One of the most important questions that parents should ask their doctor is, “If my child has a fever, when should I bring her to see you?”
Most fevers are caused by harmless viruses and hundreds of studies published over the last 25 years has shown that there are at least three answers to that simple question.
1) If the child is under six months of age, she must see a doctor immediately. This is because small babies, unless they are being nursed exclusively, do not have much protection against infections and even minor infections can generalise quickly and become life-threatening. Even a breastfeeding baby should be seen quickly, although they do tend to catch infections much less and these infections become life-threatening even less. This is because of the hundreds of antibacterial and antiviral factors found in every mother’s milk. The immunity against every disease that the mother has ever been exposed to is passed on to her child in her milk.
2) If the child has any of the “DANGER SIGNS” (see below), then the child must see the doctor immediately. The most important of those signs is the first: “if you think the child is ill”. No paediatrician should ever be upset if a child is brought by an anxious parent and turns out not to have a serious illness. You know your child better than anyone else and it is your right to seek medical care whenever you think your child is ill. If you are not sure ask a friend or family member. I can think of many cases where a very sick child was fortunately brought in at the urging of grandparents.
3) The most common situation is that of the febrile child over the age of six months who does not have any of the danger signs. These children do not appear very ill. Their behaviour is much more important than the presence of fever. Their appetite may not be as good. They may whine and cling to you more than is customary and they may sleep more than they generally do. In general their behaviour is quite good. In between the crankiness and general misery, they play and smile as usual. These children do not need to see a doctor right away. They undoubtedly have a viral infection, which is self-limiting.
They should be kept at home and rested, to enable their bodies to organise its defences and fight off the viral invasion. There is no medication in regular use that a doctor can give you that will help a child with a viral infection. The statement, “Your child has a virus. This antibiotic will help her,” only serves notice that the doctor in question is in need of an update. What these children really need is close observation at home by the parents or someone trusted e.g. a granny or aunt or a close friend of the family, for any of the “Danger Signs” and an immediate visit to the doctor if that happens.
Finally, if the fever persists for longer than three days (72 hours), the child should be taken to her doctor. Most viral infections last three days so if the child still has fever on the fourth day, it is wise to have the child checked. It will probably turn out to be something minor or an atypical presentation of a bacterial problem.
Have you lost anything by not seeing the doctor before? No. Most of the time doctors cannot diagnose atypical diseases on the first day or two of the illness and provided the child is behaving well and is reasonably comfortable, no harm will have been done.
TEN DANGER SIGNS IN CHILDREN
(see the doctor immediately)
1. You think your child is ill.
2. The child is unusually quiet or listless or drowsy.
3. The child is unusually hot or cold or floppy (“weak”).
4. The child is having difficulty breathing or is breathing rapidly or is making a “funny” or unusual noise when breathing.
5. A child who turns blue or very pale.
6. A baby who cannot breathe freely through its nose.
7. A baby or young child who cries for an unusually long time or in an unusual way.
8. A baby who keeps refusing to drink.
9. Frequent vomiting or diarrhoea. (More than once an hour for three hours).
10. A child in pain.
