Fever

The Problem

Your child has a fever if:

• The rectal temperature is over 100.4 degrees F
• The oral temperature is over 100.4 degrees F

The body’s average temperature, when measured orally is 98.6 degrees F, but it normally fluctuates during the day. Exercise, excessive clothing, a hot bath, or hot weather can cause mild elevations of 100.4 degrees F to 101.3 degrees F. Warm food or drink can also raise the oral temperature. If you suspect that one of these factors is affecting your child’s temperature, wait 30 minutes and take it again.

Fever is a symptom, not a disease. It is the body’s normal response to infections and plays a role in fighting them. In other words, fever activates the body’s immune system. The usual fevers up to 104 degrees F, that all children get are not harmful. Most are caused by bacterial illnesses. Teething rarely causes fever and never a fever over 101 degrees F.

Most fevers that occur with viral illness range from 101-104 degrees F and last for two to three days. Low-grade fevers are 100.4-102 degrees F and moderate fevers are 102-104 degrees F. A fever isn’t “high” until it’s over 104 degrees F or 105 degrees F. In general, the height of the fever isn’t related to the seriousness of the illness. What counts is how sick your child acts. Fever causes no permanent harm until it reaches 107 degrees F or higher. Fortunately, the brain’s “thermostat” keeps fevers caused by infection, even if untreated, below this level. Fevers over 107 degrees F usually result from environmental heat overload, such as overdressing a child with a fever or leaving a child in a closed car.

Few children with fever, about 4%, develop a brief convulsion. This type of seizure, called a febrile seizure, is harmless and not a cause for medical concern. Although a febrile seizure can be very frightening to parents, it does not cause brain damage, lower IQ or learning disabilities.

Home Treatment

Try to keep fever in perspective. “Fever phobia” is a term that describes the unwarranted fears many parents have about the normal fevers that all children experience. A study in 1980 found that 80% of parents mistakenly believed that fevers between 100-106 degrees F could cause brain damage or death. About 20% of parents thought that if they didn’t treat the fever, it would keep going higher. Neither statement is true. Because of the misconceptions many parents treat low-grade fevers unnecessarily with medicines and sponging. They also spend sleepless nights worrying about fevers. Try to keep fever in perspective when your child’s temperature is elevated.

Give acetaminophen to reduce fever

Children older than 2 month’s of age can be given an acetaminophen product to reduce fever.

Remember that fever is helping your child fight infection. Use medication only if the fever is over 102 degrees F and preferably only if your child is also uncomfortable. Give the correct dosage for your child’s age no more than every 4 to 6 hours. The accompanying table show oral acetaminophen dosages for children.

Two hours after they are taken, these drugs will reduce the fever by 2 degrees F to 3 degrees F. Repeated doses of the drugs are necessary because the fever will go up and down until the illness runs its course. Remember that the fever’s response to medicine tells little about the severity of the infection. If your child smiles, plays and drinks adequate fluids you need not worry about the fever. If your child is sleeping, don’t wake him up to give medicines. If the fever is high enough to need medication, your child will awaken.

Caution

• Do not switch droppers from one brand of liquid acetaminophen to another
• Do not use medications for more than three days or give them to children under 2 month’s of age without consulting your physician
• Since all of these drugs are poisonous if an overdose is taken, keep them out of sight and reach of children

Liquid Ibuprofen

Liquid ibuprofen (children’s Motrin or children’s Advil) was approved in 1989 for treating fever in children 6 month’s to 12 years of age.

Ibuprofen and acetaminophen have similar safety records and abilities to lower fever. One advantage that ibuprofen has over acetaminophen is a longer effect – 6 to 8 hours instead of 4 to 6 hours. In most situations, however, acetaminophen is still the drug of choice for controlling fever. Some children with high fevers that do not respond well to acetaminophen may do better with ibuprofen.

Do not give aspirin without consulting your doctor. The American Academy of Pediatrics has recommended that children and adolescents through 21 years of age should not take aspirin if they have chicken pox, flu or any cold, cough, or sore throat symptoms. This recommendation is based on several studies that have linked aspirin to Rye syndrome, a severe illness. Most pediatricians have stopped using aspirin for fevers associated with any illness.

Sponge your child only when necessary

Sponging is usually not necessary to reduce fever. Do not sponge your child without giving acetaminophen first, except in emergencies such as heatstroke, delirium, febrile seizure or fever over 106 degrees F. In other cases, sponge your child only if the fever is still over 104 degrees F when you retake the temperature 30 minutes after giving acetaminophen, and your child is still uncomfortable. Until acetaminophen takes effect, sponging will just cause shivering, which is the body’s attempt to raise the temperature.

If you do sponge your child, use lukewarm water (85 to 90 degrees F) or slightly cooler water for emergencies. Sponging works much faster than immersion so have your child sit in 2 inches of water and keep wetting the skin surface over the entire body. If your child shivers, raise the water temperature or wait another 10 to 20 minutes for the acetaminophen to take effect. Don’t expect to get the temperature below 101 degrees F.

Encourage extra fluids

The body loses fluids during fevers because of sweating. Encourage your child to drink extra fluids, but do not force her to drink. Popsicles and iced drinks are helpful.

Dress your child in light clothing

Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child. It will cause a higher fever and can be dangerous. During the time your child feels cold or is shivering (the chills), give him a light blanket.

Discourage vigorous activity

Vigorous activities produce additional heat that the body must release. Normal quiet play is fine.

When to take your child’s temperature

In general, take the temperature once a day in the morning until the fever is gone. Take it more often if your child feels very hot or is acting miserable despite taking acetaminophen. She may also need sponging. Take the temperature just before calling your physician.

With most infections, the level of fever bounces around for 2 or 3 days. Shivering or feeling cold means the fever is going up. A flu shed (pink) appearance means the fever has peaked. Sweating means it is coming down. The main purpose of taking temperatures is to determine whether fever is present or absent, not to chart it’s every move.

Call our office immediately if:

• Your child is less than 3 month’s old, unless the fever is caused by a DtaP vaccine
• The fever is over 105 degrees F
• Your child is crying inconsolably or whimpering
• Your child is difficult to awaken
• Your child cries if you touch him or move him
• Your child’s neck is stiff
• Any purple spots are present on the skin
• Breathing is difficult and no better after you clear the nose
• Your child is unable to swallow anything and is drooling saliva
• Your child looks and acts very sick (if possible, check your child’s appearance one hour after he has taken acetaminophen).

Call within 24 hours if:

• The fever is 104 degrees F, especially if your child is less than 2 years old
• Burning or pain occurs when urinating
• Your child has had a fever for more than 24 hours without an obvious cause or location of infection

Call during regular office hours if:

• Your child has had a fever for more than 72 hours
• The fever went away for more than 24 hours and then returned
• Your child has a history of febrile seizures
• You have other questions or concerns

 

Acetaminophen Dosage (for fever and pain)
Child’s weight more than (pounds)	7	14	21	28	42	56	84	112	lbs
Total Amount (mg)	40	80	120	160	240	325	480	650	mg
Infant Drops 80 mg/0.8 ml	0.4	0.8	1.2	1.6	2.4	—	—	—	ml
Syrup: 160 mg/5 ml (1 tsp)	—	½	¾	1	1½	2	2½	4	tsp
Chewable 80 mg tablets	—	—	1½	2	3	4	5-6	8	tabs
Chewable 160 mg tablets	—	—	—	1	1½	2	3	4	tabs
Adult 325 mg tablets	—	—	—	—	—	1	1½	2	tabs

 

• Acetaminophen (e.g., Tylenol) Dosage: determine by finding your child’s weight in the top row of the dosage table
• Adult dose = 650 mg
• Repeat every 4-6 hours as needed. Don’t give more than 5 times a day
• Note: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth)
• Use with caution under 3 months of age for pain. Don’t use under 3 months of age for fever. (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation.)

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.