Anyone who’s had to stay up night after night with a sick child understands what a terrifying experience a pediatric fever can be. Most of the time, though, fevers are a totally normal response to an infection, and little needs to be done. The most common causes of fevers in children are respiratory viruses – the cold or the flu – ear infections, and gastroenteritis. These non-life-threatening infections can usually be treated at home with rest, fluids, and pediatric Tylenol. However, there are a few causes of fever that can be dangerous. If you’re looking to give a very young character (under five years old) a potentially life-threatening fever, here are a few options.
Bronchiolitis
Bronchiolitis is caused by an infection of the lower airways, called bronchioles, by a respiratory syncytiovirus (RSV) or rhinovirus. It usually affects kids less than 2 years old. Symptoms include fever, cough, runny nose, and decreased appetite. If this sounds a lot like the common cold, it’s because it is; rhinovirus is one of the many viruses that causes colds. So what’s the difference between bronchiolitis and a cold?f
The short answer is wheezing. An infant or child with RSV will have wheezing and rapid breathing. In infants, especially premature infants, the first sign may be that they go for long periods without breathing at all, called apneic episodes. As the disease progresses, the child will have more and more difficulty breathing. A child who is struggling to breathe, grunting, or turning blue needs immediate medical attention.
Bronchiolitis is treated symptomatically, with fluids and nose-drops if they are at home, and oxygen and IV fluids if they require hospitalization. Most kids won’t need to be hospitalized. Infants under three-months are at the highest risk of needing a higher level of care.
Croup
Croup is a viral infection that leads to swelling of the upper airways and vocal cords. It’s most commonly seen in children between the ages of 3 months to five years. The hallmark of croup is a barking cough accompanied by fever, runny nose, rash, and swollen lymph nodes.
Like bronchiolitis, most cases of croup don’t require hospitalization. However, if the airway gets too swollen and the child may begin to have difficulty breathing. They’ll develop a high-pitched whistle, called stridor, on inhalation and exhalation. As they struggle to breathe, their ribcage will visibly begin to suck in with every breath (called retractions), and they may begin to get disoriented or sleepy. When they cry, their face may begin to turn blue. This is a medical emergency.
Croup is diagnosed clinically–no tests needed–and treated with humidified oxygen and steroid medications. If the case is severe, they might be admitted to the hospital for IV fluids and even intubation if necessary.
Meningitis
Meningitis is the infection of the membranes that cover the brain and spinal cord (the meninges). It usually starts with a fever, headache and tiredness that is easy to mistake for a more benign illness. However, meningitis also causes sensitivity to light (photophobia) and a stiff, painful neck. That neck stiffness, called nuchal rigidity, is the hallmark of bacterial meningitis, which is a medical emergency.
The characteristic triad of acute bacterial meningitis is fever, nuchal rigidity, and change in mental status, such as drowsiness or confusion. In a very young child, nuchal rigidity can present as an unwillingness to move their head. In a newborn or very young baby, nuchal rigidity is unusual. Instead, the soft spot in their skull – called the fontanelle – may feel full or may even bulge outwards. Other signs include a rash, dilated pupils, or difficulty flexing or straightening the knees,
| Aseptic meningitis, or viral meningitis, is usually mild and does not usually require hospitalization. |
Children are particularly susceptible to meningitis. In fact, toddlers, teenagers and young adults living in dorms, boarding schools, or military bases are particularly susceptible, as one type of bacteria causing meningitis is spread through the respiratory system. Lucky, there is a vaccine to prevent some of the most common causes of bacterial meningitis – but small children cannot get the vaccine and thus are at higher risk of this potentially deadly infection.
Ultimately, meningitis needs to be diagnosed through examination of the spinal fluid extracted via spinal tap (lumbar puncture). But if your character has all the worrisome symptoms, they’ll be started on IV antibiotics and admitted to the hospital even before the confirmatory results come back.
Febrile Seizure
Febrile seizures are convulsions in young children–usually before the age of five–triggered by a fever of at least 101oF. In a febrile seizure, the child will lose consciousness, and their limbs begin to shake. Most of the time, the shaking will be symmetrical, but sometimes the shaking will occur on only one side, will be accompanied by eye-rolling, or will be only loss-of-consciousness, without convulsions.
If your character knows what they’re doing, they’ll place the child on their side on a protected surface, where they can’t roll off things or hit their head, but they won’t try to restrain the child or put anything in their mouth. Most febrile seizures last only a few minutes; if it lasts longer, your character should call the ambulance.
While they look scary, febrile seizures aren’t actually that big of a deal. Somewhere between 2-5% of all kids under five will have febrile seizures at some point.1. It doesn’t mean they have epilepsy; it doesn’t even increase the risk of epilepsy. If you’re looking to scare the cr*p out of your character – a new parent, a babysitter, or even an older sibling – without actually causing harm to the child character, giving them a febrile seizure is a great option.
Works Cited
- Millichap, John J. “Febrile Seizures (Beyond the Basics).” UpToDate, 17 Aug. 2021, https://www.uptodate.com/contents/febrile-seizures-beyond-the-basics.
Well done, Natalie. Very informative.
Thank you, Gary! Glad you found it helpful.