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Your 3 year-old girl developed a fever in the middle of the night. She kept you and your spouse awake all night. The next morning she still feels warm and is clingy. You are worried that she is not eating and is not her usual self. You contact your GP to make an appointment for her to be seen. On the phone the practice nurse asks you a series of questions.  You get upset because you want your girl to be seen by a doctor straight away. You wonder why the nurse is wasting time and not getting an urgent appointment with the GP.

What happens in a GP office when a child has fever?

In the Netherlands, the practice nurse at your GP office is the first professional you will speak to with regards to your child with fever. Her or his task is to ask a series of questions to determine one main goal: How serious is the problem?. The reason behind this process is because fever is very common in children aged between 0 and 4 years old. So much so that in the first 2 years of a child’s life, they will be sick with fever an average of 8 times. In order to avoid seeing every child with a fever which typically is caused by a virus with a naturally innocent prognosis, it is therefore important to determine any alarm symptoms. Doing so prevents potential complications to occur and allocates the doctor at the right time to treat the fever in the child. This is a system practice nurses use to inform the GP how serious the situation is and when the child should be seen.

12 signs your child’s fever is serious

During the conversation with the practice nurse, the questions asked are done so to determine the presence of alarm symptoms. There are 12 of them and these are listed below to help determine when a child with fever should be seen urgently (within 15 minutes).

  • Less than 1 month old ; babies do not yet have an immune system developed enough to help them fight off infection even if a mild one. 
  • Looks very ill
  • Behaviour is not usual 
  • Drowsy appearance
  • Cries inconsolably 
  • Takes less fluids or has very few to no wet nappies
  • Vomits several times an hour 
  • A rash that does not blanch when pressed upon
  • Changes in skin color (pale, red, grey, blue lips)
  • Shortness of breath and/or fast breathing with or without drooling 
  • Convulsions

If your child has more than 2 alarm symptoms then a GP will need to see the child within 30 minutes.This can be at home or at the practice and depends on convenience.  Should your child not have any of these alarm symptoms but is aged between 0 and 3 months then the doctor will see the child within a few hours. 

Typically a GP will see your child within 24 hours if there are no alarm symptoms however, the following situation are present

  • You are a worried parent who has contacted the GP practice due to the same complaint in the past 24 hours
  • Uncertainty about the answers given 
  • Complicated communication due to language barrier 
  • New onset of fever after a few days without fever 

What is fever and why does it occur?

You are given an appointment to come with your girl to the practice. In the waiting room, while your girl is finally asleep in your lap, you see a brochure about fever in children and read the insert: 

“ Fever is when the body temperature rises above 38 degrees Celsius. It occurs as a response to an infection caused by a virus or bacteria. During this process, cells release certain enzymes called cytokines that activate the temperature regulatory organ in the brain called the hypothalamus. The response is to increase the body’s temperature in order to release more enzymes that fight off the infection. However when the temperature rises above 42 degrees Celsius, the body is not able to get rid of the excess heat and this can cause damage to vital cells in the body. This process can lead to (severe) complications…”

13 signs your GP will look for in a child with fever

You are called through into the GP’s office. You repeat the story you told the practice nurse and you highlight what a rough night you all had and do not anticipate going through it again. Your GP decides to examine your child and looks out for the following signs:

  • Is the child alert or drowsy?
  • Does the child seem over sensitive?
  • When the child cries can the parent calm her down?
  • Is the temperature measured done rectally (this must always be done in children less than 3 months old)
  • Does the child have cold shivers?
  • What is the colour or appearance of the skin?
  • Can the child move their neck freely, or does she lie still on the bed?
  • Are there any visible signs of difficulty in breathing?
  • How fast is the heart rate?
  • Does the abdomen feel soft or hard?
  • Are there any swollen joints?
  • What do the ears look like from the inside?
  • Are there any swollen lymph glands in the neck or throat?

4 things to do at home when your child has fever

In many cases if there are no obvious abnormalities during physical examination, a urine test can be useful to rule out bladder infection in a child with fever without a ‘focus’. A focus is a source of where the fever originates from. In most children aged 0 to 4 this is from the ears, nose and throat region. If there are no serious complications expected,  your GP will be able to send you and your child home with advice on what to do.

  • It is important to realise that a child with fever will generally not have an appetite. So it is better to take time to get the child to drink fluids than to eat. 
  • Typically, a child will have fever for 4-6 days, sometimes even 10 days without any complications. Should the child experience pain then the GP will advise paracetamol and/or ibuprofen (dosage based on weight and age) to manage the pain in  your child. 
  • Antibiotics will not be needed if there is no evidence of a bacterial infection. 
  • There is no need to measure temperature frequently during the day. You can observe the child’s behaviour and monitor any changes which will be more informative for the GP. 

A child with fever is one of the most common reasons why you as a parent will contact your GP. The most important take home message is that in the vast majority of casse, if there are no alarm symptoms, the fever will resolve after 4-7 days. The guidelines are used to help determine which child needs urgent care and which can wait 24 hours for further examination. Always observe and monitor your child’s appearance or behaviour and communicate any concerns with your GP.