Fever is a symptom of much concern for every parent. It can create insurmountable fear among caretakers. Obsession to bring down the temperature can draw the attention away from what truly matters in the care of a child with fever. Parents may have different definition of fever from health care providers. Our body temperature fluctuates throughout the day (a swing of as much as 1.7°C) and doctors generally do not consider a child to have fever unless the body temperature reaches 38°C.
There are various methods and types of thermometers to measure body temperature at different parts of the body, giving rise to more confusion to parents. Temperature can be measured by placing the thermometer in the rectum (most accurate), armpit (least accurate) or under the tongue. Fever strips and pacifier thermometers are inaccurate. Thermometer placed in the ear canal is unreliable for temperature measurement of infants less than 6 months old. The forehead thermometer is reliable for all ages.
Fever is commonly caused by infections but there are other causes of fever which are not related to infection, for example cancer, autoimmune disease and even teething. In the event of infection, the body temperature is raised due to higher set point in the brain. This is a mechanism to disable the enzyme function of bugs which are responsible for infections, retard bacteria growth and enhances our body immune system to fight the infection. However, when fever is too high, it gives rise to metabolic stress, increases consumption of energy, and may lead to dehydration.
When a parent sees that his or her child has high-grade fever, one of the commonest comment is that it will lead to brain damage. This is utterly untrue and unfounded. Brain damage due to fever is considered a myth. What is more important is to look for the underlying cause of the fever.
“Fever is directly related to death”. Another false claim by many lay people. It is the underlying disease process that leads to death. And the height of temperature alone is not always related to disease severity. Fever also does not predict that seizure will happen in a child, even if the child has history of febrile convulsion (a condition where the child develops seizure in the presence of fever).
There are people who routinely recommend giving paracetomol (a type of fever medicine) for children who had vaccination in order to prevent fever. Such practice may blunt antibody response to the vaccination received earlier. Even if there is fever after vaccination and the child appears well and not disturbed by it, the fever can be left alone because most of the time it is self-limiting.
Having mentioned all these, fever should still be treated if it causes the child to be uncomfortable or dehydrated. The aim is to keep the child as comfortable as possible and not treat the fever at the expanse of the child’s comfort. There is really no point to force fever medicine down the throat of the child or insert medicine into the anus if the child is feeding well, active, running about and is unaffected by the presence of fever. These can be traumatic for the child. And imagine if we do that, it will create an uphill task for us to ensure the child to take other more essential medication like antibiotics.
There are times that parents give oral paracetomol to a child regularly (4 to 6 hourly) but the fever never really subsides. In fear of myths such as fever causing brain damage, death or seizures, they give further doses of paracetomol into patient’s rectum, not realizing that this may cause overdosage and liver toxicity. Sometimes alternating different type of fever medicines may help but it increases chances of inaccurate dosing or overdosing. Different types of medicines should not be combined because of potential toxic effects when given together.
One common practice is to perform tepid sponging on a child with high fever with the sole aim to bring down the high fever. In essence, this can only be detrimental to the patient. This is because the brain which is functioning like a thermostat had already been trying very hard to regulate the body temperature at a higher set point but over enthusiastic and ignorant caretakers and even some health care providers (sorry to say) decides to overcome this natural phenomenon by fully exposing and sponging the child with water (sometimes with ice cold water). This in turn will lead to severe shivering, increased metabolic rate and energy consumption of muscles. Imagine if we walk into winter naked and without clothes. This is the exact experience that our children will get when they have fever and have to undergo this awful experience of tepid sponging. This method is outdated and certainly not recommended in the management of a child with fever. All the child needs is some loose clothing and fever medicine combined with care and love from all of us, of course with some awareness as well.
In summary, the temptation to treat fever as if it were the noxious culprit of all childhood febrile illness can be great, even to health care providers, but we cannot lose sight of what science has taught us, that is fever is only a sign, a part of many other symptoms of a real problem. If we succumb to such temptation, then we are treating our children less for the benefit and more to allay our own anxieties as parents. A sleeping child should not be awaken solely to be given fever medicine.
(written by Dr Ng Khuen Foong)
Dear Dr
I worry about your flat statement “no tepid sponging “. How does a parent manage a fever thst is pushing 40 and the child is shivering (with loose clothing on and now tepid sponging initiated yet ) ? Thanj you
Probably the shivering is caused by much lower external temperature and use of tepid sponging to bring the temperature down too fast. In any case, with such high fever, antipyretic medication would be very helpful to reduce the temperature and of course it must be accompanied by treatment of underlying cause of fever illness.
Hi Dr,
I have problem similar to the above but i still have few questions for your advice.
My daughter is now 20 months. She started to have fever 5 days ago. The fever was up and down through out the days. But it will spike at 8pm and in the midnight about 2pm (similar to one of the parents mentioned above).
My questions are:
1) Can i continuously giving her fever medicine for so many days? What is the side effect?
2) I think the medicine which was used to put inside her rectum is very effective. May i know is there any side effect? How frequent can i use it?
3) Why would her fever continue for so many days? Shall i be worried? When should i bring her to see Dr again if not yet recover?
4) Shall i give her fever medicine during the day if there was no fever? This is because she would suddenly have fever in the middle of the night.
You need to follow the recommended prescription of fever medicine. You cannot give too frequent or too high dose. Read the prescription slip or drug insert. After giving rectal medicine, the oral dose should be omitted, if not it will cause overdosageand organ toxicity. Once fever subsides for 24 hours, you can continue fever medicine for another day and then you can stop. You seemed to mention only about the fever but not your daughter’s otherwise wellbeing. Since you are so worried and fever is more than 5 days, you should seek medical attention from your doctor.
*comment notification *
doc, my daughter has fever since 6days already. we’ve bring to normal clinic twice, 1st when 2nd day of fever which is her temperature reach 39degc. and 2nd time is on her 4th day and this time we did the blood test for dengue and she is negative.
however, i am very concern because even we consistently given her medicine, she doesn’t show any improvement of recovery. her fever pattern only attack her at night, usually at 8 pm and above and also midnight at 2am++ . we just continue sponging and giving her the medicine provided by the clinic every 4 hrs (type brufen/ibuprofen). not to forget she also shaking and her leg and hand also cold. but she doesn’t have flu and cough. just her body temperature is so high sometimes reaching 39degc.
so my question is, is this normal? should i bring her to paed or child specialist? or just continue with medicine. i am very worried now. and don’t know what to do. btw, my daughter is 18 months. and still consider active during days. and very weak at night.
Sorry for the late reply. In any case if the fever is prolonged, please seek medical attention from pediatrician.
If it is common cold, don’t worry about the fever if your child is not disturbed by the fever. But look out for signs of worsening illness or a condition other than common cold. Please consult your doctor if the fever doesn’t resolve, there is worsening symptoms or development of new symptoms.
Even if it is due to influenza, the treatment for it only had marginal benefit, especially if it is short lived and there is no extension to the lungs. Please get advice from your doctor.
doctor, my son has fever since yesterday. I have brought him to one of the child clinic at TTDI and the result is just flu. His fever symptom is the neck and body portion are very hot 37.8 celcius, forehead only 36.9 celcius. Paracetamol given, but less than 4 hours, the fever is back. He is having light cough too. Please advise what should I do? Can it be influenza?
So we now not need to tepid sponge?thanks for this doc!
Tq so much for this article. I do have some queries though. My daughter used to have fever, sometimes viral fever all throughout the 1st year of her life. Doc asked us to give meds (PCM) every 6 hours. However sometimes we noticed her temperature spiked within 4 hours and because she was crying and we suspect she was uncomfortable, we medicated her as well as sponging her (which i now learnt is not recommended). is this ok? did we do any damage to our daughter?
our parents told us to give meds even though temp was not high because they were scared that our child could get fit. is this true? doctors told us the same thing too.
Giving too much of and too frequent medicine to our children if not in accordance to doctor’s prescription can cause harm. If your daughter is well now, I don’t think so that there is any permanent damage done. For your last question about fits, please refer to the article.
this article actually help relieves some of my anxiety! recently my 7mo daughter had a viral fever (im not sure what is the correct term, small red spots appear all over her body and i asked the doctor for a blood test, he said that the fever was due to virus). her temperature sometimes spike up until 39.7’C and the fever continues for a week with occasionally very high temperature. am i doing it right by giving her fever medicine every 6 hours during that 1 week? because i noticed that sometimes, even after 6 hours, her temperature is not that high, she is active, she drinks her milk and are eating, but the doctor told me to keep doing it until im sure that she is cured from her viral fever. currently, she still coughs occasionally and had runny nose every morning but i decide to only give her medicine if it is truly necessary..
I admire your courage. If the child is willing to take the medicine prescribed by the doctor at the correct dose and frequency, then it’s alright to continue the medicine but DO NOT OVERDOSE even if the fever recur before the next dosing. But if the child refuses medicine and he is well, then I would just watch. Agree with you when you said that you give medicine only when truly necessary.
We will work on it. Thank you.
It is possible to have this article in Bahasa Malaysia? I think this is a very useful information. Thank you.
Thank you for the helpful information.
Let’s say the fever reaches 39°C and the child is still active and playing as usual, should I be worried and give him paracetamol?
You should search for the cause of fever and give the fever medicine if he is willing to take it. I am not surprised if you are worried even after reading my article because I do understand since I am a parent myself. But please don’t be overly worried if he remained active and feeding well. Bring your child to visit your doctor if you have any doubt.