By Michael Lyons, MD
When is a child’s fever something to worry about? When is it NOT okay to watch and wait at home? These questions perplex almost all parents (often in the middle of the night). The following guidelines can help your decision-making during a stressful time.
What is a fever?
Simply, a fever is an elevation in body temperature, the body’s natural immune response is a fever. When our bodies are insulted, usually by an infection like a sore throat or the flu, the immune system responds. The fever is not an illness in itself; it actually helps the body get rid of the infection by making it a less favorable place for bacteria or viruses to grow.
Normal body temperature is often defined as 98.6°F. In truth, body temperatures can vary, so a true elevated temperature or fever is usually defined as a body temperature above 100.4°F.
Facts about fevers
- A fever itself won’t hurt a child. In fact, elevated body temperature may help him get better.
- The height of the fever usually does not indicate severity of the illness. For example, a child with scarlet fever may have a temperature of 101°F, while temperature of a child with a severe cold may be 103°F. Over time and with lots of tender, loving care, the child with the cold will get better. The child with scarlet fever, however, will benefit from antibiotics. Rather than the height of the fever, what matters is how sick the child acts and the cause of the fever.
- An estimated 80 to 90 percent of all fevers in young children is related to common viral infections — the kind of infections that get better without treatment.
- Fevers of less than 105°F are not harmful and do not cause brain damage.
- A small percentage of toddlers get seizures from fever. The first seizure needs immediate medical evaluation. Seizures are frightening to witness, but do not cause residual problems. Subsequent, even low-grade fevers will need to be treated early.
- Mild elevations of up to100.4°F can be caused by exercise, excessive clothing or hot weather.
- Teething does not cause a true fever.
When you suspect a fever
Even if the degree of a fever does not equate with severity of an illness, the presence or absence of a fever can tell us a lot. If you are worried enough to call the doctor’s office, then it’s time to know your child’s temperature rather than just feeling his or her forehead.
Always have a thermometer in a designated place in your house, especially if your kids are little. For infants under three months, use a rectal thermometer, for older infants and toddlers, the axillary (under the arm) thermometer is best. As soon as your child is old enough to hold an oral thermometer in her mouth for the required time, you can expect an accurate reading from that method. Ear thermometers are easy, but still are not consistently reliable.
Assessing the child
Once you know your child has a fever, stop focusing on the temperature itself. Focus instead on the child’s behavior. Your child’s doctor or nurse will not be as concerned with the exact temperature as much as other symptoms such as diarrhea, a runny nose or headache. An important indicator is how your child is acting, his level of alertness and appetite. The further the child gets from a semblance of her usual self, the more likely it is she needs a medical evaluation.
Treatment of fever
Whether or not to treat a fever always comes down to judgment. If you have four children, you have a lot of experience. Trust your judgment. If the child is acting unusually sick, then an evaluation by the health care provider is warranted. Other suggestions:
- If your child has a fever under 101°F but, overall, appears to be well, there is no reason to treat the fever.
- If the fever is making your child feel miserable, giving medication to reduce the fever can help him be more comfortable. Being comfortable at night seems especially important. Fever-reducing medicine might help your child sleep so her body can fight back. A well-rested body is more likely to heal faster.
- Another reason to treat the fever is to get a sense of how sick the child is. If your parental sense reaches the worry point, treat the fever with an appropriate dose of medication and check the fever every 30 to 60 minutes. A child who acts close to his normal self after the fever has gone down is not likely to have a serious underlying illness.
The common fever-reducing medicines are acetaminophen (Tylenol), and ibuprofen (Motrin, Advil). We recommend beginning with acetaminophen. If you find the ibuprofen works better, that’s okay. When the fever won’t come down to a level that allows your child to sleep comfortably on the appropriate dose of one medicine, then it’s reasonable to use a dose of both medications at bedtime. Do not use aspirin to treat a fever.
When to call the doctor
The bottom line: it is okay to contact your doctor when your informed judgment tells you to do so. Have a safe and happy winter!
Guidelines from Contemporary Pediatrics for when to take your child to a doctor’s office for evaluation:
- An infant under 3 months of age has a fever over 100.4°F degrees.
- The child is lethargic or irritable or has a fever that has lasted more than three days.
- The child consistently complains of sore throat or ear pain.
- The child has abdominal pain or pain when urinating.
- The child is not drinking fluids or is producing a decreased amount of urine.
- The parent is worried about the child’s breathing, level of activity, intake or loss of fluids or whether the child really has a fever.
Michael Lyons, MD, assistant professor at Dartmouth Medical School, is a Vermont native and has been practicing at White River Family Practice since 1995. He has three children.