What is a fever?
A fever means the body temperature is above normal. Your child has
a fever if his:
- Rectal temperature is over 100.4°F (38.0°C).
- Oral temperature is over 99.5°F (37.5°C).
- Axillary (armpit) temperature is over 99.0°F (37.2°C).
- Ear (tympanic) temperature is over 100.4°F (38°C). (This
measuring method is not reliable for babies under 6 months
old.)
- Pacifier temperature is over 100°F (37.8°C). (The pacifier
thermometer works well for babies over 3 months old.)
Tactile (touch) fever is the impression that your child has a
fever because he feels hot to the touch. Checking a fever this way
is more accurate than we used to think. But if you're going to
call the doctor, use a thermometer to measure the fever.
The body's average temperature when it is measured orally is
97.6°F (36.5°C). Oral temperature normally can change from a low
of 95.8°F (35.5°C) in the morning to a high of 99.4°F (37.5°C) in
the afternoon. Mildly increased temperature (100.4 to 101.3°F, or
38 to 38.5°C) can be caused by exercise, heavy clothing, a hot
bath, or hot weather. Warm food or drink can also raise the oral
temperature. If you suspect such an effect on the temperature of
your child, take his temperature again in a half hour.
What is the cause?
Fever is a symptom, not a disease. It is the body's normal
response to infections. Fever helps fight infections by turning on
the body's immune system. Most fevers (100 to 104°F, or 37.8 to
40°C) that children get are not harmful. Most are caused by viral
illnesses such as colds or the flu. Some are caused by bacterial
illnesses such as Strep throat or bladder infections. Teething
does not cause fever.
How long will it last?
Most fevers with viral illnesses range from 101°F to 104°F (38.3°C
to 40°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 does not cause permanent
harm. Brain damage occurs only if the body temperature is over
108°F (42°C). Fortunately, the brain's thermostat keeps untreated
fevers well below this level.
While all children get fevers, only 4% develop a brief seizure
from the fever. This type of seizure is generally harmless, but a
child who has a febrile seizure should always be checked by a
healthcare provider. If your child has had high fevers without
seizures, your child is probably safe.
How can I take care of my child?
- Extra fluids and less clothing
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.
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), give
him a light blanket.
If the fever is less than 102°F this is the only treatment
needed. Fever medicines are not necessary.
- Medicines to reduce fever
Remember that fever is helping your child fight the infection.
Fevers only need to be treated with medicine if they cause
discomfort. That usually means fevers above 102°F (39°C).
These medicines start working in about 30 minutes, and 2 hours
after they are given, these drugs will reduce the fever 2°F to
3°F (1°C to 2°C). Medicines do not bring the temperature down
to normal unless the temperature was not very high before the
medicine was given. Repeated dosages of the drugs will be
necessary because the fever will go up and down until the
illness runs its course. If your child is sleeping, don't
awaken him for medicines.
Acetaminophen: Children older than 3 months of age can be
given acetaminophen (Tylenol). Give the correct dosage for
your child's weight every 4 to 6 hours.
Ibuprofen: Ibuprofen (Advil, Motrin) is similar to
acetaminophen in its ability to lower fever. Its safety record
is also similar. The FDA has approved it for infants over 6
months of age. One advantage ibuprofen has over acetaminophen
is a longer lasting effect (6 to 8 hours instead of 4 to
6 hours). Children with special problems requiring a longer
period of fever control may do better with ibuprofen. Give the
correct dosage for your child's weight every 6 to 8 hours.
CAUTION: The dropper that comes with one product should not be
used with other brands.
Avoid aspirin: Doctors recommend that children (through age 21
years) not take aspirin if they have any symptoms of a cold or
viral infection, such as a fever, cough, or sore throat.
Aspirin taken during a viral infection, such as chickenpox or
flu, has been linked to a severe illness called Reye's
syndrome. If you have teens, warn them to avoid aspirin.
See also Dosage information
- Sponging
Sponging is usually not necessary to reduce fever. Never
sponge your child without giving him acetaminophen or
ibuprofen first. Sponge immediately only in situations such as
heatstroke, delirium, a seizure from fever, or any fever over
106°F (41.1°C). In other cases sponge your child only if the
fever is over 104°F (40°C), and hasn't come down when you take
the temperature again 30 minutes after your child has taken
acetaminophen or ibuprofen. Until acetaminophen or ibuprofen
has taken effect (by resetting the body's thermostat to a
lower level), sponging will just cause shivering which is the
body's way of trying to raise the temperature.
If you do sponge your child, sponge him in lukewarm water (85
to 90°F, or 29 to 32°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. Cooling comes from evaporation of water. If your
child shivers, raise the water temperature or stop sponging
until the acetaminophen or ibuprofen takes effect. Don't
expect to get the temperature down below 101°F (38.3°C). Don't
add rubbing alcohol to the water; it can be breathed in and
cause a coma.
When should I call my child's healthcare provider?
Call IMMEDIATELY if:
- Your child is less than 3 months old.
- The fever is over 104°F (40°C) and has not improved 2 hours
after giving fever medicine.
- Your child looks or acts very sick (fever along with severe
headache, confusion, stiff neck, trouble breathing, rash, or
refusing to drink).
Call within 24 hours if:
- Your child is 3 to 6 months old (unless the fever is due to a
DTaP shot).
- Your child has had a fever more than 24 hours without an
obvious cause or location of infection AND your child is less
than 2 years old.
- Your child has had a fever for more than 3 days.
- The fever went away for over 24 hours and then returned.
- You have other concerns or questions.
Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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