EDP column by Professor Ketan Dhatariya

“My 1 year old recently had a very high fever at 39.80C. I gave her paracetamol but that only brought it down a bit. What else could I have done?”

Children get viral infections commonly. Before the age of 2 or 3 months they have the protection of antibodies that were transferred from their mother before birth, but after that, they need to build up their own immune systems. That is why the immunisation programme starts when it does.

When we get an infection, the body produces an immune response. This includes the infection fighting white cells gathering to try and fight off the virus. To do this, the infection fighting cells produce chemicals that raise the body’s temperature. A normal body temperature is about 37oC. The rise in temperature is normal, because it allows the infection fighting cells to work more efficiently. In adults, this rise in temperature may be mild, because we have ways of regulating our temperature, such as removing our clothes. We also have a greater body surface area from which to radiate heat. Babies and children cannot do this as efficiently and they can get very hot, very quickly. This is why they can become irritable, flushed and tired. The best way to take a child’s’ temperature is to use an infrared ear thermometer – but these can be expensive.

Very occasionally, a child may have a seizure if they have a high temperature. This is known as a febrile convulsion. It can be very frightening, and can last for several minutes. Thankfully, they usually do not have any long term consequences, but the child may be prone to them in the future. They often run in families.

The best way to keep a child’s temperature down is to give them regular paracetamol (e.g. Calpol) and undress them in the first instance. You may wish to also use ibuprofen for children. Use the ones designed specifically for children. It is important never to give them more that the stated safe dose. Remember never give to aspirin to a child under 16 years old.

If their temperature still does not come down, you can use tepid sponging of the head. This involves using warm – but not hot – water. This allows the skin to evaporate the water away, so taking the excess heat with it. It is important not to use cold water, because then the blood vessels in the skin will close down and the heat will be kept in, making things potentially worse.

In those few hours and days, life can be very miserable for the parents and for the child. It is always difficult to know when to call the doctor, but when you have any concerns ask them for help.

For more information about High Fever click these links:

http://hcd2.bupa.co.uk/fact_sheets/html/fever.html

http://www.patient.co.uk/showdoc/23068835/