Paediatric Fever

Fever in children can present in different forms depending on the underlying cause and contributing factors.

• Viral fever occurs when the child is infected with viruses such as influenza or respiratory syncytial virus (RSV).
• Bacterial fever develops due to bacterial conditions like urinary tract infections (UTIs), streptococcal throat infections, bacterial meningitis, or sepsis.
• Non-infectious fever arises from autoimmune diseases, cancers, or inflammatory conditions, though these are less common in children.
• Fever related to immune immaturity is common in children under 5 years, as their immune systems are still developing.
• Fever due to exposure often affects children who spend time in communal settings, such as schools and daycare centres, where infections spread easily.

Symptoms accompanying fever in children can vary depending on the underlying cause. 

• General symptoms include irritability, lethargy, poor feeding, vomiting, cough, diarrhoea, and rash.
• Localised symptoms in older children, such as sore throat, ear pain, or abdominal pain can help identify the source of infection.
• Severe symptoms, such as high fever, difficulty breathing, or persistent vomiting may indicate more severe underlying conditions.

Fever in children can be triggered by various conditions, most commonly infections. 

• Viral infections such as influenza, respiratory syncytial virus (RSV), and enteroviruses are the leading viral causes of fever in children.
• Bacterial infections such as urinary tract infections (UTIs), streptococcal pharyngitis, bacterial meningitis, and sepsis can cause high fever.
• Non-infectious disease, such as autoimmune diseases, malignancies, and inflammatory conditions can also present with fever but are less common in the paediatric population.
• Immature immune system, especially in children under 5 years.
• Exposure to pathogens in communal settings such as daycare centres or schools increases the risk of fever-causing infections.

Diagnostic methods are used to determine the cause of fever in children:

• Medical history includes details such as duration and pattern of the fever, associated symptoms, recent exposures, and vaccination status.
• Physical examination helps doctors look for localised signs of infection or other abnormalities.
• Laboratory tests such as blood tests, urine analysis, cultures, and inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) provide important clues.
• Imaging with chest X-rays, abdominal ultrasounds, or other radiological studies help identify hidden infections or inflammation.
• Specialised tests such as lumbar puncture (to check cerebrospinal fluid in suspected meningitis) or viral panels (to detect specific viruses) are used in selected cases.

Managing fever in children focuses on treating the underlying cause, alleviating discomfort, and preventing complications. 

• Severe illness is managed with supportive care, including adequate hydration, administering antipyretics, such as paracetamol or ibuprofen for fever and discomfort, and monitoring for severe illness.
• Viral infections usually require only supportive care, as most viral fevers resolve on their own.
• Bacterial infections are treated with antibiotics prescribed according to the suspected pathogen, especially for serious conditions like sepsis or meningitis.
• Non-infectious causes require specific therapies, such as immunosuppressive agents for autoimmune diseases or chemotherapy for malignancies.
• Hospital monitoring is needed for children with signs of severe illness or underlying chronic conditions, which may include intravenous fluids, oxygen therapy, and intensive care, if necessary.

Parents or caregivers should seek medical attention for a child with fever in the following situations:

• High or persistent fever that lasts more than 3 days or is unusually high for the child’s age.
• Severe illness signs, such as difficulty breathing, persistent vomiting, dehydration, or lethargy.
• Seizures or convulsions triggered by fever (febrile seizures).
• Rash, stiff neck, or unusual behaviour, which could indicate serious infections like meningitis.
• Any fever in infants under 3 months, as even mild fever can indicate serious illness.
• Underlying chronic conditions, such as heart disease, immune deficiencies, or cancer, which increase the risk of complications.

Preventing fever in children largely involves preventing the infections that cause it. 

• Vaccination helps protect children against common pathogens such as the influenza, measles, mumps, rubella, and varicella viruses and pneumococcus, and decreases the incidence of fever-causing infections.
• Hygiene practices such as regular handwashing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with sick individuals, can lower the risk of infections.
• Public health education ensures parents and caregivers can recognise warning signs of serious illness, use antipyretics correctly, and keep vaccinations up to date.
• Child health initiatives includes breastfeeding, balanced nutrition, and general health reduces the incidence and severity of febrile illnesses.
   

Children with persistent, recurrent, or unexplained fevers should be evaluated by a paediatrician. If an underlying chronic, autoimmune, or complex condition is suspected, referral to a paediatric specialist, such as a paediatric infectious disease physician, immunologist, or rheumatologist may be necessary. In acute or severe cases, children should be seen promptly in a hospital emergency department for immediate assessment and treatment.