When the body temperature is above 38°C (100.4°F), the person has a fever. Fevers are a common and normal response to fight infection and in most circumstances, are not harmful (El Radhi, 2012). While they can affect people of all ages, they are more common in children. Fever has the potential to cause a Seizure in children because their bodies cannot yet regulate their temperature. First aid providers should consider the possible causes of a high temperature (e.g., infection or disease) and help the person access medical care if necessary.
Guidelines
- . Paracetamol may be given to the person with a fever who is feeling really unwell. *
Good practice points
- Sponging the person with fever using lukewarm water may help to decrease the temperature faster, as long as it does not upset the person or make them feel cold and start to shiver. Cold water should not be used. It can cause the blood vessels to constrict and prevent the body from giving off heat or cause the person to start shivering and inappropriately to produce more heat.
- People with fever should rest and drink fluids to replace the fluid loss caused by sweating.
- People with fever should dress lightly and the first aid provider should avoid layering them with excessive blankets or coverings.
- Access emergency medical care if a person with a fever also has any of the following signs and symptoms:
> a rash
> a change in mental status
> difficulty breathing
> severe abdominal pain
> sensitivity to light and vomiting
> signs of Shock. - A baby, child or adult should receive medical care as soon as possible if:
> the baby with a fever is under three months of age
> the child has a temperature higher than 39° C (102.5° F)
> the person with fever is over 65 years of age
> the person with fever has cancer, a weakened immune system, sickle cell disease, or is taking medications which affect their immune system
> the fever does not decrease with paracetamol or lasts more than three days
> additional symptoms occur that worry you. - Depending on the local context (e.g., areas where malaria is present), people with fever should seek medical care, even if they have no other symptoms.
- A high fever may cause a child to experience a seizure. While the seizure could be an indication of a more serious infection, such as meningitis, it is often the result of an increase in temperature only. See Seizure.
Chain of survival behaviours
Prevent and prepare
- Know the causes of fever in children and take any available precautions, such as vaccinations or medication against particular illnesses in areas where there is a risk.
Early recognition
If possible, check the person’s temperature. A fever above 39°C (102.5°F) can be harmful and may indicate a serious infection or disease. Consider this as you assess the person.
In the early stages of fever, the person may have a high temperature but tell you they feel cold, or they may be shivering or have chattering teeth or goose pimples.
The person may experience:
- a high temperature above 38°C (100.4°F)
- hot, flushed skin and sweating
- headache or other aches and pains
- loss of appetite
- fatigue.
First aid steps
- Advise the person to rest and dress lightly.
- Offer the person fluids to drink to replace lost fluids from sweating.
- In many cases, medication is not necessary. If the person is feeling unwell, you can control their fever by giving them the recommended dose of paracetamol (or acetaminophen). You can also sponge the person with lukewarm water, as long as this does not upset them.
- Monitor the person’s condition and be aware of any additional signs and symptoms that occur.
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CAUTION
- Do not overheat the person with layers of clothing or blankets.
- Do not use cold water to sponge the person as this may cause them discomfort and may stop their body from releasing some heat.
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Access help
Sometimes a fever can indicate a more serious condition. Access emergency medical services immediately if the person has a fever combined with any of the following:
- a rash
- a change in mental status
- difficulty breathing
- severe abdominal pain
- sensitivity to light and vomiting
- signs of Shock.
Access medical care if:
- a baby with a fever is under three months of age
- a child has a temperature higher than 39° C (102.5° F)
- the person with fever is over 65 years of age
- the person with fever has cancer, a weakened immune system, sickle cell disease, or is taking medications which affect their immune system
- the fever does not decrease with paracetamol or lasts more than three days
- additional symptoms occur that worry you.
Education considerations
Context considerations
- The use of paracetamol or acetaminophen for a fever depends on local laws, regulations and processes, including liability protection. Depending on the national context, educators may need to adapt their programme accordingly.
- Many endemic illnesses cause fever (e.g. malaria). Consider the endemic illnesses in your country or region and draw on these to help learners understand how fever works and how best to deal with it.
- If a person has a small fever without any discomfort, it may not be necessary to give them paracetamol.
Facilitation tips
- Misconceptions and unfounded fears about fever exist among people who care for children. In some cases, this fear can lead to aggressive and dangerous practices, including overdosing with antipyretics and sponge bathing with alcohol (Clark, 2014). Take time to explore and dispel myths and misconceptions with learners.
- Since fever can indicate a more serious illness or trigger a Seizure, it is important for learners to understand their role in looking out for signs that indicate the need to access medical care.
- Include education that addresses managing a person’s fever, even if they say they feel cold. Ask learners to reflect on their experience with having a fever and feeling chilled at the same time – how did their body react? For example, were they sweating and shivering at the same time? What did they need to feel better? Caution that while the goal is to bring the person’s temperature back down, this needs to happen gradually. Highlight the importance of monitoring the person’s temperature to ensure they do not become too cold (e.g., by removing too many layers or sponging with cold water).
- Discuss clothing in the context of your country and climate – what clothing or layers will make the person most comfortable and not cause them to overheat or feel cold?
- Consider which fluids will best keep the person hydrated and cool (e.g., a baby should have their breast or bottle milk while an adult will benefit more from cool water).
Facilitation tools
- Set out containers with different temperatures of water. Have learners test the different samples and see if they can determine what lukewarm water feels like. If you are short on time, provide a sample of lukewarm water and allow learners to familiarise themselves with the water’s temperature.
Learning connections
- Fever in children is often caused by an infection or disease. Explore connections to topics such as Earache, meningitis, or any endemic diseases that result in fever.
- Fever in young children can result in a Seizure as their bodies are not yet able to regulate temperature properly.
Scientific foundation
In 2020, the Centre for Evidence-Based Practice (CEBaP) conducted two evidence summaries for this topic.
Systematic reviews
Paracetamol versus placebo
There is limited evidence from one Cochrane systematic review in favour of paracetamol compared to placebo for treating fever in children. The review showed that paracetamol resulted in a statistically significant increase in fever relief at the second hour, compared to placebo or physical interventions (such as tepid cooling). However, this relief could not be demonstrated in the first hour. A statistically significant difference in adverse events, using paracetamol compared to placebo or physical methods, could not be demonstrated. Evidence is of low certainty and results cannot be considered precise due to the low number of events and large variability of results.
Physical methods versus placebo
There is limited evidence from two experimental studies, extracted from one Cochrane systematic review, neither in favour of sponging, nor placebo. The first study, using tepid water sponging compared to placebo, could not demonstrate a statistically significant increase in resolution of fever within one hour. The second study showed that tepid water sponging resulted in a statistically significant increase in resolution of fever within two hours, compared to placebo. Evidence is of low certainty and results of these studies are imprecise due to limited sample size and large variability of results.
Physical methods combined with antipyretics versus antipyretics
There is limited evidence from one systematic review in favour of antipyretics only. In making this conclusion, we place a higher value on adverse effects.
Regarding effectiveness, it was shown that using physical methods combined with antipyretics resulted in a statistically significant increase in resolution of fever after one hour, compared to antipyretics only. A statistically significant increase of resolution of fever after two hours, using physical methods combined with antipyretics compared to antipyretics, could not be demonstrated. In addition, a statistically significant increase of children with a temperature fall of 1.5°C by one hour or by two hours, using sponging with tepid water combined with paracetamol compared to paracetamol only, could not be demonstrated. Also, a statistically significant decrease of temperature after 30 minutes, using tepid massage combined with antipyretics compared to antipyretics only, could not be demonstrated. It was shown that using antipyretics only resulted in a statistically significant decrease in temperature after 120 minutes, compared to using tepid massage combined with antipyretics. However, in another study a statistically significant decrease of temperature after 120 minutes, using tepid massage combined with antipyretics compared to antipyretics only, could not be demonstrated.
Concerning the adverse events, it was shown that sponging with tepid water combined with antipyretics resulted in a statistically significant increase of adverse events, compared to antipyretics only. It was also shown that alcohol combined with paracetamol or ice water combined with paracetamol resulted in a statistically significant increased number of children with a poor comfort score. Evidence is of low certainty and results are considered imprecise due to limited sample size and large variability of results.
References
Systematic reviews
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Fever – Paracetamol. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2016). Evidence summary Fever – Physical methods with or without paracetamol. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Non-systematic reviews
El-Radhi, A. S. M. (2012). Fever management: Evidence vs current practice. World journal of clinical pediatrics, 1(4), 29. DOI https://doi.org/10.5409/wjcp.v1.i4.29
Education references
Patricia, C. (2014). Evidence-based management of childhood fever: What pediatric nurses need to know. Journal of Pediatric Nursing, 29(4), 372-375. DOI https://doi.org/10.1016/j.pedn.2014.02.007
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