Would a temp of 40.4 freak you out for toddler ?

[hookline]

Some people would go to hospital for this kind of temperature.

My boy is 18 months and has had a temperature all day ( no other obvious symptoms).

Temperature was around 38-38.5 all day. I've been giving him paracetamol and ibuprofen. He's been lethargic when his fever was high but when the medicine kicked in, he'd be pretty happy.

Since this evening it's risen quite dramatically to 40.4 just now ( he did sleep on me so it made him hotter ).

He was wrenching a bit earlier, but no vomiting.

I have him medicine an hour ago, but temp has just risen ( but was also sleeping on me ). Anyway it went up to 40.4. I've now taken off his very thin top. His temperature is now 40.

Is a high temperature like this a reason to take them to a and e?

I think if it responds to medication it's probably ok.

Or am I being too relaxed about it ?

Ive noticed with my children that if they have a fever of 39° it's bacterial and they need an antibiotic.

Dd had scarlet fever last year. Rash, strawberry tongue, lethargic, red sandpaper rash and I was told it was viral at the hospital. Went to the GP the next morning and she was diagnosed correctly with scarlet fever. I think it depends what dr you see.

Go with your gut instinct.

I'd take him back to A&E.

When my DD was a toddler she had similar symptoms & her arms & legs swelled then a rash appeared.
Our GP phoned Paediatrics at the hospital & we had to take DD straight there.
It was Staphylococcal A infection & she was placed on antibiotics & had a short stay in hospital to keep an eye on her.

Hi, I'd go back as well. My daughter, when she was 3, had a high temp which went done a little with paracetamol, took her to GP who diagnosed tonsillitis but luckily took a throat swab which turned out to be positive for scarlet fever and so she needed antibiotics

He's on antibiotics already. It's really tough because he's perked up now. My sister has come around and he's playing the most he's played all day and his temp did respond well to the last dose of ibubrofen. He seems better than he's been all day ! Tough !

It really does depend on the child. Dd1 is wiped out at 38 and looks terrible, but usually responds well to ibuprofen/paracetamol, won't sit still and just wants to be up doing something.

Dd2 spikes to 39/40 and sleeps all day pretty much. I panicked the first time dd2 was poorly when her temp spiked and she just lay on the sofa all day. I thought something was seriously wrong. Some people just like to sleep things off.

If he's started antibiotics I'd be keeping a very close eye and seeing how things go. Our A&E is only 10 minutes away though so may be different if you have a longer drive.

Back in the hospital because his temperature kept spiking above 40 again. I don't know if it's the right thing that we are back.

I feel like I know what they're going to say- give it time and he'll get better. That's it.

You are in the right place. It's better to err on the side of caution.

Reassurance that your child will get better with nothing more than time and your parenting care is the best possible outcome I always feel.

@hookline what I learnt through a very awful 3 years with DS (he has outgrown it now) it that it doesn’t matter if it turns out they think you are over reacting it is always the best thing DS would always detoriate fast and badly and it was scary but the horror stories made me realise I would rather overreact to make sure I was there the time I didn’t (and DS had that with scarlet fever and a febrile seizure at 6) than miss the times he needed me

you are in the right place

If you are not happy, you refuse to leave the hospital OP. Ask them to check check check and check again for all markers of sepsis, given how much it's been in the news recently. If oral antibiotics aren't doing the trick, maybe they need to step up to IV.
No Dr worth their salt should ignore a parents gut instinct, you know your child best. Xx

Peads nurse here.

DO NOT DO THIS!

That is NOT what we do in hospital, we weigh the child and give them a mg/kg dose based on their weight!

Doc said that it's not a concern that his temp keeps spiking above 40, as we know the source of the infection ( tonsillitis ) and he's on antibiotics for it ( which need to kick in still ). He also said it's normal he's unhappy and not himself. He saw zero reason to do any further tests, mainly because the source of infection is known and being treated.

I guess it makes sense. My throat is killing me too now, can barely swallow.

Oh poor you. I hope you both feel better again very soon.

You’ve just reminded me of a friend’s experience. They were in hospital for investigation for her child’s abdominal pain. One doctor briefly mentioned the possibility of appendicitis but went off shift. Other doctors said subsequently confirmed that the test results, examination (didn’t have the common rebound response on their right hand side of abdomen) and her child’s behaviour (very bright and chatty although saying it hurt) all didn’t suggest appendicitis. They wanted to send her child home, she insisted she felt something was really wrong, they insisted it was ok to go home and monitor from there, she asked as it was now the middle of the night if they could stay in hospital till the next morning and the doctors agreed. Thank goodness she’d pushed for that, as it turned out her child did have appendicitis with untypical presentation (which this initial doctor who had gone off shift had thankfully told her can happen in a very small percentage of cases). A couple of hours after they would have gone home, her child was rushed for emergency surgery because they collapsed - the hospital leapt straight into action and saved her child’s life at that point because by the time they went into theatre the appendix had clearly ruptured quite some time ago and they had to spend a lot of time in surgery trying to get the infection out of the abdomen as best they could and post surgery care involved a long course or IV antibiotics followed by oral course as septis was a huge risk.

My best friend is a pediatrician and I have asked for advice on fevers and her advice is always that fevers aren’t dangerous in and of themselves, only when accompanied by other worrying symptoms, like extreme lethargy (unable to rouse), stiff neck etc. I asked her what temp would actually merit A&E on her own and she said like 42, which seems crazy but 🤷‍♀️. I’d probably text her for a sustained 40.4 but definitely wouldn’t go to the ER.

In my experience, very experienced paediatricians and GPs are very adept at making these judgement calls and would send my daughter home with the caveat I must return any time I felt any concern or need for reassurance, especially if they could find an obvious cause for the high temp like obvious infection in ears or throats. They gave me the impression that not easily finding the reason for such a high temp would concern them much more. However more inexperienced GPs, quite rightly, were more cautious and would send us up for hospital evaluation at lower temps around 40. Our child routinely hit temps of 41/42 with reoccurring bouts of viral tonsillitis. So we ping ponged in and out of hospital monitoring of their symptoms for a couple of years (they have a system for this where your not officially admitted but you have a 3-5 window where you are can return to them directly rather than via gp service or A&E). I was told some children, like mine, can have routinely such high temps for unconcerning viral bugs but it is relatively rare and even with that history they never assume it’s that again with each new occasion she had a extremely high temp, as it is always possible it’s not that on each new extremely high temp and even if it is the high temps of 41/42 do present their own concerns too.

Whenever my oldest was ill her temperature would spike to 40/41, it didn't matter what kind of illness, if she had a fever it would be a high fever. So with her I was not worried about how high the fever was, just how she was otherwise, and if it went down with meds or not. I wasn't worried with DS either until he had a febrile seizure so now I do get concerned when he spikes a high temperature in case it happens again but I wouldn't take him to the hospital just because of the fever, I still just follow how he is, but I keep a close eye.

I have doctor friends as well and this is what they say, hence why I was reluctant to take him both times. But I guess better safe than sorry.

My doc friends parents obsess way too much about high temperatures.

In my sons case right now, I've just never seen him this unwell for this long.

Id say that the advice whilst a great benchmark is really hard with a toddler, they cant tell you whats sore or whats wrong.

My DD was 1 month shy of her second birthday.

Her first main symptom was a temp on Thursday and just seemed unwel but no specific symptoms.

We took her to the GP on Friday who couldnt find anything and said viral.

By sunday i felt she was really unwell and took her to out of hours at 6pm. The GP there said possibly an ear infection but because she was screaming he said she had energy and seemed fine.

Monday was a bank holiday

Tuesday morning my DH took her to the GP, the gp again couldn't find anything specific but said based on what we were telling her she couldn't rule out something more serious and to go to the hospital.

Arriving at hospital things moved very quickly, her CRP blood test showed a result of 270 (this is infection markers and anything over i think 10 is classed as an infection needing antibiotics)

She had 2 lumber punctures ( 1 failed) but they started treating her immediately as a meningitis patient until the results came back which also confirmed.

Things that were different from other illnesses were:

Uncontrollable temp, she would wake up in the night in our bed shaking and burning hot, she would gulp down apple juice and take more medicine and then go to sleep again and repeat.

She would whimper alot

By the Monday she wasn't moving from the couch, just dosing and lying, she could be woken but wasn't speaking just whimpering as if in pain.

So really if i break it down it was Whimpering, lethargic and uncontrollable temp.

Her consultant said they just got her in time.

Sorry also meant to add.

THERE WAS NO RASH

This was the first thing i said when they told me meningitis.

The consultant said to me that by the time the rash has kicked in only 10% of patients will walk out of the hospital with no issues.

The rash is the last thing to happen.

I look back all the time and i can honestly say that she just felt more unwell and i felt like she was dying but i didnt trust myself that i wasnt being unreasonable because 2 GPs had told me i was panicking.

@Littlecatonthefence that's so worrying about your DD. I'm so glad you made sure they caught it in time. They didn't even do any blood tests on my son.

He sounds like he's similarly ill, but because there is an obvious cause, they're not concerned.

He's not whimpering but sleeping a lot.
Hope he gets better soon.

What antibiotics as well is he on. Yes they know the cause but if he isn’t getting better it maybe as well he is on the wrong ones -DS always perked up within 24 hrs on antibiotics other than once where he had to go on another type.

I do agree though with the whimpering DS had that (and a non blanching rash) when he had scarlet fever and needed the iv antibiotics he also was v hard to rouse rather than just sleeping

He's on Clarithromycin.

He's now had three doses. We started 24 hours ago, he only needs to take it twice a day.

He's fast asleep now. He had a high temp this morning of 39.5 and above. I gave him calpol and now he's sleeping and I've just touched him and he seems the coolest I've felt him in ages, so fingers crossed.

He also got up for a short while earlier and played with his fire engine.

I think he's absolutely exhausted as he didn't want to sleep at all in a and e last night and just lay in his buggy watching everyone for 6 hours.

Ultimately temperatures are the body’s natural response to an infection, and so until that infection is under some level of control then of course he will continue to have temperatures.

Give the antibiotics 48 hours or so to start getting that control and then you will probably find his temperatures will naturally reduce.

As you said, his temperature comes down with paracetamol/ibuprofen and when he is awake he’s alert and playing so you just need to ride it out and keep him hydrated and fed as best as you can manage depending on how sore his throat feels.

It’s such a worry when they are ill but he’s not doing anything or behaving in a way that isn’t to be expected with an infection.

Hey everyone. He's still struggling and his temp was spiking high again during the night.

He has mostly wanted to sleep/ lie down on the sofa all day yesterday but he perked up for a while ( after I gave him double dose ibuprofen, as directed by the doctor ). But when that wears off, he's really poorly again and just wants to lie down on me.

Today is the fourth day like this. He's just had his 5th dose of antibiotics. He needs to take it twice a day ( so he's had two full days already ) this is the third day and honestly I can't see much improvement.

Am I expecting too much too soon ? I haven't seen him this knocked out by something for this long before.

But yeah the positives are that with double dose ibuprofen, he perks up for a few hours and plays and eats.