Would you take a child to hospital just for having a temp over 40?

[SinkGirl]

One of my twins (2.5) has been having random high temperatures with no other symptoms for 10 days now. It was at its worst Friday - Monday. They’ve become much less frequent - had one Friday morning, Saturday morning, then one in the middle of the night last night but it was only 38.2 and it came down quickly.

He hasn’t had any other symptoms at all and apparently lots of the kids at his nursery have the same thing going on.

Took him to nursery this morning as normal as he was absolutely fine. Got a call from them at 11am sounding very worried saying he had a temp of 40.4 - I rushed over there (only took 10 mins to get there) and it had already come down but he was very sleepy so I brought him home. He’s been fine since, no more temps, ate lunch and had a nap.

The staff at nursery said that children should go to hospital if they have a temp over 40 - I looked on the NHS site earlier this week as I was worried and it doesn’t give any cut offs like this. He didn’t have any of the other symptoms they list to be concerned about. I was considering taking him to the GP on Friday but it seemed to be improving by then. They called me this afternoon and asked if I’d taken him to hospital - I said I didn’t think it was necessary as he was absolutely fine by the time we left nursery.

Obviously I will take him to the GP in the morning (couldn’t get an appointment today by the time I picked him up) or seek help sooner if he deteriorates, but AIBU to think a child doesn’t need to go to hospital for a high temp alone, especially when it comes down on its own quite quickly? I don’t want to take any risks but I don’t want to overreact either.

Paediatric nurse here. If it comes down with it paracetamol and ibuprofen then no need for hospital. I'd possibly go to the go if it didn't come down despite medication or if they were otherwise unwell.

GP*

Personally if it comes down quickly I wouldn’t immediately go to hospital - was in the same boat last week with my 3.5 DS. But I’d be keeping an eye on other factors - wet nappies, rashes, general lethargy. And potentially call 111 for advice.

No I wouldn’t take them to hospital but I would get them a GP appointment to have them checked out.
I think the ‘over 40, go to hospital’ thing is a nursery guideline not an NHS one (ours have the same rule). Maybe due to higher chance of convulsions at that temperature and they don’t want to risk it happening at nursery?x

I wouldn't. My DD always goes over 40 when she's ill and her GP has never given a single fuck when I've taken her.

I was once at a GP appointment with my 1 year old when he had a temp of 39.9, the GP phoned the hospital and had us admitted to the ward. He turned out to be fine but I would say that is very high and needs medical attention of some sort.

Thanks everyone - that’s what I thought but I have this horrible fear of under-reacting! Aside from seeming tired and a very slight runny nose he really doesn’t have any other symptoms - not a full blown cold, no cough, no D&V, no rash. Obviously if any of those happen I will take him in right away - we have open access to the children’s ward due to another condition so I’m sure they’d be happy to check him out, but I would feel a bit daft going in there with a kid with a normal temp who is smiling because they had a high temp earlier! He’s clearly knackered and is more cuddly but there’s no sign of being in pain or anything.

Will take him to the GP tomorrow to get checked over just because it’s been going on so long. He’s non verbal so couldn’t tell me if his ears hurt or anything but I’m sure he’d be crying or pulling at them if they were.

His temp did reach 40.0 earlier in the week - that’s when I looked up nhs advice - but it came back down quickly.

If it flares up again this evening I’ll call 111, otherwise will see the GP tomorrow.

Young children haven't fully developed their thermoregulatory system so high temps are fairly common. I'd be more concerned if they felt/looked rubbish or were distressed/agitated with it.

Also, our immune system works much more efficiently at a higher temperature so when you have some sort of illness your body will automatically raise its normal set point for temperature and you then catch up with it (hence why some people get rigours/shiver when ill - it's your body trying to catch up to its new set point). If there are no other symptoms and you aren't distressed/uncomfortable there's no huge need to give/take paracetamol etc. Let the body work as efficiently as it can. Any uncomfortable symptoms though and do consider meds.

I’m a paeds nurse too and generally any temperature lasting more than a week is further investigated. I’d get a GP appt for first thing. I don’t think you need to be worried - just alert.

Thank you, I so appreciate the advice.

We do treat temps with him generally as he has hypoglycaemia and fevers can cause his sugars to crash, so we’ve been told to give nurofen or calpol whenever he has a temp. I’ve generally been waiting 5-10 mins to give it though as on a few occasions it’s just come right back down on its own, but when it’s been over 39 I’ve felt safer to just give medication.

I’ve already been in touch with his paediatrician about it a week ago and she felt it was probably just viral then, but obviously it’s dragging on a bit so I will get him seen tomorrow (or sooner if he goes downhill).

I should add, I’ve been monitoring his sugars more closely all week and they’ve been completely normal for him - he had a hypo the first day of the fevers which is why I emailed his paed, but since then no problems at all. Aside from the temp and being a bit lethargic I wouldn’t think he was ill at all. Fingers crossed it’s just a virus that’s taking a while to shift but it definitely needs looking at.

No I wouldn’t (another children’s nurse here), I would look at any other symptoms my child was having, lethargy, rashes, pain etc and make a decisions based on that rather than a temperature.

If the temperature has been going on for a while I would visit the GP, otherwise I would just medicate at home if necessary. I’ve rarely got my children seen just because they have a temperature.

Thank you - it’s reassuring to know my gut instinct was right on this as I was starting to worry I was being too blasé.

There definitely is lethargy but only when the temp is up - once it goes down he’s babbling and alert. He is wanting more cuddles but I’m putting that down to him just feeling a bit rubbish. I’m sure if he were really unwell there’d be more signs than this. I will absolutely be on the phone to the GP first thing tomorrow for a same day appointment though - they’re very good at seeing kids the same day so I’m sure it will be fine, if not I’ll call the paeds day assessment and get their opinion on bringing him in.

Fingers crossed he stays as he is now until then!

If I couldn’t get it down with brifen plus calpol yes.

No, I wouldn't - my DS has just had that same virus btw, as have most of his nursery friends. It lasts 5 days and the temp goes up and down repeatedly. DS was occasionally over 40 degrees, but not unwell in himself.

As my GP always says "we treat the patient, not the number".

Hopefully someone more medically qualified can confirm this but I don't think the seriousness of the illness correlates to the Temperature in every case (obviously if you're 50 degrees Celsius it's probably not good!)

Relatively serious infections can have lowish fevers and something like roseola can be very high.

So like others I'd be more concerned if Calpol didn't bring it down at all or if other symptoms were present.

Nursery assistant here - we would tell a parent to take a child to hospital if their temperature was that high and not coming down with paracetamol. If we couldn't contact a parent we would take a child to hospital ourselves. However if it's normal for your child, and it's coming down with medicine I'd probably just get a gp appointment. The nursery has to say to go to hospital to cover themselves really, once the child is in your care it's your call. I think I'm your case I'd have done exactly the same as you

Thanks everyone - a few people have said it lasts five days ish so I definitely need to get him seen as it’s been going on for 11 days (although he’s only had high temps on 7 of those days and often only once). His twin had a few temps last week but he seems to be over it now.

The first night I was struggling to get it to come down with calpol and then tried nurofen and it did come down after a while but took ages. For the rest they’ve either gone on their own or after a dose of nurofen.

I find it so difficult to assess them - I think I’m overly anxious because of a long nicu stay, especially with this twin who had a lot of health issues and spent almost his whole first three months in hospital. They both have ASD so I find it harder to gauge. He had whooping cough at 9 weeks old and went from seeming like a baby with a cold to floppy and unresponsive in minutes - he was only 5lb then and very vulnerable, obviously much bigger and stronger now but I think that’s always in the back of my mind. That stuff really sticks with you and you don’t realise how much until they’re unwell.

But I also worry about seeming like a neurotic parent and don’t want to take them in for every little thing. Generally they fight off bugs quite well and cope well, even with norovirus in December, DH and I felt like we were dying for a week but they had a rough 24 hours and bounced straight back for the most part.

The other conditions he has are often linked to endocrine issues (he had a very rare one for his first 18 months), so I’m wary about things like adrenal crisis but there really are no other signs of that - if there were I would obviously call 999 right away.

I’ll update his consultant and hopefully the GP can check him over and put my mind at rest tomorrow.

No. I would go by how ill otherwise they were.

One of mine used to fairly frequently hit 40 degrees if she was ill-and she'd be running round and playing happier than another of mine would by the time it hit 38.5 degrees. 41 for her was not unheard of, and never did she appear especially ill.

The only time I did go to A&E with one of mine (sent by GP) it was temperature of only 37.9, but was very floppy and not responding well.

Thanks shopaholic, that’s reassuring - I really don’t want them to think I’m neglectful! By the time I arrived his temp was already down to high 37s and it only took ten minutes to get there - they didn’t give him any medicine, I took some with me, but it came down on its own. If he hadn’t been so tired you wouldn’t know he’d been unwell at all!

I have always been advised to treat the child in front of you, not the temp on the thermometer. My son could happily spike a temp over 40 whilst still being apparently reasonably well. Obviously it needed treating with calpol or calprofen but he was not unduly “poorly” with it. Another child however might be having febrile convulsions at 39 degrees.
As long as the temperature is coming down with over the counter meds and they are responsive and having wet nappies then I wouldn’t go to hospital.
If he doesn’t seem to be getting better then I’d get him checked by GP

I got a call from nursery on Monday to say DD2 (3) had a temp of 40.6. She’s always been prone to fevers, and although she looked really dazed and clearly unwell when I picked her up, her temp quickly dropped again after she had some Calpol. She’s been a bit under the weather the last couple of weeks with another ear infection and bad cough, but most of the time she’s fine in herself. I definitely wouldn’t take her to hospital just because of a high temperature, as long as it comes down with meds and she’s not showing any other worrying signs.

@SinkGirl they shouldn't do - they might ask if you'd gone to hospital but I doubt it. And if they did I'd just say about his temperature going down and staying down, and how he didn't seem unwell otherwise. They might note it down (they'll have a record that they sent him home with a high temperature) but they wouldn't think any more of it unless it became really regular I suppose

He’s got a really runny nose this evening with a few coughs and sneezes so I’m now wondering if he’s having two bugs back to back. I’ll still take him to get checked out tomorrow.

I find it so hard to look at the advice and figure out what to do since it’s never that cut and dried is it? For example he always has cold pale feet, even when he’s been in a sleeping bag all night. With a few of his temps his feet have stayed cold which makes me nervous but there’s no way he could have meningitis with no other symptoms. I’ve been checking religiously for any signs of a rash, any reaction to bright lights, stiffness, cries of pain etc but there’s been nothing.

To be fair he doesn’t normally get high temperatures when he’s unwell, never seen him go over 39 before, so it is very unusual for him, but the fact they are coming down makes me think it can’t be anything too bad. I’ll keep a close eye on him overnight and get him to the docs in the morning or sooner if necessary.