Why does my child have on-and-off fever with a mild cough?

Question

Hello doctor,

My seven-year-old daughter, normally a highly active and extremely smart child, is showing signs of lethargy. She would like to sleep. She is still acting semi-like herself, but not completely like herself. She was running a 102° fever. I administered Acetaminophen (Tylenol) and then gave her bone broth soup, ginger, and honey tea. By morning, the fever was gone.

She did not really play as much. She kind of just sat down and relaxed, but she was still very active in the sense of being on the electronics. Towards the evening, she started running a fever again, requested to take a shower, and was given a shower. Body temperature had come down to 99.9. Body temperature had risen again.

The fever was 102. We could not get it to break. I took her to the urgent care center, where they tested for influenza, coronavirus disease 2019 (COVID), and streptococcal infection. They basically did a nasal swab. Everything came back negative. They told me that there was nothing wrong with my child, that it could be nutritional, and sent her home.

Her fever broke again. She went to bed. By morning, she was fine. In the evening, her fever was back. In the morning, it was gone. She went to school. In the evening, it was back, and I have not been able to break it since. It has been running lower than 102. It has been at about 99 to 100.1 for the last couple of readings. Since about this morning, I gave her some Acetaminophen (Tylenol), which may have contributed to the low-grade fever. However, her fever is showing signs of rising again.

So, it has been roughly about six days with an on-again, off-again fever. Urgent care is telling me that it is not a typical virus. She is eating just fine. She is hydrating just fine. She is not vomiting. She does not have diarrhea. She has a slight cough. It is not a recurring cough. It is now and then, like she is trying to clear her throat, but it is dry. Yesterday, there was some sneezing. Today, not so much.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have explained everything very clearly. Based on what you have described, your child has an intermittent fever for about six days with relatively preserved activity, appetite, and hydration, along with mild upper respiratory symptoms (occasional cough and sneezing). This pattern is still most commonly consistent with a viral illness, even if initial rapid tests (influenza, coronavirus disease 2019 (COVID), streptococcal infection (strep)) are negative, as many viruses are not detected on routine panels and can cause on-and-off fever for up to seven to ten days.

The reassuring signs are that she is eating, drinking, not vomiting, has no diarrhea, and remains interactive, even if slightly more tired than usual. However, because the fever has persisted beyond five to six days, it is reasonable to consider a clinical re-evaluation to rule out other causes such as urinary tract infection, sinus infection, or, less commonly, inflammatory conditions. I suggest basic tests like complete blood count, C-reactive protein, and urine analysis, depending on examination findings.

For now, you can continue supportive care: adequate fluids, light diet, rest, and Paracetamol (Acetaminophen) as needed for comfort (not necessarily to normalize temperature completely). Avoid overuse of multiple home remedies if they are not helping, and focus on hydration and monitoring.

Please seek prompt medical review if you notice any of the following: persistent high fever more than 102° Fahrenheit, increasing lethargy, difficulty waking, breathing difficulty, rash, red eyes, swollen hands or feet, neck stiffness, severe headache, abdominal pain, or reduced urine intake.

This still appears likely to be a prolonged viral illness, but given the duration, a repeat in-person evaluation is appropriate to be safe. You are doing the right thing by monitoring closely.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.