Fever in Kids: Why You Shouldn’t Lower It!

You’ve certainly had to deal with fever in kids, and someone may have recommended paracetamol to lower it. But why should it not always be lowered? In this article, we’ll discuss what fever is, when it is worrisome, and when it may not be lowered to facilitate the child’s recovery.

Fever in kids: let’s start with the basics.

Let’s start this article with some useful terms:

low-grade fever: between 37-38°C;

fever: between 38-40 °C;

hyperpyrexia: above 40 °C.

Now that we’re clear on at least the basics, let’s talk about what science says about baby fever.

Let’s start by understanding our sources, we have several and you’ll find them all in UpToDate, for us “insiders” (I.E. Pediatricians and MDs) an inexhaustible source of solid and always up-to-date medical knowledge based on solid studies published in authoritative journals.

From here, we can deduce one main thing:

“[…] educational interventions provided before episodes of illness had the potential to improve medication management and health care seeking behavior by parents when the child became ill.”

Source 1 – Footnote.

Once again, the importance of information and health education, which is sorely needed all over the world, is emphasized. So, let’s take a look together at what fever guidelines are. You will find some surprises!

fever in kids

What do I do if the child has a fever?

What do the guidelines tell us about fever in the child?

Let’s summarize them in 10 points (Sources 2 and the following that you will find at the bottom of the article).

  1. Fever is not a disease but a physiological response of the body to infection;
  2. In children without underlying disease, most fevers are self-limiting and benign, provided the cause is known and fluid loss is replenished;
  3. Fever does not cause brain damage;
  4. If there are signs of severe illness (significant pain, respiratory distress, excessive drowsiness or agitation, repeated vomiting or numerous discharges resulting in contraction of diuresis due to inability to supplement losses by drinking) or if it is an infant (first 30 days of life) or an infant (first month to one year of age and particularly in the first 6 months of life) it is necessary to have the child examined quickly (if he or she is well enough, there is no need to rush to the emergency room after an hour after the onset of fever!);
  5. Fever does not make the infectious disease worse; on the contrary, it serves to fight it. During the initial phase of fever elevation when the child is shivering and/or feeling cold with cold hands and feet and sometimes perioral pallor, you can cover him or her: he or she is generating heat! Once the temperature has peaked, it is a good idea to uncover him and offer drinks often.
  6. Fever should be lowered with medication (paracetamol or ibuprofen) if and only if the child is in pain/lamentous, and not if he just needs to rest and be “in peace” to let his immune system (which we remind you is helped by the fever!) can best fight the infection.
  7. Whether or not a child responds to antipyretic therapy does not help us determine whether it is a bacterial or viral infection. If, however, after the antipyretic effect of the medication (which should always be given by mouth when possible, and it takes at least an hour for it to act) the child is better, it is always a good sign.
  8. If a febrile child is sleeping peacefully, he or she is clearly not in pain and therefore should not be awakened to administer medication (much less taken to the ER at any time of the day or night!): fever, let us remember, is not a disease.
  9. Administration of antipyretics cannot prevent febrile seizure episodes (in predisposed children): no point in dogging (as you will find in Source 9). At most, it reduces the risk of episodes following the first within that same febrile episode.
  10. Antipyretic drugs should always be dosed according to weight, not age, and, if possible, administered after the temperature has reached its maximum value.

We consider a decrease in temperature of at least 1°C (e.g., from 40°C to 38.9°C) to be a good response to the medication.

If one administers the drug just past 38.5°C (as is often done without a rationale) not knowing what the maximum value would have been (perhaps 40°C), one might be “disappointed” by the antipyretic effect of the drug: the typical “fever is not going down.”

In fact, it did not go up further, but it is as if it had gone down.

Is high fever a problem?

A large proportion of pediatric emergency room admissions are due to the infamous “high fever.” Without respiratory distress, unusual major headache, repeated vomiting, pain (belly, ears, throat), altered consciousness.

Almost all white codes, almost all improper access.

If the child presents with pain or is in pain/lament, it is good to choose a medication BETWEEN paracetamol and ibuprofen.

Paracetamol is repeatable every 6 hours, ibuprofen every 8 hours.

If it is not possible to wait for the respective intervals (because the child is in pain/hurting, not because the fever is rising again!), the 2 drugs can be alternated every 4 hours for a few days.

But for the management of the pain that should ALWAYS be resolved, not the fever!

Can a high fever be indicative of a severe infection? Yes, but even minor infections (e.g., pharyngitis) can present with fever above 40°C (hyperpyrexia).

So too could septicemia or severe viral respiratory failure present in apyrexia or with a few lines of fever.

How do I measure it well?

To measure fever, the classic axillary measurement is preferable to the others (auricular, frontal, rectal): it does not lie.

I close the informative article with a simple calculation to always precisely dose paracetamol syrup and ibuprofen oral suspension by weight:

  • Paracetamol syrup (24 mg/mL, ex Tachipirin): weight x 0.625 repeatable every 6 hours. E.g. 10 kg baby, must take 6.25 mL.
  • Ibuprofen oral suspension 100 mg/5 mL (“classic,” e.g. Momentkid, Nurofen with orange packaging): weight divided by 2 repeatable every 8 hours. Ex. 10 kg baby should take 5 mL.
  • Ibuprofen oral suspension 200 mg/5 mL (e.g., Nurofen with green packaging, more concentrated than “classic”): weight divided by 4 repeatable every 8 hours. Ex. 10 kg baby must take 2.5 mL.

Conclusions

We have understood from this article that it is not always necessary to lower the fever and that it is not an illness, but only one among many symptoms. There are situations, in conjunction with symptoms of malaise, that may require lowering the fever, or where it is a sign not to be underestimated, but taken alone it is almost never an indicator of the underlying condition.

That is why a pediatric visit and knowledge of how our bodies and our children’s bodies work is important to provide them with the best support during times of illness.

We are with you.

We at Parentalife are here to support you with the best possible information, our guides and classes, and personalized consultations. Remember, on this journey, you will never be alone, we are with you.

SOURCES

1. https://pubmed.ncbi.nlm.nih.gov/27432451/
2. https://pubmed.ncbi.nlm.nih.gov/6333668/
3. www.nice.org.uk/guidance/ng143CG160
4. https://pubmed.ncbi.nlm.nih.gov/18562453/
5. https://pubmed.ncbi.nlm.nih.gov/21357332/
6. https://pubmed.ncbi.nlm.nih.gov/3324040/
7. https://pubmed.ncbi.nlm.nih.gov/3627881/
8. https://pubmed.ncbi.nlm.nih.gov/8344044/
9. https://pubmed.ncbi.nlm.nih.gov/23702315/

About the Author

Giorgio Cuffaro - Paediatrician