 Fever - What To Do
When The Heat Is On
 Fever is a very hot topic in pediatrics! In fact we get more calls for fever than any other
problem. But fever is misunderstood and is a source of anxiety in parents and even in some
pediatricians. Fever is a symptom (like a cough or a stomach ache) and not a disease in itself.
So it is important to look at your child's temperature in the context of all their symptoms
instead of just focusing on a single number.
A fever is part of the body's normal response to illness and the elevation of temperature helps
activate our body's immune system to better fight off infection. It also slows down the growth
of certain bacteria and viruses. In fact, there are studies that suggest the rash of chicken
pox gets better slightly faster when children are not
treated with fever medicines.
Fear of Fever
But people are afraid of fever and think that fever itself is harmful. The following are some
important points to remember about fever:
-
Fever is designed in the body to be a protection and not something that will cause
harm or brain damage in itself (this is in contrast to hyperthermia - heat stroke,
for example from being left in a car in hot weather - where the body can overheat to a degree that can cause brain
damage)
-
Fever can increase fluid loss and lead to dehydration. But it does this only if
someone is not drinking well or having excessive vomiting or diarrhea.
-
Fever can increase the risk of febrile seizures in young children who are predisposed
but these brief convulsions occur in only 4% of children and are generally harmless.
Click here to read more about febrile
seizures.
-
The height of the fever is not related to how severe the illness is, so it is
important to remember that how your child is acting and how well they are keeping themselves
hydrated is more important than just the number!
Taking the temperature
Another controversial subject is how to take the temperature and what that number means. Even
among doctors you might get different answers. Our take on this is as follows:
-
To get a truly accurate temperature, a temperature for a child under 5-years-old
should be checked RECTALLY and for a cooperative child 5-years-old and older should be checked
ORALLY.
-
Temperatures in the armpit or ear are not as reliable and there is no accurate
correction formula! (you might use them as an estimate but they will not be exact)
-
Detecting fever by touching the forehead or other skin is even less accurate. While
some studies have shown parents can be 99% accurate in saying when there is
not a fever, they are only right 22% of the time when they say there is a
fever!
-
Digital thermometers are at least as accurate as glass thermometers, are easier to
read and are safer to use!
-
Temperatures under 100.5ºF are generally not considered a fever!
But wait a minute, weren't we just saying we don't care so much about the number itself? Well
usually we don't but there are a few situations where we do care a lot:
-
In very young babies under 3 months old
-
In children with weak immune systems (such as those with cancer or sickle cell
disease)
-
In children whose fevers have been going on longer than 5 days (so it might be a good
idea to check an accurate temperature in your child once daily while they are sick)
To Treat or Not To Treat
We feel that it is generally reasonable to treat a fever in a child but it is important to do so
accurately - to use the proper dose and not to give the medicine too often
(click here to see our dosing calculator for fever
medicines). Keep the following points in mind:
-
Do not give aspirin to
children 16-years-old unless explicitly told to do so by your doctor (for a heart condition or Kawasaki's disease). Aspirin can cause a potentially fatal
liver condition called Reye's syndrome.
-
Because children under 3 months old may be very ill and have limited ways of showing
it, you should contact your pediatrician if a baby under 3 months old has a fever
(100.5ºF or higher) right away and do not give medicine until talking with the doctor.
-
Ibuprofen (a.k.a. motrin®/advil®) is not recommended for babies under 6 months old
-
Ibuprofen (a.k.a. motrin®/advil®) can cause upset stomach, especially when not taken
with food. So for a child with GI symptoms (vomiting, stomach ache) or who is not eating well,
tylenol® might be a better choice for fever.
-
While some people alternate using tylenol® and motrin®, there are no studies saying that
this is safe or works any better than using one medicine alone!
-
External cooling measures (sponge bathing, lukewarm bath) for fever may help bring a
temperature down faster in the first hour when used in combination with a fever
medicine. However, it will probably have no affect on what the temperature will be by two hours later and
might make the child feel cold and uncomfortable.
-
Keep your child dressed comfortably if they have a fever. Do not bundle them too much
to avoid excessive heat loss. A light blanket might help a child be more comfortable who has
the chills.
When To Call
Call immediately if:
-
Your child is less than 3 months
old
-
The fever is over 105ºF
-
Your child is acting or looks significantly ill (i.e. difficult to awaken, confused, crying
inconsolably, severe persistent pain)
-
Your child has a stiff neck or a seizure
-
Your child has purple spots on the skin
-
Your child is having difficulty breathing
-
Your child is unable to take liquids and urinate well
Call within 24 hours if:
-
Your child has specific signs of common infections (ear pain, sore throat without congestion,
pain with urination)
-
Your child has fever for more than 24 hours without an obvious cause or source of infection
(i.e. no cold symptoms)
-
Your child has a fever for more than
72 hours 
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