Diurnal variations of fever in children: results from an app-based observational study
Abstract
Background: Fever is a frequent concern in early childhood. However, its management remains inconsistent, driven in part by persistent "fever phobia" and heterogeneous advice. Although body temperature follows a well-established circadian rhythm, the diurnal expression of fever in young children is insufficiently described. We aimed to characterise 24-hour patterns of febrile temperatures in children aged 0-7 years using real-world data from a participatory mobile health registry (FeverApp), with specific attention to age and antipyretic use.
Methods: We analysed 28,620 fever episodes recorded in the FeverApp registry between September 2019 and September 2023, comprising 12,454 children (median age 14 months) and 122,890 time-stamped temperature measurements. Mean hourly temperatures were calculated by pooling all eligible entries within hourly bins and were stratified descriptively by age group and recorded antipyretic use, without consideration of dependency. Between-group differences were summarised descriptively using mean differences.
Results: Mean temperature demonstrated a clear diurnal pattern, reaching a nadir at 06:00 (38.25 °C) and a late-evening peak at 23:00 (38.93 °C), corresponding to an observed trough-to-peak difference of 0.68 °C. Infants (< 12 months) showed lower entry-level mean temperatures than older children (1-7 years), with differences smallest around the morning trough and more pronounced later in the day. Recordings close to documented antipyretic…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 12,454 participants or records.
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