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Parents see fever as the troublesome disease, urgently seeking reassurance and treatment from their doctors.
But what is fever?
“Fever is not an illness. It is a natural response of the body,” Dr Sam explains.
“It’s an indicator that something is going on inside our bodies, an important clinical sign. But it is not the only clinical sign or symptom we look for.”
Fever results from the overall system that fights infection in the body. Tiny chemicals are released by our immune system that flow through our blood, land in the brain, and reset our natural thermostat. The body then produces more heat (metabolic rate rises amongst other processes), with body temperature rising to the new setpoint.
“Whether fever is beneficial or harmful is hotly debated across the world,” says Dr Sam, “and there’s no evidence that fever makes illness worse.”
The magic number defining a fever depends on the age of kids but generally, “over 38.5 degrees is classed as a fever.”
Every time my child has a high temp do we need to panic?
“Absolutely not,” says Dr Sam.
“We have to deal with babies first though. Babies under four weeks with a fever have about a 10 per cent chance of serious bacterial infection. Neonates with a fever must be seen by a doctor urgently.”
“The risk of serious infections like meningitis, meningococcal disease, or kidney infections, all the ones we as parents worry about the most, is greatest for our youngest babies.”
Thankfully the risk of severe bacterial infection drops quickly once baby is a few months old. For kids over six months of age the risk of the most serious infections is around 1 percent.
“But where it gets trickier for parents is when it comes to toddlers and children who, other than the high temperature reading, appear totally fine.”
Sometimes, kids just seem to have a fever
“They might bounce around happily, their nose is dry, they breathe clearly, and we aren’t clearing up poo-nami after poo-nami. They don’t have a ‘focus’, ” says Dr Sam.
These kids should be well fed, drink lots, and observed closely to make sure they don’t get worse.
“Regardless of the cause, as an infection worsens, kids become tired, stop eating and drinking, and could even become irritable, all whingey or whiney. They can struggle [with] breathing or become unconscious if a condition becomes severe,” warns Dr Sam. “If symptoms like these occur, kids need to be checked out.”
“The well kids can usually be observed, re-assessed periodically with the family doctor, checking repeatedly for new clues from the parents. Eventually a urinary tract infection (UTI) might pop up when we check their urine, an ear might become red, or the poo-nami waves finally hit, but ultimately the child remains well”.
Most times, when a cause of the fever is found, it is usually a common virus.
“UTIs, influenza, Respiratory Syncytial Virus (RSV), and enteroviruses are the most common causes, usually.”
“USUALLY,” he stresses. “Of course we can be surprised, but with a good history and examination we can identify the site and cause of an infection, and institute the right treatment straight away.”
Bottom line - Be alert and aware, but not alarmed.
Dr Sam urges parents to also remember, the likelihood of the fever being the first sign of something extremely serious, while real and understandable, is unlikely.
“In medical school, the mantra ‘common things occur commonly’ was drummed into me during long laborious ward rounds,” says Dr Sam. “We were taught to avoid jumping straight to unusual or rare diagnoses – the zebras - and stick to what is most likely”.
“If kids become more unwell, they will need more investigations to try and find a cause, perhaps a chest X-ray or blood tests. As a kid's illness become more severe, these tests should be followed up in hospital, and maybe more advanced tests like lumbar punctures needed”.
Here, doctors are looking for severe bacterial infections, the zebras, but the ones parents rightly worry about the most.
“I don’t ever want to stop parents bringing their kids in to see me, but often kids who only have a fever, can start by being closely monitored at home,” says Dr Sam.
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