Fever and Signs of Infection in Childhood and Adolescent Cancer

What are Signs and Symptoms of Infection?

An infection can be life-threatening in a childhood cancer patient. It should be treated as a medical emergency.

Treatments such as chemotherapy can affect the immune system. They work by killing the body’s fastest-growing cells. These include healthy cells and cancer cells. 

When the number of infection-fighting white blood cells called neutrophils is decreased, a condition called neutropenia results. Patients with neutropenia cannot fight infections well. They can become seriously ill very quickly. It is important to watch for signs of an infection, so it can be treated right away.

Signs and symptoms of infection: 

• Fever – Sometimes this is the only symptom. (Read more about Fever and How to Take a Temperature.)
• Coughing or fast breathing
• Blisters, rash, or skin sores
• Runny nose
• Earache
• Loose stools
• Sore throat
• Stomach pain
• Sores or pain around the rectum
• Headache and stiff neck
• Dizziness
• Confusion
• Drowsiness

What to Do If Your Child Has a Fever or Signs of Infection

Whether you are at the hospital or at home, tell a medical care provider right away if you notice signs of infection in your child.

• If it is during the day and you are close to your child’s cancer center, call your child’s care team or primary clinic.
• If it is after hours or the weekend, follow your hospital’s procedure for after-hours emergencies. You should tell your primary clinic or the doctor on call as soon as you are aware that your child has a fever.
• If you are not close to your child’s hospital, call your child’s local care provider or go to the emergency room at your local hospital.
• Be sure to tell the care providers that your child is a cancer patient and where he or she is being treated. They also need to know if your child has a venous access device and if your child has been receiving chemotherapy or other drugs that suppress the immune system.
• If you go to a doctor or hospital at home, call your child’s primary clinic or care team to give them an update on your child’s condition as soon as you can.

What Is a Fever?

A fever is an increase in body temperature. Body temperature can vary slightly from person to person and may depend on factors such as time of day and physical activity. The method used to take a temperature can also affect the results. 

For children over 3 months of age, fever can be defined as:

• An oral (by mouth) temperature of 100.9°F (38.3°C) or higher
• An oral temperature of 100.4°F (38.0°C) or higher that persists for one hour
• An under the arm (axillary) temperature of 99.9°F (37.7°C)
• An under the arm temperature of 99.4°F (37.4°C) or higher that persists for one hour

In a child younger than 3 months, a fever is an under the arm temperature of 99.4°F (37.4°C) or higher.

What Causes a Fever?

The most common cause of fever is an infection caused by bacteria or viruses. Other causes of fever may include heat exposure, cancer, autoimmune disorders, certain medicines, or immunizations.

What Are Signs of a Fever?

Fever symptoms include:

• Skin that feels hot to the touch
• Flushed (red or pink color) cheeks
• Chills
• Headache and body aches
• Low energy or not feeling well  

How Can I Prevent Infection?

Parents and other caregivers are encouraged to take steps to prevent infections from occurring.

• Patients and anyone around them should wash their hands with soap and water often.
• Practice good personal hygiene.
• Wear a face mask in public. Patients with neutropenia should always wear face masks. 
• Perform daily oral care as instructed by your medical team. This can help prevent sores that could lead to more severe infections.
• Keep patient areas clean.
• Avoid contact with people who are sick.
• Avoid taking the patient’s temperature rectally.