Fever present for 4 to 14 days
If fever persists beyond 4-5 days a less common infection should be suspected since most common viral infections will have resolved by about 4 days (e.g. Epstein-Barr mononucleosis, PID, drug fever, zoonosis, travel acquired infection, abscess including dental abscess).
Fever in children
The fever is usually a response to a viral infection. Fever itself is not harmful until it reaches a level of 41.5°C. Temperatures above 41°C are usually due to CNS infection or the result of human error, e.g.:
• shutting a child in a car on a hot day
• overwrapping a febrile child.
Complications include dehydration (usually mild) and febrile convulsions.
Management • Treatment of low-grade fevers should be discouraged.
• Treatment of high-grade fevers includes:
—treatment of the causes of the fever (where appro-priate) —adequate fluid intake —paracetamol (acetaminophen) is the preferred anti¬pyretic since aspirin is potentially dangerous in young children. The usual dose of 10-15 mg/kg every 4-6 hours may represent undertreatment. Use 20 mg/kg as a loading dose and then 15 mg/kg maintenance.
Advice to parents
• Dress the child in light clothing (stripping off is unnecessary).
• Do not overheat with too many clothes, rugs or blankets.
• Give frequent small drinks of light fluids, especially water.
• Sponging with cool water and using fans is not effective.
Febrile convulsions
Features:
• The commonest cause is an upper respiratory infection.
• Rare under 6 months and over 5 years.
• Commonest age range 9-20 months.
• Recurrent in up to 50% of children.

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