DEAR DOCTOR,

My toddler sometimes gets a fever when she gets a cold. I have been told to stock up on paracetamol syrup to help with the fever. Is this advisable? 

NINA

DEAR NINA, 

How old is your toddler? The temperature regulating system of the body in small babies is immature and sets slowly as a baby grows up. Hence, even in presence of a serious infection, temperature may be only slightly elevated. Most frequent cause of fever in a toddler is upper respiratory tract infections like common cold, flu, ear infections. Here, the fever may be associated with running of the nose, blocked nose, throat pain, ear pain, and et cetera, one or more of these symptoms. Tonsillitis, kidney or urinary tract infections, common childhood illnesses like chicken pox and whooping cough are other common causes of fever in a toddler. A child may develop parasitic infection like malaria as in adults if exposed to mosquito bites and develop a fever. Most of these infections, if viral in nature, subside spontaneously, without any active treatment within a week or 10 days.  However, bacterial infections need antibiotic for cure. Cause for fever can be determined by clinical features and basic investigations like full blood count, urine analysis, and peripheral smear for malaria.

Generally, a fever per se is not dangerous and may not need active treatment. But if it is very high, if the toddler becomes listless due to fever, if he develops convulsions or loss of consciousness due to high fever, treatment is necessary to bring it down. High fever by itself can give rise to dehydration. Moreover, if fever is associated with diarrhoea, nausea, vomiting, one or more of these symptoms, dehydration is further aggravated.  

Lukewarm baths, drinking more fluids, are some measures which help fever to reduce naturally, without any active treatment. The toddler should also be made to wear comfortable lose clothes. Wrapping him in excess warm clothes, blankets, should be avoided. These measures tend to trap the heat of the body, thus preventing its return to normal temperature. Tepid sponging can be done. This involves removing clothes, keeping compresses or towels, soaked in room temperature water over the forehead, nape of neck, underarms and even groins. However, this is useful for initial few minutes to bring down the high temperature. It may rebound, if underlying cause of fever is not treated.

Drugs like paracetamol and ibuprofen are best avoided in toddlers. The toddler’s liver and kidney are immature to handle and detoxify these drugs. Hence, toxic levels can build even in low doses, causing damage to the liver and kidneys. If at all necessary to give, as in a toddler with distress symptoms due to fever, give strictly in dose appropriate for his age and do not give further, if fever settles down.

Dr. Rachna Pande is a specialist internal medicine