"At six o’clock, she refused her dinner. She seemed tired and wanted to stay on my lap so we brought her up to bed early and took her temperature (which was 38.2°C). We gave her some medicine, which seemed to bring it down, and she fell asleep. At 1 am we checked her and she was much hotter. Her temperature was 39.1°C. We really didn’t want to bother a doctor at that time of the night but we were very worried."
You may know the situation. The thermometer tells you that she is 39°C, too hot, that something is badly wrong, yet she lies on the sofa happily squinting at the television. Meanwhile, you push work deadlines to the back of your mind. Should you call the doctor?
A high temperature can be one of the hardest symptoms to call. How many busy doctors sigh as they see ‘yet another’ child with a fever? And how many parents hover over the telephone as the thermometer rises? It is a little like an airport security X-ray: the vast majority of suitcases passing through are harmless. Likewise, most children with a temperature have a simple viral infection. But you need to be alert to the exception.
One thing is certain. Your child is absolutely certain to get a fever. After all, the average child will have some six to eight viral infections in her pre-school years.
- In most cases, a temperature is not a cause for alarm.
- It’s a very useful symptom that something is wrong.
- It prompts you to watch carefully for other (more specific) signs of illness.
- A fever alone will not kill her.
- I tend not to worry about a child with a temperature who is smiling.
BUT
If your child under two months has a temperature, she should see a doctor immediately.
Is It a Fever?
- An arbitrary definition of fever is a temperature of 38°C or over.
- When your toddler goes very quiet and feels hot to touch, you really need to check her temperature.
- The biggest decision is always whether or not to call the doctor. Nothing substitutes for a doctor’s expertise, but I’m a great believer in the instincts of a smart parent. When a mother tells me she is very worried about her child, I get worried.
The Viral Illness ‘Excuse’
You bundle your feverish child into the car only to learn from the doctor that she has a ‘viral illness that will pass’. Some parents suspect that this is a medical excuse for ‘cause unknown’. In reality, many fevers
are caused by a viral illness – one of any hundred or so that can rarely be identified outside a laboratory. In most cases, the illness will disappear of its own accord, provided you control the temperature.
Many viruses can only be identified in a laboratory.
Is It a Serious Infection?
A very small number (up to three per cent) of children reaching hospital with a temperature will have a serious bacterial illness. Thanks to vaccination, almost no child in our part of the world will die of a serious infection nowadays (meningitis being the rare exception).
Is It Meningitis?
This can be a little scary, but remember that meningitis is rare. Fewer than one in 1,000 children arriving in hospital with a fever develops meningococcal disease. (Not so many when you consider that most feverish children
don’t end up in hospital.)
The problem for family doctors is that early meningitis can be hard to distinguish from a viral illness – the common cause of fever. They see viral illnesses daily, but may see a case of meningitis, at most, every ten years. Most doctors now keep pre-loaded penicillin for suspected cases.
When your child has a temperature, always examine her for rashes, as a precaution. As I tell trainee doctors, ‘eyeballing’ is not enough – examine the whole body. Look in the nappy area and at the feet, as some rashes may show in these areas only. A meningitis rash has flat, ‘non-blanching’ Meningitis rash
spots – they
don’t fade when you press the base of a drinking glass against them. It is most unlikely to be meningitis if a rash is confined to the head, neck and upper trunk.
Don’t wait for a crisis – practice the glass test now.
A rash is not the only sign of meningitis. In fact, there may be no rash at all at first and (just to make it really difficult) up to 20 per cent of meningococcal cases don’t develop one. If your child has
a number of these symptoms, you should call your doctor or hospital at once:
- Fever.
- A flat, spotty rash that doesn’t fade when pressed.
- Unusual drowsiness.
- Unusual crying.
- Vomiting.
- Cold hands and feet, leg pains and skin colour change.
- (In older children) headache: stiff neck; cannot tolerate bright light.
This is an extract from When Your Child is Sick by Professor Alf Nicholson, Professor of Paediatrics at Temple Street Children's University Hospital and Grainne Malley.
