Fevers

A fever is an elevation in body temperature >/= 100.4 degrees. Fevers are very common in children, and are generally not harmful unless they climb above 106 degrees (this level of fever is quite uncommon and generally only seen in the setting of heat stroke). A fever, however, is telling you that your body is reacting to something. In fact, a fever is part of your body's natural way of fighting an infection, and is likely beneficial. Most commonly, a fever is caused by a virus. An infant or child can have a very high fever with the same virus that would give an adult only a runny nose or mild diarrhea. Often, a fever is your first warning sign that your child is becoming ill with a virus. The fever will typically last from 24-72 hours. Within that time, your child will likely develop viral symptoms, most commonly either respiratory symptoms (runny nose, cough, congestion), or gastrointestinal symptoms (vomiting, abdominal pain, and/or diarrhea).

How to take your child's temperature

Rectally: The most accurate way to take a temperature. This is most important in infants, especially those less than 2 months of age. Apply a small amount of lubricating jelly on the tip of a digital rectal thermometer and insert ~1/4-1/2 inch into your child's rectum. The thermometer will beep within one minute when the reading is done. Parents are often nervous to check their child's temperature rectally. Don’t worry, you won’t hurt your child with a rectal thermometer!

Axillary (under the armpit): An easy way to take a temperature, but may underestimate a temperature by one degree, and therefore we don’t recommend this method for infants less than 2 months. If your child’s axillary temperature is over 100.4 degrees, then he has a fever. If your child’s axillary temp is 99.5-100.4 axillary, he may have a low grade fever.

Ear thermometers: This is a reasonable way to check a temperature in children over 6 months. Pull the outer ear backward and point the thermometer directly into the ear canal.

Oral thermometers: This is a good way to take a temperature in older children. Have your child close his lips securely around the thermometer with the thermometer under his tongue.

Pacifier and forehead strip thermometers are inaccurate and we do not recommend their use.

Mercury thermometers should not be used as mercury is toxic if the thermometer breaks.

What to do about a fever

Fever reducers: As fevers are not dangerous and are likely beneficial in fighting infection, treat with fever reducers only to make your child more comfortable. Consider treating a fever only if it climbs >101.5 degrees. Don't feel the need to wake your sleeping child to give a fever reducer.

If <6 months old, you can give acetaminophen (Tylenol) every 4-6 hours. If >6 months, you can give Tylenol every 4-6 hours or ibuprofen (Motrin, Advil) every 6-8 hours.

Most fevers can be managed by giving only Motrin or only Tylenol. Both work equally well as fever reducers, but Motrin lasts a little longer. Acetaminophen (Tylenol or Feverall) also comes in suppository form if your child is vomiting or refusing to take oral medication. Dosing for suppositories is higher than for oral medications as less is absorbed. (See website section on medication dosing).

If a fever is particularly high or persistent, you can give both Tylenol and Motrin, but be very careful that Tylenol is not dosed more than every 4 hours, or Motrin more than every 6 hours. It is helpful to keep a medication log.

Of note, fever reducers generally reduce a fever by 2-3 degrees. Don't be surprised or alarmed if medication does not return your child's temperature to normal.

Fluids: It is helpful for your child to drink extra fluids when febrile. For infants, breast milk, formula, or Pedialyte is appropriate. Infants over 6 months can also have juice (such as apple, pear, or white grape). For children over one, milk, water, or other clear fluids are appropriate.

Sponge bath: A lukewarm bath may make your child more comfortable and help reduce the fever as the water evaporates and cools his skin. Never sponge your child with alcohol!

Watch for other symptoms to develop, and treat these symptomatically (see section on colds and vomiting and diarrhea).

ALWAYS REMEMBER:

HOW YOUR CHILD LOOKS AND BEHAVES IS MORE IMPORTANT THAN THE HEIGHT OF THE FEVER!

When to call the doctor:

IMMEDIATELY

• If your child is less than 2 months old and has a temperature greater than 100.4 degrees, taken rectally.
• If your child is breathing hard or fast. Children breathe more rapidly when their temperature is elevated. Reassess your child's breathing once the fever is down. Also keep in mind that children who are truly having breathing difficulties usually have cough and congestion as well.
• If your child is acting strangely or is difficult to arouse. When children have fevers they look "wiped out." You can give him Tylenol or Motrin. He may look better once the fever comes down. He will likely want to sleep more and play less; this is expected. He should, however, be easily aroused from sleep.
• If you think your child is dehydrated. It is okay if your child doesn't eat when she is sick. She does need to drink. If, while awake, a child <1 year hasn’t urinated in 6 hours, or a child >1 year in 8 hours, she may be getting dehydrated. Other clues are that she is no longer interested in drinking, her lips and the inside of her mouth are dry, or she is no longer crying tears.

DURING REGULAR OFFICE HOURS

If your child is over 2 months old and has had a temperature >/= 100.4 for more than 72 hours.

Febrile Seizures

One reason parents get nervous about fevers is that they fear their child may have a seizure with fever. Although febrile seizures are very scary for a parent, they are usually short and not harmful to the child. They are also fairly uncommon, but tend to run in families. Febrile seizures occur in children between the ages of 6 months and 6 years, and usually come at the beginning of a febrile illness, during the initial rapid temperature elevation. Therefore, often the seizure happens before you are even aware that the child is ill with a fever. For this reason, treating fevers more aggressively, or trying to prevent fever completely usually does not prevent a febrile seizure.