girl with feverHaving a baby or small child with a high fever is a common cause for anxiety in parents and a frequent reason to call the doctor for guidance.   Here are answers to some common questions and some advice on how to make your child more comfortable when they have a fever.

Is Fever Dangerous?
Fever is a person’s normal response to infection and is often the very first sign that an illness is starting.The first thing to remember is that fever, in and of itself, is not dangerous. It is the body’s way of fighting an infection. High fever caused by illness does not cause brain damage. For children with temperatures less than 105, the degree of the fever is not always related to the seriousness of the illness. Temperatures of 103-105 are quite common in children. This means that you can have very high fevers with a simple cold or stomach virus and low temperatures for more serious illnesses. It also means that it is unnecessary to record the exact numbers of temperature, i.e., 104.2. An approximate range is more useful to the doctor and for you to determine a response to medication. Hallucinations occur in some children with high fevers (usually greater than 104). The child may say they see things which aren’t there, or may sing or act strangely. These symptoms should resolve quickly as the fever responds to treatment and the temperature is brought down.

If fever (T100.8 or greater) occurs in infants younger than 3 months, call your doctor immediately for the baby to be seen.

How Do I Take my Child’s Temperature?

Many products are marketed today to measure an infant or child’s temperature, but the gold standard is a digital thermometer.  In small infants, the only reliable method for taking a baby’s temperature is to use a digital rectal thermometer. It is safe and accurate. Color strips for the forehead, or ear thermometers do not work well in small infants.  For older children, the oral thermometer or one placed under the armpit works well and is an economical option, but you can also use thermometers which measure the temperature of the inner ear. Placing your hand on a forehead will work as well as strips that change color.

How Do I Know If a Fever Is Serious?
The best way to tell is by observing how the child looks and acts, especially after the fever is brought down by medicine. No one looks great with a high fever, but after treatment with acetaminophen, ibuprofen, or a lukewarm bath, the child should look a bit brighter. If a baby can suck on a bottle, or nurse, make eye contact, or maybe even smile at a familiar face, then the illness is probably nothing serious at that time. If the baby is very lethargic, avoids eye contact, has no moments of playfulness or interest in faces or objects, then the illness may be more serious. For older children the same guidelines apply. However, once a child can talk, he or she can describe how he or she is feeling and what hurts. If your child has a severe headache or stiff neck, severe abdominal pain, an unusual rash, severe sore throat or drooling, severe cough, chest pain, earache, or pain with urination, you should call your doctor’s office regardless of the child’s temperature.

I’m Afraid My Child Will Have a Convulsion!
Convulsions ( or seizures) occur with rapidly rising fevers in about five percent (5%) of children between the ages of 6 months to 6 years. Watching your child have a convulsion is very frightening for parents.  The child, however, will have no memory of the convulsion and if there are no other complications, no long term effects or brain damage. These “febrile convulsions” occur as the fever rises rapidly within a few minutes to a height usually close to 105. The child becomes stiff and may turn blue around the mouth, as arms and legs begin to jerk. The eyes are usually turned to one side of the body. The convulsion usually only lasts about five minutes and the child will be sleepy for a while after awakening. If your child should have a convulsion, the local rescue squad should be notified after you have removed the child from any dangerous surroundings. Usually the convulsion is over by the time help arrives, but the rescue squad can be helpful by communicating with your doctor or the nearest hospital.

How Long Does a Fever Last?
Fevers that accompany most viral illnesses last 3-4 days. There are exceptions to this rule and some viruses, like influenza or mononucleosis, can cause fever for up to 10 days. If there is a bacterial infection present-i.e., ear infection, Strep throat, pneumonia, urinary tract infection-the fever may be present for more than the usual 3 days. So the presence of fever and the number of days your child has had the fever is important to relay to the doctor. Also, it is normal for temperatures to increase late in the day. The child who seems better in the morning may be looking and feeling worse by late afternoon.

Why Do We Treat a Fever?
If fever is the body’s way of responding to (and possibly fighting) infection by raising the temperature of the body, then why do we treat fever? The answer is that regardless of the cause of the fever, fever makes an infant or child uncomfortable. So doctors will treat fever to make the infant or child more comfortable.

Should We Always Treat a Fever?
If the temperature is greater than 101 and your infant or child seems uncomfortable, then treating the fever is indicated. If your child is “running around” and playing with a 103 temperature, you may not need to treat the fever at that time.

How Do We Treat a Fever?
Doctors treat fever in two ways: by treating the underlying illness when possible, and by treating the fever directly. Our role as physicians is to diagnose and treat the underlying illness which is causing the fever. Viral illnesses do not respond to antibiotics, so those illnesses need time and supportive care.

Your role as parent is to treat the fever directly. There are three common ways to treat fever:

1. Acetaminophen (Tylenol, as well as generic forms) is the most common medicine used to treat fever today. It is very useful in reducing fever and relieving pain. It does not work as well as aspirin or ibuprofen for inflammation and muscle and joint aches; however, it is a safe drug to use, and has minimal side effects. Aspirin should never be used in children and adolescents because of the risk of Reye’s syndrome.

Acetaminophen comes in a variety of forms, including infant drops, children’s elixir and suspension, chewables, swallowable tablets, and caplets. It also is available in suppository form. This can be useful when a child is vomiting or refusing to take the drug by mouth.

2. Ibuprofen (Children’s Advil, Children’s Motrin), available in liquid form, chewable and swallowable tabs, is another useful treatment for fever in infants and children. As an anti-inflammatory, it is also useful for pain. The advantages to using ibuprofen over acetaminophen are less frequent dosing (every 6 hours, as compared to every 4 hours) and perhaps a better response for treating very high temperatures (over 104).

3. Non-medical treatments include bathing the child in a lukewarm bath. The trick is to lightly rub the water over the child’s body to help evaporate the heat. It is best to do this 30 minutes after giving acetaminophen or ibuprofen to avoid chilling. Drinking lots of cool fluids will help bring down body temperature. Increasing the amount of fluids is also necessary in infants and children with fever because they can become dehydrated more quickly. Dressing the child in light cotton underwear and pajamas and the infant in a t-shirt or onesie over a diaper will help prevent the temperature from rising higher.

What Shouldn’t I Do?
Avoid heavy layering of clothing. Avoid high room temperatures indoors in winter and high temperatures outdoors in summer. Avoid space heaters. Avoid alcohol rubs or baths with alcohol. (Children have had convulsions from alcohol toxicity absorbed through the skin.) Avoid aspirin (and products which contain aspirin/salicylates, such as Pepto-Bismol) to avoid Reye’s Syndrome.