As a paediatric doctor I frequently get asked by worried parents how to control temperatures, when to worry about a temperature and to seek medial help, and what is the risk of febrile convulsions that is associated with a temperature?  As a parent myself I completely understand the concerns that you have.  It can be frightening looking after a child who has a fever and is not themselves.  Do you go to the doctor, do you wait at home?  What is the best thing to do to control a temperature?  Which thermometer do I use?

Children frequently get temperatures. A temperature is anything more than 37.50C, but as paediatric doctors we rarely react to a fever until it is above 380C.  The child/baby may have hot, flushed skin and be sweating.  They may also feel cold and clammy and look pale.

There are several different types of thermometers on the market currently.  It does not really matter which type you use provided it is age appropriate.  Generally we do not use thermometers that go under the tongue in a child less than 5 years old.  Mercury containing thermometers should not be used as the glass can break easily and they contain mercury which is poisonous.

It is important to try to bring the temperature down in a controlled way.  It used to be advised to put the baby or child in a cool bath- this works only momentarily as they can quickly raise their core temperature again and you are then back where you started.  It can also cause the temperature to shoot up again quickly and this can lead to a febrile convulsion in the under 3 year olds.   Instead you should aim to bring the temperature down in a controlled fashion, nice and slowly.

  1. Remove excess layers of clothing, babies can be left in only their nappies.
  2. Give them water or diluted juice/squash, this will help stop them from becoming dehydrated.
  3. Place a fan near to aid with cooling them.
  4. Give them paracetamol and/or ibuprofen.

You can give a baby/child over 3 months 4 full doses of Paracetamol within 24 hours and 3 full doses of Ibuprofen over 24 hours.  They can be given at the same time. When I say full doses I mean the dose that is recommended on the box of your specific product. Different preparations of liquid paracetamol/ibbuprofen vary in their dosing and strength.

If your baby is under 2 months and they have a temperature you should go and seek medical advice immediately.  Babies of this age should be reviewed by a GP or paediatric doctor if they have a temperature.  Ibuprofen and paracetamol is not licensed in this age group- however we have special doses of the medicines that we are able to give in the hospital setting.

There are 2 regimes you can use in which to give the correct dose of paracetamol and ibuprofen over a 24hr period.

A.

  1. Full dose Paracetamol and full dose Ibuprofen
  2. 6 hours later the same again
  3. 6 hours later the same again
  4. You then have one full dose of Paracetamol that you can give if they wake up in the night.

B

  1. Give a full dose of Paracetamol
  2. 4 hours later give a full dose of Ibuprofen
  3. 4 hours later give a full dose of Paracetamol
  4. 4 hours later give a full dose of Ibuprofen
  5. 4 hours later give a full dose of Paracetamol
  6. 4 hours later give a full dose of Ibuprofen
  7. Finally 4 hours later give a full dose of Paracetamol

If you are unable to get the temperature down at home then you need to seek medical help.  Using the advice above you should see the temperature coming down within 1-2 hours.  You ideally need the temperature to come down slowly and then to remain down.  Once the temperature is down it is tempting to stop giving the Paracetamol and/or Ibuprofen however the temperature is probably being controlled by the medicines so if you miss the next dose the temperature may rise and then you will be back to the beginning again.  If your child has a fever I would advise you to give the Paracetamol and/or Ibuprofen for at least 36 hours before you stop the medication and see if the temperature will stay down on it’s own.

If your child is under 3 years old they are at risk of getting a Febrile Convulsion.  This is a complication of a child’s temperature going up very quickly, it does not need to be a very high temperature.  The rapid rise in temperature can cause an effect on the brain that results in a generalised seizure.  The child will become unconscious and begin twitching/shaking both their arms and legs.  Their fists may become clenched.  Their teeth may be clenched and they begin to foam from the mouth.  There may also be some blood within the foam as they may have accidentally bitten their tongue.  Their eyes will be rolled back.

A fit or seizure can last for a few seconds to a few minutes.  Seizures can be very frightening to watch.  You need to remain calm.  There are some things that you can do to help.

  1. Make a note of the time as it is very useful information for the medical team to know how long the seizure lasted.
  2. Remove or loosen anything tight around their neck that may impair their breathing.
  3. They must be left to twitch/shake, you must not try to restrain them. Make sure that they are not hurting themselves.   Ideally you do not want to touch your child whist they are fitting but if they are near objects that they can hit and therefore hurt themselves on then you must move these away if you can.  If you can’t move the objects away because they are too big or heavy then you must move your baby/child to a place of safety.
  4. When the seizure is over place them on their side with their head tilted back. For babies pick them up in your arms and hold them on their tummies looking down towards the ground.

Seizures of this nature are usually short, only a few seconds.  If your child is still fitting after 3 minutes then you need to get them to medical assistance.  The best way to do this is to call 999 for an ambulance.  When the ambulance arrives the paramedics will have medication to stop the seizure.  For a seizure to do damage the child needs to be fitting for more than 30 minutes, therefore you will have plenty of time to seek medical help.

For a child who has had their first ever seizure they need to be taken to hospital to be checked over by a doctor, even if you are sure that it was caused by a quickly rising temperature.  The doctor needs to confirm this and also keep them for observation for 12-24 hours as it is common for a second seizure to occur within this time period.

Help is at hand! There is a wonderful app from the British Red Cross specifically for baby and child first aid- I highly recommend this and it is free.  I have it on my phone!

DR ANASTASIA ALCOCK
MRCPCH MBBS BSc(Hons) DTM&H DPID DRCOG 

www.ThePrenatalClassroom.com  

About The Author

Anastasia Alcock
Paediatric Doctor

Mother-of-two Anastasia qualified as a doctor from Imperial College School of Medicine in London. She has worked as a paediatric doctor in hospitals including Guy's and St Thomas' Hospital London, St Mary's Paddington and The Royal Brompton Hospital London. She is currently working at the John Radcliffe Hospital in Oxford. Her main love is working in paediatric A&E where she can help families with both minor and major medical problems.

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