Persistent Fever in Toddlers: Causes and Concerns

Fever in children?

Hello, doctor! My child is currently 14 months old.
She started having diarrhea on June 18 (seven times a day).
We saw a doctor that day, who diagnosed her with gastroenteritis.
That night, she developed a high fever of 39 degrees Celsius.
On June 19, we switched doctors, and the diagnosis remained gastroenteritis, with the doctor stating that the fever would last for 3-5 days.
However, as of June 25, while her diarrhea has improved (2-3 times a day, becoming mushy after the second time), her fever symptoms have not improved.
Whenever she wakes up from sleep, her temperature rises.
After her afternoon nap, her temperature ranges between 37.5-38 degrees Celsius, but in the morning, it reaches 38-39 degrees Celsius.
Without antipyretics, her temperature does not come down.
In between, we consulted another doctor who suggested that she might be teething, but there were no symptoms.
On June 24, I took her to see a doctor again, who noted that her throat was red.
I had blood and urine tests done there, and the doctor diagnosed her with urethritis.
That day, I was referred to the emergency department at a hospital.
The emergency doctor conducted blood and urine tests again, stating that the urine test was normal, but the blood test indicated a viral infection without bacterial infection.
When asked about the cause of her fever, it was unclear; they only mentioned her red throat and prescribed gastrointestinal medication and antipyretics before sending us home.

What I would like to ask the doctor is, if she has throat inflammation, having seen four doctors in between, she should have improved by now.
Isn't the fever caused by some inflammation? After taking the medication, there should have been improvement, but I feel my child has not improved and is still experiencing fever.
When we went to the hospital, her temperature was also 37.8 degrees Celsius, and there was a significant discrepancy in the results of the two urine tests; one showed bacteria and white blood cells, while the other reported all zeros.
How can the values differ so much between the two tests? Importantly, doctor, I cannot determine the cause of my child's fever, and her symptoms have not improved.
Is it okay for me to keep giving her antipyretics?

irisyu, 20~29 year old female. Ask Date: 2005/06/25

Dr. Lin Huizhen reply Pediatrics

Dear Iris Yu,
Dr.
Lin Huizhen, Chief of Pediatrics at Tainan Hospital, Department of Health, Executive Yuan, would like to respond to you: There are numerous reasons for a child's fever, including gastroenteritis, pharyngitis, or infections in other areas.
To determine the cause of a child's fever, a thorough physical examination and additional tests are necessary.
Some viral infections that cause pharyngitis can indeed lead to a fever lasting over a week.
However, if your child is experiencing persistent high fever, it may be important to discuss with your pediatrician whether there are any other underlying issues.
Generally, if antipyretics are administered at the appropriate dosage and on schedule, they can be effective.
The Tainan Hospital wishes you good health and all the best!

Reply Date: 2005/06/25

More Info

Understanding persistent fever in toddlers can be quite challenging for parents, especially when multiple medical evaluations yield inconclusive results. In your case, your 14-month-old child has been experiencing diarrhea and persistent fever since June 18, with the fever reaching as high as 39 degrees Celsius. Despite seeing several doctors and receiving various treatments, the underlying cause of the fever remains unclear, which understandably raises concerns.

Firstly, it is important to recognize that fever in children can be a common response to infections, including viral and bacterial illnesses. In toddlers, viral infections are often the most frequent culprits, and they can lead to symptoms such as fever, diarrhea, and irritability. Gastroenteritis, which your child was initially diagnosed with, is typically caused by viral infections and can result in fever and diarrhea. The fever may persist even after other symptoms improve, as the body continues to respond to the infection.

The fact that your child’s fever spikes upon waking and remains elevated during the day could indicate that the body is still fighting off an infection. It is also worth noting that the immune response can vary significantly among children; some may experience prolonged fever even after the initial illness has resolved.
In your situation, the repeated evaluations and tests, including blood and urine tests, have not provided a definitive diagnosis. The discrepancy in the urine test results could be due to various factors, including the timing of the sample collection, the hydration status of your child, or even the presence of transient infections that may not be detectable at all times. It is not uncommon for test results to vary, especially in young children whose bodies are still developing and responding to infections.

Regarding the treatment of fever, it is generally acceptable to use antipyretics, such as ibuprofen or acetaminophen, to manage your child’s discomfort. However, it is crucial to monitor the dosage and frequency according to the pediatrician's recommendations. Persistent fever can be concerning, and while antipyretics can help alleviate symptoms, they do not address the underlying cause of the fever.
If your child continues to have a high fever without any clear diagnosis or improvement in symptoms, it may be necessary to seek further evaluation from a pediatric specialist, such as a pediatric infectious disease expert. They may recommend additional tests, such as imaging studies or more specialized blood tests, to rule out less common causes of fever, including autoimmune conditions or rare infections.

In conclusion, while it is understandable to be worried about your child's persistent fever, it is essential to remain in close communication with healthcare providers. Keep a detailed record of your child's symptoms, fever patterns, and any changes in behavior or appetite, as this information can be invaluable for healthcare professionals in diagnosing and managing your child's condition. If you feel that your child's health is deteriorating or if new symptoms arise, do not hesitate to seek immediate medical attention. Your child's well-being is the priority, and persistent fever warrants thorough investigation to ensure appropriate care and treatment.

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