Fever in Infants

Pharmacists are often questioned by parents whose children have fever (defined as a temperature of 38.5?C or higher 1). It is sometimes difficult to determine the best course of action in a busy community pharmacy; however, there are some guidelines that should be followed.

The key factors to keep in mind when assessing a child with fever are:
* The child’s age. 2
* The presence of signs of toxicity (eg, decreased alertness, breathing difficulties). 2
* The presence of a focus of infection (eg, painful ear). 2
* Recent immunisation. 1

Here is a helpful mnemonic to check for signs of toxicity: 2
A is for a decrease in arousal, alertness or activity
B is for breathing difficulties
C is for poor colour, circulation, or cry
D is for decreased fluid intake (less than half normal) and/or decreased urine output (fewer than 4 wet nappies/day)

The presence of these puts a child at risk of having a serious illness 2 and you should recommend that the customer take the child to their doctor. Parents should also seek medical advice if the child is younger than 6 months; has a fever for more than 2 days; has a headache or pain in the stomach or limbs; an earache; problem swallowing fluids; vomiting or diarrhoea; or a rash. 1


Key recommendations/tips. 1
* Fevers are common in young children, particularly if they have a respiratory tract infection or have recently been immunised.
* A fever doesn’t necessarily mean the child has a serious illness (in fact, fever helps the body’s immune system fight infection).
* Let the child rest and dress them lightly.
* Give the child lots of clear fluids to drink.
* If the temperature is higher than 38.5?C and this is making the child uncomfortable or miserable, ibuprofen or paracetamol can be given to help ease discomfort; if fever persists for longer than 2 days advise customer to seek medical advice.

Useful URL
BetterHealth Channel. www.betterhealth.vic.gov.au/health/conditionsandtreatments/fever-children

1. NPS Medicinewise (Accessed November 10, 2015, at http://tinyurl.com/gnpknl5).
2. NSW Health Policy Directive. North Sydney, NSW: NSW Department of Health, 2010.