When A Child Is Sick: How to Deal With a Fever Fit

Small children do have fits. It is a terrifying experience for parents. You see your child turn very blue, shake dramatically and froth at the mouth. Most parents, very naturally, believe that she is going to die.

It is likely to be a fever fit if:

• Your child has a temperature of over 38.5°C.
• She has a cold or viral infection and has been off colour.

Fever fits are more common, and generally less serious, than you think and she will usually outgrow them.

Home Treatment: Fever

If your child is over two months old and only has a temperature, you can normally treat her at home. But if you’re worried, or the symptoms seem to be worsening, a call to the doctor is absolutely the right course to take.

• Always examine her for a rash, as a precaution.
• Lower the temperature with medicine. Any children’s medicine containing paracetamol or ibuprofen should show results within half an hour.
• Cool her body by stripping her down to her vest. Try sponging her with a facecloth and lukewarm (not cold!) water.
• Give her regular, but small, sips of water. Ice pops can go down easily, too.
•  Watch her for other symptoms and for a temperature rise.
• Antibiotics are not usually needed. A viral illness is most likely and viruses don’t respond to them.

Parents are often keen to start their child on a course of antibiotics, just in case it is a bacterial infection. If she has clear symptoms of a bacterial illness (e.g. an ear infection or tonsillitis), I prescribe antibiotics. Giving antibiotics to a child with a fever (but no other symptoms) will not prevent serious illness.

First Aid for Fits

If she has a febrile convulsion, simply:

•  Strip her down to her vest.
• Lie her on her side in the ‘recovery position’
• Put nothing in the mouth.
• Sponge her down with lukewarm water.
• If you have a paracetamol suppository, use it (in the bum only, please).
• Call the doctor for advice.
• The fit is unlikely to last more than five minutes, but if it does you should get emergency help.

Using Thermometers

A rectal temperature is the most accurate of all (closest to body temperature) and is the gold standard in hospitals, but it may not suit every parent. You can, in fact, measure a fever in the mouth, armpit or ear – if you follow the right technique.

However, I advise against using plastic strip or forehead thermometers (liquid crystal), because they are simply not accurate enough. And the glass mercury thermometer is no longer used, because of the risk of mercury exposure.

A temperature of 38°C or more is generally seen as a fever. If you use a digital thermometer, keep spare batteries and remember to turn it on!

ORAL TEMPERATURE This is best confined to children over five years old.

First, clean the thermometer with cool water and soap and rinse it.

• Put the tip under her tongue, near the back. She can hold it between her lips (not her teeth).
• Hold it in her mouth until it bleeps. Most digital thermometers need less than one minute.
• If she has eaten or drunk in the last 30 minutes, it will affect the reading. Use an armpit or ear thermometer instead.
• Don’t leave her alone while the thermometer is in her mouth.

ARMPIT TEMPERATURE The reading will be slightly less accurate – around 0.6°C lower than her actual body temperature.

• Put the tip of the thermometer in her armpit (make sure it is dry).
• Hold the thermometer in place for up to five minutes– clasp her elbow against her chest.

EAR TEMPERATURE Ear thermometers (tympanic) are easy to operate and are now regularly used in the home. But remember that the reading will be slightly lower than the actual body temperature. You can use it when she is over six months – but under six months it will not be as reliable.

• Pull her outer ear back, then insert the aural thermometer.
• Hold the probe in her ear for about two seconds.
• Disposable tips need to be replaced every time you use it.
• If it is a cold day and she has just come indoors, wait about 15 minutes before you take her temperature.

Red Alert

I USUALLY TAKE A CHILD INTO HOSPITAL:

• With a fever and a spreading rash.
• With a fever and another symptom (such as headache, listlessness, pain, vomiting, poor colour, limping, reaction to bright light, stiff neck).
• If the fever has lasted more than four days and is unexplained by any other illness.
• If she is under two months old.
• I also want to know if she perks up when the temperature comes down. I am concerned if she doesn’t.

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.