Is your child’s fever pain scary?

Most patients feel anxious when they have a child with pain plus a high temperature. It is a common occurrence and thankfully it is mostly benign.

But when the two occur together it is important not to be complacent as they may indicate a serious illness.

Doctors rely on a history from the parent to determine the source of an infant’s pain.

How your child feels and describes the pain may be muddled and confused. They may lack effective communication skills and have difficulty explaining where exactly their pain is located.

Pointing to where they ‘feel hurt’ can be relatively straightforward for an infant when the pain is on the body surface. But when they refer to ‘a pain in the tummy’ it may actually reflect pain anywhere on the inside of their body.

This can make assessment of pain complex and tricky.

Pain is usually assessed in infants by looking carefully at facial expressions, body movements and vocalisations. The doctor will also make certain physiological measures.

Fever is usually benign and is a sign that the body is fighting off an infection. Treatment is not usually required for mild fever and simple measures to ensure the patient remains hydrated and their body temperature does not rise too much are recommended. Fever in children is usually caused by viral infection and most mild infections run their course in 3-4 days.

Seizures caused by persistent fever are in most cases harmless. If the parent feels less anxious and calm, this will also reduce infant anxiety and improve outcomes.

Treatment of pain associated with fever symptoms in infants is limited by the contraindication of many adult medicines.

Parents should seek the advice of a health professional or pharmacist before they medicines they buy in the pharmacy, as they are potent drugs and may exhibit adverse effects in younger children.

The dose of medication given will depend on the size of the child and severity of the condition. Parents should also be advised to stick to the dose recommended by their health professional and seek further advice if necessary, as children at different ages metabolise drugs at different rates and adult doses of drug will be toxic to them.

Simple analgesics such as ibuprofen and acetaminophen are effective palliative agents and will alleviate headaches or for example the pain associated with a sore throat.

The NSAIDS, ibuprofen and acetaminophen, are the usual medicines given to children with fever and pain.

Ibuprofen is a more effective pain reliever and it also reduces symptoms of inflammation associated with infection. Ibuprofen is given every 6-8 hour and acetaminophen given every 4-6 hour, so the former is also more convenient at night.

Aspirin is not recommended in infants because of the risk of Reyes Syndrome, a potentially life-threatening illness. Children who have been given aspirin and may have Reye’s will be vomiting, lethargic and be more cranky and vocal than is normal in a sick child.

Fever that occurs with pain may be indicative of a medical emergency and it is important to be vigilant for the cases that will require prompt treatment with antibiotics or other management strategies.

Serious underlying conditions that may have fever and pain together as presenting symptoms include:

  • Meningitis: symptoms can include fever, severe headaches, pain or stiff neck, characteristic rash, lethargy, photophobia.
  • Pneumonia: symptoms can include rapid breathing, fever, abdominal pain, vomiting.
  • Appendicitis or abdominal obstruction: symptoms can include fever, severe abdominal pain, vomiting bile.
  • UTI: symptoms can include fever, pain on urination, increased urgency, abdominal pain (can be severe)
  • Strep throat: symptoms can include fever, sore throat, sudden onset of headache or stomach pain, enlarged tonsils and swollen glands.
  • Severe otitis media: symptoms can include fever, headaches, earache.

Conor Caffrey is a medical and scientific writer.


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