Children’s body temperature is usually an average of around 36.4?C, but varies from child to child and will fluctuate naturally throughout the day. It is only when their temperature hits 38?C or higher that they officially have a fever.
A high temperature is the body’s natural response to fighting infections such as coughs and colds, but as a temperature is one of the officially recognised Covid-19 symptoms and many support services have been unavailable to families during the pandemic, it is perhaps unsurprising that concern about fever among carers of young children is at a high.
In June, hospital emergency departments reported a surge in the number of young children being brought in with mild fever by anxious parents, with three times the number attending than the figure for the previous year.
Dr Michelle Jacobs, of the Royal College of Emergency Medicine’s (RCEM) paediatric emergency medicine professional advisory group, explains, ‘We are seeing a huge surge in under-fives presenting with fever in emergency departments, and it is getting worse.
‘The majority of these children are not that unwell, but for many parents it may be the first time their child has been ill. Access to a GP is variable at the moment, and if you are worried about your child, a conversation over the phone is perhaps not going to reassure you. The whole process can be long, complicated, drawn-out and not easy to navigate. Many parents think at least they will get to see someone face-to-face in an emergency department, when ordinarily they would have seen a GP or got support or advice from family or contacts like an antenatal class or pharmacy. There’s a lot less of that happening at the moment.’
DEALING WITH A FEVER
Online resources are often the first port of call for carers who are concerned about a child with fever.
The NHS website advises that many things can cause a high temperature in children, from common childhood illnesses such as chickenpox and tonsillitis to vaccinations, and most fevers should go down over three or four days.
If a child in your care has a high temperature, you should:
- provide plenty of fluids
- look out for signs of dehydration, such as dark yellow and strong-smelling urine, feeling dizzy, lightheaded or tired, having a dry mouth, lips or eyes, or passing urine less than four times a day
- provide food if wanted
- give paracetamol if they are distressed or unwell.
- You should avoid:
- undressing or sponging down the child to cool them
- covering them in too many clothes or bedclothes
- giving aspirin to children under 16 years old
- combining ibuprofen and paracetamol, unless a GP tells you to
- giving paracetamol to children under two months old
- giving ibuprofen to children under three months old, under 5kg, or with asthma.
You should call 111 or a GP if a child:
- is under three months old and has a temperature of 38?C or higher, or is between three and six months old and has a temperature of 39⁰C or higher
- has other signs of illness as well, such as a rash
- has a high temperature for five days or more
- does not want to eat, or is not their usual self
- has a high temperature that does not come down with paracetamol
- is dehydrated, with signs including nappies that are not very wet, sunken eyes, or no tears when crying.
- You should call 999 if a child:
- has a stiff neck
- has a rash that does not fade when you press a glass against it
- is bothered by light
- has a fit 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 their normal cry
- is drowsy and hard to wake
- does not stop crying or is confused
- finds it hard to breathe and sucks their stomach in under their ribs
- is not responding like they normally do, or is not interested in feeding or normal activities.
CHECKING UP
With more children attending hospitals, many emergency departments are testing using multi-viral swabs, which track the spread of Covid-19 along with many other viruses.
While many children going to emergency departments with high temperatures have colds, upper respiratory tract infections, or other viruses common in the first few years of life as they build up immunity, Dr Jacobs says there is growing concern about a notable rise in respiratory syncytial virus (RSV), which causes bronchiolitis. Many children will recover from bronchiolitis within two to three weeks without needing treatment, but some can become very unwell.
‘RSV is usually very much restricted to the winter, beginning around September or October then petering out in early spring, but data from Australia and other parts of the world is showing the seasonality has changed this year,’ says Dr Jacobs. ‘We are seeing RSV now, and regionally numbers are going up. It’s starting earlier, it’s going to last longer, and we are going to see many more children with it as so few had it last year due to the pandemic. These children will need admission to hospital and maybe even paediatric intensive care, so we are very concerned about the lack of beds, especially for children who were born prematurely or have other immune or cardiac problems.’
Greater awareness of how to safely monitor a fever outside of hospital where possible is key to keeping more children safe, says Dr Jacobs. ‘What we need to be doing above all is keeping children who are generally well out of hospital, or at least getting them seen in the community first,’ she explains. ‘It’s not good for children to be in hospital when they don’t 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 GPs are much better at looking after children who are generally well, while junior doctors in emergency departments are used to seeing children who are on average much more unwell than children in the community.’
Some GP surgeries have set up regional ‘hot hubs’ for children with high temperatures.
‘Many practices can’t be Covid-compliant,’ Dr Jacobs explains. ‘They might only have one front door so can’t have a one-way system, for example. Some have been clubbing together to find a practice that is compliant so hot children can be referred there for face-to-face appointments. If these could be expanded and used more, they would be a very good resource.’
However, for early years practitioners, Dr Jacobs acknowledges that knowing how to respond to fever outbreaks in the current climate is a hot topic.
‘On the one hand, if you want to err on the side of caution, any child or adult who has any viral symptoms whatsoever should not be at nursery,’ she says. ‘But in practice, that could mean the whole workforce is decimated and half the children are at home at any one point, without even accounting for the NHS app pinging people. The gold standard would be that anyone with any viral symptoms would stay away from nursery, whether that’s staff, parents or children, but how workable is that? It’s very difficult for everyone at the moment.’
FURTHER INFORMATION