Q: My 9-year-old child has a 40°C fever despite low CRP. Can I give both Modim and Maxibufen, and is an IV needed?
Medically reviewed by Sang Hyun Ahn, MD
Content edited by Myeongchan Kim, MD
This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Question:
My 9-year-old child (weighing 38 kg) has been taking medication for ear infection and sinusitis for the past 5 days without any fever or cough, just nasal congestion. Yesterday morning, a fever suddenly spiked to 38.2°C and climbed to 39.8°C by evening.
We visited an acute pediatric clinic where tests showed a clean chest X-ray, negative flu test, and a low inflammation marker (CRP 0.7). The doctor diagnosed pharyngitis. However, overnight the fever rose past 40°C (reaching 40.2°C) every 4 hours, and my child was mumbling incoherently in their sleep.
The new prescription from the ENT includes Modim tablets 350 mg (0.6 tablet per dose), which seems to be an anti-inflammatory pain reliever. Normally, Tylenol doesn't bring down my child's fever much, but Maxibufen works very well (I usually give 15 mL). Can I give Maxibufen alongside Modim? If so, how should I alternate them with Tylenol? Also, is it normal to have a 40°C fever when CRP is under 1, and would getting an antipyretic IV fluid help today?
Answer:
Seeing your child’s fever spike above 40°C (104°F) while already being treated for an infection is understandably frightening. Because the fever is persistent and exceptionally high, your child requires an in-person medical evaluation today.
🚨 Seek Immediate Emergency Care If You Notice:
Extreme lethargy, difficulty waking up, or inability to make eye contact
Difficulty breathing or bluish lips/skin
Stiff neck, severe headache, or repeated vomiting
Signs of severe dehydration (no urination for over 8 hours, no tears when crying)
Critical Medication Safety: Do NOT Combine Modim and Maxibufen
Modim (morniflumate) and Maxibufen (dexibuprofen) belong to the same drug class (NSAIDs).
Modim 350 mg (0.6 tablet) is an appropriate dose for a child around 38 kg.
Never give Modim and Maxibufen together. Combining two NSAIDs does not improve fever relief and dramatically increases the risk of serious complications, including severe stomach bleeding, abdominal pain, and kidney injury.
How to manage fever reducers safely:
Continue the ENT prescription (which includes Modim) only at its prescribed scheduled intervals.
Discontinue Maxibufen completely while your child is taking Modim.
If a high fever causes significant discomfort between Modim doses, use Acetaminophen (Tylenol) only, spaced at least 2 to 3 hours after the Modim dose.
Are IV Fluids Necessary?
Intravenous (IV) fluids do not directly lower body temperature; their primary role is rehydration.
If your child is alert enough to drink water, electrolyte solutions, or broth, an IV is generally not needed.
An IV may be warranted if your child is vomiting constantly, refuses all oral fluids, or has not urinated in over 8 hours.
High Fever with a Normal/Low CRP (0.7)
Viral infections: Common viral pathogens (such as adenovirus or enterovirus) frequently cause intense fevers exceeding 40°C without significantly elevating CRP levels.
Co-infection: It is also possible that your child developed a new viral pharyngitis on top of the pre-existing sinus and ear issues.
Febrile delirium: Mumbling or talking nonsensically in sleep can happen during rapid fever spikes (febrile delirium). While often benign, you must confirm that your child wakes up fully and responds normally once the fever decreases.
Recommended Next Steps
See a pediatrician or ENT specialist today: Explain that despite the new diagnosis and medications, the fever has crossed 40°C and is recurring rapidly. The physician may need to reassess the ears, throat, and sinuses, consider alternative antibiotics, or run additional tests (such as a urine test or throat culture).
Bring all medication bottles or prescription slips to the clinic so the doctor can review the exact dosages and prevent accidental drug duplication.
Keep the child comfortable: Offer small sips of fluids every 5 to 10 minutes, dress them in lightweight clothing, and keep the room cool. If any red flag symptoms appear, go to the nearest emergency room immediately.
For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.
