To think her temperature should have come down by now

[Narnia72]

Dd (7) had a nasty fall, grazing her knee on Thursday. It became infected and we had to take her to urgent care this morning, where she was given penicillin. She's had 4 doses of penicillin and alternating doses of calpol and nurofen every 2 hours since. Her temp first thing this morning was 40, since the first dose of penicillin it came down to 39,but has stayed there ever since. It's been 13 hours since the first penicillin dose and I've just checked her temp again -it's 38.5. She is lethargic but that may well be because it's 10.30 and she's exhausted. She's been dozing fitfully on the sofa with me since 7pm. If I took her back to urgent care at this time of night, are they going to be able to do anything, or should I give the abs overnight to work and see how she is in the morning? Taking her to urgent care at 10.30 pm on a Saturday night is something I'd rather avoid if possible, but I would have thought her temperature would have come down a bit more by now. I last checked 20 mins after giving nurofen, so should have been brought down by that.

Take her. If she's lethargic with high temp, she needs checking for sepsis.

I'd take her. The possibility is sepsis and that needs urgent medical attention.

I think I'd phone 111 and ask their advice.

Take her. I assume you're giving paracetamol as well?

Antibiotics given orally usually take a good 24-36 hrs to kick in fully (there are exceptions). Be careful with regards to calpol and neurofen doses. You can only given paracetamol 4 times in 24 hrs and ibuprofen 3 times in 24 hours and the doses should be spread out over the 24 hrs not bunched together. I would keep giving her plenty of fluids and let her rest at home, keep a check on her a few times during the night temp wise. Ring 111 if worsens overnight and see how she is in morning. What type of thermometer are you using?

Take her. Possibility of sepsis and with lethargy along with a temp and known infection.

Temperature isn't an indicator of sepsis itself. Sepsis is an overwhelming reaction to infection. The temperature is an indicator of infection, which is part of why penicillin has been prescribed. But the penicillin can't work instantly. It will take up to 48 hours for it to show a good effect.

However, what you do need to be aware of is if her breathing is faster than usual (more than 24-26 breaths per minute) or if her heart rate is faster than normal (more than 120 beats per minute) or if she has leg pains or has mottled skin or cold hands or feet or doesn't pass urine, or won't wake when you try to wake her (other than being a bit drowsy because you're prodding her at midnight and she's tired - it's fine for a child to wake, say hi, then want to go to sleep again. It's not fine if you can't get them to wake up at all).

Normally I would agree with Lougle.

However, if the ONLY source of infection is the knee (no sore throat, cold, cough etc) then I would seek help tonight. Because a temp that high from a small local surface infection is decidedly odd. So either the temperature is from something else entirely, or she needs looking at properly, and quite possibly IV antibiotics... Oh, and penicillin sounds like very narrow coverage for a soft tissue infection. What does her knee actually look like? Is there spreading redness?

Are there tracking marks from the knee up her leg? My DSis ended up with sepsis from a similar type wound at a similar age, over a similar timescale. It was pretty scary at the time. I'd just take her in- better safe than sorry and I've never known A&E staff mind with kids in these kind of situations.

I would get her seen tonight. hope all's ok.

How is she doing Op?

Thanks all. She was very feverish and uncomfortable, so we ended up going to be checked as I wasn't happy. They observed her for an hour and felt that, although her temp was still high, she was responding to the penicillin appropriately and more importantly, there were no signs of sepsis. After we got home (about 2am) she fell asleep properly and at some point (no idea when as I was checking her half asleep)her fever broke and she cooled down a lot. She's just woken up and is like a different child. Will keep a careful eye, but think we're over the worst. Thanks for all the advice last night, I was reading it but didn't get a chance to respond. It was really helpful though.

Just to confirm, you got the message re Ibuprofen for next time? It should be given 6 hourly, NOT 4 hourly and the maximum 24hr dosage needs to be adhered to as well. People mix it up with paracetamol and give incorrect dosages.

I'm so glad she's on the mend!

ShowOfHands that's not quite true. Ibuprofen has a maximum 3 times per day dosage, so ideally should be given 6-8 hourly, but can be given as long as 4 hours has elapsed between doses.

My ibuprofen says leave a minimum of 6hrs on the back...