Fevers and fits
ParentsCentre's expert Dr Stuart Flanagan continues his series of articles with a piece on fevers and fits. Dr Flanagan is an experienced physician who also works as a contributor and medical adviser for a number of BBC projects - you can download his biography at the bottom of this page. He will be writing monthly articles for the site, including bedwetting, Sudden Infant Death Syndrome, discussing contraception with teenagers, acne in adolescence and common diseases in childhood.
Fevers and fits
In this column, I'm looking at how to deal with one of the most common symptoms of illness in childhood - fever. Around five per cent of children will develop a seizure in conjunction with a fever (known as febrile convulsion) and in the second half of this article I'll explain exactly what they are, and how to manage them.
Fever
Fevers, or pyrexia, are very common when we are ill and are part of the body's defence system in fighting infection from bacteria and viruses. The slight rise in core temperature reflects the body's defence system being activated and helps to make the body's environment more hostile for the infective organism. Therefore when we're treating infection, we should aim to make a feverish patient more comfortable without causing their temperature to plummet quickly.
In children, the part of the brain that controls temperature (the hypothalamus) isn't fully developed, and so children can experience a wider variation in body temperature than adults. However, normal core body temperature for children is taken to be 36.0C to 37.0 C.
A temperature between 37.0oC and 37.5oC could be considered a low grade fever, but usually a value of >38oC designates a raised temperature. Illness can cause a fever of up to 40oC.
Most fevers in children are caused by simple colds or viral illnesses, but if their fever persists or they have other symptoms, you should seek medical advice.
Don't forget that in children, illness is not the only cause of a fever - their temperature can go up if they are overdressed or bundled in warm bedclothing. Vaccinations can often cause a temporary rise in body temperature too.
How do I know my child has a fever?
Your child will probably be symptomatic - irritable, crying, sweating, perhaps with a hot forehead, or may even feel clammy. The simplest way of measuring temperature is using a digital thermometer, which can be bought over the counter in any pharmacy. These are best used to read the temperature in the rectum, which is a better measure of core body temperature than the forehead or armpit. They can be used to take an oral temperature if your child is over four years old. An oral temperature is about 0.5oC less than core body temperature. Here's a quick guide should you wish to take either the rectal or oral temperature (no need to take both!):
Taking the rectal temperature with a digital thermometer
- lie your child tummy down on your lap
- put some lubrication (eg Vaseline) on the thermometer tip and at the opening of the bottom (the anus)
- gently insert the tip of the thermomenter inside the anus to about ½ -3/4 inch - don't force the thermometer if there is any resistance
- keep your child still until the thermometer bleeps, having made a recording
- take the reading and remove the thermometer - fever is 38oC or higher with a rectal reading
Taking the oral temperature with a digital thermometer
- make sure your child hasn't eaten anything for the past 10 to 20 minutes
- place the thermometer tip underneath one side of the tongue towards the back
- ask your child to close their mouth and breathe through their nose until the digital thermometer bleeps
- read the value and remove the thermometer. A fever is 37.5oC or higher with an oral reading
How do I treat a fever?
Firstly allow your child to cool down gradually - they will be more comfortable sitting in just their nappy or underwear. If they start to get shivery (actually a sign of temperature rising), cover them with a light blanket as they cool down. As they'll be losing fluid through their sweat, offer sips of water regularly.
Paediatric preparations of Paracetamol (e.g. Calpol) is the recommended drug to reduce fever. Read the box carefully for instructions on dosage, which will depend on age and weight. For most children this will be 10 to 15mg/kg every four hours.
NEVER give Aspirin to a child under 16 years old - it has an association with Reye's Syndrome in children - a rare but potentially fatal condition.
Let your child rest in bed if they feel tired.
If your child's temperature is higher than 40oC, bathe your child with lukewarm water, which will help them feel more comfortable. However, you should offer them a dose of Paracetamol first.
Should I call a doctor?
Not all fevers need to be treated. But you should certainly call for medical advice if your child exhibits any of the following:
- a fever at aged less than six months old
- a persistent fever of more than 38oC for more than 24 hours
- poor oral and fluid intake
- headache, earache or other pains
- recurrent vomiting or diarrhoea
- inability to tolerate bright light
- lethargy
- persistent irritability
- any new rash or spots on the body or limbs
- stiff neck
- seizures
Remember, if you're not happy with your child's health, ask your doctor for help.
Febrile convulsions
Febrile convulsions (or fever fits) are seizures which occur when a child experiences a rapid rise in temperature. Around 1 in 20 children experience febrile convulsions, which typically occur between the ages of six months and five years.
A fit usually occurs because an individual with a lower seizure threshold (usually determined genetically) endures a trigger factor (e.g. a rapid temperature rise). A child is more likely to suffer a febrile convulsion if their parents also had them as children, and if they are susceptible to recurrent infections.
However, febrile convulsions in childhood do not mean your child is at any greater risk of developing epilepsy later in life. Indeed, the vast majority of children have grown out of febrile convulsions by school age thanks to the full development of the part of their brain responsible for thermoregulation.
What happens during a febrile convulsion?
Witnessing a fit is a distressing experience for any parent. Usually the fit will occur after your child has started to show symptoms of a high fever - they may be sweaty and agitated. The child will lose consciousness and look pale. Their limbs will stiffen and head may fall back. Then the arms and legs will start to jerk in a random, agitated fashion. This seizure activity may last for a few minutes and will gradually start to subside. The child's colour will start to return to normal.
What should I do?
Fits can be distressing so firstly don't panic - try to stay calm. Place your child in a safe environment (e.g. soft bedding) so that they won't harm themselves when they are jerking about. Gently rest your child's head to the side to keep the airway open and prevent them choking. Stay with your child and try to time the length of the seizure. Note your child's colour and look.
Your child will need to be assessed by a doctor so call them as soon as the fit subsides. If the fit lasts for five minutes or longer you may need to call an ambulance, as the child may require treatment with a small dose of rectal diazepam to terminate the seizure.
If your child has a fever after the seizure, follow the advice above about the management of a fever.
Many children are admitted to hospital for 24 hours of basic observations and tests after a seizure, so don't be alarmed if your doctor advises this. Around 50 per cent of children who have had a febrile convulsion will suffer another the next time they have a fever or infection, but the risk of further fits decreases with time. Also, a history of febrile convulsions does not put your child at any increased risk of epilepsy in later life.
Stuart
Flanagan's biography
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