YOUR CHILD’S FEVER
Fever (temperature greater than 100.4) is a common manifestation of infection or
inflammation of any kind. Many studies now indicate fever is a helpful part of your
child’s response to infection, so fever itself is not to be feared.
There are many myths about fever which are not true, but cause parents a great deal of
anxiety. Fever does not damage the brain unless it is higher than 107-108 degrees.
Except in very unusual circumstances (such as meningitis or sun stroke), the body’s
“thermostat” will prevent fevers from going higher than 105-106. Also, fever will not
cause seizures in most children. In the 5% of children who do experience a febrile
seizure, there is no harm caused.
Fever may make your child uncomfortable, but the degree of fever does not generally
indicate the severity of the illness. It is possible to have a serious infection and relatively
mild temperature elevations just as it is possible to have a very high temperature during a
mild illness. It is not unusual or harmful for a child to run fevers as high as 105 with
simple viral infections. Specific symptoms (for example, sore throat or diarrhea) and
how a child acts and feels (for example, fussiness or pain) are more helpful than the
degree of fever in evaluating a sick child.
Our efforts are generally directed at keeping your child comfortable until the illness
subsides, unless the child’s condition or symptoms warrant an office visit. These
measures include light clothing, plenty of fluids to drink, and medication as discussed
below. Your ability to take your child’s temperature and assess your child’s symptoms
is important.
Taking Your Child’s Temperature
Rectal temperatures are most reliable in young children. Inexpensive digital
thermometers are preferable to glass mercury-containing thermometers, due to concern
about breakage with release of mercury into the child’s environment. They are also
easier to use and read. If you are using a glass thermometer, use only a thermometer
designed for the rectal area (small rounded bulb on the end). Lubricate the bulb well with
KY jelly or Vaseline and insert gently into the rectum until the tip is no longer visible.
Do not push in the thermometer, but let it glide in and stop by itself. Hold the child’s
legs firmly so he or she cannot buck or kick. Normal rectal temperature can be as high
as 100.4 Oral temperatures and temperatures measured under the arm can be inaccurate in
young children. “Fever strips” or “pacifier” thermometers should not be used. Earthermometers are usually less accurate, and should not be used. When you call us about
your sick child, please be prepared to report the actual temperature, and how it was
obtained. It is not necessary to add or subtract degrees.
General Measures
Clothing should be light, as heat loss through the skin is hampered by heavy clothing and
blankets. Do not “sweat the fever” by piling on blankets. Activity is best determined by
how a child feels—if the child feels like being out of bed, there is nothing to be gained by
enforcing bed rest for simple infections. Eating will usually decrease, sometimes to
almost nothing. This is expected and not harmful for several days. Drinking, however, is
important and must be encouraged. Adequate fluid intake will tend to keep the
temperature lower. Clear fluids are beneficial, and milk is not harmful to a child with
fever.
Medication
Studies have shown fever medications can decrease temperature by 2-3 degrees from
what it would have been without treatment.
Acetaminophen (Tylenol, Tempra, Feverall) is the safest medicine to use in controlling
fever. It is dosed by weight and is meant to be given every four hours if needed, up to a
maximum of five doses in a 24 hour period. Many different preparations are available,
so be careful to use the appropriate dosage of the form you are using. The
suppository form (to be used rectally) is sometimes of value when your child is vomiting.
Children older than 12 years may take two regular-strength acetaminophen tablets (325
mg. each) or one extra-strength acetaminophen (500 mg.).
Another effective medication used to control fever is Ibuprofen (Motrin, Advil). Studies
indicate comparable effectiveness is fever control between acetaminophen and ibuprofen,
but ibuprofen has the advantage of less frequent administration (every 6-8 hours), and
anti-inflammatory effects which may be of greater value when pain is involved.
Note: Do not use Ibuprofen in children less than 6 months of age.
Children over 12 years of age may take two tablets (200 mg. each). Ibuprofen should be
used with caution in children with asthma, aspirin allergy or intestinal bleeding.
Note: We do not recommend “alternating” acetaminophen and ibuprofen, as this is
not known to be safe.
As with all medications, accidental ingestions can have serious consequences. Please
store all medicines away from children. In addition, many “combination” medications
contain acetaminophen or ibuprofen and can result in over dosage when used with fever
medication. Over dosage and poisoning can result from aggressive fever treatment by
caretakers. Remember, fever is not dangerous. The goal of treatment of fever is to
increase the child’s comfort, not to eradicate the fever.
Note: Aspirin is no longer recommended for children except in unusual
circumstances.
Sponging
Sponging with warm water can be effective for those young children who are particularly
uncomfortable or prone to seizures during fever. Fever medications should be
administered at least 30-40 minutes prior to bathing, in order to reduce chilling. Place
the child in a tub or basin and rub warm water on the chest and back until the temperature
begins to fall, usually 20-30 minutes. This procedure may be repeated as needed.
Alcohol baths are dangerous, as they may precipitate seizures, and should not be used.
Evaluating the Child with Fever
Young infants can sometimes have few symptoms other than fever during a serious
illness, so we ask that you call us promptly whenever your infant, less than three
months old, has a rectal temperature greater than 100.4
In a child three months or older, fever should be treated as discussed in this pamphlet.
Fevers are generally higher at night and you may anticipate this as you try to control the
fever. If, after treating the fever, the child still seems quite ill to you, has a seizure, or is
less than three months old, a phone call to the doctor will be necessary, even at night.
If your child is three months or older and seems reasonably comfortable, continue your
fever control efforts. Otherwise, call our office during regular office hours if the child is
under one year of age, is unusually irritable, is refusing fluids, or if there is a history of
repeated fevers. Also call if there are other symptoms which are of concern, or if you
have any questions. If symptoms persist past the usual three to five days, an office visit
is often necessary. Antibiotics or other medications are not prescribed by phone as they
are not treatment for fever itself.
Please save this fever control sheet for future questions and update your child’s
medication dose as he or she grows.