Fever

Definition

Diagnostic Findings

Your child has a fever if his/her

  • Rectal temperature is over 100.4o F (38.0o C).
  • Oral temperature is over 99.5o F (37.5o C).
  • Axillary (armpit) temperature is over 98.6o F (37o C).
The body's average temperature when it is measured orally is 98.6o F (37o C), but it normally fluctuates during the day. Mild elevation (100.4o to 101.3o F or 38o to 38.5o C) can be caused by exercise, excessive clothing, a hot bath, or hot weather. Warm food or drink can also cause a rise in oral temperature. if you suspect such an effect on the temperature, take his temperature again in one-half hour.

Fever

Fever is a symptom, not a disease. Fever is the body's normal response to infection and pays a roe in fighting them. Fever turns on the body's immune system. The usual fevers (100o to 104o F [37.8o to 40o C]) that a children get are not harmful. Most are caused by viral illnesses; some are caused by bacterial illnesses. Teething does not cause fever.

Expected Course

Most fevers with viral illnesses range between 101o and 104o F (38.3o to 40o C) and last for 2 to 3 days. In general, the height of the fever doesn't relate to the seriousness of the illness. How sick your child acts is what counts. Fever causes no permanent harm until it reaches 107o F (41.7o C). Fortunately. the brain's thermostat keeps untreated fevers below this level. Although all children get fevers, only 4% develop a brief febrile convulsion. Since this type of seizure is generally harmless, it is not worth worrying about, especially if your child has had high fevers without seizures.

Home Care

Acetaminophen Products for Reducing Fever. Children older than 2 months of age can be given any one of the acetaminophen products. Tylenol, Anacin-3, Liquiprin, Panadol, and Tempra all have the same dosage. Remember that fever is helping your child fight the infection. Use drugs only if the fever is over 102o F (39o C) and preferably if your child is uncomfortable. Give the correct dosage for your child's age every 4 to 6 hours, but no more often. Two hours after they are given, these drugs will reduce the fever 2o to 3o F. Medicines do not bring the temperature down to normal unless the temperature was not very elevated before the medicine was given. Repeated dosage of the drugs will be necessary because the fever will go up and down until the illness runs its course. If your child is seeping, don't awaken him for medicines.

CAUTION: The dropper that comes with one product should not be used with other brands.

Dosages Of Acetaminophen
(mg = milligrams; ml = milliliters; tsp. = teaspoon; tabs = tablets)

Brand Strength Age And Dosage

Liquid Ibuprofen. Liquid ibuprofen was approved by the U.S. Food and Drug Administration (FDA) in 1989 for treating fever in children 6 months to 12 years old. It is available only by prescription. (Ibuprofen pills, a non prescription product, have been used for many years to treat menstrual cramps and sports injuries.) Ibuprofen and acetaminophen and acetaminophen are similar in their abilities to lower fever, and their safety records are similar. One advantage that ibuprofen has over acetaminophen is a longer-lasting effect (6 to 8 hours instead of 4 to 6 hours). However, acetaminophen is still the drug of choice for controlling fever in most conditions. Children with special problems requiring a longer period of fever control may do better with ibuprofen.

Cautions About Aspirin. The American academy of Pediatrics has recommended that children (through 21 years of age) not take aspirin if they have chickenpox or influenza (any cold, cough or sore throat symptoms).This recommendation is based on several studies that have linked aspirin to reye's syndrome, a severe encephalitis-like illness. Most pediatricians have stopped using aspirin for fevers associated with any illness. On the other hand, aspirin may be a better drug for relief from muscle and bone pain. For such pains not caused by flu use the same dosage of aspirin as given above for acetaminophen.

CAUTION: A hidden source of aspirin that is commonly overlooked is Pepto-Bismol. Don't give your child Pepto-Bismol if he has a fever.

Sponging. Sponging is usually not necessary to reduce fever Never sponge your child without giving him acetaminophen first. Sponge immediately only in emergencies such as heatstroke, delirium, a seizure from fever, or any fever over 106o F (41.1o C). In other cases sponge your child only if the fever is over 104o F (40o C), the fever stays high when you take the temperature again 30 minutes after your child has taken acetaminophen, and your child is uncomfortable. Until acetaminophen has taken effect (by resetting the body's thermostat), sponging will cause shivering, which is the body's attempt to raise the temperature. If you do sponge your child, sponge him in lukewarm water (85o to 90o F [29o to 32o C]). (Use slightly cooler water for emergencies.) Sponging works much faster than immersion, so sit your child in 2 inches of water and keep wetting the skin surface. If your child shivers, raise the water temperature or wait for the acetaminophen to take effect. Don't expect to get the temperature below 101o F (38.3o C). Don't add rubbing alcohol to the water; it can cause a coma if breathed in.

Extra Fluids. Encourage your child to drink extra fluids, but do not force him to drink. Popsicles and iced drinks are helpful. Body fluids are lost during fevers because of sweating.

Less Clothing. Bundling can be dangerous. Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child; it will cause a higher fever. During the time your child feels cold or is shivering (the chills), gives him a light blanket.

Call Your Doctor

Immediately if

  • Your child is less than 2 months old.
  • The fever is over 105o F (40.6o C).
  • Your child is crying inconsolably.
  • Your child is difficult to awaken.
  • Your child's neck is stiff.
  • Any purple spots are present on the skin.
  • Breathing is difficult and no better after you clear the nose.
  • Your child is unable to swallow anything and drooling saliva.
  • Your child looks or acts very sick (if possible, check your child's appearance 1 hour after your child has taken acetaminophen).
Within 24 hours if

  • Your child is 2 to 4 months old (unless the fever is due to a DPT shot).
  • The fever is between 104o and 105o F (40o to 40.6o C); especially if your child is less than 2 years old.
  • Burning or pain occurs with urination.
  • Your child has had a fever for more than 24 hours without an obvious cause or location of infection.
During normal business hours if

  • Your child has had a fever more than 72 hours.
  • The fever went away for more than 24 hours and then returned.
  • Your child has a history of febrile seizures.
  • You have other questions or concerns.