Fever, or an elevation in the body temperature above predefined normal ranges, is a common ailment in children during the first year of life. In babies, fever can be measured and confirmed in two ways, rectally and orally. In infants aged 0–12 months, rectal temperature of >38°C (100.4°F), oral temperature of >100°F or 37.8°C or axillary (armpit) temperature of >99°F or 37.2°C indicates fever. However, although rectal thermometers are known for their precision, they are inconvenient to use compared to oral, or axillary thermometers. Nowadays, handy, easy to use digital thermometers are also available for use at home. So, if your child feels warm to touch, measure his temperature to confirm that he has fever.
Most febrile episodes in children resolve without any complications. However, a high temperature can make a child feel uncomfortable, which can be a cause of distress to parents. But don’t worry, because fever, in most cases, is a normal response of the body to many adverse health conditions. It is usually indicative of the body mounting an immune response. In fact, contrary to popular beliefs, temperature spike may not always indicate a critical illness. Therefore, your challenge, as a parent, is to identify the danger signs and know when to seek help in case your child has fever.
According to the American Academy of Pediatrics (AAP), the primary goal of treating fever should be to improve the child’s overall comfort instead of normalising his body temperature. Here’s what you need to know to deal with your baby’s febrile episode:
1. Adequate rest: Often, a child with fever tends to feel tired and cranky. A fretful child, complaining of aches or pains all over, can easily overwhelm a parent. In such a situation, you should encourage your child to rest. But at the same time, try not to force your child to rest even after he starts feeling better.
2. Intake of fluids: A rise in the body temperature can result in the loss of fluids through the surface of the skin, leading to dehydration.
To prevent your child from becoming dehydrated, it’s important to rehydrate her with adequate amounts of fluids. Therefore, offer fluids like milk or water more frequently than normal. Older children can be given fluids in the form of soup, popsicles, flavoured milk and ice chips. Do not presume that a febrile child may not feel hungry or may be too uncomfortable to eat or drink. Ensure that there is adequate intake. If your child is unwilling to consume fluids or is vomiting them out, rush her to the doctor. Another cause for alarm is when she does not urinate for hours together.
3. Sponging: Contrary to popular belief, sponge baths and cold compresses do not help in lowering fever. These methods are no longer supported by current medical research. In fact, medicines may be more effective than sponging and cold compresses. If at all you resort to sponging, use lukewarm water (90°F to 95°F) and not cold water or ice. But, remember not to use alcohol for sponging as it can enter the body through the skin, thereby increasing the risk of toxicity.
Also, refrain from using excessive clothing or quilts to keep your child warm because doing so can increase his body temperature. In fact, you can safely bathe your child during febrile episodes.
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4. Medicines to reduce fever: A child with fever can be treated with medicines such as paracetamol. The dosage of paracetamol depends on the weight of the child; it can be given once every four or six hours, depending on the child’s requirement. Remember, paracetamol should be given in the right dosage and frequency only after the child has been properly fed. Only then can you avoid dangerous side effects like liver failure. To ensure right dosage, use accurate measuring devices provided with medicines (dropper, calibrated caps, etc.) instead of incorrect measures like teaspoons. Do not use over-the-counter medicines for children, especially if they are less than three months old. Furthermore, children are prone to quick weight changes during illnesses, so remember to ask the paediatrician to revise the dosage of medicines according to weight in children less than one-year-old. And, remember that not all types of fever need to be treated, let alone be treated with antibiotics.
5. Speed-dialing the doctor: While it helps not to panic when your child develops fever, it’s even more important to know when to seek urgent medical attention
Children with temperatures of >103°F are at a higher risk of harboring serious underlying infections and must be urgently evaluated. But in children 3–6 months old, even a temperature >101°F warrants a visit to the doctor. However, as mentioned earlier, you must pay attention to the general condition of the child, and not just his body temperature. If your child shows signs of excessive vomiting, diarrhoea, unreasonable sleeplessness, excessive irritation, poor appetite or rashes, a trip to the doctor is mandatory. Remember to trust your instincts and seek medical attention if the baby is not being ‘himself’, even if the temperature spikes do not seem dangerously high.
6. Tending to the child: Febrile seizures occur in babies when their body temperatures exceed 102°F. This is more prevalent in children >6 months old.
During febrile seizures, a child may roll his eyes upward, give vacant stares, have violent contortions, and may experience stiffening of the whole body or one or more limbs. After such an episode, he might seem a little drowsy or may be irritable. Febrile seizures are usually benign and resolve without any sequelae. Although febrile seizures can cause much distress to parents, try to remain calm during such episodes. Embrace your baby and lay him down sideways. Ensure that there is nothing near him that could harm him during the jerky movements of the seizure. Loosen any constricting clothing around the neck to allow him to breathe freely. Do not try to put anything in his mouth, including medicines, during the seizure.
So, the next time you kiss your baby on the forehead and he feels warmer than normal, remember not to panic. Instead:
• Check the temperature to see if it officially qualifies for fever
• Make sure to keep your child well-hydrated and rested
• Use medicines sparingly and appropriately
• Watch for danger signs and do not hesitate to call your doctor
Follow these few simple steps and most babies would be on the road to recovery soon.
The author is a Fellow of Pediatric hemato-oncology at TATA Medical Center, Kolkata.