Fever: Recognising the Red Flags in Your Child.

Intro:

In another #FirstAidFriday segment, we have a question in from Tarnee on fevers:

“Hi Kat, I am so worried about Arlo getting fevers.

How high does the temp need to be before I call an ambulance?”

What is a fever (and why do I LOVE them so much)?

Yes- you read that right. I ❤️ fevers. Don't be shocked. Let me explain why.

Our body temperature roughly sits around 37 degrees. The germs that love to invade human bodies want our temperature to stay around this number. So in they come to our bodies, which are the perfect environment for them to set up camp and multiply in numbers. Kind of how we like the Bahamas.

But thankfully, our immune system says "Hang on a minute, these guys are NOT meant to be here!", and it kindly lets our brain know that there are some unwanted guests inside our body. Our brain then says “No worries mate, let's crank up the heat!”.

But WHY would our brain want to do that???

Well, the answer is two-fold:

1️⃣ Firstly, the germs do not like the new increase in body temperature, and they become weakened, which makes it easier for our immune system to then get rid of them.

2️⃣ Secondly, our immune system is actually MORE effective at elevated temperatures. Amazing, huh? 👏

But Kat, won't the temperature just keep going up and up and up and up if we don't stop it?

It's also important to be aware that our brain is pretty clever, and monitors how hot our body is becoming. It puts the breaks on the temperature rise if we start getting too hot, and it begins cooling itself down again. After we’ve cooled down again, if our immune system says: “Hey- these germs are still here” the brain cranks up the heat again. That’s why with fevers we have the rise and fall of temperatures. This is because our brains KNOW when to stop increasing the temperature. I’ve personally never had a patient who’s temperature has risen above 42℃ from just a fever. So please understand, in nearly all cases of a fever, while it can be scary to watch that temperature increase, your child’s body will stop the temperature from increasing before it gets too high.

In addition to this, fevers are a crucially important way for the body to defend itself against invading germs. It’s one of the bodies main lines of defense. In fact, research has shown that by artificially lowering a fever, you can actually prolong the illness and increase the severity of symptoms. Why? Because without the fever defense mechanism, it’s a lot harder for our bodies to get rid of the germs.

**In Australia, we define a fever as a body temperature of 38℃ or higher, regardless of what thermometer you have used, body part you are checking, or age of the person having their temperature taken**

Now, here’s something really important to know. The higher the temperature on the thermometer does NOT mean the sicker your child is. Instead of using the numbers on your thermometer to determine when to get help, I want you to focus on these red flags instead when your child has a fever.

If your child has a temperature of 38 degrees or above, along with ANY of these red flags, then it's time to call your doctor.

🚩 Fever Red Flags 🚩

🚩 Fever Plus Vomiting & Refusal to Feed:

🔸 Fevers use up a lot of energy and fluid, so your little one is at risk of dehydration if they have a fever and can’t maintain their fluid intake, even more so if they’re losing fluids through vomiting or diarrhoea.

🚩 Fever Plus a Rash:

🔸 Fevers and a lot of viral rashes go hand in hand. However, usually the rash appears AFTER the fever has passed. So if your little one has a fever and a rash at the same time, call your doctor. If your little one has a fever and a rash that does not disappear when you press down on it, or if you press a clear glass firmly to it like this, we call this non blanching. If your child has a fever and a non blanching rash, then call an ambulance or head straight to your nearest ED.

🚩 Fever Plus Stiff Neck & Photophobia:

🔸 A stiff neck, or reluctance to move their head, or a light that is hurting their eyes (photophobia) accompanied by a fever warrants medical help as this could be a sign of meningitis.

🚩 Fever Plus Drowsiness:

🔸 If your child has a fever and is drowsy or more sleepy than usual, this is a sign that they are starting to use up all their fluid and energy stores fighting off the infection, and need more help.

🚩 Fever Plus Pain That Doesn't Improve With Pain Medicine:

🔸 If your child has a fever and pain that doesn’t get better with pain relief medication such as paracetamol or ibuprofen, it’s time to get help. An example would be fever along with tummy pain. If the tummy pain doesn’t settle with medication, it could be a sign of appendicitis, so best to get your child checked out!

🚩 Fever Plus Trouble Breathing:

🔸 If your baby has a fever and they’re also having trouble breathing, definitely contact your doctor. We take trouble breathing VERY seriously. If you would like to know what signs to look for if your baby is having trouble breathing, check out our article on respiratory distress.

🚩 Prolonged Fever With Unknown Cause:

🔸 If your child has had a fever for more than a couple of days with no obvious cause, it's time to chat to the doctor. One of the most common reasons being a UTI that your little one might need some help getting rid of.

🚩 Your Child Is Becoming More Unwell:

🔸 If you EVER feel like you're child's becoming more unwell as time progresses, I want you to ALWAYS trust your instincts as a parent and get help if you feel like there is something not right! Believe me when I say that you know your child best, and any health care worker who is worth their weight in salt will listen to you.

🚨*Caveats*🚨

Ok, so there’s a few times I want you to head straight to the emergency department if your child has a fever. We’ve already mentioned fever with a non-blanching rash, please head straight to the ED if your little one is under 3 months or if they are immunocompromised. It’s not so much the fever that we’re concerned about in these situations, but what is causing that fever. A fever in these 2 groups could indicate a serious underlying infection in a body that is not as well equipped to deal with it. 

Summary:

Most of the time, a fever is not a medical emergency, so no ambulance is required. I want you to forget the numbers on the thermometer, because a very sick little child might only have a mild fever, while another child can be running around no worries with a temp of 40. Be guided by these red flags instead of the numbers on your thermometer.