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febrile temperature readingHow to
Manage a Fever


A fever is a temperature of 38*C and above.
It’s normal to be concerned when a child develops a fever for the first time – but did some of that worry perhaps come from all the stories you’ve heard over the years about febrile seizures and hyperthermia?

Were you taught that a temperature is a bad thing?

Why would the body raise it’s own temperature?

To start, a fever signals to us that some type of pathogen (such as a virus or bacteria) has entered the body. The body has recognised that the pathogen does not belong there and that it could make you quite sick. The immune response is triggered to begin fighting off the infection and a part of that response involves the brain resetting the bodies thermostat. The body knows that most pathogens cannot function properly or replicate in an environment above normal body temperature
(around 37*C), so by raising its core body temperature it gives itself a better chance of fighting off the infection.

Normal body temperature is dependent on the individual, their level of activity, the time of day and so on. It’s quite natural for body temperatures to fluctuate. As part of that immune response, the brain takes the average temperature range and elevates it. So instead of sitting around 36.5*C – 37.5*C the core body temperature might jump to 38*C or higher – resulting in a fever.

The Fever Is NOT the illness…

It is important to distinguish that the fever is not the illness, it is a sign or symptom of an underlying infection – and is the body’s natural response to help fight off that infection .

The problem is… that our “good” bacteria and cells also like normal body temperature. And when it is elevated, they too cannot function or replicate effectively – which is why we tend to feel so rubbish and run down when we have an elevated temperature.

Since a fever is controlled by the body, it is not designed to do itself any harm.
What we should be focusing our attention on is the underlying cause of the fever.

The body has chosen to increase its own temperature, so it stands to reason that it would be self-limiting and reset its thermostat back to within normal range when it needs to. So why do we feel the need to intervene?

We tend to place a lot of focus on the number displayed on the thermometer, and while it is a useful tool to help us confirm a fever – it’s not the only piece of information that counts. It is important to look at that patient as a whole and consider things like their colour, tone, breathing and level of consciousness. If your patient has a soaring temperature but they are not exhibiting any other symptoms and feel otherwise well…. Is medication necessary?

It is not necessary to treat a fever…

While paracetamol and ibuprofen can be used to help bring a fever down, clinicians only tend to use it for relieving discomfort. And only ever in accordance with the directions on the bottle. Think of its use as a comfort… not a cure.

If a fever is initiated from within the body.
Hyperthermia, by contrast, is when the heat is generated outside of the body.

External heat is incredibly dangerous because it can go well beyond a range we can control. Take, for example, a child that has been locked in a hot car. According to Kidsafe W.A. the internal temperature of a vehicle during an Australian summer can be as much as 30° to 40° higher than the outside temperature. And if we feel rubbish when our core body temperature rises a mere two or three degrees higher than normal range… imagine what 30 degrees can do!

In that scenario the child can definitely become very unwell incredibly quickly. They can have seizures or end up with brain damage, they can even die from being exposed to extreme heat.
But a fever is very different.

When to call an ambulance or see a doctor

First of all, if your baby is under the age of three months and they have a temperature above 38*C  they need to see a doctor – immediately. They do not have the immune system yet to appropriately fight off an infection and medical intervention may be necessary. At the very least, a newborn can be monitored and treated accordingly if they are under the watchful eye of medical staff.

If your child is looking unwell, how do you know if they are “big sick” or “little sick”?
Generally you can feel if a child is too hot by placing a hand on their chest. Feeling the forehead, hands or feet can be unreliable as these areas can often feel cool and clammy. Remember that you are only really measuring whether they feel hotter or colder than yourself here, so it’s working on the assumption that you are within a normal body temperature range yourself. Be aware that if you have a fever too then they may feel normal by comparison.

Things to consider:

Child with a fever

Appearance – Skin
Pink / warm to touch – Normal
Flushed / hot to touch – Bed rest, monitor for changes
Rash with a fever – Doctor
Pale and clammy – Doctor
Rash that doesn’t go away when you press on it – Ambulance
Blue or mottled appearance – Immediate Ambulance

Consciousness
Alert and orientated – Normal
Lethargic but can still rouse them – Doctor
Difficult to rouse – Ambulance
Floppy – Immediate Ambulance
Unconscious – Immediate Ambulance

Breathing
Barking Cough – Doctor
Noisy Chest – Doctor
Difficulty breathing – Ambulance

Fluids in and out
Drinking/ Taking less than half of their normal feeds – Doctor
Not feeding/ drinking at all – Emergency Department
Drowsy and not waking to feed /drink – Ambulance

Nappies just damp or much lighter than usual – Doctor
No urine output at all – Emergency Department
Excessive vomiting and diarrhoea (concerns for dehydration) – Doctor

 

What can you do to help manage a fever with symptoms?

If they are still eating and drinking well and there is an obvious source of infection (like a runny nose or a bit of a cough) there may not be a need to take them to a doctor. If they are clearly uncomfortable you may simply need let them rest and administer paracetamol and/ or ibuprofen (if appropriate) to help keep them comfortable. One medication would typically be enough to manage symptoms – Remember it takes a good 20 minutes to be absorbed by the gut and take effect, so give it time. 

These medications can be used concurrently, in an alternating fashion if needed. As long as each is used according to the directions on the bottle (administered 4- 6 hourly). So I might start with paracetamol, then administer ibuprofen two hours later followed by paracetamol again two hours after that (a total of 4 hours between paracetamol doses).

It’s important that they keep drinking lots of fluids during this time. Their requirements for fluids when sick can be higher than usual, so they might need more breastfeeds or offering more water… or, if it is age appropriate, you can offer an oral rehydration solution.

We need to be mindful that if they have a fever, we shouldn’t be wrapping them up in lots of clothes and blankets. Similarly, you wouldn’t be stripping them down to nothing. Just keep them in loose, comfortable clothing.

It is not necessary to place them in a cold bath or sponge them down with tepid water and then fan them off – We call this active cooling and it is reserved for the treatment of hyperthermia (remember, external heat). Instead, just focus on keeping them comfortable.

It is expected that they will start to get better with this simple management over the course of the next two or three days. But if you notice they are getting worse or not improving – please see a doctor. It’s important to find the underlying cause of the fever.

Consider popping down to sit in on one of our Children’s First Aid courses, where you can ask more questions and get some hands on training with our paramedic trainer in relation to other common child related injuries and illnesses

Alicia White
Alicia White

Registered Paramedic - Perth, W.A.