When to see the doctor for fever?

By Leva

Fever generally refers to a temperature of 38oC (100.4oF) or greater. It is not a disease in itself, but an adaptive response which indicates that the body is reacting to something. It is no surprise that fever is a cause of concern for most parents as fever usually indicates infection especially in newborns and infants. 

Although not all fevers are due to infections, it is one of the most dreaded causes of fever in newborns and babies. Infections are one of the leading causes of death in children less than five years old. Extra attention is given for newborns and infants because unlike older children, they cannot express what they are feeling. It is important to know when you should bring your baby to a doctor for fever and to know the warning signs of infection in babies. 

Although infections are one of the most common causes of fever in babies and infants, some babies may have increased temperature due to reasons other than infection. Babies are susceptible to temperature changes because they are still not good at controlling their own body temperature. This is why it is important to check the temperature because they may feel warm but have no fever. In other cases such as teething or vaccinations, the baby’s immune system can produce a low-grade fever. In most cases, if the baby appears well, has a good appetite, latches well, is playful or active, then they are most likely okay and do not need an immediate consultation. 

Fever due to infections usually accompanies other signs and symptoms which indicate the focus of the infection. This can help doctors know what is causing the problem with your baby. Fever with cough or colds might suggest a problem with the lungs, while fever with vomiting suggests a gut problem or a urinary infection in pediatric patients. As a general rule, in the presence of fever, any abnormal sign or symptom that you notice in your baby is a cause for concern and should alert you, even if you do not seek medical consultation right away. You can observe your baby for a short period of time but a check-up is recommended if the symptoms do not resolve in a few days.

Infection that spreads throughout the body is called sepsis. In newborns they may present as any kind of symptom. These include increased irritability, decreased appetite, poor latching or sucking, decreased activity and poor or weak cry. These may be simple and subtle signs, but in the presence of fever are highly suggestive of infections. If they look sick, are not smiling and do not settle, you must consult a doctor. In severe cases, babies may have lethargy and can be difficult to arouse. These are signs of infection spread and are harder to treat and cure. 

Some infections, especially those that involve the airways and lungs can cause an increased effort for the baby to breathe. Signs of difficulty of breathing include flaring of the nostrils and the sinking of the area between the ribs or the neck during breathing (medically termed retractions).  Other infections can present with vomiting or diarrhea and lead to loss of water and electrolytes from the body. This may also lead to dehydration, which further adds to the complications. If these are present in your baby, it is best to seek emergency care. 

The baby’s skin may change color as well. It can turn pale, blue (medically termed as cyanosis), and yellow (medically termed as jaundice) or have a patchy blue or violet discoloration (medically termed as mottling). A rash may be observed in some cases of infection. Some of these occur later in the course of infection and should be checked by a doctor. 

Fever is not always a reason for consultation, but it is important to know when to see the doctor if your baby has a fever. Warning signs are helpful to determine if you should consult. Bringing them early can prevent worsening of the condition and prevent further complications.

• References:

  Children’s Health Queensland Hospital and Health Service. (2019). Fever in Children. Retrieved from the WWW: https://www.childrens.health.qld.gov.au/fact-sheet-fever-in-children/

  Children’s Health Queensland Hospital and Health Service. (2019). Febrile illness- Emergency management in children. Retrieved from the WWW: https://www.childrens.health.qld.gov.au/guideline-febrile-illness-emergency-management-in-children/

  Kliegman, R. St Geme, J. Blum, N. Shah, S. Tasker, R. Wilson, K. Behrman, R. (2019). Nelson textbook of pediatrics (Edition 21.). Philadelphia, PA: Elsevier.