Common illnesses and other sleep disruptions
Most children experience a range of common difficulties that affect sleep, some of which are related to a baby or child’s physical health. In this chapter, we discuss the most common issues you may encounter, their symptoms, ways to treat them and what to do about your child’s sleep. Here’s what’s covered so you can find the section relevant to you:
• infant colic
• gastro-oesophageal reflux (GOR)
• gastro-oesophageal reflux disease (GORD)
• other sleep-related problems:
• nightmares
• night-time fears
• night terrors
• head banging, body rocking, head and body rolling
• common childhood illnesses:
• coughs
• ear infections
• fevers
• the common cold
Get medical help immediately anytime your baby or child becomes unresponsive to you, if she has a fit or seizure, a fever or a rash.
Infant colic
If your baby has colic, she’s not alone. Anywhere from 5 to 19 per cent of healthy, well-fed babies get colic, especially at around 4 to 6 weeks of age.
Everybody has an opinion on colic and they’ll usually give it to you. They might say your baby has a tummy ache or wind.
But what is colic? To tell you the truth, there’s still a lot of uncertainty among experts about what colic actually is and what causes it. There’s debate about whether there’s just one cause or multiple causes. Quite a lot of scientific studies are being done to understand why your baby might experience colic.
Of course, that bit of information doesn’t help you while you’re trying to calm down your extremely distressed baby each evening.
So, it doesn’t really matter what’s specifically causing the colic – what matters is the effect it has on you and your baby. Having a baby who cries all the time can be stressful, and your baby is experiencing a lot of distress as well. She doesn’t understand what’s happening to her.
One of the most difficult aspects of colic and excessive crying is that it can affect your relationship with your baby, your partner and your family. And all that crying will also affect your baby’s sleep, so it’s useful to understand a bit about colic.
You have probably seen your doctor, child and family health nurse or other health professional many times already for help and advice. You may have received conflicting opinions and lots of different remedies. Don’t worry, you’re not alone, this is a common pattern when you have a baby who cries a lot.
If you criticise yourself because you can’t figure out what’s wrong with your baby, well don’t! You’re not a bad parent; you’re a confused parent.
Seeing as no one is quite sure what the cause of colic is, the best thing to do is focus on ways to manage it. If you do that, you can feel good about yourself as a parent.
During her first three months, your baby will cry between 1 to 5 hours a day, even if she doesn’t have colic. That’s the normal crying period for her age (see Chapter 5: Why your baby cries). Whenever your baby happens to cry at the extreme end of the crying spectrum, people may call this ‘colic’.
Definition of colic
The most common expert definition of colic is called the ‘rule of three’, and this is how it works. Your baby is healthy and well fed and she:
1. has sudden and intense episodes of unsoothable crying and fussing for what seems like no reason at all
2. cries for more than 3 hours a day on at least 3 days a week
3. cries for more than 3 weeks.
Having said that, you’re probably too caught up with all the crying to know if your baby is crying that much – for you, it just feels like she’s crying all the time.
You may have been told that when your baby has colic she may also display some of these behaviours:
• her muscles seem stiff
• arches her back
• draws up her legs
• her tummy is swollen – which may be wind or she’s had lots of feeds to try to calm her, so she’s feeling very full
• clenches her fists
• windy and farting – this probably is more a result of crying so much rather than being the cause of the colic
• struggles when she’s held.
Even if your baby doesn’t have colic, you will see some of these behaviours during the first three months. These behaviours are non-verbal cues and she will show more of them if she’s crying a lot (see Chapter 6: How your baby communicates). These symptoms don’t necessarily mean she’s in pain, even if she looks like she is.
Possible remedies for colic
So, what about all those remedies that have been suggested to you? Many remedies are based on the idea that colic has a physical cause. Not all experts agree that colic is a physical problem, that’s why there are lots of different colic remedies.
Changing formula or weaning from breastmilk. If your baby has been diagnosed by your GP or paediatrician with lactose intolerance, they may suggest a change to one of the new specialised hypoallergenic formulas.
Scientific studies are uncertain on whether soy formulas are helpful for colic. If you think your baby has a cow’s milk allergy, have her checked by your GP or paediatrician before changing her formula or using a specialised formula.
Importantly, if you’re breastfeeding, you definitely don’t have to wean her.
Excluding cow’s milk from your diet during breastfeeding is rarely required, and you should seek advice from your GP or dietitian first.
Using medications. Colic usually resolves by the time your baby is 4 months old. Occasionally, it may last to 6 months, which to you will seem like forever.
There are a number of ‘colic remedies’ that can be purchased as over-the-counter medicine from chemists, but there is no evidence that these are effective, and some may have side effects. Tresillian does not recommend the use of over-the-counter medications for colic.
Alternative therapies. Herbal teas are thought to help with colic but there needs to be much more research done to prove this, and some can also cause serious side effects.
Chiropractic and osteopathic remedies have been studied and the evidence suggests they don’t show a reduction in crying.
Massage has been shown to have some benefits. If you like to massage your baby, you can do this once a day, for one week. She might begin to relax and the length of her crying bouts may decrease.
Behavioural interventions. Make an appointment to see your paediatrician or child and family health nurse for advice on feeding, winding and burping a colicky baby.
There are a number of useful strategies for you, your partner, friends and family to try to help calm your baby. Even if she doesn’t seem to like it, when she’s distressed what she needs most of all is close human contact. You are her favourite person and she will be reassured by you soothing and calming her. However, you can’t possibly manage her crying all the time, so when you need a break, someone else she’s familiar with can take her and provide any of these strategies for her.
When she’s really distressed she needs soothing touch, a soft and calming voice, gentle movements and containment and safety. That’s usually in your arms or swaddled in a soft cotton wrap.
Calming techniques for colic
• rocking gently
• carrying her in a pouch
• playing soft music or white noise
• going for a walk in the pram
• giving her a warm bath
• singing lullabies and other songs softly.
Colic affects your baby’s sleep. Take the time to read back over chapters 1 to 4 to review the first three months of your baby’s life, how her sleep develops and the importance of predictable routines; Chapter 7 for sleep and settling, birth to 6 months; and Chapter 5 for how to manage crying.
Ensuring you get support from your family and friends is vital. You can’t look after a very unsettled baby who cries 4 or more hours a day on your own. No one should expect you to do that. That’s not a good idea for either you or your baby because you won’t enjoy being with each other. Having a baby isn’t meant to be like that, so you need someone to help you get your confidence back and get you through the 3 to 4 months that colic and crying usually last.
GOR and GORD: two types of reflux
Gastro-oesophageal reflux (GOR) is a common occurrence in many healthy, well-fed babies. It is physical condition. Your baby has a circle of muscle at the top of her tummy that’s supposed to stay closed and keep the milk down. If she has GOR, this muscle relaxes and allows milk to come back out. About 40 per cent of babies have GOR and it usually starts before your baby is 8 weeks old.
Your baby can bring up some milk after or between feeds as many as six times a day. Other times, she may simply spill a little bit of milk from her mouth. As she gets older, however, the reflux will decrease and, by the time she’s 12 months old, it will usually be gone altogether.
Your baby can bring up some milk after or between feeds as many as six times a day.
Some babies can continue to have GOR through the first year, but it usually doesn’t hurt or bother them. Take heart, only 5 per cent of babies still have GOR at 12 months, so it’s not very common to continue past that point. GOR usually resolves itself and disappears as your baby matures. Even though she brings up some milk, most babies will continue to feed well and gain weight.
You may have noticed that when your baby does bring up her milk, she does it without any effort. Many babies are not distressed by this at all because it’s simply the contents of her tummy coming back up into her oesophagus and into her mouth. If she’s not distressed, is putting on weight and doesn’t show any signs of pain, then she really doesn’t need any treatment or medicine.
The milk she brings up usually isn’t much, although it might look like it. Sometimes you might worry that she’s brought up a whole feed. With GOR, the amounts your baby typically brings up are quite small, with the occasional large vomit if her tummy is over full.
Estimating amount of milk that comes up
A good way to get a sense of the amount she’s bringing up is to tip 20 ml of water onto a cloth, let it soak in (it usually spreads quite a long way) and then compare that area to the amount of milk your baby has brought up.
GOR is normal for some babies, so if your baby has GOR then it probably won’t change the amount of crying she does during the first three to four months. It just so happens that GOR usually occurs at the same time as her peak crying period; therefore, it may seem as if the GOR is causing her to cry with pain and you may be worried something is wrong with your baby. That’s an easy mistake to make. (It’s a bit like colic appearing around the same time.)
The main problem with GOR is that it’s messy. You spend a lot of time cleaning up. If your baby tends to bring up a lot of milk, you might wear regurgitated milk stylishly on your shoulder or as a badge of endurance on the front of your clothes. You will belong to the bib-brigade you promised yourself you would never join. The only solution is to choose fashionable bibs to get you through this phase.
Gastro-oesophageal reflux disease (GORD) is much less common than most people think. Simple GOR is frequently mistaken for the more serious GORD, which leads to more severe symptoms that need assessment by your doctor and possibly medical treatment.
Symptoms of GORD
These are the symptoms of GORD to look out for:
• frequent vomiting
• she brings up large amounts of milk when she vomits
• refusal to feed
• poor weight gain and failure to thrive
• she may have a persistent cough but no sign of a cold.
Excessive crying and behaviours such as back arching and irritability aren’t symptoms of GORD. Your baby will be going through a period of increased crying at the same time as the appearance of this, similarly to colic and GOR. She will often be crying and distressed during this period anyway. The difference is, she may have GORD if she also has the symptoms listed above.
Treatment for GORD requires a visit to your GP or paediatrician to investigate the reason for the frequent vomiting and large amounts of milk that comes up, as well as the other symptoms. Importantly, you do not have to discontinue breastfeeding if your baby has GORD.
Medications aren’t always required as the first treatment, and they should be used only when other methods have proved unsuccessful.
These are some methods that can be tried first:
• keeping your baby upright after feeding
• asking your doctor or child and family health nurse about thickening her feeds
• giving her antacids at the direction of your doctor.
She will be very unhappy and uncomfortable at times. Imagine vomiting all the time and probably having heartburn. She probably won’t find it easy to go to sleep and you will have to cope with the distress both you and she are feeling. Getting support from your family, friends, doctor and child and family health nurse is essential.
Other sleep-related problems
Sleep-related problems are common during the first three years. About 20 to 30 per cent of children experience:
• nightmares
• night-time fears
• night terrors
• head banging, body rocking, head and body rolling.
Some problems are more common than others, but most healthy and normally developing children will experience one or more at some point throughout childhood. Some of these sleep problems can make you feel really worried and concerned, but all of them usually resolve as your child matures and grows up.
Nightmares
Nightmares are vivid, terrifying dreams that occur during active sleep. Generally, your child will wake up and call for you when she has one. She will wake quickly, so the management is to comfort and soothe her. She will usually respond straightaway to reassurance that you’re with her and the nightmare isn’t real. But you may have to stay with her for a while if she is scared to return to sleep.
Bad dreams are different to nightmares: even though bad dreams can be scary, they don’t usually wake your child up and are much more common than nightmares.
Nightmares usually occur in the second half of the night and it’s thought that the onset of nightmares occurs when your child has the language development to tell you what the nightmare was about. Your preschooler generally has nightmares about threats to her safety – that’s why she dreams about monsters, scary creatures or people.
Nightmares are common and it’s thought that almost all children will have at least one nightmare during their early years. However, the occurrence of regular nightmares is relatively rare, with only about 1 to 4 per cent of children experiencing them frequently.
Nightmares are common and it’s thought that almost all children will have at least one nightmare during their early years.
If your child is having frequent nightmares, it’s usually due to some sort of stress, such as family conflict, social exclusion by children or bullying from another child at preschool. The resulting stress experienced by your child can result in her having nightmares.
If your family is experiencing a period of conflict, parental anxiety or separations, then it’s important to understand the social and emotional impact on your little one. Nightmares, night-time fears and behavioural problems during the day are some of the ways she’ll tell you she’s not coping. This is the time to get some support for you and the family.
If there are no family difficulties and she goes to day care or preschool, investigate if there’s a problem with another child or even an educator. This is a matter of discussing with the educators and making sure your child feels safe and secure.
Night-time fears
It’s pretty normal for preschoolers to have night-time fears. Almost all children will at some time or other express fear of the dark, scary dreams or monsters, but with your help these fears usually disappear by 5 to 6 years of age. However, some night-time fears can be associated with heightened anxiety due to separation from you, family conflicts, parental anxiety, or your child may be experiencing trouble at preschool.
The management of night-time fears varies with the cause and the severity of her fear.
Managing fears about darkness and monsters
• If your child is very fearful of the dark, you can try putting a night-light in her room or soft lighting outside her bedroom.
• You can find a bedtime story that discusses fear of the dark and monsters under the bed or in cupboards to help reassure her they are not real.
• Try not to reinforce the idea that there could be a monster. For example, don’t go searching for monsters in every nook and cranny every night before she goes to bed. If your child is very fearful, this behaviour could reinforce that there are monsters somewhere in the house. Explain to her there are no monsters and they are imaginary.
• Gently reassure her that you would never let anything bad happen to her.
• Encourage her to talk and think of what makes her bedroom and her bed a nice place to be. Most 4-year-olds are usually pretty good at describing positive aspects. Thinking about pleasant things is much better than monsters or worrying.
• Talk about how brave she is and reward her for her bravery – this could be in the form of a star chart.
• She might like to have a special stuffed animal or toy that’s soothing and comforting.
The management of night-time fears related to your child’s anxiety because of family difficulties, parental anxiety and preschool conflicts is a bit more challenging, especially if you are going through a difficult period in your life.
Managing anxieties about personal situations
• Use the strategies listed earlier, leaving out any advice that applies to fear of monsters and the dark.
• Find stories to read to her about children in similar situations.
• Help her to relax with a soothing bedtime routine.
• Sometimes your child will use bedtime stalling (see page 213) to express her anxiety about the family situation. You can use the techniques on page 215 to help her stay in bed
• You need to give her reassurance, understanding and support during the period of family upheaval. Your child will be emotionally affected by family conflict no matter how young she is and this will affect her sleep.
Night terrors
Night terrors usually occur between 2 to 4 years of age, although sometimes toddlers as young as 18 months can have them. After this, night terrors begin to resolve, and only 1 to 6 per cent of children between the ages of 4 and 12 years will continue to have them.
Night terrors occur when your child is in a deep sleep or quiet sleep state during the first half of the night.
Indicators of night terrors
Initially, your child will scream and when you go to her, she may display some of the following behaviours:
• look terrified with her eyes wide open
• be trembling and sweating
• be sitting up
• push you away
• get more upset when you attempt to comfort her
• seem confused and not recognise you
• wake briefly and be confused and disoriented.
This episode could last for 30 seconds to a few minutes and will then just settle on its own. Once it’s over, your child usually settles back to sleep.
She probably won’t remember the night terror or, if she does, it will be fragments of scary things. As for you, you’ll find it very frightening the first time it happens.
Managing night terrors
• Maintain a predictable and soothing bedtime routine.
• Eliminate screen time, scary stories, movies and games.
• Eliminate drinks that contain caffeine to ensure that your child’s sleep is not interrupted and decreased in length.
• Ensure she has a reasonable bedtime for her age, to avoid her becoming sleep deprived.
• Don’t wake her up or restrain her, as this may prolong the episode.
• If she doesn’t remember the episode, don’t tell her about it, as this may just make her feel anxious.
Night terrors occur in a small percentage of children and they usually disappear during childhood. The good thing about them is your child won’t remember having a night terror, so you are the one who experiences the alarm when an episode occurs. Be reassured that a night terror every so often is not a cause for concern.
Head banging, rocking, body and head rolling side to side
These sleep problems are self-soothing behaviours your child uses to get to sleep. They involve rhythmic and repetitive body movements when she’s falling asleep or at any stage during sleep.
If your child does any of these sleep behaviours, she will probably start around 6 to 9 months. This may happen even when she is quite healthy and growing normally. She will usually outgrow such behaviour in early childhood. Most children don’t hurt or damage themselves when they do this, though sometimes your child may bruise her forehead or develop a forehead callous. In this case, you will probably need to visit your doctor just for a check-up. There aren’t any specific treatments for this particular sleep problem but here are some simple safety measures to implement.
Safety measures for head banging, rocking and rolling
• Make sure that her cot is well made and won’t rock and move. Make sure it can withstand her constant rocking movements. Check all the screws are tight.
• Protect your child from falls by always keeping the cot sides up or, if your child is in a bed, use bed rails, or she can sleep on a mattress on the floor.
• Make sure she can’t hurt herself on a hard object like a wall, shelf or other furniture. Move her bed away from anything she can hurt herself on.
• See your doctor if you think your child is harming herself.
• Don’t use padding or bumpers in her cot to protect her head, as this is not recommended by Red Nose. Check their website (rednose.com.au) for information about bumpers and pillows.
Researchers have suggested behavioural strategies you can try. Continue to use safety measures (above) and include the following rhythmic behaviours for her self-soothing head banging or rocking.
Soothing strategies for head banging, rocking and rolling
1. Replace her rhythmic movement with your own soothing rhythmic touch, such as gentle, rhythmic patting or stroking. Keep rhythmically soothing until she’s calm and sleepy.
2. Once she’s soothing with your help, slowly reduce your patting or stroking and introduce a rhythmic sound, such as repetitive white noise or a fun clock with loud ticking. There are lots of children’s bedroom clocks to choose from.
3. It may not happen quickly, but you should be able to stop patting or stroking completely after a period of time.
Common childhood illnesses
As if getting your child to sleep through the night wasn’t hard enough, you have to contend with common childhood illnesses interfering with sleep. Colds, fevers and a bad cough all cause disruptions to sleep routines.
When your baby gets sick, her sleep will be disrupted in the short term. Once she’s better, you can return to business as usual and get her back into her routine. However, take a moment to look at it from her point of view. If she’s been having lots of cuddles and attention through the night, she’s not going to give that up easily. She’s not being naughty; she’s just being like anyone else who has to give up something special. That’s being human.
In the meantime, if you do have trouble convincing her to return to her previous sleep routine, check through the earlier chapters for the appropriate settling strategies for her age.
The common cold
Your child can have 6 to 12 colds every year. She experiences the common cold just like you do. Her symptoms will be a blocked and runny nose, headache, watery eyes, a cough, sore throat, mild fever and, just like you, she will feel absolutely miserable.
Colds are usually caused by viruses, so antibiotics won’t be any help. And there’s no specific treatment that will make a cold go away. It’s a matter of waiting it out over 7 to 10 days.
In the meantime, any treatment for your baby or child will involve lots of cuddling, sympathy and attention from you. She will be clingy and probably won’t sleep well.
Apart from that you can try the usual remedies. As you know from your own experience, a blocked nose is probably the worst part of a cold. Your baby’s nasal passages are so small she will be very uncomfortable and will find feeding and sleeping difficult.
Ensure she has plenty of fluids, and keep breastfeeding or bottle-feeding as normal.
You can use saline sprays or nasal drops for 2 to 3 days to help clear her nose, but it’s important to speak to the pharmacist to make sure you’re using the right medicines for her age.
Ensure she has plenty of fluids, and keep breastfeeding or bottle-feeding as normal. If your older child isn’t hungry, that’s fine so long as she drinks plenty of fluids.
If your baby or child has a fever of 38.5°C or higher, you can try to lower her fever using liquid paracetamol or ibuprofen. Carefully follow the instructions on the medication label, make sure you have the correct paracetamol or ibuprofen for her age and use the recommended dosage and frequency. Don’t give your child paracetamol or ibuprofen for more than 48 hours without seeing your doctor. If she has a persistent fever or you are concerned about your child’s health, see your doctor for a check-up and advice.
Decongestants and cough medicines aren’t recommended for children under 6 years of age. If you think your child needs some other type of medicine, then it’s best to visit your doctor.
Coughs
Coughing is a symptom of an illness and it usually accompanies a cold, fever or even an ear infection. Usually, a cough will go away on its own. If your child has a persistent cough, it is best to have this checked by your doctor.
Coughs can also be caused by the exposure of your little ones to household irritants, such as cleaning sprays, disinfectants and cigarette smoke. These can irritate your child’s airways and cause her to cough. Make sure that anyone who smokes goes outside the house; be mindful that cigarette smoke also stays on hands, clothes and furnishings.
Croup. Croup is another reason why your child may have a cough. Caused by a viral infection, croup can occur in children usually aged between 6 months and 3 years, and it occurs mostly at night.
Symptoms of croup
• barking cough
• wheezing
• gasping sound as she breathes
• looks as if she’s working hard to breathe
• may have a fever
• may seem okay even though she’s coughing.
If your child has croup, try not to panic as this will just distress her even more. Hold her calmly in a position she’s comfortable in and see a doctor for treatment.
Fevers
Your child has a fever when her temperature is 38°C or higher. A fever is a sign she has an illness and is fighting an infection of some sort. Most childhood illnesses are caused by viruses, which don’t need antibiotics and last only a few days.
Symptoms of a fever
• feels hot and dry
• is irritable
• may be sleepy or lack of energy
• may cry, fuss and be very clingy
• vomits or seems very unwell
• has a lack of appetite
• may shiver when her fever is rising and sweat when her fever falls.
Treating a fever
What you can do when your baby or child has a fever:
• If you’re concerned about her, see your doctor.
• Make sure she has plenty of fluids.
• Make sure she has lots of rest.
• Dress her in enough clothes so she doesn’t shiver.
• Babies under 6 months need extra breastfeeds to avoid dehydration. If your baby takes formula, you can try some extra formula or cooled boiled water.
• If your baby or child has a fever of 38.5°C or higher, you can try to lower her fever using liquid paracetamol or ibuprofen. Carefully follow the instructions on the medication label, make sure you have the correct paracetamol or ibuprofen for her age and use the recommended dosage and frequency. Don’t give your child paracetamol or ibuprofen for more than 48 hours without seeing your doctor.
• If your baby is under 3 months of age and has a fever of 38°C, take her to see the doctor straight away.
• Watch carefully to see if your child’s illness is getting worse and if you think it is, go straight to your doctor or emergency room.
• Importantly, note that it is not recommended to give her a sponge bath with warm water or blow a fan on her.
Ear infections
Ear infections are common in the first six to 18 months. This is because your baby’s ear canals are small and can become blocked easily. Ear infections mostly involve the middle ear and usually occur when your child has a common cold. Ear infections cause your child a lot of pain.
Symptoms of an ear infection
• clinginess
• pulling at her ears or pushing her fingers into her ears
• irritable, cranky or crying
• it might seem that she’s being naughty, but she’s not; she just can’t tell you how much her ears are hurting
• a yellow discharge coming from her ears
• cold symptoms, such as a blocked or runny nose
• fever.
Treating ear infections
• If you think your baby or child is in pain or has a fever of 38.5°C or higher, you can try to lower her fever using liquid paracetamol or ibuprofen. Carefully follow the instructions on the medication label, make sure you have the correct paracetamol or ibuprofen for her age and use the recommended dosage and frequency. Don’t give your child paracetamol or ibuprofen for more than 48 hours without seeing your doctor.
• If the ear infection is a viral illness, it should clear up after a few days without the need for any antibiotics.
• If your baby or child doesn’t seem to get better, take her to see your doctor to check if her ear infection needs treatment.
All of these common problems and illnesses will disrupt your little one’s daily naps and night-time sleep. You can’t avoid the disturbance to her daily routine and bedtime routine. She will want all your attention most of the day and be really clingy.
If you go to work, you may have to stay home to look after your little one, as day-care centres won’t allow you to bring your child in when she’s sick. She will need to miss a day or two until she’s better. That can be difficult for you as you juggle your work and other commitments and may have a financial impact if you don’t have sick leave or carer’s leave.
With your worries, it can be hard to focus, but your baby will need you to look at it from her point of view. She hasn’t experienced common colds, ear infections, fevers, coughs, croup, colic or reflux before (or even if she has), and not only will she be uncomfortable but she can also be distressed and scared – that’s why she’s clingy. She’s saying to you, ‘I don’t like this. I don’t understand what’s happening to me. Help me with this new and uncomfortable experience.’
She needs you to be calm and reassuring when she asks to be held; that’s what she needs from you to get her through her first encounters with the awful common cold or colic. And you know that the more cuddling and reassuring you do when she’s little, the more confident she’ll be as she grows up, and she’ll cope better with colds and other common illnesses she gets along the way.
As for her sleep, it will be disrupted. But once she’s better again you can return to your predictable yet flexible routines and use the soothing and settling strategies suitable for her age.
Key message
• If your baby has colic, swaddle her and carry, cuddle, rock and speak to her in a calm, soothing voice.
• If your child has night-time fears, ask her to think about all the nice things about her bedroom and how safe it is, as well as telling her you’ll always keep her safe.
• If your baby has a temperature of 38.5°C or higher, you can try to lower her fever using liquid paracetamol or ibuprofen. Carefully follow the instructions on the medication label, make sure you have the correct paracetamol or ibuprofen for her age and use the recommended dosage and frequency. Don’t give your child paracetamol or ibuprofen for more than 48 hours without seeing your doctor.
• Importantly, note that a giving her a sponge bath or using a cooling fan for a fever is no longer recommended.