Fever in Infants: Symptoms, Causes, and When to Seek Help

Fever

Hello Dr.
Hsiao,
Here are the symptoms of my baby (1 year and 4 months) over the past few days.
Could you please help me assess the situation, possible illnesses, and necessary examinations? Thank you, doctor.

1.
On November 19 (Wednesday) afternoon, my baby suddenly had a fever with a rectal temperature of 39°C.
In the evening, there were some rashes on the buttocks and thighs, but my baby was eating well, in good spirits, and sleeping okay.
By the morning of November 20, the fever had subsided! However, the rashes became more pronounced (on the limbs) and persisted for a week before naturally fading away.
On November 21, since my baby was scheduled to receive the varicella vaccine, I took my baby for a check-up (the doctor suspected it might be EB virus).
On November 23, my baby started experiencing diarrhea (2 times with more watery stools, both green) and continued for 3 days (the frequency decreased in between, and there were also normal stools).
By November 26 and 27, everything returned to normal without any medication or antipyretics.
2.
On November 28, my baby received the varicella vaccine and 2 drops of oral polio vaccine.
3.
On December 2, my baby had a fever starting at 00:30 with an axillary temperature of 38°C.
(At 11:00, axillary temperature was 38°C; at 15:00, rectal temperature was 39°C; at 16:30, axillary temperature was 38°C; at 18:30, axillary temperature was 38.5°C; at 20:30, rectal temperature was 39°C; at 21:30, after a lukewarm bath).
On December 3, at 00:30, axillary temperature was 37.8°C; at 10:30, axillary temperature was 37.8°C; at 15:30, rectal temperature was 39.8°C; at 16:15, rectal temperature was 39.4°C; at 18:30, rectal temperature was 40.1°C upon waking; at 21:00, we visited the clinic where the doctor administered half a dose of a rectal antipyretic.
The doctor mentioned that if the fever does not subside in three days, we should go to the hospital for further examination, noting that my baby had roseola at 7 months old, but the doctor mentioned there are two types of roseola????, and advised further observation.
At 22:45, after a bath, the rectal temperature was 38.8°C; at 23:40, rectal temperature was 36.6°C.
On December 4, at 10:00, rectal temperature was 37.5°C; at 14:30, rectal temperature was 38.2°C, and I administered 2.5cc of antipyretic syrup; at 17:00, rectal temperature was 37.5°C.
{During these days, my baby remained active, ate well, slept better when the fever subsided, had normal bowel movements, and showed no other symptoms.}

Xuan Mami, 20~29 year old female. Ask Date: 2008/12/04

Dr. Xiao Kaiwen reply Pediatrics

1.
The fever on November 19 may have been caused by a viral infection, viral rash, and gastroenteritis, which is generally manageable for individuals with normal immunity.
2.
The fever on December 2 is likely due to a new infection (since it has been some time since November 19, and the previous illness has likely resolved).
The varicella vaccine typically causes fewer fevers, usually occurring 5 to 12 days post-vaccination; oral polio vaccine has even fewer side effects, thus not resembling typical vaccine side effects.
The patient is active, eating well, and sleeping better when the fever subsides.
Bowel movements are normal, and there are no other symptoms, which is more indicative of a viral infection.
It is advisable to observe for three to four days, and if the "high fever" persists, a visit to the hospital for tests (such as blood tests, urinalysis, and X-rays) is warranted.
3.
Roseola has two types, but only a very small number of children experience it twice; most infants will only have it once.

Reply Date: 2008/12/04

More Info

When it comes to understanding fever in infants, it is essential to recognize that fever is a common symptom and can be caused by various factors. In your case, your 1-year-and-4-month-old baby has experienced several episodes of fever, accompanied by other symptoms such as rashes and diarrhea. Here’s a comprehensive overview of fever in infants, including symptoms, potential causes, and when to seek medical help.

Symptoms of Fever in Infants
Fever in infants is typically defined as a rectal temperature of 100.4°F (38°C) or higher. Common accompanying symptoms may include:
1. Rashes: As you noted, your baby developed rashes on the thighs and limbs. Rashes can be associated with viral infections, such as roseola or other exanthematous diseases.

2. Diarrhea: The occurrence of diarrhea, especially if it is watery and green, can indicate a viral infection or gastrointestinal upset.

3. Behavioral Changes: Changes in activity levels, such as lethargy or irritability, can indicate the severity of the illness.

4. Feeding Patterns: Changes in appetite or feeding can also be a sign of illness.

Potential Causes of Fever
Fever in infants can be caused by a range of conditions, including:
1. Viral Infections: Common viral infections such as roseola, hand-foot-and-mouth disease, or respiratory viruses are frequent culprits. Your baby’s previous episode of roseola could suggest a predisposition to similar viral infections.

2. Bacterial Infections: While less common, bacterial infections can also cause fever and may require antibiotic treatment.

3. Vaccination Reactions: It is not unusual for infants to develop a mild fever after vaccinations, such as the varicella (chickenpox) vaccine.

4. Other Causes: Less commonly, fever can result from other conditions such as urinary tract infections or more serious infections.

When to Seek Medical Help
While many fevers in infants are benign and resolve on their own, there are specific situations where you should seek medical attention:
1. Persistent Fever: If the fever lasts more than three days or is consistently high (over 104°F or 40°C), it is essential to consult a healthcare provider.

2. Severe Symptoms: If your baby exhibits severe lethargy, difficulty breathing, persistent vomiting, or signs of dehydration, immediate medical attention is necessary.

3. Rash: If the rash spreads rapidly or is accompanied by other concerning symptoms, it is advisable to seek medical evaluation.

4. Post-Vaccination Fever: If your baby develops a high fever following vaccination that does not improve with over-the-counter medications, consult your pediatrician.

Conclusion
In your case, it appears that your baby has had a series of mild febrile episodes, which may be related to viral infections, especially considering the history of roseola. The rashes and diarrhea could also be indicative of a viral etiology. Since your baby is maintaining good energy levels, eating well, and has normal bowel movements, these are positive signs.

However, it is crucial to monitor your baby closely. If the fever persists or if you notice any alarming symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. Keeping a record of your baby's symptoms, including temperature readings and any other changes, can be helpful for the doctor in making an accurate diagnosis. Always prioritize your child's health and well-being, and when in doubt, seek professional medical advice.

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