Fever

What is Fever and What to Do if Your Child Has Fever

Fever is a very common problem in children. Fever describes an elevation of body temperature that is usually a response to an infection with a virus or bacteria. How to respond to fever can be confusing for parents because fevers are treated differently in children of different ages, and many other features of a child’s illness can influence what response is needed. Fever is not a disease by itself but rather a sign that your child’s body is fighting an infection. Fever makes children not only warm but also irritable, achy, and more vulnerable to dehydration. We can treat fevers to make your child more comfortable during their time of illness.

What temperature is a fever? How should you take a temperature?

Many people speak of “low grade fever” when they take their child’s temperature at find that it is 98° or 99° F. While these temperatures are higher that many children run typically, they can be normal depending on environmental circumstances. A true low grade fever is between 100° F and 101° F.

The method of taking temperatures can vary a great deal. Temperature in young infants is usually taken rectally with a thermometer covered in Vaseline and then gently inserted into the rectum no more that ¼ to ½ inch deep. Older children can have their temperature taken by holding the thermometer under the tongue. In our office we typically use a device that is placed in the ear. Different devices have different levels of accuracy, but most commercially available thermometers have enough precision to determine if a child has a fever or not.

Fevers at Different Ages

Young infants up to 3 months of age are more at risk from serious infections than other children. Because of this, when an infant less than three months old has a fever greater than 100.0 ° F, you must ALWAYS call your pediatrician. We will discuss with you any other signs of illness your child is having, and how your child is doing overall. We can then give you the best advice about what to do next. Many young infants with fever will need to be seen in the office or in the Emergency Room if it is after hours.

Infants older than 3 months are at much lower risk of serious infection and can be treated differently. The most common cause of fever in children of this age is a viral infection such as the common cold. If your child is eating and drinking well, you can manage the fever at home by giving your child Acetaminophen (Tylenol). Tylenol is given every 4 hours as needed for fever and pain. Please call the office if you have questions about the correct dose of Acetaminophen for your child. You should avoid Ibuprofen (Motrin) until a child is 6 months old. If your child has a fever greater than 104° F, is not drinking, or is behaving as if they have no energy to cry or move, call your pediatrician.

Children older than 6 months can also be treated with Acetaminophen (Tylenol) but are also old enough to receive Ibuprofen (Motrin). Sometimes Ibuprofen is preferred because it lasts longer than Acetaminophen (Tylenol) and is given every 6 hours as needed. If your child has a fever greater than 104F, is not drinking, or is behaving as if they have no energy to cry or move, call your pediatrician.

Alternating Acetaminophen (Tylenol) and Ibuprofen (Motrin)

Sometimes when a child is ill, their fever returns before it is time to give the next dose of medication. One technique that can help with this problem is alternating between using Acetaminophen (Tylenol) and Ibuprofen (Motrin) every 4 hours.

You can ONLY use this technique if:

  • Your child is older than 6 months of age
  • You know the appropriate dose of both medications for your child
  • You keep a written log of what medication you have given your child and what time you gave it

As always, if your child has a fever greater than 104° F, is not drinking, or is behaving as if they have no energy to cry or move, call your pediatrician.

References:

Baker MD; Bell LM; Avner JR Outpatient management without antibiotics of fever in selected infants. Engl J Med 1993 Nov 11;329(20):1437-41

Dagan R, Powell KR, Hall CB, et al: Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis J Pediatr  1985; 107:855-860.

McCarthy CA; Powell KR; Jaskiewicz JA, et al: Outpatient management of selected infants younger than two months of age evaluated for possible sepsis Pediatr Infect Dis J 1990 Jun;9(6):385-9.