Treatment of Fever in Children

Dr. Parang Mehta, MD.

Fever is one of the most common problem children have.  However, it still causes a lot of anxiety in parents, and sometimes in doctors also.

Before Fever Treatment

It is important to find the cause of the fever, and to determine if the fever needs treatment.  Most fever does not need much treatment, or a large diagnostic effort.  However, under certain conditions, a fever may signify a major disease (see Dangerous Fever).

On the whole, fever is a useful thing.  It helps the body to fight disease, and should not be treated unnecessarily.  However, very high fever can lead to febrile seizures or hyperpyrexia and should be treated.  Fever also makes the child uncomfortable, reduces the appetite, and can make the child feel ill.  Fever treatment becomes necessary for these reasons.

Fever Medication

There are several drugs available that bring down the fever in children.  The ones we use commonly are paracetamol (acetaminophen) and ibuprofen.  Many others are available, but these two have been in use for many years, and are generally accepted as safe and effective.

Acetaminophen (paracetamol) and ibuprofen are both effective drugs.  Ibuprofen, is addition to bringing down fever, also reduces swelling.  It is thus a good drug for use in the fever after some vaccinations, where there is significant swelling and pain over the thigh where the injection was given.  Both drugs also reduce the headache and bodyache sometimes associated with fever.

One drug that should not be given to children is aspirin.  This was commonly used in the past, but has now been found to be associated with Reye's syndrome.  This is a rare but dangerous illness involving damage to the liver and brain, and is sometimes fatal.  It is especially common when aspirin is given for fever associated with influenza or chicken pox.  

Whatever drug is chosen, it should be given only if the fever is very high, and in the dose prescribed by your pediatrician.  Usually, medication is not recommended for fever below 101º F, measured in the mouth (100º F in the armpit).

Too much fever medication can cause adverse effects, especially paracetamol.  This drug should not be given at intervals of less than 4 hours.  Ibuprofen should not be given at intervals less than 6 hours.

Specific Treatment

This depends on the cause of the fever, and needs an examination by your pediatrician.  After making a diagnosis, the doctor will tell you whether specific treatment is needed.

Some illnesses, like a cold, or other viral fever, subside in a few days' time without any specific treatment.  On the other hand, diseases like malaria or tonsillitis will continue to cause fever till specific curative treatment is given.

Are Antibiotics Needed?

This depends on the cause of the fever.  Antibiotics do not bring the temperature down, and should not be used in every child with fever.  Antibiotics are powerful and dangerous drugs, and should only be used when an infection is clearly present and needs treatment.  In some situations, antibiotics are given without clear evidence of infection.  

Very young children with fever are likely to have a serious bacterial infection like bacteremia, pneumonia, meningitis, etc.  The policy is to collect blood samples for laboratory testing, and then to start antibiotics, so as to prevent progression to a serious situation.  The antibiotics should be stopped if the reports are normal.

Bacteremia is a condition of bacteria in the bloodstream.  It is common in babies, and is very dangerous.  When babies develop fever, it is a major reason to shoot first and ask questions later — in other words, to give antibiotics without any infection being visible.  In countries where children receive the Hemophilus influenzae and pneumococcal vaccines, bacteremia is becoming uncommon.

Fever in Children
When is Fever Dangerous?

Last Revision: February 16, 2016

Sponging for Fever

Medicines take time to act.  They have to be swallowed, absorbed from the stomach and intestines, and then reach the bloodstream to act on the brain.  It can be an hour or more before a dose of fever medicine brings the temperature down.

Sponging is an alternate method that brings down the temperature quickly, and is a help in children prone to getting febrile seizures.  Children with hyperpyrexia (temperature above 106º F) also benefit.  There are not many other reasons to bring a child's temperature down in a hurry.

Sponging depends on bringing the body temperature down by evaporation of water from the skin.  Water at room temperature should be used, and spread over the body using a napkin.  Allow the water to dry, and then spread some more.  Doing this repeatedly will bring the child's temperature down quickly.

Using very cold water or ice makes the child very uncomfortable, and is not as effective as using tap water.  Alcohol sponging should not be done, especially in small babies.  The alcohol is absorbed through the skin, and can cause serious side effects.

Contact Information

Dr.   Parang Mehta,
Mehta Childcare,
Opposite Putli, Sagrampura,
Surat.          Tel: +91 9429486624.