Accompanying symptoms of fever

Febrile infectious diseases can be accompanied by various symptoms.

The most common ones are summarized here.

It can often be observed, that children respond to colds and infections in their unique, individual ways.

In many cases, elevated temperature is not the first and only symptom. Symptoms can be with or without fever:

  • fussiness
  • apathy, fatigue, drowsiness
  • cuddly (need for proximity)
  • loss of appetite
  • shiny eyes
  • vigilance, lethargy 

These symptoms typically change during different stages of the fever.

 

During the first phase of the fever at the ascent:

  • paleness, cold limbs,
  • shivering, trembling, muscle trembling

 

During the second phase of the fever peak:

  • flushing, hot limbs

 

In the third phase of the fever at the beginning of the decrease:

  • sweating, wet palms and soles
  • thirst

 

During the fourth stage of fever, when body heat returns to normal:

  • increasing activity
  • returning appetite

 

Heart rate changes in optimal fever

In the case of fever, the heart rate increases naturally. Seek immediate medical care if the values are below or above the rates for more than 10 minutes in rest.

 

Normal range of heart rate for children at rest without fever:

Age

Heart rate

New-born

70 - 190 / min

1 - 11 months

80 - 160 / min

1 - 2 years

80 - 150 / min

3 - 4 years

80 - 140 / min

5 - 6 years

75 - 120 / min

7 - 9 years

70 - 110 / min

Above 10 years

60 - 100 / min

These rates might rise 5-25% in case of fever. In this case use the application.

 

Respiratory rate

Seek immediate medical care if:

  • the breathing rate is below or above the range in rest over more than 10 minutes,
  • wheezing, whistling, forced breathing and bluish lips and skin at any age.

In case of fever, breathing will increase with the heart rate.

 

Normal range of breathing rate for a non-feverish child at rest:

Age

Respiratory rate

0 - 1 year

30 - 50 / min

1 - 3 years

24 - 40 / min

3 - 6 years

22 - 34 / min

6 - 12 years

18 - 30 / min

Above 12 years

12 - 16 / min

These rates might rise 5-25% in case of fever. In this case use the application.

 

 

Pain

Head and limb pains typically occur with influenza.

A pain scale can be used to assess its severity.

Frequent and harmless diffuse general pain throughout the body. Muscles and joints are affected.

Limb pain deserves special attention if it is associated with localized (small site), worsening and possibly localized swelling. In this case, seek medical advice.

When fever elevates, headache itself is common.

If it’s accompanied by stiff neck, it may be a sign of meningitis. This can be examined by raising the head of the child lying on his back the child’s knees will also flex (Brudzinski’s sign).

 

Vomiting and diarrhea

If vomiting and/or diarrhea occurs with fever, it can be a sign of common gastrointestinal infection, sunstroke, appendicitis, or a rare meningitis.

Seek medical attention if with diarrhea lasting for more than 12 hours continuously or bloody stool and/or

  • vomiting for more than five hours, the vomit is frequent biliary yellow and/or
  • with severe stomach ache and/or a state of drowsiness.

Otherwise, rest and swallow liquid by single gulps at intervals.

 

Loss of appetite

Physiological loss of appetite is normal in a febrile state.

Nutrition should be a low-calorie, higher-carbohydrate diet by bites, as much as the child requires. Preferably in the morning when the fever is lower. Children regain the lost kilograms quickly after the fever has passed and gain even more strength.

 

Fluid loss and drinking

In rare cases, infants and young children may develop dehydration during a febrile illness.

The following things can play a role in it:

  • sweating
  • vomiting, diarrhoea
  • little drinking.

If they occur at the same time, small children can dehydrate quickly.

 

Signs of dehydration:

  • Decreased urine volume. If a child does not pee for more than 12 hours, consult a physician.
  • The turgor and firmness of the skin is reduced. A sign of this is that when the skin is lifted into the fold of the abdomen, it disappears much more slowly than normal. If the fold does not disappear, consult a doctor.
  • When crying, the tearing decreases or stops. If no tears appear at all when crying, consult a doctor.
  • Arched, deep-set eyes?
  • The moistness, mucus of the tongue is reduced.
  • In infants (up to 1.5 years of age), the large fontanelle is sunken. See the picture.
  • Lethargy, intoxicated state of mind, in severe cases the child cannot be awakened or only briefly. In this case consult a doctor.

Here you should consult a doctor for the signs for which we indicate below.

Otherwise, replace fluids as described below.

 

Important questions:

  • How much did he/she drink? If either in one go or by sips the child drank the normal amount or slightly less in total, then continue to give more drinks. If the child has not taken any sips for more than 12 hours, consult a doctor.
  • Did the child have diarrhoea? Seek medical attention in the case of more than 12 hours of continuous or bloody stool.
  • Was the child vomiting? Seek medical attention if bile is frequent for more than five hours.

 

Forms of rehydration:

  • Breastfeeding is best for breastfed babies. If the child pukes or vomits, you can try a small amount again after a short break.
  • Make the child drink by taking sips. All liquids except cow's milk are suitable (but preferably not sugary and carbonated).

 

Rash

Rashes may occur before, during or after fever.

Often before fever, it is a sign of infection at the end of the incubation period.

During fever it is often a sign of viral or childhood diseases. See our other page for a description of these.

Rashes that occur after the fever has subsided are usually signs of a harmless viral infection, no action needs to be taken, no need to see a doctor.

These harmless rashes should be distinguished from dangerous bleeding rashes (petechiae) that require immediate medical attention.

Fortunately, the latter is very rare and easily distinguishable from harmless rash.

The glass test is suitable for this. Use a pair of glasses or a plain glass. When applied to the skin, if the bleeding does not disappear it is bleeding rashes. If it's gone, it's harmless.

A red rash on the right (see the picture) is bleeding rash and it's dangerous. The one on the left is not dangerous because it can be suppressed.

However, glass test should be repeated for every rash after 4-6 hours to see if it remains suppressed.

 

Refer to the literature by numbers in this document here: References

Version update: 10th July 2020