Management of fever

Woman and baby with a fever

Fevers are usually treated when a child is in discomfort.

This applies to both children and adults. It’s also important to remember that fever is a sign that something else is going on in the body and that treating it does not treat the underlying cause of the fever.1,2

However, in children < 3 months old, a temperature > 38°C and other “red flag” symptoms should be seen by a doctor.2,3

Managing fever in adults

Man with fever

Assessment of fever in adults 2,4,5

To determine if a patient has fever, the most common route of taking a temperature in adults is a thermometer placed under the tongue (oral route).

If the temperature is > 38°C, consider that the patient is febrile.

Don’t forget to ask the patient for other symptoms to determine cause of the fever, “red flag” symptoms and if they require any other treatment recommendations other than medicines for fever.

Signs and symptoms

  • Pharmacist seeing a young child

    Adult patients may be recommended to do the following to help reduce feeling uncomfortable during a fever:

    Keeping hydrated by drinking plenty of fluids

    Water and juices will help recover the fluid loss and combat dehydration usually accompanying a fever

    Taking rest will help the body recover while heavy or strenuous activity would increase the body temperature further
    Dressing in light clothing and keeping the room temperature cool may also help
  • Management of fever

    A low-grade fever in an adult does not require any medication. However, if the patient is feeling uncomfortable or has a high fever then over-the-counter antipyretics can be recommended. The two most common are paracetamol or ibuprofen, which is a non-steroidal anti-inflammatory (NSAIDs).

    Before recommending a treatment, check with your patient to see if there are any precautions and contraindications for taking the medicines such as:

    May recommend paracetamol if

    May recommend NSAIDs if

    There is increased risk of bleeding when on certain drugs e.g. acetylsalicylic acid (aspirin), warfarin, corticosteroids, other medications containing NSAIDs

    Currently on certain antihypertensive drugs e.g. angiotensin converting enzyme inhibitors, angiotensin II receptor blockers or diuretics

    Having chronic kidney disease (less risk with paracetamol but dose should not be > 3 g/day over long duration)

    Peptic ulcer disease

    Cardiovascular disease

    There is increased risk of paracetamol toxicity such as currently on certain epilepsy medications (e.g. carbamazepine) or alcohol abuse

Managing fever in children

Child with fever

Assessment of fever in children12,13

Temperature taken rectally is the recommended method of assessing fever in children up to 3 years old. For children older than 3 years, other methods of taking a temperature are orally (under the tongue), under the armpit or in the ear. However the later two are less accurate.12,13

As with adults, assess for other symptoms accompanying the fever as well as “red flag” symptoms that would require a referral to a doctor.12,13

Signs and symptoms

  • Man with child

    Parents of children with fever may be recommended to do the following when their child has a fever:1

    Dressing the child light as, excess clothing traps body heat causing the temperature to rise

    Encourage the child to drink plenty of fluids such as juices or even eat popsicles
    Giving the child a lukewarm bath
    Placing cold washcloths over certain areas of the body such as the forehead, groin and wrist
  • Baby

    The general recommendations for managing fever in children are that infants < 3 months old with a fever of ≥ 38°C should be seen by a doctor regardless of other signs and symptoms whilst children > 3 months old can be observed and/or treated with over-the-counter medications unless exhibiting any “red flag” symptoms.

    Treatment with medicines should only be recommended if the child’s temperature is > 38.9°C or at a lower temperature if he/she seems uncomfortable.

    Among the medicines available for fever, paracetamol is the recommended first-line treatment for fever in children as it is effective in reducing fever and is gentle on children’s stomach.

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