Last Updated on September 22, 2023 by Shabnam Sengupta
How many times have you found yourself standing there uncertain and anxious, asking the same question whether your child’s fever is something to worry about or if is it just another passing ailment? Instead of worrying about fevers, it would be more productive to focus on enhancing our knowledge about the causes and treatment methods for high temperatures in children. To help decipher the complexities of fevers in children, THIP Media spoke to Dr Meghana Phadke Sultania.
Dr Meghana is an accomplished paediatrician and neonatologist with more than 11 years of experience. She specialises in child health and development and currently practices at the Metro Heart Institute and Multispeciality Hospital in Faridabad. Her areas of expertise include managing pediatric patients, immunization pediatric infections, seizures in children, and nutrition issues for both pediatric and adolescent patients.
Excerpts:
What temperature is considered a fever in children? How can parents distinguish between mild and serious fevers?
Dr Meghana Phadke: When we talk about fevers in children, we divide it into several groups – newborn, infant, child, and adolescent. In the cases of newborns and infants, their body has not yet learned and the brain is not mature enough to regulate their own temperatures. So, when a newborn is in a hotter environment, they start having fever and in a colder environment, their body temperature drops. That’s what we call hypothermia.
The same happens more or less with infants as well. Their temperatures need to be taken care of. That’s a very extremely sensitive area. When we talk about older children and adolescents having fevers, the regulation is definitely better. But the fever can go very high and that has to be properly controlled in time to avoid complications.
We can measure temperature orally or through the tympanic membrane, which is called central body temperature. Also at bum area, the rectal body temperature and the skin surface, like with a standard thermometer, which we generally use in the axilla.
The normal body temperature is 97.7 to 98.6 degrees Fahrenheit, which is a normal body temperature. It may slightly vary in terms of seasons as well. So, when we are recording a temperature which goes beyond 98.6, then it is fever. But when we are checking temperatures in the axilla surface, we have to add roughly one degree Celsius or one degree Fahrenheit to it to make it comparable to the central body temperature. If you’re taking it in an axilla and it shows 99 degrees, then it will be read as 100. Whereas an oral 99 will be 99, or a tympanic membrane or a year thermometer showing 99 will be 99. This is how we measure the temperature.
In the cases of newborns and infants, if their temperature goes up beyond the normal range, we have to check first if they are overwrapped. We have to remove the excess clothing in case they do, sponge the baby properly and recheck the temperature in 30 minutes. If the temperature still shows in a higher range, then it will mean that they have a fever and we have to give them medicines.
In extreme seasons like extreme heat or extreme cold, checking and sensing temperature becomes a task. The parents have to do it with due attention. I would like to mention here that when we are checking these temperatures, we have to carefully note them down. Sometimes it happens that the fevers do not respond to antipyretics immediately. So, in such a situation, we need to check the temperature every 30 minutes in the case of children.
Apart from this, we can get other signs which are a little subjective like they may have central body parts that are hotter and peripheral body parts like the palms or the feet that are colder. If you put your palm over the child’s chest, then you may feel that the heartbeat is faster or the child is looking dull suddenly. These are the signs which tell you that you have to see and check the temperature. Maybe there’s a fever.
What are the common causes of fever in children and how can parents differentiate between viral and bacterial infections?
Dr Meghana Phadke: Yes, that’s a very important question. So when it comes to common causes of fever, all of us know infection is the most common cause of fever. Infection can be viral, bacterial, parasitic or something like malaria. Various causes are there. Apart from these infections, the other cause which makes a lot of importance is severe dehydration and heat stroke. Sometimes fever can be caused because of certain diseases. These conditions may show fever for a longer range rather than three to four days.
Certain rheumatic conditions like rheumatoid arthritis or rheumatological heart disease can also cause fever which will go prolonged. Certain Mediterranean fevers are fevers which happen in a recurrent way. In general, fever is a very wide variety of genres and all sorts of diseases are possible even in infancy or childhood. So, we have to be very particular and we have to be attentive when it comes to the duration of fever and how often fever is recurring.
In general, for those under five years of age and there is a high-grade fever, viral diseases are very common and viral fevers generally tend to recur, often in a day, like four hours, or six. They tend to have a higher degree of temperatures, like 103, often 104 and generally apart.
Once the fever settles down, a child is happy, the smile comes back, the movement or the activity starts and lethargy is generally off once the fever settles down. In bacterial fever, the child is dull throughout. Even if once the fever settles down, the child is dull, not interested in their surroundings, not happy with their routine toys, or even after some buddies visit, etc. Bacterial fever can be even low grade or high grade. And there are signs of toxaemia also. There could be eyes are red or a heartbeat thrown out on a higher side and the child is even not able to stand or tremble and eat less. All these things are possible in bacterial fever.
What are the possible complications of prolonged or high recurrent fevers in children?
Dr Meghana Phadke: There are complications of fevers like lethargy and being inactive. At the same time, when the fever increases, it dehydrates the child’s body. So dehydration is very common. It can lead to a decrease in the urine output of the child, which needs to be monitored. The child may have sticky hands or tremors, which can be a result of low glucose. In some cases, the blood pressure may also fall down.
When there is toxaemia of bacterial disease or certain viral diseases with rashes, they are notorious. That can also cause this fallen BP where the child can have giddiness and dizziness or they can become unresponsive. These things are possible. Extremely high temperatures like 105, etc. They may cause bluishness around your mouth. Sometimes children also do breath holding during very high fevers. They may have shivers or jitteriness and some odd ways are there when the children can actually throw a seizure, also an extremely high fever.
How would a doctor address these medical emergencies?
Dr Meghana Phadke: The medical modality is that we see the children and their conditions and we assess their condition. We need to know there is an emergency. First of all, that is what we call a triage. If there are any red flags like a child coming into seizures, has not passed urine for more than 12 hours, a child whose body function is fine but food intake is very poor and the blood sugars have gone down. These are emergencies in paediatrics. This is what we assess. And if the fever is very high, generally an injectable mode is preferred and even giving fluids is preferred.
Can fever in children be managed using home remedies? What are the potential disadvantages of using home remedies?
Dr Meghana Phadke: First of all, one of the things that can be done at home to control fever is sponging. It is very important. It is highly effective. However, at the same time, if we do sponging, along with giving a simple dose of Paracetamol, it always helps, because fever breaks from within the body. And if the child feels much better after Paracetamol, why not give it? It’s a very simple, small basic medicine. Fevers can go very high in a child and since they aren’t old enough, they are unable to do it themselves. Therefore, we have to assist them.
Secondly, if the fever takes a lot of time to break, dehydration can happen. So, giving paracetamol at the right time can prevent other complications as well.
When it comes to home remedies, fever is an acute condition. So if you have something that can work faster than Paracetamol, then it is your choice. However, there are other paramedical sciences also, wherein there can be certain medications, such as Ashwagandha or other herbs, which may work. If there is no Paracetamol available and you are in some area where there are no such resources, you can use these herbs. But then you have to be doubly sure about these herbs. There has to be a proper prescription for the theme. If you do not have an idea, then suddenly giving something which you yourself have no knowledge about is not good. You cannot use the trial-and-error method with health.
Paracetamol is available even in rectal suppositories. If the children are not able to take the paracetamol orally, we can insert a rectal suppository of Paracetamol to bring the fever down. So it’s that easy. There are patches also at times available, things are dead and one must take the whole full advantage of them.
Along with it, sponging is essential in high fevers. It brings down your temperature at least by a degree and it helps aid the child. So that’s what is important. And why I insist more on sponging is because giving medicine also has its limits. For example, we cannot repeat Paracetamol within 4 hours. There are other medicines apart from Paracetamol, which is to be used only in case of hydrate fever and after your doctors prescribe it. But there are also limitations of dose and duration.
Sometimes it happens with children that you’ve given Paracetamol. There is no effect. You keep on sponging. After 4 hours, the fever is again there. That means the fever is there continuously. We call it something like a continuous or a remittance fever. And in such cases, the medicine only brings it down to a certain level. This is why sponging is very important. It really aids apart from medicine.
Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.