If your child appears sick and feels hot, you should take a temperature: More than 38.5 °C? Then it is fever. Newborns in the first 4 weeks are considered to have a fever as low as 38°C!
Correctly measure fever
One of the first things parents do when their child appears sick and feels hot is to take the child’s body temperature.
This is best done in the buttocks ("rectally") with a digital thermometer. But also an electronic ear thermometer can be used (error possibilities with earwax or draught).
More than 38.5 °C is considered a fever (for newborns younger than 1 month already 38 °C).
How fever develops?
In the vast majority of cases, fever is not an illness in its own right, but only a symptom.
The body temperature is determined by a part of the brain called the. hypothalamus, controlled and regulated to a normal set point between 36.6 and 38 °C. Certain messenger substances that are produced in the body during infections can reach the hypothalamus and cause an adjustment of the set point towards higher values:
The body suddenly perceives 37 °C as too cold and regulates the temperature upwards, for example by shivering. This produces a fever, and certain metabolic and defense processes run more quickly.
For newborns, this procedure sometimes does not work. Newborns and young infants can have severe infections without developing a fever! So if at this age a child z. B. If the child is noticed by a reluctance to drink or a change in skin color or sensitivity to touch or by other signs that are unusual for the parents, the pediatrician should be consulted, even if no fever is present. The same applies to children whose immune system is impaired due to an underlying illness or medication.
Where does fever come from? What are the causes?
The pediatrician can often determine what is causing the fever during the physical examination: otitis media, tonsillitis, bronchitis, gastrointestinal infection. Some infections produce a typical rash of the skin, such as in the so-called ‘childhood diseases’. If the child’s examination does not find a cause for the fever, a urine test is usually needed to rule out a urinary tract infection.
With clinical examination and urine testing, about 90 % of all fever states can be explained and also specifically treated. If your pediatrician suspects a serious infection, further testing will follow (blood draw for the lab, possibly. X-ray, etc.).
Address possible warning signs of a complicated course when visiting the doctor: Fever can also be an indication of a threatening infectious disease. Ask these questions as part of your normal checkups when your child is not sick.
Knowing such warning signs will help you decide when you definitely need to present your child (again) to the doctor’s office or pediatric emergency services. Also ask who you can contact if the practice is closed.
In rare cases, the fever is not due to an infectious disease, and the pediatrician must consider a large group of diseases that may also be characterized by prolonged or recurrent episodes of fever. Your doctor will initially refer to fever as having an unknown cause: Fever of unknown origin). The specific clarification is complex, sometimes pediatric specialists at appropriate centers must be involved. However, the correct diagnosis is the crucial prerequisite for effective treatment of the cause of the fever. Sometimes no cause is found and the fever disappears by itself.
When making a diagnosis, it can often be helpful for the doctor if he/she knows the course of the fever, i.e. if the temperature has been measured regularly over several days, sometimes even weeks. Such temperature curves should be brought to the presentation to the pediatrician and adolescent doctor.
What can I do at home?
No measures need to be taken for children who are lively and eat and drink normally despite an elevated body temperature. However, a fever can affect a child’s general condition: Feels poorly, has muscle and limb pain, has poor appetite, and is crotchety. On the other hand, there are children who remain relatively unaffected even by a high fever and who then do not need fever reduction.
There is no absolute limit above which fever reduction is necessary, but as a rule, fever should be reduced above 40 °C.
But even at lower temperatures, if the child is obviously suffering, it is useful to reduce the fever.
For small children, suppositories or juices are available for this purpose, large children can take tablets. The active substances paracetamol or ibuprofen are useful. Some children respond better to one medication, some to the other. Which of the two can be tried out, but otherwise both medications should not be given in combination (or alternately / one after the other)!
The drug acetylsalicylic acid (z. B. Aspirin®) should always be taken with feverish children not Be applied.
In addition, abdominal or calf compresses can be used in cases of high fever – but only if the extremities are warm (and well supplied with blood). Use body-warm (not cold) temperature medication!) moist compresses to take advantage of evaporation for better "temperature radiation".
Depending on whether your child is cold or sweating profusely, either wrap him or her up warmly or just cover him or her with a light blanket.
All measures only relieve the discomfort, but do not combat the cause of the fever. Fever reduction is therefore no substitute for an examination by a pediatrician or adolescent doctor!
When to do something?
In the past, it was often advised to apply to children who were too sog. "fever cramps" tend to consider the use of fever-reducing medication at an early stage. This is no longer recommended because it has been shown that, contrary to expectations, early fever reduction does not prevent the development of febrile convulsions.
In most cases, temperatures of 38.5 °C or even above 39 °C can be accepted if the child is in good general health and lively, as long as the child consumes enough fluids. Important questions here are whether the diapers are still wet and the child’s mucous membranes are moist.
Are antibiotics necessary?
Antibiotics are very important, often life-saving drugs for certain infectious diseases caused by bacteria. In most otherwise healthy children with fever, the underlying cause is a trivial viral infection. In this case, antibiotic treatment is necessary only in the fewest cases. Your pediatrician will weigh the benefits and risks very critically and carefully in each individual case. Please discuss your concerns when you visit the doctor – and also what exactly you expect from the medical examination and consultation.
Prepared on behalf of the German Society for Pediatric and Adolescent Medicine e. V. (DGKJ)
from Arbeitsgemeinschaft Padiatrische Immunologie (API): Prof. Dr. Michael Weib, Cologne, Prof. Dr. Ansgar Schulz, Ulm; German Society for Pediatric Infectiology (DGPI): Prof. Dr. Johannes Hubner, Munich, Prof. Dr. Arne Simon, Homburg / Saar
Society for Child and Adolescent Rheumatology (GKJR): Prof. Dr. Johannes-Peter Haas, Garmisch-Partenkirchen, Prof. Dr. Dirk Foll, Munster; German Society for Child and Adolescent Medicine (DGKJ): Prof. Dr. Reinhard Berner, Dresden; in cooperation with the Professional Association of Pediatricians and Adolescents e. V. (BVKJ)