever is an adaptive response to challenge with micro-organisms or other known pyrogens.  Although the associated conditions are often self limiting, the fever itself can cause distress and discomfort to the child and anxiety to parents.

What are the cut-off values for fever?

To define fever, it is important to understand that temperature elevation that is considered “abnormal” depends on the age of the child and the site of measurement. A study conducted in Harvard with a multiethnic and socially diverse sample of parents showed that only 42% of parents knew the correct temperature for fever, far less than one should expect.
Note that in children who suffer from diseases that compromise the immune system (sickle cell disease, neutropenia, HIV), cut-off values are different. The table below shows the cut-off values considered as fever; if your child has a temperature measure correspondent to “fever of concern” as stated below, take her/him to the doctor.

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Cutt-off values for fever by age and site of measurement

Age Cutt-off for fever (ºC) Cutt-off for fever (ºF) Fever of concern

(ºC / ºF)
Newborn (0-28 days) ≥38.0 ≥ 100.4 ≥38 / ≥100.4
1 – 3 months ≥ 38.0-38.2 ≥ 100.4 – 100.7 ≥38 / ≥100.4
3 – 36 months ≥ 38.0-39.0 ≥ 100.4 – 102.2 ≥39/ ≥102.2
> 3 years ≥ 37.8-39.4 ≥ 100 – 103.4 ≥39.5/ ≥103.1

 

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What are the most common causes of fever?

A fever poses the diagnostic of infection on top of the list of possible underlying causes; colds, bronchiolitis, ear infections and urinary tract infections are among the most likely illnesses to cause fever.

Can fever be a sign of pneumonia?

Yes, in fact among children presenting with fever to an emergency department, bacterial pneumonia is the most common serious bacterial infection, in developed countries. However, to identify children at risk, many signs and symptoms other than fever should be taken into account. According to the latest research, respiratory rate is the clinical feature with the most consistent and the strongest evidence for predicting lower respiratory tract infection.
Respiratory rate is simple to measure: count the number of times your child breathes in one minute. The table below shows the normal range values for respiratory rate, according to APLS (Advanced Pediatric Life Support).  A respiratory rate above the normal range values is named tachypnoea and reflects an acute response of body to respiratory distress.
The other table is taken from a study and shows how respiratory rate increases with temperature. The study concluded that respiratory rate, adjusted for age, increased by around 2.2 breaths / minute per 1°C rise in body temperature.

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Respiratory Rate Normal range values by age –breaths/minute (APLS)

Age Respiratory Rate Age Respiratory Rate
Newborn 40-60 2 years 20-28
1 month 30-50 4 years 20-26
3 months 30-45 6 years 18-24
6 months 25-35 8 years 18-22
1 year 25-30 10 years+ 16-20

 

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Respiratory Rate values expected for different temperatures in children (1 month to 16 years)

Respiratory Rate Centiles (breaths/minute)

Temperature (ºC) by age group
1 to < 12 months
36.0-36.9ºC 37 45 55 65
37.0-37.9ºC 38 48 57 69
38.0-38.9ºC 40 50 60 72
39-39.9ºC 42 52 63 75
12 to < 24 months
36.0-36.9ºC 28 35 41 49
37.0-37.9ºC 32 39 47 55
38.0-38.9ºC 35 42 50 60
39-39.9ºC 36 44 53 62
24 to < 5 years
36.0-36.9ºC 23 27 31 36
37.0-37.9ºC 25 30 35 40
38.0-38.9ºC 27 32 38 44
39-39.9ºC 29 35 41 48
5 to < 16 years
36.0-36.9ºC 19 23 27 32
37.0-37.9ºC 21 26 30 36
38.0-38.9ºC 23 28 34 41
39-39.9ºC 24 30 36 44

 

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What are the available treatments?

Fever may play a role in fighting infections, however it makes children uncomfortable and it is dangerous for children in shock – this is the rationale to treat fever. Also, keep in mind that a high temperature value is not necessarily correlated to more serious disease. That is why it is so important that you monitor your child’s appearance and behavior.
Your doctor may prescribe acetaminophen, ibuprofen or a combination of these two.  Some cost-effectiveness results from studies have shown that over the course of the whole illness, treating children with both acetaminophen and ibuprofen may lead to less use of other healthcare resources than does either of the drugs alone. This would result in lower costs to the health system, as well as to parents because of time off work.

Summary and Recommendations

  • Fever is one of the commonest symptoms of childhood diseases.
  • Fever is generally a response the body generates to combat infection.
  • The cut-off values that define fever depend on age, place of measurement and state of the immune system.
  • Colds, bronchiolitis, ear infections and urinary tract infections are among the most frequent causes of fever.
  • Acetaminophen, ibuprofen or the combination of these two are the most common therapeutic regimens.
  • You should carefully monitor your child with fever and look for the following alarm signs:
  • Temperature values above the “fever of concern” values stated in the table above.
  • Febrile seizures.
  • Fever in a children with a chronic disease.
  • Fever accompanied by skin rash.

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References

  • Erkek, N., Senel, S., Sahin, M., Ozgur, O. and Karacan, C. (2010), Parents’ perspectives to childhood fever: Comparison of culturally diverse populations. Journal of Paediatrics and Child Health, 46: 583–587.
  • Taveras EM, Durousseau S, Flores G. Parent’s beliefs and practices reagarding childhood fever: a multiethic and socioeconomically diverse sample of parents. Pediatr Emerg Care. 2004 Sep; 20(9): 579-87.
  • Hay AD, Heron J, Ness A; ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Fam Pract. 2005 Aug;22(4):367-74.
  • Hollinghurst S, Redmond N, Costelloe C. et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): economic evaluation of a randomised controlled trial. BMJ. 2008 Sep 9;337:a1490.
  • Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, et al.
  • Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age:a systematic review of observational studies. Lancet 2011;377:1011-8.
  • Nijman RG, Thompson M, van Veen M Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: prospective observational study. BMJ. 2012 Jul 3;345:e4224.

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