Fevers in Children
Fevers are good. Fevers are not dangerous. Fevers do not need to be treated. Usually.
Like with coughs and colds, fevers are a big reason kids come to a doctor. Most of the worries aboutnfevers are based on myths and memories of a world before vaccines (clean water, reliable food, indoor plumbing, etc.).
There are lots of not-quite-right beliefs about fevers.
Fevers don’t always disappear with medications – typically they only decrease by 1-1.5 degrees C. Fevers don’t just worsen if a medication is not given, and it’s normal for them to recur for several
days after a dose of paracetamol or ibuprofen wears off.
A high fever (>39.5) does not mean it’s a more serious infection.
In most cases, tests do not help determine if a fever is dangerous and are unnecessary. Pain with urination? A urine test is needed. Full blood counts (FBCs), nose swabs, and polymerase chain reaction (PCR) tests? Rarely helpful and usually only confusing – a high white blood cell count does not mean you have a bacterial infection!
There are some worries, of course.
Fevers can cause seizures, especially in children around age 1 year. The risk is about 4% at most, and except in rare cases is harmless and resolves as your child gets older, and does not cause brain damage or any developmental problems. They are terrifying to see but not harmful. They normally last less than 5 minutes.
When to worry about fevers?
When to worry about fevers? A child under a month old always needs to be seen. The main concern is pain or overall appearing very unwell. A fever with ear pain, chest pain, or pain with urination typically should be looked at – so a very young child who can’t talk yet or describe the pain, we usually see just to be sure it’s OK to wait. Fevers that worsen are concerning, and fevers past 5 days. Many times, we will see it just for reassurance it is harmless, especially if travel is nearing or a holiday/weekend coming.
If your child has not been fully vaccinated, fevers are more worrisome. For most children the reason to come see a doctor is not the fever, it is how your child looks overall.
So, what about “unwell”? That’s pretty subjective. And it’s common to feel awful on the first day of a fever. There is no universal rule, it’s parents’ knowledge of their child and experience, and a pediatrician’s experience with decades of seeing children.
About Author
This article is written by Dr Leo Hamilton, who is a US board-certified Paediatrician since 2003. Dr Leo relocated to Singapore in 2011, caring for expat and Singaporean children from newborns at delivery to teenagers. Beyond his background in Hematology/Oncology, he has an interest in asthma, behavioural issues (primarily ADHD), teen health, and modern management of routine childhood illnesses such as ear infections, bronchiolitis, and pneumonia.
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