How dangerous is the febrile condition?

Fortunately, it is usually much less dangerous than most people connote. In order to be certain about this, the 2011 professional protocol of the Ministry of National Resources provides excellent assistance (123). So the NHS standard (165).

Based on this, we have developed the smart phone application called FeverFriendTM.

Download the App and give it a try!

The app will give you accurate judgment and advice on what you can do for your feverish child.

Elevated body temperature (fever) itself is very rarely dangerous.

 

When is it?

  1. When the thermostatic centre of the brain itself is damaged. For example, oxygen deficiency or recent traumatic brain injury (133),
  2. For foetuses in the last trimester (134) and for new-borns (17).
  3. Where the person is unable to perform enhanced cardiac work due to severe heart disease. This is not the case in healthy people.
  4. Very rare hereditary cardiac conduction abnormalities (an ion-channel defect: Brugada syndrome), in which cardiac arrhythmias may occur (121, 122).

 

It must be clearly distinguished from when the fever itself is under optimal control, but the underlying cause (the disease itself) is risky.

The following table can be used to assess this (123):

 

 

Low risk

Medium risk

High risk

Skin colour

   normal skin, lip and tongue colour

   paleness according to parent

  • paleness
  • not fading spots
  • blotchy, blue or grey skin
  • cyanosis

Activity

  • normal reaction to social stimuli
  • smile
  • alert or can be easily awakened
  • strong, normal crying or no crying
  • abnormal reaction to social stimuli
  • decreased activity
  • drowsiness
  • no reaction to social stimuli
  • looking severely ill
  • cannot be awakened or remain awake after waking
  • faint/weak, headachy/high-pitched cry that's not like normal cry or continuous crying

Breathing

-

  • nasal breathing
  • tachypnoe:

                ≥ 50/min btw. 3-6 months​

                 ≥ 40/min > 12 months

  • oxygen saturation < 95%
  • rales                           
  • grunting
  • tachypnoe: ≥ 60/min at any age
  • moderate to severe dyspnoea
Hydration
  • normal skin firmness and eyes
  • wet mucousa (mouth, eye)
  • dry mucousa (mouth, eye)
  • CRT more than 3 sec
  • decreased urine
  • decreased appetite, fluid intake
  • decreased skin firmness

Other

 

  • fever ≥ 5 days
  • swelling of the extremities or joints
  • sparing the limbs
  • newly developed swelling greater than 2 cm
  • 0-3 months of age fever ≥ 38°C
  • 3-6 months of age fever ≥ 39°C
  • non-fading rash under pressure
  • bulging fontanelle
  • stiff neck
  • status epilepticus
  • focal neurological signs
  • focal cramps
  • bile vomiting

 

What to do?

In the case of low risk:

Everything is fine. No medical examination or intervention is needed in this condition. Home care and observation for the next three days is sufficient. There is no indication for reducing fever. Please repeat the status assessment in 24 hours.

 

In the case of medium risk:

Careful parental monitoring and care are sufficient. There is no indication to reduce fever. Repeat the status assessment after 6 hours, but no later than 12 hours. If the child remains stable, you can take care of the child at home for three days. You can find out what to do in our other articles in this app. If your child's condition worsens over the next six to 12 hours, see your doctor. If your child's condition does not improve after three days from the start of the event, seek medical assistance.

 

In the case of high risk:

get medical asssistance immediately!

 

High risk status summarized:

Skin rash and skin colour: skin haemorrhage (non-fading rash *), cyanosis (purplish colour).

Activity, state of consciousness: unarousable (cannot be woken), cramping, crying, stiff neck.

Respiratory rate: >50-60/min below 12 months, >40/min above 12 months; shortness of breath.

Heart rate: >160 bpm below 12 months, >150 bpm between 12-24 months of age; >140 rpm for two- to five year olds.

Hydration: dry mouth, decreased skin firmness, fallen eyes and sunken fontanelle.

Other: unusual symptoms, localized swelling, pain.

If fever: ≥41.5°C (toxic, septic) at any age; in children between three to six months ≥39°C; below three months ≥38°C; if it lasts longer than three days.

* Glass test: Gently press a glass on the skin. If the skin does not fade when viewed through the glass, it is most likely a bleeding rash.

If you need to see a doctor, be prepared for these questions:

  • How long has the child been feverish?
  • When was the fever high?
  • How despondent was the child, and to what extent does the child give the impression of a seriously ill patient?
  • Has the child been vaccinated in the last three weeks? If so, against what?
  • Does the child have a rash?
  • Has the child vomited?
  • Does the child have diarrhoea?
  • Pain?
  • Other symptoms (cough, cold…)?
  • Does your child have an underlying disease, has he/she had any surgery?
  • Is the child currently taking medication?
  • Is the child allergic to something?
  • Is there any infectious patient in the child's surrounding? What disease does the person have?

 

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

Version update: 21th March 2020