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2019 Apr

Don't Fear the Fever

Who knew a fever could be good for sick children?

You kiss your child and she feels hot. You check her temperature. It’s 102.5°F! You panic. What should you do? Take a deep breath. Fever is common in children. Some parents fear fever, but fever is a friend. In fact, fever is good for sick children.

What is a fever?

Fever is an elevation in the body’s temperature to fight invading germs or illness. It is a symptom of illness or infection. Fever turns on the immune system and means that the immune system is fighting. A fever is defined as a temperature that is over 100.4°F (38°C) rectally; 100°F (37.8°C) orally; or 99°F (37.2°C) axillary (under the arm).

What causes fever?

Both viruses (like colds or flu) and bacterial infections (like ear infections or strep throat) may cause fever. Viral fevers occur at the beginning of the illness and last 3-4 days. Viruses do not respond to antibiotics. Bacterial infections may also cause fever and may require antibiotic treatment. Bacteria and viruses are temperature sensitive, so fever “cooks” them.

Children may also get a fever after a vaccine. This is the desired immune response. Vaccines work by tricking the body into thinking it’s been invaded by a disease so that it will produce antibodies against that disease. Those antibodies then protect against future disease exposures. Fever after a vaccine is normal. It usually starts within 12 hours and lasts only a day or two. This means the vaccine is working. Vaccines are safe and effective.

How should you take the temperature?

A digital thermometer is recommended to take a temperature in infants and children. In infants, a rectal temperature is preferred. In kids over 4 years, an oral temperature is recommended. Ear temperatures are not accurate before 6 months of age. I do not recommend forehead strips and pacifier thermometers as they are less accurate. Of course, a kiss on the forehead may be all you need to determine if your child is feverish.

Should you medicate your child?

A fever may not need to be medicated if the child is comfortable and acting normally. You may medicate your child’s fever if they are fussy or uncomfortable. Fever-reducers are available. Infant/children’s acetaminophen is available for 2 months and older and is dosed every 4 hours, while children’s ibuprofen is available for 6 months and older and is dosed every 6 to 8 hours. Dose the medication by weight rather than age. Aspirin is not recommended for children.

What if the temperature doesn’t go back to normal?

Treatment of fever will usually decrease the temperature 2 to 3°F. The goal of treating a fever is to make your child comfortable, not to bring the temperature back to normal. A sponge bath is generally not necessary as fever will usually respond to medication therapy. If you choose to bathe your feverish child, use warm water.

Can I alternate acetaminophen and ibuprofen?

I recommend choosing either acetaminophen or ibuprofen, rather than alternating. Alternating the medications increases the risk of over-dosing or inaccurately dosing your child. There is no evidence that combination therapy is better than single dose therapy. If you chose to alternate medications, wait 4 hours after giving acetaminophen before giving ibuprofen. After giving ibuprofen, wait 6 to 8 hours before giving acetaminophen.

Do you need to rush your feverish child to the hospital?

Any fever in a young infant (two months of age or younger) is an emergency. Take your baby immediately to the emergency department. Fever is very serious in a young infant. Otherwise, it depends. If your three-year-old has a cut which is now red and painful with that fever, the answer is yes. If your five-year-old developed a temp to 101°F just two hours ago, maybe not yet.

Fever is a symptom, not a disease. Sometimes it takes a little time (up to 24 hours) for the illness to develop symptoms. If your child has a fever for more than a day or two without other symptoms or a fever with illness that lasts more than 3 days, see your provider. If you have concerns, call your pediatric provider for specific recommendations.

Most fevers are short-lived. Although fever may make your child uncomfortable, it helps to start the healing process. Don’t fear the fever. Fever is a friend.

Learn more at Search for Fever without Fear. 

Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on


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