FEVER IN CHILDREN

Fever is a common but non specific presenting sign in children. Any child with a temperature of 37.5 C or above is said to be febrile. Fever accompanies a wide variety of illnesses and does not always need to be treated on its own. In general,
the cause should be ascertained as far as possible before therapy is started.

Clinical Features

History should take into account the duration, place of residence or travel to areas of high malaria transmission, pain on passing urine, pain in the ears, and whether there is a rash or not. A thorough physical examination to find localizing
signs should also be done.

  • Fever without localizing signs can be due to:
    • Malaria
    • Septicaemia
    • Urinary tract infection
    • HIV
  • Fever with localizing signs can be due to:
    • Ear or throat infection
    • Pneumonia
    • Septic arthritis or osteomyelitis
    • Meningitis
    • Skin and soft tissue infection
  • Fever with a skin rash is commonly due to:
  • Viral infections
  • Could also be due to meningococcal infection
  • Fever lasting longer than 7 days can be due to:
    • Abscesses
    • Infective endocarditis
    • Tuberculosis
    • HIV
    • Salmonella infections
    • Any chronic infection or inflammatory condition
    • Malignancies

Investigations

  • Full blood count
  • Blood smear for malaria parasites
  • Urinalysis and microscopy
  • Blood culture and sensitivity
  • If fever lasts > 7 days, in addition to the above do:
    • Mantoux test
    • Chest x-ray
    • HIV test
    • Any specific test according to suspected cause

Management – General

  • Ask parent to reduce child’s clothing to a minimum in all cases.
  • Ensure adequate fluid intake.
  • Ensure adequate nutrition.
  • If fever is high (>39°C) or child in pain, give paracetamol
  • Treat the cause if identified.
  • Give an antimalarial if at risk (see Section 20, on malaria).
  • Review child after 5 days.
  • Ask parent to return any time if child is not improving or is getting worse.

Paediatric paracetamol doses, every 6 hours

Age Weight(kg) 500mg tablet l20mg/5ml syrup
2 months up to 12 months 6–9 ¼ 2.5–5ml
12 months up to 3 years 10–14 ¼ 5–10ml
3 years up to 5 years 15–19 ½ 10ml

Fever alone is not a reason to give antibiotic except in a young infant (age less than 2 months).

Management – Specific

Identification of the cause is the key to management and helps to prevent overuse of specific drugs, e.g., antibiotics or antimalarials.

Management of Fever at the Community Level

Since most of the cases of fever occur at the community level, it is essential to train health care providers and caregivers where applicable on early recognition and prompt initiation of treatment at the community level. This includes not only
the use of the appropriate antimalarial, but also the use of other methods to control fever. The patients should be taken immediately to a health facility if there are any features of severity as described in the section on severe malaria below.