Fever

There is a lot of information available about fever and its management. This information should never replace advice obtained from your physician.

Fever is defined as:

  • Rectal temp over 100.4° F (38.0° C)
  • Oral temp over 99.5° F (37.5° C)
  • Axillary temp over 99.0° F (37.2° C)
  • Ear temp over 100.4° F (38.0° C)

Children with the following conditions should be seen immediately in the office or medical facility:

  • Any newborn less than one month of age who acts sick
  • Any infant less than 3 months of age with rectal temperature over 100.4°
  • Any fever over 105° F
  • Child will not move an arm or leg normally
  • Difficulty breathing (after cleaning out the nose)
  • Signs of dehydration (no tears with crying, very dry mouth, no urine for more than 8 hours)
  • Child is limp, weak or not moving, or is unresponsive or difficult to awaken

Children should be seen on the day of calling the office if:

  • Fever over 102° in a 3-6 month old infant
  • A 3-6 month old infant who acts sick but has a lower fever
  • Child is 3-24 months old with fever lasting longer than 24 hours and no obvious cause such as a cold, cough or diarrhea
  • Child has burning or pain with urination

Call office immediately for the following symptoms:

  • Your child looks very sick one hour after giving fever reducing medicine
  • Fever goes above 105°
  • Fever lasts longer than three days
  • Your child seems to be getting sicker

FEVER

I. Myths About Fever

II. Taking Your Child’s Temperature

III. Home Care Of Fever

IV. Dosing Chart For Acetaminophen (Tylenol) And Ibuprofen (Motrin Or Advil)

 

I. Myths about Fever

Myth: All fevers are bad for children.

Fact: Fevers turn on the body’s immune system. Fevers are one of the body’s protective mechanisms to fight infections. Most fevers are good for children and help the body fight the illness that produced the fever.

 

Myth: Fevers cause brain damage, especially fevers of 104° or higher.

Fact: Fevers do NOT cause brain damage. Temperatures that cause brain damage only go this high due to elevated environmental temperatures (e.g. being confined in a closed car).

 

Myth: Anyone can have a convulsion with fever.

Fact: Only 4% of children have febrile convulsions. Children who are prone to febrile seizures (convulsions) most likely will have one during the first 24 hours of the febrile illness.

 

Myth: Febrile seizures are harmful.

Fact: Simple febrile seizures are scary to watch and usually stop within 5 minutes. However, they cause no permanent harm.

 

Myth: All fevers need to be treated with fever medicine.

Fact: Fevers only need to be treated if they cause discomfort. Discomfort may occur with fevers over 101°.

Myth: Without treatment, fevers will keep going higher.

Fact: Fevers generally do not go over 106° due to control by the brain’s built-in thermostat.

 

Myth: With treatment fevers will return to normal.

Fact: With treatment fevers come down 2 or 3 degrees. Temperature may rise again when the fever medicine wears off in 4 to 6 hours.

 

Myth: If the fever doesn’t come down, the cause is serious.

Fact: Fevers that do not respond to fever medicine can be caused by mild or serious infections.

 

Myth: The exact level of the temperature is very important.

Fact: How your child looks is what’s important.

 

Myth: "I don't use a thermometer. I can tell by touch if my child has a fever."

Fact: When this observation was put to the test of clinical research, here is what was learned: Experienced mothers were wrong 50% of the time in diagnosing low grade fevers (101-102°) by touch. If you think that your child has a fever you must use a thermometer to measure the temperature.

 

Myth: Teething causes fevers.

Fact: Teething is not associated with fever. During the first two years of life many teeth come in. It is also common during the first two years for children to develop fevers from viral infections (like colds) at least 4 to 8 times per year. Naturally the two events (teething and infections) may occur at the same time, but they are not related. When teeth come in, your child may have mild discomfort for a few days and not feel like eating. It is incorrect to blame fevers and fussiness on teething.The reason for the fever may be a viral infection, ear infection, urinary infection or other serious infection.

 

Do Not Use Mercury (Glass) Thermometers:

If you have a mercury thermometer, please call Montgomery County or Frederick County to find out how to safely dispose of the thermometer.

 

Rectal Temperature:

Rectal temperature is the preferred method for infants. Use a digital thermometer. We can show you how to use one during your next visit. (It is really easy)

 

Digital Thermometers: To use a digital thermometer follow the directions on the package insert.

Lay your child across your lap. Lubricate tip with Vaseline. Gently insert the bulb no more than one inch into the anus. Firmly grasp cheeks closed while holding the stem of the thermometer where it enters the body. Remove thermometer when it beeps.

 

Fever: We consider a reading of 100.4° or above a fever, when taken rectally.

 

Oral Temperature:

Oral temperatures are usually accurate only for children 6 years of age and older.

 

Digital Thermometers: Follow directions on package insert.

 

Fever: We consider a reading of 99.3° or above a fever, when taken orally.

 

Axillary Temperature

Axillary (under the arm) temperature can be used as a screen for fever, but may not be accurate. If your baby is under 6 months of age and has an axillary temperature over 99.0°, you should confirm the temperature using a rectal thermometer in the bottom.

 

Ear Thermometers: Generally ear thermometer readings in children over 6 months of age are reliable. Follow the directions on the package insert.

 

Forehead Thermometer Strips: These are not recommended because they are not accurate.

 

III. Home Care Advice for Fever

Be calm. Your child most likely has an early viral infection.Most fevers are good for children and help the body fight infection. Use the following definitions to help put the child’s level of fever into perspective:

  • 100 - 102°: low fever and beneficial.
  • 102 - 104°: moderate fever and beneficial.
  • 104° and over: high fever and causes discomfort but may be harmless.
  • 105° and over: high fever and some risk of bacterial infections.
  • 107° and higher: the fever itself may be harmful.

Treatment of All Fevers

Offer extra fluids and dress child in lighter clothing.

 

Fever Medicine: Give acetaminophen or ibuprofen (if child is over 6 months of age) for fevers above 102° if your child is uncomfortable. The goal of fever treatment is to bring the temperature down to a level where your child is showing no visible signs of discomfort. Fever medicine usually lowers the temperature two or three degrees. Follow the dosing charts in this pamphlet using the weight of your child. Do not give aspirin (risk of Reyes Syndrome, a potentially fatal nervous system disease).

 

Sponging: Sponging may be tried for fever over 104° which is causing discomfort. Always give fever reducing medicine first.

 

How to Sponge: Place child in tub of lukewarm water which covers the tops of the thighs, so most of the trunk and upper extremities are exposed to the air. Do NOT use rubbing alcohol. Sponge for 20 minutes. Should shivering occur, increase water temperature if possible or stop sponging. Note that sponging is NOT required for high fever - it is optional.

 

Expected Course of Fever: Most fevers associated with viral illness fluctuate between 102°- 104° and last for two or three days.