fever & your child

by gurumommy on July 13, 2010

in from the desk of

A big gurumommy welcome back to Dr. Larry Kagan of Westside Pediatrics (310-979-7337, www.wspeds.net).  Today Dr. Kagan gives some tips for how to know if your child’s fever is too high and how to treat a fever.

At some point, all parents become concerned about their child’s fever.  How high is too high?  Do I have to treat it?  When should I call the doctor, go to the emergency room, or call 911?  In a healthy child older than 3 months of age, fever is typically not serious, but it is important that pediatricians take the time to educate parents on how to manage this common medical issue and when to seek advice.

A fever is an elevation of the body temperature above the normal range.  Our temperature normally fluctuates throughout the day and can be modestly affected by our environment, exercise, even teething.  That said, a core body temperature of ≥ 100.4°F (38°C) is a fever and indicates that something is going on.

The most accurate measurement of core body temperature is rectal, which is the best way to confirm suspected fever in all infants ≤ 3 month of age.   Alternative modalities and their relative accuracy are as follows: oral > ear/forehead/temple > underarm.  Whatever option you choose, fever height tells us very little about how severe your child’s illness is.  Simple viral illnesses can produce fevers to 104°F while terrible bacterial infections can produce little to no fever, or even hypothermia.

A fever is simply a sign that something is going on.  Despite what you may have heard, a high temperature in and of itself is not dangerous.  Even a febrile seizure, albeit a terrible experience for the child and family, is typically not dangerous.  It is what is causing the fever that needs to be addressed.  So when should you, as a parent, be alarmed?

Age Temperature or Symptom Action
≤ 1 month old ≥ 100.4°F Go to emergency department immediately
1 month to ≤ 3months old ≥ 100.4°F Call pediatrician or go to emergency department
3 month to ≤ 3 years ≥ 102°F Call pediatrician ASAP
Any age ≥ 104°F Call pediatrician ASAP
Any Age Fever WITH pain or rash, Fever lasting ≥ 5 days Call pediatrician ASAP

It is your child’s overall appearance that will dictate their management.  Fever can cause shivering, cold sweats, rapid heart rate, rapid breathing, anxiety and crankiness.  But when the fever is controlled with medications these symptoms should go away.  Once the fever is reduced your child should be alert, active, breathing comfortably, eating and drinking well, with normal skin color and a well appearance.  If they are not, call your doctor.

Management:

  • Always watch for signs of dehydration (decrease urine output, crying without tears, dry/cracked lips, sunken eyes…) and offer oral rehydration solutions (Pedialyte, Gatorade…) or water at regular intervals.
  • Ibuprofen is a more effective pediatric fever reducer than Acetaminophen.  They can be used together safely, just be aware Ibuprofen is given every 6 hours while acetaminophen is given every 4 hours.
  • Aspirin is not recommended in children due to the risk of Reye Syndrome.
  • Cough / Cold remedies should never be used in children ≤ 2years old and I do not recommend their use until ≥ 6 years of age.

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