What should caregivers and parents do when a child has a high temperature, especially amid Covid concerns, asks Meredith Jones Russell
Children’s body temperature is usually around 36.4°C on average, but it varies from child to child and fluctuates naturally throughout the day. Only when their temperature reaches 38°C or higher do they officially have a fever.
A high temperature is the body’s natural response to fighting infections such as coughs and colds, but as temperature is one of the officially recognized symptoms of Covid-19 and many support services have not been available to families during the pandemic, it is perhaps not surprising that this concern is felt. Fever among people caring for young children is at a high level.
In June, hospital emergency departments reported an increase in the number of young children brought in with mild fevers by anxious parents, with the number three times that of the previous year.
Dr Michelle Jacobs, from the Royal College of Emergency Medicine (RCEM) Pediatric Emergency Medicine Professional Advisory Group, explains: “We are seeing a huge increase in the number of children under the age of five presenting with fever on wards. emergency, and the situation is getting worse.
“The majority of these children are not that sick, but for many parents, this may be the first time their child has been sick. Access to a GP is variable at the moment, and if you are worried about your child, a telephone conversation may not reassure you. The whole process can be long, complicated, tedious and difficult to follow. Many parents think they will at least have the opportunity to see someone in person in the emergency room, when they would normally have seen a GP or gotten support or advice from family or contacts such as an antenatal class or a pharmacy. There’s a lot less of that going on these days.
DEALING WITH FEVER
Online resources are often the first point of contact for caregivers who are concerned about a child with a fever.
The NHS website says many factors can cause a high temperature in children, from common childhood illnesses such as chickenpox and tonsillitis to vaccinations, and that most fevers should subside within three or four days .
If a child in your care has a high temperature, you should:
- provide plenty of fluids
- watch for signs of dehydration, such as dark yellow, strong-smelling urine, feeling dizzy, dizzy or tired, dry mouth, lips or eyes, or urinating less than four times a day
- provide food if desired
- give them paracetamol if they are distressed or unwell.
- You should avoid:
- undress or towel dry the child to cool him down
- covering them with too much clothing or bedding
- giving aspirin to children under 16
- combining ibuprofen and paracetamol, unless otherwise indicated by a general practitioner
- give paracetamol to children under two months old
- give ibuprofen to children under three months old, under 5 kg or with asthma.
You should call 111 or a GP if a child:
- is less than three months old and has a temperature of 38°C or more, or is between three and six months old and has a temperature of 39°C or more
- also has other signs of illness, such as a rash
- has a high temperature for five days or more
- does not want to eat, or is not in his usual state
- has a high temperature which does not go down with paracetamol
- is dehydrated, with signs such as poorly wet diapers, sunken eyes, or no tears when crying.
- You should call 999 if a child:
- has a stiff neck
- has a rash that doesn’t go away when you press a drink against it
- is bothered by light
- has a seizure for the first time
- has unusually cold hands and feet, blue, pale, or blotchy skin, lips, or tongue, or a weak, high-pitched cry unlike his or her normal cry
- is sleepy and difficult to wake up
- won’t stop crying or confused
- has difficulty breathing and draws his stomach under his ribs
- is not responding as he usually does, or is not interested in eating or normal activities.
VERIFICATION
As more children are hospitalized, many emergency departments are testing using multiviral swabs, which track the spread of Covid-19 as well as many other viruses.
While many children who go to the emergency room with high temperatures suffer from colds, upper respiratory infections, or other common viruses in the first years of life as they build up their immunity, Dr. Jacobs says there is growing concern about a notable increase in respiratory syncytial virus. (RSV), responsible for bronchiolitis. Many children recover from bronchiolitis in two to three weeks without needing treatment, but some can become very ill.
“RSV is usually very winter-restricted, starting around September or October and then disappearing by early spring, but data from Australia and other parts of the world show that the seasonality has changed this year,” explains Dr. Jacobs. “We are seeing RSV now and the regional numbers are increasing. It’s starting earlier, it’s going to last longer and we’re going to see a lot more kids with it, like so few had it last year because of the pandemic. These children will need to be admitted to the hospital and perhaps even to pediatric intensive care. We are therefore very concerned about the lack of beds, especially for children born prematurely or with other immune or heart problems.
Greater awareness of how to safely monitor for fever outside of the hospital when possible is key to keeping more children safe, says Dr. Jacobs. “What we need to do above all is keep children who are usually far from the hospital, or at least have them seen in the community first,” she explains. “It is not good for children to be hospitalized when they do not need to be, when they often have to wait a long time and with all the infection control risks that come from a hospital.” And general practitioners are much better at caring for children who are generally well, while junior doctors in emergency departments are used to seeing children who are on average much sicker than children in the community.
Some GP practices have set up regional ‘hot centres’ for children suffering from high temperatures.
“Many practices cannot comply with Covid standards,” says Dr Jacobs. “They may only have one entrance door and therefore may not have a one-way system, for example. Some banded together to find a compliant practice so the hot kids could be referred there for face-to-face appointments. If these resources could be developed and used further, they would be a very good resource.
However, for early childhood practitioners, Dr. Jacobs acknowledges that knowing how to respond to fever outbreaks in today’s climate is a hot topic.
“On the one hand, if you want to err on the side of caution, any child or adult with viral symptoms should not be present at daycare,” she says. “But in practice this could mean the entire workforce is decimated and half the children are at home at any given time, without even taking into account the NHS apps that send queries to people.” The gold standard would be for anyone with viral symptoms to stay away from nursery, whether staff, parents or children, but how feasible is this? It’s very difficult for everyone at the moment.
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