My child has fever

Information for parents and caregivers

The aim of this patient information is to provide answers to questions in relation to fever. This in no way, however, replaces communication with your doctor.

What is fever?

Normal resting body temperature ranges between 35.5°C and 37.5°C. Physical activity or psychological stress can easily cause the temperature to rise.
There is no universally accepted definition of the temperature above which one speaks of fever. In Germany, temperatures between 37.5°C and 38.5°C are called subfebrile temperatures and fever is defined as a core temperature above 38.5°C.

In babies less than the age of three months, older people and some people who constitutionally have low temperatures, a temperature of 38°C can already be a sign of a severe infection.
Fever typically rises in the evening. A high fever in the morning is a sign of more severe infection.
Fever is a controlled increase of body temperature as a reaction to a stressor or pathogen. It reduces the proliferation of bacteria and viruses and the body’s defense system works faster. The high body temperatures are therefore important to fight the pathogens that caused the disease.

If warning signs (see “First signs of fever”) appear, you should contact your doctor.

There is no upper temperature limit above which the fever must be reduced.
Paracetamol and ibuprofen should not be given for the sole purpose of lowering body temperature.
Paracetamol and ibuprofen do not prevent the development of febrile convulsions.
Simple fever cramps look dramatic, but do not cause permanent brain damage.

Antibiotics have no effect on viral diseases and are not always necessary even for bacterial infections. The use of antibiotics increases the probability of developing antimicrobial resistance.

Fever strengthens the immune system and is a healthy function in an otherwise healthy person.
Anthroposophic and integrative medicine offer many possibilities to alleviate fever symptoms without suppressing the fever.
Children should be kept warm when they freeze (during rising fever) and should be allowed to cool when they sweat.

First signs of fever

As parents of small children, you will probably have experienced something like the following:
your child seems somehow different, moody, without energy, tired. He may have a stomachache, nausea and sometimes vomiting. Others may have headaches or pains in their body. Sometimes the child has a cough, a cold, or is whiney, shivering and without appetite. A warm forehead lets you guess that the thermometer will show febrile temperatures.
Now, what to do? Should you rush to the doctor or first try known home remedies? Is fever dangerous? Should you lower the temperature?

Measuring fever properly

One of the first things that parents do when their child appears ill and feels warm is to measure body temperature.
A precise way of doing this is rectally with a digital thermometer and this is definitely the best way to measure temperature in small children. Use a little cream to facilitate entry. Many children find rectal measurements uncomfortable and in some countries it is felt to be inappropriate. An electronic ear thermometer is a good alternative, but its measurements can be flawed by earwax or inappropriate placement.

How does fever come about?

Fever is usually a reaction of the body to viruses, sometimes to bacteria or other pathogens.
In some cases fever is a sign of an autoimmune inflammation or other illnesses.
Hence fever is usually a symptom and not a disease in itself.

Body temperature is mainly regulated by the hypothalamus, a part of the brain.
In response to the above-mentioned stimuli the hypothalamus can increase its so-called set temperature. This leads your child to feel as if her normal temperature were too cold. She will develop warmth-seeking behavior, the blood vessels in the periphery will contract, causing the hands, feet and nose to be cold and your child to look pale. The muscles will produce heat to the point of shivering.

It is important, that you understand fever. The course of the fever can be described as follows:

  1. The brain sends a signal that the temperature should be increased.
  2. The whole body is then occupied with producing heat. The muscles tremble to warm the limbs. 
    We call this “chills”. At this stage, the child often feels cold even though the temperature is rising, because the body has shifted to a higher set-point. 
    When the fever rises, you can help the body by warming and covering the child until the hands and feet are really warm.
  3. When a child is feverish, he is often tired and limp because his body is busy fighting the disease.
  4. Once the fever has done its job and the child is warm from head to toe, the body lowers the temperature again after a while.
     During this time the body sweats and the child may feel better with less cover.
     However, the little patient should always feel warm and not cold.

In about 90% of the cases, your child’s doctor is able to tell whether fever is related to, e.g., an ear infection, tonsillitis, bronchitis, pneumonia, intestinal infection or urinary tract infection (the latter generally requires an examination of the urine).
Some rashes and symptom constellations are typical for some so-called childhood diseases. In some cases, further examinations such as a blood test or an X-ray may be called for.

In rare cases, a chronically recurring or long-lasting fever is not caused by an infection. Proper therapy then depends on the right diagnosis, which means that a large range of diseases must by systematically searched for. In some cases no cause is found and the fever disappears again of its own accord.

When should you seek professional support?

Fever is a healthy reaction to stress or pathogens. Feverish temperatures slow down the proliferation of bacteria and viruses and the body’s defense (immune) system works faster. The high temperature is therefore important to fight the pathogens that led to the disease.

However, there are situations in connection with fever where, to be safe, you should consult a doctor:
All children under the age of 3 months should see a doctor on their first day of fever.
You should also consult a doctor if your child:

  • seems to be seriously ill, pale or livid
  • does not react normally
  • has a stiff neck
  • has a skin rash
  • has strong pain, or cannot be comforted
  • is breathing very quickly and with effort
  • won’t drink anything for a long time, especially if the child has diarrhea, vomiting or is listless
  • has a fever for longer than 3 days (then, at the latest, a urine test should be done)

In the first few weeks of their life, babies are much less likely to develop fever and therefore may have a severe infection without fever. At this age signs like paleness, lividity, oversensitivity to being touched and refusal to drink are more common. In these cases a doctor should be consulted even if no fever is found.
This also applies to the rare cases in which children have immune deficiencies caused by medicines or an immune defect.

Febrile convulsions (febrile seizures)

Many parents are afraid of febrile convulsions. They occur in less than 5% of children, and it runs in the family. Young children may have seizures with rolling eyes, shaking, changed breathing, and even turning blue, and a visit or call to the emergency room may be required.
Even though they look terrible, simple febrile seizures are harmless and usually cease within 2 to 4 minutes.
If your child has a febrile convulsion that does not stop within the first few minutes, call an ambulance.
If the febrile convulsion stops quickly, you can ask your pediatrician for advice by phone.
Febrile convulsions cannot be prevented by antipyretics such as paracetamol or ibuprofen.
In rare cases, febrile seizures can be caused by epilepsy. To exclude this, an EEG examination is done in the weeks following a first febrile convulsion in many countries. The EEG should not be done less than two weeks after the convulsion because in this time residuals of the febrile seizure may be falsely interpreted as epilepsy. Parents whose children frequently have febrile seizures learn how to handle it at home and do not need to bring the child to the emergency room every time.
Warming the child as soon as he or she appears ill may reduce the rate of seizures.

What can you do when your child has fever?

  • Please make sure that you or someone familiar is there for your child.
    Your sick child needs care and support. Days of illness in a child’s life are an opportunity for nurturing the relationship between you and your child—and relationship quality is most important for health, development and learning.
  • A feverish child is internally active and should not be expected to be additionally externally active.
    Each child reacts to fever differently. While some hardly notice and continue to play and eat normally, others may be very tired and just want to sleep. Some children may be very whiney and suffer from not feeling well, as well as having diffuse pains.
  • As long as your child has cold hands or feet, or chills, she needs warmth!
    Make sure your sources of warmth do not burn. You can avoid stress and suffering by gentle warming during the rise of a fever.
  • Once your child has warm hands and feet, and maybe even sweats, less warming is necessary, but still keep the child comfortably warm.
  • If your child is asleep, let him sleep.
    You don’t need to wake your child to measure the temperature.
  • In cases of severe discomfort, body-temperature compresses can help.
    Do not apply cold.
  • Offer enough to drink, in sips. Eating is less important.
  • Simple household remedies can be used to improve the condition in case of fever without lowering the fever by medication:
    - Warm thin calf compresses (not cold to avoid a counter-reaction). They will remove heat through evaporation.
    - Compresses on the forehead.
    - Lemon slices on the soles of the feet.
    - Teas (lime tea, or whatever the child likes) may be slightly sweetened; light food.
    - For further information on compresses, see: https://www.kindergesundheit-info.de/themen/krankes-kind/alltagstipps/im-krankheitsfall/wickel-umschlaege/ and http://www.pflege-vademecum.de/anwendungen_bei_fieber.php?locale=de.
  • Anthroposophic, herbal or homeopathic medicines, such as Belladonna, Aconitum or Ferrum phosphoricum do not primarily reduce fever, but are rather given to stabilize the general condition.
    Please consult your doctor or a trustworthy source of information. Often, Aconitum is given in the pale, shock-like phase of fever and Belladonna in the red-faced congested child.
    (In some countries, enemas are used to prevent dehydration and improve general condition. This can stabilize the circulation, especially in small children who drink little, and gently reduce the temperature. This is especially justified where hospitals are far away, dangerous or traumatizing. An approximately 35 to 37°C warm enema with an electrolyte solution, such as those offered in pharmacies for children with diarrhea (e.g., Oralpadon® neutral) is used, filled with 50–100 ml for infants and up to 200 ml for young children; corresponding enema bulbs are available in the pharmacy or on the internet.)
  • Inform the school or kindergarten.
    Children should only return there when they have been looking and feeling well again for at least one fever-free day without medication.

Are antipyretic drugs like ibuprofen and paracetamol necessary?

Antipyretic medications are not necessary even in cases of high fever. Since they interfere with the course of the disease and an overdose is dangerous, they should only be administered when advised by a doctor, for example in cases of pain or to save a night’s sleep. Infectious diseases do not heal faster when the fever is lowered (but you notice them temporarily less).
Quite the contrary: many scientific studies on this topic show that infection control and antibody production at 39°C to 41°C is more effective than at 37°C.
After an antipyretic, the child sweats temporarily, the body temperature cools down, the child may then feel temporarily less ill than he is, and if the cause of the fever persists, after about 6 to 8 hours he may have renewed chills and a worsening general condition. If you give an antipyretic medicine, please reckon with this course and accompany your child with appropriate care for warmth (uncover, cover).
Some grown-ups take aspirin® when they have fever. Aspirin® should NOT be given to children.

Suppressing the fever with ibuprofen or paracetamol only suppresses the symptom and is therefore not a substitute for seeking professional help.

Are antibiotics necessary?

Antibiotics can save lives when they are really needed. However, they are still used much too often in cases where they are useless or not necessary, causing side effects and enabling bacteria to become resistant to them. It is important to realize that antibiotics do not work at all against viruses and are not always needed for bacterial infections.
Please speak openly with your child’s doctor about your concerns, questions and expectations.

In a nutshell

In summary, fever is an important ability for dealing with an infection and, for an otherwise healthy child, there is no upper limit at which one must lower a fever. Depending on the child’s general condition, a temperature even over 40°C can be tolerated. A sick child needs warmth, calm parents, safety and closeness.
If you do not know what to do, are worried, or if your child shows warning symptoms, please contact a health professional.
See also: www.warmuptofever.org