Fever Clinic with Dr David

Confused about the recent fever debate? It can be very frightening when our children run a temperature and get ill.

With children's medicines in the press again (visit the NHS choices website for an overview of the report) Dr David came in to answer your fever-related questions.

Q: My son regularly gets temperatures; his last 'bad one' was around Christmas where it spiked to 41.1 degrees. He has yet to have a convulsion but that's possibly because I give him Nurofen and Calpol at regular intervals or perhaps it's just that his body is able to 'cope'. With the latest advice I am now doubting whether this is the right thing to do and if not what the alternative is as neither Nurofen or Calpol used on their own seem to work for my son?

A: Here are the NICE guidelines (in bold) on treating a fever below (fever reducing drugs and measures are referred to as 'Antipyretic', by the way):

• Tepid sponging is not recommended
• Do not over or under dress a child with fever
• Consider either paracetamol or ibuprofen as an option if the child appears distressed or is unwell
• Do not routinely give antipyretic drugs to a child with fever with the sole aim of reducing body temperature
• Do not administer paracetamol and ibuprofen at the same time, but consider using the alternative agent if the child does not respond to the first drug
• Do not use antipyretic agents with the sole aim of preventing febrile convulsions

It is true that the body's response to infection by inducing a fever is protective since our bodies are working to help us (on the whole!) However, it's worth giving your child medicine if they are distressed, rather then just being hot. We need to always think what's causing a fever and make a judgement on whether we need to see a doctor or manage the fever at home, since most infections are viral.

I would suggest not giving both Nurofen and Calpol in first instance and if you need to give something as regularly as two-hourly I'd want the child to have a check-up first to make sure there's nothing too serious going on as a fever that's difficult to treat may be a sign of a bacterial infection. If the child has been seen by someone medical who's happy with the cause you can perhaps be more proactive but only give something if your child is clearly distressed/unwell. We know giving these meds DOES NOT protect from febrile convulsions necessarily as often the fit occurs early on in the infection and happens as the temperature rises rather then when it peaks, so often a fit is the first sign your child perhaps has a fever.

Ten per cent of children have febrile seizures, usually occurring between the ages of six months and six years, so if your LO has had lots of temperatures in past and never had a fit, it seems less likely one might come on, but I don't know your son's age. So, Calpol vs Nurofen - some children seem to respond better to one more then the other. Calpol is perhaps a bit safer. But the important thing to remember is to stick to one and use the same preparation to reduce the risk of dosage errors etc.

Q: As a mum of three girls, I get confused about what to give and when to give it. I was led to believe that to reduce a fever of 38.5+ you should give Calpol with ibuprofen or Calpol at regular times, eg: breakfast, lunch and teatime, and then ibuprofen in between, but is this OK? If this is the case, how long can I do this for? My oldest child had a fever for over four days the last time she was unwell. Standard advice is to see a GP after three days, which we did, but they told us to continue with what we were doing ... it's just so confusing.

A: Both will work but Calpol is perhaps safer (in the right dose.) Often parents prefer one and find one more effective then the other. Give your child medication if they are clearly unwell/distressed. And certainly if your child still has a fever after three days it is reasonable to get a medical review. NICE guidelines say you definitely should see your GP after five days; so much depends on how your child is improving (if at all) in other ways. So, if they're feeling lot better after three days, but still have a slight temperature, they may not absolutely require seeing a doctor every time. But you know your own child and you should always see your GP if you're worried.

Q: My toddler (who is nearly three) always refuses to take medicine so when she has a fever it is nigh on impossible to give her Calpol. She just has to ride it out but I feel so helpless. Is it ok NOT to give medicine for a fever? I have tried everything - spoons, syringes, mixing with juice but my daughter just spits the medicine out.

A: You don't have to give these medicines. They don't necessarily make your child recover from infection any quicker (in fact they may delay recovery) but they can help to make your child feel better. If they don't feel too bad then don't worry. If your child is very unwell then you should get her checked out and if she's feeling really ill she may be more compliant about taking the medicine. You can give paracetamol as a suppository, by the way, but you'll need a prescription so you would need to see your GP first.

Q: My daughter has been unwell over the past six weeks. The doctor says she has a viral infection and to give her Calpol and ibuprofen. But she doesn't seem to be getting any better and her temperature without Calpol is always around 39 degrees. Surely it's not right to be giving her this much Calpol? She has been having at least two doses a day for the past five weeks. She has had one course of antibiotics and picked up for a few days after but then started being really tired and unwell again.

A: Your child shouldn't be getting such frequent temperatures though it can be hard to get accurate readings at home, depending on how you take your child's temperature. It may be your daughter is getting recurrent viral infections but there should be periods in between of getting better with no fever until next one takes hold. Has she had her urine checked? I would push for another review. You can always go to A&E and though this is not ideal this may get you referred to a paediatrician for another opinion.

Q: My daughter, aged two and a half, has had a febrile convulsion and they are very scary. How can I stop it from happening in the future?

A: It can be difficult to prevent febrile convulsions but you should be reassured that the vast majority of children grow out of them by six years (and many do before that age) with no future problems. In the vast majority of cases a child who has had a febrile convulsion will recover and get back to normal.

Historically we've advised undressing and tepid sponging but now NICE guidance doesn't recommend that. The important thing to remember is that there's nothing you can do to 100% protect your child from getting a convulsion but that's not to say don't do anything at all. Be careful with measures to bring a temperature down quickly (such as cool bath/fanning/opening a window) as you can do harm with sudden changes and if your child isn't too unwell with it then remember a fever is thought to be a way the body responds to fight infection.

Evidence shows that often a convulsion occurs early as the temperature rises and some children may not have a fever when they start to fit yet afterwards the temperature goes up. Once a temperature is high, if there's no fit then potentially they won't get one, although it's still a risk and may occur during the next temperature rise. But I want to point out that you don't necessarily need to panic when your child is hot and standard advice (Calpol if distressed, medical review if worried) is the same in all children, whether they've had a febrile convulsion in the past or not.

Q: Can children get too cold as well as too hot and when exactly should we worry and seek further advice?

A: Yes, they can. Sometimes children feel cold before a temperature goes up. Just having a temperature shouldn't determine when to seek advice but you should consider the overall picture of how your child is. If a child gets cold, they may become drowsy, very sleepy and clearly then you should seek medical advice quickly.

Q: My mum says "starve a fever, feed a cold" - is this true? Are fluids really more important than food when a child has a fever? How can you tell if a baby or child is getting dehydrated?

A: If you have a fever you are at risk of dehydration - more fluid evaporates as your hot, illness-causing fever might make you dry (diarrhoea, vomiting or sleepiness all mean you'll be drinking less) so fluids are important. As long as that fluid contains some sugar it's fine not to eat for a while.

Signs of dehydration in babies/children include:

• sunken fontanelle
• dry mouth
• sunken eyes
• absence of tears
• poor overall appearance and decreased wet nappies, cool hands and feet (late sign), sleepy. You can see if a child is at risk if they keep vomiting or having diarrhoea yet they are not taking much in.

NICE has guidelines on diarrhoea and vomiting in children, and list the following as things to look out for to pick up children at increased risk of dehydration:

These children are at increased risk of dehydration:

• children younger than 1 year, especially those younger than 6 months
• infants who were of low birth weight
• children who have passed six or more diarrhoeal stools in the past 24 hours
• children who have vomited three times or more in the past 24 hours
• children who have not been offered or have not been able to tolerate supplementary fluids before presentation
• infants who have stopped breastfeeding during the illness
• children with signs of malnutrition