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Everything you need to know about Fever - 5 key points



1. Measuring the body temperature

  • We need to use a good quality thermometer to measure body temperature as wrong temperature detection can cause delay in seeking medical care, delayed diagnostic workup and eventually leading to delayed treatment. 

  • Criteria for a good thermometer

  • Safe
  • Easy to use
  • Time-efficient
  • Reading is accurate and reliable
  • Reading should not be influenced by environmental temperature
  • If you are doubtful about your thermometer’s accuracy, please send it back to the manufacturer for calibration.
  • We usually encourage parents to use a thermometer which measures the temperature at child’s forehead or ear.

  • Below is a list showing the type of thermometers available in the market and its pros and cons:-

  • Oral or Armpit
    • Pros:  
      Price is cheap
    • Cons:
      Not hygienic because there is bodily contact
      Not child-friendly
      Takes 1 minute to read the temperature.
  • Ear:
    • Pros:
      Price is reasonable
      Child-friendly
      Able to read temperature within 2 seconds
      Hygienic due to minimal bodily contact
    • Cons:
      Might not be accurate if the ear drum is blocked by ear wax
      Cost is incurred to replace the covering cap at the infrared emission tip
  • Forehead
    • Pros:
      More child-friendly.
      Able to read temperature almost immediately
      Hygienic. No bodily contact at all
    • Cons:
      Price is slightly expensive
      The body temperature reading might be affected by cold skin surface if tepid sponging has been done or cool pad has been put on the forehead prior to temperature taking


2.  Definition of fever

Body temperature°C

Severity

37.5 – 37.9

Mild fever

38 – 38.9

Moderate fever

≥ 39

High fever








3. Misbelief in treating children with fever that we should avoid:-

a. Not allowed to take porridge or rice

Advice from Dr Chin: 

Taking porridge or rice will not aggravate the febrile illness. But bear in mind, when the kid is sick during the febrile period, the digestion will be slower and the appetite will surely be affected. If the kid does not want to take in any food, it’s alright!

Avoid force feeding as this may induce vomiting. Parents should ensure their child drinks plenty of fluid.

b. Not allowed to shower

Advice from Dr Chin: 

Once the body temperature returns back to normal, parents should allow their child to shower even during the illness period.

c. Cover child with a thick blanket or wear thick clothing to prevent from getting cold

Advice from Dr Chin:

Dangerous action!

It may cause the body temperature to rise up tremendously and predispose the child to have febrile fit.

d. Rub child’s body (skin) with wet flour and egg to reduce body temperature

Advice from Dr Chin: 

Body temperature may go down after vaporization of water that come from the wet flour or egg.

But I do not encourage such action as the food substance may cause skin allergy.

e. Offer the child canned carbonated / isotonic drink

Advice from Dr Chin: 

Not encouraged because canned drinks contain carbonate that makes the stomach very gassy and bloated. This will induce vomiting.


4. Correct ways to treat a child with fever:

  • General
  • Wear thin clothing to release the body heat.
  • Take plenty of fluid. Any sort of fluid is acceptable; not restricted to plain water. You should include fruit juice, supplement drinks such as Glucolin, honey drink (Note: honey should only be allowed for child age 1 year and above), blackcurrant-based drink such as Ribena, herbal tea, yoghurt drink and more. Try to avoid taking canned soft drinks if possible.
  • Take good rest. Avoid active physical activities.
  • Sponge the child’s forehead, neck, armpit and inner thighs with a wet towel moistened with water directly from the water tap -- room temperature tepid sponging.  Once the towel is warm, rinse the towel again with water. If your child refuse to allow you to put the towel on his/her forehead, you may splash water drops on the forehead to let the water drops vaporize and absorb the body heat. Do not use ice cubes or directly shower your child. These actions will cause your child’s body to shiver and make the body temperature rise up further.
  • Alternatively, you may use the commercial fever cooling pad on your child’s forehead to reduce fever if he/she is sleeping or moving around. Do not stick the cooling pad on any body parts that are non-heat conserved areas such as the back of the body, palms and soles etc. This method will not help to reduce the body temperature.

  • Oral medicine
  • There are 2 types of oral fever medicine available in the market that can be given to the kids safely, namely – PARACETAMOL and IBUPROFEN

  • (a) PARACETAMOL (PCM) 
  • PCM syrup is available under different names in the market.
  • Parents are advised to read the PCM concentration carefully.
  • There are two (2) concentrations of PCM syrups in the market:- 120mg/5ml and 250mg/5ml.
  • The daily maximum dose for PCM is 6 times a day or 4 hourly interval.
  • The dose for every feed of PCM is 15mg/kg/dose, which means for every 1kg of the body weight, 15mg PCM is needed

How to get 15mg PCM from a bottle of PCM with concentration of 120mg/5ml

  • 15mg/120mg x 5ml = 0.625ml =  *0.6ml

How to get 15mg PCM from a bottle of PCM with concentration of 250mg/5ml

  • 15mg/250mg x 5ml = **0.3ml


(b) IBUPROFEN

  • IBUPROFEN syrup is available under different names in the market.
  • It belongs to the Non-Steroidal Anti-Inflammation Drugs (NSAIDs) group; where the mechanism of action reduces inflammation, pain and thus indirectly lowers the body temperature.
  • The concentration is 100mg/5ml.
  • This cannot be given for infant below 6 months old.
  • The maximum daily dose is 20-30mg/kg per day and can be divided into 3 to 4 times a day.
  • It can be given intermittently with PCM.
  • Must be given after meal.

  • Rectal suppository (supp)
  • There are 2 types of suppository  -- Paracetamol Supp (brand name is PORO) and Diclofenac Supp (brand name is VOREN, VOLTAREN) as shown in the table:

Age and Weight

Suppository to be given

< 1 year old

Insert one (1) PORO Supp 125mg or half (½) PORO Supp 250mg

1 year old

Weight < 20kg

Insert one (1) VOREN or VOLTAREN 12.5mg Supp


> 1 year old

Weight 20kg

Insert one (1) VOREN or VOLTAREN 25mg Supp


  • Rectal supp can be given 8 hourly in a day.
  • When body temperature reaches 39oC and oral PCM is due, forego PCM and insert rectal supp instead.
  • 4 hours after insertion of the rectal supp, oral PCM can be given to the kid even though there is a mild fever to prevent the temperature rebound.
  • Generally rectal supp is safe for children, with an exception that some children may experience loose stool following rectal supp insertion.

5. Kids with fever who need to see doctor immediately – Red-flagged signs

  • Fever with seizure – febrile fit or febrile convulsion. In this condition, child is not responsive and presents with involuntary limbs movement – stiffness followed by jerky movement.
  • Fever with signs of dehydration – child is inactive, has poor urine output and dry mouth. This happens when the child has experienced severe vomiting and diarrhoea.  
  • Fever with signs of brain infection – meningitis. The child is inactive, drowsy, irritable, disorientated and unable to recognise parents.
  • Fever still very high (body temperature 39oC) on day-3 of illness.
  • Fever does not subside completely on day-5 of illness. Usually, the body temperature would be spiking high and comes back very frequent during the first 2 days of illness. However, on day-3, the body temperature would gradually decrease. There will be lower peaks and occurs less frequent too. By day-5, the fever would usually subside.
  • Fever with skin rashes.
  • Parents are worried and unsure what to do.
  • Dr. Phuong Doctor

    HSR Clinic

    Đường Trần Hưng Đạo, District 1, Ho Chi Minh City, Vietnam

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