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Introduction Fever is frightening to parents and this can sometimes be due to misinformation. Old fashioned ideas that fever can …


Fever is frightening to parents and this can sometimes be due to misinformation. Old fashioned ideas that fever can cause brain damage or will trigger convulsions results in frantic attempts to control fever. A fever is a sign that something is wrong. A useful analogy is a warning light in a car indicating something is not right. Treating a fever is like treating the warning light without finding out why the light is on. So understanding fever will help allay some of these anxieties.

What Causes Fever?

Fever is the body’s sign that it is fighting infection. The fever helps the body mobilise the immune system to eradicate the infection. In most children the fever is caused by a virus that cannot be treated with antibiotics. Bacterial infections which tend to be more serious will also cause a fever and these need to be investigated and treated. The Key is working out whether the fever is due to a simple infection or something more sinister. When doctors see a child with a fever there are a number of ‘rules’ that if followed will avoid missing a serious cause. The most important part is getting an overall opinion of how unwell the child is. Age, colour, hydration, level of activity, breathing rate, pulse rate, state of alertness are all factors that should be assessed. An unwell infant, who appears lethargic and has a temperature of 38 degrees is far more concerning than a well looking healthy child with a high temperature approaching 40 degress. The following is a guide based on age :

An infant under 3 months with a temperature needs to be assessed urgently. This will often involve tests such as urine and blood examination. This is because this age is highly vulnerable to invasion by bacteria. Immune protection is poor and barriers to infection are not mature. In addition infants can deterioate quickly and are ‘hard to read’. This should be done in a hospital with good paediatric support

An infant between 3 – 12 months with a temperature can be reviewed by a GP depending on how unwell he or she is. The most comon causes are viruses, and so if this age group has a simple cause, such as cough, runny nose, viral rash then tests are unnecessary. However if there is no obvious cause for the fever, further investigations are needed. The most common cause of fever that is not due to a virus is a urine infection, particularly in infant girls. If the infant is unwell then hospital assessment is mandatory.

Between 12 – 24 months of age fully immuniseed toddlers with a fever will generally be due to viruses. However if after examination and history the cause of the fever is still unclear and the child appears unwell then further investigations are needed, such as urine and blood tests.

Older children will have a more mature immune system and in most instances the cause of the fever is obvious and can be managed accordingly.

If a fever lasts more than a few days it is worth being assessed, especially if the source is unclear.

Some other Fever Facts

A fever generally means 38 degrees or above. Viruses and bacteria do not like a higher temperature.

Cool baths to ‘get the fever down’ are not recommended and are not necessary.

If the child is otherwise well, and the source of the fever is known, (such as a cold or sore throat) then the height of the fever is of little consequence

Febrile seizures occur in only 3% of the population. There is no evidence that controlling a fever with panadol, or sponging etc will prevent those that are susceptible from having a seizure. Many nurses and paramedics actually do not realise this and will contribute to a parent’s concerns about fever by concentrating on trying to lower the temperature. This is not a priority.

Fever management

Dress your child in light clothing

Give your child frequent small drinks of clear fluid (eg. water, diluted fruit juice or cordial). Do not worry if your child refuses to eat at this time. If your child is under six months give extra cooled boiled water, breast feeds, or bottle.

Paracetamol or nurofen can be given especially at night when the child fever can cause irritability and discomfort.

A cool flannel to forehead will help with the discomfort.


– Dr Scott Parsons