Fever in Infants: When to Seek Medical Attention

Pediatric Fever

Hello Doctor: My child is 10 months old and on the afternoon of April 9th, I noticed that his forehead and palms felt warm.
I measured his ear temperature and found he had a fever (38.1°C), but he did not exhibit any significant symptoms such as coughing or runny nose.
Therefore, I took him to a clinic for evaluation.
The doctor at the clinic noted that "his throat is slightly red and there is a little bit of nasal discharge," and advised to continue monitoring his temperature and activity level.
Since April 9th, he has had recurrent fevers (averaging between 38.1°C and 38.9°C), with the highest temperature reaching 39.4°C on the night of April 10th at 9 PM.
The fever intervals were about 4-6 hours, and the last recorded fever was at 2 AM on April 11th (38.4°C).
By 5 AM, he was sweating profusely and was no longer febrile (no rash appeared after the fever subsided).
I would like to ask if, given that my child does not have significant cold symptoms but did have a fever up to 39.4°C, and is active, is there a possibility of a urinary tract infection? Or could this simply be a fever caused by a viral infection? Is there a need for a follow-up visit? Thank you for your response, Doctor!

Er Bao Ma, 20~29 year old female. Ask Date: 2022/04/12

Dr. Xiao Kaiwen reply Pediatrics

To determine if there is a urinary tract infection (UTI), a urinalysis is necessary.
In cases of viral infections, blood tests may sometimes be required for a preliminary assessment.
If a young child has a fever without an obvious cause, a urinalysis can be performed first, as UTIs are bacterial infections that can be relatively serious and should be treated promptly.
A 10-month-old infant still has a relatively low immune response, and their immune system requires time to develop.
If the child remains active, it is usually acceptable to monitor the fever trend.
However, if the fever persists for 3 to 4 days and remains high and frequent, a blood test may be needed (consider starting with a urinalysis).

Reply Date: 2022/04/12

More Info

When it comes to understanding fever in infants, particularly in a 10-month-old child, it’s essential to approach the situation with both caution and knowledge. Fever is a common symptom in children and can be caused by a variety of factors, including viral infections, bacterial infections, and other non-infectious causes.
In your case, the child exhibited a fever of 38.1 degrees Celsius initially, which escalated to 39.4 degrees Celsius. The absence of significant respiratory symptoms such as cough or nasal discharge, along with a slightly reddened throat, suggests that the fever might not be due to a typical upper respiratory infection. Instead, it could be indicative of a viral infection, which is quite common in infants and young children.

The pattern of fever you described, with temperatures fluctuating between 38.1 and 39.4 degrees Celsius, is also noteworthy. In many cases, viral infections can cause intermittent fevers that may last for several days. The fact that the child had a fever that resolved with sweating is a good sign, as it indicates that the body is responding to the infection. However, the concern about a possible urinary tract infection (UTI) is valid, especially since UTIs can present with fever in young children without other obvious symptoms.

To determine whether this fever is due to a UTI or another cause, consider the following points:
1. Symptoms to Watch For: In addition to fever, look for other signs such as irritability, poor feeding, vomiting, or changes in urination (e.g., frequency, color, or odor). If the child starts showing any of these symptoms, it would warrant a visit to the doctor.

2. Duration of Fever: If the fever persists for more than 48 hours or if it spikes again after a period of resolution, it is advisable to seek medical attention. Persistent fever can indicate a more serious underlying condition.

3. Physical Examination: A thorough physical examination by a healthcare provider can help identify any additional signs of infection. This may include checking for signs of dehydration, abdominal tenderness, or any rashes that may develop.

4. Laboratory Tests: If there is a suspicion of a UTI or other bacterial infection, a urinalysis and possibly a urine culture may be necessary. This can help confirm or rule out a UTI.

5. Follow-Up: Since the child has shown some improvement and is maintaining good activity levels, it may not be immediately necessary to return to the clinic unless new symptoms arise. However, if there is any doubt or if the fever returns, it’s always better to err on the side of caution and consult a healthcare professional.

In summary, while the fever could be due to a viral infection, the possibility of a urinary tract infection should not be overlooked. Monitoring the child’s symptoms closely and maintaining communication with your healthcare provider is key. If you notice any concerning changes or if the fever persists, do not hesitate to seek medical attention. Remember, as a parent, your intuition about your child's health is invaluable, and it’s always better to seek help if you have concerns.

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