What to Do When Your Child Has a Fever | Parenting

Fever in children is one of the most common parenting concerns. Fever is also the main reason children are seen in the pediatrician’s office. Parents frequently ask the following questions:

• What temperature means my child has a fever?
• What is the best way to take a child’s temperature?
• What is the best way to treat a fever?
• When should you go to the doctor or emergency room?

It is important to know that the body’s normal temperature can vary slightly from person to person and fluctuates naturally during the day. Although 98.6 F (37 C) is considered the “norm”, body temperature can vary from 1 to 2 degrees throughout the day. Generally, body temperature is lowest in the early morning and rises slightly throughout the day, depending on your level of activity.

Fever itself is not an illness; rather it is a symptom of an underlying cause, such as illness, becoming overheated due to heat exposure, dressing too warmly, or overexertion. A fever is rarely harmful or dangerous and in fact, it can be beneficial for fighting infection. It is a natural defense response to help kill bacteria and viruses and to heal from infection.

The best method for taking your child’s temperature varies depending on your child’s age. For infants, a rectal temperature is the most accurate. This can be done using a digital thermometer and petroleum or KY jelly. Hold your baby on her belly across your lap, or lay her face down on a flat surface, turn on the thermometer, clear any previous readings, insert the thermometer approximately ½” to 1” and hold until it beeps or signals that it is finished reading.

For toddlers and older children, a digital thermometer can be used to take an oral temperature or an axillary temperature (under the arm). Your child must be able to hold the thermometer still under her tongue and not breathe through her mouth, and not have had anything to eat or drink within 30 minutes of taking an oral temperature in order to have an accurate reading. If this is not possible, you can use the digital thermometer under the arm, against the skin only, to take an axillary temperature. Oral temperatures are usually 1 degree lower than the rectal temperature and axillary temperatures are usually 1 ½ to 2 degrees lower than the rectal temperature.

Tympanic (ear) thermometers can be used for children older than 3 months but may give less accurate readings than digital thermometers. Forehead strips and pacifier thermometers may be able to tell you if your child has a fever, but are usually not accurate in telling the amount of fever. The new forehead thermometers are also not as accurate as a digital one. Glass thermometers, while highly accurate, are no longer recommended due to the risk of breakage and mercury exposure. If you take your child to the doctor, let her know which method you used.

A fever is medically defined as a body temperature of 100.4 F (taken rectally) or above. Temperatures of 101 F and below are considered low grade and do not require treatment unless your child is 3months old or younger, or if your child is very uncomfortable and fussy. If you have a newborn less than 3 months of age, it is important to have him seen by a doctor immediately for a fever of 100.4 F or higher. Infants and toddlers between 3 months and 3 years of age warrant a call to the doctor’s office if running a fever of 102 F or higher. For older infants and children, the amount of fever is less important than the other symptoms the child is having when determining whether to see a doctor. If your child is running a fever under 104 F but the fever reduces using acetaminophen or ibuprofen, and your child is not exhibiting signs of a serious illness, then it is okay to treat your child’s fever as needed and not rush to the doctor. A good general rule is to take your child to the doctor if a fever under 104 F persists for 72 hours even if she does not have other symptoms or has mild symptoms. For a fever of 104 F or higher, call or visit the doctor if it persists for more than 24 hours, or does not reduce with fever-reducing medications, or if the child has other symptoms that need to be evaluated. Fever of 105 F or higher warrants a visit to the doctor’s office or a call to the doctor’s answering service if after hours. The doctor can tell you whether to take your child to the emergency room or whether it is okay to wait and come in the next morning to the office.

When treating a fever at home, your goal should be to make your child comfortable. If the fever is under 101 and your child is not extremely fussy or uncomfortable, it is not necessary to use medication. Remember, fever is the body’s way of helping fight infection, so it is counter-productive to reduce the temperature unless the child is truly uncomfortable.

Ways to reduce fever:

• Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can be used if fever is high or if your child is very fussy or achy. Use only according to the directions on the package and if possible, base the dose on your child’s weight instead of age. For children under 2 years of age, ask your doctor for the appropriate dosage. Do not give medication more often than recommended and do not give any other medications containing fever reducing ingredients (such as some cough/cold multisymptom medications). Always use an appropriate measuring device, such as the dropper or cup that came with the medicine. Using a kitchen spoon is not an accurate method of measuring and you can risk giving an overdose.
• Dress your child in lightweight clothing and only use a sheet or light blanket if your child gets chills.
• If your child has a high fever, you can sponge her off with cool washcloths on her forehead, back of the neck, wrists and groin.
• If you give your child a bath, do not use cold water, instead use lukewarm water and only bathe for a few minutes.
• Never use rubbing alcohol, only water.
• Keep your child hydrated with water, juice, popsicles, ginger ale, chicken noodle soup, or electrolyte solutions (Pedialyte).
• If your child has diarrhea or has been vomiting, do not give juice or a lot of water, opt for an electrolyte solution or soup instead.
• Do not give sports drinks, or tea and cola drinks containing caffeine.

Take your child to the doctor or emergency room if:

• He has been vomiting or having diarrhea for more than a few hours. The younger the child, the more quickly they can become dehydrated.
• If your child shows signs of dehydration: urinating less frequently than every 4 hours, dark colored urine, dry lips, dry mouth, not crying tears, sunken or bulging soft spot in an infant, eyes that appear sunken in.
• If your child is lethargic, listless, or inconsolable, shows signs of moderate to severe dehydration, or has a severe headache, go to the emergency room.
• If your child has a febrile seizure, which can occur from a rapid rise or drop in body temperature. Febrile seizures are rarely dangerous, but the child does need to be evaluated afterwards. If your child has a seizure, keep him comfortable, safe, and turn him sideways to prevent saliva and/or vomit from going into the lungs. Do not attempt to put anything in his mouth during a seizure. If the seizure lasts for more than a few minutes or if your child appears to have trouble breathing, call 911. Otherwise, wait for the seizure to end then take your child to the emergency room.

Generally, doctors advise keeping kids home from school and daycare until they are fever-free without the use of medication for at least 24 hours.

Above all else, trust your instincts as a parent. You know your child and if you feel something is wrong and needs to be evaluated, call or take your child to see the doctor. Every child is unique and some will run a high fever with every slight illness and some may run little or no fever even with a serious illness. As a mom, I’ve had both extremes. My daughter ran very high fevers every time she had an ear infection or strep throat. My son could have a double ear infection and a throat infection at the same time with no fever at all. I learned to pick up on the other signs of illness to determine whether a trip to the pediatrician’s office was necessary.