A high temperature, commonly referred to as fever, is one of the most frequent symptoms in children. It is typically defined as a body temperature of 38°C (100.4°F) or higher. Fever is not a disease in itself but a clinical sign that indicates the body’s immune system is responding to an infection or other underlying cause.
Causes of Fever in Children
Fever in children can arise from a wide range of conditions:
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Infections (most common cause):
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Viral infections: influenza, common cold, roseola, COVID-19, chickenpox, hand-foot-and-mouth disease.
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Bacterial infections: ear infections (otitis media), strep throat, pneumonia, urinary tract infections, meningitis, sepsis.
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Non-infectious causes:
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Recent immunization (post-vaccination reaction).
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Autoimmune or inflammatory conditions (e.g., juvenile idiopathic arthritis, Kawasaki disease).
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Malignancies (rare, but possible in persistent unexplained fever).
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Heat exhaustion or dehydration.
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Clinical Features
Children with fever may present with:
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Warm or hot skin, flushed appearance.
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Sweating or shivering (rigors).
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Irritability, fussiness, or lethargy.
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Poor feeding in infants, decreased appetite in older children.
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Increased heart rate and breathing.
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Associated symptoms: sore throat, cough, ear pain, vomiting, diarrhea, rash, or drowsiness depending on the cause.
Diagnosis
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History: Onset, duration, associated symptoms, recent contacts, travel, and vaccination history.
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Examination: Measurement of temperature (oral, tympanic, rectal, or axillary), hydration status, rash, signs of respiratory distress, meningism, or localized infection.
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Investigations (if clinically indicated):
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Blood tests: CBC, CRP, cultures.
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Urinalysis and urine culture (especially in infants and toddlers).
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Chest X-ray if pneumonia suspected.
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Lumbar puncture in suspected meningitis.
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Management and Treatment
Most fevers are self-limiting, particularly when caused by viral infections. Management depends on the underlying cause and the child’s overall condition.
1. General Care:
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Ensure hydration: encourage fluids (oral rehydration solutions in small children).
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Lightweight clothing, comfortable room temperature.
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Rest and monitoring.
2. Medications (antipyretics for comfort, not for routine lowering of fever):
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Paracetamol (Acetaminophen):
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Dose: 10–15 mg/kg every 4–6 hours (maximum 4 doses in 24 hours).
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Ibuprofen (in children over 3–6 months, if not contraindicated):
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Dose: 5–10 mg/kg every 6–8 hours (maximum 4 doses in 24 hours).
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Avoid aspirin in children due to the risk of Reye’s syndrome.
3. Antibiotics or antivirals:
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Only if bacterial infection or specific viral illness is confirmed or highly suspected.
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Common examples:
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Amoxicillin for bacterial ear or throat infections (doses vary by age and weight).
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Ceftriaxone IV for severe infections (e.g., sepsis, meningitis).
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Oseltamivir for influenza in high-risk cases.
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Red Flag Symptoms (Seek urgent medical attention if present):
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Fever in infants under 3 months (≥38°C).
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Fever persisting >5 days.
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Severe lethargy, difficulty waking, persistent irritability.
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Breathing difficulties, fast or labored breathing.
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Convulsions (febrile seizures).
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Rash that doesn’t blanch under pressure (petechiae or purpura).
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Stiff neck, severe headache, photophobia.
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Signs of dehydration: dry mouth, no tears, sunken eyes, reduced urine output.
Precautions for Parents
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Do not overdress or heavily blanket the child.
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Do not use cold baths; tepid sponging is rarely recommended.
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Monitor temperature regularly.
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Avoid unnecessary antibiotics for viral infections.
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Ensure all vaccinations are up to date.
Drug Interactions and Considerations
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Paracetamol: relatively safe, but overdose can cause liver toxicity. Caution in children with liver disease.
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Ibuprofen: avoid in children with dehydration, kidney disease, or history of gastric ulcer.
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Combining paracetamol and ibuprofen may be used in alternating doses under medical supervision, but routine combined use is discouraged.
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