Fever Management

What is a fever?  Fever is defined as a temperature greater than 100.4°F.  A fever is one of the body’s ways of fighting infection. Viruses and bacteria often cannot live in hotter temperatures, so the body temperature elevates in order to help fight off the infection. While it is a great sign that having a fever means your child’s body is working well to fight off infection, it is very frustrating that an elevated temperature often makes your child feel poorly.  This leads to our next few questions. 

How should I measure temperature? You can find helpful charts and step by step instructions explaining how to check a child’s temperature depending on his/her age here:  www.healthychildren.org/English/health-issues/conditions/fever/Pages/How-to-Take-a-Childs-Temperature.aspx

Should I give my child medication and when do we come to the doctor? The answer to this question depends on several factors, including your child’s age and the height of the temperature.

If your child is under 3 months old and they have a rectal temperature over 100.4 °F, call your pediatrician’s office right away; it is important he/she be seen promptly by a medical provider. A young infant with a fever needs to be evaluated.  Always use a rectal thermometer to measure temperature for infants under 3 months old.

If your child is 3 months – 2 years old and they have a fever greater than 102 °F, call your pediatrician’s office.  If the fever is less than 102 °F and your child is acting okay and does not seem very uncomfortable, it is okay not to treat the fever with medication. This elevated temperature is not harmful and shows us that your child’s body is working well to fight the infection.  If a child is very uncomfortable, even if the fever is not high, it is okay to give acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).  Be sure to talk with your pediatrician’s office to ensure you are giving the correct dose.

If your child is over 2 years of age and has a temperature over 102 °F, it is usually okay to watch them at home. Of course, if they have severe symptoms, are in distress, you are concerned, or fever lasts over 3 days, please call your provider.  If the fever is less than 102 °F and your child is acting okay and does not seem very uncomfortable, it is okay not to treat the fever with medication. This elevated temperature is not harmful and shows us that your child’s body is working well to fight the infection.  If a child is very uncomfortable, even if the fever is not high, it is okay to give acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).  Be sure to talk with your pediatrician’s office to ensure you are giving the correct dose.

If you are giving your child a fever reducer, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), it is important to remember that these medications often will not bring a temperature all the way back to normal.  Often, fever reducers only lower temperature 1 or 2 degrees; this is normal.

Does a fever mean there is something serious going on?  A fever does not always mean something serious is going on. Also, a high fever does not necessarily indicate a severe infection. It is more important to evaluate your child based on how he/she is feeling than the height of the temperature.  When fever is present, look for encouraging signs such as that your child still wants to play, continues to drink well, is alert, and has normal skin color. These encouraging signs will be seen more and more as the fever goes down. 

How high is too high?  The number of the temperature does not tell us how sick your child is, so a very high temperature does not necessarily mean that the child is severely ill.  There are many viruses that can cause higher temperatures which do not cause any complications and from which the child is well in 3-5 days.   Typically, though fever is not necessarily harmful unless it is 1-2 degrees over 105°F, when the fever nears 105°F, and shows no sign of decreasing despite fever reducer medication, we recommend heading to the local children’s hospital.  Don’t forget that fevers will naturally rise when the child’s body temperature rises, in the evening and night.  As the temperature falls, the child will often sweat to release the extra heat; this is normal and is not concerning.   One other thing parents often notice is that children with fever breathe faster and may have a faster heart rate.  This is completely normal.  Call your doctor if after fever comes down, there is any trouble breathing or your child continues to breathe much faster than normal.

What can I do to help my child with a fever?  Giving them medication to reduce the fever can be helpful if your child is particularly upset.  Be sure to talk with your pediatrician’s office to ensure you are giving the correct dose.   Fever reducers such as acetaminophen and ibuprofen will not likely bring a temperature all the way back to normal.  Often, these medicines only lower temperature 1 or 2 degrees; this is normal.  

You can decrease the amount of clothes your child is wearing.  For example, for an infant or toddler with a fever, you can dress them down to their diaper or their diaper and a t-shirt.  Though it will not lower temperature, you can apply a luke-warm wet towel to the child’s forehead for comfort.  Avoid putting the child in a cold bath or rubbing the child’s skin with alcohol; this will not help and can cause adverse symptoms.

Assure your child is well hydrated by offering more clear liquids as fever can cause your child to lose fluids more quickly. If your child is crying without tears, has a dry mouth, does not urinate at least 3 times in 24 hours, or is very lethargic, call your child’s provider right away. These are all signs of dehydration.

Additional information: Under some circumstances, children can have a seizure due to a rapid change in body temperature. If this occurs, contact your doctor for further guidance.  There is great information on fever found at the following website:  www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-Without-Fear.aspx  There are additional helpful links at the bottom of this website such as: How to Take a Child’s Temperature, Fever and Pain Medicine: How Much To Give Your Child, Signs and Symptoms of Fever, The Healthy Children Show: Fever, The Healthy Children Show: Giving Liquid Medicine Safely.