Fever is a symptom and not a disease, but ...

As I have mentioned in my earlier post, fever is not a disease by itself. Treating it with paracetamol merely causes the fever to subside, without actually affecting the underlying cause of the fever. It is important to know the following additional facts about fever:

1. High fever can produce fits in infants and toddlers; although these fits look very dangerous to parents and care-takers, they are merely a reflection of the immaturity of a small child's brain and nervous system pathways; no long-term medicine is needed except in the rarest of circumstances.
2. In children (and adults) of all ages, fever increases the thirst and fluid requirements of the patient; thus, febrile children or adults must be given extra liquids - usually 10% more than the usual for every degree Centigrade the fever is above 38 degrees.
3. A patient who is running a fever should never be force-fed food; nor should food be withheld from one who desires it. In short, let the patient decide what, how much and in what form he needs. Starving a child with fever is a criminal act, since it further weakens his/her body and prevents it from fighting the underlying cause of the fever (usually an infection with bacteria).
4. Very high fever (more than 105 degrees Fahrenheit) is termed malignant hyperpyrexia ... and in the extreme case, it can be potentially fatal, i.e. kill the patient due to complete derangement of all systems in the body.

While most causes of fever in children are easy to manage and not life-threatening, fever accompanied by any of the following additional symptoms should be considered as "not just fever" and such children should be referred to a Paediatrician immediately:           

• High grade fever
• Uncontrolled or repeated or very large-sized vomiting or loose stools
• Irritable, excessively jumpy or crying child
• Older child who remains in bed all the time and refuses to drink liquids or appears inactive, dull or lethargic
• Has had fever-associated fits in the past, or during the present illness
• There are significant symptoms pointing to a serious infection such as arching of the back (meningitis), dark coloured, blackish urine (malaria), stomach bloating (typhoid) or moist, hacking cough with sputum and chest pain (pneumonia)

Learn to understand fever and try not to panic.  Check out the link to my earlier detailed post on fever to learn how to manage fever at home. When in doubt, go to your child's doctor immediately.

How to give medicines to a child

Several of my patients used to come back to me within a day or two of the consultation, complaining the child wasn't taking the medicine willingly, and had to be forced to take it, whereupon, it so happened that the child cried and vomitted out the medicine along with his/her previous meal. I made it a part of my consultation, therefore, to advise the parent/care-giver on how to give the medicine to a sick, unwilling, often hungry and irritable child. Let me share these tips with you.


The first thing to remember is that the sick child is often an unco-operative subject. It is, therefore, worthwhile to taste a little of each of the medicines you are going to give her and decide which of the medicines is the most bitter, which is less so, and which is definitely palatable. If possible, tell your pediatrician at the outset to choose palatable medicines if you know your child is fussy about this aspect of treatment. Often, however, the doctor is helpless as the medicine in question does not come in a more palatable form, and is irreplaceable in the prescription. Your doctor may choose to give one or more medicines in another, less troublesome, formulation: some medicines can be given as rectal suppositories, for example. This is a form of medicine that looks like a long-nosed bullet. It has to be inserted from the anal side, and it starts to work within 5-10 minutes after administration. Paracetamol is often available as rectal suppositories.


There are several oral formulations, such as suspensions (they come as a powder in a bottle, and the patient has to add water to the bottle up to a certain mark on the bottle. Once made in this form, the medicine needs to be stored in a cool dark place, or preferably, in a refrigerator.), syrups, tablets, drops, etc.


Okay, so now you know the medicine. How do you give it? The first thing to know is that the younger the babv, the more it will depend upon or trust the care-giver. Your attitude should always be that of a smiling and encouraging elder. Never get annoyed or frustrated as that can directly affect the baby's willingness to open its mouth to swallow the medicine, regardless of its taste! If the baby just keeps rolling the medicine in its mouth without swallowing it, use a dropper to slowly give the medicine the next time. You may, if needed, hold the baby's jaws open with your thumb and first finger and wait till the medicine is properly swallowed. DO NOT CLOSE THE BABY'S NOSE TO AID THE SWALLOWING. This can prove to be a dangerous tactic!


For an older child, the best posture to give the medicine is with her sitting upright. This prevents irritation by the medicine of the back of the throat, allows gravity to assist in swallowing the medicine downward, and removes the anxiety that older children feel when they are forced to lie down to swallow the medicine.


It may be worthwhile to make the child drink a little water BEFORE being given the medicine. This will definitely help her retain the medicine after she has managed to swaow the medicine. This is very useful to give tablets in older children.