Dr Suresh is a GP and skin cancer doctor in Brisbane, and patients can book with him at this link

Those who follow me on social media may have seen my tweet last night about paracetamol vs ibuprofen in my daughter, highlighting that ibuprofen always seems to work just that bit better to make my kids feel better. She still has some temperatures today, which brings me on to this installment today – how to manage fever in children.

Fever is a useful thing. To a point. Raising the core body temperature can help to fight off infections, however as with everything we can have too much of a good thing. A little fever, can be beneficial, and most children won’t be too affected by this, but of course once temperatures reach higher levels it can become either uncomfortable, or dangerous. The main concern that we have as doctors, and of course as parents, is febrile convulsions. I’ll post about this another time, but if you wish to read more on it, further information can be found here. Interestingly though despite what you would think, evidence shows the use of Paracetamol and Ibuprofen does not reduce the risk of febrile convulsions.

So what then is the point of managing fever? Well primarily to make the patient, our children, feel better. Think about the last time you were unwell. A chest infection or flu-like illness for example. How amazing did you feel when you had a high fever? Probably not very I’d wager. That’s how your kids feel with high temperatures too (although sometimes they will be happy as larry and running around gleefully with a temp of 39C).

Ok so how do we manage fever? How do we make our kids feel better?

There are some guildelines on Fever Management, but most importantly first of all, before anything else, we need to be happy that they don’t have a serious illness. If in doubt, take them to see their GP. If any red flags are present, such as a non-blanching rash (doesn’t go clear if you press on it), your child is blue or grey, or they are extremely lethargic or floppy, then you need to be calling an Ambulance for an immediate assessment. If in doubt, call the ambulance service (Australians it’s 000, UK it’s 999, US it’s 911 – other countries please check your local emergency services).

Ok so we are happy they aren’t seriously unwell, or they’ve already been seen by a doctor. How do we manage fever?

Well local guidelines may differ, but generally the principles of fever management are:
– Anti-pyretic medications (parecetamol and ibuprofen) – dosed on age or weight (if in doubt ask your GP or pharmacist)
– Paracetamol and/or Ibuprofen (recommended to avoid in certain conditions such as Chicken Pox) if your child appears distressed. If they are happy, alert and active, they may not need it and you may be better to hold off
– Single piece of cool light clothing
– Avoid under or over dressing children
– Tepid sponging (damp clothes/wet sponges) is not recommended
– Cold showers/baths are not recommended
– Sitting in front of a fan or AC unit is not recommended
– Regular fluids (high temps increase fluid loss through sweating)

The last thing is undoubtedly the hardest. Try not to worry about the actual temperature.

What? You mean don’t measure it and don’t worry about the number?

Well certainly measuring the temperature can be helpful at times, but it is more important, and far more useful to monitor and observe your child, rather than their temperature. A child with a temperature of 39, running around happily, playful and alert, is less of a concern than a sick child with a temperature of 37.5 who is lethargic and floppy.

The question I probably get asked the most about fever in children is ‘at what temperature should I worry?’ Well there isn’t really a specific temperature at which you need to act immediately. More important is how is the child as above. Having said this, a child under 3 months with a temp of 38C or more, or a child 3 – 6 months old with a temp of 39C or more needs an urgent assessment. Generally speaking a neonate (under 1 month old) with a temp over 37.5C needs an assessment also.

So hopefully after reading this you can all feel a little more confident about managing fever in your children, but if you have any further questions please get in touch or speak to your local GP.

Dr Suresh is a GP and skin cancer doctor in Brisbane, and patients can book with him at this link

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