HOW TO MANAGE FEVER



What is fever and how can we measure body temperature

Fever means an elevated body temperature but what we define as elevated temperature depends on which part of the body we place the thermometer at. In infants under 6 months we suggest checking either the axillary or rectal temperature using a simple electronic thermometer


Axillary: an elevated body temperature is anything more than 37.2 . Because axillary temperature can sometimes be affected by hot environments or being overdressed it might be a good idea to confirm the reading using a rectal temperature.

Rectal : a reading more than 38 counts as fever. Use a bit of Vaseline as lubricant and insert the tip of the thermometer approximately 2 cm into the rectum. Rectal temperatures are considered more reliable than axillary ones .

Ear thermometers : they can be used in children over 6 months as long as you have an infant type thermometer which has a slim tip and can fit well into the ear canal. Be mindful that adult type ones will not fit well and therefore give fallacious readings.

Forehead thermometers: they are generally unreliable in children under 5 years. Avoid using these.


Note: some parents check for temperature by feeling their child’s skin. This can be misleading as can be affected by a hot environment . Always use a thermometer to confirm if your child is indeed febrile.



Paracetamol

This is the commonest medicine we use to bring down fever. It is safe and effective and can be used as early as the first month of life. There are different brands in the market ( calpol, remedol , depon ) and comes in syrup or suppositories. Be mindful that syrups come in 2 versions. One is for children under 6 years containing 120mg of paracetamol in 5 ml of syrup and another for those over 6 years ( designated 6 PLUS) and contains double the amount of paracetamol in 5 ml of syrup.

Dose can be calculated in 2 ways. Either by age as written on the box or more accurately by weight. The age calculator is a gross approximation and might not work well for children who are larger than average for age. For example one 12 month old can weigh 11 kg and another can be 7 kg . Therefore the dose for the bigger infant might be insufficient and might not bring the temperature down.

Other uses: Paracetamol can also be used as painkiller for example for teething pains.


How many doses: can be given up to 4 times in a 24 hour period.



Ibuprofen

This is commonly used to treat fever but also as a painkiller. It can be found in 2 versions , one for children under 6 which contains 100mg of ibuprofen in 5 ml and one for children over 6 years containing 200 mg in 5 ml ( 6 PLUS) . Brand names include Nurofen and Ibuprofen.

In general we tend to use it as an auxiliary back up medicine when paracetamol doesn’t manage to bring the temperature down.


How many doses: you can give up to 3 doses in a 24 hour period.

Caution: if your child is dehydrated or has kidney problems ibuprofen may cause side effects. Seek advise from your doctor.



Frequently asked questions

Should I use syrup or a suppository ? : there is no need to use a suppository if a child can take a medication orally. They are generally used when a child is vomiting or refuses oral intake.


My child’s fever persists despite having the medicine what should I do ? : medications may sometimes take up to 1 hour to bring the temperature down. If the fever persists beyond that point then you can add an alternate medication. For example if your child had paracetamol at 8 then you can add ibuprofen at 9 , or vice versa.