What temperature would you give calpol at?

[walkbesideme]

My daughter (2 yrs) has a temperature - no other symptoms except falling asleep on the sofa. She is now in bed. I suspect she is teething - she has 13 teeth still to come and none have come through for the last 10 months.

Her temp has gone up to 38.9 - should you always give calpol? Or let her fight it for a bit?

The temp only came on this afternoon at about 4pm. I'm checking her every 20 mins - I don't want to over medicate her if possible. Does this make sense?

If the child is in pain, then I might give it (so that covers earache, sore throat, headache etc).

But I wouldn't give it to a child, even a feverish child, who was not in pain. As posted above, a raised temperature is a sign of the immune system working properly and I'd rather not suppress that unless there was a compelling level of pain as well. (On the same reasoning, I wouldn't take Immodium).

mememummy - ibuprofen has been proven to be more effective than paracetamol for bring down the majority of children's fevers (and keeping them down for longer.)

We experienced this first hand with ds1 when he developed a 40.9C temperature from an otherwise pretty innocuous viral respiratory infection at 13 months old. We took him to A&E (a memorable New Years eve!) They admitted him to the children's ward and paracetamol given there, at quite a bit higher doseage than we'd been giving (as we'd followed the bottle, not the actual medical maximum safe dose) hardly dropped his temp at all, and what little it did was effective for no more than an hour or so... Thankfully the ibuprofen they gave in between worked fantastically.

We've found it to be much better for ds2, too, although he's never reached those levels of fever in the first place!!

To the OP: 38.9C is pretty high. At her young age, I think I would give something to bring it down, by that point, but I'd generally only give it at temps lower than that if the child is acting miserable/uncomfortable along with the raised temp. As others have said - fever helps fight infections by making the environment less hospitable for the bug!

Gail - I have recently spoken to DS consultant (my DS has GEFS+ which basically means he has a lot of febrile convulsions and past the age of 6) and the advice is still to dose with paracetamol/ibroprufen for febrile convulsions. I suspect she knows a little more about than Bubbleymummy.

sneezecakes - not sure what you mean by 'fever symptoms' surely fever itself is a symptom. It can mask symptoms of serious underlying infection eg. pneumonia. I did say that paracetemol/ibuprofen should be given for pain - eg the sore throats and earaches you mentioned (although again there are other alternatives that I find can be more helpful for those) but not solely to reduce the fever. (This is in keeping with the NICE and WHO guidelines.) There are other methods of cooling that can show if the fever is responding and fluctuating as normal. In any case, there more important things to watch that will give a better indication of the seriousness of the illness and I would be reluctant to base my judgement solely on whether or not the temperature comes down.

"..it only seems to reduce the illness by one day, and the child would have had several days severe discomfort to achieve this. "

Not every child is in discomfort with a fever. My boys can be bouncing around with temperatures over 39.5! Obviously if they are uncomfortable then you should give them something, otherwise just let their body get on with it.

There are some studies showing that paracetemol can inhibit immune response which I think is one of the reasons it is no longer recommended to give it to children when they are getting vaccinations (unless they really need it). Other studies have shown that chickenpox take longer to scab over in children who are given paracetemol.

I think the best course of action is to go by the child - if they are still uncomfortable when you have tried everything else then give antipyretics but I wouldn't reach for the bottle first.

bruffin nice guidelines here

" It can mask symptoms of serious underlying infection eg. pneumonia. "

Just to clarify - 'it' refers to paracetemol/ibuprofen. Written in response to sneezecakes question.

Bubbleymummy my consultant understands the situation - you don't. You often can't prevent the first convulsion bercause it is often the first sign of illness, so you don't give paracetamol/ibroprufen willy nilly to just prevent them.

Once a child has a temperature, then the advice I have been given by every single paediatrician/gp/consultant I have seen is to reduce temperature with paracetamol/calpol and other means.
Everytime ds has been taken into hospital the first thing they have done is find out what doses he had then top up.
Yo love to quote NICE ,WHO extra but only when it suits you and are quite happily to ignore their advice re vaccines, so I am not going to listen to some l stranger on the internet (who seems to have set themselves up as an expert with no medical training at all) thankyou and I suggest anyone who has a child with FC to take proper medical advice.

Can I just add that not all consultants know what they are talking about. There is a misconception that they are gods and give 100% the correct, researched and audited advice.............. Not always true!!

Bruffin, if you are happy to follow the advice from your consultant then by all means go ahead. I would be reluctant to recommend it to others (you also bring a stranger on the internet) because, as I've pointed out, it contradicts current official guidelines. The information is there for anyone to read themselves, they don't have to take it just from me.

P.s. Can I also say how much it amazes me how people just presume that posters have no medical qualifications.

being* not bring

bubbly. When you refer to masking symptoms. Scenario: hot feverish miserable child with very rapid breathing. (rapid breathing is normal with a fever). Give calpol - fever is reduced but child is still distressed and breathing rapidly - I would look more carefully then at chest infection symptoms. To me, this is a case of giving anti pyretics and it helping to recognise a more serious chest problem, not masking it as you suggest.

Also never use fanning, as you suggest. Non medicinal methods such as fanning rapidly reduce the temperature but it rises equally quickly, and it is the rapid rise in temperature that causes febrile convulsions.

I can't help but feel you are deliberately misunderstanding me. I have never said anywhere to give anti pyretics just to reduce temps, but to let parents do what is right for them. No one method, even NICE or WHO guided, is right for everyone

Lulabye you only have to read Bubblymummys posts to know she has no medical qualifications.

Sneezecakes, are you disagreeing that antipyretics can potentially mask symptoms of an infection? I'm not saying they do in every case but it is considered one of the potential disadvantages of their early use.

Re. fanning. I'm not talking about blasting them with it! :) I was more thinking of ensuring that there is air circulating because a stuffy room is not going to be comfortable for a hot child.

"There is also a case to be made for what makes the parent feel comfortable."

and

"let parents do what is right for them."

could very well result in a child being medicated unnecessarily and being used solely to reduce the temperature regardless of whether or not the child is in any discomfort. I think this is one of the reasons that more information about fevers, their function etc could help parents to assess whether or not their child needs to be given something rather than just reaching for the bottle automatically every time a child is unwell.

I am aware about it being the rapid rise in temperature that causes the convulsions too. I think many people medicate because they believe that a high fever causes a convulsion and that unless they give something the fever will continue to rise uncontrollably.

I would just like to add that whilst at ooh with our daughter 2 years ago her temp was 38.7. She'd had nurofen 40 minutes earlier and the dr asked the nurse to give her calpol as well there and then. On the Internet lots of posters are saying not to medicate, but in my experience Drs always medicate for a high fever. I would also add that we should all seek proper medical advice for our children rather than rely on strangers on here. Don't get me wrong this site is amazing but there can tend to be posters reeling off lots of advice and who knows if it's right or not? I would also expect any posters who were medically trained to say so and if they dont I assume they're not.

The whole problem with this topic is that at the moment in the medical field there is a lot of controversy whether to medicate above a certain temperature.
At the moment either way is right as their has been research to show that both ideas are correct.
These same discussions go on in emergency departments all over the world where no two members of staff can agree.
You just need to give your child what your are happy with, as long as the right dose is given.
This is an internet forum and where medical advice is given, one would be a fool to use that advice without checking with a known medical professional.

I think I know what causes Febrile convulsions, we have at least 4 generations of abnormal history of febrile convulsions. I have witnessed 25 with my own children and numerous with my sister. It's a rare genetic defect that has only just been "discovered" which thankfully the consultant I spoke actually knew about and we were able to get a proper diagnosis.

The febrile convulsion happens when the temperature shoots up, hence usually the first sign of illness so is something that cannot be prevented. However when my ds has had subsequent convulsions in the same illness it has always been because the paracetamol has worn off or he has had an inadequate dose. I used the calpol sachets once and it is impossible to get it all out. This is also why I was told to alternate ibroprufen and calpol, because when one wears off they other one should still be working. The a&e department also dose by weight so ds being a tall boy needs higher dose than on the packet ie adult dose at age 10.

this is an internet forum and where medical advice is given, one would be a fool to use that advice without checking with a known medical professional.

Exactly. Other parents can give you their experiences and point you in certain directions or make suggestions so you can go to the gp/paediatrician/consultant etc and aske the right questions but these forums shouldn't be used to play doctors.

"This is an internet forum and where medical advice is given, one would be a fool to use that advice without checking with a known medical professional."

I agree lula. Which is why I think it is important to know what the official guidelines are rather than taking advice purely on the basis of one person's experience. Especially when, as you have also pointed out, so many doctors themselves are doing things in different ways.

FWIW Bruffin, the NICE guidelines don't recommend alternating paracetemol and ibuprofen either. The recommendation is to try one and if it isn't working, try the other and stick with the one that works best. Of course, if you are working specifically under a doctor's instruction who has seen and assessed your child then that is a different matter but it is another piece of advice that is frequently given out on MN to treat any fever which I don't agree with at all.

I don't think it's a case of playing doctors on behalf of the advice giver, I just think the whole point is to take everything on board and take any ideas you may have to a doctor who sees your child.
If you are asking for advice then you should expect people to give that advice and if there is medical research and well documented guidelines then all the better.

By the way op, I hope you dc is better

any fever which I don't agree with at all.
Exactly playing doctors. You are very selective with official advice. Official advice is to give mmr but you spend an inordinate amount of time on the internet pursueding others not to! A lot of doctors don't agree with NICE guidelines and in this case the guidelines are because they think parents are too thick to follow the regime of alternating ibroprofen/paracemtamol and will over dose.
I would also point out that if a child has a febrile convulsion they are ill, they will more than likely be in pain from flu/ ear infection /tonisllitis/pneumonia and basically pretty miserable so you would give pain relief and reduce fever anyway.

Bruffin, I'm disagreeing with people on the Internet giving advice that goes against the official guidelines. In this case, alternating ibuprofen and paracetemol. Not sure how that means I'm playing doctor. You yourself have said that you shouldn't take advice off strangers on the Internet. (yet you seem happy enough to give it)I happen to think advice from strangers that contradicts official advice is even worse. Just because you alternate medication and don't make a mistake does not mean that no one else would. Are you prepared to take responsibility for a tired mum who accidentally overdoses her sick child? In any case, iirc the advice was also based on it actually not making that much difference than just using the most effective one. (based on trying another if the first isn't working)

Not sure what vaccines have to do with any of this but seeing as you've brought it up - I don't tell anyone not to get MMR. I just advise making an informed decision and I will point people in the direction of official figures and information. How people interpret that information is up to them.

Some doctors may disagree with NICE guidelines, others do not. Who is right? Why are you so determined to convince people that the NICE guidelines are wrong and that your doctor is right? Surely you are doing the very thing that you object to?

Also, having a fever does not necessarily mean the child is in pain or miserable. Some fevers are low grade and cause little discomfort and some children tolerate even high fevers without distress. As you know, the febrile convulsion occurs because of the rapid rise in temperature so the fever itself may not even be that high or the rise in temperature may not even be due to illness. They can occur with over heating as well. No one is advising not giving pain relief if the child is uncomfortable just not giving it for every fever if the child is otherwise content or because you think it may cause a convulsion. Both of those recommendations are supported by the WHO and NICE so even if your particular doctor happens to disagree with them doesn't make them wrong. What authority do you have to dismiss them? What qualifications do you have?