Fever in a Child: How to Safely Reduce It and When to Seek Emergency Help

What is a fever and why does it occur?

An increase in body temperature, or fever, is not a disease, but rather the body's protective reaction to an infection or inflammation. It is a natural mechanism that helps fight pathogens, as many viruses and bacteria reproduce less effectively at higher temperatures. A child's normal body temperature usually ranges between 36.5-37.5°C (97.7-99.5°F), but may vary slightly throughout the day.

Most often, fever in children is caused by viral infections (ARVI, influenza), but it can also be a symptom of more serious conditions, such as bacterial infections, sepsis, or meningitis [1, 2]. Therefore, it is important not only to lower the temperature, but also to closely monitor the child's overall condition.

When and how to reduce a child's temperature?

The decision to reduce a temperature depends on the child's age, the temperature level, and their well-being. It is generally recommended to start lowering the temperature if it exceeds 38.5°C (101.3°F), or if the child is tolerating the fever poorly (lethargic, cranky, refusing to drink), regardless of the thermometer readings.

Medications

Two medications are most commonly used to reduce fever in children:

• Paracetamol (acetaminophen): Suitable for children from the first months of life. It acts relatively quickly (in 30-60 minutes) and effectively. It is important to strictly follow the dosage indicated in the instructions based on the child's weight and not to exceed the recommended intervals between doses.
• Ibuprofen: Approved for use in children over 3-6 months of age (depending on the dosage form and manufacturer's recommendations). It has both antipyretic and anti-inflammatory effects. It is also necessary to strictly follow the dosage instructions and intervals.

Never give a child aspirin (acetylsalicylic acid) to reduce a fever due to the risk of Reye's syndrome, a rare but very dangerous condition.

Non-pharmacological methods

These methods can help relieve the child's condition and enhance the effect of medications:

• Plenty of fluids: During a fever, the body loses a lot of fluid. Offer the child water, unsweetened tea, compote, or fruit drink. This helps prevent dehydration and promotes the elimination of toxins.
• Cool and humid air: Maintain a comfortable room temperature (around 20-22°C or 68-72°F) and ensure adequate humidity. Ventilate the room.
• Light clothing: Do not bundle the child up. Clothing should be loose and made of natural fabrics so as not to impede heat dissipation.
• Warming water sponge baths: You can wipe the child's skin with a sponge soaked in warm (not cold!) water. The evaporation of water from the skin surface helps with cooling. However, avoid wiping with cold water, alcohol, or vinegar, as this can cause vascular spasms, worsen heat dissipation, and lead to intoxication.

It is important to remember that excessive cooling or overly aggressive methods can lead to a dangerous condition—hypothermia, when body temperature drops below 35°C (95°F) [6]. Always act reasonably and observe the child's reaction.

Warning signs: when is urgent medical help needed?

Although most cases of fever in children do not pose a serious threat, there are situations when it is necessary to immediately consult a doctor or call an ambulance. Fever can be a sign of serious conditions requiring timely diagnosis and treatment [1, 2, 8].

• Age under 3 months: Any temperature rise above 38°C (100.4°F) in infants requires an immediate medical consultation.
• Very high temperature: A temperature above 39-40°C (102.2-104°F) that is poorly reduced by antipyretic drugs.
• Changes in behavior: The child becomes unusually lethargic, drowsy, apathetic, or, conversely, excessively agitated and inconsolably crying.
• Difficulty breathing: Rapid, noisy breathing, shortness of breath, retractions of the intercostal spaces.
• Rash: The appearance of any rash, especially hemorrhagic (in the form of petechiae or bruises that do not fade when pressed).
• Seizures: Febrile seizures can be frightening, but are usually not dangerous. However, they require a medical examination to rule out other causes.
• Signs of dehydration: Dry mucous membranes, absence of tears when crying, infrequent urination, sunken fontanelle in infants.
• Severe headache, neck stiffness: These symptoms may indicate serious infections such as meningitis, for the diagnosis of which a lumbar puncture may be required [2].
• Suspected sepsis: Sepsis is a life-threatening condition caused by the body's uncontrolled response to infection. It is one of the leading causes of child mortality and morbidity. Timely medical care significantly improves survival [1]. Symptoms of sepsis may be nonspecific, but include high fever, rapid heart rate and breathing, pale or mottled skin, cold extremities, decreased activity, and refusal to eat and drink. Unfortunately, not all hospitals have protocols for the early detection and treatment of pediatric sepsis, and diagnostic procedures such as blood cultures are not always performed [1]. Therefore, parental vigilance and timely seeking of help are critically important.
• Prolonged fever: The temperature lasts for more than 3 days without visible improvement.

Modern research is actively studying new methods for diagnosing infections and sepsis in children, including gene expression analysis, which can help in faster and more accurate identification of the pathogen and the selection of adequate therapy [8].

What NOT to do when a child has a fever?

• Do not panic: The parents' calmness is transmitted to the child.
• Do not use aspirin: As already mentioned, it is contraindicated in children.
• Do not wipe with alcohol or vinegar: This can lead to intoxication and vascular spasm.
• Do not bundle the child up: This interferes with natural heat dissipation.
• Do not give medications "just in case": Strictly follow the dosage and intervals.
• Do not ignore warning signs: If they appear, consult a doctor immediately.

Maintaining comfort and recovery

In addition to lowering the temperature, it is important to provide the child with rest and comfort. Offer a favorite book, cartoon, or quiet game. Do not insist on food if the child refuses, but ensure adequate fluid intake. Once the temperature normalizes, give the child time to fully recover. Gradually return to normal activities, avoiding overexertion.

Sources

1. Pediatrics. In-Hospital Quality-of-Care Measures for Pediatric Sepsis Syndrome. (2017). https://pubmed.ncbi.nlm.nih.gov/28739652/

2. Archives of disease in childhood. Education and practice edition. How to use… lumbar puncture in children. (2015). https://pubmed.ncbi.nlm.nih.gov/26104280/

3. Forensic science, medicine, and pathology. Hypothermia. (2010). https://pubmed.ncbi.nlm.nih.gov/20151230/

4. Acta paediatrica (Oslo, Norway : 1992). Use of transcriptomics for diagnosis of infections and sepsis in children: A narrative review. (2024). https://pubmed.ncbi.nlm.nih.gov/38243675/

The information presented in this article is for reference purposes only and cannot replace a professional medical consultation. Always consult a specialist for the diagnosis and treatment of diseases.