Oh Boy! Temp of 40.8....

[rattlesnake]

My DS (6) is in 5th day of nasty virus, we've had the vomiting bit at the beginning, now its just nasty cough but the bit Im concerned about is his temp, I've never seen it so high!! 40.8...can get it to 39.5 with nurofen. Thing is, he's sat up in bed, drinking and apart from being purple with heat!!! he seems quite ok!! Should I worry too much about this temp? I'm a worrier :) Ps. He was given penicillin by GP on Thursday cause she didn't like look of his throat, they have done diddly! obviously virus.

Bump

Weird, covered in heat lumps, temp still 40 but leaping around like a frog!! and quite happy..I guess thats good eh? :)

I wouldn't worry too much. Last time DD was poorly, GP explained to me that a lot of research has gone into febrile convulsions and that a child can withstand a temp of up to 41 for an indeterminate time. Its when it spikes by more than on full degree that it can cause convulsions

If you're DS is happy enough in himself, I would make sure he is drinking plenty to prevent dehydration as obviously he'll be losing more fluid, but other than that I wouldn't be too stressed. The heat lumps are good too, it means its coming out of his system

DS1 (5.8) gets fevers like this whenever he is ill. He has never had anything serious but has become significantly dehydrated from the fever. As a precaution, when DS1 has really high fevers, I take him to the doctors for a check up every couple of days in case he needs antibiotics. In the meantime, to manage the fever:

Alternate maximum doses of calpol and nurofen, being sure to save a dose of each for the middle of the night (I write down a schedule); strip him down to a loose t-shirt and short pj bottoms; give him loads to drink (squash or ribena slip down better than water); stick to a light diet as vomiting with high fever can quickly lead to dehydration; try to encourage him to rest by providing lots of tv, computer, ds - whatever will make him sit still for longest.

Then just ride it out. He will probably be back to himself in a few days.

But as I said before, do keep going back to the doctors until the fever is gone to ensure you don't miss a potentially serious infection. Also, if they haven't done so already, ask the doctors to check his urine. Urine infections sometimes need a different antibiotic to throat infections, so don't assume he has got a virus because he has not responded to the antibiotics he was given.

Alternating paracetemol and ibuprofen isn't recommended and doesn't seem necessary if he is bouncing around :) the guidelines say to treat a fever if it is causing discomfort and your little boy is obviously coping well. My eldest has been like that too!

DD 4 yrs had a temp of 40 on Saturday - was 39 degrees today on and off - she is hot and has lost her appetite and seems not to want to do much just rest but on the other hand seems fine in herself. She is drinking water and passing urine ok - not being irritable in any way and has gone off to sleep fine tonight. I am worried to but think I may give it another day or two and then go to docs.

I think what bubbley means is that NICE guidelines don't recommend it as it's never shown in any tests to be more efficient than just using one on its own. Individual doctors do still recommend it though. It's an area of debate still, certainly.

But yes, go by symptoms. Anti-pyretics shouldn't be used solely for a fever if the child is otherwise happy and not in discomfort.

Pixie, I am only reiterating what it says in the guidelines in front of me (and they do say that it's not efficient so that's where I got that- erroneous I admit - nugget from and can now see that more recent research disagrees).

"It is okay to give
your child paracetamol or ibuprofen if they have a fever and they are
distressed or unwell. These medicines should not be given at the same
time, but if you give your child one medicine and it does not help, you
may want to consider using the other."

I've done some random googling and found several studies that agree with the one you have quoted and a suggestion that they should consider changing the guidelines from the group review but they have issued caution about doing so because there still aren't enough trials looking at the safety of this regimen and it's not clear from all trials into efficacy that the effect is significant enough to be recommended officially across all trials.

For the time being the official advice remains the same I think.

I have alternated the two btw but NEVER for reducing a fever as this is not what anti-pyretics should be used for in general terms. But I've only done it under medical guidance for a child in pain.

DN's paediatrician was saying only recently that he advises against it as per the guidelines he works to unless single usage of either isn't working sufficiently and only then he advises alternating. He says it should never be done routinely. And not for fever reduction in isolation (DN sees him due to febrile convulsions).

It remains an area of much confusion I think. NHS Direct always say no ime, individual doctors say yes sometimes and guidelines dither about trying to make up their mind.

The NICE guidelines do not recommend it. [[http://guidance.nice.org.uk/nicemedia/live/11010/30523/30523.pdf From 2007] see section 1.6.

It's also usually unnecessary - fever is actually a good thing and unless the child is uncomfortable there is no need to treat it. (again from NICE guidelines) Going by the clock to administer medication every few hours without taking the child's behaviour into consideration is a bit silly really and is preventing the body from doing its job in helping to fight the illness which paracetemol and ibuprofen won't do.

NICE Guidelines

bubbley, there is a lot of confusion isn't there? Not from NICE but in general terms. Calpol is whipped out for fevers as routine. I understand it. People still advise against letting a fever go unmedicated in case of febrile convulsion (when febrile convulsions aren't caused by high temps or prevented by anti-pyretics). And at the same time there are instances, albeit rare, where a high fever in isolation MUST be treated.

I'm not sure what the answer is. It's because selling anti-pyretics is a business and a lucrative one. Same as pregnancy tests (CB and its 'can you afford to guess how pregnant you are', NO buy this £10 wee stick immediately) or formula (closest to breastmilk taglines and immunofortis bollocks). While these things are part of brands and there to make money, there's always a lot of confusion.

I've only ever been prescribed paracetamol and ibuprofen but generic liquid suspension ones. You buy it from a shop and it's ££ for a pink bottle with a teddybear on it and the echo of an advert where a child leaps about on a sofa being mischievous.

But I guess it's the same with adults. MIL won't buy generic ibuprofen, only Nurofen as 'it's better'.

rattlesnake, sorry to hijack. How's your lovely leapfrogging ds this morning?

What do you think they are based on Pixie?

Logically, do you think it makes sense to unnecessarily suppress part of a child's immune response when they are sick? Why are you so scared of the fever? It's the disease it is helping to fight that is the problem.

But Pixie, you're an intelligent woman. You know how to make a decision, when to make the decision and how to read your child. And that's a good thing. And you know the current research, you know how to weigh it up against official guidelines and you make an informed decision.

But too many people have children who are well but with a slight temp and they read on a forum or a friend says 'oh alternate both' and they do it. I've seen it advised incorrectly too so that actually too much ibuprofen in particular is given as they go for 2 hourly alternate doses. I think the vast majority of parents are sensible enough and alert enough to manage to get the dosage right. But is it necessary to do it? I wouldn't double dose myself unless really under the weather but now it's becoming routine on here and in other places to recommend it. The op here for example says her ds is just fine in himself but it's still being recommended within a few posts. I've seen it recommended for a 'dd seems fine but has a mild fever of 38.2 following jabs'. Just days ago people were advising calpol pre-jabs for an 8wk old as a preventativew measure. This is just NOT advisable and even says so on the Calpol bottle but it's still in the public consciousness that you should do this.

I think the best course- as always on an internet forum -is to advise individuals to consult their own GP/NHS direct.

bubbley, I don't think Pixie is afraid of fever and doesn't medicate to reduce fever, she looks at her child as she said above. Sorry to speak for you Pixie. I know you have enough experience of having an unwell child to have some little experience in this (tis Showy).

Sorry pixie. Missed your comment where you said you only medicated if necessary.

Rattlesnake, sorry for the hijack too! Hope your DS is a bit better today :)

I cannot believe this debate. 40.8 is a dangerous fever which needs checking out and reducing as quickly as possible. Yes, it is the disease which is the main problem but a fever that high is close to the feedback loop level where it will keep going higher unless intervention is used.

I cannot believe people are suggesting not to alternate the two most effective anti pyretics. Further, a fever that high tends to be (though is not always) indicative of some form of bacterial sepsis. If the OP is still about, get your son down to A&E and have him properly examined by someone who has studied medicine. This is not a cold and, sure, it could be that he has just excessively responded to a relatively benign virus but it could also be that there is a relatively localised bacterial infection which could become more generalised and extremely serious. When in doubt, go see a real expert!

What larry said

what larry said. and pixie. sorry to jump on the bandwagon at the last minute but i agree that a fever of almost 41 needs looking at by a doctor in the first instance. it also needs reducing. i just don't get why you would leave a child unmedicated with a fever that high.

i have had a similar sounding experience to pixie. i very nearly lost a child due to dehydration from having such a high fever. i now medicate for pretty much any fever over 39 or so. but i also find that my dc's always feel ropey with a fever of over 39 so i want to make them comfortable anyway.

in my experience (and it is unfortunately plentiful) hospitals reduce fever regardless.

The height of the temperature does not indicate the severity of the illness. Any doctor will tell you that. They will also tell you to watch the child and not the thermometer. Yes, a prolonged fever needs to be looked at but not just because it is high. ANY fever that is not responding to attempts to reduce it or lasts for longer than three days and/or any child that is not responsive needs to be seen by a doctor. No one would argue that. A child that is eating, drinking and playing despite a high temperature is not a cause for concern unless the fever lasts for more than 3 days in which case there could be a bacterial infection that may need antibiotics.

Larry, I'm not sure why you think it is a dangerous fever. Sustained fevers over 42 degrees pose a risk to the brain but the hypothalamus will not allow the body to reach these temperatures ( self preservation if you like!) unless it has been compromised eg. In cases of heatstroke or poisoning.

BubbleyMummy

www.seattlechildrens.org/medical-conditions/symptom-index/fever/

Guide from the Seattle Children's hospital.

"Fever AND >105 F (40.6 C) by any route or axillary >104 F (40 C). (EXCEPTION: age >1 year, fever down and child comfortable. If recurs, see now.)"

In addition, there is a good correlation between the height of a fever and illness severity as bacterial sepsis tends to be accompanied by very high fever.

And your last statement is untrue. There are plenty of times with sepsis and some tropical viruses where the hypothalmus fails to do its job and hospitals have to use extreme measures such as cold drips to bring down fevers.

So you mean the hypothalamus has been compromised in those situations? Like in the EXAMPLES that I gave - it wasn't meant to be an exhaustive list. In any case the OP's son is unlikely to have a tropical virus.

His temp spiked at 40.8 but was responding to medication and he was drinking and seemed ok to her. There is more to assessing a child's illness than the numbers on a thermometer and your link and quote support that. The OPs son is 6 yo so he falls into the exception of 'greater than 1 yo, fever down and child comfortable.'

Yes, I agree that higher temperatures can be an indication of some bacterial illness but they can also be caused by viruses eg. roseola, measles etc. Serious illnesses can also present with low grade fevers which is why it is important to look at the child as a whole, not just go by the height of the temperature.

So, your suggestion to the OP (which this thread is actually about) is not to seek medical advice despite:

Fever of 40.8 degrees

5th day of infective illness

Problematic throat non responsive to penicillin.

??

Well, personally I feel that is irresponsible. If it is glandular fever (quite likely), it is nice to do a test and confirm it and then at least you know where you stand. If it is a bacterial throat infection non-responsive to penicillin, it would be useful to do a culture and prescribe an appropriate antibiotic.

There is robust and there is negligently robust. I know what I would do if it were one of my children.