How dangerous is the febrile condition?

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

In order to be certain about this, the 2011 professional protocol of the Ministry of National Resources provides excellent assistance (123). So do the NHS standards (165).

 

When is it dangerous?

  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. In infants 0-6 months of age, fever is not dangerous in itself, however, it should be known that the severity of the underlying disease is proportional to the height of the fever. Therefore, in case of body heat exceeding 38 degrees with babies up to 3 months of age, and in case of body heat above 38.5 degrees in 3-6 month olds, consult a doctor!
  4. Where the person is unable to perform enhanced cardiac work due to severe heart disease. This is not the case in healthy people.
  5. 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

The child can be treated at home for 3 days. 

Status should be reassessed again if its condition gets worse, otherwise after 24 hours.

Medium risk

The child should be carefully observed and cared for at home.

Status should be reassessed again if its condition gets worse, otherwise after 6-12 hours. Possibly the child should be presented to the doctor.

High risk

The condition is severe.

Please get medical assistance immediately!

 

 

Skin colour

   normal skin, lip and tongue colour

   light paleness

  • strong paleness

  • non-blanching 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

  • dyscomfort

  • decreased activity

  • drowsines

  • no reaction to social stimuli

  • looking severely ill

  • cannot be awakened or remain just short awake

  • faint/weak, headachy/high-pitched cry that's not like normal cry or continuous crying

Breathing

normal breathing

  • Tachypnoe

  • 6-12 month 50-60/min.  

  • 1-6 years 40-50/min. 

  • 6-12 years 30-40/Min.

  • over 12 years 20-30/min.

  • rales, light dyspnoe                           

  • grunting

  • nasal breathing

  • moderate to severe dyspnoea

  • tachypnoe more than at medium risk

Fluid balance

Hydration

  • normal  skin firmness and eyes

  • wet mucousa (mouth, eye)

  • decreased appetite, fluid intake
  • no urin since more than 6 hours
  • decreased skin firmness and eyes

  • dry mucousa (mouth, eye)

  • no urin since more than 12 hours

Other

 

  • fever ≥ 5 days

  • swelling of the extremities or joints or any tissue over 2 cm

  • sparing the limbs, local pain

  • 0-3 months of age fever ≥ 38°C

  • 3-6 months of age fever ≥ 39°C

  • non-blanching rash under pressure

  • bulging fontanelle

  • stiff neck

  • status epilepticus, focal neurological singns, focal cramp

  • bile vomiting, bloody stool

 

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 mark in the FeverFriendTM application if the child’s state gets worse, and repeat the status assessment in 24 hours.

 

In the case of medium risk:

The child’s condition requires careful parental monitoring and care, but these are sufficient. There is no indication to reduce fever. 

Complete the status assessment in the FeverFriendTM application again in 12 hours at the latest. If the patient's condition worsens over the next 6 to 12 hours, see your doctor. If the patient's condition does not improve after three days of the illness, see your doctor. If condition is stable, you can care for the child for three days at home.

 

In the case of high risk or alarming symptoms:

Please get medical assistance immediately!

 

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

  • How long has the child been feverish?
  • When was the fever high and how high was it?
  • Has the child gotten antypyretics?
  • Pulse rate, breath rate after 10 minutes of rest?
  • How despondent was the child, and to what extent does the child give the impression of a seriously ill patient?
  • What is his state of consciousness?
  • Does the child have a rash?
  • When and how much has the child drunk?
  • 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 there any infectious patient in the child's surrounding? What disease does the person have?
  • Is the child currently taking medication?
  • Has the child been vaccinated in the last three weeks? If so, against what?
  • Has the child travelled to an exotic country recently?
  • Is the child allergic to something?

 

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

Version update: 03 October 2020