Persistent High Fever in Children: What to Do When It Reaches 39°C?

The child has a persistent fever above 39 degrees Celsius?

If a child has a fever over 39 degrees Celsius and a consistently sore throat, and despite seeing a pediatrician and using rectal antipyretics, the condition remains unchanged, what should be done?

Wen Chi, 20~29 year old female. Ask Date: 2013/08/18

Dr. Xiao Kaiwen reply Pediatrics

The effects of various antipyretics can only last for a few hours, and their purpose is to provide temporary comfort for children.
If the illness is not resolved (common viral infections typically cause fever for three to four days, and some may last up to a week), it is quite common for the fever to return after the antipyretic has worn off (or even if the temperature has not returned to normal).
Physical methods of cooling, such as ice packs and lukewarm sponge baths, do not effectively reduce fever and may instead cause additional discomfort for the febrile child.
Fever is a response of the immune system and does not harm the sick child.
Parents should be vigilant for the following danger signs and continue to follow up with medical treatment (the presence or absence of fever and the height of body temperature do not necessarily indicate the severity of the illness): Regardless of fever, if a child exhibits any of the following symptoms, they should be taken to a pediatric specialist promptly: fever in infants under three months old, significantly reduced urine output, no tears when crying, altered consciousness, persistent lethargy, restlessness when not febrile, a vacant stare, seizures, muscle spasms, limb paralysis, persistent headache and vomiting, neck stiffness, coughing up blood-streaked sputum, rapid or difficult breathing when not febrile, retractions of the chest wall during inhalation, bradycardia or irregular heartbeat, inability to perform normal activities (e.g., difficulty climbing stairs or shortness of breath after walking a short distance), appearance of purpura on the skin, and cyanosis of the lips, fingers, or toes.

Reply Date: 2013/08/18

More Info

When a child has a persistent high fever, particularly one that reaches 39°C (102.2°F) or higher, it can be concerning for parents. It's important to understand that fever is a common response of the immune system to infection, and while it can be uncomfortable, it is not inherently harmful. However, persistent high fever can indicate an underlying issue that may need medical attention.

Initial Management of High Fever
1. Monitor Symptoms: Keep a close eye on your child's overall condition. Note any additional symptoms such as lethargy, irritability, difficulty breathing, or signs of dehydration (such as dry mouth, lack of tears, or decreased urination).

2. Hydration: Ensure your child stays well-hydrated. Offer plenty of fluids, such as water, clear broths, or electrolyte solutions. Dehydration can occur quickly in children, especially when they have a fever.

3. Medications: Over-the-counter fever reducers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help lower fever and provide comfort. Always follow the dosing instructions based on your child's age and weight. If you have already administered rectal medications and the fever persists, it may be time to consult a healthcare provider.

4. Physical Comfort: Dress your child in lightweight clothing and keep the room at a comfortable temperature. Avoid excessive bundling, as this can trap heat and worsen the fever.

When to Seek Medical Attention
While fever itself is not usually dangerous, certain signs and symptoms warrant immediate medical attention:
- Age Considerations: For infants under three months with a fever, immediate medical evaluation is necessary. For older children, if the fever persists for more than three days or is accompanied by severe symptoms, a doctor's visit is advised.

- Severe Symptoms: If your child exhibits any of the following symptoms, seek medical care promptly:
- Persistent vomiting or diarrhea
- Severe headache or stiff neck
- Rash or unusual bruising
- Difficulty breathing or rapid breathing
- Unresponsiveness or extreme irritability
- Seizures

Understanding the Cause of Fever
Fever can be caused by a variety of factors, including viral infections (like the common cold or flu), bacterial infections (such as strep throat or urinary tract infections), and other conditions. In some cases, the cause may not be immediately apparent, and further evaluation may be necessary.

In the case of your child, if the fever persists despite medication and home care, or if you notice any concerning symptoms, it is crucial to consult a pediatrician. They may perform a physical examination and possibly order tests to determine the underlying cause of the fever.

Conclusion
In summary, while a high fever in children can be alarming, it is often a natural part of the body's immune response. Careful monitoring, ensuring hydration, and using fever-reducing medications can help manage the situation at home. However, do not hesitate to seek medical advice if the fever persists or if your child shows any alarming symptoms. Always trust your instincts as a parent; if something feels off, it's better to err on the side of caution and consult a healthcare professional.

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