40+ temperature, nothing bringing it down - when to worry?

[TripleTruffle]

DC(3) has been ill for a few days, temp hasn't been as high but has had a fever.
Today the fever has reached 40 and won't go down. We've done everything we usually do, plus alternated meds because the temperature wasn't really coming down enough before but it's been going up as if the liquid ibuprofen and paracetamol aren't doing anything. I've checked the 'warning signs' and DC is quite tired yet is wakeable, has cold feet and had a bout of vomiting which we initially put down to the fever itself (as we once had similar with our eldest) but there's no other signs of any other symptoms. Has anyone had similar? Is A&E an overreaction here?

Over 40 even with paracetamol and ibuprofen, I would be called 111.

At that temp he needs a and e

They can detoriate quickly so need monitoring and antibiotics if needed

X

No, a&e is not an over-reaction. Especially for a 3yo. If 40+ and nothing bringing it down, a&e is the right place.

With those symptoms and the temperature not coming down, I'd be going to A&E now, definitely not an overreaction, he needs to be seen and treated.

He is three.
Better a few hours in a and e and checks

A&E and ask them specifically to rule out sepsis and meningitis (mention the words). Good luck!

Another one for A and E. A temperature you can't bring down IS an emergency, especially in little ones.

? and cold feet ?
Seek immediate medical help.
All the best.

Not an overreaction at all - especially with the cold feet. We had similar with DD2 - we called 111 who sent an ambulance and she was taken to a&e to rule out sepsis. Checked over, various swabs taken, nothing bacterial found so sent home as viral. Hope your DC gets better soon.

Hope your little one is feeling better soon. I agree with the others - I would take to A&E for this.

@TripleTruffle how is your little one? I hope it’s settled down a bit.

A&E

Thank you, for the responses. As DC was asleep, we thought we'd monitor it and he woke up wanting to drink more not long after so with a cold fluids and a bit of rest, it seemed to help. The paracetamol seems to be working fine now but just not ibuprofen. He's been diagnosed with tonsillitis and told symptoms were likely due to the high temperature. He now seems to have streaming eyes and nose as well, we've been keeping an eye on him constantly through sleep as he's so congested, he's going silent and waking up not being able to get enough air in. We've had a vicks humidifier on the go, saline, etc., but can't seem to help with the breathing. That has started to panic us a bit, weve not had this before so me and DH are taking turns at night at the moment.

I want to also put it out there if anyone were to find this thread in future that we were extremely worried and if it were much longer after, we'd have taken him to A&E. So no one at any point should read the outcome and just think it'll be OK, I'm well aware circumstances could be much different for others.

I’m glad you are hopefully coming through the other side.

Has he seen a doctor in person? Honestly, if not, you really must take him urgently if he is having pauses in his breathing.

It's not clear from this post if he's seen a doctor today - when was he diagnosed with tonsillitis?

The vomiting and cold feet are common symptoms of a high fever, and it's good that he's now responding to paracetamol, but if he's got tonsillitis currently and is now having sleep apnoeas he needs to be reassessed tonight. Paediatric airways are very small and if the tonsils are significantly inflamed they may well be obstructing his airway. I'm a HCP and if you presented to our ED with those symptoms we would likely admit for continuous monitoring at the very least.

It is really important that you get him seen tonight, OP. As a mum I know it's really hard when they're finally asleep to drag them out late at night and can be tempting to leave them but with the history I would want him reviewed by ENT to ensure his airway isn't at risk. I'm really not saying any of this to scare you, and complications like Quinsy are vanishingly rare in very young children like yours, it's not something I would want to risk.

He did see someone in person, yes, and they were pretty adamant after looking in his mouth that it was tonsillitis. Although his breathing wasn't checked at the time and the pauses in breathing during naps and sleep started after being seen. It seems like heavy congestion but everything is running, his nose is being wiped often, he's been propped up, and there's nothing else we can think of to try.

I was just thinking about it, he had Scarlet Fever before and it could actually be that. I doubt that will make a difference as the antibiotics are the same but might explain why it's been that bit harder to manage the temperature.

https://www.nice.org.uk/guidance/ng254/chapter/evaluating-risk-level#criteria-for-stratification-of-risk-from-sepsis-in-under-5s
Your child has cold peripherals and apnoeas, these are classified as HIGH risk for sepsis by NICE. Take him to A&E. (I’m a Paramedic)

The breathing is worrying. I have taken both of mine in to A&E for that and had them admitted to hospital for several days. A&E will absolutely not think you’re overreacting- they need to check his oxygen levels. If they’re going down low while he sleeps he will need support and monitoring.

Hadn't seen your post @FestiveFancy when I posted, we'd rather he be checked so we'll see what the hospital says.