Dear Dr Nina: 'Could I have harmed my baby with fever medicines?'
Question: My sister-in-law lives in the UK and she was over visiting recently. At the time, my 10-month-old daughter had a high temperature and was generally unwell. We were treating her with Calpol and Nurofen, an hour apart, as per my GP's instructions. My sister-in-law told me that the NHS now advise against this as a treatment for fever. I continued with the treatment until the fever passed but I am now worried that I may have harmed her. What are your thoughts on this?
A Having a fever is not necessarily a bad thing. It is a sign that the immune system has been stimulated. If a child has a fever below 40°C but is in good form, it is not necessary to treat this. Fever over 38°C does however cause distress and discomfort in many children and it is for this reason that treating at this temperature may be beneficial.
Normal body temperature is a temperature up to 37.5°C or 99.5°F. A temperature between 37.5°C and 38°C (100.4°F) is a very mild fever and in an otherwise well child doesn't require intervention. If you think your child has a fever, it is essential to confirm this with a thermometer. Other symptoms to watch for are the child's state of consciousness, their intake of fluids, how much urine they are passing, whether or not there is a rash, and whether the child is unusually out of sorts.
It isn't always necessary to give medicine. Start by keeping the child comfortable and cool. Don't strip but do allow them to wear loose, cool clothing. Sponging down is no longer recommended. Ensure the child drinks plenty of fluids. Offer frequent, light, plain snacks. Big meals may be refused.
If your child is distressed or uncomfortable then it is reasonable to offer them some form of medication. Both paracetamol (such as Calpol) and ibuprofen (such as Nurofen) can be used to reduce fever and pain in children.
The best way to give these is an on-going topic of research and debate. NICE in the UK issued guidance in recent years stating that one or other preparation should be used. Another study in the BMJ then suggested that ibuprofen was more effective at reducing temperature and also suggested it was OK to give both medications. The guidance now is to give one medicine first, and if the child remains distressed or uncomfortable after this to, give the other. There isn't evidence to suggest that both given together are harmful. There just isn't evidence to show that using both is of any extra benefit.
It is reasonable to give the correct dose of one medication and only give the second if after 30 minutes your child is still distressed or unwell and the temperature isn't settling.
You wont have harmed your child giving both once you stayed within the safe dosing guidelines. Ibuprofen can irritate the stomach, especially if your child isn't eating, so paracetamol may be the easier place to start.
However, ibuprofen does last longer and also has anti-inflammatory effects so may work a bit better and be a good one at night due to its eight-hour benefit.
Keep an eye on your child's well-being. If they have signs of illness such as poor fluid intake, reduced urine and unusual sleepiness, they require doctor review.
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