Contrary to most parents’ perception, your child having a fever can actually be a good sign, says Dr Mfed Mosely, consultant neonatologist and paediatrician. “Fever revs up the body’s immune system and activates it to fight off any viral or bacterial ‘invaders’,” he says. “The ability to mount a fever has been shown to increase survival rates in animal species. So, when your child has a fever, it means his or her body is doing its job.”
However, the pandemic has made how you respond to your baby or child’s fever a lot more complicated.
As one of the key signs of COVID-19 - alongside a cough and shortness of breath – a temperature of more than 37.5°C will see your child being turned away from any one of the many temperature checkpoints now set up outside schools, malls and other public venues across the UAE.
But fevers can be a side effect of many other common childhood ailments, from cold and flu to allergies, heat stroke, and even teething has been associated with a mild raise in body temperature.
So what should you do if your baby or child is displaying a fever? Should you put them through a COVID test right away? Can you monitor them at home? Does the whole family need to go into isolation too?
Gulf News spoke to UAE-based paediatricians to answer parents’ most pressing questions on fevers in children during the pandemic.
How can you tell if your baby or child has a fever?
“If your baby or child is hot, irritable or crying with flushed cheeks, or feels sweaty or clammy, check his or her temperature,” says Dr Anjana Kannoth, paediatrics and neonatology (specialist) at Aster Hospital, Mankhool. “If the temperature is high, give medicine for fever, or contact your pediatrician for the dosage. If your child is spiking fever again, consult your paediatrician.”
Even if you don’t notice your child is hotter than usual straight away, you may well be alerted if you try to enter any sort of public venue these days, as most places have thermal scanners or thermometer-gun checkpoints at the entrance.
What is classed as a paediatric fever?
Although traditionally a temperature of 38°C (100.4°F) or above was generally classified as a fever in children, during the pandemic the threshold has lowered to a temperature of 37.5°C and above. “This can vary from child to child so trust your instincts,” says Dr Kannoth.
Dr Anjana Kannoth, Paediatrics and Neonatology (Specialist), Aster Hospital, Mankhool
Research shows that normal baseline temperatures can vary between people by a few degrees, so if you know your child normally “runs cold” then you may want to lower the threshold for a fever even more. “You know your little one better than anyone else,” adds Dr Kannoth. “If you are worried, contact your paediatrician.”
How should you check your child’s temperature?
“The most reliable method to check the baby's temperature is the ear thermometer, which is a more accurate technique than the skin, forehead or armpit-based recordings,” says Dr Reena Sankar, specialist paediatrician at Medcare Medical Centre, Motor City.
Digital thermometers are preferred, and you should never use an old-fashioned glass mercury thermometer due to the risk of breakage (mercury is poisonous).
“The closer we get to the core of the body, the more accurate the temperature reading is,” adds Dr Mosley. “That’s why, when we measure the temperature of a baby, we often want to take the temperature rectally.” However, this can be uncomfortable for both baby and parents.
Armpit readings can frequently be inaccurate, while young children may find it difficult to co-operate with an oral thermometer reading.
But ear thermometers can be less reliable with very little children because of their small ear canals.
"Temporal artery thermometry is also very accurate,” says Dr Kannoth. These use infrared technology to measure the temperature of the blood flowing through the temporal artery on the forehead. “This causes less discomfort than a rectal thermometer. It's also less stressful for a newborn.”
Has the way we should respond to a fever changed due to COVID-19?
“Yes, we should be more cautious, but do not panic about the situation,” says Aster Hospital's Dr Kannoth. “If your child has a fever, look for any associated symptoms like cough or cold, breathing difficulty, tiredness, poor activity, or signs of dehydration. If the child is stable and has no history of contact with COVID-19 patients, nor any recent travel history, then observe the fever and consult your paediatrician if the fever spikes.”
Medcare's Dr Sankar says: “COVID-19 presents with or without fever, with other symptoms like a cold, sore throat, headache, body aches, rashes, diarrhea, chest pain, breathing difficulty, and many more. Hence, for any fever at any age, except for a mild one-day fever, it is better to get the child checked.”
What should you do if your baby or child has a fever but is displaying no other symptoms of COVID-19?
Your child’s age matters a lot when it comes to how to react to a fever. “For infants under a month of age, even a really low-grade fever can signal a serious infection from a bacterium,” says Dr Mosely. “Generally speaking all infants less than 6 months of age are classified in the danger-zone category when it comes to fever, and should be evaluated by a professional to rule out any abnormal condition.”
It’s also important to note that when very young babies are sick they might present at times with a low temperature rather than a high temperature.
“Babies under 6 months should always be evaluated by a paediatrician if they have even a low-grade fever, as they pose the highest risk of spreading of the infection,” says Dr Kannoth.
“In older, vaccinated children, if they have a low-grade fever but display no other symptoms of COVID-19, they can be observed at home,” she adds, “but if they have a high-grade fever and it continues for more than two days, a doctor should be consulted to rule out other serious infections.”
Should you take your child for a COVID test if they have a fever but no other symptoms?
“If a baby under the age of 2 has a fever with no other symptoms of COVID-19 and no history of contact with COVID-19 patients in the last 14 days, and no recent travel in last 14 days, then COVID-19 testing is not recommended,” says Dr Kanooth.
Other viral and bacterial infections should be ruled out first, she explains, but if a child has a fever for more than two days it will have to be re-evaluated and the doctor will decide whether the child needs COVID testing or not. “This is the same for an older child. But if at any time a child falls sick with the signs and symptoms of COVID-19, they must be tested.”
“The doctor will decide whether your child needs a COVID swab or not based on the current best practices in your area considering their symptoms, clinical examination, and contact and family history,” says Dr Sankar of Medcare. “Parents themselves can decide to have a test at a testing centre if the child is well physically, but there is contact history for the baby with anyone in the family who has been infected.”
Dr Reena Sankar, Specialist Paediatrician, Medcare Medical Centre, Motor City
How can parents help kids to go through a COVID test?
The COVID-19 test is done by taking nasopharyngeal swab, which could be painful and disturbing for children, says Dr Kanooth. “Before sampling, the procedure should be calmly explained to older children so that they will be co-operative. For younger children, whoever is collecting sample should be gentle and careful. If a child is sick with fever and it is clinically indicated to collect a COVID-19 sample, it can’t be avoided.”
Do parents have to pay for babies’ and children’s COVID tests?
“COVID-19 test are covered under most insurances,” says Dr Kanooth. “But if a child doesn’t have insurance they might have to pay.”
If your child has a fever but no other symptoms should they be quarantined for 14 days?
“Quarantine is indicated only for children who have tested positive for COVID-19”, says Dr Kanooth. “Consult a doctor and take his or her opinion on whether your child should be tested or not.”
But Dr Sankar from Medcare warns: “If any child has a fever for more than 1-2 days they should be evaluated by a doctor, so as to decide whether a COVID test is needed. Then quarantine will be decided based on the medical assessment. If a COVID swab is taken, it is mandatory to quarantine until you get the results, if the result is negative. But if you test positive then 14 days’ quarantine, or quarantine as decided by the government authority of the country, has to be followed no matter what the patient’s age is.”
If your baby has a fever but no other symptoms can the rest of the family continue to go to work or school?
If your child has even a mild fever it is vital that you do not send them to school or out into public places where they may mix with the community until either they receive a negative COVID test or their symptoms subside.
But, during the pandemic, the rest of the family should also self-isolate if one of your children has a fever, until COVID-19 can be ruled out, says Dr Reena Sankar: “If anyone in the family has a fever then medical evaluation and tests as decided by the physician are needed before the other family members - including the nanny, parents and older siblings - can get back to school or work or go outside into public places."
When should you seek emergency help for a child's fever regardless of other symptoms?
Dr Sankar says, “Persistent fever more than 38.5C is a significant fever and needs to be evaluated. Fever above 39C needs to be evaluated urgently by a doctor.”