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When to worry about your child's temperature

I think my child has a fever - should I be worried?

Fevers can be worrisome. As parents, we’re often on high alert the moment our children show the slightest hint of a high temperature. Could it be the flu? A cold? Chickenpox?!

Aside from worrying about our child getting sick and whether or not they should take the day off school tomorrow, there’s another reason our parental radars go on high alert: we wonder whether our child’s temperature is too high (and what that could mean).

At very high temperatures (40℃ or more), a child is more likely to have a serious infection (though most won’t)1, so it is important to keep track of your child’s temperature. But at what point should you start to worry?

What is a fever in babies and children?

Let’s begin by understanding why kids have fevers in the first place. A fever is the body’s natural response to fighting infections like coughs and colds. Normal temperature in babies and children is about 36.4℃ (though this can vary between children)2. It is classified as a fever when that temperature climbs to 38℃ or higher (in children under 5)3.

High temperatures are common in young children. Over 60% of parents with children aged between six months and five years say their child has had a high temperature3. The temperature usually returns to normal within 3 to 4 days2.

Many parents first notice their child’s high temperature when they touch their child’s forehead, back or tummy. These areas may feel hotter than usual. The child may also feel sweaty or clammy and have red cheeks2.

If your child feels hotter than usual and you believe your child may have a fever, there’s a good chance your instincts are spot on–a study showed that mothers who predicted that their child had a fever by touching their skin were very often correct4.

But you shouldn’t rely on this to work out if your child has a fever. It’s important that you use a thermometer (such as a digital or smart thermometer *) to accurately take, and track, your child’s temperature.

Should you be worried about your child’s fever?

Let’s say your child has a temperature above 38℃. Does that mean you should automatically rush to the doctor? If you are ever concerned about your child’s health, then certainly do. You know your child best.

But some children may seem very ill at a lower temperature, while others may have a higher temperature and seem perfectly well5. If your child has a fever, it’s important to focus on making your child comfortable, keeping them well-hydrated and remaining aware of signs of serious illness. If your child does have a fever and is distressed or feeling unwell, you can use paracetamol or ibuprofen ** (as appropriate for your child’s age and weight) which may help them feel better6. Many parents also like the peace of mind that comes with being able to monitor their child’s temperature constantly.

Sometimes, your child’s high temperature may indicate something more serious. At that point, you should be calling your doctor.

When to see a doctor

Though fevers often go away on their own within a few days 2 , be on the lookout for any of the following signs or symptoms which may indicate a more serious cause of fever. Call your doctor for an urgent appointment (or NHS 111 if you can’t get through to your doctor) if your child2:

● is under three months old and has a temperature of 38℃ or higher, or is 3 to 6 months old and has a temperature of 39℃ or higher (or you think they have a fever)

● has a high temperature that's lasted longer than five days

● has a high temperature, as well as other signs of illness such as a rash

● has a high temperature that doesn't come down with paracetamol or ibuprofen **

● doesn't want to eat, or isn't their usual self and you're worried

● shows signs of dehydration (such as nappies that aren't very wet, sunken eyes, and no tears when they cry)

Call 999 or go to the emergency department if your child 2 :

● has a stiff neck or is bothered by light

● has a rash that doesn't fade when you press a glass against it

● has a fit (febrile seizure) for the first time

● has unusually cold hands and feet, or pale, blotchy, blue or grey skin

● has a weak, high-pitched cry that's unlike their usual cry

● is drowsy and difficult to wake

● sucks their stomach in under their ribs and finds it hard to breathe

● has a soft spot on their head that curves outwards (the fontanelle is bulging)

Trust your judgement. If you believe your baby is ill, call a doctor no matter the temperature.

 

*Nurofen For Children FeverSmart™ Temperature Monitor does not replace continuous parental vigilance. Continue to monitor your child’s health and well-being.Accurate within ±0.2°C with correct usage. Environmental factors & child’s position may result in greater variance.Always read the label. Use only as directed. If symptoms persist see your healthcare professional. Always continue to monitor your child’s wellbeing.

** Nurofen for Children Orange/Strawberry: Singles / Cold, Pain and Fever 100g/5ml Oral suspension / Baby Oral suspension /3 months to 9 years 100mg/5ml Oral suspension / 3 months to 12 years Oral suspension. Contains ibuprofen, for children over 3 months (weighing more than 5kg) to 12 years. For pain relief. Nurofen for children 100 mg, chewable capsules, soft. For fever and pain relief in children aged 7 to 12 years. Contains Ibuprofen. Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional. All information presented on these web pages is not meant to diagnose or prescribe.

For further advice please speak to your doctor or pharmacist

1. NHS-Wales. When should I worry?Your guide to Coughs, Colds, Earache & Sore Throats. Available at: http://www.wales.nhs.uk/sitesplus/documents/866/2012%20-%20When%20shoudl%20I%2 0worry%20-%20English.pdf. (Accessed: 25th October 2018)

2. NHS-UK. Fever in children. www.nhs.uk Available at: https://www.nhs.uk/conditions/fever-in-children/. (Accessed: 8th October 2018)

3. NHS-UK. Treating a fever (high temperature) in children. nhs.uk Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/treating-high-temperature-children/. (Accessed: 16th October 2018)

4. El-Radhi, A. S. & Barry, W. Thermometry in paediatric practice. Arch. Dis. Child. 91 , 351–356 (2006).

5. NHS-UK. What is a fever (high temperature) in children? nhs.uk Available at: https://www.nhs.uk/common-health-questions/childrens-health/what-is-a-fever-high-temper ature-in-children/. (Accessed: 25th October 2018)

6. NHS-UK. Advice for managing child fever. nhs.uk Available at: https://www.nhs.uk/news/pregnancy-and-child/advice-for-managing-child-fever/. (Accessed: 25th October 2018)

How to treat a sore throat in children

Sore throat in children: causes, symptoms, and treatment

Sore throats come in all shapes and sizes.

From the little ones that give your child a tickle to the ones that may leave them speechless, sore throats can interfere with your child’s life. Find out what causes a sore throat, symptoms of a sore throat, and how to treat it.

What causes a sore throat in children?

Sore throats (pharyngitis) are very common and usually nothing to worry about 1. They will normally improve on their own within a week. Sore throats are not an illness in themselves, but a symptom of something else, such as a viral or a bacterial infection.

The most common infectious cause of a sore throat is a viral infection, such as a cold or flu2.

Other infectious causes of a sore throat include:

● tonsillitis

● glandular fever

● strep throat

● hand, foot, and mouth disease

A sore throat that is caused by an infection will usually come along with other symptoms too, such as a cough, runny nose, difficulty swallowing, fever, or mouth ulcers.

If your child has an occasional mild sore throat and no other symptoms, it may have a non-infectious cause such as2,3:

● allergies

● snoring

● shouting

● smoke inhalation

● air pollution

● dry air during winter

● side-effects of asthma preventer inhalers or chemotherapy

Sore throat symptoms in children

Pain in the throat is often a sign of inflammation. The symptoms that come along with a sore throat will depend on what’s causing it.

Cold and flu

The viruses that cause cold and flu can cause a sore throat and symptoms such as a runny and blocked nose, cough, lethargy, and fever.

Glandular fever Glandular fever is a viral infection which mostly affects teenagers but can also affect children. It often causes a very high fever, a severe sore throat, and extreme tiredness4.

Hand foot and mouth disease

This condition is caused by a virus and often spreads amongst young children. When your child catches hand, foot, and mouth disease, they may first complain of a sore throat or mouth pain, not wanting to eat, and they may have a fever5. Soon, they may develop a rash (a mix of small red bumps and blisters) on their hands, feet, and around their mouth (hence the name!). Blisters inside the mouth and throat can make it very difficult to swallow. Hand, foot, and mouth disease usually resolves on its own within 7 to 10 days.

Strep throat

Strep throat is a common bacterial infection that affects up to 30% of school-aged children with a sore throat3. It usually occurs in the winter and develops very suddenly. In addition to a sore throat, symptoms can include fever, headache, nausea, white patches of pus in the throat, and swollen glands. Look out for fussy behaviour and decreased appetite in younger children. Strep throat is usually treated with antibiotics3.

How to treat a sore throat in children

Most sore throats are caused by a virus and are self-limiting. This means they will usually get better on their own. You can help your child cope with discomfort in the following ways1,4:

● get rest and sleep

● drink plenty of fluids to avoid dehydration

● eat cool, soft foods

● suck on an ice lolly

● use paracetamol or ibuprofen* to relieve the pain and discomfort of a sore throat or fever If the cause of your child’s sore throat is bacterial (such as strep throat)3, your doctor may prescribe antibiotics and take a swab of your child’s throat to find out which bacteria is causing it.

How to prevent illnesses that cause a sore throat

Preventing a sore throat is all about taking steps to prevent the spread of infections that cause them. A great way to reduce the chances of catching an infection that can cause a sore throat is to teach your child how to wash their hands correctly3. Hands should be rubbed with water for 15-30 seconds at minimum. Show your child how to thoroughly clean under their nails and between their fingers. Ask your child to wash their hands after coughing, blowing their nose, or sneezing. Try to avoid touching or allowing your child to touch the eyes, nose or mouth of someone who is sick to help limit the spread of infection3.

When to call a doctor

Sometimes, a sore throat can indicate something more serious. Take your child to see the doctor if he or she1,3:

● gets sore throats frequently

● has a sore throat that doesn't improve after a week

● has a sore throat that is worrying you

● has a sore throat and a very high temperature, or feels shivery

● has a weakened immune system – for example, if your child is on chemotherapy or has diabetes

See your doctor or emergency department immediately if your child has:

● difficulty swallowing

● difficulty breathing

● swollen neck

● severe tummy pain

● drooling

● a high-pitched sound as they breathe

● symptoms are severe or getting worse

 

*Nurofen for Children Orange/Strawberry: Singles / Cold, Pain and Fever 100g/5ml Oral suspension / Baby Oral suspension /3 months to 9 years 100mg/5ml Oral suspension / 3 months to 12 years Oral suspension. Contains ibuprofen, for children over 3 months (weighing more than 5kg) to 12 years. For pain relief. Nurofen for children 100 mg, chewable capsules, soft. For fever and pain relief in children aged 7 to 12 years. Contains Ibuprofen. Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional. All information presented on these web pages is not meant to diagnose or prescribe.

For further advice please speak to your doctor or pharmacist.

1. NHS-UK. Sore throat. nhs.uk Available at: https://www.nhs.uk/conditions/sore-throat/. (Accessed: 15th October 2018)

2. Renner, B., Mueller, C. A. & Shephard, A. Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inflamm. Res. 61, 1041–1052 (2012).

3. Wald, E. R. Patient education: Sore throat in children (Beyond the Basics). in UpToDate (eds. Edwards, M. S. & Torchia, M. M.) (UpToDate, 2018).

4. NHS-UK. Glandular fever. nhs.uk Available at: https://www.nhs.uk/conditions/glandular-fever/. (Accessed: 15th October 2018)

5. Guerra, A. M. & Waseem, M. Hand Foot And Mouth Disease. in StatPearls (StatPearls Publishing, 2018).

7 common illnesses in childhood (and what to do about them)

Common childhood illnesses: how to treat them and when to worry

Kids constantly seem to be catching something.
If it isn’t a cold or a dribbly nose of some sort, they may be complaining of a tummy ache, scratching at something or pulling their ears in pain. The good news is, most of the problems you’ll come up against are just an everyday part of growing up1. If you have a young child, here’s a list of some common childhood conditions you may (or hopefully, won't!) have to deal with.

1. Coughs, colds and flu

Your child’s nose is dribbling. They’re coughing and sneezing, have a bit of a
temperature and seem unwell. If your child has recently started going to the nursery or playgroup, this may feel like a never-ending story in your house. The good news is, these regular coughs and colds are helping to build your child’s immune system. Flu tends to be a little more severe and can be more serious than a common cold. It can leave your child feeling pretty unwell, achy and uncomfortable for a week or even longer. You can help your child feel more comfortable by 1:

● Giving your child plenty to drink
● Giving them junior paracetamol or ibuprofen* (check you have the right dose and strength for your child’s age)
● Keeping them away from smoke and anyone who smokes
● Speaking to your pharmacist about other ways to help
See a GP if your baby:
● has a temperature of 38 C or more
● has a fever with a rash
● isn’t waking up or interacting with you
● is finding it hard to breathe

2. Asthma

Asthma is a common lung condition that often begins in childhood. It affects the
airways, making it difficult to breathe and often presents with symptoms such as
wheezing, coughing, breathlessness, and chest tightness. The severity of symptoms is different for each child with asthma and is usually treated with an inhaler. See your doctor if you think your child may have asthma. Your GP may carry out some simple tests and ask about your child's symptoms to make a diagnosis2 . If your child has a sudden, severe onset of symptoms, they may be having an asthma attack. If your child is struggling to breathe or is showing severe symptoms of asthma, dial 999 immediately 3.

3. Bronchiolitis

Bronchiolitis is a common respiratory tract infection which affects babies and children under two years old. Most cases are mild and will clear up within 2 to 3 weeks on their own, though some children may need hospital treatment if symptoms are severe. Early signs of bronchiolitis resemble a common cold (such as a runny nose and cough), but as it develops, your child may also have a slight fever, dry and persistent cough, difficulty feeding, and rapid or noisy breathing. There’s no medication to kill the virus that causes
bronchiolitis so you would care for your child in the same way that you’d treat a cold. This may include keeping your child hydrated and giving them ibuprofen * or paracetamol (as appropriate for their age) if the fever is upsetting them 4.

See your doctor or call NHS 111 if 4:
● you’re worried about your child
● your child has had less than half their usual amount during the last 2 or 3 feeds
or has had a dry nappy for 12 hours or more
● your child has a persistent temperature of 38C or above
● your child seems irritable or very tired

Diall 999 for an ambulance if:
● your baby is struggling to breathe
● your baby’s tongue or lips are blue
● there are long pauses as your baby breathes

4. Gastroenteritis

Gastroenteritis is a common condition that causes diarrhoea and vomiting in children and is most often caused by a bacterial or viral tummy bug 5. The main symptoms of illness are sudden, watery diarrhoea, feeling sick, vomiting (may be projectile) and mild fever. They may also have a loss of appetite, aching limbs, stomach upset, and a headache. Gastroenteritis usually passes within a week on its own but can sometimes last longer. You can usually look after your child at home until he or she feels better.

Ways to help care for your child at home, include3:
● giving them regular drinks, water, or ice-lollies (for older children), avoiding fruit
juice or squash as this can make diarrhoea worse. If breastfeeding, continue
doing so.
● giving them rehydrating solutions available from your pharmacist if they have
signs of dehydration, which usually come in pre-measured sachets that you mix
with water
● offering them plain foods like pasta or boiled rice (nothing too rich or salty), if they want to eat
● being very careful about hand hygiene to avoid passing along the infection. Use
soap and water or anti-bacterial hand gel, and use a clean towel to dry hands
very well

See your GP if your child 6:

● shows signs of dehydration, or is at increased risk of dehydration
● shows signs of a more serious illness
● has been vomiting for more than three days
● has had diarrhoea for longer than a week
● had blood or mucus in their stools
● has a weakened immune system
● has been overseas recently

5. Ear infection

If your bub is pulling at their ear or complaining of ear pain, listen up–they may have an ear infection. Ear infections are common in babies and toddlers (particularly after a cold), and most are caused by viruses which cannot be treated with antibiotics 3. Ear infections may be painful for children, and a child may rub or pull at their ears. Young babies may simply cry and seem irritable as they can’t always tell where the pain is coming from. They may also have a temperature and discharge coming out of their ear. It’s usually not serious and clears up on its own within three days. To help them feel better, you can use painkillers such as paracetamol or ibuprofen, place a warm or cold flannel on their ear, and remove any discharge by wiping the ear with cotton wool. And don’t forget to give them lots of extra cuddles!

See your GP if your child has 7:
● a very high temperature, or is feeling hot and shivery
● an earache that doesn’t start to get better after three days
● swelling around the ear
● hearing loss or a change in hearing
● symptoms like being sick, severe throat, or dizziness
● regular ear infections
● a long-term medical condition such as diabetes, lung, kidney or neurological disease
● a weakened immune system, due to chemotherapy for example

6. Chickenpox

Chickenpox is a mild disease that most children will have at some point 3. It’s easy to catch chickenpox, and the main symptom is the rash–red spots that can appear anywhere on the body and fill with fluid before they begin to scab over. Blisters may burst, and some blisters may appear as others are scabbing over. Other symptoms your child may have, include a high temperature above 38 C, aches and pains, loss of appetite, and generally feeling unwell. It usually gets better within a week without seeing a GP, but your child will need to stay away from school or the nursery until all spots have crusted over; usually, about 5 days after spots begin to appear 8.

See your GP if 8:
● you’re not sure if it’s chickenpox
● the skin around the blisters is red, hot or painful (signs of infection)
● your child is dehydrated
● you’re concerned about your child, or they are getting worse

7. Conjunctivitis

Conjunctivitis is a common eye infection that may affect children. It is caused by allergies or infection. If your child has conjunctivitis, they may have bloodshot, itchy eyes that burn or feel gritty; their eyes may water more than usual and might have a discharge which sticks to the lashes. Conjunctivitis that produces sticky pus and red, gritty eyes is usually contagious. If allergies are behind your child’s conjunctivitis, their eyes may be red and watery, but they won’t be contagious 9 .

Viral or bacterial conjunctivitis is infectious (allergic conjunctivitis is not). You can help prevent the spread of infection and care for your child while they have conjunctivitis by 9:
● encouraging them to wash their hands frequently with warm soapy water
● washing pillows and face cloths in hot water and detergent
● asking them to try to avoid rubbing their eyes
● not sharing towels or pillows
● gently cleaning away crusty discharge with clean cotton wool soaked in boiled
cool water (use a clean piece of cotton for each eye)

Conjunctivitis usually isn’t serious and often gets better within a couple of weeks without treatment. See your doctor if your child’s conjunctivitis doesn’t clear up within that time or if your baby’s eyes are red 9. See your GP urgently if your baby has red eyes and is less than 28 days old, or your child complains of sensitivity to light, changes in their vision, or has an intense redness in one or both eyes 9.

 

*Nurofen for Children Orange/Strawberry: Singles / Cold, Pain and Fever 100g/5ml Oral suspension / Baby Oral suspension /3
months to 9 years 100mg/5ml Oral suspension / 3 months to 12 years Oral suspension. Contains ibuprofen, for children over 3 months (weighing more than 5kg) to 12 years. For pain relief. Nurofen for children 100 mg, chewable capsules, soft. For fever and pain relief in children aged 7 to 12 years. Contains Ibuprofen. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. All information presented on these web pages is not meant to diagnose or prescribe. For further advice please speak to your doctor or pharmacist

1. NHS (Bromley Clinical Commissioning Group). Common childhood illnesses. Available at:
https://www.bromleyccg.nhs.uk/Downloads/Your%20health/Childrens%20health/General%20Guide%20on%20Common%20Childhood%20Illnesses%200-5/common%20childhood%20illnesses%20guide%20for%20parents%20and%20carers%20of%20children%200-5%20years.pdf.
2. NHS-UK. Asthma. nhs.uk Available at: https://www.nhs.uk/conditions/asthma/. (Accessed: 5th September 2018)
3. Common childhood illnesses: A guide to NHS services. NHS Sunderland Clinical Commissioning Group Available at:
http://sunderlandccg.nhs.uk/wp-content/uploads/2016/01/Sunderland-CCG-Common-Childhood-Illnesses-web-version.pdf.
4. NHS-UK. Bronchiolitis. nhs.uk Available at: https://www.nhs.uk/conditions/bronchiolitis/.
(Accessed: 22nd October 2018)
5. NHSInform. Gastroenteritis. Available at:
https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastroenteritis. (Accessed: 22nd October 2018)
6. NHS Direct Wales. NHS Direct Wales - Encyclopaedia : Gastroenteritis in children. Available at:
https://www.nhsdirect.wales.nhs.uk/Encyclopaedia/g/article/gastroenteritisinchildren/.
(Accessed: 4th December 2018)
7. NHS-UK. Ear infections. nhs.uk Available at: https://www.nhs.uk/conditions/ear-infections/.
(Accessed: 9th October 2018)
8. NHS-UK. Chickenpox. nhs.uk Available at: https://www.nhs.uk/conditions/chickenpox/.
(Accessed: 22nd October 2018)
9. NHS-UK. Conjunctivitis. nhs.uk Available at: https://www.nhs.uk/conditions/conjunctivitis/.
(Accessed: 4th December 2018)