Fever Without Symptoms in Children: Causes and Concerns

Asymptomatic fever?

Hello, Doctor.
My child will turn eight years old in July.
He is 120 cm tall and weighs 196 kg.
On the evening of June 17, my child said he had a stomachache.
He has experienced discomfort from constipation before, and after an enema, he felt better.
However, this time he had a fever of 38.1°C.
After taking medication, his temperature dropped to 36.7°C at 10 PM, but he seemed fatigued and kept sleeping.
I could wake him up.
On June 18 at 4 PM, he had a fever of 39.6°C, took medication, and at 6 PM, his ear temperature was 38.8°C.
By 7 PM, it was 39.5°C, so we took him to the hospital immediately.
At the hospital at 8 PM, his ear temperature was 38.2°C.
I informed the doctor that he had stomach discomfort on the first day of the fever, but the doctor said it was not gastroenteritis since he had not had diarrhea or vomiting, and he only complained of stomach discomfort once.
Therefore, we were advised to observe him at home.

In the early morning of June 19, his temperature was 39.6°C, and we used a suppository.
At 2 AM, it was 37.7°C, but by 7:20 AM, he had a fever of 39.9°C again, so we used a suppository.
At 8 AM, it measured 39.2°C, at 9 AM it was 38.3°C, and at 10 AM it was 37°C.
He still has no symptoms except for feeling dizzy when he has a fever.
His appetite is not very good, but his activity level is okay when he is not feverish.

I would like to ask the doctor why he continues to have a fever without any other symptoms.
Does my son need any tests? Last year, he also had a fever without symptoms, and on the first day, we took him to a major hospital for emergency care.
The doctor suggested doing some tests since there were no symptoms, including blood tests and an X-ray.
The results showed pneumonia with phlegm in the lungs, but the doctor could not hear any wheezing.
During his hospitalization, he had no symptoms except for the fever, and the doctor still could not hear any wheezing.
He was treated with antibiotics, and after the fever subsided, he was discharged.

I would like to know if my son could possibly have pneumonia again.
Also, if his activity level is okay, should we not worry about the fever?

Wenwen, 40~49 year old female. Ask Date: 2018/06/19

Dr. Xiao Kaiwen reply Pediatrics

It is common for children to have a fever without obvious external symptoms, as there may be some underlying viral infections.
The fever typically resolves as the immune system gradually kicks in.
However, sometimes a physical examination by a pediatrician is necessary to identify the cause of the infection, and laboratory tests may be required to determine the source of the infection (such as a chest X-ray for pneumonia or a urinalysis for urinary tract infections).
The cause of each infection may not always be the same, so it is not certain whether pneumonia is present.
Should you be concerned about the fever? Without personally examining your child, I cannot provide a definitive answer.
I can only advise you to closely collaborate with a trusted pediatrician (preferably one trained in a major hospital) and discuss the appropriate timing for referral to a larger hospital for further evaluation.

Reply Date: 2018/06/19

More Info

Fever in children, especially when accompanied by a lack of other symptoms, can be a perplexing situation for parents. In your case, your 8-year-old son has been experiencing recurrent fevers without any clear accompanying symptoms, which understandably raises concerns.
Fever itself is a common physiological response to infection or inflammation. In children, it can be caused by a variety of factors, including viral infections, bacterial infections, or even non-infectious causes such as autoimmune diseases or malignancies. The fact that your son has had episodes of fever without other symptoms does not automatically indicate a serious underlying condition, but it does warrant careful observation and, in some cases, further investigation.

The initial evaluation by the physician who noted that it was not gastroenteritis is a good start. Since your son has had a history of fever without other symptoms, it is essential to consider the possibility of viral infections, which are often self-limiting and may not present with overt symptoms. Common viral infections can sometimes cause fever and fatigue without other significant signs.
However, given your son's history of pneumonia, it is prudent to remain vigilant. Pneumonia can sometimes present with fever and minimal respiratory symptoms, especially in children. If your son exhibits any signs of respiratory distress, such as difficulty breathing, persistent cough, or chest pain, it would be essential to seek medical attention promptly.
In terms of what further evaluations might be necessary, if the fever persists for more than three days or if your son develops new symptoms, it would be advisable to consult with a pediatrician. They may recommend blood tests, urine tests, or imaging studies such as a chest X-ray to rule out any underlying infections or other conditions.
Regarding your concern about whether his activity level being normal means you should not worry about the fever, it is generally a good sign. If a child is active and alert, it often indicates that they are not severely ill. However, persistent fever, even in an otherwise well-appearing child, should not be ignored.
In summary, while fever without other symptoms can often be benign, it is essential to monitor your son closely. Keep track of his temperature, watch for any new symptoms, and maintain communication with your healthcare provider. If the fever persists or worsens, or if you have any concerns about his health, do not hesitate to seek medical advice. It is always better to err on the side of caution when it comes to the health of your child.

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