Fever in children Written by Dr Stuart Crisp, paediatric specialist registrar and Dr Per Grinsted, specialist Temperature control in the

body The 'core temperature' means the temperature of the deep tissues of the body and in normal circumstances this is kept at a very even level by a range of automatic adjustments. When we are too hot we increase the amount of blood flowing through the skin by opening up the tiny capillary blood vessels. This radiates away excess heat and sweating can further enhance this. When we are too cold we shut down skin blood vessels and conserve heat within the internal organs. If necessary we can generate more heat by shivering. Fever is part of the body's defence mechanism against viruses or bacteria. The body tries to create extra heat so that the foreign organism cannot survive. Having a temperature helps you fight illness. Actions to reduce a fever can help make someone feel more comfortable but it is not possible, or desirable, to aim to normalise the temperature while someone is fighting off an infection. The part of the human brain that controls body temperature is not fully developed in children. This means that a childs temperature may rise and fall very quickly and the child is sensitive to the temperature of his or her surroundings. One of the simplest and most effective ways to help a child with a fever feel more comfortable is to take off some of the child's clothes so heat can escape from their body more easily. What is the normal temperature for a child? If you take the temperature in your child's mouth or from the ear, the normal temperature is 36-36.8C (97.7-99.1F). Thermometers Traditional mercury thermometers are being phased out although many are still around. Mercury is a highly toxic substance if taken into the body, which can be done through skin contact, breathing in the vapour or swallowing it. All these risks can apply to the fragile glass thermometer if it is broken, for example by a child biting it. If you have a mercury thermometer, check with your local council how to dispose of it safely.

Modern probe-type digital thermometers are quicker to use, more reliable and are much safer if bitten. Taking a child's temperature A body temperature reading can be taken from the mouth, armpit, ear, skin surface or the rectum. Although a rectal temperature reading is the most accurate and is quite often used in hospital it is not necessary to be so precise when taking temperature readings at home. Rectal temperature reading is therefore not recommended for home use. Rectal temperatures are the closest to 'core' temperature and are about 0.5C (2F) higher than readings taken from the mouth or ear. Temperature readings from the armpit are not very reliable and are about 0.5C lower than mouth temperature. Temperature tips You can take a reading: from your child's mouth under the arm in the ear using a forehead strip.

Thermometer strips that are placed on the child's forehead are popular and give a rough guide.

Most of the time the exact level of a childs temperature is not particularly important, unless it is very high (39C or over). In practical terms the temperature reading will be enough to give an indication of whether a fever is present. Ear temperature If you are willing to pay for an ear thermometer, this is a very quick method and will give a read-out in seconds. Ear thermometers rely on measuring infrared (heat) radiation from the eardrum. Other types of thermometer (such as the probe type) are not suitable for taking ear readings and must never be placed within the ear canal. Some ear thermometers are adjustable so they can be made suitable for adults or children.

To get a reliable temperature measurement, the thermometer must be used exactly as directed. When you buy the thermometer, ask the salesperson how to use it, and read the instructions carefully before you start. Especially with small children, ear thermometers require a

steady hand to find the right spot.

The ear canal has a natural curve, so to ensure that the thermometer is pointing towards the eardrum it may be necessary to pull the top part of your child's ear gently upwards during the reading. If your child has been lying with their head on a warm pillow, or has just come inside out of the cold, you will need to wait 10 to 15 minutes before the ear can provide an accurate measurement of body temperature.

Under the armpit This method is not good for small children, since they will not stay still for long enough.

With children old enough to co-operate and keep still you need to keep the thermometer under their armpit for at least 5 minutes.

From the mouth This method is not suitable for a young child, because they may bite the thermometer and break it.

The thermometer is placed in the mouth, under the tongue. It will take two to three minutes to measure the temperature accurately. If your child has just eaten anything hot or cold, you will need to wait 10 minutes before an accurate temperature can be taken.

What can I do if my child has a temperature? Liquids A child with a high temperature needs more liquid than usual, because the fever will make them sweat a lot. Make sure your child drinks plenty of liquids - a teaspoonful every few minutes, if necessary. Provided they drink plenty of liquids, it won't matter too much if they eat very little for a couple of days. Rest

A child with a high temperature also needs rest and sleep. They do not have to be in bed all day if they feel like playing, but they must have the opportunity to lie down. Body temperature You do not sweat out a fever. If your child shivers while their temperature is rising, it's okay to cover them with a duvet or a blanket. But as soon as your child's temperature has stabilised and he or she starts sweating, they need to cool down. Your child only needs to wear underwear or a nappy, which will help the heat escape from the body. Make sure their room is ventilated and cool, but not draughty. Tackling fever Make sure your child drinks plenty of fluids. Let them rest. Keep them cool. Get advice on Medicines medicines. If you want to use medication to get Give them lots of the temperature down, ask your doctor 'TLC' (tender loving or pharmacist. They will be able to tell care). you what to use and how much. The dosage will depend on both the age and weight of your child. Paracetamol suspension (eg Calpol) is the usual choice and ibuprofen (eg Nurofen for children) is an alternative. Aspirin should not be given to children under 16 years of age. Attention Sick children are often tired and bad-tempered. They sleep a lot and when they are awake; they want their parents around all the time. They might whine and act younger than their age. It is okay to give in and spoil a child a little when they are sick. Read to them, play with them and spend time with them. This is not the time to teach a child good manners. A child usually recovers quickly and will go back to their old self again. When is a fever critical? Look at your child and use common sense. Do they look exhausted or ill? Are they behaving differently? If the answer is yes, call the doctor. You should also call your doctor if:

you have a young child, less than three months old, who runs a high fever. your child cries and cries, without you being able to comfort them,

and doesn't wake up easily.

your child has a temperature over 38C (101.3F) for more than three days. your child has just had an operation. your child doesn't seem to be getting better.

If your child experiences any of the following symptoms with a fever, call your doctor.

Stiff neck. Affected by bright light. Hallucinations. Red rash or blue/purple dots or patches. Trouble breathing. Cramps. Continued vomiting or diarrhoea. Continued tonsillitis. Pain when urinating, or urinating more than usual. Other illnesses.

Fever in children
This factsheet is for people who want to know more about childhood fevers. Average body temperature varies from 36.5 to 37.5C. A fever is an abnormally high body temperature. Children frequently develop fever, usually due to viral infections that clear up on their own. But occasionally high fever can be a sign of a more serious illness.

What causes a fever?

Fever is not an illness in itself. It is a sign of other problems in the body, and is usually caused by a viral or bacterial infection. It is thought to be part of the body's natural defence mechanism.

Fever can be a symptom of a wide variety of illnesses. For example, certain blood disorders, breathing problems, or inflammatory disorders may cause fever. Fever can also be caused by dehydration and some childhood immunisations. All these conditions trigger the immune system (the body's defence system) to produce chemicals. These chemicals affect a part of the brain called the hypothalamus, the heat-regulating centre in the brain.

Symptoms
Fever means having a body temperature at least 0.5C above normal on two recordings taken at least two hours apart. As well as having a high temperature, children with a fever are often:

clammy sweaty irritable and crying flushed tired

They may also complain of a headache or aches and pains. A rapidly rising fever may cause chills periods of shivering. In some children between six months and six years old, a sudden increase in body temperature can lead to seizures (fits), which are called febrile convulsions. During a febrile convulsion, part or all of the body may shake and twitch, and the eyes may roll back in the head. Although simple febrile convulsions can be frightening they usually last less than 15 minutes and the child makes a full recovery within an hour.

Taking a child's temperature

A satisfactory temperature reading can usually be obtained by placing a digital display thermometer in the child's armpit, directly against the skin, and holding the arm gently against the chest. The reading will be 0.5C lower than it would be if the temperature was measured with a thermometer in the mouth (oral). This should be taken into consideration when assessing the child's fever. Digital thermometers usually give a reading within a few seconds. Remember to clean the thermometer after use. Another option is a digital aural thermometer that measures the temperature in the ear. A clean cover is placed over the thermometer and the tip is placed in the ear. Pressing the button activates the thermometer and gives an immediate reading. These are now used routinely in hospitals and by GPs and give very accurate readings, but they are expensive to buy. Forehead thermometers and forehead strips, which can be held on the child's forehead, are not very accurate, but give a general idea of the child's temperature.

It is best to read a child's temperature before giving any fever-reducing medicines.

Treating a fever
In most cases, fever is due to a viral infection and will get better within a day. There is some debate about the best action to take if your child has a fever. Many parents and carers spend a lot of time trying to bring fevers down in children, the theory being that this will decrease the chance of febrile convulsions. But some experts suggest that the fever helps the child to get better, and that it should be left to run its course. Although there is still no definite advice, researchers have looked at the small number of studies on this subject and have come to the following conclusions.

There is some limited evidence that sponging with lukewarm water may reduce fever. However it also causes shivering and goose bumps - uncomfortable for anyone with a feverish illness - so only sponge your child's forehead, not their whole body. The evidence for using paracetamol to reduce fever in children is inconsistent. That's not to say that it doesn't work, but there haven't been good studies comparing paracetamol with other medicines or treatments. If you do decide to give your child medicines, only give those that are suitable for children, such as children's paracetamol (eg Calpol) or ibuprofen (eg Nurofen for children). Always follow the guidelines on the container. Never give aspirin to a child under 16 years because, rarely, it can cause a serious illness called Reye's syndrome.

Sweating and shivering can cause dehydration so encourage your child to drink enough. But the actual amount can be hard to gauge. Generally, urine should be pale yellow - if it's darker your child may need to drink some more. He or she will need to drink more if they have diarrhoea or vomiting. Check your child's temperature regularly to check that the fever is under control.

When to call a doctor

It can be hard to know when to call your GP or out-of-hours service, as parents often worry that they will be dismissed for making a fuss. Generally, if in doubt, contact a doctor for advice. NHS Direct nurses can give advice 24-hours a day on 0845 46 47 and is a good place to start if you're not sure what to do. Their website (www.nhsdirect.nhs.uk) advises that you contact your GP or go to hospital if your child:

is unusually sleepy won't drink fluids has an unusual rash has a headache

has a stiff neck has difficulty breathing has had a febrile convulsion has a febrile convulsion that lasts longer than five minutes doesn't seem to be getting better after a febrile convulsion has more than one convulsion, one after another

Always seek medical advice if your child develops a fever soon after an operation, or after recently returning from foreign travel.

Could it be meningitis?
Although it's a rare illness, parents should be aware of the signs of meningitis. Fever is one of the symptoms of meningitis, but there are others to look out for. These include:

neck stiffness - the child is unable to bend his or her neck forwards, and attempts to do so are painful photophobia - the child does not like light because it hurts the eyes vomiting drowsiness rash (in some types of meningitis) - this is patchy and may occur all over the body. The rash of meningitis is called a non-blanching rash, and can be distinguished from other skin conditions by using the glass test. With meningitis, the rash does not fade (blanch) but remains visible through a glass when it's pressed over the skin. Medical advice should be sought immediately.

The symptoms of meningitis are less specific in children under six to 12 months. Any parent who is worried about their child should contact a doctor straight away. For more information on meningitis, please see the separate BUPA factsheet, Meningitis.