My baby girl was SO sick this past week. The boys have been bringing home all sorts of germs from kindy, and it was only a matter of time before Mia picked up some of those germs. What is it with brothers smothering their sister and popping their fingers in her mouth?? Don’t they get that she doesn’t love it?! :)
At the peak of her illness, Mia had a 40.5°C temperature. I knew this was getting dangerously high. Anytime a child has a temperature over 40°C (104° F) that is a red flag and it’s time to get them to a doctor ASAP. So I knew I had to try and get the temp down. I was taught at University to give Paracetamol (commonly Panadol, or Acetaminophen in the US) or Ibuprofen (commonly Nurofen) to help reduce the temperature. With my first two children I would have automatically turned towards this solution and dosed with pain medication. However, these days I am much more reluctant to just reach for medication (the reasons behind this I will explain in a minute). A good friend of mine, a nurse, called me to check how Mia was going. I told her she had a 40.5°C temp and her response was “Are you doing alternate dosing with Panadol and Nurofen to keep the temp down?”. I could hear in her voice that she was horrified when I said that I hadn’t given any pain relief. I was in her shoes only a few years ago, when my traditional pharmacist training was all that I knew. But the guidelines for controlling a temperature have changed, and it got me thinking, how many other parents out there are following the old school of thought on this one.
So here you go. This is how you treat a fever, based on the latest research and keeping in mind natural options where possible.
1. What causes a fever?
The presence of a fever usually signifies that the body’s immune response is activated and is fighting an infection. A fever is a positive immune response to a virus or a bacteria that has entered the body. By increasing the body temperature, it makes the body less favourable for the nasties to set up camp, replicate and spread throughout the body. Our body really is an amazing and sophisticated being! So allowing the body to have a mildly elevated temperature can be a good thing by giving the immune system a chance to fight the nasty invaders. It is thought that by lowering the temperature with pain relief medication, that you can interfere with body’s natural immune response and can prolong the illness. A fever will usually go away within a couple of days.
2. What is a normal temperature?
A “normal” temperature can vary from person to person, and can also vary throughout the day. Body temperature is lower in the morning and higher in the afternoon and evening. Normal can be anywhere from 36.1-37.2°C (98.6° F). It is a good idea to check your child’s temperature when they are well so you know what their baseline is. It’s also helpful to work out how to use your thermometer BEFORE your child is sick. Trust me, I’ve been there! It’s not fun for anyone trying to work out how to use the goddamn ear thermometer at 1am with a screaming, miserable baby and a very stressed out Mumma and Dadda!!!
3. When is a fever too high?
A fever is considered to be anything over 38°C (100°F). Fevers are very common in childhood illnesses and a fever alone is not cause for alarm. It is very important to monitor the temperature regularly (I usually measure hourly), and to record the temperatures. It is amazing how easy it is to forget what happened earlier in the day when you are sleep deprived, and nursing a sick child (you’ve all been there right?).
4. How to treat a fever?
According to latest research, there is no benefit in lowering a child’s fever, except to provide comfort to the child. These are important tips to remember when trying to manage a fever:
- Give plenty of water, a child can become dehydrated very quickly
- If your child is under 6 months old, give extra breastfeeds or cooled, boiled water.
- If your child is older than 1 year, you can give oral rehydration drinks or ice blocks such as Pedialyte, Hydralyte or Gastrolyte. I like to use the ones without any added colouring.
- Do not worry if your child refuses to eat while they have a fever. Keeping up fluids is the most important thing.
- Keep your child cool by dressing them in light clothing. Enough so they aren’t shivering. Keep the room temperature cool and only use a sheet or a light cotton blanket when sleeping.
- You could try giving a tepid bath (the water should be luke warm NOT cold). This can be effective in helping cool the body but can cause discomfort in some children.
- A cool face washer on their forehead may bring relief
- Plenty of rest. Allow your child to rest and sleep as needed.
- Monitor your child for any signs that they are getting worse and contact your doctor immediately
5. When to use pain relief?
Paracetamol (Panadol or Dymadon) and Ibuprofen (Nurofen) are pain relief medications that can be used for their anti-pyretic effect (lowering a fever). As mentioned above, the latest guidelines recommend there is no benefit in lowering a fever except to provide comfort to your child. Remember, allowing the body to have a slightly elevated temperature is important to fight the invading nasties in the body.
If however, you feel that you need to give medicine to help with your child’s discomfort these are the recommended guidelines:
- If the fever is above 38.5°C and your child is miserable or has other symptoms such as a sore throat or sore ear, they may be given pain relief.
- Follow the correct dose according to your child’s weight on the bottle or packaging.
- Paracetamol can be given every 4 hours as direct on the bottle. No more than 4 doses should be given within 24 hours.
- Paracetamol is a common ingredient in other medicines. Be sure when giving paracetamol to your child that they haven’t had any other medicines containing paracetamol within the last four hours.
- Ibuprofen can be given every 6-8 hours as directed on the bottle. No more than three doses in 24 hours should be given.
- Ibuprofen is best given with or soon after food
- If your child has asthma, Ibuprofen may cause wheezing. It is best to give Paracetamol
- It is ok to alternate dosing of Paracetamol and Ibuprofen. The latest research states that there is inconclusive evidence that alternating doses has any better effect on reducing the fever, than dosing with either Paracetamol OR Ibuprofen. Alternating doseing does however provide good relief of discomfort in the child.
However, it is easy to accidentally give too much of either medicine. It is important to keep a diary of dosage times and make sure you do not exceed the maximum dose in 24 hours.
6. When to seek medical advice?
- If your child is under 3 months old and has a temperature over 38°C
- If your child has a temperature above 40°C and it does not lower after trying any of the options above
- If your child has not improved within 48hrs
- If your child has any of the following symptoms with their fever:
- Complaining of a stiff neck or light hurting their eyes
- Vomiting and refusing to drink (they can get dehydrated very quickly)
- A rash
- More sleepy than usual
- Problems with breathing
- Or if your child is in pain
When in doubt contact your GP, 13 HEALTH (in Australia) or your emergency department for advice. A new service has launched in Australia called Doctors on Demand, which might be handy for you and your family. You can instantly have a video conference with a GP. I've used it, it's simple and easy to use, and so handy when you either can't, or don't want to bundle everyone into the car to visit the doctor.
I hope this helps you navigate with a bit more clarity and confidence the next time your bubba is sick.