Fever! What Parents Need to Know About This Childhood Condition

Learn how to diagnose fever, identify fever symptoms in young children and what to do for a child with a fever.

Fever is a normal physiological response to illness, which facilitates and accelerates recovery. The condition is common in young children, and often benign and self-limiting. However, as childhood fever may be associated with increased morbidity in children, it frequently causes concern among parents and healthcare providers, and is consequently one of the most common reasons for which children are brought to seek medical attention.

In most cases, fever is a presenting symptom of a self-limiting viral infection. However, it may also be associated with serious bacterial infections, such as meningitis and pneumonia, and other non-infective illnesses such as Kawasaki’s disease and malignancy.

Thus it is important for healthcare professionals to determine the underlying serious illness causing the fever, and to identify children with life-threatening features and those at risk of serious illness so that timely intervention and proper referral can be made.

The most common causes of fever seen in young children who seek medical treatment at the Children's Emergency department at KK Women's and Children's Hospital include viral fevers, upper respiratory tract infections and gastroenteritis.

Related: Fever

What to Do for A Child With a Fever?

Guidelines for Clinical Assessment and Management of Fevers in Children

Identify fever symptoms and treat immediate life-threatening features
Be alert to features such as compromised airway, breathing or circulation, and decreased level of consciousness.
Conduct thorough history-taking and systematic examination
After stabilising the child with fever, a thorough history-taking and systematic examination should be carried out to determine the underlying cause of the fever and assess the child for risk of serious illness.
It is crucial to measure and record the child’s vital signs such as temperature, heart rate, respiratory rate and capillary refill time. Signs of dehydration such as prolonged capillary refill time, abnormal skin turgor, abnormal respiratory pattern, weak pulse and cool extremities should also be assessed.

Identify and treat features suggestive of specific diseases (Table 1)

TABLE 1. FEATURES IN CONJUNCTION WITH FEVER THAT ARE SUGGESTIVE OF SPECIFIC DISEASES
DIAGNOSIS TO BE CONSIDERED	FEATURES IN CONJUNCTION WITH FEVER
Meningococcal disease	Non-blanching rash, particularly with one or more of the following features: an ill-looking child lesions larger than 2 mm in diameter (purpura) capillary refill time of ≥3 seconds neck stiffness
Kawasaki disease	Fever for more than five days, and at least four of the following features: bilateral conjunctival injection change in mucous membranes change in the extremities polymorphous rash cervical lymphadenopathy
Bacterial meningitis	Neck stiffness Bulging fontanelle in infants Decreased level of consciousness Convulsive status epilepticus
Herpes simplex encephalitis	Focal neurological signs Focal seizures Decreased level of consciousness
Septic arthritis	Swelling of a limb or joint Avoiding use of, or bearing weight on, an extremity
Pneumonia	Tachypnoea > 60 breaths/minute, age 0–5 months; > 50 breaths/minute, age 6–12 months; > 40 breaths/minute, age more than 12 months Crackling sounds in the chest Nasal flaring Chest indrawing Cyanosis Oxygen saturation ≤95%
Urinary tract infection	Vomiting Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria

"Children with features indicating low risk of illness can be cared for at home; however, it is important to diagnose and treat the underlying cause of fever appropriately."

Assess the risk of serious illness in young children with fever (Table 2)

TABLE 2. TRAFFIC LIGHT SYSTEM FOR ASSESSING THE RISK OF SERIOUS ILLNESS IN CHILDREN YOUNGER THAN FIVE YEARS
FEATURE	LOW RISK	INTERMEDIATE RISK	HIGH RISK
Colour (skin, lips or tongue)	Normal colour	Pallor reported by parent or carer	Pale/mottled/ashen/blue
Activity	Responds normally to social cues Content/smiles Stays awake or awakes quickly Strong normal cry/not crying	Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity	No response to social cues Appears ill to a healthcare professional Does not wake or if roused does not stay awake Weak, high-pitched or, continuous cry
Respiratory		Nasal flaring Tachypnoea -respiratory rate: >50 breaths/minute, age 6–12 months >40 breaths/minute, age >12 month Oxygen saturation ≤95% in air Crackles in the chest	Grunting Respiratory rate >60 breaths/minute Moderate or severe chest indrawing
Circulation and hydration	Normal skin and eyes Moist mucous membranes	Dry mucous membranes Poor feeding in infants Reduced urine output Capillary refill time ≥3 seconds Tachycardia: >160 beats/minute, age <12 months >150 beats/minute, age 12–24 months >140 beats/minute, age 2–5 years	Reduced skin turgor
Other		Age 3–6 months, temperature ≥39°C Fever for ≥Five days Rigors Swelling of a limb or joint Non-weight bearing limb/ not using an extremity	Age <3 months, temperature ≥38°C Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures