Hesperian Health Guides

3. Fever and seizures

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HealthWiki > Helping Children Live with HIV > Chapter 12: Common health problems > Fever and seizures

When we are well, our bodies stay at a steady temperature, no matter what the weather is like or how hard our body works. But when we fight an illness, our body temperature often rises. Children regularly get fevers as they fight illness, and children with HIV sometimes have fevers that last several weeks.

You can measure body temperature with a thermometer, but you do not need one to know a child has a fever. You can tell by feeling her forehead or belly using the inside of your wrist. A child with a fever may be more drowsy or fussy than usual.

To lower a fever and help a child feel better:

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  • Gently cool her skin with wet cloths, or give her a cool (not cold) bath.
  • Keep the child in the shade, or near a breeze from a window or doorway.
  • Give plenty of fluids to prevent dehydration.
  • Give paracetamol (acetaminophen) or ibuprofen (see Chapter 13: Helping children with pain).
  • Most importantly, try to find and treat the cause. Some fevers come from viruses, including HIV. But fever can also be a sign of an infection or problem needing treatment, such as difficulty breathing (pneumonia), a stiff neck (meningitis), diarrhea, redness in or around the ear or throat, a rash, or infection in the umbilical cord of a newborn (sepsis, below).
  • A health worker can help you discover the cause of the fever.

Blood infection (sepsis)

It is very dangerous when an infection spreads from one part of the body into the blood. A newborn can get sepsis when germs get into her umbilical cord, perhaps if it was cut with an unsterilized knife. But sepsis can also spread from something as simple as an ear infection.

Signs of sepsis
  • Fever: temperature above 38.3° C (101° F) or below 36° C (96.8 ° F)
  • Fast breathing and fast heart rate
  • The nose flares or chest pulls in as child tries to breathe
  • Seizure or convulsions
Treatment of sepsis

Anyone with these signs needs treatment as soon as possible — get medical help. If you know how to give injections, use ampicillin AND gentamicin:

GIVE Ampicillin: Inject 50 mg for each kg, 4 times a day, for 10 days.

AND Gentamicin: Inject 2.5 mg for each kg, 2 times a day, for 7 to 10 days.

Otherwise, give 2 medicines by mouth, ciprofloxacin AND clindamycin.


Ciprofloxacin: Give 10 mg for each kg, 2 times a day, for 10 days. Or dose by age:
Under 3 years old: give 125 mg (½ of a 250 mg tablet), 2 times a day, for 10 days.


Clindamycin: Give 5 mg for each kg, 3 times a day, for 10 days. Or dose by age:
Under 1 year: give one 100 mg tablet, 3 times a day, for 10 days.
1 to 3 years: give 150 mg (1½ 100 mg tablets), 3 times a day, for 10 days.
4 to 7 years: give 200 mg (2 tablets of 100 mg), 3 times a day, for 10 days.

If there is no improvement after 2 days, ALSO GIVE

Metronidazole: Give 7.5 mg for each kg, 4 times a day, for 10 days. Or dose by age:
Under 1 year old: give 37 mg, 4 times a day, for 10 days.
1 to 5 years old: give 75 mg, 4 times a day, for 10 days.
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Malaria is caused by a parasite spread by the anopheles mosquito. Where malaria is common, children with HIV catch malaria more easily and more often than other children. Having HIV also makes their malaria worse. All children with malaria need treatment, and children with HIV need malaria treatment very quickly. Unlike adults, they will not develop immunity after repeated attacks.

Signs of malaria
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  • Where there is a lot of malaria, fever may be moderate but often it can get very high
  • Fever that goes away but returns after 1 to 3 days
  • Chills and sweats
  • Headache, sore muscles, belly ache
  • Vomiting or diarrhea
Signs of severe malaria

These are life-threatening signs that the child needs urgent medical help:

  • Trouble breathing
  • Seizure, or difficulty waking
  • Unclear thinking, loss of consciousness, or any other signs malaria has infected the brain (see meningitis)
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Prevent malaria with bed nets and window screens.
Treatment of malaria

Different medicines work against malaria in different places. Go to a clinic as quickly as possible to get a malaria test and find medicines that are sure to work for your child.

Prevention of malaria

See ways to prevent malaria in your family and community. You will also find information about giving your child cotrimoxazole to prevent malaria and a number of other infections.

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Seizures and convulsions

Seizures are sudden, brief periods of fainting (child seems to be asleep) or changes in mental state, sometimes with jerking body movements. Some seizures make a child very stiff and still.

A young child can have a seizure because of high fever, infection, dehydration, a head injury, malaria, exposure to chemicals, or for other reasons. When a person has seizures a lot, this is called epilepsy — see a health worker.

During a seizure, clear the space around the child so he does not hurt himself. Turn him on his side so he does not choke if he vomits.Do not hold a seizing child down or try to hold his tongue.

  • One seizure is usually not a serious problem. However, if seizures happen several times, get medical help.
  • If a seizure happens with other signs of illness or a child who has been ill has a seizure, get medical help. Seizures can be a sign that an illness is getting worse.
  • Meningitis (see below) often causes seizures. Get medical help for this very dangerous problem as soon as possible.
  • The spasms of tetanus (when the jaw shuts tightly, called “lockjaw,” and the body suddenly bends back), may be mistaken for seizures. A child with tetanus needs medicine immediately — get help.


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Meningitis is a very serious infection of the brain and spinal cord. Most often, fever is the first sign and it starts with no other clear cause. Sometimes meningitis results from another illness such as tuberculosis, measles, or mumps. Meningitis from tuberculosis may take weeks to develop.

Signs of meningitis
  • Fever
  • Bad headache
  • Vomiting
  • Seizures
  • Stiff neck and arching back — the child cannot put his head between his knees
  • Touch is painful — trying to hold a child makes him cry
  • Light hurts the child’s eyes
  • Child is irritable, sensitive, and upset
  • Weakness, sleepiness, or losing consciousness
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Signs of meningitis in a newborn
  • The soft spot (fontanelle) on top of a baby’s head may bulge
  • Vomiting or diarrhea
  • A fever or an unusually low temperature
  • A high-pitched cry
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A healthy baby’s neck bends forward when you lift his head. The neck of a baby with meningitis is stiff. When you lift his head, his back follows and he often cries louder.
Treatment for meningitis

Get medical help right away. If you know how, on the way give injections of ampicillin AND gentamicin:

GIVE Ampicillin: Inject 50 mg, for each kg, every 6 hours.

AND Gentamicin: Inject 5 mg, for each kg, once a day.

If the child recently had malaria, check for tuberculosis as well.

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Ear infection

If a baby or child is rubbing his ear and crying, an ear infection may be the cause. Ear infections are very common in children, especially after a cold or runny nose. The inside of the nose is connected to the inner part of the ear and germs easily pass the short distance between them. Children with HIV may get many ear infections.

Signs of ear infection
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  • Mild fever
  • Babies cry, or rub their ears or the sides of their heads
  • An older child can tell you his ear hurts
  • Not wanting to eat, difficulty sleeping, or just general fussiness
  • Sometimes pus may drain from the ear
Signs of dangerous ear infection
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Get medical help for any of these signs:

  • Pain, tenderness, or swelling behind the ear. This may be a dangerous bone infection called mastoiditis.
  • Headaches, dizziness, or a seizure
  • Child is very tired or weak
  • Hearing loss, deafness
Treatment for ear infection

Not all children need medicines to recover from an ear infection. However, for children with HIV,

Amoxicillin: Give 25 mg for each kg, 3 times a day, for 7 days. Or dose by age:
Under 1 year old: give 125 mg, 3 times a day, for 7 days.
1 to 3 years old: give 250 mg, 3 times a day, for 7 days.
4 to 7 years old: give 250 mg, 3 times a day, for 7 days.

If there is bad-smelling pus draining from the ear, ALSO GIVE

Cotrimoxozole (trimethoprim + sulfamethoxazole): Give 3 mg trimethoprim and 15 mg sulfamethoxazole for each kg, 2 times a day, for 10 days. Or dose by age, using a single-strength 480 mg tablet with (80 mg trimethoprim and 400 mg sulfamethoxazole).
6 weeks to 1 year old: give ¼ tablet (20 mg trimethoprim and 100 mg sulfamethoxazole), 2 times a day, for 10 days.
1 to 3 years old: give ½ tablet (40 mg trimethoprim and 200 mg sulfamethoxazole), 2 times a day, for 10 days.
4 years to 7 years old: give 1 tablet (80 mg trimethoprim and 400 mg sulfamethoxazole), 2 times a day, for 10 days.
Note: If the child already takes cotrimoxazole, give it as usual and also give amoxicillin.
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Breastfed babies have fewer ear infections than formula-fed babies.
Prevention of ear infection

Feed babies in an upright position to prevent ear infections. Sometimes a child gets something inside her ear. Gently flush the ear with a mixture of half water and half hydrogen peroxide or vinegar, using a syringe with no needle. Or, if you are very careful not to poke the inside of the ear, you can remove a small object with tweezers. Otherwise, avoid putting anything in the ear. Germs are easily spread into the ear or you can accidentally puncture the eardrum. Even a tiny scratch can become infected. This is especially dangerous for a child with HIV.

Giving your child daily cotrimoxazole will protect him from ear infections.

This page was updated:27 Nov 2019