Consider cause:

• Disease e.g. malignant pyrexia, lymphoma, neuroblastoma metabolic disease
• Drugs e.g. opioids, amitriptyline, chemotherapy
• Infection

Management

General measures

• Anti-cancer limiting treatment may improve sweating if it is part of a malignant syndrome
• Fan, cotton clothing, skin care
• Encourage plenty of fluids to avoid dehydration

Medication

Paracetamol (indicated if child is pyrexial)

Form

Tablet: 500mg; dispersible tablet. 120mg; 500mg.
Oral solution: 120mg in 5mL
Oral suspension: 120mg in 5mL; 250mg in 5mL.
Suppositories: 60mg, 125mg, 250mg, 500mg. 30mg & other doses as special
IV infusion: 10mg/mL

Dose

The recommended indications and doses of paracetamol have been revised to take account of MHRA and Toxbase advice that paracetamol toxicity may occur with doses between 75-150mg/kg/day (ingestion of over
150mg/kg/day is regarded as a definite risk of toxicity).

Oral

Neonate 28 – 32 weeks corrected gestational age: 20mg/kg as a single dose then 10-15mg/kg every 8 - 12 hours as necessary (maximum 30mg/kg/day in divided doses),
Neonates over 32 weeks corrected gestational age: 20mg/kg as a single dose then 10-15mg/kg every 6 - 8 hours as necessary (maximum 60mg/ kg/day in divided doses),
1 month – 6 years: 20-30mg/kg as a single dose then 15-20mg/kg every
4-6 hours as necessary (maximum 75mg/kg/day in divided doses),
6-12 years: 20-30mg/kg (max 1g) as a single dose then 15-20mg/kg every 4-6 hours as necessary (maximum 75mg/kg/day or 4g/day in divided doses),
Over 12 years: 15-20mg/kg (maximum 500mg-1g) every 4-6 hours as necessary (maximum 4g /day in divided doses).

Dose (rectal)

Do not use rectal route if child is neutropenic.

Neonate 28 – 32 weeks corrected gestational age: 20mg/kg as single dose then 10-15mg/kg every 12 hours as necessary (maximum 30 mg/kg/day in divided doses),
Neonates over 32 weeks corrected gestational age: 30mg/kg as a single dose then 15-20mg/kg every 8 hours as necessary (maximum 60mg/kg/ day in divided doses),
1 – 3 months: 30mg/kg as a single dose, then 15-20mg/kg every 4-6 hours as necessary (maximum 75mg/kg/day in divided doses),
3 months to 12 years: 30mg/kg as a single dose (maximum 1g) then 15-20mg/kg every 4-6 hours as necessary (maximum75 mg/kg/day or 4 g/day in divided doses),
Over 12 years: 15-20mg/kg (maximum 500mg -1g) every 4-6 hours as necessary (maximum 4g/day in divided doses).

Dose (IV: as infusion over 15 minutes)

Preterm neonate over 32 weeks corrected gestational age: 7.5mg/kg every
8 hours, maximum 25mg/kg/day,
Neonate: 10mg/kg every 4-6 hours (maximum 30mg/kg/day),
Infant and child bodyweight <10kg: 10mg/kg every 4-6 hours (maximum 30mg/kg/day),
Child bodyweight 10-50 kg: 15mg/kg every 4-6 hours (maximum 60mg/kg/day),
Bodyweight over 50 kg: 1g every 4-6 hours (maximum 4g/day).

Contraindications and warnings: dose related toxicity in hepatic failure; in moderate renal failure (creatinine clearance 10-50mL/min/1.73m²) minimum interval between doses should be 6 hours. In severe renal failure (creatinine clearance <10mL/min/1.73m²) the minimum interval is 8h. Paracetamol is significantly removed by haemodialysis but not by CAPD.

Licence: Oral and rectal preparations licensed for antipyretic and analgesic use in children >3months.

Naproxen

Form

Tablets: 250mg, 500mg.
Oral suspension: 25mg/mL (available from specials manufacturers).

Dose (oral)

>1 month: 5mg/kg b.d. (max. 1g/24h)

Contraindications and warnings: Contraindicated in children who have shown hypersensitivity to aspirin or other NSAIDs. Caution in asthma and cardiac, hepatic or renal failure; avoid if creatinine clearance<20ml/min/1.73m². Extreme caution if current or previous history of peptic ulceration.

Licence: not licensed for use in children for this indication.