Fever in Children: When to See a Doctor

Fever is one of the most frequent symptoms seen in pediatric practice. It accounts for a significant number of outpatient visits and emergency consultations. Although fever often causes anxiety among parents, it is important to understand that fever itself is not an illness. It is a physiological response to infection or inflammation.

The body raises its temperature as part of the immune response. Elevated temperature can enhance white blood cell function and inhibit the growth of certain pathogens. However, in infants and young children, fever sometimes signals a serious underlying infection that requires prompt medical attention.

What Is Fever?

Normal body temperature varies depending on age, time of day, and method of measurement.

Average normal temperature: 36.5°C to 37.5°C

Fever is defined as:

• ≥ 38°C (100.4°F) rectally
• ≥ 37.5°C orally
• ≥ 37.2°C axillary

Rectal temperature measurement is considered the most accurate in infants under one year of age.

It is important to distinguish fever from hyperthermia. Fever is regulated by the hypothalamus in response to infection, whereas hyperthermia (such as heat stroke) occurs due to environmental overheating and is not immune-mediated.

Why Do Children Develop Fever?

1. Viral Infections

Viral infections are the most common reason for the occurrence of fevers in children. Some of the most common viral infections that lead to fevers include:

• Upper respiratory infections (common cold)
• Influenza
• Viral gastroenteritis
• Dengue
• COVID-19
• Roseola (in infants)

Viral fevers usually last for 3 to 5 days and do not require antibiotics.

2. Bacterial Infections

In the case of bacterial infections, the child may be required to undergo specific treatment for the infection. Bacterial infections that lead to fevers include:

• Urinary tract infections (UTI)
• Pneumonia
• Bacterial meningitis
• Otitis media (infection of the middle ear)
• Streptococcal infection of the throat

3. Post-Vaccination Fever

In some children, fevers may develop due to the effects of a vaccine. This type of fever usually develops within 24 to 48 hours of receiving the vaccine and is a sign of the immune system responding to the vaccine. This type of fever is usually mild and does not have any severe effects.

4. Inflammatory or Autoimmune Conditions

Less commonly, persistent fever may be associated with:

• Juvenile arthritis
• Kawasaki disease
• Multisystem inflammatory syndrome in children (MIS-C)

These require specialized evaluation.

Age-Based Risk Assessment

Age is an important factor in the assessment and seriousness of fever.

Infants Below 3 Months

• If the fever is ≥ 38°C, it is considered a medical emergency.
• Newborns and young infants may not exhibit the classical symptoms of infection, and serious bacterial infections may develop rapidly.
• Blood tests and admission to the hospital are recommended.

Infants 3-6 Months

• If the fever is > 38.5°C, medical evaluation is recommended.
• The doctor checks the child's feeding pattern, irritability, breathing, and hydration.

Children 6 Months to 5 Years

• In children, fever is usually caused by a virus.
• However, medical evaluation is recommended if the fever lasts longer than 3 days, the fever is > 39-40°C, the child looks lethargic, there are difficulties in breathing, and so on.

Clinical Evaluation by a Pediatrician

During the examination, the pediatrician checks the child's general appearance, skin color and rash, hydration, respiratory effort, neck stiffness, abdominal tenderness, ear and throat symptoms, and so on.

If necessary, the pediatrician may also recommend the following tests:

• Complete blood count (CBC)
• C-reactive protein (CRP)
• Urine analysis
• Chest X-ray
• Blood culture
• Viral antigen tests

Febrile Seizures

Febrile seizures happen to 2-5% of children from 6 months to 5 years of age.

• Simple febrile seizures: These are generalized, less than 5 minutes long, and happen once in 24 hours.
• Complex febrile seizures: These are prolonged, focal, or recurrent.

Simple febrile seizures are not associated with brain damage or long-term neurological problems. However, first-time seizures need immediate medical care.

Warning Signs That Require Immediate Medical Attention

Watch for these symptoms and get immediate medical care for the child:

• Difficulty breathing
• Bluish lips or skin
• Persistent vomiting
• Severe headache
• Stiff neck
• Seizures
• Rash that does not go away with pressure
• Decreased urine output
• Unusual drowsiness
• Persistent crying in infants

Home Management of Fever

Comfort is the main goal in the treatment of a child’s fever. General measures include.

• Ensure the child takes plenty of fluids
• Avoid overdressing the child
• Ensure the room is well ventilated
• Encourage the child to rest
• Dosage should be based on the weight of the child.
• Overdosing can cause damage to the liver or kidneys.
• Aspirin should not be taken by children because of the risk of Reye’s syndrome.

Common Myths About Fever

Myth: High fevers cause brain damage.

Brain damage happens only when the temperature crosses 41.5°C.

Myth: Not all fevers need antibiotics.

Most fevers in children are due to a virus and don’t need antibiotics.

Myth: The higher the fever, the worse the infection.

It’s the condition of the child and not the fever that’s important.

Prolonged or Recurring Fever

Prolonged fever is one that lasts for more than 7 days and needs to be investigated.

Causes of prolonged fever:

• Typhoid fever
• Tuberculosis
• Autoimmune diseases
• Hidden infections

Recurring fevers should be referred to a specialist.

Prevention of Fever

• Immunization of the child
• Maintenance of hygiene
• Balanced diet
• Avoid exposure to infected persons
• Prompt treatment of minor infections

Immunization helps prevent life-threatening diseases such as meningitis, pneumonia, and measles.

When to Consult a Doctor

A child should be referred to a pediatrician if:

• Child is less than 3 months of age and has a fever
• Fever lasts for more than 72 hours
• Child refuses to drink fluids
• Symptoms worsen
• Parental intuition should not be ignored, if something seems unusual, medical advice is appropriate.

Conclusion

Fever in children is an indication that the body's immune system is actively fighting an infection. While the fever may not be serious in most cases, certain factors require immediate medical attention. Proper evaluation and assessment of the child, depending on the child's age and symptoms, are crucial in determining whether the fever is harmless or requires urgent medical attention.

Pediatric Services at Prakash Hospital

Our pediatric services at Prakash Hospital are designed to provide the best care and treatment for fever in children. Our team of medical experts provides the safest and most effective treatment for children with fever.

Consult our experts today!