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Three Part Question

In [children under the age of 12] what [body temperature] would [be classed as a fever]?

Clinical Scenario

A 36 month old child arrives in A and E looking well, the parent says she has had a temperature for the last 24 hours with no additional symptoms. You measure the temperature and it is 38°c you wonder whether this is a fever that we should be concerned about or can the child be sent home without any intervention.

Search Strategy

OVID Medline <1966-June week 3 2006>
EMBASE < 1980 to 2006 week 26>
CINAHL <1982 to June week 5 2006>
Paediatric filter applied
([exp Body Temperature/ OR body temperature.mp. OR exp TEMPERATURE/]) AND (reference values.mp. OR exp Reference Value/ OR exp NORMAL VALUE/ OR normal.mp.) Limit to (human and english language)

Search Outcome

Medline: 1529 papers found
EMBASE: 429 papers found
CINAHL: 67 papers found
Cochrane: 0 relevant papers found
2 relevant papers found 1 from medline 1 from article references.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Herzog, L.W. and Coyne L.J. 1993 USA	69 infants less than 3 months old seen for well baby visits	Retrospective study	Fever temperature (°c ) Infants < 30 days old	greater than/equal to 38.0°c	Temperatures were only checked once with electronic thermometers- validity of results affected. Same patient could be included more than once if made more than one visit- not representative of infant population. Small sample size and only children 6 to 36 months
			Fever temperature (°c ) Infants 1 month old	greater than/equal to 38.1°c
			Fever temperature (°c c) Infants 2 months old	greater than/equal to 38.2°c
Sowunmi, A. and Akinbami, F.O. 1991 Nigeria	346 healthy children aged 5 months to 10 years between April 1988 and September 1988	Prospective cohort	Mean temp day 1	36.48 +/- 0.47	Normal body temperatures for Nigerian children only. Large room temperature variation throughout the study-confounding variable.
			Mean temp day 7	36.64 +/- 0.40
			Mean temp day 14	36.70 +/- 0.32
			Mean temp day 21	36.70 +/- 0.32

Comment(s)

In this study if the most commonly accepted definition of fever (greater than/equal to 38.0°c ) was used 6.5% of the healthy children in the study by Herzog would have been diagnosed with a fever. There are a wide range of temperatures in normal infants and many variables that can affect temperature so we must not rely on a single reading. This highlights the need for clinical observation and judgement alongside statistical measurements.

Clinical Bottom Line

Once the normal distribution is known 2 standard deviations above the mean is the cut off point for the definition of fever. To do this for every age group and ethnic minority of children would be exhaustive and so a high temperature must not be judged on it's own but alongside a thorough clinical examination in order to decide whether further investigations and treatment are required.

References

1. Herzog, .W. & Coyne, L.J What is Fever? Clinical Pediatrics. March 1993 p142-146.
2. Sowunmi, A. & Akinbami, F.O. Body temperature in apparently healthy African children under 10 years of age Afr J Med Sci. Vol 20 1991, p 97-99