One the most common reasons I see a child in my office is for evaluation of a fever. I receive many phone calls in the middle of the night from frantic parents because their child has a fever. Although it should not be taken lightly, a fever is not always an emergency.
A fever itself is not an illness. It is usually a symptom of an illness or a sign that the body is fighting an infection. The fever is actually a good sign that your child’s body is working to heal itself as it stimulates other immune defenses. Normal body temperatures can be different depending on age, activity level, and time of the day. The average normal body temperature range is between 97.5° F and 99.5° F. Most pediatricians consider a temperature above 100.4° F a fever.
Although you can tell if your child feels warm, feeling the forehead does not detect a fever. It is best detected with a digital thermometer. The American Academy of Pediatrics recommends that parents not use mercury thermometers to prevent accidental exposure and poisoning. The three most commonly used thermometers are the standard multiuse one, the temporal artery one, and the tympanic thermometer.
Pediatricians consider the rectal temperature the “gold standard” of measurement. In children younger than 3 years, this is the best way to measure a temperature. When a child is 4 or 5 years old an oral measurement can be used. An axillary (armpit) temperature is less reliable, but is often used for screening in schools and daycares. The temporal thermometer is fairly reliable and a better screening device than an axillary temperature. Tympanic thermometers are not reliable in babies younger than 6 months. It requires proper placement and excess earwax might affect the reading.
Parents often ask me what number should cause worry. I am not always concerned about the height of the fever unless it is above 105° F. I want to know how the child looks and how they are behaving. I have seen many children with high fevers running around the exam room and playing, while some fevers might be low but the child appears very ill.
Not every fever needs to be treated, but there are things you can do to make your child comfortable. The main reason to treat a fever is to help your child feel better. Make sure to keep your child well hydrated with plenty of fluids since fevers cause the body to lose fluids more quickly. Offer them water, juice, or Pedialyte. Do not put too many clothes on your child or give an alcohol bath.
Acetaminophen and ibuprofen are safe and effective medicines available over the counter to reduce fever when used correctly. The doses are based on weight so be certain to read the labels carefully. Ibuprofen should not be given to children under 6 months of age or to those who are dehydrated or vomiting. Never use aspirin as it has been linked to a serious illness called Reye Syndrome. If your child is under age 2, discuss use of these medications with your pediatrician.
WHEN TO CALL THE DOCTOR
• Any fever in a child under 3 months of age
• If your child looks very ill, lethargic, drowsy
• If your child is very fussy or inconsolable
• Your child has difficulty breathing
• Your child looks dehydrated
• If your child has a severe headache, stiff neck, rash
• Persistent vomiting and/or diarrhea
• A child with immune problems
• If your child has had a seizure
• If your child has been in the heat for a long period of time
• Your child acts sick when the fever is down
• Your child is getting worse
• Persistent fever > 48 hours
I recommend parents keep thermometers, acetaminophen, ibuprofen, dosing charts, and their doctor’s office number on hand. When your child has a high fever, it can be scary, but being prepared will help alleviate some of the anxiety.
