Fever treatment for children: a doctor's advice

As you may remember from my scarlet fever article, I have a young child at home and can relate to the constant infections coming through the door. This also relates to the GP surgery where I work, where we are seeing lots of toddlers that are unwell.

By far the most common cause of fever in children in the winter is viral infections. There are thousands of viruses, and we can't always tell you which bug is causing the problem. We do know that there are symptoms that are the same for most common infections.

In general, if children have snotty noses but are well then we don't really worry. You can usually manage these at home with good advice so that you know when to come to see us in the surgery.

Treating a fever with paracetamol and ibuprofen

It is important to know the reason for the high temperature - such as a cold or viral illness. If you have already seen a doctor and have a diagnosis then you can manage fever and symptoms at home.

If children aren't unwell or in pain you don't have to use paracetamol or ibuprofen - but often it will bring them comfort.

Paracetamol

Paracetamol is a good first-line medicine to help children feel better. It is usually fine to give to anyone and in the doses stated on the bottle. For those born prematurely, you should have already been given advice on the right doses for an infection. Always check if you are unsure.

The correct dose will be according to the age group. You can only give paracetamol four times a day (a 24-hour period) and each dose has to be at least four hours apart.

When can I not give paracetamol?

If the child is allergic to paracetamol or they have liver problems, do not give paracetamol. You also need to seek advice if they are on medications for epilepsy.

Ibuprofen

Ibuprofen is a great second-line medication for both pain and fever. I always advise to give it after some food as it can cause an upset tummy. Always read the instructions on the bottle and check the correct dosage for the age. Always ensure there is a 6 to 8 hour gap between each dose and give no more than 3 or 4 doses over a 24 hour period. For those children who are born prematurely - their doctor should have advised whether they can or cannot have ibuprofen and in what dose.

When can I not give ibuprofen?

This is an important question:

Other people who cannot have ibuprofen are those who:

• Are allergic to the ingredients or allergic to non-steroidal anti-inflammatory medications (NSAIDs). Ibuprofen is an NSAID.

• Have asthma.

• Have heartburn or reflux symptoms.

• Have gut problems - such as Crohn's disease or ulcerative colitis.

• Have kidney problems.

• Are severely dehydrated as this can cause kidney damage.

Patient picks for Fever

Signs and symptoms

Fever

A high temperature is called a fever (or sometimes a high fever). Fever itself is not an illness. A fever is usually a symptom of an underlying condition, usually an infection.

by Dr Pippa Vincent, MRCGP

Signs and symptoms

Rigors

Rigors are episodes in which your temperature rises - often quite quickly - whilst you have severe shivering accompanied by a feeling of coldness ('the chills'). The fever may be quite high and the shivering may be quite dramatic.

by Dr Toni Hazell

Tips to keep you right:

One thing I’ve found as a parent - usually when sleep-deprived - is that I forget what I have given at what time. Recent studies have shown that parents are at risk of accidentally overdosing or underdosing their children because they forget when and how much they have given.

• I find that writing it down helps, and I also send a text to my partner, so they are aware of what and when I am giving each medicine. For example - I gave my unwell toddler Calpol - which is a paracetamol - at 12 pm and ibuprofen at 3 pm. At 6 pm his fever was creeping up so I knew I could give him Calpol safely.

• Using a syringe to measure doses helps to give out the exact amounts needed without wastage.

• Loose clothing - I tend to let them run around in their underwear and a loose tee shirt. It keeps them cooler and more comfortable - avoid cold sponges and direct cooling from fans. Lowering a temperature too quickly can be problematic too.

When to seek help urgently - the same day

• If you are concerned - I always tell patients that they know their children the best so if they are concerned then call the doctor.

• If a fever is not coming down despite the full doses of paracetamol and/or ibuprofen and cooling measures.

• If you don't know what is causing the fever.

• If a fever lasts more than five days - or sooner if they are getting worse.

• If children have stopped eating and drinking.

• If there are less than three good wet nappies or children have not been for a wee or have a dry nappy for more than 12 hours.

I know it is hard to know when to seek help but If your instinct is saying that your child needs to be seen, then go with it, because you know best - all doctors will understand this.