How to cope with your baby’s fever

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A baby with a high fever is a scary experience, especially in the middle of the night. Many parents immediately grab the paracetamol or ibuprofen to try and lower the fever, because they are scared of their baby suffering from seizures or even brain damage. Ina Opperman spoke to Dr Carla Els, a paediatric pulmonologist and allergy specialist, about fever in babies.

“Fever and even high fever in babies should not scare parents as much as it does. Fever in babies is actually good, because it turns on the body’s immune system to fight infection.

“A fever is a sign that your baby has probably picked up a viral infection and the fever is a symptom of the baby’s little body fighting back, but parents must remember that it can be harmful in a child with an underlying condition,” says Els.

Normal baby temperature
During the first few weeks, babies normally do not run a temperature and therefore it is important to look out for other symptoms such as irritability, poor feeding, lethargy, and poor circulation, which is indicated by very cold hands and feet.

The normal rectal temperature for a newborn baby from birth to 28 days is 37.5°C, with an upper limit of 38°C. When the baby’s temperature rises to above 38°C, it is considered to be a fever. In babies between the ages of three and 36 months a temperature of 38-39°C is considered a fever and a fever of concern is a rectal temperature above 39°C. In older children an oral temperature of 37.8-39.4°C is considered a fever and a fever of concern is above 39.5°C, says Els.

Myth: Children always have a fever when they feel warm.
Fact: Children can feel warm due to the weather, from crying or getting out of a warm bed.

Other symptoms of fever
Apart from a temperature above 37.5°C, babies can also show the following symptoms of fever:

• A flushed face
• Sweating
• Skin that is warm or hot to the touch
• Shivering
• Rapid heart rate
• Rapid breathing

Treating fever at home
There is no need to panic when your baby has a mild fever, Els says. “Fever is the body’s reaction to infection and this is a sign that the immune system is trying to fight the infection. Parents should first try to determine why the baby has a fever.

“If they are unable to determine the cause, they should take the baby to a doctor. A fever is not necessarily dangerous, harmful or bad, and we usually give babies antipyretic medicine for fever because they are in pain, irritable or miserable and not really to stop the fever.”

She says it is more important to watch your baby’s hydration and be on the lookout for symptoms of serious illness.

• If the fever is not rising and you can break it by taking off some clothes, giving her fluids and keeping her still, you can treat your baby’s fever at home when she is drinking and sleeping well and seems happy without using an antipyretic.
• If you do use an antipyretic, only give your baby four doses of paracetamol or three of ibuprofen per day, as more can cause side-effects. Also never use both medicines at once.
• Make sure your baby is wearing something comfortable, but do not take all her clothes off, because this can make her feel cold even if she is hot to the touch.

Myth: Sponging your baby with lukewarm water will help to break the fever.
Fact: Keeping your baby hydrated is more important.

When to go to the doctor
Get immediate medical attention if your newborn baby has a fever, or if your baby:

• has a fever higher than 40°C
• is difficult to wake
• cries and cannot be comforted
• has a rash as well
• has a stiff neck
• has difficulty breathing
• is drooling and cannot swallow or feed
• has convulsions
• has an underlying medical condition

In addition, see a doctor within 24 hours if your baby:

• has a fever for longer than 24 hours without an obvious infection
• has a fever for more than three days
• has a recurring fever that comes and goes
• is younger than a year old
• has pain urinating

Myth: A high fever is serious cause for concern.
Fact: The cause of a fever can be serious, but also not serious. If your baby looks very sick, she likely is, and you should get medical attention.

Risks of a high fever
The risk of high fever in babies is mostly that parents can suffer from what is called “fever phobia.” This is when a parent is so desperate to lower a baby’s fever that they overdose the baby with medicine.

Myth: A high fever can cause brain damage.
Fact: Only a fever higher than 42°C can cause brain damage and the brain will never allow the body’s temperature to get that high. This can only happen if the air around the baby is hot, such as when a baby is left in a car with closed windows.

Fever and convulsions
Febrile convulsions or seizures can happen when a baby between the ages of six months and three years has a fever that is usually caused by an infection, such as chickenpox, flu, a middle ear infection or tonsillitis. Fortunately these seizures are usually harmless and almost all children recover completely.

Take your baby to the doctor if she is having a seizure for the first time, if it lasts longer than five minutes and shows no signs of stopping, if you suspect it is caused by another serious illness, such as meningitis, or if your baby finds it difficult to breathe.

Also watch out for symptoms, such as a dry mouth, sunken eyes, a lack of tears when crying and a sunken fontanel, the soft spot on the baby’s head, which indicates dehydration.

Myth: Seizures from a fever are always harmful.
Fact: Seizures are harmful when the child is having repeated seizures, the seizures last for a long time and if they continue. Usually seizures do not cause any permanent harm such as increasing the risk for speech delays, learning problems, or seizures without fever.

Fever and infection
Fever is not always an indication of infection, says Els. “Vaccinations and teething can cause a baby’s temperature to increase slightly.” Gastrointestinal and respiratory infections usually cause fever in babies and symptoms usually include:

• Not wanting to feed
• Listlessness
• Diarrhoea
• Vomiting
• Ear pain
• Runny nose
• Coughing

Myth: If you cannot “break the fever” the cause is serious.
Fact: Fevers that do not come down to normal can be caused by viruses or bacteria, but the response to fever medicines does not give any indication about the cause of the infection.