Fever in children: know what to do and when to take them to the emergency room

A common symptom in children, fever accounts for about 20% to 30% of complaints in pediatricians' offices, according to the Brazilian Society of Pediatrics (SBP). Although it's not a disease, it's a sign that something is wrong. But when should parents be concerned and seek medical attention?

A rise in temperature is the body's natural response to fight off aggressors, such as viruses or bacteria. Fever is often accompanied by other symptoms, such as cold extremities, a feeling of chills, and rapid heartbeat or breathing. It also frightens parents and caregivers due to the fear of serious illnesses or seizures—a fear known among doctors as "feverphobia."

It's important to know that body temperature naturally varies throughout the day, based on the circadian rhythm itself, reaching its highest values in the late afternoon. In adults, the variation can reach 0.5°C, and in infants, up to 1°C.

In Brazil, the Brazilian Society of Pediatrics (SBP) until recently considered fever to be a temperature above 37.8°C. However, in the document "Aproach to Acute Fever in Pediatrics and Reflections on Fever in Arboviruses ," published in May, the organization began recognizing this mark as 37.5°C when measured in the armpit. "It's a reference for defining fever in clinical studies, not for prescribing medications," notes pediatrician Tadeu Fernando Fernandes, president of the SBP's Department of Outpatient Pediatrics and one of the document's authors.

The measure is in line with international practice, as organizations like the American Academy of Pediatrics also adopt 37.5°C as a reference. "This value avoids a false sense of security and is in line with the parameters of other countries," says pediatrician Claudio Schvartsman of Einstein Hospital Israelita.

Fever: what now?

When the temperature rises, it's essential to maintain good hydration and closely monitor the child's progress and other associated symptoms. Fever should be assessed within the context of the overall clinical picture, as this, not the temperature itself, indicates the severity of the illness. There's no "magic number" at which medication should be started. "What matters is the child's overall condition," Fernandes emphasizes.

If your child's temperature is 37.5°C, observe how they are doing: if they are lively, playing and eating, medication may not be necessary; however, if they are crying, irritable, have reduced appetite or stop urinating, this is a warning sign and requires medical evaluation.

Many also associate the thermometer's reading with the risk of seizures. However, seizures generally occur in children predisposed to these conditions—which can occur even with a low-grade fever.

In Brazil, the most commonly used antipyretics are paracetamol, dipyrone, and ibuprofen. However, they should always be taken according to the dosages and intervals recommended by the doctor, according to weight and age. And, although common practice, alternating or combining different types of medication is not recommended due to the risk of overdose and indiscriminate use.

Seeking emergency care depends on other factors. "A low-grade fever alone isn't a reason to go to the hospital," says Schvartsman. According to the Einstein pediatrician, it's important to assess the child's discomfort—a very high fever, symptoms such as shortness of breath or listlessness, failure to respond to medication, and inability to eat or drink are signs that more expeditious care may be needed.

Source: Einstein Agency

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