Fever is by far the most common pediatric complaint we encounter. Fever is the topic of daily phone calls, office visits, and is often responsible for unnecessary (and costly) emergency room visits. Although panic associated with rising thermometer readings is an understandable reaction, it is usually unwarranted. Understanding the cause of fever as well as treatment strategies will hopefully dispel some of the fears surrounding this “hot” topic.
What is fever? Fever is an important protective biologic mechanism. In the absence of infection, the brain keeps the body regulated between 98.2° and 99.2° F, with higher temperatures usually occurring in the evening. Generally, temperatures over 100° F are considered a fever. In children over 3 months, normal fevers range between 102-104° F although it is not uncommon to see temperatures as high as 105.0° F.
Do I need to take my child’s temperature? NO! In most cases, feeling your child’s forehead will be enough to identify a fever. A recent study showed that mothers could predict the temperature of children as young as 12 months within 0.3 degrees simply by feeling their forehead and the nape of their neck. The actual numbers are not important; rather observe your child’s other symptoms and how he or she is responding to treatment. The degree of fever is not related to the severity of your child’s illness. It is important to remember that fever is not a disease but rather a symptom of an illness. The only time we may ask you to take a temperature is when you baby is less than 3 months of age. In this age group, it is best to take a rectal temperature.
Why does fever occur? The most common reason for fever is infection although consumption of hot foods, recent exercise, over-bundling, hot weather, or an overheated room can drive body temperature up a degree or two. Medications, immunizations, dehydration, and teething may also cause a fever. When a virus or bacteria enter the body, white blood cells are activated to fight off the infection. The white blood cells release substances called “pyrogens”, which signals the brain to raise the body's thermostat setting. In turn, the body heats up by increasing its metabolic rate. The fever is actually a useful mechanism because it implies a revved up immune system.
How long does fever last? Fever can last from 1-5 days. Please call us if your child’s fever lasts more than 4 or 5 days.
What does fever “look” like? As the body tries to heat up, you may see shivering as your child tries to “get warm.” The body will try to minimize heat loss by restricting blood flow to the skin, giving it a pale appearance. Once body temperature rises, the skin sweats in order to reduce the fever. A child with a fever usually loses her appetite and feels lethargic, achy, and sleepy. When this happens, it is best to tuck her into bed and let her sleep. With a fever, its normal for your child to breathe faster and have an increased in heart rate.
What are the benefits of fever? Fever is a good sign that your child’s immune system is working. Fever increases the amount of interferon (a natural antiviral and anticancer substance) in the blood and also increases the white blood cells that kill viruses and bacteria. Fever also impairs the replication of many bacteria and viruses.
Do I need to treat a fever? You only need to treat a fever if your child is uncomfortable. Books, videos, and toys often provide enough distraction to keep children comfortable during the day. If your child has difficulty sleeping, drinking, or is inconsolable it is reasonable to treat a fever with acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). See dosage chart at the end of this document. Non-pharmacologic treatments for fever include bathing your child in lukewarm bathwater, holding a cold cloth to the forehead or neck, undressing, and eating/drinking cold foods such as PopsiclesTM and ice water.
Are there any risks associated with fever? Sweating and loss of appetite during a fever can lead to fluid loss and a decrease in some vitamins and minerals. Drinking water and/or electrolyte rich drinks such as PedialyteTM or GatoradeTM will help restore fluids, vitamins, and minerals. Your child should be urinating at least twice a day and her mouth should remain moist. Although fluids are important, there is no reason to force your child to eat solids. Any weight loss will quickly be regained as soon as the illness ends. Very high fevers -- those above 106 F can be harmful but are not usually related to infection. High environmental temperatures, heatstroke, or poisons are often the cause for such fevers. It is important to look at your child once the fever comes down. If she “looks ill” when the fever is down, it suggests the underlying illness (and not the fever) is the cause of the symptoms.
What about febrile seizures or seizures with fever? Febrile seizures are rare, occurring in less than 5% of the population. They most often occur between the ages of six months and five years. Febrile seizures tend to be associated with how fast a fever rises rather than the how high the temperature is. The seizure, characterized by jerking body movements and twitching, generally last less than 5 minutes. The reason some children have this susceptibility isn't well understood. Family history of febrile seizures or previous febrile seizure increases the likelihood of seizure. Frightening as these seizures sound, they are harmless and have no impact on brain development. If your child has a seizure, try to stay calm, keep the environment around your child safe, and allow the seizure to resolve spontaneously without restraint. Try to look at your watch so you will know how long the seizure lasted. Please call our office and let us know when you child has a seizure.
Medications and Dosage: Ibuprofen (Advil or Motrin) can be given safely every 6 hours while Acetaminophen (Tylenol) can be given every four hours. If your child seems very uncomfortable or the fever medicine wears off, it is fine to alternate Ibuprofen and Acetaminophen every three hours. For example, if Ibuprofen is given at 9 am, then Acetaminophen can be given at 12 pm and Ibuprofen again at 3 pm, etc. If you do this, please keep a log so you know when you gave your last dose. There is no need to wake a sleeping child to give her a dose of medicine; sleep will do far more good. PLEASE DO NOT GIVE YOUR CHILD ASPIRIN. Aspirin also reduces fever but has been linked to Reye’s Syndrome, a disease that may affect the liver and brain, and should not be used in children under the age of 12. Beware of concentration difference for Infants and Children’s preparations. Generic preparations are just as effective as brand name medicines and are usually much cheaper.
When can my child return to school or daycare? Your child may return to daycare or school when he/she is feeling better. This usually occurs when the child has been fever free for at least 12 – 24 hours without medication.
When should I call or come into the office? Please let us know if:
- your child is under three months and has a rectal temperature > 100.4° F
- your child’s temperature exceeds 105° F
- your child has a seizure or convulsion
- your child cries inconsolably or otherwise acts extremely irritable even with medication or when the fever is down
- your child acts lethargic or confused or won't awaken easily
- your child complains of stiff neck and/or can't touch his chin to his chest
- your child breaks out in a purple rash that resembles tiny bruises. Pink flat and/or bumpy rashes are common with fever and usually signify the end of the illness.
- your child seems to be in severe pain
- your child becomes dehydrated (dry skin and lips, crying without tears, no urination within 12 hours or more, listlessness)
- your child has respiratory distress (rapid breathing, sucking of the skin between the ribs and above the breastbone when breathing in, bluish tinge around the mouth, wheezing or crackling sounds with breathing).
Fevers can be uncomfortable for children and scary for parents. Keep in mind the mechanisms underlying fever and the purpose it serves; your child’s immune system is doing its job to fight bacteria and viruses! Keeping your cool and allowing the fever to run its course is the best approach.