Fever in Children

Fever occurs when the body’s temperature is elevated as a result of the body thermostat being reset to higher than usual temperature.

What group of children is to be labelled as having fever

Digital thermometer readings

1. Armpit/oral temperature > 100° F
2. Rectal temperature > 100.3° F

1. 0-5 years – Armpit or Rectal
2. More than 5 years – Oral

1. Rectal digital thermometer temperature is mandatory in
1. 0 to 3 months of age
2. When armpit temperature is between 99° F to 100° F
3. In hospital settings in children less than 5 years.
2. It is not correct to estimate a child’s temperature by feeling the child’s skin.
3. Plastic strips and pacifier thermometers can be highly inaccurate to measure temperature.
4. Temperature measured in armpit by digital thermometer and temperature measured by forehead ultrasonic thermometer is not very accurate.

1. 0-3 months child with temp greater than or equal to 100.4 even if appearing well
2. 3 months to 1 years child with rectal temp greater than or equal to 101° F
3. 1-3 years child with rectal temp greater than or equal to 102° F
4. Child greater than 3 years with armpit/oral/rectal temperature > 103° F
5. Children (0-6yeras) with previous history febrile conclusion (fits following fever) with greater than or equal to 100.4° F.
6. Child with ill appearance of  0-3 years even if temp is greater than or equal to 100.4° F by rectal route.
7. Children with fever along with new skin rash.

Management of Fever

1. Paracetamol (Acetaminophen) is drug of choice 15mg/kg per dose and can be repeated after 4 to 6 hrs. It cannot be given more than 90mg/kg/day (4gm/d) and so with the recommended dose of 15mg/kg, paracetamol can be maximally given 6 times in a day provided one does not cross more than 4gm in 24 hours.
2. Increase oral fluids in the form of WHO ORS Electrolyte drinks, frequent mother feeding or formula milk feedings.
3. Lukewarm water sponging if temperature is >102° F
4. Complete body bath in case of temperature greater than 103° F
5. Avoiding undue Exertion & allowing child to rest or sleep.

1. Paracetamol is available as
   1. Paracetamol drops (1ml=100mg)
   2. Paracetamol suspension 5ml=120mg
   3. Paracetamol suspension 5ml=240mg
2. Dose Calculation
1. Normal Paracetamol dose Weight of the child X 15mg = mg of paracetamol to be given at one go Can be repeated after 4hrs provided one does not exceed more than 4gm/day.
2. Maximal single dose is 20mg/kg i.e Weight of the child X 20= mg of paracetamol at one go.

   My Personal Experience

1. It is always better to take rectal temperature in children 0-5 years of age and oral temperature in children greater than 5 years of age.
2. Luke warm water sponging of whole body is essential in temp >102°  (0-3years) and in temp >103°  (>3 years)
3. Whole body wash is mandatory with luke warm water if temp is greater than > 103 (0-3 yrs) and 104° (>3yrs)
4. Shivering in a child already going through fever episodes, is an early sign to clinically foresee where temperature is going to rise to > 102°F within 20 minutes of start of shivering, even if the temperature at the beginning of shivering by rectal route is < 100.4. So treat it effectively then and there only.
5. Child with fever episodes having forehead and stomach area very warm to touch along with palms and soles cold to touch, is another sign where the fever will mostly be greater than 102° F.